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THE  JOURNAL  OF 

INDUSTRIAL 
HYGIENE 


EniTORS 

DAVID  L.   EDSALL,  M.D.,  S.D.,  United  States 
EDGAR  L.  COLLIS,  M.D.,  M.R.C.S.,  Great  Britain 


VOLUME  III 

MAY,   1921  — APRIL,   1922 


3'' 


n>pjv 


PUBLISHED  BY 

HARVARD  MEDICAL  SCHOOL 

240  Longwood  Avenue,  Boston,  Mass. 


EDITORS 
United  States  Great  Britain 

David  L.  Edsall,  M.D.,  S.D.  E.  L.  Collis,  M.D.,  M.R.C.S. 

HONORARY  CONSULTING  EDITOR 
Thomas  M.  Legge,  M.D.,  D.P.H. 

ASSOCIATE  EDITORS 

United  States  Great  Britain 

W.  Irving  Clark,  Jr.,  M.D.  W.  F.  Dearden, 

Alice  Hamilton,  A.M.,  M.D.  M.R.C.S.,  D.P.H. 

Emery  R.  Hayhurst,  Sir  Kenneth  Goadby, 

A.M.,  Ph.D.,  M.D.  K.B.E.,  M.R.C.S.,  D.P.H. 

Yandell  Henderson,  Ph.D.  Leonard  Hill, 

William  H.Howell,  M.B.,  F.R.S. 

Ph.D.,  M.D.,  Sc.D.,  LL.D.  T.  Lister  Llewellyn, 

Frederic  S.  Lee,  B.S.,  M.D.,  M.I.M.E. 

A.M.,  Ph.D.,  LL.D.  Sir  Thomas  Oliver,  M.D. 

Harry  E.  Mock,  M.D.  R.  Prosser  White, 

J.  W.  Schereschewsky,  M.D.  M.D.,  M.R.C.S. 

C.-E.  A.  Winslow,  H.  M.  Vernon,  A.M.,  M.D. 

M.S.,  A.M.,  Dr.P.H.  D.  A.  Coles,  M.D. 

South  Africa 
W.  Watkins-Pitchford,  M.D.,  F.R.C.S. 

Canada  Australia 

J.  J.  R.  Macleod,  M.B.  H.  W.  Armit, 

M.R.C.S.,  L.R.C.P. 
MANAGING   EDITORS 
Cecil  K.  Drinker,  M.D.  Marion  C.  Shorley,  A.B. 


CONTENTS  OF  VOLUME  III 


MAY.  1921.    NUMBER  1 


rAOK 


An  Output  Study  of  Users  and  Non-Usess  op  Tobacco  in  a  Stre^nuous  Physi- 
cal. Occupation.  J.  P.  Baumberger,  Edna  E.  Perry,  and  E.  G.  Martin,  Lab- 
oratory of  Physiology,  Stanford  University    1 

A  Survey  of  Carbon  Monoxide  Poisoning  in  American  Steel  Works.  IIetal 
Mines,  and  Coal  Mines.  Henry  S.  Forbes,  M.D.,  Division  of  Industrial  Hy- 
giene, Harvard  Medical  School   11 

A  Di.scussioN  of  the  Etiology  of  So-Calleu  Aniline  Tumors  op  the  Bladder. 
Alice  Hamilton,  M.D.,  Assistant  Professor    of    Industrial    Medicine,    Harvard 
Medical   School,   and    Special   Investigator  of  Industrial  Poisons,  U.  S.  Bureau 
of  Labor  Statistics   16 

Health  in  Mercantile  Establishments.  TIT.  Common  Sanit^vry  Defects  in 
Stores.  Arthur  B.  Emmons,  2d,  M.D.,  Director,  Harvard  Mercantile  Health 
Work,    Boston,   Mass 29 

Book  Notices  37 


JUNE,  1921.     NUMBER  2 

The  Pregn/VNt  Woman  in  Industry.    Carey   P.  McCord,   M.D.,  and   Dorothy   K. 

Minster,   Cincinnati,  Ohio    39 

A  Method  for  Determining  the  Finkr  Dust  Particles  in  Air.  A.  L.  Meyer, 
M.D.,  Associate  in  Physiological  Hygiene,  Si-luol  of  Hygiene  and  Public 
Health,   The  Johns  Hopkins  University    51 

Aniline    Poisoning    in    the    Rubber  Industry.      Paul    A.    Davis,   M.D..    Akron, 

Ohio    57 

Oil  Folliculitis.  Calvin  (i.  Page,  Assistant  Professor  of  Bacteriology,  Harvard 
IVfcdipnl  Sehool.  and  L.  D.  Hushiiell,  Professor  of  Bacteriology.  Kansas  State 
Agricultural  College,  Manliattaii.  Kansas.  From  the  Bacteriological  Labora- 
tories of  Harvard  Jledical  School 62 

Book  Notices  "^6 


JULY,  1921.    NUMBER  3 

Physioixigioal  Effects  of  Automobile  Exhaust  Gas  and  Standards  of  Venti- 
lation FOR  Brief  Exposures.  Yaiuli'll  Henderson,  Howard  W.  Haggard,  Mer- 
wyu  C.  Teague,  Alexander  L.   Prince,  find  Ruth   M.   Wunderlich    79 

The  Influence  of  Fatigue  on  Health  and    Longevity.     H.    M.    Vernon,    M.D., 

Investigator  for  the   Industrial   Fatigue  Research  Board,  London   93 

Syphilis  and  Industry.     Alec  N.  Thomson,  M.D.,   Director,  Medical  Department, 

American    Social    Hygiene   Association    99 

Trinitrotoluene  as  an  Industrial  Poison.  Alice  Hamilton,  M.D.,  Assistant  Pro- 
fessor of  Industrial  Medicine,  Harvard  Medical  School,  and  Special  Investiga- 
tor of  Industrial  Poisons  for  the  V.  S.  Bureau  of  Labor  Statistics  102 


iv  THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

AUGUST,  1921.     NUMBER  4 


PAGE 


Does  the  Magnetic  Field  Constitute  an  Industrial  HazuVrd?  C.  K.  Drinker, 
M.D.,  and  R.  M.  Thomson.  From,  the  Laboratory  of  Applied  Physiology  of 
the  Harvard  Medical  School    117 

The  Indistrial  Physiciax  and  the  Qualifications  Essential  to  his  Success. 
William  J.  MeConnell,  M.D.,  Passed  Assistant  Surgeon  (Reserve),  U.  S.  Pub- 
lie  Health  Service 130 

An  Interchange  op  Physical  Examinations  in  Industry.     Harry  Myers,  M.D., 

Personnel  Superintendent,   Ohio  Brass  Company,    ilansfield,   Ohio    135 

Physiological  Effects  of  AutomobiE/E  Exhaust  Gas  and  Standards  op  Ven- 
tilation FOR  Brief  Exposures.  (Continuerl.)  Yandell  Henderson,  Howard 
W.  Haggard,  Merwyn  C.  Teague,  Alexander  L.  Prince,  and  Ruth  M.  Wunder- 
lich    137 

Book  Notices  147 


SEPTEMBER,  1921.    NUMBER  5 

Fatigue  and  Error  in  a  Mental  Occupation.      J.    P.    Baumberger.      P>om    the 

Laboratory    of    Physiology,    Stanford   University    149 

A  Work  (^hair.  Arthur  B.  Emmons,  2d,  M.D.,  Director,  Harvard  Mercantile 
Health  Work,  Boston.  :\rass..  and  Joel  E.  Goldthwait,  M.D.,  Orthopedic  Sur- 
geon, Boston,  Mass 154 

The  Practical  Hy'GIenic  Efficiency  op  the  Palmer  Apparatus  for  Determin- 
ing Dust  in  Air.  Henry  Field  Smyth,  M.D.,  Dr.  P.  H.,  and  ^Miriam  Iszard, 
M.A.     From  the   School  of  Hygiene,  University    of    Pennsylvania    159 

Physical  Education  from  the  Standpoint  of  the  Industrial  Physician.  Ralph 
W.  Elliott,  M.D.,  Manager,  Medical  Department,  National  Lamp  Works  of 
General   Electric   Company,    Nela   Park.    Cleveland 168 


OCTOBER.  1921.     NUMBER  6 

Headache.      Stanley    Cobb.    :\[.D.,    Assistant     Profc^ssor     of     Neuropathology      Har- 
vard  Jledical    School,  and    Assistant    Neurologist,    Massachusetts    General    Hos- 
pital, and  1).   C.  Parmenter,  M.D..  Assistant   in   Industrial   Ilvgiene,    Harvard 

Medical  School,  and  Instructor  in  Hygiene,    Harvard    University    173 

Medical  Supervi.vion  in   Industry.     C.  W.  J.  Brasher,  M.D.,  Bristol,  England    . .     179 
The   Framin'gham    IIf.altii    Demon.stk.atkix  and  Industrial  Medicine     D  B  Arm 
strong.  M.D.,  Executive  Officer.  Franiin-ham  Ilealtli  and  Tuberculosis  Demon- 
stration      

Study  of  Accident  Records  in  a  Textile  Mill.  Prepared  un.ler  the  Direction  of 
Amy  TIewes  by  Ruth  Fear.  Edith  Graves,  Marjorie  Laurence,  Florence  Metz 
and  Helen  F.  Smith.  Students  in  the  Course   in    Statistics   at    Mount    Holvoko 

^""^■^'^    :...      187 

Book  Notices  

196 


CONTENTS  V 

NOVEMBER,  1921.    NUilBER  7 

P.MIB 

When  Are  DisABiiiixiEs  of  the  Back  Arising  oit  of  Pathological  Conditions 
Reit'ortable:  Accidents?  Rufiis  B.  Grain.  ]\r.D.,  and  Benjamin  J.  Slater, 
B..S.,    M.I)..    Medical    Department.    Eastman  Kodak  Company.  Rochester.  N.  Y.     197 

Picric  Acid  in  Industrial  Surgery.  Alfred  G.  Boldue.  M.D..  Company  Physi- 
cian, The  Babeoek  &  Wilcox  Company.  Bayonne,   N.   J 202 

Suggestions  for  Cuspidors  in  Industrial  Plants.  H.  P.  Smyth,  M.D..  Dr.  P.  II., 
Assistant  Professor  of  Industrial  Hygiene,  School  of  Ilyfriene.  University  of 
Pennsylvania 204 

Spray  Infection.     S.  R.  Douprlas  and  Leonard  Hill.     From  the  National  Institute 

for  Medical  Research,   Hampstead,  London    206 

Carbon  ^Iono.xide.  Illumin.vting  G.\s,  and  Benzol:  Their  Effect  on  Blo<id 
Co.vGUL.vTioN  Time.  Henry  S.  Forbes  and  Louise  Ilompe.  From  the  Lalwra- 
tory  of  Applied   Physiolofry.   Harvard    .Medical    School    213 

Book  Notices  •. 217 

Notices    218 


DECEMBER.  1021.     Xr:\mER  S 

The  Problem  of  He.vrt  Disea.se  in  the  Industri.m-    Workick.      Paul     I).     White. 

M.D.,    Boston.    Ma.ss 21^ 

Cardiac  Disf^vse  and  its  Relation  to  Industrial  Efficiency.  Carey  F.  Coombs. 
M.I).,  F.R.C.P.,  Lond.,  Consulting,'  Physician  for  Disea.ses  of  the  Heart.  Min- 
istry of  Pensions  (S.  W.  Rejrion).  From  the  Department  of  Medicine.  Uni- 
versity  of  Bristol 227 

Chronic  M!ANGANt>E  Poisoning  :    Two  Cases.     Georgre  G.    Davis,    M.D.,    Chicago, 

Illinois,   and   Walter  B.    Huey,   M.D.,   Joliet,    Illinois    231 

Trinitrotoli-ene  Poi.soning  —  I'rs  Nature.  DiACNo.'iis,  and  Pre\'Ention.  Carl 
Voegtlin,  Charles  W.  Hooper,  ami  J.  M.  Johnson.  From  the  Division  of 
PharmaeologA-.    Hygienic    Laboratory,    U.  S.  Public   Health   Service    239 

Book  .Notice-;  254 


JANUARY.  1922.     NliMBER  9 

Dust  in  Printers'  Workrooms.  C.  B.  Roos,  B.Sc,  F.I.C.  H.M.  Inspector  of  Fac- 
tories         257 

Influence  of  Industrial  Noises.     D.  J.  Glibert.  M.D.,  Chief  Medical  Inspector  of 

Factories.    Brussels    264 

The  Rehahilitatio.n  of  Employees:  An  Experience  with  1.210  C.vse.-^.  Fred- 
eric S.  Kellogg,  M.D..  Phvsician,  Western  Union  Telegraph  Company,  Pitts- 
burgh,  Pa ....■- 276 

Trinitrotoluene  Poisoning — Its  Xature,  Diagnosis,  and  Pre\'ention.  (Con- 
tinued.) Carl  Voegtliii,  Charles  W.  Hooper,  and  J.  M.  Johnson.  From  the 
Division   of   Pharmacology'.   Hygienic  Laboratory.  U.  S.  Public  Health  Service     280 

Book  Notices  293 


vi  THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

FEBRUARY,  1922.     NIMBER  10 

PAOI 

Modern  Views  upon  the  Development  op  Lung  Fibrosis.  Cecil  K.  Drinker, 
M.D.,  Associate  Professor  of  Applied  Physiology,  Harvard  Medical  School. 
From  the  Laboratory  of  Applied  Physiologj-,  Harvard  Medical  School,  Bos- 
ton,  Mass 295 

Investigative  Opportunities  in  the  Physical    Examination    of    Large    Groups 

of  lNDnm>UALS.    Roger  I.  Lee,  M.D.,  Professor  of  Hygiene,  Harvard  University     304 

A  Report  on  the  Brief  Neuropstchiatric  Examination  op  1,141  Students.  Stan- 
ley Cobb,  M.D.,  Assistant  Professor  of  Neuropathology,  Harvard  Medical 
School,  and  Assistant  Neurologist,  Massachusetts  General  Hospital   309 

Static  Equilibrium  as  a  Useful  Test  op  Motor  Control.  "Walter  R.  Miles, 
Ph.D.,  Nutrition  Laboratory  of  the  Carnegie  Institution  of  "Washington,  Bos- 
ton,  Mass 316 

Notices 332 


MARCH,  1922.     NUMBER  11 

Common  Colds  in  Rel.\tion  to  Industrial  Hygiene.  Harold  G.  Tobey,  M.D.,  Bos- 
ton, Mass Sija 

Infectious  Arthritis  of  the  Spine.  J.  P.  Curran,  M.D.,  and  S.  F.  Foster,  Statis- 
tician, Norton   Company,  "Worcester,   Mass 339 

Some  Observ.ations  on  the  Epinephrin  Hydrochloride  Test    (Goetsch  Test)   in 

A  Group  op  Normal  Individuals.    "William  P.  "Van  "Wagenen   343 

Lighting  and  "S^'entilation  of  Factories,  Hours  op  Labor  and  Health.  J.  S. 
Purdy,  D.S.O.,  M.D.,  C.H.,  (Aberd.)  D.P.H.,  (Camb.)  F.R.S.,  (Edin.)  F.R.G.S., 
Metropolitan  M.O.H.,  Sydney,  Australia     349 

Book  Notices  359 

Notices 361 


APRIL,  1922.     NUMBER  12 

Adequate  Industri.il  Medical  Service  for  the  Small  Plant.    Carey  P.  McCord, 

M.D.,  and  Dorothy  K.  Minster,  Cincinnati,    Ohio    363 

Metatarsophalangeal  Fractures,  with  a  Report  of  Twenty-Seven  Cases.  Al- 
fred G.  Bolduc,   M.D.,  Bayonne,  N.  J 371 

The  E.st.ablishment  op  a  Dental  Clinic.    L.  E.  Hastings,  M.D.,  The  J.  G.  Brill 

Company,   Philadelphia    376 

Report  on  an  Investigation  to  Determine  the  Hazard  to  the  Health  of  Oper- 
ators Using  the  Spraying  Machine  for  Painting:  The  Risk  op  Lead  Poi- 
soning. N.  C.  Sharpe,  A.B.,  M.B.  From  the  Department  of  Pharmaeologv  of 
the  University  of  Toronto   "  373 

An  Appreciation  op  Sheridan  Delepine  337 

Book  Notices  3^0 

Index  to  "Volume  III  "".^ 395 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


Volume  III 


MAY,  1921 


Number  1 


AN  OUTPIT  STl  1)V  OF  USERS  AND  NON-USERS  OF  TOBACCO 
IN  A  STRENUOUS  PHYSICAL  OCCUPATION* 

J.  V.  B.\lMnEHGKl{,  KDNA  K.  rKUUY,  and  E.  G.  MAUTIX 
(From  the  Laboratory  of  Physiology,  Stanford  University) 


I.NTRonrrTioN' 

IN  a  previous  paper,  the  first  of  a  scries 
of  articles  dealing  with  the  general 
prohlein  of  the  significance  of  tlu-  use  of 
tohacco  in  industry,  some  ohservations 
were  reported  on  the  ett'ects  of  smoking  on 
efficiency  in  a  strenuous  menial  occupation 
(1).  Tlie  present  pajier  is  concerned  with 
the  second  phase  of  the  general  tojjic: 
namely,  the  relation  of  the  use  of  tobacco 
to  efficiency  in  a  strenuous  physical  occu- 
pation. In  this  investigation,  as  in  our  jire- 
viojis  report,  we  have  ado])ted  output  as 
the  criterion  of  efficiency  (2). 

An  output  study  reciuires  a  routine  oc- 
cupation in  which  the  same  ]>rocess  is  re- 
peated nuiny  times  during  the  day  and.  to 
be  wholly  satisfactory,  requires  also  that 
the  number  of  repetitions  be  entirely  de- 
pendent on  the  sjjced  of  the  individual 
worker,  luiaffected  by  the  rate  at  which 
machinery  is  driven.  Obviously  tobacco 
eli'eets,  if  any  exist,  would  be  most  likely 
to  appear  in  a  very  strenuous  occupation. 
The  occupation  to  be  selected  for  study 
should,  therefore,  be  routine,  physically 
strenuous,  and  dependent  on  individual 
initiative. 

*  Received  for  publication  Dec.  14,  1920. 


After  some  search  w-e  decided  on  bottle 
making  as  meeting  these  conditions  satis- 
factorily. Permission  was  obtained  to 
make  an  outi)ut  study  in  a  large  glass 
bottle  manufacturing  plant,  which  operates 
thirty-five  bottle-making  machines  and 
employs  500  persons.  We  wish  to  take  this 
oj)portunity  of  thanking  the  superintend- 
ent and  the  personnel  of  the  factory  for 
their  courteous  treatment  of  us  during  the 
three  weeks  of  the  investigation. 

Process 

The  i)rocess  of  glass  blowing  may  be 
briefly  described  as  follows:  The  old 
method  of  blowing  glass  bottles  by  mouth 
has  been  largel.V  abandoned  except  for 
small  special  orders,  and  this  highly  skilled 
work  is  now  done  by  machinery  manipu- 
lated by  a  skilled  "gatherer"  and  "cut- 
ter" and  inexperienced  helpers.  In  some 
machines  the  whole  process  is  carried  out 
automatically  and  only  an  unskilled  at- 
tendant is  required.  In  the  majority  of 
machines,  however  —  and  it  was  with  this 
type  of  machine  that  our  work  was  con- 
cerned —  the  gatherer  regulates  the  speed 
of  the  machine  by  his  own  motions.    The 


2 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


machines  are  located  at  one  end  of  an  oval 
tank  containing  the  fused  glass,  which  is 
kept  at  a  temperature  of  '2650° F.  The  wall 
of  the  tank  is  perforated  with  working 
holes  at  intervals  of  about  12  feet,  and  foot 
benches  of  appropriate  height  for  the  gath- 
erers are  situated  at  each  hole.  The  ma- 
chine is  located  at  the  left  of  the  foot  bench 
and  consists  usually  of  two  revolving  tables, 
the  first  of  which  bears  a  number  of  iron 
blanks  in  which  the  neck  of  the  bottle  and 
a  depression  in  the  center  can  be  formed. 
The  second  revolving  table  carries  molds 
in  which  the  final  form  can  be  gi\-en  to  the 
bottle.    The  operation  is  as  follows: 

The  gatherer  stands  on  the  foot  bench  at 
the  working  hole  with  a  "punty"  in  hand. 
This  is  an  instrument  43  inches  long,  con- 
sisting of  an  iron  rod  witli  a  wooden  handle 
at  one  end  and  a  clay  ball  on  which  the 
glass  is  collected,  at  the  other  end.  The 
gatherer  has  his  back  toward  the  machine 
and  holds  the  punty  handle  with  both 
hands,  allowing  the  clay  ball  to  touch  the 
surface  of  the  fused  glass.  The  iron  rod  of 
the  punty  rests  on  an  iron  supijort  ("dog 
leg")  at  the  edge  of  tlie  working  hole, 
while  the  gatherer  revolves  the  punty  until 
sufficient  glass  adheres  to  form  a  "gob"  of 
the  size  required  to  make  the  proper  weight 
bottle.  The  gatherer  then  turns  to  the  left 
and,  suspending  the  gob  over  the  mouth  of 
the  blank,  allows  the  glass  to  drip  off. 
When  the  proper  amount  has  fallen,  the 
cutter  clips  the  stream  of  glass  with  a  pair 
of  shears.  The  gatherer  then  turns  back 
to  the  hole  and  again  inserts  the  punty. 
The  motions  of  the  gatherer  are  exceed- 
ingly rajiid  and  accurate  and  as  many  as 
twenty-six  ^-ounce  gobs  may  be  gathered 
in  one  minute. 

The  cutter  sits  on  a  stool  at  the  edge  of 
the  foot  bench  and  clips  off  the  stream  of 
glass  from  the  punty  as  it  falls  into  the 
blank;  he  then  pulls  a  lever  which  brings 
down  a  plunger  into  the  center  of  the 
blank,  shaping  the  neck  and  making  a  de- 


pression in  the  glass,  revolves  the  table  so 
that  the  bottle  is  partially  blown  auto- 
matically, greases  (with  a  graphite  cov- 
ered plunger)  another  blank,  and  is  ready 
to  receive  the  next  gob  of  glass. 

The  "take-out  boy"  (unskilled)  is  seated 
on  a  stool  opposite  the  cutter;  he  opens 
the  blank,  removes  the  half-blown  bottle 
by  means  of  pincers,  and  drops  it  into  a 
mold  on  the  mold  table.  The  second 
helper  is  seated  at  the  mold  table  which  he 
revolves  so  that  the  bottle  is  fully  blown 
by  an  automatic  blower,  and  passes  under 
a  torch  to  smooth  the  mouth.  He  then 
opens  the  mold,  places  the  finished  bottle 
on  a  table,  and  closes  the  mold. 

The  "carrying-in  boy,"  by  means  of  a 
"carrying  stick"  (an  asbestos-covered,  long 
handled  implement)  transfers  the  bottles, 
a  row  at  a  time,  into  the  "tempering  lehr," 
the  floor  of  which  moves  the  bottles  very 
slowly  through  an  oven  of  decreasing 
temperature  until  the  bottles  are  taken  out 
cool  at  the  other  end,  where  they  are 
packed. 

In  the  Lj-nch  machine,  this  whole  process 
is  carried  out  by  a  gatherer  and  a  carrying- 
in  boy,  the  gatherer  regulating  the  speed 
of  the  machine  just  as  he  does  in  the  type 
described  above.  In  the  Lynch  type  in 
the  process  of  drijjping  the  gob  into  the 
blank,  the  gatherer  touches  with  his  punty 
a  lever  which  puts  the  whole  machine  into 
motion.  Thus,  for  each  gob  gathered  the 
machine  makes  one  complete  revolution. 

Operatives 

The  helpers,  carrying-in  boys,  and  take- 
out boys  are  all  unskilled,  unorganized 
laborers  and,  though  called  "boys,"  are 
usually  over  '20,  the  carrying-in  being  done 
by  men  of  40  or  over,  who  are  not  quick 
enough  for  the  other  work.  During  the 
war  many  women  were  taken  on  as  help- 
ers, and  some  white  and  some  colored 
women  have  continued  in  this  work.     The 


BAmiBERGER,  PERRY,  AND  MARTIN— TOBACCO  AND  EFFICIENCY       3 


labor  turnover  among  tlic  unskilled  em- 
ployees is  very  high. 

The  gatherers  alternate  every  half  hour 
in  the  processes  of  cutting  and  gathering. 
On  the  Lynch  machine  three  gatherers 
operate  two  machines;  one  gatherer  is  as- 
signed to  each  machine  on  which  he  works 
40  minutes,  and  then  rests  and  oils  the  ma- 
chine for  '■20  minutes;  the  third  man  works 
20  minutes  on  each  machine  and  rests  and 
oils  the  two  machines  for  '20  minutes.  The 
gatherers  are  the  only  skilletl  workers  on  the 
machines  and  have  inherited  the  pride  of 
the  craft  of  glass  blowing  and  are  very 
proud  of  their  dexterity-  and  si)eetl.  In- 
deed, a  speedy  man  is  usually  the  center  of 
attraction  for  all  who  happen  not  to  be  at 
work  at  the  time.  This  pride  buoys  the 
men  up  and  increases  their  output,  as  will 
be  shown  in  another  paper.  Tlic  turnover 
for  gatherers  is  very  slight,  and  it  i^  not 
rare  to  find  men  who  have  workid  oxer 
five  years  in  the  .same  plant. 

The  average  age  of  the  eiglity-fi\c  gath- 
erers studied  was  30  years,  of  wiiidi  an 
average  of  twenty  ye;irs  had  been  spent  in 
the  glass  industry.  A  study  of  the  correla- 
tion of  age  an«l  outi)ut  gave  negative  re- 
sults as  did  al.so  a  study  of  correlation  of 
overweight  and  underweight  and  output. 
The  men  averaged  4  pounds  overweight, 
on  the  basis  of  the  biometric  tables  of  the 
Provident  Life  iSs:  Trust  Co.,  which  seems 
to  indicate  that  the  work  is  not  too  strenu- 
ous. The  men  are  unionized  and  work 
under  definite  regulations  as  to  hours'  and 
weeks'  work.  The  shifts  are  from  7  a.m.  to 
3  P.M.,  3  i'..M.  to  11  i'..M.,  and  11  p.m.  to 
7  A.M.,  and  the  nu-n  work  for  a  week  on 
each  shift.  The  plant  runs  from  Monday 
7  A.M.  to  Saturday  hZ  m.  Two  weeks'  va- 
cation (without  pay)  between  June  15  and 
September  15  must  be  taken.  Apprentice- 
ship is  for  three  consec-utive  years.  A  bene- 
fit association  is  maintained  by  the  Class 
Blowers'  Association  of  the  L^nited  States 
and  Canada.    The  gatherers  are  largely  of 


native  stock,  with  little  schooling,  as  the 
average  length  of  experience  shows,  and 
are,  on  the  whole,  a  very  steady,  clean- 
lived  group  of  men.  ^Vfany  expressed  the 
belief  that  their  work  was  so  hazardous  and 
hard  that  dissipation  could  not  be  indulged 
in  without  great  risk  to  their  health  and 
injury  to  their  efficiency.  The  nuMi  earn 
from  $8  to  $10  a  tlay,  working  on  a  piece- 
work basis  except  when  the  machines 
break  down,  and  then  they  are  paid  by  the 
hour.  The  men  claim  that  they  can  esti- 
mate their  speed  closely  enough  to  calcu- 
late their  output  for  the  day,  but  in  some 
cases  the  carryiug-in  boy  .scores  each  load 
of  l)ottles  he  places  in  the  tempering  lehr. 

Method 

The  output  records  were  obtained  by 
|)a,ssing  from  one  maciiine  to  auotlier  each 
half  hour  and  counting  the  number  of  gobs 
of  gla.ss  gathered  by  each  num  in  a  ])eriod 
of  from  one  to  five  nu'nutes.  The  data, 
therefore,  show  output  rate  only  and  are 
not  to  !)(>  construed  as  actual  outjjut.  It 
was  found  that  actual  output  is  not  a  de- 
pendable criterion  of  the  working  capacity 
of  the  individual,  as  in  this  trade  machine 
breakdown  and  nn'nor  delays,  such  as  re- 
.suit  from  imjiurities  adluriug  to  the  jjunty- 
head,  are  a  constant  and  unaccountable 
factor  entirely  independent  of  the  work- 
ers" efficiency.  It  is  obvious,  however,  that 
output  would,  in  general,  correspond  to 
differences  in  rate  of  gathering  between 
individuals. 

'i'he  counting  was  done  by  means  of  a 
tally  register  and  the  timing  by  means  of  a 
stojj-watch.  The  records  were  kept  on  a 
.separate  cartl  for  each  nuin  together  with 
the  weight  of  the  bottle  made  and  data 
obtained  by  a  personal  interview  as  to  age, 
height,  weight,  marital  status,  years'  ex- 
perience, and  smoking  and  chewing  habits. 
All  counts  were  made  at  times  when  the 
machinery   was   working  without  trouble. 


4  THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

and  in  no  case  was  a  count  made  when  any  conversation.  They  appeared  to  be  honest 
accidental  obstruction  to  the  full  speed  of  and  straightforward  in  their  answers  and 
the  worker  was  present.  The  gathering  were  all  on  the  best  of  terms  with  the  in- 
had  an  extremely  uniform  rate  for  each  vestigator.  The  following  arbitrary  classi- 
TABLE  1.- NUMBER  OF  iMEN  IX  EACH  fication  seemed  logical,  on  the  basis  tha^t 
HABIT  GROUP  about  the  same  amount  of  tobacco  is  in- 

Number  of  men  included  in  habit  groups.  .  .     76  volved  in  each  Case. 

Non-users  of  tobacco 6  Persons  who  smoked  more  than  ten  ciga- 

Chewers 2-2  day,  Or  morc  than  two  pipefuls  of  tobacco 

Light  smokers 23  per  day  Were  called  heavy  smokers.    Those 

Heavj-  smokers. . .   40  ^.j^^  smoked  less  than  this  were  called  light 

Non-smokers  who  chew 7  „ 

Light  smokers  who  chew 8  smokers,   and   chewers   and   non-users   ot 

Hea\y  smokers  who  chew 7  tobacco  Were  classified  separately.    Table  1 

Light  smokers  who  do  not  chew 15  gj^.^g  j-j^g  j^^bit  groups  and  the  number  of 

Heavy  smokers  who  do  not  chew 33  .              ,,              t-iiipi            j. 

Non-chcwers                                            54  "^^^  ^^  ^^"^^  class.     *or  lack  ot  adequate 

Non-chewers  who  smoke 48  data,  nine  men  had  to  be  omitted  from  the 

...  habit  groups,  leaving  seventv-six  that  were 

mdividual,  and  it  was  found  that  one  mm-  ^,,^1^^^^^     Onlv  8  per  cent,  of  the  men  do 

ute  was  a  long  enough  period  in  which  to  ^^^  ^^^^  ^^^^^^^^  ^.j^il^  83  p^^  ^^^^^   ^^^^j^^^ 

obtain  a  count  characteristic  of  the  opera-  ^g  ^^^,  ^^^^    ^^^^^^^  ^^^  20  p^^  ^^^^   ^^^^ 

tor.    The  investigation  was  carried  on  for  ^^^^j.^  ^^^  ^1^^^, 
about  three  weeks  and  1,569  hourly  counts 
were    made  —  i.e.,    an    average    of    20.3 

hourly  counts  per  man.  Output  Rate  and  Weight  of  Bottle 

..^  In  order  to  determine  the  efiiciency  of 

the  men  grouped  according  to  their  habits, 
The  smoking  or  chewing  habits  of  the  it  is  necessary  to  compare  their  actual  out- 
men  were  obtained  by  questioning  them  put  rates.   The  men  were,  however,  work- 
directly  and  by  observation  and  indirect  ing  on  bottles  of  a  number  of  different  sizes 

TABLE  2.  — ACTU.\L  AVERAGE  HOURLY  OUTPUT  RATE  AND  PERCENTAGE  HOURLY 

OUTPUT  RATE  OF"  ALL  WORKERS 


Hour 


8-9 


9-10 


10-11 


2-8 


Actual  Output  Rate  op  All  Workers  (m  Number  of  SJ-Ounce  Bottles  per  Minute) 


Mean 

Standard  deviation 

Probable  error  of  mean  =t 
Coefficient  of  variability . 


13.6 

13.59 

13.53 

13.75 

13.53 

13.i5 

13.59 

2.32 

1.98 

2.02 

1.98 

1.77 

1.99 

2.01 

0.186 

0.141 

0.146 

0.141 

0.155 

0.149 

0.15 

17.1 

14.6 

14.9 

14.4 

13.0 

14.8 

14.8 

13.U 
1.88 
0.14 

14.0 


Percentage  Hourly  Output  Rate  of  All  Workers 


Mean 

Standard  deviation 

Probable  error  of  mean  =* 
Coefficient  of  variability . 


99.3 
6.0 
0.48 
6.0 


100.5 
5.4 
0.386 
6.0 


100.0!, 
4.2 
0.30 
4.17 


100.3 
4.16 
0.29 
4.14 


lOO.U 
5.4 
0.46 
5.36 


100.01 
5.2 
0.39 
5.29 


100.08 
4.48 
0.35 
4.46 


99.3 
5.3 
0.39 
5.31 


BAmiBERGER,  PERRY,  AXD  INIARTIN— TOBACCO  AXD  EFFICIENCY       5 


and  weights.  Each  machine  was  assigned 
a  particular  weight  bottle  to  be  made  for 
a  day,  or  weeks,  as  the  case  might  be.  It 
requires  different  lengths  of  time  to  gather 
different  weight  gobs  of  glass,  but  this  re- 
lationship is  not  a  direct  proportion;  thus, 
six  and  five-tenths  55-ounce  gobs  can  be 
gathered  in  a  nu'nute,  wliile  only  twenty- 
two  and  five-tenths  IJ-ounce  gobs  can  be 
gathered  in  the  same  time.  So  that  the 
outputs  of  all  the  men  would  be  compara- 
ble, they  were  reduced  to  out])ut  for  a 
standard-sized  Ijottle.  This  was  accom- 
plished in  the  following  manner:  The  aver- 
age output  for  each  indivitlual  who  had 
worked  on  a  certain  weight  bottle  was 
plotted  on  co-ordinate  jiajjer  with  the  hori- 
zontal axis  as  the  number  of  gobs  of  glass 
gathered  in  a  minute,  and  the  vim! leal  axis 
as  weight  of  the  gob  in  ounces.  Having 
plotted  all  the  individual  average  outputs 
for  all  the  ditfereiit  weight  bottles  that  had 
been  handled,  tlie  grand  average  for  each 
weight  was  also  ])l()tted.  A  curve  was  then 
drawn  which  coincided  as  closely  as  possi- 
ble with  the  loci  of  the  grand  averages. 
Such  a  smoothed  curve  can  be  drawn  with 
great  accuracy  according  to  Bayliss  (3). 
The  curve  is  shown  in  Figure  1.  It  was 
then  assumed  that  the  loci  of  the  curve 
represented  the  relation  existing  l)etween 
the  weight  of  the  gob  of  glass  gathered  and 
the  mnnber  of  gobs  that  coidd  be  gatliered 
in  one  minvite.  The  largest  numl)er  of 
individuals  and  records  had  been  involved 
in  determining  the  grand  average  output 
of  8^-ounce  bottles,  and  the  locus  of  this 
point  seemed  to  be  in  good  general  con- 
formity with  the  curve  as  a  whole;  it  was, 
therefore,  selected  as  a  standard. 

An  example  will  best  serve  to  illustrate 
the  method  used  to  reduce  the  output  of 
one  individual  operator  to  the  standard. 
Operator  1  gathered  twenty-four  If-ounce 
gobs  of  glass  in  one  minute.  Referring  to 
Figure  1  we  find  that  twenty-two  and  five- 
tenths  is  the  grand  average  for  If-ounce 


bottles,  also  that  thirteen  and  three-tenths 
is  the  grand  average  for  S^-ounce  bottles. 
Therefore,  Operator  1  would  be  expected 
to  make  more  than  thirteen  and  three- 
tenths  8i-ounce  bottles  in  proportion  as  he 
had  made  more  than  the  expected  number 
of  Ij-ounce  bottles;    in  other  words,  the 


Fig.  1.  —  Relation  of  gathering  rate  to  weight  of  gob. 
Horizontal  axis  =  number  of  gobs  gathered  per  minute; 
vertical  axis  =  weight  of  gobs  in  ounces;  dots  =  a\erage 
gathering  rates:  circles  =  grand  average  gathering  rates; 
crosses  =  theoretical 'gathering  rates. 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

TABLE  3.  —  HOURLY  OUTPLT  RATE  BY  HABIT  GROUPS 


Hour 

7-8 

8-9 

9-10 

10-11 

11-12 

1«-1 

1-2 

2-3 

All  Non-Smokers 

Alean              

13.27 
1.25 
0.34 
9.4 

1J,.13 
1.44 
0.27 

10.2 

13.S9 
1.45 
0.27 

10.4 

13.96 
1.74 
0.32 

12.5 

U.O 
1.36 
0.29 
9.7 

13.75 
1.87 
0.364 

13.6 

13.96 
1.69 
0.316 

12.1 

u.oi 

1.82 

Probable  error  of  mean  ± 

Coefficient  of  variability 

0.34 
13.0 

All  Smokers 

IMS 
2.4 
0.23 

17.1 

13.9 
2.33 
0.199 

16.6 

13.95 
2.24 
0.188 

16.0 

lUl 

2.16 
0.18 
15.2 

li.O 
1.91 
0.191 

13.6 

13.89 

2.1 

0.183 
15.1 

13.87 

2.1 

0.183 
15.1 

13.82 

Standard  deviation    

1.97 

Probable  error  of  mean  =*= 

Coefficient  of  variability 

0.175 
14.2 

All  Chewers 

Mean 

Standard  deviation    

13.31, 
1.22 
0.188 
9.15 

13.71 
1.51 
0.208 

11.0 

13.i6 
1.21 
0.165 
8.99 

13.71 
1.47 
0.202 

10.7 

1J,.09 
1.09 
0.177 
7.73 

13.i6 
1.58 
0.22 

11.7 

13.i2 
1.39 
0.19 

10.4 

13.62 
1.48 

Probable  error  of  mean  ± 

Coefficient  of  variability 

0.198 
10.9 

All  Non-Users  of  Tobacco 

13.5 
1.0 
0.275 
7.4 

li.O 
1.12 
0.308 
8.0 

U.6 
1.07 
0.294 
7.3 

li.O 
1.12 
0.308 
8.0 

13.9 
1.2 
0.357 
8.6 

li.2 
1.48 
0.4 

10.4 

U.3 
1.07 
0.294 
7.45 

H.5 

1.52 

Probable  error  of  mean  =t 

Coefficient  of  variability 

0.42 
10.4 

All  Heavy  Smokers 

Mean 

U.67 
2.68 
0.310 

18.2 

13.92 
2.52 
0.266 

18.1 

U.17 
2.32 
0.236 

16.4 

Ihi 

2.2 

0.224 
15.3 

li.2i 
2.02 
0.24 

14.2 

1.',.29 
2^ 
0.232 

15.5 

u.u 

1.36 
0.145 
10.0 

U.Oo 

Standard  deviation 

1.9 

Probable  error  of  mean  ± 

Coefficient  of  variability 

0.203 
13.6 

All  Light  Smokers 

Mean 

13.ii 
1.69 
0.288 

12.6 

13..5Jt 
1.29 
0.19 
9.5 

13.22 
1.29 
0.214 

10.9 

13.5 
1.41 
0.212 

10.4 

13.0 
1.36 
0.256 

10.1 

13.06 
1.55 
0.244 

11.9 

13.31 
1.99 
0.308 

14.9 

13.U 
1  99 

Standard  deviation 

Probable  error  of  mean  ± 

Coefficient  of  variability 

0.308 
14.8 

Heavy  Smokers  Who  Chew 

\ 

Mean 

13.0 
1.29 
0.35 

12.3 

13.12 
1.22 
0.29 
9.3 

U.06 
0.68 
0.152 
4.85 

13.S3 
0.9 
0.2 
6.5 

li.07 
1.06 
0.269 
7.54 

U.O 

0.7 

0.167 

5.0 

13.0 
0.7 
0.167 
5.18 

13.83 
0.48 
0.104 
3.48 

Standard  deviation 

Probable  error  of  mean  ± 

Coefficient  of  variability 

BAUMBERGER,  PERRY,  AND  I^IARTIX— TOBACCO  AND  EFFICIENCY       7 

TABLE  3.  — HOURLY  OUTPLT  RATE  BY  HABIT  GROUPS  Icoxtinued) 


Hour 


9-10 


10-11 


1*-1 


»-S 


Hea\t  Smokers  Who  Do  Not  Chew 


Mean 

Standard  deviation.  .  . . 
Probable  error  of  mean 
Coefficient  of  variability 


li.G7 

li.SG 

U.27 

14.56 

n.29 

li.S9 

n.^ 

2.92 

2.68 

2.62 

2.44 

2.32 

2.46 

2.30 

0.386 

0.325 

0.306 

0.28 

0.312 

0.292 

0.27 

19.9 

18.8 

18.4 

16.7 

16.2 

17.1 

16.0 

n.ii 

2.20 
0.27 
15.5 


Light  Smokers  Who  Chew 


Mean 

Standard  deviation .... 
Probable  error  of  mean 
Coefficient  of  \arial>ility 


13.5 
0.17 
0.047 
1.26 

13.8 
1.42 
0.318 

10.3 

13.0 
1.25 
0.296 
9.6 

13.37 
1.16 
0.276 
8.76 

li.l 
0.65 
0.195 
4.65 

13.38 
1.62 
0.363 

12.1 

13.17 
1.56 
0.35 

11.8 

13.39 

1.67 

0.373 
12.5 

Light  Smokers  Who  Do  Not  Chew 


1!,.09 
1.89 
0.367 

13.5 

13.9 
0.95 
0.165 

0.8 

13.93 
1.35 
0.24 
9.7 

13.93 
1.45 
0.26 

10.4 

13.G 
1.44 
0.307 

10.6 

11,.0 
1.04 
0.202 
7.41 

U.Oi 
1.82 
0.34 

13.0 

13.75 

1.96 

Probable  error  of  mean  =*= 

Coefficient  of  variability 

0.382 
14.3 

Chewers  Who  Do  Not  Smoke 


Mean 

Standard  deviation 

Probable  error  of  mean  = 
Coefficient  of  variability. 


15.07 
1.48 
0.37 

11.3 


l!,.Sl 
1.67 
0.42 

11.7 


1S.S1 
1.39 
0.37 

10.5 


13.93 
2.13 
0.54 

15.3 


1!,.0 
1.48 
0.445 

10.6 


13.3!t 
2.12 
0.583 

15.9 


13.G!t 
1.81 
0.46 

13.3 


13.Gi 
1.96 
0.49 

14.3 


following  formula  was  applied :  .v  :  13.3  :  : 
S.'t :  22.5,  and  .solvin<r  for  .r  wo  have  1 4. 19  a.s 
the  nunibor  of  .standard-sized  bottles  which 
Ojjerator  1  would  make  in  one  minute. 
Individuals  who  had  worked  on  several 
different  weight  bottles  were  found  to  have 
outputs  for  the  different  weights  corre- 
sponding to  our  curve,  confirming  the  valid- 
ity of  our  method.  Furthermore,  as  will 
appear  in  a  subse(|uent  paper,  the  rela- 
tionship of  weight  of  gob  to  the  number  of 
gatherings  per  minute  involves  the  time  of 
gathering,  of  transfer  back  and  forth,  and 
of  dropping  the  glass.  The  last  two  factors 
vary  in  an  arithmetical  progression,  and 
the  time   of  gathering,   in   a   geometrical 


progression.     The  form  of  our  curve  is  a 
logical  outcome  of  the.se  relationships. 

The  formula  given  above  was  used  to 
reduce  the  output  to  terms  of  a  standard- 
sized  bottle  so  that  the  men  could  be  di- 
rectly compared  as  to  output.  The  actual 
average  output  rate  of  the  men  in  Si- 
ounce  bottles  per  minute  for  each  hour  dur- 
ing the  day's  work,  calculated  by  the 
method  described  above,  is  given  in  Table 
2.  The  percentage  output  is  also  given  in 
Table  2  and  serves  as  a  check  on  the 
former,  as  the  percentage  output  is  deter- 
mined directly  from  the  actual  number  of 
bottles  which  each  man  makes,  reduced  to 
a  percentage  on  the  basis  of  his  average  as 


8 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


100.  The  two  sets  of  figures  vary  in  the 
same  manner  throughout  the  day,  except 
for  minor  differences  which  prove  to  be  due 
to  the  smoothing  effect  of  the  formula 
method,  for  if  the  percentage  output  curve 
is  smoothed  it  approaches  the  actual  out- 
put curve  even  more  closely. 

Output  Rate  by  Habit  Groups 

In  order  to  determine  the  output  of  each 
group  the  standardized  output  records  were 
added  and  the  mean  output  rate  per  min- 
ute for  each  hour  was  obtained.  For  the 
eighty-five  men  studied  the  mean  rate  per 
minute  for  the  day  was  13.56,  and  for  the 
seventj'-six  men  in  the  habit  groups  the 
output  was  13.99.  The  output  rate  for 
each  hoiu"  was  about  the  same  throughout 
the  day  (see  Table  2),  showing  that  fatigue 
does  not  affect  the  output  rate  to  any  ap- 
preciable extent.  Table  3  shows  that  all 
the  habit  groups  are  equal  in  this  regard. 
The  question  of  fatigue  will  be  taken  up  in 
a  separate  paper. 

The  mean  output  rate  for  the  day  for 
each  of  the  thirteen  habit  groups  is  shown 
in  Table  4.  The  highest  output  is  found  in 
the  heavy  smokers  who  do  not  chew,  and 
the  lowest  in  the  light  smokers  who  chew. 
The  difference  between  these  two  extremes 
is  1.01  bottles  per  minute,  or  7.2  per  cent, 
of  the  grand  average  output.  Industrially, 
this  is  an  important  difference,  amounting 
to  more  than  a  thousand  bottles  in  a 
twenty-four-hour  daj-.  Statistically,  how- 
ever, the  difference  is  so  slight  that  before 
we  can  draw  any  conclusions,  some  statisti- 
cal criterion  must  be  applied  to  determine 
whether  or  not  it  has  any  significance. 

The  probable  error  of  the  mean  can  be 
used  to  determine  the  degree  of  unreliabil- 
ity of  the  mean;  therefore,  if  we  are  com- 
paring two  means,  the  significance  of  the 
difference  between  them  will  be  deter- 
mined bj^  the  chances  that  one  mean  will 
coincide  with  the  other.    The  chances  that 


the  difference  between  the  means  is  signifi- 
cant are  1  :  1  if  the  probable  error  of  the 
difference  is  contained  once  in  the  differ- 
ence; 4.5  :  1  if  contained  twice;  and  21  :  1 
if  contained  three  times.  It  is  usually  con- 
sidered that,  in  order  to  be  significant,  the 
difference  between  two  means  must  con- 
tain the  probable  error  of  the  difference 
twice,  and  in  order  to  have  a  degree  of 
certainty,  must  contain  it  three  times.   We 

TABLE  4. —  MEAN  OUTPUT  RATE  FOR  DAY 
BY  HABIT  GROUPS 


Group 


Hea%y  smokers  who  do 
not  chew 

Non-users 

All  non-chewers 

Non-chewers  who  smoke. 

All  heavy  smokers 

Mean  of  all  habit  groups . 

All  smokers 

Light  smokers  who  do  not 
chew 

AU  non-smokers 

Heavy  smokers  who  chew 

All  chewers 

Non-smokers  who  chew. . 

All  light  smokers 

Light  smokers  who  chew. 


True 
Mean 


14.33 
1-1.24 
14. 21 
14.19 
14.14 
13.99 
13.93 

13.88 
13.87 
13.72 
13.59 
13.44 
13.37 
13.32 


Stand- 
ard De- 
viation 


2.4 

1.32 

2.3 

2.17 

2.32 

2.13 

1.54 

1.66 

0.3 

1.4 

1.82 

1.61 

1.37 


Coeffi- 
cient of 
Varia- 
bility 


16.9 
9.25 
16.1 
15.2 
16.4 

15.3 

11.0 
12.0 
2.2 
10.3 
13.3 
12.4 
10.3 


Probable 
Error  of 
Mean 


=.101 
=.130 
=  .078 
=  .078 
=  .093 

=  .065 

=  .099 
=  .112 
=.025 
=  .066 
=  .169 
=  .089 
=  .114 


have,  therefore,  arranged  in  Table  5  the 
differences  between  groups  that  can  be 
compared  and  the  number  of  times  the 
probable  error  of  the  difference  is  con- 
tained in  these  differences. 

From  Table  5  it  appears  that  chewing 
has  a  marked  effect  on  output  rate,  while 
smoking  has  little  effect.  The  non-user 
group  may  be  considered  as  a  standard, 
and  we  find  that  the  whole  group  of  non- 
chewers  coincides  with  it  in  output  rate, 
but  the  chewers  fall  far  below  these  two 
groups,  the  difference  being  significant  as 
the  probable  error  of  the  difference  is  con- 
tained 2.7  times.  The  difference  between 
smokers  who  do  not  chew  and  the  non- 
users  is  too  small  to  be  of  significance; 


BAUMBERGER,  PERRY,  AND  MARTIN— TOBACCO  .^T)  EFFICIENCY       9 


therefore,  it  appears  that  smoking  has  less 
effect  on  output  rate  than  chewing.  When 
we  separate  the  smokers  who  do  not  chew 
into  light  and  heavy  smokers,  no  significant 
difference  appears  between  the  non-users 
and  the  light  smokers  or  between  the  non- 
users  and  the  liea\'y  smokers.  The  heavy 
smokers  who  do  not  chew  do  slightly  better 
than  the  non-users,  but  the  difference  is 
not  statisticallj'  dependal)le.  The  light 
smokers  who  do  not  chew,  however,  do  less 


in  like  manner  among  the  light  smokers 
where  the  difference  contains  the  probable 
error  of  the  difference  1.2  times.  These 
comparisons  are  also  given  in  Table  5  and 
show  that  chewers  have  in  every  case  a 
markedly  lower  output  rate. 

Table  6,  in  which  the  groups  holding  the 
highest  and  lowest  hourly  records  are  given, 
shows  that  the  workers  who  chew  in  no 
case  make  a  highest  output  rate  record, 
but  in  seven  out  of  eight  of  the  hours  nuike 


TABLE  5.  —  COMPARISON  OF  HABIT  GROUPS.  SHOWING  SIGNIFICANCE  OF  DIFFERENCES 


.                                               G  H  0  O  PB 

Algebraic 
DilTerenoe  from 

Probable  Error 

Number  of  Time) 
Probable  Error  of 

First  Group 

Sccoad  Group 

Mean  of  First 
Group 

of  Difference       Lfiuerence  is  v.,on- 
.toincd  in  Dillcn.nce 

All  chewers 

-0.65 
-0.05 

o.ii         1            2.7 

Non-chewers 

0.28 
0.34 
0.34 
0.41 
0.33 
0.48 
0.45 
0.37 

(« 

Smokers  wlio  do  not  chew 

i« 

Light  smokers  wlio  do  not  chew. . .  i        —0.36 
Heavy  smokers  who  do  not  chew .  .  i        -1-0.09 

1.0 

(. 

.\ll  light  smokers 

-0.77 
-0.61 
-0.56 
-0.45 
-0.40 

1.9 

Heavy  smokers  who  do  not  chew. . .  . 

Light  smokers  who  do  not  chew 

Heavy  smokers  wlio  <io  not  chew .... 
Heavy  smokers  who  chew 

Heavy  smokers  who  chew 

Light  smokers  who  chew 

Light  smokers  who  do  not  chew. . . 
I.i^liF  <*mokers  who  chew    

1.8 
1.2 

1.0 

1.1 

well  than  the  non-users,  but  the  chances 
that  this  is  significant  are  only  1  :  1.  We 
cannot  offer  an  explanation  of  the  fact  that 
the  light  smokers  have  a  lower  output  rate 
than  the  heavy  smokers.  A  difference  of 
the  same  nature,  however,  exists  between 
the  output  of  heavy  and  light  smokers  as 
a  whole,  the  probable  error  of  the  differ- 
ence being  contained  in  the  difference  1.9 
times,  and  also  between  the  heavy  and 
light  smokers  subdivided  into  chewers  and 
non-chewers,  the  probable  error  of  the 
difference  being  contained  1.1  and  1.0 
times,  respectively. 

The  fact  that  chewing  has  a  much  more 
marked  effect  on  output  rate  than  smok- 
ing is  further  brought  out  by  a  comparison 
of  heavj'  smokers  who  chew  with  heavy 
smokers  who  do  not  chew,  in  which  the  dif- 
ference is  large  enough  to  contain  the  prob- 
able error  of  the  difference  1.8  times,  and 


a  lowest  record.    The  actual  output  rates 
are  given  in  Table  3. 

Discussion 

From  the  foregoing  data  it  appears  that 
workers  who  chew  have  a  much  lower  out- 
put rate  than  those  who  only  smoke  or  who 
do  not  use  tobacco  in  any  form.  The  light 
smokers,  however,  do  show  some  inferiority 
in  output  rate  and  the  heavy  smokers  a 
very  slight  superiority,  although  these  dif- 
ferences are  too  small  to  be  statistically 
dependable.  The  difference  between  the 
light  and  heavy  smokers  is  apparently 
significant.  The  fact  that  light  smokers 
have  a  lower  output  rate  than  heavy 
smokers  is  difficult  to  explain  but  may  be 
an  indication  that  insufficient  use  of  to- 
bacco has  more  deleterious  effects  than  a 
larger  use  which  might  confer  an  immunity 


10 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


that  would  be  lacking  in  the  case  of  light 
smokers.  This  explanation  is  entirely  a 
surmise,  but  should  be  followed  up. 

The  low  output  of  chewers  may  be  due 
to  a  greater  absorption  of  nicotine  into  the 

TABLE  6.  — HABIT  GROUPS  HOLDING 

HIGHEST  AND  LOWEST  HOURLY 

OUTPUT  RATE  RECORDS 


Highest  Average  Hourly 

Lowest  Average  Hourly 

Output  Rate 

Output  Rate 

1 

Heavy  smokers  who  do 

1 

Chewers  who  do  not 

not  chew 

smoke 

2 

Heavy  smokers  who  do 

2 

Heavy  smokers  who 

not  chew 

chew 

3 

Non-users            

3 

Light  smokers  who 

chew 

4 

Heavy  smokers  who  do 

4 

Light  smokers  who 

not  chew 

chew 

5 

Heavy  smokers  who  do 

5 

Light  smokers  who  do 

not  chew 

not  chew 

6 

Heavy  smokers  who  do 

6 

Chewers  who  do  not 

not  chew- 

smolve 

7 

Heavy  smokers  who  do 

7 

Light  smokers  who 

not  chew 

chew 

8 

Non-users 

R 

Light  smokers  who 
chew 

system  than  takes  place  from  smoking. 
Some  reason  for  this  is  obvious  when  we 
consider  that  in  smoking  at  least  half  the 
nicotine  is  lost  in  the  smoke  from  the  burn- 
ing point  and  that  a  large  part  of  the  nico- 
tine in  the  inhaled  smoke  may  be  exhaled 
before  it  is  absorbed.    This  is  quite  likely, 


as  smoke  can  be  drawn  through  several 
wash  bottles  without  losing  all  its  nicotine, 
because  the  alkaloid  is  probably  adsorbed 
on  the  surface  of  liquid  particles  in  the 
smoke  which  are  notably  difficult  to  absorb 
in  a  wash  bottle.  (This  point  will  be 
brought  out  in  a  paper  to  follow  shortly.) 
In  chewing  tobacco,  on  the  other  hand,  the 
saliva  of  the  chewer  seems  to  have  ample 
opportunity  to  absorb  the  nicotine  of  the 
tobacco,  and  from  the  saliva  the  mucous 
lining  of  the  mouth  may  absorb  the  poison. 
Furthermore,  in  most  chewing  a  certain 
amount  of  saliva  is  swallowed,  which  gives 
abundant  opportunity  for  absorption  of 
nicotine.  It  is  possible,  therefore,  to  offer 
an  explanation  for  the  fact  that  chewers 
have  a  lower  output  rate  than  smokers  on 
the  basis  of  the  relative  nicotine  absorption, 
although  until  actual  absorptive  studies  of 
the  two  groups  have  been  made,  such  an 
explanation  can  be  only  tentative. 

Conclusions 

1.  Smoking  has  little  effect  on  output 
rate  in  the  strenuous  physical  occupation 
studied  by  us. 

2.  Chewing  markedly  lowers  output  rate 
in  this  strenuous  physical  occupation. 

3.  Light  smokers  have  a  slightly  lower 
output  rate  than  heavy  smokers  in  this 
strenuous  physical  occupation. 


BIBLIOGRAPHY 


1.  Baumberger,  J.  P.,  and  Martin,  E.  G.:  Fatigue 
and  Efficiency  of  Smokers  in  a  Strenuous  Men- 
tal Occupation.  Jour.  Indust.  Hyg.,  1920- 
1921,  2,  207. 


2.  Florence,  P.  S.:  Columbia  Univ.  Studies  in 
Hist.,  Econ.,  and  Law,  1918,  81,  3. 

3.  Bayliss,  W.  M. :  Principles  of  General  Physiol- 
ogy. New  York  and  London,  Longman's 
Green  and  Company,  1915,  p.  40. 


A  SLRVEY  OF  CARBON  MONOXIDE  POISONING  IN  AMERICAN 
STEEL  WORKS.  :METAL  MINES,  AND  COAL  MINES* 

HENRY  S.  FORBES,  M.D. 
Division  of  Industrial  Hygiene,  Harvard  Medical  School 

THIS  report  is  the  result  of  a  survey.         In  mines,  exposure  to  carbon  monoxide 

chiefly  in  mines  and  about  bhist  fur-  usually  occurs  in  one  of  three  ways:  (o)  after 

naces,  to  obtain  more  accurate  information  explosions  or  during  serious  fires;  (b)  about 

regarding    the    clinical    effects    of    carl)on  smouldering  fire  areas;  or  (c)  after  blasting, 

monoxide.  Carbon   monoxide   is  the  chief  poisonous 

In   the  United   States   and   abroad   the  element    of    the    miners'    "white    damp," 

literature  gives  many  instances  of  mental  "after  damp,"  and  "powder  smoke."    Its 

impairment,  psychoses,  and  paralyses  fol-  presence  in  0.0'-25  per  cent,  is  sufficient  to 

lowing  acute  gassing  by  carbon  monoxide,  cause  dizziness  and   severe   headache;   in 

and  it  is  stated  that  anemia,  neiwifis  and  0.'2  per  cent,  it  is  dangerous  ('?). 
other  symptoms  follow  chronic  poisoning  In  Montana  the  copper  mines  at  Butte 

from    this   gas    (1)    (2).     It    undoubtedly  and  t  lie  smelters  at  Anaconda,  East  Helena, 

causes  more  accidents,  fatal  and  non-fatal,  andCJreat  Falls  were  examined.  Thesmelt- 

than  any  other  gas  in  industry,  and  it  seems  ers  appear  to  present  no  carbon  monoxide 

important  to  find  out  how  unich  crii)i)ling  hazard  under  ordinary  conditions.    In  the 

and  how  much  loss  of  working  linu'  it  is  coi)per  mines,  the  gas  does  occur  frequently 

responsible  for.    Few  accmale  data  arc  to  in  small  amounts  about  the  fire  areas  and  is 

be  found  in  regard  to  this,  and  two  definite  rather  troublesome.    Occasionally,  also,  it 

problems,    therefore,   present    themselves:  causes  headaches  after  blasting  at  certain 

(1)  How  frequent  are  late  sequelae  of  acute  points  where  the  air  current  is  not  good  and 

carbon  monoxide  gassing?    and  ('■2)   What  where  two  or  three  shifts  are  working.    In 

effect  does  the  gas  have  on  men  fref|uenlly  these  mines  there  is  no  record  of  lost  time 

exposed  to  small  doses.'  due  to  this  cause,  and  only  rarely  is  a  man 

An  attempt  to  answer  these  cpiestions  overcome  for  a  few  hours  about  the  fire 
has  been  made  by  a  survey  of  metal  mines,  areas.  In  the  coal  mines,  especially  in  the 
coal  mines,  blast  furnaces,  and  producer  South,  owing  to  the  danger  of  explosions 
gas  boilers  and  engine  rooms  in  Montana,  from  natural  gas  and  fine  coal  dust,  there 
Colorado,  Oklahoma,  Arkansas,  Alal)ania,  is  always  free  ventilation,  and  the  powder 
Tennessee,  Kentucky,  and  Pennsylvania,  smoke  only  occasionally  causes  symptoms. 
Data  were  obtained  from  mine  hospitals.  The  iron  ore  mines  near  Birmingham,  Ala- 
mine  doctors,  United  States  Bureau  of  bama,  are  less  well  ventilated  and  after 
Mines  officials,  superintendents,  foremen,  blasting  the  carbon  monoxide  lies  in  the  fine 
shift  bosses,  fire  bosses,  and  indi\  idnal  dust  and  is  stirred  up  by  the  "muckers," 
miners,  as  well  as  by  inspection  of  the  less  who  often  have  headaches  from  it.  But 
well  ventilated  workings  and  of  drifts  and  there  is  apparently  no  lost  time  from  this 
stopes  near  fire  areas.    In  a  few  cases  red  cause. 

blood-cell  counts  were  made,  and  in  others.         About  the  blast  furnaces  the  gas  seems 

tests  for  carbon  monoxide  in  the  blood.  to  cause  practically  no  loss  of  time  among 

♦  Received  for  publication  Jan.  6, 1921.  the  men  most  frequently  exposed  to  small 

11 


12 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


percentages  of  it  —  i.  e.,  the  top-fillers,  hot 
blast  men,  or  the  men  tending  the  boilers  or 
engines  run  by  producer  gas.  Among  the 
pipe-fitters  and  repair  men  who  encounter 
occasional  high  percentages  of  carbon 
monoxide,  loss  of  time  is  fairly  common, 
but  the  man  gassed  usually  lies  down  for  a 
few  minutes  and  then  returns  to  work. 
Only  a  small  proportion  of  these  cases  are 
sent  to  the  hospital,  and  the  company 
oflBce  has  no  record  or  even  knowledge  of 
them.  In  the  large  plants,  such  as  those  at 
Pittsburgh,  the  number  of  hours  lost  in  this 
way  must  be  considerable. 

Acute  Carbon  Monoxide  Poisoning 

Symptoms.  —  The  symptoms  of  acute 
carbon  monoxide  poisoning  may  vary  from 
sudden  unconsciousness  without  warning 
to  merely  a  slight  headache.  The  usual 
symptoms,  in  the  order  of  their  occurrence, 
are:  dizziness  or  sense  of  fullness  in  the 
head,  frontal  headache,  weakness  of  the 
knees,  nausea,  sometimes  vomiting,  general 
weakness,  inability  to  walk  or  stand,  and 
unconsciousness.  The  symptoms  depend 
chiefly  on  the  concentration  (3)  of  carbon 
monoxide  and  on  the  duration  of  exposure, 
but  also  vary  with  the  individual  and  his 
physical  condition  at  the  time  of  gassing. 
Often  there  is  a  stage  of  excitement  like 
alcoholic  intoxication.  Different  persons 
react  as  difi'erently  as  they  do  to  alcohol, 
and  many  men  are  well  knowm  to  be  able 
to  stand  amounts  of  the  gas  which  would 
speedily  overcome  others.  The  most  sen- 
sitive are  men  with  pre-existing  pulmonary 
or  cardiac  disease.  Sudden  entrance  into 
cold  air  or  sudden  exertion  causes  an 
exacerbation  of  symptoms.  Gastric  indi- 
gestion and  constipation  seem  to  make  a 
man  temjjorarily  more  susceptible  to  car- 
bon monoxide. 

Sequelae.  —  In  severe  acute  gassing, 
when  unconsciousness  has  lasted  minutes 
or  hours,  the  usual  after-effects  are  intense 


headache,  fatigue,  and  muscle  pains,  lasting 
from  one  to  three  days.  It  is  interesting 
that  the  muscle  after-pains  appear  to  be 
worst  in  those  muscles  most  used  during 
exposure  to  the  gas.  The  temporary  char- 
acter of  the  effects  of  acute  gassing,  how- 
ever, are  illustrated  by  the  following 
instances.  In  a  mine  disaster  in  Butte, 
Montana,  twelve  cases  were  admitted  to 
the  hospital,  gassed.  Nine  left  relieved  in 
twent^'-four  hours,  and  tlie  other  three,  two 
days  later.  No  readmissions  and  no  known 
sequelae  occurred.  In  another  hospital,  in 
the  past  year  ten  miners  were  admitted, 
gassed  in  mine  accidents.  Nine  went  home 
in  twenty-four  hours  or  less.  The  tenth, 
unconscious  at  entry,  stayed  thirty-six 
hours.  This  patient  had  always  been  neu- 
rotic, a  state  which  was  accentuated  after 
the  gassing,  but  no  new  condition  de- 
veloped. There  were  no  re-entries  and  no 
sequelae.  The  same  story  was  told  every- 
where by  miners,  foremen,  and  mine 
doctors  of  many  years'  experience.  They 
knew  of  no  men  jjermanently  incapacitated 
through  mental  or  physical  injury  from 
gassing.  One  Bureau  of  Mines  official, 
however,  knew  of  two  men  gassed  after  a 
coal  mine  dust  exi)losion,  who  were  men- 
tally incapacitated  some  months  later.  It 
was  not  known  what  their  mental  or 
physical  condition  had  been  before  being 
gassed.  Another  Bureau  of  Mines  engineer 
said  that  two  other  men  had  been  partly 
paralyzed  after  short  exposure  to  mine  gas. 
The  history  given  suggested  coinjilicating 
disease  or  hysteria  as  the  probable  ex- 
planation, but  no  clinical  details  were  ob- 
tained. Cases  of  pneumonia  following 
gassing  were  rare  and  occurred  usuallj' 
when  smoke  or  irritating  gases  were  present. 
About  blast  furnaces  the  testimony  was 
the  same  —  almost  no  late  nervous  or  men- 
tal secjuelae  were  known.  Two  cases  of 
mental  impairment  were  reported  by  com- 
pany doctors,  one  of  which  occurred  in  a 
chronic  alcoholic,  the  other,  in  a  man  who 


FORBES  —  CARBON  MONOXIDE  POISONING 


13 


had  a  strongly  positive  Wassermann.  Con- 
current disease,  and  especially  cerebral 
arteriosclerosis,  seems  to  be  a  very  impor- 
tant factor  in  causing  cerebral  lesions  in  a 
person  severely  gassed  (4).  In  fact,  if  a 
young,  healthy  adult  is  severely  gassed  bj^ 
"white  damp"  or  by  blast  furnace  gas,  he 
either  dies  in  a  few  days  or  recovers  en- 
tirely —  a  rule  to  which  there  are  few 
exceptions. 

Chronic  Carbon  Monoxide  Poisoning 

In  regard  to  the  question  of  chronic  car- 
bon monoxide  poisoning,  it  was  found  that 
in  certain  mines  about  the  fire  areas  men 
were  exposed  to  "white  damj)"  almost 
daily  for  months.  While  at  work,  these 
men  complained  of  frontal  lusu  ladies 
which  sometimes  lasted  till  tliey  fell  asleep. 
Next  morning  they  felt  well  again  unless 
the  exposure  to  carbon  monoxide  had  been 
unusually  severe,  in  which  case  they  suf- 
fered from  headache  and  felt  "all  in"  for  a 
day  or  two.  But  at  any  time  if  they  stopped 
work  and  stayed  outdoors  for  a  day  or  so, 
all  symptoms  disap])earcd. 

Some  men  notice  a  certain  degree  of 
tolerance  when  working  frequently  in  the 
gas.  For  example,  a  mine  foreman,  whom  I 
questioned  —  a  nuiu  50  years  old  —  had 
done  mine  work  since  he  was  a  boy.  For 
months  at  a  time  he  had  had  enough  gas  to 
cause  daily  headaches,  yet  was  sure  that  at 
the  end  of  such  a  period  he  could  stand 
more  gas  than  he  could  at  the  beginning 
and  more  than  a  "green"  man  working  be- 
side him  could  stand.  Tolerance  to  carbon 
monoxide  has,  moreover,  been  demon- 
strated experimentally  by  Nasmith  and 
Graham  (5),  and  has  been  noticed  before  in 
man  by  Haldane  ((>)  and  others.  ]Most 
miners  noticed  neither  tolerance  nor  cu- 
mulative ill-effects.  A  few  veteran  miners, 
however,  thought  that  they  had  never  been 
quite  so  strong  since  a  series  of  severe  gass- 
ings.   Such  a  man  was  a  fire  boss  who  had 


been  under  tremendous  strain,  emotional 
and  physical,  fighting  a  fire  for  eighteen 
months  in  a  coal  mine.  He  had  always  been 
able  to  stand  a  large  amount  of  "white 
damp"  and  had  never  been  rendered  uncon- 
scious by  it,  though  many  times  men  beside 
him  had  been  overcome.  He  stated  that  for 
months  after  this  ordeal  he  was  nervous 
and  his  hand  shaky.  He  believed  also  that 
his  heart  was  affected,  as  he  noticed  palpi- 
tation and  precordial  distress  on  exertion  or 
on  entering  gas,  yet  he  admitted  that,  even 
now,  he  could  stand  as  much  gas  as  most 
men.  This  man  had  had  no  careful  medical 
examination.  The  fire  in  question  occurred 
thirteen  years  ago  and  he  had  been  at  work 
constantly  ever  since. 

Anemia.  —  No  evidence  of  anemia  re- 
sulting from  fre<|uent  exposure  to  carbon 
monoxide  was  found,  either  in  the  rei)orts 
of  the  doctors  or  in  red  blood-cell  counts. 
These  counts  and  many  more  previously 
taken  from  Illinois  blast-furnace  workers 
show  polycythemia  rather  than  anemia.  In 
1911  Karasek  and  Apfelbach  (7)  examined 
sixty-eight  steel  workers.  The  red  blood- 
cell  counts  in  their  eases  ran  between 
5,500,000  and  9,(500,000,  two-thirds  being 
over  6,000,000.  The  appearance  of  the  red 
blood-cells  was  normal.  Dr.  Davis,  chief 
surgeon  of  the  Illinois  Steel  Company  (8), 
reports  that  175  red  blood-cell  counts  taken 
at  Gary  and  in  South  Chicago  on  men  who 
had  worked  in  the  blast  furnace  and  open 
hearth  de])artments  for  years  showed  no 
counts  below  4,000,000;  04. 1  per  cent,  over 
5,000.000;  and  '2.'-2  pvr  cent,  over  0,000,000. 
Physical  examinations  of  these  men  showed 
no  lesions  of  the  nervous  system. 

Neurological  Symptoms.  —  No  histories 
were  obtained  from  miners  or  mine  doctors 
suggestive  of  nuiltiple  neuritis,  mental 
deficiency,  or  paralysis  following  chronic 
carbon  monoxide  exposure.  Even  with 
illuminating  gas,  which  has  been  shown  to 
be  more  toxic  than  pure  carbon  monoxide 
(9),  no  serious  nervous  or  mental  results 


14 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


seem  to  be  common,  at  least  after  acute 
exposure.  In  the  past  two  years,  134  cases 
of  acute  illuminating  gas  poisoning  were 
admitted  to  the  wards  of  the  Boston  City 
Hospital.  Of  these,  not  one  patient  has 
been  readmitted  with  neurological  symp- 
toms or  committed  to  an  insane  hospital 
unless  a  definite  pathological  condition 
existed  prior  to  the  gassing.  This  informa- 
tion was  obtained  by  personal  examination 
of  the  hospital  records. 

Tests  for  Carbon  Monoxide  in  Blood.  —  In 
the  mines  it  was  difficult  to  find  men 
actually  suffering  from  carbon  monoxide 
headaches  at  the  moment  and  it  was  useless 
to  examine  the  blood  of  miners  for  carbon 
monoxide  after  they  had  walked  to  the 
hospital,  for  they  had  then  lost  the  gas 
through  respiration.  The  few  specimens 
taken  in  mines  at  the  working  face  were 
negative.  About  blast  furnaces,  however, 
there  was  one  situation  where  men  inhaled 
carbon  monoxide  at  intervals  all  through 
the  day,  and  every  day.  These  men  were 
the  top-fillers  on  the  old  style  hand-filled 
furnaces.  Blood  specimens  from  two  of 
such  workmen  out  of  six  tested  were  posi- 
tive for  carbon  monoxide  hemoglobin.  The 
tannic  acid  test  was  used  (10)  and  the  l)lood 
was  taken  while  the  men  were  actually  at 
work  on  the  furnace  top.  The  two  patients 
whose  tests  came  out  positive  had  com- 
plained of  slight  headache  at  the  time  the 
blood  was  taken.  Some  of  these  top-fillers 
had  done  this  work  for  years  (one  for 
twenty  years)  without  apparent  injury  to 
their  health. 

Treatment 

Carbon  monoxide  does  not  form  a  per- 
manent combination  witli  licnioglobin. 
This  has  been  conclusively  shown  by  Hal- 
dane  (11),  Henderson  (l'-2)  and  others.  The 
affinity  of  hemoglobin  for  carbon  monoxide 
is  approximately  three  hundred  times  tliat 


for  oxygen,  but  the  reaction  is  reversible. 
As  soon  as  the  man  breathes  oxygen  or 
fresh  air,  the  oxygen  Exactly  replaces  the 
carbon  monoxide  in  his  blood,  molecule  for 
molecule,  at  a  speed  depending  on  the  par- 
tial pressures  of  the  two  gases  in  the 
alveoli.  The  red  blood-corpuscles  are  ap- 
parently uninjured  and  are  able  to  take  up 
and  transport  oxygen  normally  as  soon  as 
the  carbon  monoxide  has  been  expelled. 

In  the  treatment  of  carbon  monoxide 
poisoning,  bleeding,  as  Haldane  and  Hen- 
derson have  clearly  stated,  is  harmful. 
Transfusion  is  unnecessary  because  under 
proper  treatment  the  blood  can  be  brought 
back  nearly  to  normal  within  half  an  hour. 
The  most  recent  advance  in  treatment  has 
been  made  by  Henderson  (9),  who  advo- 
cates administering  with  oxygen  a  small 
percentage  of  carbon  dioxide,  to  induce 
better  pulmonary  ventilation.  Hender- 
son's results  are  striking.  In  his  experi- 
ments dogs  were  gassed  thirty  to  forty 
minutes  with  illuminating  gas  in  such  di- 
lution as  to  give  0.4  per  cent,  carbon 
monoxide,  until  they  became  completely 
unconscious.  Untreated,  these  animals 
took  approximately  two  hours  to  exhale 
sufficient  carbon  monoxide  from  their  blood 
to  reduce  the  percentage  of  this  gas  to  10 
per  cent.  AVith  oxygen  treatment  alone, 
this  result  was  attained  in  sixty  to  eighty 
minutes;  with  oxygen  and  carbon  dioxide  it 
took  only  twenty  minutes. 

Another  ad\-ance  of  real  importance  in 
protection  against  carl)on  monoxide  is  the 
perfecting  of  an  efficient  respirator  by  the 
U.  S.  Chemical  Warfare  Service  (13).  The 
cannister  of  this  respirator  is  smaller  than 
the  army  type  and  is  effective  even  at  zero 
degrees  against  1  per  cent,  of  carbon 
monoxide.  Its  life  is  approximately  three 
hours.  Information  in  regard  to  it  can  be 
obtained  from  the  Director  of  the  Bureau 
of  Mines,  Washington,  D.  C. 


FORBES  —  CARBON  MONOXIDE  POISONING 


15 


StJMMARY 

Carbon  monoxide  as  met  with  in  metal 
and  coal  mines  and  about  blast  furnaces 
in  this  country  rarely  causes  late  after- 
effects following  acute  severe  gassing. 
When  such  effects  do  appear,  there  is 
evidence,  almost  always,  of  a  pre-existing 
pathological  condition. 

Frequent  exposure  to  carbon  monoxide 
causes  headache  and  malaise,  but  no  evi- 
dence has  been  found  of  a  cumulative 
harmful  effect. 


As  was  to  be  expected,  owing  to  the 
compensating  increase  of  hemoglobin  and 
red  cells  from  prolonged  oxygen  want  (14) 
(15),  it  is  possible  to  acquire  some  tolerance 
to  carbon  monoxide. 

A  recent  advance  in  treatment  has  been 
made  by  adding  carbon  dioxide  to  the 
oxygen  inhalations  administered.  Recovery 
is  three  times  as  rapid  as  when  oxygen 
alone  is  used. 

An  efficient  portable  carbon  monoxide 
respirator  has  been  jierfected  by  the  U.  S. 
government. 


BIBLIOGRAPHY 


1.  McCombs,  R.  S.:  Clinical  Manifestations  of 
Bliiminating  Gas  Poisoning.  Am.  Jour.  Med. 
Sc,  1912,  New  Series,  144,  577. 

2.  Glaister,  J.,  and  Logan,  D.  D.:  Gas  Poisoning 
in  Mining  and  Other  Industries.  New  York, 
William  Wood  and  Company,  1914. 

3.  Burrell,  G.  A.,  and  Scibcrt,  F.  M.:  Gases  Found 
in  Coal  Mines.  U.  S.  Bur.  Mines,  Miners' 
Circular  14,  Washington,  191C. 

4.  Hill,  E.,  and  Semerak,  C.  B.:  Changes  in  the 
Brain  in  Gas  (Carbon  Monoxid)  Poisoning. 
Jour.  Am.  Med.  Assn.,  1918,  71,  044. 

5.  Nasmith,  G.  G.,  and  Graham,  D.  A.  L.:  The 
Haematology  of  Carbon-Monoxide  Poisoning. 
Jour.  Physiol.,  1900-1907,  35,  3*2. 

0.  Haldane,  J.  S. :  Organism  and  Environment  as 
Illustrated  by  the  Physiology  of  Breathing. 
New  Haven,  Yale  University  Press;  London, 
Oxford  University  Press,  1917. 

7.  Karasek,  M.,  and  Apfelbacli,  G.  L. :  A  Report 
of  Investigations  on  Carbon  Monoxide  Poison- 
ing. Report  of  Illinois  State  Commission  on 
Occupational  Diseases,  Jan.,  1911,  p.  90. 

8.  Davis:  Personal  Communication,  1918. 


9.  Henderson,  Y.,  and  Haggard,  H.  W.:  The 
Elimination  of  Carbon  Monoxide  from  the 
Blood  after  a  Dangerous  Degree  of  AsphjTcia- 
tion,  and  a  Therapy  for  Accelerating  the  Elim- 
ination, .lour.  Pharmacol,  and  Exper.  Therap., 
1920,  16,  11. 

10.  McNally,  W.  D. :  Carbon  Monoxide  Poisoning. 
Jour.  Am.  Med.  Assn.,  1917,  69,  1586. 

11.  Haldane,  J.:  The  Relation  of  the  Action  of 
Carbonic  Oxide  to  Oxygen  Tension.  Jour. 
Physiol.,  1895,  18,  201.  The  Action  of  Car- 
bonic Oxide  on  Man.     Ibid.,  430. 

12.  Henderson,  Y.:  Carbon  Monoxid  Poisoning. 
Jour.  Am.  Med.  Assn.,  1910,  67,  580. 

13.  Lamb,  A.  B.,  Bray,  W.  C,  and  Frazer,  J.  C.  W.: 
The  Removal  of  Carbon  Monoxide  from  Air. 
Jour.  Indust.  and  Engin.  Cheni.,  1902,  12,  213. 

14.  Manual  of  Medical  Research  Laboratory.  Air 
Service  Division  of  Military  Aeronautics, 
Washington,  1918,  p.  13. 

15.  Dallwig,  H.  C,  KoUs,  A.  C,  and  Loevcnhart,  A. 
S.:  The  Mechanism  Adapting  the  Oxygen 
Capacity  of  the  Blood  to  the  Requirements  of 
the  Tissues.  Am.  Jour.  Physiol.,  1915-1916,  39, 
77. 


A  DISCUSSION  OF  THE  ETIOLOGY  OF  SO-CALLED  ANILINE 
TUMORS  OF  THE  BLADDER* 

ALICE  HA:\ULT0N,  M.D. 

Assistant  Professor  of  Industrial  Medicine,  Harvard  Medical  School,  and  Special  Investigator  of  Industrial  Poisons, 

U.S.  Bureau  of  Labor  Statistics 


FOR  the  last  twenty-five  years  the  Ger- 
mans have  been  aware  that  there  is  an 
undue  prevalence  of  malignant  tumors  of 
the  bladder  in  aniline  dye  workers.  The 
first  to  call  attention  to  this  curious  fact 
was  Rehn  (1),  who  presented  before  the 
German  Surgical  Society  in  1895  the  his- 
tories of  thi-ee  cases  of  malignant  bladder 
tumor  in  employees  of  one  of  the  great  dye 
works,  the  men  forming  part  of  a  force  of 
forty-five  who  were  employed  in  making 
fuchsin.   Rehn  concluded  as  follows : 

For  the  majority  of  bladder  tumors  one  can  only 
assume  that  compomids  excreted  by  the  kidneys  and 
existing  in  solution  in  the  urine  are  capable  of  setting 
up  tumor  formation  through  chemical  irritation. 
So  far  these  compoimds  have  eluded  our  search.  .  .  . 
The  gases  produced  in  the  manufacture  of  fuchsLn 
lead  to  disturbances  of  the  urinary  system,  and  pro- 
longed employment  over  many  years  in  the  fuchsLn 
department  may  cause  the  development  of  bladder 
tumors  because  of  continual  irritation.  The  harmful 
effects  depend  essentially  on  the  inhalation  of  aniline 
fumes. 

The  manufacture  of  fuchsin  consists  in 
heating  a  mixture  of  aniline,  ortho-tolui- 
dine  and  para-tohiidine,  with  nitrobenzene, 
or  ortho-nitrotoluene  and  para-nitrotolu- 
ene,  in  the  presence  of  iron  and  hydro- 
chloric acid. 

This  theory  of  Rehn's  was  challenged 
immediately,  especially  by  Grandhomme, 
the  chief  authority  on  industrial  poisoning 
in  color  manufacture,  since  he  had  been  for 
many  years  in  charge  of  the  great  plant  at 
Hoechst-am-Main.  Grandhomme  admitted 
that  aniline  was  irritating  to  the  blad- 
der mucosa,  as  shown  in  observations  on 
men  and  on  animals,  but  as  to  its  being 

*  Recieived  for  publication  Jan.  28,  1921. 


responsible  for  tumor  growth,  he  pointed 
out  the  fact  that,  while  Rehn  had  found 
three  cases  among  forty-five  fuchsin  men 
exposed  to  aniline  fumes,  there  were  in  the 
factor}^  at  the  time  about  4,000  men  ex- 
posed to  the  fumes.  Eleven  years  later, 
however,  Rehn  (2)  was  able  to  present  to 
the  German  Surgical  Society  records  of 
thirty-three  cases  which  he  had  collected 
from  German  dye  works,  all  malignant  and 
all  occurring  between  1889  and  1906.  To 
these,  Sej^berth  added  five,  others  three, 
making  forty-one  in  all. 

In  1912,  Leuenberger  (3)  of  Basel  pre- 
sented a  paper  before  the  same  society  in 
which  he  reviewed  the  whole  subject  of  the 
occurrence  and  causation  of  bladder  tu- 
mors in  aniline  workers  and  added  eighteen 
cases  from  the  works  in  Basel,  which  had 
then  been  running  for  about  twenty-seven 
years.  He  specially  urged  physicians  at- 
tached to  dye  works  to  study  these  tumor 
cases  and  to  try  to  discover  the  substances 
responsible  for  them.  The  following  year 
the  German  Congress  of  Industrial  Physi- 
cians endorsed  Leuenberger's  request  and 
drew  up  a  set  of  questions  to  be  answered 
in  connection  with  each  case  of  bladder 
tumor.  This  questionnaire  was  sent  to  all 
the  German  and  Swiss  dye  works.  The 
results  of  the  studies  made  since  then  are 
now  appearing  in  the  German  medical 
journals.  Many  new  cases  have  been 
added  to  Leuenberger's  list  of  fifty-nine, 
and  in  the  last  article  on  the  subject,  by 
Curschmann  (4),  the  final  corrected  list 
includes  177  cases. 

The  statistics  on  which  the  Germans 
base  their  statement  that  bladder  tumors 


16 


HAiVnLTOX  —  ANILINE  TUMORS 


17 


are  strikingly  frequent  among  aniline 
workers  are  not  satisfactory.  They  are  in- 
complete in  several  respects,  and  it  is  sur- 
prising that  when  so  much  careful  clinical 
and  experimental  work  has  been  done  in 
this  field,  nobody  has  troubled  to  present 
indisi)utable  proof  of  this  basic  statement. 
We  do  not  know  how  many  men  are  ex- 
posed to  fumes,  and  cannot  tell,  therefore, 
what  proportion  of  the  whole  such  a  num- 
ber as  177  is.  The  number  of  employees  in 
these  dye  works  is  estimated  at  80,000  to 
100,000  —  an  estimate  which  is  more  de- 
pendable, owing  to  the  small  labor  turn- 
over, than  would  be  a  similar  one  in  our 
dye  works.  Nassauer  (5)  gives  the  labor 
turnover  for  one  of  the  plants  in  the  Frank- 
furt region  as  only  15  per  ci'Ut.  ]icr  year. 
That  would  be  more  nearly  the  monthly 
turnover  in  an  American  jilant.  During  the 
war,  however,  there  must  have  been  a  great 
deal  of  shifting;  indeed,  Nassauer  s]>eaks  of 
the  introduction  of  women  workers  and 
speculates  as  to  the  probable  apjiearance  of 
bladder  tumors  among  them  during  the 
next  twenty  years. 

The  exact  number  of  men  exposed  to 
what  is  regarded  as  the  exciting  cause  of 
tumor  growth  is  not  the  only  missing  link 
in  the  train  of  reasoning  on  which  the  (ier- 
mans  base  their  statement  that  dye  work- 
ers have  more  than  their  due  proi)ortion 
of  bladder  tumors.  'J'he  figures  given  by 
Rehn  for  the  Frankfurt  region  are  as  fol- 
lows: Between  1895  and  1918  there  were 
92  cases  of  bladder  tumor  in  the  City  Hos- 
pital, 22  of  which  were  iniquestional)ly 
caused  by  anihne  and  24  possibly  so  caused, 
making  46  or  50  per  cent,  of  the  whole 
number.  The  proof  would  be  much  more 
convincing  if  the  records  showed  what  pro- 
portion of  the  male  population  of  the  hos- 
pital was  employed  in  the  dye  works.  The 
same  criticism  apphes  to  Leuenberger's 
figures  from  the  Basel  hospital,  which 
cover  fifty  years.  (See  Table  1.)  Nas- 
sauer's  plant  (5)  had  32  cases  in  twenty 


years,  with  a  working  force  of  105  men  and 
an  annual  turnover  of  about  15  per  cent. 
This  is  really  the  most  striking  record 
offered  in  the  literature,  but  Ojjpenheimer 
(6)  believes  that  the  i)roportion  is  higher 
than  that  given  in  any  official  rcjiort. 
According  to  the  tales  of  his  jjatients  there 
was  one  factory-  with  (iO  men  in  which 
during  twelve  j'ears  15  cases  ajjpeared;  in 
another  with  60  men  there  were  27  cases, 

TABLE  1.  — C.\SES  OF  BL.VDDER  TUMOR 
IN  B.^SEL  HOSPITAL,  1861-1910 


Number 
of  Male 
Fatienb 

Number  of  Cases  of  Bladder 
Tumor 

Years 

In 
Hospital 

In  Color 
Makers 

In 
Dyers 

1861-1870  

1871-1880  

1881-1890*  

1891-1900 

1901-1910 

2600 
3450 
4250 
5500 
9050 

1 
0 
1 
4 
16 

0 
0 
0 
0 
10 

0 
0 
0 
0 

^ 

*  The  dye  industry  began  in  Basel  in  1885. 

9  of  which  were  known  to  have  been  fatal; 
and  in  a  third,  29  out  of  30  men  died  of 
bladder  disease  in  ten  years'  time. 

A  typical  history  of  the  earlier  cases  of 
bladder  tumor  reads  as  follows:  Tiic  man 
comes  to  the  plant  doctor  for  treatment 
usually  because  he  has  noticed  blood  in  the 
urine.  Cystoscopic  examination  *  then  re- 
veals a  papillomatous  growth,  more  rarely 
a  flat  carcinoma  with  a  broad  base.  In 
more  recent  years,  since  physicians  have 
been  on  the  watch  for  these  tumors,  the 
examination  is  often  made  before  the  ap- 
pearance of  blood  and  discloses  sometimes 
only  a  cystitis,  with  ulceration  perhaps, 
then  later  on,  even  if  the  man  is  removed 
from  contact  with  aniline,  a  new  growth  is 
found.  DiflFercnt  varieties  are  described  — 
pediculated  pai>illoma,  villous  polypus, 
wart-like  excrescences,  or  general  papil- 
lomatosis of  the  whole  bladder.  These 
benign  growths  may  undergo  carcinoma- 

*  The  use  of  the  electric  cystoscope  was  first  introduced 
in  1830  in  Germany  by  Nitze,  and  undoubtedly  as  its  use 
extended  many  early  cases  of  tumors  were  discovered  which 
formerly  would  have  gone  undetected. 


18 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tons  degeneration,  but  there  are  also 
malignant  growths  which  are  quite  different 
in  appearance  and  which  apparently  have 
not  passed  through  the  papillomatous 
stage,  being  solid,  with  a  broad  base  (6). 
In  some  instances,  a  small  fresh  polyp  can 
be  seen  on  one  side  of  the  bladder,  and  a 
carcinoma  on  the  other.  The  cancerous 
gi-owth  may  invade  the  neighboring  lymph 
glands  or  the  ureter  and  kidney,  as  in  one  of 
Rehn's  cases,  or  the  bones  of  the  pelvis  and 
the  lower  abdominal  wall,  as  in  a  case  seen 
by  Czerny.  Only  one  autopsied  case  has 
shown  metastases  in  liver  and  lungs.  In 
the  earlier  cases,  it  was  said  that  the  seat 
of  predilection  was  near  the  mouths  of 
the  ureters,  but  later  reports  showed  that 
they  might  be  [situated  in  any  part  of  the 
bladder. 

A  long  exposure  to  the  chemical  which  is 
the  exciting  cause  seems  to  be  necessary. 
The  statistics  from  Hoechst,  Ludwigshafen, 
and  Greppin  (7)  show  that  the  cases  de- 
veloping in  the  fuchsin  department  were  in 
men  who  had  been  employed  on  an  aver- 
age from  twelve  years  in  Greppin  to  nine- 
teen in  Ludwigshafen.  Those  who  worked 
in  the  benzidine-naphthionic  department 
had  had  a  shorter  period  of  exposure,  aver- 
aging five  years  in  Ludwigshafen,  and  six 
years  in  Greppin.  Oi)i)enheimer's  patients 
had  worked  from  two  to  twenty-eight 
years,  averaging  eighteen  years.  The  two- 
year  case,  which  was  far  below  the  average 
—  indeed,  the  shortest  exposure  on  record 
so  far  —  occurred  in  a  man  who  worked  in 
the  benzidine  department. 

Both  Curschmann  and  Oppenheimer 
find  that  there  is  no  connection  between 
the  length  of  exposure  and  the  malignant 
character  of  the  growi;h,  nor  is  there  any 
relation  between  the  particular  compound 
causing  the  tumor  and  the  character  of  the 
tumor.  Oppenheimer  observed  six  men 
who  had  worked  together  in  the  same  room 
for  twenty  years;  two  were  healthy,  two 
had  been  operated  on  for  bladder  tumor 


and  had  recovered,  and  the  last  two  had 
died  from  bladder  tumor.  Of  Cursch- 
mann's  twentj'-six  cases,  one  developed 
after  five  years,  six  after  five  to  ten  years, 
six  after  fifteen  to  thirty  years,  and  thir- 
teen after  more  than  thirty  years'  emploj-- 
ment.  The  Basel  cases  did  not  begin  to 
appear  till  the  industry  was  16  to  17  years 
old,  and  in  England  the  only  dye  works  in 
which  information  about  bladder  tumors 
among  the  men  can  be  obtained  is  the 
oldest  one,  more  than  20  years  old.  Cursch- 
mann finds  the  great  majority  of  cases  of 
cystitis  among  dye  workers  as  reported  in 
the  literature  occurring  after  -40  years  of 
age.  Oppenheimer's  twenty  patients  were 
between  34  and  47  years  of  age,  decidedly 
younger  than  the  average  for  bladder 
tumors  in  general. 

The  histories  of  color  makers  who  suffer 
from  bladder  tumors  show  that  ordinary 
aniline  poisoning  has  nothing  to  do  with 
the  condition  in  the  bladder.  A  man  may 
have  had  repeated  attacks  of  acute  aniline 
poisoning  or  the  chronic  form  of  poisoning, 
yet  never  have  even  a  cystitis;  or  he  may 
never  have  had  t^-pical  aniline  poisoning 
and  yet  develop  a  tumor  of  the  bladder. 

One  very  interesting  feature  of  this 
variety  of  bladder  tumor  was  brought  out 
by  Leuenberger  and  confirmed  by  Schwerin 
(7)  and  by  Oppenheimer  —  namely,  the 
fact  that  the  tiunor  may  develop  long  after 
the  ex])osure  to  the  exciting  cause  has 
ceased.  Leuenberger  tells  of  a  man  who 
worked  in  benzidine  for  seven  years,  had 
cystitis,  and  was  transferred  to  another 
department  where  he  worked  for  two  years. 
He  then  left  the  factory,  and  two  years 
later  blood  appeared  in  the  urine  and  he 
was  operated  on  for  tumor  of  the  bladder. 
Schwerin  of  Hoechst  reports  two  similar 
cases:  one,  a  man  who  worked  five  years 
in  the  benzidine-naphthionic  department 
and  twenty-three  years  later  had  tumor  of 
the  bladder;  the  other,  a  man  who  worked 
eleven  years  in  aniline  and  eight  years  after 


HA:\nLTOX  — ANILIXE  TOIORS 


19 


leaving  the  factory  had  a  tumor  removed 
from  the  bladder.  Oppeiiheimer  saw  tu- 
mors develop  ten  years  and  seventeen 
years  after  the  men  had  left  the  factory. 

It  seems  from  the  observations  of  Nas- 
sauer  and  of  Oppenheimer  that  an  ex- 
tremely slight  exposure  to  the  exciting 
cau.se  is  .sufficient.  Oppenheimer  had  tliree 
cases  which  de\'elopcd  in  men  who  never 
came  in  contact  with  the  chemicals,  but 
who  worked  in  rooms  adjoining  the  j)rocess 
departments.  These  cases  were  slow,  the 
tumors  developing  after  twenty  to  twenty- 
six  years.  Several  of  Nassauer's  patients 
were  employed  in  de])artmeiits  in  whicli  no 
manufacturing  was  carried  on  but  which 
were  next  to  tlie  departments  making 
benzidine. 

In  tlie  searcii  for  the  exact  comi)()und  or 
compounds  which  are  responsible,  a  careful 
study  has  been  made  of  the  history  of  eadi 
case  so  far  rejiorted,  in  order  to  see  whicli  of 
the  intermeiliates  used  in  color  manufac- 
ture seem  to  be  connected  with  bladder  tu- 
mors. A  great  variety  of  compounds 
emerge  as  probable  agents,  comj)oun(ls  with 
different  degrees  of  toxicity  and  with  ilif- 
ferent  physical  and  chemical  properties,  but 
with  this  feature  in  common,  that  they  are 
all  amido  compounds,  containing  the  ratli- 
cal  NH2,  produced  by  the  reduction  of 
nitro  compounds.  The  latter,  though  dis- 
tinctly more  toxic  than  the  amido  group,  do 
not  have  this  peculiar  effect.  These  are  the 
lists  which  have  been  submitted: 

List  from  Hoechst-am-Main  (7) 

Naphtliylamines 30  cases 

Benzidine  and  naphthionic  acid  .  28      " 

Fuchsin 21      " 

Aniline 8      " 

Black  and  blue  colors 4      " 

Curschmanns  List  (4) 

Beta-naphthylamine 10  cases 

Aniline 5      " 

Fuchsin 3      " 

Benzidine-naphthionic 3      " 

Other  bases 3      " 

Blue  colors 4      " 


Oppenheimer's  List  (6) 

.Vniline 3  cases 

Aniline  colors i  " 

Benzidine 5  " 

Aiiiline-naphthylamines 3  " 

Aniline-bcnzene-toluene 1  " 

Benzidine-aniline 1  " 

Benzidine-tolidin 1  " 

Am  i<  lo-naphthol-cresoldicarbon  ic 

acid 1  « 

Xapiithylamine-cresoldicarbonic 

acid 3  " 

Not  directly  exposetl 1  " 

Nassauer  gives  the  following  substances 
in  connection  with  which  bladder  tumors 
have  appeared:  aniline,  para-toluidine.  xyli- 
dines.  cumidins.  naphthylamines,  fuchsin, 
Ijenzidine,  tolidin,  and  blue  rosaniline 
coloring  matters  made  from  fuchsin  by  the 
action  of  aniliiu'  in  the  presence  of  acetic 
or  l)enzoic  acid. 

In  trying  to  determine  which  of  these 
compounds  is  tlie  responsible  agent,  there 
are  several  difficulties  which  must  be  borne 
in  mind  —  difficulties  encountered  more 
or  less  in  every  studj^  of  industrial  poison- 
ing, but  especially  in  connection  with  such 
complicated  processes  as  those  of  dye 
manufacture.  In  the  first  place,  every 
process  involves  the  use  and  production  of 
more  than  one  compound,  so  that  even  if  a 
man  is  engaged  in  only  one  i)rocess  it  can- 
not be  said  that  he  is  exposed  to  only  one 
poi.son.  ^Moreover,  it  is  very  connnon  to 
have  two  distinct  processes  going  on  in  the 
same  room,  so  that  the  workmen  are  ex- 
posed to  other  compounds  than  those  with 
which  they  are  working.  The  benzidine- 
naphthionic  department,  mentioned  so 
often  in  connection  with  bladder  tumors,  is 
one  in  which  Congo  red  is  manufactured 
from  benzidine,  which  is  a  product  of  nitro- 
benzene, and  from  naphthionic  acid,  wliich 
is  a  product  of  alpha-naphthylamine.  The 
harmful  substance  here  has  sometimes 
been  considered  benzidine,  sometimes  al- 
pha-naphthylamine —  neither  of  which  is 
markedlv  toxic  —  while  Nassauer  believes 


20 


THE  JOmXAL  OF  INDUSTRIAL  HYGIENE 


that  it  is  the  small  percentage  of  aniline 
accidentally  formed  in  the  conversion  of 
nitrobenzene  to  benzidine.  Nor  must  it  be 
forgotten  that  certain  poisonous  substances 
may  be  formed  accidentally  in  the  course 
of  industrial  processes,  and  their  presence 
not  suspected,  as  when  hydi-ogen  sulphide 
is  given  off  in  the  making  of  sulphur  dyes, 
or  hj'drogen  arsenide  in  various  reduction 
processes. 

Industrial  conditions  bring  about  other 
difficulties  which  are  especially  evident 
when  the  form  of  poisoning  to  be  studied  is 
very  slow,  drawn-out  over  a  great  many 
years.  Workmen  change  from  one  depart- 
ment to  another,  and  each  change  brings 
new  compounds  into  question,  or  they  go 
from  one  factory  to  another,  in  which  the 
processes  are  different.  It  is  also  true  that 
the  same  compound  used  in  diiferent  proc- 
esses may  be  attended  with  very  different 
degrees  of  danger.  Thus,  it  is  said  that  in 
the  making  of  benzidine  there  may  be  more 
actual  exposure  to  aniline  vapor  than  in  the 
manufacture  of  aniline  itself. 

These  difficulties  strike  one  forcibly 
when  one  tries  to  bring  into  some  sort  of 
harmony  the  results  of  the  studies  in  the 
different  German  factories.  For  instance, 
Nassauer  believes  that  all  the  cases  in  the 
literature  can  be  traced  to  one  department 
—  the  manufacture  of  benzidine.  He  has 
been  very  strongly  impressed  by  the  dan- 
gers in  benzidine  manufacture,  but  then,  it 
is  obvious  that  the  plant  with  which  he  is 
connected  makes  benzidine  chiefly,  produc- 
ing before  the  war  60  to  70  per  cent,  of  the 
world's  supply.  It  is  easy  to  understand, 
therefore,  why  he  finds  that  every  one  of 
the  thirty-two  cases  which  occurred  there 
were  in  men  who  had  been  working  in  or 
near  or  outside  of  the  benzidine  rooms. 
Curschmann  of  Hoechst  and  Engel  (8)  of 
Ludwigshafen  find  a  singularly  large  num- 
ber of  cases  in  men  exposed  to  beta-naph- 
thylamine,  but  Nassauer  insists  that  this 
compound  could  not  be  responsible  since 


he  has  never  seen  a  case  of  hematuria  or 
strangury  in  a  naphthylamine  worker  in 
twenty  years,  and  he  believes  that  there  are 
other  fumes  in  the  naphthylamine  depart- 
ments.* 

The  Hoechst  investigators,  Schwerin  (7) 
and  Kuchenbecker  (9),  agree  with  Nas- 
sauer that  the  greater  number  of  cases 
come  from  the  benzidine-naphthionic  de- 
partment. They  do  not  attribute  this  to 
aniline  fumes,  however,  but  to  benzidine 
dust.  The  earlier  reports  of  bladder  tu- 
mors placed  the  danger  in  the  fuchsin 
department.  Aniline  began  to  be  used  on  a 
large  scale  for  the  manufacture  of  fuchsin 
in  1872  and  about  twenty  years  later  the 
reports  of  bladder  tumors  in  aniline  work- 
ers began  to  appear.  But  aniline  is  not  the 
only  compound  used  in  fuchsin  manufac- 
ture; ortho-toluidine  and  para-toluidine 
must  also  be  considered. 

Th&  causation  of  these  tumors  is  a  sub- 
ject at  present  occupying  most  of  the 
attention  of  the  German  investigators, 
for  obviously  it  is  a  matter  not  only  of 
scientific  but  of  practical  importance,  as 
no  efficient  sj'stem  of  prevention  can  be 
devised  until  the  dangerous  substances  are 
discovered.  Experiments  on  animals  have 
so  far  cast  very  little  light  on  the  subject. 
It  has  been  known  for  a  long  time  that 
irritation  of  the  bladder  could  be  produced 
by  injection  of  aniline  and  some  of  its 
homologues,  and  such  dye  intermediates 
as  tolylenediamine,  phenylenediamine,  and 
paranitraniline  will  set  up  not  only  irrita- 
tion of  the  bladder  mucosa  but  also  hem- 
orrhage. As  soon  as  the  administration 
of  the  poison  is  suspended,  however,  the 
symptoms  subside,  nothing  further  occurs, 
and  the  bladder  mucosa  becomes  quite  nor- 
mal again.    Nor  are  these  particular  com- 

*  Hematuria  and  strangury  have  been  reported,  how- 
ever, in  connection  with  beta-naphthylamine  by  German 
factory  inspectors  and  in  the  one  American  factory  where  I 
have  seen  it  used  it  has  been  found  decidedly  more  toxic  than 
alpha-naphthylamine,  causing  frequent,  burning  micturition, 
as  if  the  urine  were  over-acid,  as  Engel  has  found  it  to  be 
in  dogs  which  have  been  fed  beta-naphthylamine. 


HA:\IILT0X  —  AXILIXE  TUINIORS 


21 


pounds  connected  with  cases  of  bladder 
tumor  in  dye  workers.  Oppenheimer  tried 
to  produce  tumors  in  animals  by  repeated 
injections  of  benzidine  and  tolidin  in 
suspension,  but  although  he  continued  his 
experiments  for  eighteen  months,  there  was 
absolutely  no  result. 

Leuenberger  recalls  the  work  done  on 
aniline  excretion  in  Schniiedeberg's  laljora- 
tory  (10),  which  showed  that  aniline  under- 
dergoes  in  the  body  hydroxylation  to 
para-amidophcnol  and  is  excreted  in  the 
urine  in  conjugation  with  ethyl  sulphuric 
acid.  He  maintains  that  it  is  this  hy- 
droxyl  derivative  of  aniline  and  similar 
bodies  which  sets  up  proliferative  processes 
in  the  whole  urinary  tract:  first,  inflamma- 
tory infiltration  and  atyi)ical  jiroliferation 
of  the  mucosa,  then,  ])ai)illonui  formation, 
granuloma,  carcinoma,  sanonui,  and  mixed 
forms.  He  assumes  a  precancerous  stage  of 
inflammation  and  proliferation,  such  as 
occurs  in  arsenical  granuloma  and  epithe- 
lioma, in  X-ray  lesions,  and  in  the  so- 
called  pitch  cancer.  The  late  development 
of  the  tumors  he  ex})lains  by  the  fixation 
in  the  body  of  decom]>osition  ])roduets  of 
the  poisons,  with  continual  damage  to  the 
bladder  cells,  or  the  eflfect  of  the  chemical 
may  be  passed  on  through  successive  gen- 
erations of  cells.  He  jioints  out  the  sim- 
ilarity between  these  aniline  tumors,  which 
are  clearly  caused  by  some  chemical  irri- 
tant, and  other  growths  which  are  known  to 
be  the  result  of  chemical  irritants,  such  as 
the  cancer  of  chimney  sweeps  so  thoroughly 
studied  by  the  English,  and  the  cancer  of 
briquette  makers  first  reported  by  ^'olk- 
mann,  then  by  the  English,  in  all  of  which 
thei'e  is,  first,  irritation  of  the  skin,  then, 
the  formation  of  warts,  or  nodules,  or 
sclerodermatous  patches.  If  the  man 
leaves  work,  nothing  more  serious  may 
occiu",  but  if  his  exposure  is  prolonged,  slow 
carcinomatous  degeneration  sets  in. 

Nassauer  also  compares  aniline  workers' 
tumors  to  the  pitch  and  tar  cancers  de- 


scribed by  the  English,  and  he  speaks  of 
a  curious  observation  made  among  the 
miners  of  cobalt  arsenide  ore  in  the  Saxon 
Erzgebirge,  who  were  found  to  have  an 
enormous  incidence  of  lung  carcinoma.  As 
for  the  ability  of  aniline  and  similar  bodies 
to  set  up  proliferative  changes  in  the 
bladder  mucosa,  there  seems  to  be  only 
one  observation.  Fischer  (11)  found  that 
epithelial  growth  was  stimulated  by  the 
injection  of  certain  fat-soluble  colors  in  oil. 
"Scharlach  Roth"  (amidoazotoluene)  was 
the  most  active  and  has  since  been  used  to 
encourage  healing  after  extensive  burns. 

Oppenheimer  l)elicves  that  there  is  a 
biological  afhnity  of  these  jwisons  (ben- 
zidine, aniline,  naphthylamines,  tolidin, 
etc.)  for  the  epithelium  of  the  excretory 
part  of  the  lu-inary  system.  The  kidneys 
are  not  involved  but  the  bladder  is  affected. 
He  suggests  that  perhaps  more  than  one 
substance  is  resj)onsible,  one  sensitizing  the 
tissue  to  the  action  of  the  other.  The 
length  of  exposure  to  the  exciting  cause 
seems  to  be  a  matter  of  no  importance. 
Oppenheimer  agrees  with  Nassauer  that  a 
short  exposure  may  set  up  the  process 
which  eventuates  in  a  tumor.  It  is  plain 
that  the  "revolution"  in  the  tissue  once 
begun  keeps  on  after  the  cause  is  removed, 
cessante  causa  non  cessat  morbus. 

According  to  Nassauer  the  irritative 
substance  is  always  aniline,  mixed  with  air. 
The  condition  is  ahvajs  produced  by 
fumes,  containing  a  quantity  of  aniline 
which  is  too  small  to  set  up  clinical  symp- 
toms of  intoxication,  but  which,  dissolved 
in  the  moisture  of  the  alveoli  of  the  lungs 
(aniline  is  3  per  cent,  soluble  in  water), 
penetrates  the  cells  and  reaches  the  lymph 
stream  or  the  blood.  A  very  dilute  mixture 
of  aniline  with  air,  such  as  is  breathed  by 
men  working  in  a  room  next  to  the  one 
containing  the  source  of  aniline  fumes, 
causes  a  more  rapid  tumor  growth  than 
does  a  larger  quantity  of  aniline  in  the  air, 
and  the  men  who  work  out  of  doors,  get- 


22 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ting  only  minute  quantities  of  fumes  from 
the  nearby  building,  have  an  even  shorter 
latent  period.  Nassauer  considers  the  ac- 
tion of  aniline  so  powerful  that  one  year's 
exposure  to  the  fumes  is  too  long,  and  since 
1904,  in  the  factory  under  his  charge,  he 
has  permitted  only  three  months'  employ- 
ment in  the  benzidine  department  —  in  his 
opinion,  the  danger  spot. 

Leuenberger  suggested  that,  since  the 
amido  compoimds  which  seem  to  be  re- 
sponsible for  tumor  growth  undergo  hy- 
drolysis in  the  body,  it  should  be  possible  to 
ascertain  wliich  of  the  amido  compounds 
used  in  the  dye  industry  are  eliminated  in 
this  particular  form,  as  para-amidophenol, 
and  then  to  check  up  the  clinical  cases  and 
see  whether  they  could  be  linked  up  with 
these  compounds.  To  this  Engel  replies 
that  there  are  several  compounds  appar- 
ently associated  with  tumor  formation 
which  do  not  undergo  hydrolysis  in  the 
body  and  appear  in  the  urine  as  para- 
amidophenol.  For  instance,  para-toluidine 
is  excreted  unchanged,  as  is  also  alpha- 
naphthylamine,  while  diphenylamine  un- 
dergoes a  complete  loss  of  the  amido  group. 

Kuchenbecker  also  undertook  to  test 
this  statement  of  Leuenberger's.  Since  a 
hydroxyl  amido  compound,  containing  as 
it  does  a  free  amido  group,  can  be  diazo- 
tized  in  acid  solution  with  a  nitrite  and 
produce  an  azo  color,  it  is  comparatively 
simple  to  prove  its  presence.  If  aniline  is 
administered  to  animals,  a  red  azo  color 
can  be  obtained  in  the  m-ine,  and  the  same 
result  is  obtained  with  ortho-toluidine,  but 
not  with  para-toluidine.  This  is  because 
aromatic  amido  compounds  undergo  such  a 
change  only  if  the  para  position  is  free,  but 
not  if  it  is  occupied,  as  it  is  in  para-tolui- 
dine. Kuchenbecker  then  fed  benzidine  to 
dogs  and  found  a  substance  in  the  urine 
which  was  not  a  hjdroxyl  compound,  nor 
was  it  benzidine.  Practically  the  same  re- 
sult was  obtained  with  tolidin.  Alpha- 
naphthylamine  is  excreted  unchanged  and 


gives  typical  reactions  with  beta-naphthol. 
Beta-naphthylamine  is  also  excreted  un- 
changed. It  seems  impossible,  therefore, 
that  jjara-amidophenol  should  be  respon- 
sible for  the  occurrence  of  bladder  tumors, 
since  all  the  last-named  substances  are 
apparently  as  much  concerned  in  their 
causation  as  is  aniline. 

At  present,  Engel  is  conducting  experi- 
ments with  beta-naphthj'lamine,  which 
apparently  has  been  connected  with  a 
large  number  of  tumors  —  an  especially 
singular  fact  because  it  is  not  particularly 
volatile,  and  does  not  cause  much  ordinary 
industrial  poisoning,  and  because  there  is 
nothing  in  the  work  that  brings  about  un- 
usual exposure.  Engel  wishes  to  discover 
whether  beta-naphthylamine  undergoes 
hydroxylation  and,  if  so,  whether  amido- 
naphthol  is  formed  or  amido-dioxynaphtha- 
lene,  and  whether  these  are  eliminated  in 
conjugation  with  ethyl  sulphuric  acid  or 
with  glycuronic  acid.  So  far  he  has  been 
able  to  prove  that  after  the  administration 
of  beta-naphthylamine  to  dogs,  both  acids 
are  increased  in  the  urine.  If  the  animal  is 
on  a  meat  diet,  it  is  the  ethyl  sulphuric 
acid  which  shows  a  marked  increase;  if  on  a 
carbohydrate  diet,  the  glycuronic  acid. 

There  the  matter  rests  at  present;  the 
problem  is  no  nearer  solution  than  that. 
There  is  one  compoimd,  however,  which 
must  be  considered  as  having  a  ])ossible 
bearing  on  the  occiu-rence  of  bladder  tu- 
mors in  dye  workers  and  which  is  not 
mentioned  by  the  German  investigators  — 
namel^',  hydrogen  arsenide.  The  danger  of 
arsenical  poisoning  in  fuchsin  manufacture 
was  well  knowm  in  the  early  days  of  the 
indu.stry,  for  arsenious  acid  was  one  of 
the  compounds  used  for  oxidation  in  mak- 
ing fuchsin,  as  nitrobenzene  is  now.  That 
method  was  discontinued  aljout  thirty 
years  ago,  but  it  is  recognized  in  (lerman 
dj'e  works  that  accidental  arsenical  poison- 
ing may  still  occur  from  an  evolution  of 
hydrogen    arsenide    not    only    in    fuchsin 


HAMILTON  —  ANILINE  TIBIORS 


23 


manufacture  but  in  all  processes  where 
acid  and  metal  are  brought  together  and 
one  of  them  is  contaminated  with  arsenic. 
The  chamber  sulphuric  acid  of  commerce, 
made  from  iron  pyrites,  is  frequently*  thus 
contaminated,  as  is  the  hydrochloric  acid 
made  by  the  action  of  such  sulphin-ic  acid 
on  sodium  chloride,  while  l)oth  the  iron 
scrap  and  the  zinc  dust  used  in  reduction 
processes  in  the  making  of  intermediates 
and  colors  may  also  carry  arsenic  as  an 
impurity,  the  zinc  dust  especially.  Ger- 
man dye  works  are  so  well  guarded  against 
the  escape  of  fumes  of  all  sorts  that  acci- 
dental poisoning  of  this  kind  is  now  de- 
cidedly rare,  yet  that  it  can  occur  is  shown 
by  the  history  of  one  of  Nassauer's  patients 
who  suffered  from  hydrogen  arseiu'de  i)oi- 
soning  while  making  benzidine. 

It  is  in  the  process  of  reduction  that  this 
danger  is  found.  Two  forms  of  reduction 
are  used  in  the  manufacture  of  interme- 
diates, acid  and  alkaline  or  neutral.  Nitro- 
benzene, subjected  to  acid  reduction  by 
nascent  hydrogen  from  iron  filings  and 
hydrochloric  acid,  yieUls  aniline.  Nitro- 
toluene  yields  ortho-toluidine  and  i)ar;i- 
toluidine.  If  either  the  iron  or  the  acid 
contains  arsenic  as  an  impurity,  hydrogen 
arsenide  may  form  in  the  course  of  reduc- 
tion, but  in  a  well-managed  ])]anl  liiis 
reaction  is  carried  on  in  tightly  closeil  auto- 
claves, and  there  is  very  little,  if  any, 
escape  of  fumes.  However,  when,  in  going 
tlu-ough  a  very  excellent  German  plant, 
I  connnented  on  the  arrangements  for 
fume  removal  in  the  aniline  reduction 
room,  I  was  told  that  the  rule  there  was  to 
allow  no  vapors  of  any  sort  to  escajjc  into 
the  room  because  of  the  ever-present  pos- 
sibility of  traces  of  arseniuretted  hydrogen. 
Of  course,  if  the  apparatus  is  not  perfect  it 
will  get  out  of  order  and  men  must  go  in 
and  clean  out  the  sludge  and  make  repairs. 
Five  mild  cases  of  arsenical  poisoning  oc- 
curred in  a  British  dye  works  from  this 
source,  but  were  recognized  as  such  oiily 


because  arsenic  was  found  in  the  urine. 
Tests  for  arsenic  are  not  made  in  American 
dye  works  and  if  such  cases  occur  they  are 
not  recognized  but  are  diagnosed  as  aniline 
or  toluidine  poisoning. 

Alkaline  reduction,  used  to  produce 
benzidine  and  tolidin,  is  attended  with 
much  more  danger  of  arsine  poisoning  than 
is  acid  reduction.  Briefly,  the  process  is  as 
follows.  Nitrobenzene,  treated  with  zinc 
dust  and  sodium  hydrate,  is  reduced  first 
to  azoxybenzene,  then  to  azobenzene,  and 
then  to  hydrazobenzene,  which  forms 
colorless  crystals.  At  this  point  it  is  cus- 
tomary in  Germany  and  in  England  to  atld 
hydrochloric  acid,  in  order  to  form  soluble 
zinc  chloride,  and  get  rid  of  the  zinc  by 
filtration.  The  temperature  must  be  kejit 
down  by  means  of  ice,  or  brine  coils,  be- 
cause benzidine  will  form  if  it  is  warm  and 
will  be  lost  with  the  filtrate.  In  the  sum- 
mer of  1918  live  cases  of  severe  arsine 
poi.soning  with  two  deaths  occurred  in  a 
British  dye  works  where,  in  order  to  keep 
down  the  temperature  of  the  hydrazo- 
benzene-zinc- hydrochloric  acid  mixture, 
tlie  reducer  was  opened  and  a  chunk  of  ice 
dropped  in.  The  fumes  of  arsine  escaped 
from  the  opening  and  j)oisoned  the  nearest 
workmen.  Five  cases  of  severe  jjoisoning 
with  one  death  were  caused  in  a  New  Jersey 
])lant  by  the  fumes  rising  from  an  un- 
covered tub  containing  hydrazobenzene 
made  by  this  same  method  of  alkaline 
reduction  and  evidently  with  arsenifcrous 
zinc.  It  was  when  the  hydrochloric  acid 
was  added  and  the  temperature  raised  to 
bring  about  the  next  stage,  the  molecular 
change  of  hydrazolienzene  into  benzidine, 
that  the  tub  '"boiled  up,"  as  the  men  said, 
and  the  five  nearest  it  were  overcome  with 
the  fumes  —  three  very  seriously,  one 
fatally. 

Dr.  T.  H.  Wignall  (12)  of  Manchester, 
who  is  connected  with  a  large  dye  works, 
has  made  a  very  interesting  study  of  the 
occurrence  of  arsenical  hematuria  in  benzi- 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


dine  makers  and  in  workers  in  certain  other 
reduction    processes.     His    attention   was 
called  to  the  possibility  of  mild  arsenical 
poisoning  by  a  fatal  case  of  jaundice  in  a 
benzidine    worker,    which    did    not    come 
under   his    observation    early    enough    to 
allow   him    to    establish  the  presence   of 
arsenic.    He  began  then  to  have  a  quanti- 
tative test  made  for  arsenic  whenever  the 
urine  of  an  employee  showed  a  color  as 
deep  as  porter.    When  this  occurred,  not 
only  was  the  urine  of  the  man  himself 
examined  for  arsenic  but  also  specimens 
from  all  the  other  workers  employed  on 
the  same  process.    The  tests  were  carried 
out   by   Delepine   of   the   Public   Health 
Laboratory  of  JNIanchester.   Wignall  found 
that  the  tolerance  to  arsenic  in  cases  of  this 
sort  was  much  greater  than  it  is  generally 
stated  to  be.   Men  whose  urines  are  deeply 
colored,  and  contain  albumin,  blood  pig- 
ment, and  casts,  may  not  consider  them- 
selves sick  at  all  and  may  not  even  be 
jaundiced.    Examination  of  those  who  do 
complain   shows   symptoms   which   might 
easily,  be  attributed  to  aniline  or  to  some 
similar  compound.    These  symptoms  are 
palor,   slight   icterus,    rapid   feeble   pulse, 
languor,  loss  of  appetite.    Hospital  treat- 
ment in  Wignall's  cases  was  always  suc- 
cessful and  there  were  no  sequelae  and  no 
neuritis.     It   is   evident   that   such   cases 
might   easily  go   unrecognized  for  years, 
especially    as    the    absorption    of    arsenic 
would  never  be  uninterrupted,  and  there 
would  always  be  periods  during  which  the 
air   was   uncontaminated   and    the   man's 
system  had  time  to  rid  itself  of  the  ab- 
sorbed arsenic.    The  histories  of  Wignall's 
cases   show  that   in   about   four  to  eight 
weeks  the  arsenic  has   practically  disap- 
peared from  the  urine.    The  essential  facts 
in  his  five  cases  are  as  follows: 

Case  1.  —  Icterus,  weakness;  urine  the  color  of 
dark  porter,  with  methemoglobin  and  casts;  0.79G 
mg.  arsenious  acid  per  100  c.c.  urine  on  Nov.  14;  on 


Dec.   12,  less  than  0.01  mg.  and  onl\-  a  trace  of 
albumin. 

Case  2.  —  Porter  colored  urine  with  0.035  mg. 
arsenious  acid  per  100  c.c.  urine  on  Nov.  9;  on  Dec. 
20,  less  than  0.01  mg. 

Cases.  —  Urine   black,   sp.   gr.    1025,   albumin; 
0.2  mg.  arsenious  acid  on  Dec.  5 ;  less  than  0.01  mg. ' 
on  Jan.  30. 

C.\SE  4. — Abdominal  pain,  vomiting,  icterus; 
urine  deep  Burgundy  red,  clear,  sp.  gr.  1025,  acid, 
much  albumin,  methemoglobin,  and  oxyhemoglobin; 
0.185  mg.  arsenious  acid  on  Jan.  24;  less  than  0.01 
mg.  on  Feb.  26. 

Case  5.  —  No  pain  or  icterus;  urine  dark  brown, 
considerable  amount  of  albumin,  sp.  gr.  1009; 
0.07  mg.  arsenious  acid  on  Feb.  13;  less  than  0.01  on 
Feb.  27. 

Cases  of  mild  arsenical  poisoning  have 
developed  in  English  plants,  I  am  told,  in 
cleaning  out  an  aniline  reducer,  and  in 
filtering  off  the  zinc  chloride  from  hydrazo- 
benzene  in  benzidine  production.  The  only 
cases  on  record  in  American  dye  works 
are  the  five  given  above.  In  our  large  dye 
works  benzidine  production  is  not  attended 
with  this  risk,  for  the  hydrazobenzene  crys- 
tals are  caught  in  a  fine  screen  and  the 
zinc  dust  filters  through  and  is  used  again. 

If  one  examines  the  histories  of  the  Ger- 
man cases  of  aniline  tumor  in  the  light  of 
this  theory,  that  arseniuretted  hydrogen 
may  be  the  causative  agent,  not  any  aro- 
matic compound,  several  features  emerge 
that  seem  to  strengthen  it. 

In  the  first  place,  all  the  products  which 
have  been  held  responsible  for  these  tu- 
mors are  reduction  products,  formed  by 
nascent  hydrogen  acting  on  a  nitro  com- 
poinul.*     As   we   have   seen   above,   such 

*  For  beta-naphthylamine  this  is  not  true.  It  is  made, 
not  by  a  reduc-tiou  process,  but  by  treating  beta-naphthol 
with  iiminonia  water.  The  ouly  explanation  1  can  suggest 
for  the  occurrence  of  tumors  in  this  department  is  one  based 
on  the  conditions  in  the  one  .\nierican  factory  where  1  have 
seen  it  made.  Here  in  the  beta-naphthylamine  department, 
naplithylamine-sulplionic  acids  are  made  Ijy  the  reduction  of 
nitronaplithalcne-sulphonic  acids,  and  the  red\icing  agents 
used  are  scrap  iron  and  chamber  sulphuric  acid.  .\t  the  time 
of  my  visit,  an  escape  of  fumes  directly  after  reduction  was 
■  very  evident.  One  would  have  to  know  just  what  processes 
were  caiTied  on  in  or  near  the  beta-naphthylamine  depa;-t- 
raents  in  the  German  factories  where  this  has  seemed  the 
danger  spot,  before  one  could  decide  the  question  whether 
there  was  or  was  not  a  possible  som-ce  of  hydrogen  arsenide 
funies  there. 


HATvnLTOX  —  ANILINE  TUMORS 


reduction  is  carried  on  by  means  of  hydro- 
chloric acid  or  sulphuric  acid  with  scrap 
iron  or  zinc  dust  exactly  as  if  one  were 
making  [Marsh's  test  for  arsenic.  The 
compounds  produced  by  alkaline  reduction 
with  subsecjuent  treatment  of  the  zinc  dust 
with  hydrochloric  acid  seem  to  be  more 
productive  of  bladder  tumors  than  those 
produced  by  acid  reduction,  and  we  have 
seen  that  there  is  more  danger  of  escape 
of  hydrogen  arsenide  fumes  in  alkaline 
reduction  than  in  acid  reduction.  'I'he 
benzidine  department  is  the  one  in  which 
the  largest  number  of  cases  are  at  jiresent 
appearing.  Nassauer  attributed  his  entire 
twenty-eight  cases  to  the  fumes  from  ben- 
zidine manufacture.  A  significant  case 
related  by  him  is  that  of  a  wonum  —  tiie 
wife  of  one  of  the  workmen  —  wlio  did  not 
work  in  the  plant  but  lived  in  a  room  next 
to  the  one  in  which  benzidine  was  pre- 
pared. She  and  her  husband  both  had 
tumor  of  the  bladder.  It  is  .shown  in  the 
statistics  from  Hoechst  and  from  Greppin 
that  l)enzidine  men  have  a  shorter  jicriod 
of  exposure  before  the  development  of 
tumors  than  do  fuchsin  men  (6),  and  the 
one  of  Ojjpenheimer's  cases  that  develo]Hd 
most  rapidly  was  in  a  benzidine  worker. 

That  long  continued  absorption  of  small 
cjuantities  of  arsenic  may  result  in  the 
formation  of  epithelial  growths,  benign  and 
malignant,  was  established  by  Jonathan 
Hutchinson  and  confirmed  by  dermatol- 
ogists in  America,  Germany,  and  France. 
In  discussing  the  chemical  bodies  which 
have  the  property  of  stinuilating  new 
growth,  Leuenberger  places  arsenic  at  the 
head  of  the  hst.  Nutt,  Beattie.  and  Pye- 
Smith  (13)  have  recently  collected  such 
cases  from  the  literature  and  have  added 
another.  Thirty-one  cases  make  up  their 
list,  in  three  of  which,  however,  the  ad- 
ministration of  arsenic  was  not  proved. 
Two  were  industrial  in  origin;  the  men  had 
been  working  for  years  in  a  factory  making 
sheep-dip  with  white  arsenic.    Three  were 


caused  by  drinking  water  contaminated 
with  arsenic  in  the  Reichenstein  epidemic 
described  by  von  Geyer  before  the  Inter- 
national Congress  of  Medicine,  Paris,  1900, 
and  twenty-three  were  attributed  to  the 
action  of  repeated  doses  of  arsenic  admin- 
istered as  a  medicine  for  many  years, 
usually  for  some  skin  disease,  but  in  three 
instances  for  constitutional  disturbances. 
In  one  in.stance,  the  lesions  developed  some 
years  after  discontinuance  of  the  arsenic. 
Dubreuilh  in  1910  described  four  cases  of 
arsenical  keratoma,  one  of  which  under- 
went carcinomatous  degeneration. 

The  (iernian.s  have  conunented  fre- 
quently on  the  analogy  between  aniline 
tumors  and  those  caused  by  soot,  jiitch, 
and  paraffin.  Leuenberger  and  Nassauer 
have  already  been  quoted  to  this  effect, 
and  it  is  significant  to  note  in  this  connec- 
tion the  findings  of  the  British  Royal  Com- 
mission on  Arsenical  Poisoning,  with  regard 
to  arsenic  in  coal.  Delepine  found  by 
analysis  5.8  grains  of  arsenious  acid,  AsjOs, 
per  pound  of  coal  in  one  specimen,  and 
28  grains  in  another.  The  epiilemic  of 
arsenical  poisoning  from  beer  in  Halifax  in 
190'-2  was  traced  to  drying  the  malt  in  air 
heated  by  burning  coal  which  contained 
arsenic. 

Even  more  significant  is  a  recent  study 
made  in  Belginm  of  brifjuette  makers' 
cancer,  which  the  authors  attribute  to 
arsenic  present  in  the  coal.  Bayet  and 
Slosse  (14)  found  in  one  briquette  factory 
three  men  with  skin  cancer  out  of  a  force  of 
only  thirteen  men,  and  later  two  more 
cases  developed.  Inquiry  revealed  a  his- 
tory of  warty  growths  in  six  more,  so  that 
eleven  out  of  thirteen  men  had  skin  lesions. 
These  were  not  typical  keratomatous 
plaques  on  soles  and  palms,  as  described  by 
Jonathan  Hutchinson  in  arsenical  cancer, 
but  carcinomatous  degeneration  of  warty 
growths.  The  likeness  to  arsenical  cancer 
was  seen,  however,  in  the  fact  that  the 
cancers  were  nniltiple  and  developed  fairly 


26 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


early  in  life.  There  was  also  an  extra- 
ordinarily large  number  of  scrotal  lesions, 
as  in  chimney-sweeps'  cancer.  Except  for 
soot  cancers  this  is  a  very  rare  location, 
only  one  among  2,400  malignant  tumors  in 
males  in  the  ^'ienna  General  Hospital 
occurring  there.  The  final  proof  that  ar- 
senic was  the  cause  of  the  lesions  was 
furnished  by  the  detection  of  arsenic  not 
only  in  the  coal,  soot,  dust,  and  briquette 
mixture,  but  in  the  urine,  hair,  and  finger 
nails  of  the  workmen.  Control  tests  made 
in  the  villages  among  other  workmen  gave 
negative  results.  Bayet  and  Slosse  would 
attribute  also  to  arsenic  in  coal  the  English 
cases  of  chimney-sweeps'  cancer  and  the 
epithelioma  of  English  briquette  makers. 

Finally,  an  analogy  has  also  been  dra^vTi 
between  aniline  tumors,  caused  apparently 
by  some  chemical  irritant,  and  the  lung 
carcinoma  of  cobalt  arsenide  ore  miners. 
The  occurrence  of  malignant  lung  tumors 
among  the  miners  of  the  Schneeberger 
cobalt  mines  in  Saxon  Switzerland,  which 
was  brought  to  light  as  long  ago  as  1878, 
has  not  aroused  as  much  curiosity  among 
German  pathologists  as  one  would  have 
expected.  A  tumor  described  by  Harting 
and  Hesse  (15)  in  1878  was  examined  by 
^Yeigert  and  pronounced  by  him  to  be 
lymphosarcoma,  originating  in  the  liron- 
chial  lymph  glands.  Harting  and  Hesse 
stated  that  75  per  cent,  of  the  cobalt 
miners  died  of  malignant  lung  tumor,  and 
they  believed  the  cause  was  the  arsenic  of 
the  ore,  which  consists  of  cobalt  arsenide, 
nickel,  and  bismuth.  Nothing  more  seems 
to  have  been  heard  on  the  subject  till  1884, 
when  An  eke  (16)  reported  a  second  case  of 
lymphosarcoma  of  the  lung.  In  19i;5, 
Arnstein  (17)  reviewed  the  whole  subject, 
and  found  that  4-4  per  cent,  of  the  deaths 
among  Schneeberger  miners  were  attrib- 
uted by  the  physicians  of  the  region  to 
malignant  tumor  of  the  lungs,  but  that  the 
diagnoses  were  not  based  on  autopsy.  He 
examined  seventy  miners  ami  found  phj's- 


ical  signs  of  lung  disease  in  about  half; 
especially  indicative  of  lung  sarcoma  was 
the  parasternal  and  paravertebral  dullness. 
He  could  secure  material  for  only  two 
autopsies,  and  one  of  these  proved  to  be 
caseating  tuberculosis,  but  the  other  was  a 
malignant  tumor  —  squamous  celled  car- 
cinoma —  originating  in  the  right  lung  and 
with  extension  to  pleura  and  pericardium, 
and  with  metastases  resembling  lympho- 
sarcoma in  lymph  glands,  liver,  and  spleen. 
He  found  that  Schmorl  of  Dresden  had  had 
two  cases  of  round-celled  sarcoma  of  the 
lungs  in  Schneeberger  miners  in  recent 
years,  and  one  case  of  squamous  celled 
carcinoma. 

In  view  of  the  jjroof  that  chronic  arsen- 
ical poisoning  is  capable  of  producing  a 
continual  irritation  which  gradually  results 
in  cell  proliferation,  benign  or  malignant, 
and  since  the  possil>iIity  of  hydrogen 
arsenide  poisoning  is  admittedly  present  in 
all  the  processes  with  wliich  the  bladder 
tumors  of  aniline  workers  have  been  asso- 
ciated, it  seems  fair  to  insist  that  hydrogen 
arsenide  is  a  possible  cause  which  must  be 
considered.  There  is  no  such  proof  of  the 
power  of  amido  compounds  to  cause  tissue 
proliferation. 

If  this  explanation  is  proved  true  by 
quantitative  tests  for  arsenic  in  the  urine  of 
men  emplo\-ed  in  dangerous  departments, 
it  will  greatly  simplify  the  problem.  In- 
stead of  a  midtitude  of  compoimds  any  one 
or  all  of  which  may  be  the  sought-for 
cause  of  bladder  tumors  we  shall  have  one 
only,  a  compound  not  constantly  present  in 
any  process  with  which  these  tumors  have 
been  connected,  but  probably  present  from 
time  to  time  in  every  one  of  them.  It  will 
explain  certain  puzzling  features  of  the 
proV>lem;  such,  for  instance,  as  the  fact 
that  it  is  only  the  production  of  aniline  or 
benzidine  that  gives  rise  to  tumors,  not 
their  subsequent  use  as  intermediates.  As 
Grandhonnne  pointed  out  in  his  contro- 
versy with  liehn,  there  is  no  reason  .why 


HAMILTOX  —  ANILINE  TU:M0RS 


27 


aniline  fumes  should  cause  tumors  in  the 
men  in  the  fuchsin  department  and  not  in 
the  other  4,000  men  exposed  to  aniline  in 
the  rest  of  the  plant.  It  is  also  singular 
that,  after  years  of  extensive  use  of  aniline 
in  rubber  compounding  and  in  reclaiming 
rubber  in  Germany,  bladder  tumors  have 
not  appeared  as  an  occupational  disease 
among  rubber  workers. 

It  is  quite  true  that  no  case  of  bladder 
tumor  has  so  far  been  traced  to  slow  al)st)rp- 
tion  of  arsenic.  The  cases  of  cancer  fol- 
lowing prolonged  administration  of  arsenic 
have  been  in  the  skin.  Whetiicr  the  dif- 
ference in  the  method  of  administration,  by 
inhalation  of  minute  cjuantities,  instead  of 
by  ingestion,  would  account  for  the  dif- 
ference in  location  of  tiie  lesions  can  be 
only  a  matter  of  speculation,  as  is  indeed 
this  whole  discussion.  Nor  is  it  a  specula- 
tion to  which  American  industrial  i)hysi- 
cians  can  contribute  anything  i)ositive  as 
yet,  for  the  making  of  dyes  and  dye  inter- 
mediates is  too  recent  in  this  country  to 
lead  us  to  expect  the  appearance  of  bladder 
tumors  among  the  workmen  for  some 
years,  if  indeed  the  excessive  labor  turn- 
over in  this  industry  does  not  serve  to 
protect  them  against  it  altogether.  For 
the  final  acceptance  or  rejection  of  this 
suggestion  as  to  the  etiology  of  bladder 
tumors  in  color  workers  we  must  look  to 
the  Germans. 

Summary 

The  case  for  hydrogen  arsenide  as  the 
cause  of  bladder  tumors  in  aniline  dye 
workers  may  be  summed  up  as  follows. 

1.  The  substances,  with  the  exception 
of  beta-naphthylamine,  which  have  been 
connected  with  tumor  formation  are  all 
reduction  (NH2)  compounds,  formed  by 
reactions  in  which  the  accidental  produc- 
tion of  fumes  of  hydrogen  arsenide  is  an 
ever-present  possibility,  and  the  processes 
in  which  this  danger  is  greatest  are  those 


noted  as  responsible  for  large  numbers  of 
tumor  cases.  Even  in  the  best  constructed 
plants  minute  quantities  of  the  gas  may 
escape,  especially  in  the  course  of  filtration 
or  of  cleaning  or  flushing  out  the  apparatus. 
It  seems  far  more  reasonable  to  attribute 
such  a  slow  toxic  action  to  small  ciuantities 
of  hydrogen  arsenide  than  to  high  dilutions 
of  aniline  vapors  or  to  benzidine  dust. 

i.  No  aromatic  compound  thus  far 
studied  has  been  indisputably  proved  as 
the  cause  even  of  the  cystitis  which  pre- 
cedes tumor  formation,  and  none  connected 
with  clinical  cases  of  bladder  tumor  has 
been  shown  to  be  capable  of  setting  up 
proliferative  growth. 

.'?.  Arsenic  absorbed  from  the  fumes  pro- 
duced by  reduction  processes  is  excreted  by 
the  kidneys,  and  has  been  recovered  from 
the  urine.  Since,  then,  arsenic  is  known  to 
be  capable  of  exciting  epithelial  prolifera- 
tion in  other  parts  of  the  body,  it  seems 
possible  that  the  same  effect  may  be  pro- 
duced wlien  it  acts  on  the  mucosa  of  the 
bladder. 

4.  The  resem]>lance  between  arsenical 
cancer  and  aniline  tumors  becomes  plain 
when  we  study  tlie  literature  of  arsenical 
cancer  caused  by  long  continued  internal 
administration  of  small  quantities  of  ar- 
senic as  medicine  or  in  drinking  water,  or 
caused  by  arsenic  in  soot  and  pitch,  or  by 
arsenic  in  colialt  ores.  In  all  these  growths, 
as  in  aniline  tumors  of  the  bladder,  there 
is  a  precancerous  stage  of  irritation,  of 
epithelial  cell  proliferation,  then  tumor 
formation,  and  then  slow  carcinomatous 
degeneration.  The  whole  process  takes 
years,  but  the  age  at  which  the  cancers 
develop  is  earlier  than  the  average  age  for 
ordinary  cancers.  The  growths  are  likely 
to  be  multiple,  and,  in  the  case  of  the  skin 
cancers  caused  by  administration  of  ar- 
senic, the  cancer  may  appear  some  years 
after  the  drug  has  been  discontinued.  The 
same  phenomena  have  all  been  noted  in 
cases  of  aniUne  tumor  of  the  bladder. 


28 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


BIBLIOGRAPHY 


1.  Rehn:  Ueber  Blasentumoren  bei  Fuchsin- 
arbeitern.    Arch.  f.  klin.  Cliir.,  1895,  50,  588. 

2.  Rehn:  Ueber  Blasenerkraiikuiigen  bei  .:Vnilin- 
arbeitern.  Verhandl.  d.  deutsch.  Gesellsch.  f. 
Chir.,  1906,  35,  313. 

3.  Leuenberger,  S.  G.:  Die  unter  dem  Einfluss 
der  syntlietischen  Farbenindustrie  beobachtete 
GeschwT.ilstentwicklung.  Beitr.  z.  klin.  Chtr., 
1912,  53,  208. 

4.  Curschmaiin :  Statistische  Erhebungen  iiber 
Blasentumoren  bei  Arlieitern  in  der  chemischen 
Industrie.  Zentralbl.  f.  Gewerbehyg.,  1920,  8, 
145,  1G9. 

5.  Nassauer,  M.:  Ueber  bbsartige  Blasenge- 
schwUlste  bei  Arbeitern  der  orgauisch-chemi- 
schen  Grossindustrie.  Frankfurt.  Ztschr.  f. 
Path.,  1919,  22,  353. 

6.  Oppenheimer,  R. :  Ueber  die  bei  Arbeitern 
chemischer  Betriebe  beobachteten  Gescliwiilste 
des  Harnapparates  und  deren  Beziehungen  zur 
allgemeinen  Geschwulstpathogenese.  INIunchen. 
med.  Wchnschr.,  1920,  67,  12. 

7.  Schwerin:  Blasengeschwiilste  bei  Arbeitern  in 
chemischen  Betrieben.  Zentralbl.  f.  Gewerbe- 
hyg.,  1920,  8,  64. 

8.  Engel :   Ueber  das  Schicksal  des  Betanaphthyl- 


amins  im  Organismus  des  Hundes.  Zentralbl. 
f.  Gewerbehyg.,  1920,  8,  81. 
9.  Kuclienbecker,  A.:  Ueber  den  Nacliweis  aro- 
matischer  Amido\'erbindinigen  im  Harn.  Zen- 
tralbl. f.  Gewerbehyg.,  1920,  8,  68.  Ueber  die 
Umwandlung  aromatischer  Amidoverbindungen 
im  Tierkbrper.    Ibid.,  69. 

10.  Schmiedeberg,  O.:  Ueber  das  Verhaltniss  des 
Ammoniaks  und  der  primaren  ^Nlonaminbasen 
zur  Harnstoffbildung  im  Thicrkorper.  Arch.  f. 
exper.  Path.  u.  Pharmakol.,  1877,  8,  12. 

11.  Fischer,  B. :  Die  experimentelle  Erzeugung  atj-p- 
ischer  Epithelwucherungen.  Miinchen.  med. 
Wchnschr.,  1906,  53,  2041. 

12.  Wignall,  T.  H.:  Poisoning  by  Arseuiuretted 
Hydrogen.   Brit.  Med.  Jour.,  1920,  1,  826. 

13.  Nutt,  W.  H.,  Beattie,  J.  M.,  and  Pye-Smith, 
R.  J.:   Arsenic  Cancer.   Lancet,  1913,  2,  210. 

14.  Baj'et,  A.,  and  Slosse,  A. :  L'intoxication  houillere 
arsenicale.  Bull,  de  I'Acad.  roy.  de  Med.  de 
Belgique,  Series  IV,  1919,  29,  607. 

15.  Harting  and  Hesse  quoted  by  Arnstein  (17). 

16.  Ancke  quoted  by  Arnstein  (17). 

17.  Arnstein,  A.:  Ueber  dem  sogenannten  "Sclinee- 
berger  Lungenkrebs."  Verhandl.  d.  deutsch. 
path.  Gesellsch.,  1913,  16,  332. 


HEALTH  IN  MERCANTILE  ESTABLISHMENTS 
III.    COMMON  SANITARY  DEFECTS  IN  STORES* 

ARTHTR  B.  EMMONS,  2d,  M.D. 

Director,  Harvard  Mercantile  Ilealth  Work;  Boston,  Mass. 


A  RECENT  hvfrienic  survey  by  the 
avitlior  of  a  number  of  larpe  stores  has 
disclosed  certain  sanitary  defects  whicli  in- 
fluence the  health  and  productiveness  of 
the  workers.  This  paper  discusses  briefly 
the  most  common  of  tliese  defects  and  suf^- 
gests  remedies  for  them.  In  the  investiga- 
tion in  question  it  was  encouraging  to  find 
that  several  of  the  newer  stores  were  almost 
perfect  in  mechanical  construction  and 
functioning  and  that  some  of  the  firms 
occupying  old  buildings  had  spared  no 
expense  in  improving  the  health  conditions 
of  their  ])lants.  In  many  of  the  stores  the 
managements  had  made  intelligent  jiro- 
vision  for  the  comfort  of  their  employees 
not  only  while  at  work  but  also  wiien  off 
duty  at  noon. 

Problems  Affecting  Healtu  and 
Comfort  ok  '\Vokkkrs 

Locker  Rooms.  —  Separate  locker  rooms 
for  men  and  women,  with  convenient  wash 
rooms  and  toilets,  require  considerable 
space  and  equipment.  The  most  common 
as  well  as  the  most  satisfactory  arrange- 
ment is  to  have  metal  lockers  set  in  rows  on 
a  concrete  floor  in  a  well-lighted  and  well- 
ventilated  basement.  In  a  large  store  the 
locker  room  usually  requires  an  attendant 
to  insure  cleanliness,  jjroper  lighting,  and 
ventilation,  and  to  ])revent  abuses,  such 
as  the  storage  of  jK-rishable  food,  the  strew- 
ing of  waste,  pilfering,  and  the  loss  of  time 
from  unnecessarily  prolonged  personal  toi- 
let. A  careful  inspection  system  is  always 
necessary.  Rigid  rules  should  be  made  to 
prevent  the  insanitary  practice  of  keeping 

*  Keceived  for  publication  Dec.  i.  1920. 


clothing  elsewhere  in  the  store,  especially 
if  food  is  to  be  handled.  To  overcome  the 
evil  of  storing  perishable  food  in  locker 
rooms  an  employees'  bundle  room  should 
be  provided. 

Liincit  Rooms.  —  The  noon  lunch,  .so 
important  to  the  worker's  health  and  vigor, 
is  a  problem  which  has  been  studied  and 
solved  b\-  many  stores.  It  is  es.sential  that 
hot,  nutritious  food  in  sutHcieut  variety  be 
supplied  as  nearly  at  cost  as  possible,  antl 
that  this  food  be  served  in  congenial  sur- 
roimdings,  where  there  is  o])])ortiuiity  for 
rest  and  recreation. 

The  emi)loyees'  lunch  rooms  at  present 
provided  grade  from  tlie  lunch  room  equip- 
j)ed  with  tal)les  and  chairs  for  the  use  of 
employees  who  bring  their  own  food,  to  the 
modern  cafeteria  which  is  jjresided  over  by 
a  trained  dietitian,  and  which  sui)i)lies  an 
excellent  variety  of  food  at  cost.  In  every 
store  there  are  always  some  workers  who 
nuist  ]>ractise  strict  economy  because  of 
dei)endents  at  home,  and  who  are  conse- 
(piently  apt  to  be  undernom-ished.  It  is  to 
the  interest  of  the  .store  that  these  em- 
ployees rec-eive  substantial  Imicheon.  In 
.some  cases  this  situation  has  been  met  by 
providing  at  very  low  rates  simple,  sub- 
stantial food,  such  as  milk,  cocoa,  bread 
and  butter.  Education  in  regard  to  a 
balanced  diet  is  much  needed.  The  a])peal 
to  the  individual  may  be  made  on  the 
.score  of  both  health  and  economy. 

Recreation.  —  Suitable  recreation  at  the 
noon  hour  is  second  in  importance  only  to 
nourishing  food.  Good  music  provides 
relaxation  more  quickly  and  for  a  larger 
group  of  i)eople  than  any  other  single 
means.    To  some  of  the  more  \outhful  and 


29 


30 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


more  energetic  workers  dancing  is  an  en- 
joyable recreation;  to  others,  who  prefer  to 
read,  a  store  branch  of  the  public  library  is 
very  acceptable.  To  still  others,  in  season- 
able weather,  a  walk  in  the  open  air  gives 
the  needed  noon  recreation. 

The  matter  of  recreation  outside  of  store 
hours  is  an  important  subject,  although  at 
first  it  may  seem  to  be  beyond  the  circle  of 
store  influence.  Studies  are  available  to 
show  that  many  shop  girls  and  other  work- 
ers lack  suitable  opportunities  for  necessary 
recreation  and  that  this  lack  of  diversion 
not  only  influences  markedly  their  produc- 
tiveness but  also  may  result  in  frequent 
change  of  occupation.  The  employment 
office  may  some  day  add  to  its  blank  an- 
other heading  —  namely,  Avocation.  On 
the  answer  to  this  question  often  depends 
the  likelihood  of  stability;  a  good  avocation 
favors  a  settled  vocation.  Already  many 
stores  have,  unconsciously  perhaps,  recog- 
nized the  importance  of  recreation  outside 
of  work  hours  and  have  organized  clubs, 
athletic  teams,  bowling  teams,  and  theatre 
parties.  Some  stores  have  vacation  or  rest 
houses,  which  serve  as  preventoria  for  those 
physically  below  normal,  and  as  club- 
houses for  social  week-end  parties.  Such 
adventures  in  friendship  have  proved 
acceptable  and  successful. 

Drinking  Water.  —  The  individual  drink- 
ing glass  which  frequently  becomes  a 
common  drinking  cup  should  be  rejilaced 
by  paper  cups  or  bubble  foiuitains.  To 
be  sanitary,  however,  a  bubble  fountain 
should  be  so  arranged  that  the  stream  of 
water  does  not  fall  back  on  the  source  and 
that  the  lips  do  not  touch  the  source. 

Waahrooms  and  Toilet.'^.  — ■  White  enamel 
paint  is  a  great  aid  in  insuring  cleanliness  in 
washrooms  and  toilets.  The  rooms  should, 
moreover,  be  sufficiently  well  lighted  to 
avoid  the  possibility  of  dirty  corners  and 
should  be  supphed  with  some  sort  of  waste 
bucket,  preferably  with  an  automatic  clos- 
ing top.    Some  stores  have  found  it  neces- 


sary, especially  in  public  toilets,  to  have 
fixtures  which  cannot  be  blocked  by  waste. 

The  matter  of  providing  towels  involves 
considerable  expense  and  has  not  as  yet 
been  entirely  solved.  Paper  towels  are 
hygienic  but  not  altogether  satisfactory. 
Individual  cloth  towels  are  expensive  to 
buy,  require  laundering  and  much  hand- 
ling, and  are  too  often  shared  with  others. 
From  a  sanitary  standpoint  the  electric  hot 
air  drier,  which  is  being  tried  in  many 
stores,  is  very  satisfactory.  It  can  be  in- 
stalled for  $98  and  furnishes  a  hundred 
dries  for  7  cents.  No  figures  are  available 
on  rejjairs  and  upkeep.  The  chief  objec- 
tions to  this  machine  are  that  it  is  noisy 
and  generally  requires  from  forty  to  fifty 
seconds  to  dry  the  hands  thoroughly  — • 
about  double  the  usual  time  with  a  cloth 
towel. 

Common  Causes  of  Fatigue.  —  For  mem- 
bers of  the  clerical  force,  who  usually  sit 
all  day  at  the  same  desk,  working  condi- 
tions should  be  made  as  favorable  as  pos- 
sil)le  to  reduce  fatigue.  Offices  should  be 
well  ventilated  without  noticeable  draft, 
and  should  not  be  too  warm.  The  best 
temperature  for  these  rooms  is  68°.  Higher 
temperatures  produce  a  gradual  strain 
leading  to  fatigue  and  lower  temperatures, 
especially  below  65°,  are  apt  to  be  un- 
comfortably cool. 

The  lighting  is  the  next  most  important 
consideration.  Daylight  in  sufficient  quan- 
tity is,  of  course,  the  best.  If  artificial  light 
is  necessary,  indirect  or  reflected  light  from 
a  favorable  ceiling  or  diffused  light  from 
ground  glass  or  porcelain  globes  is  very 
satisfactory.  The  individual  adjustable 
shaded  light  is  best  adapted  for  certain 
kinds  of  close  work.  It  should  be  so  ar- 
ranged that  the  light  falls  over  the  worker's 
left  shoulder,  and  that  no  shadows  are 
cast.  Careful  tests  should  be  made  to  dis- 
cover any  defects  in  eyesight  and  to  see 
that  suitable  glasses  are  worn  to  correct  any 
errors  that  exist  and  to  prevent  eye-strain. 


EMMONS  —  COMMON  SANITARY  DEFECTS  IN  STORES 


31 


Even  in  the  best  equipped  stores  covered 
in  the  author's  survey  a  lack  of  proper 
seats  for  clerks  was  noticeable.  The  chair, 
the  desk,  and  the  foot  rest  should  be  ad- 
justed to  the  individual  and  to  the  work  to 
be  done.  These  factors  have,  perhaps,  been 
most  successf  idly  worked  out  at  t  lie  modern 
telephone  switchboard.  The  best  chair  * 
available  for  individual  adjustment  is 
doubtless  the  typist's  chair.  It  is  essential, 
however,  that  the  worker  understand  how 
to  adjust  it  in  order  to  secure  proper  sup- 
port for  his  back.  Often  a  stool  or  foot  rest 
is  necessary  for  a  very  short  person. 

In  one  store  where  adjustable  chairs 
were  provided,-  they  were  most  unjiopular 
among  some  of  the  workers  simply  because 
the  girls  did  not  understand  how  to  adjust 
them.  Another  objection  raised  was  the 
difficulty  of  revolving  the  chairs  easily  to 
consult  files  placed  at  one  side.  On  tlie 
other  hand,  a  number  of  the  more  intelli- 
gent clerks  in  this  force  expressed  great 
satisfaction  and  said  that  since  adjustable 
chairs  had  been  given  them  they  had 
ceased  to  experience  fatigue  of  the  back. 
It  would  be  an  admirable  scheme  if  every 
new  employee,  whether  a  clerk  or  a  worker 
in  a  repair  room  or  workroom,  had  her 
eyesight  and  her  posture  determined  and 
was  then  carefully  fitted  to  her  i)lace  by 
someone  familiar  with  physical  recjuirc- 
ments.  Such  a  system  would  prevent  un- 
necessary fatigue  and  ill  health. 

As  a  further  aid  in  preventing  fatigue 
among  sedentary  workers  mid-morning 
and  mid-afternoon  exercises  in  a  well-aired 
room,  under  the  leadership  of  a  i)hysical 
director,  have  proved  to  be  worth  while. 
They  furnish  relaxation,  refresh  the  workers 
and  lead  to  an  increased  output. 

The  telephone  switchboard  has  been 
commended  for  the  excellent  mechanical 
adjustment  of  seating  and  foot  rests.  Here 
a  modified  light  is  used  to  aid  in  seeing  the 

*  A  work  chair  especially  adapted  for  use  at  tables  or 
desks  will  be  described  in  a  suliseqiient  article  in  this 
Journal.     Enquire  before  replacing  chairs. 


light  signals.  In  some  of  the  stores  sur- 
veyed the  ventilation  for  the  telephone 
girls  was  poor  owing  to  the  fact  that  the 
switchboard  had  to  be  shut  off  by  parti- 
tions on  account  of  nearby  noises.  Tele- 
phone work  has  a  certain  fascination  and 
requires  dexterity,  but  it  tends  to  keep  up 
the  nervous  tension  in  an  already  high- 
tension  type  of  person.  To  meet  the  danger 
of  fatigue,  therefore,  frequent  short  rest 
periods  are  desirable.  A  comfortable  loung- 
ing chair,  with  light  suitable  for  reading, 
placed  near  the  switchboard  and  used  in 
turn,  has  in  some  instances  proved  more 
successful  than  a  distant  rest  room. 

The  tube  room  or  cash  room,  now  for- 
tunately becoming  less  common  owing  to 
the  extended  use  of  the  cash  register,  has 
certain  common  dangers.  It  is  often  in  the 
basement  and  consequently  dependent  on 
artificial  light  and  air.  It  is  apt  to  be  noisy 
and  sometimes  overcrowded.  The  hazard 
of  dirty  money  is  also  present.  Convenient 
provision  should  be  made  for  moistening 
the  fingers  for  .sorting  bills,  and  warnings 
should  be  given  never  to  use  the  mouth  for 
this  jnirpose.  ^Yorkers  in  these  ]>laces  in 
particular  should  acquire  the  habit  of  wash- 
ing their  hands  thoroughly  before  eating. 

Women  are  becoming  more  and  more 
awake  to  the  comfort  and  pleasure  of 
comfortable  a/joc.v.  To  a  girl  who  must 
stand  most  of  the  day  a  suitable  shoe  is  in- 
valuable. A  number  of  stores  carry  good 
looking  sensible  shoes  in  their  shoe  depart- 
ments and,  recognizing  the  importance  to 
their  sales  force  of  wearing  such  shoes, 
have  offered  a  substantial  discount  to 
employees.  One  buyer  of  shoes  tells  me 
that  he  carries  a  college  girl's  shoe,  which 
he  sells  to  school  girls,  who  admire  college 
girls.  In  such  a  way  he  is  able  to  fit  with 
suitable  shoes  many  persons  who  otherwise 
would  be  guided  entirely  by  fashion  in 
purchasing. 

No  one  type  of  shoe  is  suited  to  all  varie- 
ties of  feet.    For  example,  the  growing  girl 


32 


THE  JOURXAL  OF  INDUSTRIAL  HYGIENE 


and  the  heavy,  middle-aged  woman  need 
quite  different  shoes.  In  the  store  survey  it 
was  found  that  some  workers  kept  extra 
shoes  in  their  lockers  for  store  use,  and 
changed  from  their  street  shoes  every 
morning.  This  practice  might  be  of  great 
value  if  more  generally  adopted,  for  it 
would  very  naturally  result  in  the  common 
use  of  a  suitable  store  shoe. 

Pin  Ticket  atul  String  Cutter.  —  Two 
sources  of  injury  which  are  often  respon- 
sible for  infected  wounds  are  commonly 
found  in  stores  —  namely,  the  pin  ticket 
and  the  string  cutter.  Pin  tickets  are  used 
for  marking  a  few  articles  of  clothing.  Even 
if  they  are  put  in  by  machines,  they  may 
still  be  a  source  of  injury  to  the  salesclerk 
and  to  the  customer.  They  are  a  not  un- 
common source  of  trouble  to  the  worker 
who  inserts  them  by  hand.  Some  other 
device  for  marking  articles  should  be  sub- 
stituted. The  counter  string  cutter  has  a 
point  sufficiently  sharp  to  inflict  wounds. 
It  can  be  rounded  or  dulled  to  a  safe  shape 
without  reducing  its  usefulness. 

Counter  Wash  Basins.  —  As  the  selling 
of  white  gloves  requires  the  salesgirl  to 
wash  her  hands  frequently,  small  wash 
basins  are  usually  provided,  often  below 
the  glove  counter.  A  mild  soap,  preferably 
in  the  form  of  liquid  or  powder,  should  also 
be  supplied.  A  cake  used  in  common  is  less 
desirable.  Sufficient  towels  are  usually  fur- 
nished. It  is  quite  connnon  in  winter,  how- 
ever, to  find  that  a  salesgirl  has  chapped 
or  dried  hands,  and  cannot  clean  them 
easily.  To  prevent  chapping  a  hand  lotion 
should  be  provided  in  a  form  convenient 
for  easy  application  after  each  drying. 

Sale  of  Food.  —  The  public  sale  of  food 
in  stores  dealing  jirimarily  in  clothing  and 
general  merchandise  carries  certain  risks. 
In  our  survey  the  soda  fountain  and  ice- 
cream counter  in  some  instances  were 
found  to  be  controlled  by  firms  outside 
the  store  management  —  an  arrangement 
which  is  always  attended  by  some  risk. 


Some  of  the  soda  fountains  investigated 
were  found  to  be  well  run  and  reasonably 
sanitary;  others  could  not  be  passed  with- 
out considerable  criticism.  The  public 
does  not  distinguish  between  managements, 
so  criticisms  must  be  borne  by  the  store. 
Similar  responsibility  is  reflected  on  the 
store  in  the  case  of  the  chiropody,  the  mani- 
cure, the  optical,  and  the  hair  dressing 
departments. 

If  a  store  is  selling  food  to  the  public,  the 
food  handler  must  be  not  only  neat  and 
scrupulously  clean  but  should  also  have 
been  declared  free  from  communicable  dis- 
ease by  the  store  health  department.  The 
garbage  must  be  systematically  cared  for 
and  frequently  removed.  Perishable  foods, 
such  as  milk,  must  be  carefully  guarded. 
Ice  cream  may  also  be  a  danger  if  it  is  not 
properly  protected.  The  handling  of  food 
and  money  by  the  same  person,  as  com- 
monly happens  at  candy  counters,  is  not  a 
safe  procedure. 

Customers'  restaurants  are  found  in  a 
few  stores  but  in  general  they  have  been 
given  up.  If  the  management  decides  that 
a  customers'  restaurant  is  desirable,  it 
must  be  made  a  model  of  cleanliness  and 
attractiveness  in  order  to  be  successful. 
These  restaurants,  I  am  told,  seldom  pay 
profit  equal  to  the  value  of  the  space 
which  they  occup3\  For  sanitary  equip- 
ment, healthy  personnel,  and  safe  practice, 
considerable  responsibility  is  assumed  by 
the  store,  whether  or  not  it  assumes  the 
financial  risk.  Failure  to  maintain  a  high 
standard  reflects  directly  on  the  store. 

Conditions  Affecting  Both 
Workers  and  Customers 

The  customers,  the  buying  public  — 
largely  women  —  are  directly  concerned 
with  the  conditions  in  stores.  So  far  the 
questions  considered  are  ones  which  prin- 
cipallj'  affect  the  worker.  The  problems 
discussed  below,  however,  concern  equally 
the  customer  and  the  worker. 


EMMONS  —  COAOION  SANITARY  DEFECTS  IN  STORES 


33 


The  location  of  the  store  is  favorable 
according  to  the  convenience  of  approach, 
the  breadth  of  streets  or  open  spaces 
around  the  store,  the  amount  of  sunlight 
and  air,  and  the  absence  of  noise,  smoke, 
and  dust  nuisances.  One  store  has  an 
open  canal  at  its  rear,  which  in  summer 
emits  an  odor  sufficiently  pungent  to  cause 
shoppers  to  sniff  the  air  in(|uiringly.  The 
answer  received  is  '"city  politics." 

Overcrowding.  —  The  shopping  public  is 
often  repelled  by  overcrowtling,  which  is 
common  on  the  street  floor  of  tU'i)artinent 
stores.  To  prevent  this  uiule.siral)le  con- 
dition the  entrances  should  be  large  and 
nimierous  and  easy  of  access,  tlie  aisles 
should  be  broad  and  unobstructi'd,  and 
adequate  elevator  service  should  be  i)ro- 
vided.  Congestion  may  l>e  sonunvliat  re- 
lieved by  removing  to  other  jjarts  of  the 
store  goods  wiiicli  are  in  considi-rahle  de- 
mand. The  practice  of  allotting  to  dei)art- 
ments  space  proportional  to  their  earnings 
results,  for  example,  in  a  whole  floor  being 
given  to  the  furniture  department  in  which 
may  be  found  a  half  dozen  shoppers,  while 
the  street  floor  is  overcrowded  with  ])ur- 
chasers  of  small  wares.  The  management 
alone  can  give  due  weight  to  the  comfort 
and  health  of  everyone  by  considering  these 
factors  in  apportioning  space. 

Elevator  Serricc.  —  Sufficient  and  con- 
venient elevator  service  may  create  favor- 
able contact  with  the  public.  Three  stores 
in  particular  have  strikingly  capitalized 
this  contact  by  the  neatness  and  courtesy 
of  their  elevator  operators  and  by  the 
mechanical  perfection  of  the  service.  The 
chief  fault  with  the  older  type  of  elevator  is 
that  its  entrance  is  so  narrow  that  the  time 
needed  for  filling  and  emptying  is  markedly 
lengthened.  Thus,  its  convenience  and 
efficiency  in  transportation  are  limited. 
The  elevator  about  10  feet  wide  by  6  feet 
deep,  with  doors  folding  in  six  sections,  is 
the  most  efficient  tyi)e  which  I  have  ob- 
served.    To  avoid  confusion  and  loss  of 


time  one  store  has  installed  two  banks  of 
elevators  in  the  center  of  the  building  — 
one  side  carrying  passengers  up,  the  other 
side  bringing  them  down.  At  first  thought 
this  might  seem  inefficient.  Careful  ob- 
servation has,  however,  proved  this  to  be 
the  more  efficient  service  under  the  con- 
ditions found  in  this  store.  It  took  but  a 
short  time  for  the  public  to  become  accus- 
tomed to  the  system. 

The  natural  tendency  of  the  average 
elevator  operator,  like  a  street  car  conduc- 
tor, is  to  order  about  the  meek  passengers. 
While  safety  nuiy  at  times  demand  this, 
the  American  ])vil)lic  naturally  resents  it. 
Courtesy  here  means  nnicli  to  the  shopper 
who  is  often  easily  confused. 

One  store  has  successfully  supplemented 
its  ina(le(|uate  elevator  service  by  an  esca- 
lator. Many  people  willingly  walk  down 
convenient  stairways  in  preference  to 
waiting  for  a  crowded  elevator. 

\'cntihi1ion.  —  Under-ventilation  is  the 
conunon  accomi)animent  of  overcrowding, 
a  disc'omfort  to  which  many  sho])pers  are 
very  sensitive.  Often  a  day's  shopping  is 
dreaded  for  this  reason  alone. 

Tiie  basement  store  is  particularly  un- 
popular with  some  shoppers.  This  preju- 
dice is  often,  but  not  always,  justified.  It 
is  usually  possible  to  sui)ply  sufficient 
artificial  ventilation,  exce])t  perhaps  in 
rush  times.  Tiic  practical  difficulty  dis- 
clo.sed  is  the  fad  that  the  control  of  the 
ventilating  system  is  in  the  hands  of  the 
engineer  who  has  numy  other  duties. 
Some  effective  check  or  follow-up  system  is 
needed  to  prevent  umler-ventilation.  To 
avoid  prejudice  a  basement  store  should, 
if  possible,  be  over-ventilated.  The  prac- 
tice which  is  now  in  use  in  many  stores  of 
running  the  ventilating  system  at  night 
and  sometimes  over  Sunday  offers  one 
solution  of  the  ventilation  problem.  Fear 
of  drafts  results  too  often  in  under-ventila- 
tion  which  frequently  increases  the  suscep- 
tibility to  colds.   However  good  the  system 


34 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


of  ventilation  may  be,  experience  shows 
that  a  follow-up  is  necessary.  Inspection 
should  be  systematized  and  made  a  regular 
duty  if  the  problem  is  to  be  solved,  and 
should,  if  possible,  be  superintended  by 
someone  with  a  medical  point  of  view. 

In  large,  crowded  oflBces  and  work- 
rooms, sujiplementary  ventilation  has  been 
satisfactorily  obtained  by  exhaust  fans, 
placed  in  the  upper  sashes  of  the  windows. 
Air  ducts  suppljung  fresh  air  are  necessary 
in  some  offices  where  partitions  have  been 
carried  to  the  ceiling  in  order  to  eliminate 
noise. 

Cleaning.  —  A  store  cleaning  system 
may  perhaps  be  best  judged  by  its  results. 
A  factor  of  special  importance  to  the  store 
health  department  is  the  health  of  the 
cleaning  force  who,  being  largely  absent 
during  store  hours,  may  easily  escape 
notice. 

Vacuum  cleaning  is  by  far  the  most  sani- 
tary method  of  cleaning  because  dust  and 
dirt  are  removed  with  no  danger  to  the 
worker.  The  feather  duster  is  at  the  other 
end  of  the  scale  of  cleaning  methods,  and, 
like  the  common  towel,  to  be  suppressed, 
requires  constant  watchfulness.  The  oil 
dust  cloth  can  often  be  substituted  to  do 
the  same  work. 

Flooring  is  intimately  connected  with  the 
cleaning  job.  A  smooth  surface  with  the 
fewest  possible  cracks  is  the  best  cleaning 
surface.  Other  factors  besides  cleaning 
must  be  considered  in  selecting  flooring, 
such  as  appearance,  cost,  comfort  and 
durability,  including  liability  to  injury 
from  desk,  chairs  and  truck  wheels.  From 
a  health  standpoint,  comfort  is  a  very  im- 
portant factor.  Two  kinds  of  floors  cause 
discomfort  to  the  salesperson,  who  must 
stand  the  greater  part  of  th(>  day;  concrete 
or  stone  flooring  is  cold  and  hard;  carpets, 
especially  if  they  are  soft  and  thick,  are 
hot  and  tiring. 

The  flooring  which  best  meets  all  the 
requirements  is  battleship  linoleum.    Es- 


pecially does  this  meet  the  sanitary  con- 
ditions of  comfort  and  ease  of  cleaning. 
Cork,  wood,  tile  and  concrete  are  some- 
what less  favorable  from  a  health  stand- 
point. Carpets  are  often  necessary  and, 
if  used,  require  thorough  and  frequent 
cleaning.  The  disadvantage  of  hardness  in 
flooring  may  be  partly  compensated  for 
by  the  use  of  matting  and  by  the  wearing 
of  suitable  shoes  with  rubber  heels. 

Dust  Hazards.  —  Apart  from  the  store 
cleaning  system,  dust  hazards  are  some- 
times found  in  certain  store  work,  such  as 
silver  polishing,  fur  beating,  upholstery 
workrooms  and  packing.  The  buffing  and 
fur  beating  departments  require  exhausts 
to  protect  the  employees.  The  use  of  paper 
or  excelsior  instead  of  hay  does  away  with 
much  of  the  dust  in  the  packing  and  receiv- 
ing of  goods. 

Drafts.  — •  The  entrance  door  problem  of 
cold  air  and  drafts  during  the  winter  has 
largely  been  solved  by  placing  a  generous 
heating  surface  either  in  the  vestibule  or 
just  inside  the  revolving  doors,  thus  heating 
the  fresh  air  admitted  with  the  customer. 
Glass  shields  are  sometimes  necessary  to 
protect  the  worker  and  the  goods  on  coun- 
ters located  nearby  in  the  line  of  drafts. 

Importance  of  Proper  Industrial 
Relations  and  Medical  Service 

A  follow-up  system  is  the  key  to  success 
in  all  sanitary  matters.  Experience  al- 
ready shows  that  lack  of  such  a  system  has 
defeated  more  carefully  prepared  plans 
than  any  other  factor.  The  human  ele- 
ment is  commonly  responsible  for  poor 
ventilation  in  the  modern  well-equipped 
store.  The  three  departments  which  are 
directly  interested  in  good  store  house- 
keeping are  the  management,  the  engineer- 
ing department,  and  the  health  department, 
all  of  which  should  be  rejiresented  in 
formulating  instructions  and  in  following 
them  through  to  results. 


EMMONS  —  COMMON  SANITARA'  DEFECTS  IN  STORES 


35 


Thus,  industrial  relations  become  prom- 
inent in  successful  sanitation.  One  of  the 
most  satisfactory  store  sanitary  sj'stems 
which  has  been  worked  out  owes  its  success 
to  the  ready  welcome  of  all  suggestions  or 
reports  to  the  engineering  department. 
The  chief  of  this  department  considers  that 
the  education  of  all  store  workers  to  report 
trivial  matters  immediately  and  freely  is 


means  of  bulletins,  by  notices  in  their  pay 
envelopes,  or  by  articles  in  the  store  paper. 
Misunderstandings  will  thus  be  prevented 
and  criticisms  may  be  made  which  will  re- 
sult in  wise  alterations  in  the  original  plan. 
In  following  up  the  system  of  sanitation, 
the  health  department  should  be  on  the 
alert  to  detect  illness  arising  as  the  possible 
result  of  failure  in  some  sanitary  feature. 


FlGXJRE   1 

HEALTH  SERVICE  DEPARTMENT 
DAILY  REPORT 


Date 

o 

1 

Ji 

el 

1 

i 
a 

Name 

a 

1 

in 

1 
1 

•c 

1 

-a 
a 

Complaint 

Tbeatuent 

Disposition 
OF  Case 
Remabks 

a 

1 

1 

Pi 

I 
1 

1 

a 

< 

1 

1 

(a 

•1 

the  key  to  success  in  llie  functioning  of 
his  store  housekeeping  system.  All  reports 
receive  cheerful  and  prompt  attention, 
even  though  it  is  recognized  that  perhaps 
one  in  four  or  five  such  reports  needs 
action. 

Proper  industrial  relations  of  a  store 
require  due  consideration  when  any  new 
measure,  such  as  visiting  nursing,  is  intro- 
duced. Publicity  within  the  store,  to  be 
successful,  requires  a  well-thoughtout  plan. 
It  should  first  be  explained  and  discussed 
at  the  committee  meetings  of  the  manage- 
ment and  of  the  sub-management  or  heads 
of  departments,  and  then  should  be  brought 
to   the   attention   of   all   the   workers   by 


A  dailj'  record  form  (see  Figure  1)  has  been 
worked  out  and  tried  with  success  in  a 
number  of  stores.  One  line  only  is  used  for 
each  case.  The  monthly  report  results 
from  addition  of  the  columns.  From  the 
monthly  report  an  annual  report  can 
readily  be  made,  which  will  show,  among 
many  things,  where  illness  is  most  com- 
mon, and  will  often  reveal  a  preventable 
cause.  Such  a  daily  record  will  enable  a 
store  to  compare  the  healthfulness  of  its 
employees  with  that  of  workers  in  other 
stores,  and  may  thus  constitute  an  added 
attraction  for  prospective  employees. 

In  the  store   emergency   room   it   is   a 
common   practice  for  the   nurse   to   give 


86 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


immediate  relief.  Such  relief  has  only  too 
often  consisted  in  drugging;  the  pill  has  fre- 
quently become  almost  the  sole  reliance. 
Unless  medicines  are  given  in  accordance 
with  standing  orders  of  the  doctor,  who 
thus  carries  the  responsibility,  the  emer- 
gency room  is  not  even  within  the  legal 
limits  of  medical  practice.  It  is  a  lost 
opportunity  to  do  any  lasting  good  for  the 
individual  patient  and  consequently  for 
the  future  welfare  of  the  store. 

When  patients  come  for  relief,  they  wish 
to  receive  good  medical  advice,  which  re- 
sults from  an  intelligent  understanding  of 
their    physical    condition,    their    personal 


hygienic  habits,  their  work,  and  even  their 
play.  If  the  future  health  of  the  employee 
is  of  value  to  the  store,  it  is  a  matter  of 
economy  to  furnish  high-grade  medical 
service. 

To  help  build  up  a  healthy,  stable,  and 
reliable  personnel  is  the  principal  object 
and  the  chief  justification  of  store  medical 
service.  It  is,  therefore,  recommended 
that  the  emergency  room  be  developed  into 
a  store  health  department  with  all  that 
this  term  implies.  Those  who  recognize 
early  the  importance  of  sanitary  factors 
and  adequate  medical  service,  and  who 
build  wisely  should  first  reap  the  benefits. 


BOOK  REMEWS 


37 


BOOK  REVIEWS 


Hygiene  of  Communicable  Diseases:  A  Hand- 
book for  Sanitarians,  Medical  Ofl&cers  of  the  Army 
and  Navy  and  General  Practitioners.  By  Francis 
M.  Munson,  M.D.,  Lieutenant,  Medical  Corps, 
U.S.N. ,  Retired;  Lecturer  on  Hygiene  and  Instruc- 
tor in  Militarj'  Surgery,  School  of  Medicine,  George- 
town LTniversity;  Formerly  Instructor  in  Medical 
Zoology,  Georgetown  College;  Late  Brigade  Sur- 
geon, and  Provisional  Brigade,  I'.  S.  Marines.  Cloth. 
Pp.  7i);3  with  ilhislrations  and  index.  New  York: 
Paul  B.  Hoeber,  19^.20. 

Dr.  Munson  has  written  a  hook  which,  in 
spite  of  the  sco])e  and  rather  minute  detail,  is 
still  compact  and  ])hysically  manageable  —  an 
item  of  no  .small  im])ortimce  in  the  usefulness  of 
a  book.  Due  to  the  paragra])h  arrangement 
and  an  excellent  index,  the  material  is  avail- 
able for  ready  reference,  so  that  the  book  should 
prove  of  value'  to  all  health  officers,  either  civil 
or  military,  engaged  in  field  work.  It  makes  no 
pretence,  I  think,  of  being  a  laboratory  man- 
ual, in  which  field  its  value  would  be  much  more 
questionable. 

The  author  begins  with  a  brief  consideration 
of  the  various  ty])es  of  infecting  agents  and  the 
theories  of  immunity.  Chapters  arc  devoted  to 
such  specific  problems  of  sanitation  as  mu- 
nicipal, railway,  military,  prison,  and  school 
emergencies  due  to  great  disasters  —  i.  e., 
floods,  earthquakes,  etc.  Dr.  ^Nlunson  is  per- 
haps at  his  best  when  dealing  with  military 
sanitation,  where  the  wealth  of  detail  as  to  de- 
lousing,  the  disposal  of  human  and  animal 
excreta  under  various  conditions,  dispo.sal  of 
sink  water,  etc.,  woidd  be  in\aluable  in  plan- 
ning and  administering  the  sanitation  of  a 
camp. 

In  the  second  part  of  the  book,  the  diseases 
are  groiqied  according  to  their  mode  of  si)read- 
ing  and  are  considered  individually.  Parts  of 
some  valuable  documents  are  (juoted  at  length, 
such  as  the  Interstate  Quarantine  Regulations 
of  the  Treasurj'  Department,  and  War  Depart- 
ment Orders  and  Directions  Regarding  Vene- 
real Prophylaxis.  The  consistent  use  both  in 
title  and  text  of  the  term  "communicable"  in- 
stead of  "infectious"  or  "contagious"  is 
gratifying. 

In  spite  of  the  introductorj'  remark  that  no 
statement  is  made  which  is  not  supported  by 
competent  authority,  we  find,  to  our  surpri.se, 
the  imqualified  statement  that  the  etiological 
agent  of  measles  is  a  filterable  virus,  and  the 
etiological  agent  of  influenza,  the  B.  Influenzae. 


True,  we  read  further  on  that  "the  consensus 
of  opinion  is  that  the  bacillus  of  Pfeiffer,  Bacil- 
lus Influenzae,  is  the  specific  causative  agent, 
but  that  most  cases  are  mixed  infections." 
Even  this  does  not  appreciably  lessen  the  sur- 
prise. Then,  over  two  pages  are  devoted  to 
what  reads  like  a  modern  fairs'  tale,  under  the 
heading  The  Pandemic  of  lufiuenza  of  191S- 
19,  which  has  to  do  with  a  theory  that  the  in- 
fluenza bacillus  is  metamoqjhosed  from  the 
])lague  bacillus,  and  that  the  whole  miserable 
pandemic  started  in  China  as  pneumonic 
jjlague,  and  thence  was  spread  into  Germany 
by  Chinese  coolies,  and  thence  all  over  Europe 
and  America  as  influenza. 

In  the  cha])ter  on  Venereal  Diseases,  Dr. 
Munson  deals  largely  with  the  military  and 
naval  aspects  of  the  question.  lie  feels  that 
"a  medical  program  for  civil  communities 
equivalent  to  the  military'  program  for  pre^•en- 
tion  and  treatment  should  be  encouraged."  In 
so  far  as  the  treatment  is  concerned.  Dr.  Mun- 
son's  recommendation  might  well  be  adopted, 
but  the  prevention  in  the  military  sense  means, 
besides  education  and  the  restriction  of  prosti- 
tution, alcoholism,  etc.,  the  pro])hylactic  sta- 
tion. There  lies  the  difficulty.  I  know  that 
some,  and  I  have  been  given  to  understand  that 
practically  all,  of  the  stales  have  found  it  im- 
])racticable  for  one  reason  or  another  to  endorse 
the  ])roph>lactic  station  as  a  part  of  their 
venereal  jjrogi-am.  Theoretically,  if  such  sta- 
tions work  in  the  army,  they  should  at  least  be 
of  some  value  in  a  civil  camjiaign  against  vene- 
real disease.  Practically,  it  is  not  difficult  to  see 
the  obstacles. 

Wien  considering  the  control  of  diphtheria  in 
an  institution,  the  author  recommends  the  ad- 
ministration of  antitoxin  to  aU  the  inmates, 
repeated  every  ten  days  or  two  weeks  as  long  as 
cases  appear.  No  mention  is  here  made  of  tlie 
use  of  the  Schick  test  and  toxin-antitoxin  im- 
mimization  of  susceptibles.  True,  these  pro- 
cedures are  elsewhere  mentioned  for  control  in 
military  organizations,  but  it  would  certainly 
be  a  mistake  in  an  institution  to  frustrate  the 
value  of  a  test  like  the  Schick  test  by  the  whole- 
sale administration  of  antitoxin. 

Under  the  discussion  on  measles  the  author 
argues  effectively  against  closing  the  schools  in 
the  presence  of  an  e]Mdemic.  He  also  makes  a 
plea  for  education  against  the  exposing  of 
young  children.  The  not  at  all  uncommon  prac- 


38 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tice  of  exposing  young  children  to  measles  to 
"get  it  over  ^\dth"  cannot  be  too  severely  con- 
demned, when  we  consider  that  about  80  per 
cent,  of  the  deaths  from  measles  occur  during 
the  first  three  years  of  life,  while  in  1918  in 
Massachusetts  only  about  16  per  cent,  of  all  the 
cases  of  this  disease  occurred  in  this  age  group. 

The  author  states  that  an  attack  of  yaws 
confers  immunity.  There  seems  to  be  no  rea- 
son to  suppose  that  a  person  cured  of  yaws  is 
any  more  immune  to  reinfection  than  is  a  per- 
son cured  of  sj-philis.  Immmiity  in  syphilis  is, 
to  say  the  least,  open  to  question.  With  the 
almost  unquestioned  short  viability  of  the 
Treponema  pertenue  outside  the  body,  there 
seems  to  be  but  little  need  for  the  thorough  dis- 
infection recommended  to  prevent  the  spread 
of  yaws. 

There  are  many  good  points  made  by  Dr. 
Munson,  such  as  the  paucity  of  public  comfort 
stations  in  American  cities  as  compared  with 
European  cities;  the  danger  from  the  broadcast 
distribution  of  raw  human  excreta  along  rail- 
ways particularly  when  they  border  public 
or  private  water  supplies;  that  the  ordinary 
drip  "disinfecting"  machines  in  toilets  and 
urinals  are  of  service  only  in  adding  an  un- 
pleasant odor  to  those  already  present;  that  a 
"school  without  a  playgi-ound  is  an  educational 
deformity,"  etc.  He  gives  regulations  that 
should  be  in  force  in  all  barber  shops.  The 
average  barber  shop  is  certainly  a  sanitary 
nightmare.  He  also  gives  points  of  value  in  in- 
specting markets,  abattoirs,   etc.,  and  many 


other  suggestions  which  will,  as  has  been  said, 
be  found  of  value  to  the  health  officer  in  the 
field.  —  George  H.  Bigelow. 

Organisation  Industrielle,  Medecine  Sociale  et 
Education  Civique  en  Angleterre  et  aux  Etats- 
Unis.  By  Rene  Sand,  Inspecteur  principal  au  Ser- 
vice medical  du  TravaU;  Agrege  de  I'Universite  de 
Bruxelles;  Membre  correspondant  de  I'Academie 
rojale  de  Medecine  de  Belgique;  Medecin  de  regi- 
ment de  reserve  a  rAmbulance  de  TOcean.  Paper. 
Pp.  896  with  index  and  table  of  contents.  Paris: 
J.-B.  Bailliere  et  FUs,  1930;  Brussels:  Maurice 
Lamertin,  19'20. 

Dr.  Rene  Sand  has  recorded  in  this  large  book 
the  impressions  which  he  received  during  two 
visits  to  the  United  States  and  one  to  England 
in  1918  and  1919. 

The  title  of  the  volume  only  suggests  the 
multiplicity  of  subjects  of  which  he  writes. 
The  Taylor  system,  industrial  relations,  indus- 
trial safety,  the  physiologj'  of  fatigue,  child 
labor,  unemployment,  settlement  houses,  public 
health  activ^ities  and  social  reconstruction  — 
these  and  many  other  topics  are  discussed  at 
length. 

The  work  must  be  termed  superficial  —  but 
that  the  author  doubtless  intended  it  should  be. 
It  is,  however,  in  many  instances  very  inexact, 
as  any  such  record  must  naturally  be,  when  its 
author  is  a  kindly  person  en  tour  in  a  strange 
land  and  at  the  mercy  of  a  multitude  of  individ- 
ual enthusiasts  all  arrayed  in  their  best  official 
robes,  each  with  his  best  foot  forward.  — 
Wade  Wright. 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


Volume  III 


.R'XE,  19'-21 


Number  i 


THE  PREGNANT  WOMAN  IN  INDUSTRY* 

CAREY  P.  McCORD,  M.D.,  and  DOROTHY  K.  MINSTER 

Cincinnati,  Ohio 


THFy  prcfjnant  woman,  lior  physician, 
and  Ikt  employer,  all  have  need  of  a 
better  understanding  of  pregnancy  in  rela- 
tion to  work.  The  government,  emi)loyers, 
and  lal)or  bodies  are  continualK'  seeking  to 
surround  the  woman  worker  wit  1 1  condi t  ions 
that  enhance  her  economic  worlii  and  an- 
favorable  to  the  maintenance  of  her  healtli. 
These  agencies  have,  however,  failed  j)rop- 
erly  to  appreciate  the  fact  that  the  normal 
pregnant  woman  is  capable  of  work,  and  as 
a  residt  have  neglected  the  specific  jirovi- 
sions  that  would  make  it  possible  ami  ad- 
vantageous for  her  to  continue  at  work. 

In  the  industries  of  this  country  about 
five  million  women  are  employed,  nearly 
one  million  of  whom  are  married.  An  un- 
known but  obviously  large  number  of 
pregnancies  occur  every  year  among  them. 
At  this  time  of  additional  expenses  prepara- 
tory to  the  child's  birth  and  to  after-care, 
an  even  greater  necessity  for  earning  money 
arises.  Many  times  it  is  of  mutual  advan- 
tage to  the  employer  and  to  the  pregnant 
employee  to  allow  her  to  continue  her  work 
as  long  as  it  is  not  harmful  to  her  or  to  her 
unborn  child.  Through  lack  of  dej)endable 
advice,  it  is  the  tendency  of  the  expectant 
mother,  especially  the  primipara,  to  dis- 
continue work  early  in  her  pregnancy.   She 

*  Received  for  publication  Jan.  14,  1921. 


is  influenced  in  her  decision  to  do  so  by  her 
apprehension  lest  in  some  way  she  harm 
her  child;  by  gossip  current  among  older 
women  as  to  the  disastrous  effects  of  work; 
by  her  fear  that  in  the  plant  she  will  be- 
come tiie  butt  of  idle  humor;  by  the  fact 
lliat  tin-  mental  and  physical  discomforts 
of  i)regnancy  are  at  their  height  in  this 
early  period,  thus  leading  her  to  think  that 
.she  will  continue  to  be  too  "miserable"  to 
work.  The  employer,  knowing  little  about 
the  matter,  "plays  safe"  and  acquiesces  in 
her  decision,  thus  needlessly  losing  the 
services  of  a  valuable  worker. 

There  is  great  need  of  competent  med- 
ical sui)ervision  by  physicians  who  are  not 
only  wi'll  qualified  as  ob.stetricians  but  who 
are  also  well  acquainted  with  trade  proc- 
esses, oceupaticmal  hazards,  fatigue  and 
posture  problems,  chemical  intoxications, 
and  the  like.  Unfortunately,  the  physician 
serving  this  group  of  patients  is  very  often 
wholly  unacquainted  with  industrial  med- 
ical matters  and  therefore  incompetent  to 
discriminate  between  suitable  and  unsuit- 
able plant  work.  Too  much  is  sacrificed, 
both  ])y  the  woman  and  by  the  employer, 
through  this  lack  of  scientific  knowledge  as 
to  the  desirable  work  environment  for  the 
pregnant  employee. 

The  approaches  to  the  problem,  which 


39 


40 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


TABLE 

1.  — MATERNITY  BENEFITS 

Date  of  Law 
in  Force 

Types  of  Benefit 

Source 

cottntry  or 
State 

Money  in 
Lump  Sum 

Money 

in  Instal 

ments 

Medical, 

Nursing, 

Institutional 

Care 

Payment  for 
Breast  Feeding 

Amount 

Australia 

1912 

+ 

government 

$25  total 

Austria 

1917 

-1- 

+ 

i  amount  for  ma- 
ternity benefit  to 
end  of  12th  week 

insurance  premium 
—  i  employer,  ^  em- 
ployee 

60%  of  standard  rate 
of  wage  class  to  which 
insured  belongs 

Denmark 

1915 

+ 

if  necessary 

insurance  society; 
government 

$0.27  daily 

France 

1913  with 

subsequent 

amendments 

to  govern- 
ment em- 
ployees only 

-1- 

S2.70atendof4 
weeks 

government ;    mutual 
aid  societies 

$0,096  to  $0.29  daily 

Germany 

1911 

special  war- 
time   meas- 
ure 85.95 

+ 

substitute  for 
maternity  ben- 
efit if  desired 

i  cash  benefit  for 
12  weeks:   doub- 
led for  twins 

insurance  premium 
—  i  employer,  §  em- 
ployee 

$1.19  to  $1.43  daily 

Great  Britain 

1912 

+ 

cash  benefit 
may  be  used 
in  this  way 

government  insurance 
premium,      employer 
and  employee 

S7.2Q  if  woman  is  in- 
sured;   $14.40  if  hus- 
band is  also  insured 

Italy 

1912— 
modified 
in  1917 

+ 

insurance  premium 
—  5  employer,  ^  em- 
ployee 

$7.72  in  two  instal- 
ments 

Luxemburg 

1902 

+ 

insurance  premium 
—  5  employer,  I  em- 
ployee 

cash  benefit  of  J  daily 
earnings 

Netherlands 

1913  — not 
in  effect  on 
Jan.  1,  1918 

+ 

-f 

insurance  premium 
—  i  employer,  i  em- 
ployee 

70%  of  average  wage 
until  after  childbirth; 
then  100% 

New  Zealand 

1911 

-t- 

-1- 

government  insurance 
—  J    government,    | 
insured 

not  more  than  $29.20 

Norway 

1915 

+ 

+ 

+ 

insurance  premium 
—  Vio    insured,    Vio 
employer,  Vio  gov't 

60%  of  daily  wage 

Russia 

1913 

+ 

+ 

owners   of    establish- 
ments;   insured;    do- 
nations, fines,  etc. 

}  to  full  wages 

Sweden 

1913 

+ 

government 

$0.24  daily 

Switzerland     . 

1914 

+ 

+ 

»3.86   if   mother 
has  nursed  child 
for  10  weeks 

dues  of  members, 
subsidy  of  state 

$3.86  lump  sum 

Colorado 

1913 

government 

enough  to  care  prop- 
erly for  child 

Missouri 

1917 

government 

one  child,  $16 
monthly;   $10  for 
each  additional  child 

Pennsylvania 

1919 

government 

one  child,  $20 
monthly;  $10  for 
each  additional  child 

McCORD  AXD  MINSTER  —  PREGNANT  WOINIAN  IN  INDUSTRY 

TABLE  1.— MATERNITY  BENEFITS 


41 


Time  Limit 

Persons  Included  According  to 

codntry  oh 

State 

Before  Con6nemen1 
Weeks 

After  Confinement 
Weeks 

Occupation 

Wage  Class 

Remarks 

Australia 

unlimited  except  for  natives 
and  Asiatics 

unlimited    except    for 
natives  and  Asiatics 

medical  certificate  necessary  to 
exclude  stillbirths  and  abortions 

Austria 

6 

establishments  using  power  or 
explosives;    under  industrial 
code;  building  trades;  trans- 
portation 

workers  receiving  less 
than  $4S7.20  a  year 

present  conditions  unknown 

Denmark 

10  days,  after  which 
she  is  entitled  to  us- 
ual sick  benefit 

workers    without    in- 
come-bearing property 
over  15  years  of  age 

only  slight  changes  in  law  of 
1892     because    of      ■  financial 
straits" 

France 

as  indicated  for 
mother,  not  more 
than  4 

4 

all  wage  earners  except  rural 
workers 

1917  law  provides  for  wives  of 
soldiers  regardless  of  being  wage 
earners 

Germany 

2 

medical  certificate 
required   before  re- 
txirn  to  work 

all  wage  earners 

others  if  income  is  less 
than  $5.95  yearly 

wartime    measures    providing 
special  maternity  benefits 

Great  Britain 

4 

manual    employment;     noo- 
manual  if  income  is  less  than 
»776.64 

workers  receiving  less 
than  $778.64  yearly 

pregnancy  benefit;  British  sys- 
tem  most  complex   of  all  be- 
cause of  numerous  perplexing 
features 

Italy 

4 

industries,  factories;    private 
telephone  companies;  govern- 
ment employees  excluded 

nursing   room   for   mothers  in 
factory;  no  distinction  between 
married  and  unmarried  mothers 

Luxemburg 

4 

wage  earners 

salaried  employees  re- 
ceiving less  than  $1.93 
daily 

Netherlands 

unlimited  during  en- 
tire period  of  dis- 
ability 

regularly  employed 

to  be  specified  later 

no  distinction  between  legiti- 
mate and  illegitimate  children 

New  Zealand 

all  over  16  and  under    maternity  benefit  a  part  of  old 
45  years,  receiving  less    age  and  invalidity  insurance 
than  $1,000  yearly 

Norway 

2 

6 

all  wage  earners  and  salaried 
employees  over  15  years 

workers  receiving  less 
than  $482  yearly 

admirable   provisions   for   ille- 
gitimate child 

Russia 

2 

* 

all  wage  earners  in  factories 
using  mechanical  or  animal 
power 

requires  owner  to  furnish  hoB- 
pital  care;    present  conditions 
unknown 

Sweden 

2 

!  information  incomplete 

Switzerland 

6 

all  industries  and  occupations 

maternity  benefits  of  this  coun- 
try have  served  as  a  model  to 
many  others 

Colorado 

mothers  unable  to  care  for  children  specified  period, 
before  and  after  childbirth 

mothers'  pension  fund 

Missouri 

3 

3 

unlimited 

mothers'  pension  fund 

Pennsylvania 

additional  sum  for  unborn  child  if  mother  is  already 
receiving  pension 

mothers'  pension  fund 

42 


THE  JOITRNAL  OF  INDUSTRIAL  HYGIENE 


have  thus  far  been  made,  have  been  largely 
blanket  provisions  without  consideration 
of  the  individual  case  with  its  specific  prob- 
lems of  work  environment,  health,  etc. 
The  few  measures  in  practice  are  chiefly 
the  outcome  of  the  activities  of  govern- 
ments and  labor  bodies.  In  accepting  some 
responsibility  for  the  pregnant  woman  in 
industry,  these  agencies  have  adopted  two 
general  methods  of  procedure:  (1)  the  pro- 
hibition of  employment  of  women  on  any 
work  during  specified  periods  of  gesta- 
tion, the  prohibition  of  employment  of 
any  women  in  certain  trades,  and  the 
regulation  of  conditions  of  employment  for 
women  at  work;  ("2)  the  provision  of  ma- 
ternity benefits,  thus  making  the  necessity 
for  work  less  frequent. 

Although  these  existing  measures  are  dis- 
tinctly helpful,  they  are  palpably  inade- 
quate. Obvious  shortcomings  arise  from 
the  failure  to  provide  medical  guidance 
throughout  pregnancy  and  from  the  failure 
to  determine  more  definitely  the  influence 
of  specific  work  conditions  upon  maternity. 

Maternity  Benefits  and  Legal  Con- 
trol OF  THE  Pregnant  Woman's  Work 

Is  the  pregnant  working  woman  jeop- 
ardizing her  health  by  continuing  work 
after  the  onset  of  pregnancy?  Is  the  well- 
being  of  her  child  jeojiardized  by  lier  work- 
ing.'' When  should  the  pregnant  worker 
discontinue  work?  Are  there  certain  oc- 
cupations and  types  of  work  that  are  espe- 
cially harmful?  Is  the  fact  that  she  is  to 
give  birth  to  a  child  of  such  economic  im- 
portance that  she  is  entitled  to  some  form 
of  compensation?  In  this  country  such 
questions  have  until  recently  occasioned  no 
deep  concern  and  only  five  states  have  laws 
definitely  pertaining  thereto.  Fifteen  other 
countries  are  far  in  advance  of  the  United 
States  —  namely.  Great  Britain,  France, 
Italy,  Australia,  New  Zealand,  Germany, 
Austria,     Hungary,     Denmark,     Norway, 


Sweden,   Roumania,   Servia,    Switzerland, 
and  Russia.* 

Maiernity  Benefits  (1). — In  most  foreign 
countries,  maternity  benefits  are  included 
in  systems  of  social  insurance,  are  usually 
compulsory,  and  are  designed  to  protect 
the  health  of  the  mother  and  child  by  pro- 
viding moneys  and  medical  and  nursing 
care  before,  during,  and  after  childbirth. 
By  so  doing,  the  financial  burden  of  child- 
bearing  is  lessened  and  the  mother  is  as- 
sured freedom  from  the  necessity  of  exces- 
sive work  for  a  reasonable  period  of  time. 
These  insurance  systems  usually  consist  in 
one  of  the  following  four  types  or  in  a  com- 
bination of  certain  features  of  these  types: 

1.  A  fixed  sum  is  paid  at  the  birth  of  the 
child  —  the  state  supplying  the  funds. 

2.  Insurance  systems  to  which  the 
woman,  her  employer,  and  the  government 
contribute. 

3.  The  continuation  by  the  employer  of 
a  portion  of  the  wages  of  the  woman  — 
usually  from  50  to  75  per  cent. 

4.  The  provision  of  medical  and  nursing 
care  prior  to,  at,  and  after  delivery. 

Table  1  is  a  tabulation  of  the  major  pro- 
visions found  in  the  maternity  benefit  sys- 
tem in  force  in  various  countries,  and  in  a 
few  states  within  the  LTnited  States.  In  the 
countries  indicated  in  this  table,  particular 
features  in  the  treatment  of  the  problem 
are  noteworthy.  In  a  few  of  the  countries, 
the  maternity  bonus  is  available  to  every 
mother  irrespective  of  her  economic  status. 
In  others,  only  urban  workers  participate 
in  the  provisions  on  a  compvdsory  basis. 
In  certain  countries  the  type  of  work  or  the 
amount  of  the  wage  limits  the  persons  who 
are  included.  The  unmarried  mother  is  ex- 
cluded from  all  benefits  in  a  high  percent- 
age of  the  national  laws.  In  some  instances, 
race  prejudices  lead  to  the  exclusion  of 
mothers  of  designated  nationalities.  Dur- 
ing the  war  some  countries  extended  their 

*  Conditions  in  certain  of  these  countries  may  have 
disrupted  the  appHcation  of  existing  maternity  benefit 
measures. 


McCORD  AND  MINSTER  —  PREGNANT  WOMAN  IN  INDUSTRY      43 

TABLE  2.  —  LAWS  PROHIBITING  EMPLOYMENT  OF  PREGNANT  WOMEN 


Date 

Industries  Included 

Time 

Limit 

State  or  Country  > 

Before 

Confinement 

Weela 

After 

Confinement 

Weeks 

mill,  cannery,  workshop,  factory,  manufactur- 
ing or  mechanical  establishment 

2 

4 

Connecticut        .        

1913 

factory,  mercantile  establishmen  t ,  mill  or  work- 
shop 

i 

4 

1911 

mercantile,  manufacturing  or  mechanical  es- 
tablishment 

2 

4 

New  York 

1912 

factory,  mercantile  establishment,  mill  or  work- 
shop 

provision 

4 

Austria   

1917 

establishment  using  power  or  explosives,  build- 
ing trades,  establishments  in  industrial  code, 
transportation 

6 

Denmark  ^        .  .  . 

1901 

any  factory  work 

4 

France                        

1913 

industrial  or  commercial  undertaking 

4 

1911 

remunerative  employment 

4 

1908 

2 

6 

Italy 

1907 

factories,  agriculture,  etc. 

4 

Norway     

1915 

industrial  establishments 

4  (must  be 

permitted 

to  stop 

work) 

6 

Sweden 

1891 

industrial  establishments 

42 

Switzerland 

1877 

industrial  establishments 

2 

4 

I  According  to  unauthentic  information  the  state  of  Washington  pro- 
hibits the  employment  of  women  2  months  before  and  6  weeks  after 
confinement. 


provisions  so  as  to  encourage  child-bearing 
and  to  relieve  the  wives  of  soldier.s  and 
government  employees. 

Restrictive  Measures.  —  Practically  all 
industrial  countries  have  promulgated  laws 
forbidding  the  employment  of  women  in 
various  hazardous  trades  and  restricting 
the  hours  and  time  of  work.  These  laws, 
although  not  primarily  designed  as  protec- 
tive of  the  pregnant  woman,  are  distinctly 
beneficial  to  maternity.  In  addition,  a 
limited  number  of  states  and  countries  have 


2  Unless  she  has  doctor's  certificate. 

'  Medical  certificate  required  at  end  of  6  weeks. 


devised  laws  applying  peculiarly  to  the 
pregnant  woman.  Switzerland  was  the 
leader  in  legislation  of  this  kind.  In  1877, 
the  National  Council  prohibited  the  em- 
ployment of  pregnant  women  in  industrial 
plants  for  a  period  of  eight  weeks,  a  part  of 
which  was  prior  to  and  the  rest  subsequent 
to  delivery.  The  essential  features  of  this 
type  of  legislation  in  various  countries  are 
grouped  in  Table  2. 

At  the  time  of  the  International  Labor 
Conference   held   in   Washington,   D.    C, 


44 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


November,  1919,  the  following  draft  con- 
vention with  reference  to  the  pregnant 
working  woman  was  adopted: 

Abt.  3.  —  In  any  public  or  private  industrial  or 
commercial  undertaking,  or  in  any  branch  thereof, 
other  than  an  undertaking  La  which  only  members  of 
the  same  family  are  employed,  a  woman 

(a)  Shall  not  be  permitted  to  work  during  the  six 
weeks  following  confinement. 

(b)  Shall  have  the  right  to  leave  her  work  if  she 
produces  a  medical  certificate  stating  that  her  con- 
finement will  probably  take  place  within  six  weeks. 

(c)  Shall,  while  she  is  absent  from  her  work  in  pur- 
suance of  paragraphs  (a)  and  (6),  be  paid  benefits 
sufiicient  for  the  full  and  healthy  maintenance  of  her- 
self and  her  child,  provided  either  out  of  public  funds 
or  by  means  of  a  system  of  insurance,  the  exact 
amount  of  which  shall  be  determined  by  the  com- 
petent authority  in  each  country,  and  as  an  addi- 
tional benefit  shall  be  entitled  to  free  attendance  by 
a  doctor  or  certified  midwife.  No  mistake  of  the 
medical  advisor  in  estimating  the  date  of  confinement 
shall  preclude  a  woman  from  receiving  these  benefits 
from  the  date  of  the  medical  certificate  up  to  the 
date  on  which  the  confinement  actually  takes  place. 

{d)  Shall  in  any  case,  if  she  is  nursing  her  chUd, 
be  allowed  half  an  hour  twice  a  day  during  hours  for 
this  purpose. 

Aet.  4.  —  Where  a  woman  is  absent  from  her  work 
in  accordance  with  paragraphs  (o)  and  (6)  of  Article 
3  of  this  convention,  or  remains  absent  from  her 
work  for  a  longer  period  as  a  result  of  illness  med- 
ically certified  to  arise  out  of  pregnancy  or  confine- 
ment and  rendering  her  unfit  for  work,  it  shall  not  be 
lawful,  until  her  absence  shall  ha\e  exceeded  a 
maximum  period  to  be  fLxed  by  the  competent 
authority  in  each  country,  for  her  employer  to  give 
her  notice  of  dismissal  during  such  absence,  nor  to 
give  her  notice  of  dismissal  at  such  a  time  that  the 
notice  would  expire  during  sucli  absence. 

The  shortcomings  of  all  such  measures  lie 
in  (1)  the  scant  provision  made  for  the 
supervision  of  the  health  of  the  pregnant 
woman  throughout  the  gestation  period; 
and  (2)  the  lack  of  investigation  seeking  to 
determine  the  effects  of  specific  trades  and 
occupations  upon  maternity. 

Hygiene  of  the  Pregnant  Woman 

The  pregnant  woman  is  admittedly  bet- 
ter off  in  a  normal  home  environment  than 
at  work  in  a  factory.     With  the  proper 


guidance  and  supervision,  however,  it  will 
not  be  harmful  for  the  pregnant  woman  to 
work  if  work  is  an  economic  necessity  for 
her.  For  those  who  must  work,  then,  bet- 
ter health  supervision  and  general  guidance 
must  be  evolved. 

Is  Work  Harmful?  —  There  are  many 
opinions  as  to  the  harmfulness  of  work  for 
the  pregnant  woman.  Many  years  ago, 
Jones('2)  stated  that  "the  pregnant  woman 
should  not  be  employed  in  industrial  oc- 
cupations." More  recent  opinions  hold  that 
work  of  the  proper  sort  is  definitely  good  for 
the  normal  pregnant  woman.  All  books  on 
obstetrics  and  all  directions  for  the  hygiene 
of  the  pregnant  woman  recommend  mild 
exercise  and  fresh  air.  Industrial  work  may 
meet  all  these  requirements.  For  instance, 
Paradise  (3)  states  that  "ordinary  house- 
work and  many  of  the  chores  on  a  farm  af- 
ford mothers  the  opportunity  for  necessary 
exercise."  This  is,  of  course,  not  factory 
work  but  there  is  much  factory  work  less 
arduous  than  these  domestic  duties.  In 
the  usiuil  factorj'  there  are  many  occupa- 
tions which  are  less  harmful  than  some 
housework;  at  the  same  time,  it  is  true 
that  there  are  many  processes  not  at  all 
suited  to  the  pregnant  worker.  On  the 
whole,  we  can  accept  the  principle  laid 
down  by  De  Lee  (4) :  "  In  a  general  way  the 
gravida  should  not  change  her  usual  mode 
of  life  unless  the  physician  knows  that  some 
of  her  habits  are  bad." 

Medical  Examinafiun.  —  All  these  opin- 
ions apply  to  the  normal  pregnant  woman. 
The  crux  of  the  situation,  then,  is  to 
determine  whether  the  pregnant  woman  is 
normal  and  to  keep  a  close  watch  over  her, 
so  that  her  work  may  l)e  regulated  to  suit 
her  limitations.  If  proper  industrial  medi- 
cal service  is  maintained,  she  should  be  en- 
couraged to  consult  the  doctor  as  soon  as 
pregnancy  is  suspected.  If  the  doctor  con- 
firms her  suspicion,  a  thorough  examina- 
tion should  then  be  nuide.  'I'he  industrial 
physician  is  usually  not  competent  to  carry 


McCORD  AND  MINSTER  —  PREGNANT  WOMAN  IX  INDUSTRY      45 


out  a  satisfactory  obstetrical  examination, 
nor  is  the  average  practitioner  so  qualified. 
Upon  detection  of  pregnancy,  therefore,  the 
worker  should  be  referred  to  a  suitable 
clinic  or  to  an  obstetrician.  It  is  unneces- 
sarj'  to  describe  here  the  nature  of  the  ex- 
aminations which  should  be  made.  After 
the  initial  examination,  however,  subse- 
quent examinations  should  be  made  when 
recommended  by  the  obstetrician.  At  the 
very  least,  a  complet  e  examinat  ion  should  be 
made  during  theeighth  montli  of  pregnancy. 

Although  tjie  industrial  i)hysician  may 
not  be  qualified  to  make  specific  obstetri- 
cal examinations,  there  are  many  other 
requirements  for  the  general  health  of  the 
pregnant  woman  which  he  can  fulfil.  For 
instance,  one  obstetrician  emphasizes  the 
necessity  of  watching  the  teeth  and  bony 
structures  whicli  are  likely  to  be  aiVected 
because  of  the  alteration  of  the  phosphates 
of  these  tissues. 

Full  co-operation  should  exist  bi-tween 
the  plant  physician  or  emi)loyment  nuui- 
ager  and  the  specialist.  In  this  way  only 
can  the  obstetrician  know  of  the  nature  of 
the  woman's  work  and  thus  be  guided  in 
his  recommendations  to  the  plant  physician 
or  employment  manager.  A  great  respon- 
sibility rests  with  the  plant  physician  in 
his  having  a  complete  knowledge  of  trade 
processes,  occupational  and  safety  hazards, 
and  suitable  replacement  jobs  when  they 
are  necessary.  Constant  supervision  should 
be  exercised  throughout  by  the  plant  phy- 
sician. In  a  particular  munition  factory  in 
England  during  the  war,  the  women  re- 
ceived very  careful  supervision  and  a 
definite  routine  was  adopted.  Upon  noti- 
fication of  pregnancy  the  women  were  given 
suitable  work,  and  as  pregnancy  progressed 
they  were  changed  from  tmie  to  time  to 
work  that  was  even  better  adapted  to  their 
needs.  At  the  end  of  the  seventh  month, 
the  pregnant  woman  was  transferred  to  a 
particular  room  known  as  "the  general 
clothing  store  and  sewing  depot."    While 


she  was  at  work  in  this  room  she  was  visited 
every  week  bj'  a  physician  who  examined  a 
specimen  of  the  urine  and  made  other  ex- 
aminations. The  work  was  so  arranged 
that  the  women  could  remain  at  work  until 
just  before  parturition,  without  harm  to 
themselves  or  to  the  work  (5). 

Accident  Risk. — By  means  of  such  care- 
ful supervision,  the  risk  which  an  employer 
assumes  in  keeping  a  pregnant  woman  in 
his  employ  is  reduced  to  a  mininuuu.  No 
statistics  are  obtainable  as  to  the  frequency 
of  accidents  among  pregnant  industrial 
workers.  A  knowledge  of  the  physical  al- 
teration and  the  mental  preoccupation  of 
the  pregnant  woman,  however,  makes  ten- 
able the  assertion  that  she  is  much  more 
liable  to  industrial  accident  than  the  non- 
pregnant worker.  Late  in  pregnancy  loco- 
motion is  liami)ered  through  the  changed 
posture  made  necessary  by  her  adjustment 
to  her  shifted  center  of  gravity.  This  lean- 
mg  backward  not  only  alters  locomotion  but 
is  likely  to  prevent  her  from  seeing  where 
she  is  stepping.  Since  accidents  growing  out 
of  such  circmuslances  commonly  occur  to 
the  pregnant  woman  in  her  home,  we  may 
expect  such  mishaps  as  falling  over  obstruc- 
tions  in  passageways  and  downstairs  to  be 
no  less  conuuon  in  the  factory.  Accidents  of 
this  kin<l  frequently  result  in  miscarriage. 
Consequently,  the  employer  is  incuriing 
some  liability  in  retaming  in  his  employ 
women  in  an  advanced  stage  of  pregnancy. 

Abortion  and  miscarriage,  it  must  be 
remembered,  are  more  frequent  during  the 
early  stage  of  pregnancy  and  are  due  most 
often  to  causes  in  no  way  connected  with 
the  work  environment.  In  one  factory 
where  a  study  of  pregnant  women  was 
made,  among  101  pregnant  women  in  nine 
months,  there  were  fifteen  miscarriages, 
thirteen  of  which  were  abortions  occurring 
between  the  fifth  and  tenth  weeks.  Of  the 
two  miscarriages,  one  was  caused  by  an 
operation  for  carcinoma  of  the  cervix,  and 
the  other  was  due  to  syphilis  contracted 


46 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


during  the  sixth  month  of  pregnancy.  Of 
the  thirteen  abortions,  one  fell  out  of  bed, 
one  fell  downstairs  (the  report  does  not 
state  whether  at  home  or  in  the  factory), 
one  had  tuberculosis,  and  one  had  had  pre- 
vious miscarriages.  There  are  no  facts  as  to 
the  etiology  of  the  other  nine, but  from  these 
six  it  is  apparent  that  the  greater  risk  arises 
before  the  employer  has  been  notified — that 
is, before  pregnancy  is  definitely  established. 

As  is  well  knowTi,  carelessness  is  the  great 
cause  of  accidents.  Continual  vigilance  on 
the  part  of  all  workers  is  the  best  safety 
device.  In  the  case  of  the  pregnant  worker, 
a  concentration  on  her  immediate  work 
and  its  hazard  is  more  difficult,  because  she 
is  continually  mulling  over  her  abnormal 
relations  with  other  people  and  the  circum- 
stances attending  her  pregnancy  and  an- 
ticipated confinement.  The  recognition  of 
the  fact  that  the  pregnant  woman  is  an 
increased  accident  risk  should  not  lead  to 
her  elimination  from  the  plant  but  rather 
to  her  placement  in  non-hazardous  occupa- 
tions and  to  additional  education  in  pre- 
cautionary measures. 

Harmful  Occupations.  —  Throughout  the 
discussion  of  what  work  is  injurious  to  the 
pregnant  woman,  it  must  be  remembered 
that  any  conditions  which  are  bad  for  the 
normal  woman  worker  are  even  worse  for 
the  pregnant  worker.  This  statement  ap- 
plies to  the  hours  of  employment  as  well  as 
to  general  working  conditions.  If  the  woi"k 
is  wearing  and  the  normal  woman  finds 
eight  hours  of  work  a  strain,  the  pregnant 
woman  should  not  be  forced  or  allowed  to 
work  so  long.  The  pregnant  woman  should 
never  be  allowed  on  a  night  shift.  Night 
work  generally  means  that  the  woman  has 
so  nuich  to  do  at  home  in  the  daytime  that 
she  cannot  go  out  to  work.  The  pregnant 
woman  cannot  stand  the  strain  of  day  work 
and  night  work  in  addition.  'J'here  may 
even  be  certain  times  of  the  day  when  the 
pregnant  woman  cannot  work  Ijecause  of 
her  condition.    For  instance,  if  she  suffers 


from  morning  nausea,  she  should  be  al- 
lowed to  remain  at  home  until  such  time  in 
the  day  as  she  is  able  to  take  up  her  work. 

A  knowledge  of  what  constitutes  harmful 
conditions  must  be  based  on  the  individual 
case,  that  is,  the  woman  and  her  particular 
job.  There  are,  however,  some  general 
principles  which  can  help  the  physician  in 
determining  suitable  and  unsuitable  jobs 
for  the  pregnant  woman. 

Character  of  Work.  —  Generally  speak- 
ing, any  undue  physical  strain  is  bad  for 

T.^BLE  3.  — TYPES  OF  OCCUPATION  SHOWING 

TENDENCY  TO  PRODUCE  BAD  RESULTS 

AT  PREGNANCY 


Type  of  Occupation 

Number  of 
Women  Em- 
ployed during 

Pregnancy 

Bad  Cases 

Number 

Per  Cent. 

Active.  .  . 

213 
88 
30 

83 

23 

2 

39.0 

Sitting. 

26.1 

Standing 

6.0 

the  pregnant  woman.  De  Lee  states  that 
"jolts,  running,  sudden  motions,  lifting 
great  weights,  going  up  and  down  stairs 
quickly,  etc.,  should  be  avoided."  Dorland 
(6)  states  that  "lifting  of  heavy  weights, 
rimning  upstairs  and  other  violent  forms 
of  exercise  must  be  strictly  avoided  lest 
miscarriage  residt."  In  an  article  in  the 
Monthly  Labor  Review  (7),  there  are  re- 
ported five  types  of  occupation  which  are 
harmful:  («)  Continuous  sitting  has  a  bad 
efi'ect  at  delivery  as  well  as  on  the  mother's 
health  after  confinement;  {h)  standing  con- 
tinuously is  less  harmful  except  that  it 
tends  to  induce  varicose  veins;  (c)  lifting, 
reaching,  and  stretching  up  are  universally 
bad  during  pregnancy;  id)  jolting  is  bad, 
and  also  (e)  work  to  wliich  muscles  are 
not  accustomed. 

In  Table  3  figures  are  given  which  bear 
out  this  statement  of  the  evil  effects  of  ac- 
tive occupations,  sitting  occupations,  and 
standing  occupations  on  the  pregnant 
woman.  Bad  cases  are  those  which  had 
difficultv  in  some  form  or  other  before  or  at 


McCORD  AND  MINSTER  —  PREGNANT  WOIMAN  IN  INDUSTRY      47 

the  time  of  confinement.    What  the  active  eral  principles  in  mind,  the  industrial  phy- 

occupations  comprise  is  not  stated  but  it  sician  or  the  emplojTnent  manager  must  set 

may  be  assumed  that  lifting,  reaching,  and  about   analyzing   his   particular   industry, 

jolting  art?   included.     The   percentage   of  He  should  examine  each  process  at  which 

bad  cases  is  remarkably  high  in  this  group  women  are  employed,  with  a  view  to  deter- 

and,  indeed,  is  very  little  lower  in  the  sitting  mining  whether  the  worker  is  subjected  to 

occupations.  Although  the  figures  .show  the  any  of  the  strains  enumerated  above, 

standing  occupations  to  be  far  less  harmful  Specific  reconuneudations   in  regard  to 

than  the  other  types  of  work,  it  must  be  occupations  to  be  avoided  by  women  were 

remembered  that  only  thirty  women  are  made  in  the  survey  of  work  at  Niagara 

considered  —  almost  too  low  a  number  to  Falls.    The  Woman  in  Industry  Service  of 

be  decisive.    In  a  report  on  the  Proposed  the  Department   of  Labor  demanded  the 

Employment  of  Women  during  the  War  in  prohibition  of  the  employment  of  women  in 

Industries  of  Niagara  Falls  (8)  Ci^rtam  con-  (a)  shoveling  or  wheel  barrow  work,    (b) 

ditions  of  work  were  specified  which  were  yard  work,  (c)  loading  or  unloading  freight 

more  harmful  to  women,  particularly  in  re-  cars,   (d)   lifting  weights  over  '■25  pounds, 

gard  to  their  child-bearing  function,  than  The  first  three  types  of  work  are  obviously 

to  men.    Once  again  reference  is  made  to  harmful  but  they  serve  to  show  a  specific 

liftingheavy  weights,  unusual  stretching  or  analysis  of  an  industry.    The  fourth  is  of 

straining,  but    more  especially  to  contin-  especial  interest   because  it  established  a 

uous  standing,  as  bad  for  women  because  of  maximum  lifting  weight.    The  i)ermitted 

the  difference  in  their  body  structure,  in  weight  is  probably  excessive  and  admittedly 

other  words,  the  structure  of  their  repro-  applies  only  to  some  women,  and  mu.st  be 

ductive  organs.    If  continuous  standing  is  only  an  occasional  process,  not  a  continuous 

noticeably  harmful  for  women  in  general  on  one.  The  reconunendalions  of  I hvW  oman  in 

this  account,  how  much  more  harmful  is  it  Industry  Service  were  nuide  with  reference 

for   pregnant   women    in    particular,   who  to  all  women  but  they  may  be  used  as  a 

have  an  additional  strain  on  these  organs,  gauge  in  the  case  of  the  pregnant  woman. 

Indeed,  there  can  be  no  fjuestion  that  con-  Of  more  definite  value  in  this  regard  is 

tinuous  standing  is  as  harmful  for  pregnant  the  survey  of  the  textile  industry  (!)).    It 

women  as  any  other  of  the  specified  forms  was  found  that   the   mortality   rate  from 

of  physical  exertion.  puerperal  infections  ami  childbirt  li  is  higher 

The  character  of  the  work  may  involve  in  textile  towns  than  in  non-lexlile  towns 

a    nervous   strain    as    well    as    a    physical  where  there  are  not  nearly  so  numy  married 

strain.    The  mental  attitude  of  the  preg-  women  employed.     The  V.   S.  Bureau  of 

nant  woman  which  causes  her  distraction.  Labor  Statistics  made  an  investigation  of 

referredtoabove,  isduetothefact  thather  preventable   deaths   in   the   cotton  manu- 

whole  nervous  system  is  abnornud.   She  is  facturing  industry,  process  by  process.    In 

morbid,  sensitive,  and  at  times  hysterical,  thecardroom  the  work  involves  lifting  bob- 

For  this  reason  any  undue  strain  on  her  bins  weighing  from '2  to  4  pounds  each,  and 

nervous  system   is  felt   more  than   if  she  placing  them  on  frames  5  to  (i  feet  high, 

were    normal.     Monotony,    speeding    up.  This  involves  lifting  and  stretching-^ tvvo 

noise,  vibration,  a  high  degree  of  concen-  of  the  physical  strains  to  be  avoided.    Ihe 

tration,  all  cause  a  strain  on  the  nervous  effect  which  this  work  has  upon  the  married 

system    of    the    pregnant    woman,    which  woman  and  consequently  upon  the  preg- 

ought  to  be  avoided.  nant   woman   is   very   evident    when   the 

Analysis  of  Work.  —  Keeping  these  gen-  statistics  of  deaths  from  various  causes  ac- 


48 


THE  JOLTRNAL  OF  INDUSTRIAL  HYGIENE 


cording  to  conjugal  state  are  examined. 
The  deaths  from  tuberculosis  among  un- 
married card  room  workers  exceeded  those 
of  unmarried  non-operatives  by  93  per 
cent.;  the  deaths  of  married  card  room 
workers  exceeded  those  of  married  non- 
operatives  by  323  per  cent.  The  deaths 
of  umiiarried  operatives  from  non-tuber- 
culous causes  exceeded  those  of  married 
non-operatives  by  81  per  cent.  The  report 
states  that  the  high  death  rate  of  married 
operatives  is  influenced  by  the  continued 
lifting  of  bobbins  and  placing  them  on 
frames  above  their  heads.  This  process 
"may  quite  probabjy  constitute  a  contrib- 
utory cause  of  death  from  prematurely 
terminated  pregnancy  and  from  child- 
birth." In  the  spinning  room,  where  the 
work  demands  constant  walking  or  stand- 
ing in  a  hot,  moist  atmosphere,  the  per- 
centage of  deaths  of  married  operatives 
between  the  ages  of  15  and  44  years  from 
causes  other  than  tuberculosis  —  parturi- 
tion fatalities  —  is  highest.  The  cjeaths 
from  parturition  nmnber  twenty-eight  for 
operatives  in  this  department  as  against 
five  for  non-operatives;  or  the  death  rate 
per  1,000  from  this  cause  is  4.72  for  opera- 
tives as  against  0.53  for  non-operatives.  In 
the  weave  room,  where  the  women  do  much 
bending  over  looms  and  generally  carry  the 
cloth  weighing  from  15  to  18  pounds  to  the 
scales,  the  death  rate  among  the  married 
women  is  very  high. 

In  Table  4  the  excess  of  deaths  among 
married  operatives  over  those  among  mar- 
ried non-operatives  is  appalling.  The  re- 
port throws  some  light  on  the  cause  of 
this  excess  in  the  following  statement :  "It 
will  readily  be  appreciated  how  much 
fatigue  such  lifting  (15-18  pounds)  induces 
and  how  great  is  the  danger  to  the  expect- 
ant mother,  especially  during  the  last  half 
of  her  pregnancy."  In  the  spooler  room 
the  physical  strain  resembles  that  of  the 
weave  room.  There  is  a  great  excess  of 
deatlis  of  married  women  over  those  of 


single  women,  due  almost  entirely  to  partu- 
rition fatalities.  The  deaths  among  married 
operatives  exceed  those  of  married  non- 
operatives  from  non-tuberculous  causes. 

The  number  of  deaths  among  married 
women  operatives  in  each  room  was  shown 

TABLE   4.  —  PERCENTAGE    BY   WHICH    DEATH 

RATES  OF  FE^L\LE  WEAVERS  EXCEEDED 

(4-)  OR  FELL  BELOW  (-)  RATES  FOR 

FEMALE  NON-OPERATIVES 


Conjugal  State 


Single.  .  . 
Married. 


Cause  of  Death 


Tuberculous 


—      5 

+226 


Non- 
Tuberculous 


+     7 
-1-160 


to  be  markedly  higher  than  that  of  either 
single  women  operatives  or  married  non- 
operatives.  The  deaths  from  parturition 
causes  followed  this  general  trend  without 
exception.  Further  figures  for  the  cotton 
industry  as  a  whole  show  that  many  deaths 
which  were  classified  as  "Tuberculous" 
were  "Parturition  Complicated."  (See 
Table  5.)  The  character  of  the  work,  as  it 
is  described,  can  without  doubt  be  held  re- 
sponsible for  this  high  mortality.  Figures 
for  the  industry  as  a  whole  showing  the 
deaths  from  parturition  for  operatives  and 

TABLE  5.  —  TUBERCITLOUS  DEATHS  AND  DEATH 
RATES  PER  1,000  AMONG  MARRIED  FEMALES 
(15-44  YEARS)  BY  CAUSE  AND  OCCUPATIONAL 
GROUP 


Number  of  Deaths 

Death  Rate  per  1(000 

Occupational 
Group 

Not  Parturi- 
tion Com- 
plicated 

Parturition 
Complicated 

Total 

111 

If 

£6 

Num- 
ber 

Per 
Cent. 

ToUl 

Operatives. .  .  . 
Non-operatives 

88 
77 

87 
19 

30 
20 

125 
96 

3.56 
1.06 

2.0 
0.36 

5.56 
1.42 

non-operatives  bear  out  this  conclusion. 
Between  the  ages  of  15  and  24  the  death 
hazard  complicated  with  parturition  is 
seven  times  as  great  for  operatives  as  for 
non-operatives;  between  the  ages  of  25  and 
34,  the  death  hazard  is  three  times  as  great; 
and  between  the  ages  of  35  and  44,  the  death 


McCORD  AND  MINSTER  —  PREGNANT  WOMAN  IN  INDUSTRY      49 


hazard  is  equal.  The  conchision  of  the 
whole  report  is  that  "employment  in  cotton 
mills  for  mothers  of  child-bearing  age  is 
generally  inimical  to  longevity  of  mothers." 

It  must  be  remembered  that  this  report 
contemplates  only  the  deaths  in  the  cotton 
industry.  How  many  women  and  how 
many  children  have  been  definitely  harmed 
but  not  killed  by  the  employment  of 
women  during  pregnancy  was  not  investi- 
gated. This  survey  shoidd  stimulate  addi- 
tional inquiries  into  the  cotton  industry 
and  into  every  other  industry  employing 
women,  with  a  view  to  bringing  to  light 
similar  race  hazards. 

The    general    conditions    in     industry, 
which  we  have  discussed,  do  not  constitute 
the  only  hazards  to  the  pregnant  wonuin. 
There  are  many  industries  which  utilize  sub- 
stances which  in  themselves  are  harmful. 
These   substances   are   commonly  classed 
as  harmful  to  women  in  general  and  are, 
therefore,  more  especially  injurious  to  the 
pregniftit  woman.    On  this  account,  many 
of  the  following  occupations  are  prohibited 
to  women  (10)  both  in  this  country  and  in 
certain  foreign  countries:     (1)  the  making 
of  electric  accumulators;  (2)  manufacture 
of  paints,  varnishes,  and  colors;  (3)  brass 
casting,  zinc  and  lead  smelting;  (4)  certain 
processes  of  glass  manufacturing;   (5)  the 
manufacture  of  high  explosives   (previous 
to  the  war) ;  (6)  the  curing  and  tanning  of 
skins  and  hides.    In  France,  lace  bleaching 
with  white  lead,  sharpening  or  polishing  of 
metals,   and  coating  mirrors  with   quick- 
silver  are   among  the   many   occupations 
prohibited.      All  the  countries  prohibit  the 
employment  of  women  in  any  lead  mdus- 
try.  The  majority  of  occupations  forbidden 
to   women  involve  the  presence  of  dust, 
fumes,  vapors,  gases   or  substances   of  a 
poisonous  character.   There  are  many  more 
industries  which  could  properly  be  included 
in  this  list,  especially  when  they  are  con- 
sidered specifically  with  regard  to  the  preg- 
nant woman;  i.  e.,  such  industries  as  the 


manufacture  of  cordage  and  twine,  enam- 
eling, the  rubber  industry,  and  pearl  button 
manufacture. 

In  a  series  of  articles.  Dr.  Alice  Hamil- 
ton   (11)   has  described  the  occupational 
effects  of  many  chemicals  used  in  industry. 
There  are  many  which  are  especially  harm- 
ful to  the  pregnant  woman,  such  as  ben- 
zene, used  principally  in  the  manufacture  of 
rubber,  in  paint  and  varnish  removers,  in 
making  aniline  dyes;  nitrobenzene,  used  in 
cleaning  establishments;  aniline,  employed 
in  the  manufacture  of  dyes,  rubber,  and 
black  paints,  and  in  printing  trades,  etc.; 
arsenic,  used  in  a  large  number  of  indus- 
tries, such  as  in  the  manufacture  of  in- 
secticides.    Any   substance    affecting   the 
kidneys  is  particularly  dangerous  for  the 
pregnant   woman   because  of  the  already 
overbinxiened  renal  functions  at  this  time. 
The  poisoning  which  results  from  the  use  of 
mercury,  in  processes  such  as  silvermg  of 
mirrors,  making  of  incandescent  lamps,  and 
felt  hat  manufacture,  is  especially  prone  to 
affect  the  pregnant  woman.    Carbon  mon- 
oxide i)oisoning,  which  is  one  of  the  most 
commonly  encountered  industrial  intoxica- 
tions, is  a  hazard  in  many  lavmdries,  in 
tailoring  trades  and  in  bakeries,  where  gas 
burners  are  used.   When  this  gas  is  inhaled 
in  only  moderately  large  quantities  it  has 
distinctly  deleterious  effects  both  on  the 
normal  and  the  gravid  woman. 

The  lead  industry  seems  to  be  the  most 
hazardous  industry  for  the  pregnant 
woman.  Lead  poisoning  takes  many  forms, 
for  women  its  most  disastrous  effect  being 
on  the  generative  organs.  In  her  report  on 
Women  in  the  Lead  hidxistries  (12),  Dr. 
Alice  Hamilton  states  that  "women  who 
suffer  from  lead  poisoning  are  more  likely 
to  be  sterile  or  to  have  miscarriages  and 
stillbirths  than  are  women  not  exposed  to 
lead.  If  they  bear  living  children,  these  are 
more  likely  to  die  during  the  first  year  of 
life  than  are  the  children  of  women  who 
have  never  been  exposed  to  lead.     This 


50 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


means  that  lead  is  a  race  poison."  Dr. 
Hamilton  cites  the  following  statistics 
from  the  report  of  the  British  factory  in- 
spector for  1897  as  striking  proof  of  this 
fact:  Out  of  62  women  who  were  pregnant, 
15  never  bore  a  living  child.  There  were 
212  pregnancies  among  these  62  women, 
but  only  61  living  children  resulted;  the 
stillbirths  numbered  21;  the  miscarriages, 
90.  There  are  many  available  proofs  of  the 
danger  to  pregnant  women  from  employ- 
ment in  occupations  that  bring  them  in 
contact  with  lead,  and  many  obscure  in- 
stances of  lead  poisoning  in  addition  to  the 
well-known  cases.  For  instance,  com- 
mercial artists  or  retouchers  use  a  great 
deal  of  white  lead,  thinking  that  it  is  zinc. 
Lithotransfer  work  consists  of  preparing 
transfer  papers  with  lead  colors.  There  are 
many  more  such  industries  where  lead  poison- 
ing is  common,  though  seldom  recognized. 

Summary 

1.  The  pregnant  woman  is  better  off  in 
the  normal  home  environment  than  at  work 
in  a  factory. 


2.  With  proper  supervision,  however,  it 
will  not  be  harmful  for  the  normal  preg- 
nant woman  to  work,  if  work  is  an  economic 
necessity  for  her. 

3.  All  pregnant  working  women  should 
receive  careful  medical  and  vocational 
supervision. 

4.  The  abnormal  pregnant  woman  should 
discontinue  work,  and  should  resume  it  only 
on  the  advice  of  a  competent  physician. 

5.  The  pregnant  woman  is  an  increased 
accident  risk  for  the  manufacturer.  By 
means  of  careful  supervision,  however,  this 
risk  may  be  reduced  to  a  minimum. 

6.  Any  occupation  that  is  harmful  to  the 
general  woman  worker  is  of  greater  harm  to 
the  pregnant  worker. 

7.  The  following  types  of  occupations 
are  harmful:  (ct)  continuous  sitting;  (b) 
continuous  standing;  (c)  repeated  lifting, 
reaching,  stretching;  {d)  jolting;  {e)  any 
work  requiring  new  muscle  adaptations. 

8.  Certain  specific  occupations  are  dis- 
tinctly harmful  to  pregnancy  and  to  child- 
bearing  functions.  Lead  trades  constitute 
the  outstanding  example  of  this  group. 


BIBLIOGRAPHY 


1.  Harris,  H.  J.:  Maternity  Benefit  Systems  in 
Certain  Foreign  Countries.  U.  S.  Bur.  Labor 
Statis.,  Children's  Bur.  Pub.  No.  57,  1919. 

2.  Jones,  H.  R.:  On  the  Protection  of  the  Health 
of  Female  Workers,  with  Special  Reference  to 
Pregnancy  and  Wet  Nursing.  Jour.  San.  Inst., 
1894-1895,  15,  515. 

3.  Paradise:  Maternity  Care  in  a  Homesteading 
County  in  Montana.  U.  S.  Dept.  Labor,  Bull. 
.'U,  1919,  p.  53. 

4.  De  Lee,  J.  B.:  The  Principles  and  Practice  of 
Obstetrics.    Pliiladeli)liia,  1913. 

5.  .\damson,  R.  H.  B.,  and  Palmer-Jones,  H.:  The 
Work  of  a  Department  for  Employing  Expect- 
ant Mothers  in  a  Munition  Factory.  Brit.  Med. 
Jour.,  1918,  2.  309. 

0.  Dorland:  Motlern  Obstetrics,  General  and 
Operative.  2d  Edition,  Philadelphia  and  Lon- 
don, 1901. 

7.    Effect  of  Industrial  Employment  of  Women 


upon  Maternity.     U.   S.   Bur.   Labor   Stalls., 
Month.  Labor  Rev.,  1918,  7,  1344. 

8.  Proposed  Employment  of  Women  during  the 
War  in  Industries  of  Niagara  Falls,  N.  Y.  U.  S. 
Bur.  Labor  Statis.,  Month.  Labor  Rev.,  1919,  8, 
231. 

9.  Perry,  \.  R.:  Prevental)le  Death  in  the  Cotton 
Manufacturing  Industry.  V.  S.  Bur.  Labor 
Stalls.,  Bull.  251,  1919. 

10.  Andrews,  I.  O.:  The  Protection  and  Promotion 
of  the  Health  of  Women  Wage  Earners.  KoIht 
and  Hanson's  Diseases  of  Occupation  and  \'(K'a- 
tional  Hygiene.  Philadelphia,  P.  Blakiston's 
Son  and  Company,  1916,  p.  834. 

11.  Hamilton,  \.:  Industrial  Poisoning  by  Com- 
pounds of  the  .\romatic  Series.  Jouu.  Indust. 
Hyg.,  1919-1920,  1,  200.  Inorganic  Poisons, 
Other  than  Lead,  in  American  Industries. 
Ibid..  89. 

12.  Hamilton,  .\.:  Women  in  the  Lead  Industries. 
U.  S.  Bur.  Labor  Stalls.,  Bull.  2.53,  1919. 


A  METHOD  FOR  DETERMINING  THE  FINER  DUST 
PARTICLES  IN  AIR* 

A.  L.  MEYER,  M.D. 

Associate  in  Physiological  Hygiene,  School  of  Hygiene  and  Public  Health,  The  Johns  Hopkins  Unieersity 


IT  is  well  known  that  a  suspension  may 
be  removed  from  air  by  bringing  the  air 
in  contact  with  water.  The  more  intimate 
and  prolonged  the  contact,  the  more  effi- 
cient will  be  the  removal.  One  of  the 
simplest  means  of  effecting  such  an  inti- 
mate mixture,  for  purposes  of  dust  anal- 
ysis, is  to  introduce  a  small  volume  of  air 
into  a  syringe  containing  some  water.  The 
syringe  may  then  be  shaken  vigorously  and 
a  very  thorough  mixture  of  air  and  water 
accomplished.  If  a  drop  of  the  water  be 
examined  with  the  microscope  by  ordinary 
illumination,  very  few  particles,  if  any,  will 
be  seen;  by  oblique  illumination,  however, 
the  minute  matter  scintillates  in  the  field 
and  may  readily  be  countetl.  This  con- 
stitutes, in  brief,  the  jirinciples  of  the 
method  presented  in  this  paper,  a  method 
that  is  concerned  chiefly  with  the  minute 
particles. 

In  E.  V.  Hill's  method  (1)  the  air  is  drawn  tiirougii 
the  narrow  nozzle  of  a  capsule  attached  to  a  metal 
syringe;  whereupon  some  of  tlie  i)articles  imijinge 
upon  a  small  glass  slip  covered  with  a  thin  layer  of  a 
transparent  adhesive  mixture.  A  variable  percentage 
of  particles  is  actually  caught,  owing  partly  to  the 
fact  that  the  particles  differ  in  inertia.  The  greater 
the  inertia,  the  greater  the  likelihood  of  their  being 
directed  against  the  adhesive  surface.  Because  of 
this  property  of  inertia,  the  rate  with  which  the 
piston  of  the  syringe  is  withdrawn  will  influence  the 
result.  The  count  is  made  with  ordinary  illumina- 
tion. 

Palmer's  method  (2)  consists  in  the  filtration  of 
air  by  means  of  the  water-spray;  but  here  again  the 
removal  is  far  from  complete.  Katz,  Longfellow,  and 
Fieldner  (3)  find  that  the  Palmer  apparatus  retains 
about  45  per  cent,  by  weight  of  air-floated  silica  and 
13  per  cent,  of  tobacco  smoke  as  measured  by  the 
Tyndall  effect.  The  air  passing  at  the  rate  of  i  cubic 


Received  for  publication  March  2,  1921. 


feet  per  minute  is  in  contact  with  the  water  but  a 
\ery  short  time. 

Aitken  devised  a  method  for  the  estimation  of  at- 
mospheric dust  (4)  based  on  tlie  principle  that  the 
dust  particles  serve  as  nuclei  for  the  condensation  of 
water-vapor.  In  this  case  all  particles,  even  the 
minutest  or  those  of  an  ionic  nature,  are  included  in 
the  precipitation  and  share  in  the  count.  The 
watery  envelope  makes  any  determination  of  size 
difficult.  The  coalescence  and  evaporation  of  drop- 
lets may  easily  give  rise  to  erroneous  counts.  It  is  a 
method  requiring  extraordinary  care  and  skill. 

Bill's  electric  precipitation  method  (5)  is  in  proc- 
ess of  development.  The  removal  of  dust  particles 
appeared  to  be  greater  than  in  Palmer's  method  but 
in  its  present  form  it  is  unsuitable  for  field  work.  In 
this  method,  as  in  .Vitken's,  all  particles  of  whatever 
size  tend  to  undergo  precipitation.  The  determina- 
tion is  gravimetric. 

Procedure 

A  Luer  syringe  graduated  to  100  c.  c.  but 
having  a  capacity  of  about  160  c.  c:  is 
thoroughly  cleaned  with  soap  and  water 
and  alcohol  to  remove  all  grease.  It  is  then 
rinsed  with  freshly  distilled  water  and 
filled  with  distilled  water  free  from  air 
bubbles.  After  forcing  out  all  the  water, 
^O  c.  c.  of  distilled  water  are  taken  into  the 
syringe  from  an  Erlenmeyer  flask  provided 
with  a  cotton-wool  filter  (Figure  1).  The 
syringe  is  now  ready  for  the  air  sample. 
The  piston  is  withdrawn  sufficiently  to  ad- 
mit approximately  100  c.  c.  The  exact  vol- 
ume may  be  read  from  the  graduation. 
While  placing  the  finger  tightly  against  the 
nozzle,  a  piece  of  rubber  membrane  inter- 
vening, the  syringe  is  shaken  vigorously  for 
one  minute  with  an  up  and  down  motion. 
With  the  syringe  in  a  vertical  position  the 
water  is  brought  up  to  the  very  tip  of  the 
nozzle    and    then    withdrawn    slightly    to 


51 


52 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


admit  a  small  bubble  of  air.  This  manipu- 
lation is  intended  to  catch  the  particles 
adherent  in  the  narrow  portion  of  the  nozzle 
and  bring  them  into  suspension. 

The  next  step  consists  in  allowing  a  drop 
to  flow  from  the  syringe  into  the  chamber 


mination.  It  is  well  to  have  on  hand  several 
handkerchiefs  of  pure  linen  that  have  been 
washed  several  times.  Lens  paper  is  useless. 
The  ruled  surface  is  thoroughly  rubbed 
with  the  thumb,  under  a  tap  of  warm  water, 
and  finally  rinsed  for  a  moment  in  hot 
water.  It  is  then  placed  upon  the  table  and 
rubbed  to  dryness  with  linen  wrapped 
smootlily  and  tightly  about  the  forefinger, 
the  latter  being  applied  with  considerable 


Fig.  1.  — 1.  Erienmeyer  flask.  2.  Glass  tube.  3.  Glas^ 
tube  containing  cotton-wool.  4.  Rubber  tubing.  5.  Pure 
gum  connecting  piece.  6.  Luer  syringe.  7.  Metallic  con- 
necting piece. 

of  a  Levy  blood  counter.  This  is  best  done 
with  the  metal  connecting  piece  on  the 
nozzle.  The  particles  are  counted  by 
oblique  illumination.  The  results  reported 
in  this  paper  were  obtained  with  the  No.  3 
objective  of  a  Leitz  microscope  with  a  cir- 
cular piece  of  blue  glass  below  the  Abbe 
condenser.  A  75-watt  Mazda  tlaylight 
lamp  was  placed  in  front  of  the  mirror,  a 
jar  of  water  intervening  to  absorb  the  heat 
rays.  Both  lamp  and  jar  were  covered 
with  an  asbestos  hood. 

It  will  require  patient  practice  in  the  be- 
gmning  to  free  the  ruled  surface  and  cover 
of  the  Le\7'  chamber  of  dust  particles.  A 
surface  suflScientlj'  clean  for  ordinary  illu- 
mination will  not  do  at  all  for  oblique  illu- 


pressure.  The  slide  should  be  examined 
with  the  microscope  for  cleanliness  and 
then,  with  ruled  surface  downi,  supported  on 

a  tin  I |-shaped  holder  and  covered  with  a 

shallow  dish  until  the  cover-slip  is  cleaned. 
If  the  sample  is  taken  some  distance  from 
the  laboratory  the  syringe  may  be  filled  in 
the  laboratory  and  the  piston  fixed  in  posi- 
tion by  attaching  a  short  length  of  glass  rod 
to  the  nozzle  by  means  of  black  gum  tubing 
free  from  powder.  After  the  sample  has 
been  taken,  it  remains  in  the  syringe  with 
the  piston  fixed.  This  permits  another 
thorough  niixlure  on  reaching  the  labora- 
tory. The  entire  number  of  particles  in 
two  fields,  each  a  square  millimeter,  are 
counted.  The  average  of  these  two  counts 
is  used  in  the  calculation.  Those  fields  are 
selected  which  are  divided  into  sixteen 
smaller  areas,  each  a  sixteenth  of  a  square 
millimeter.  The  particles  must  be  allowed 
to  settle  before  the  coimt  is  made. 

a  modificatiox  of  the  foregolng 
Procedure 

A  few  determinations  have  been  made 
with  a  modification  of  the  above  method, 
somewhat  more  complicated,  but  based  on 
exactly  the  same  princijile.  In  this  paper 
the  steps  will  be  merely  indicated. 


MEYER  —  DETERMINATION  OF  FINER  DUST  PARTICLES  IN  AIR     53 


A  test  tube  of  150  c.  c.  capacity,  provided 
with  a  glass  stopper  perforated  by  two  glass 
tubes,  one  of  which  extends  to  the  bottom, 
is  filled  with  distilled  water.  A  filter  (Fig- 
ure 2)  is  connected  with  the  short  tube. 


Results 

Before  proceeding  with  the  actual  deter- 
mination of  particles  present  in  air,  it  ap- 
peared desirable  to  test  the  consistency  of 


The  syringe  being  attached   to  the  long     the  method  with  a  prepared  suspension  of 


Fig.  2.  —  1.  Filter  coiilaiiiing  cotton-wool.  2.  Test 
tube  provided  with  glass  stopper  perforated  by  two  glass 
tubes.  3  and  4.  Pure  gum  eonneeliug  pieces.  5.  Luer 
syringe. 


tube,  the  contents  of  the  test  tube  are 
emptied  to  the  30  c.  c.  mark.  The  test  tube 
now  contains  filtered  air  and  30  c.  c.  of  dis- 
tilled water.  An  air  sample  may  be  taken 
by  removing  the  filter  and  connecting  the 
short  tube  with  the  syringe.  After  vigor- 
ously shaking  the  test  tube,  the  syringe  is 
again  connected  with  the  long  tube  for  the 
purpose  of  bringing  into  suspension  all  par- 
ticles adherent  in  the  long  tube.  This  is 
done  by  moving  the  piston  back  and  forth 
a  short  distance.  Finally,  a  portion  of  the 
water  is  allowed  to  remain  in  the  syringe  so 
that  a  drop  may  be  transferred  to  the 
counting  chamber. 


kaolin  and  another  of  smoke.  It  was  con- 
ceivable that  in  transferring  a  drop  of  water 
certain  factors,  such  as  surface  tension, 
might  so  alter  the  distribution  of  the  par- 
ticles as  to  render  the  coimts  very  irregular. 
Accordingly,  a  small  quantity  of  kaolin  was 
placed  in  a  beaker  with  water  and  stirred. 
The  coarser  particles  were  allowed  to  settle 
and  the  supernatant  suspension  decanted. 
The  smoke  suspension  was  prepared  by 
blowing  a  little  tobacco  smoke  into  a  flask 
containing  water.  After  shaking  the  flask, 
the  contents  were  poured  into  another 
flask  and  protected  from  the  room  dust. 
The  results  were  sufiiciently  consistent  and 
clearly  indicated  that  no  factors  ojjerate  to 
introduce  serious  irregularity  in  (his  part  of 
the  procedure. 

Counts  made  with  distilled  water  alone 
—  not  prepared  with  unusual  care  — 
showed  an  average  number  of  particles  per 
square  millimeter  of  VZ  ±  2.  This  figure  is 
used  as  a  correction  in  calculating  the  luim- 
ber  of  particles  per  unit  volume  of  air.  The 
distilled  water  is  not  entirely  responsible  for 
this  count;  some  particles  unavoidably  re- 
main on  the  ruled  surface  during  the  clean- 
ing process. 

The  results  of  the  determinations  of  the 
dust  content  of  outdoor  air  and  laboratory 
air  appear  in  Table  1.  The  outdoor  samples 
were  obtained  in  a  street  comparatively 
free  of  traffic;  those  of  indoor  air  were 
taken  in  one  of  the  rooms  of  the  laboratory 


54 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


TABLE  1.  — DUST  PARTICLES 

IN  THE  AIR 

Source  of  Sample 

Number 
of  Sample 

Size  of 

Sample 

(c.c.) 

Time 

Count  per  Sq.  Mm. 

Difference 

Average 
Count  per 
Sq.  Mm. 

Particles 

Date 

1st 
Field 

2d 
Field 

per  c.c. 
of  Air 

October      30 

outdoors 

1 

103 

10:30 

34 

28 

6 

31 

36,800 

2 

202 

11:10 

40 

50 

10 

45 

32,600 

November  1 

u 

1 

202 

1:30 

31 

29 

2 

30 

17,800 

2 

306 

2:05 

38 

50 

12 

44 

20,900 

3 

405 

3:50 

53 

60 

7 

57 

22,200 

November    3 

u 

1 

205 

9:45 

55 

54 

1 

55 

41,900 

2 

207 

11:00 

52 

51 

1 

52 

38,600 

November    -1 

u 

1 

102 

10:30 

33 

38 

5 

36 

47,000 

2 

202 

11:40 

59 

53 

6 

56 

43,500 

3 

205 

4:40 

50 

53 

3 

52 

39,000 

November    5 

u 

1 

205 

1:42 

43 

53 

10 

48 

35,000 

2 

302 

2:50 

58 

56 

2 

57 

29,500 

November    8 

a 

1 

306 

10:30 

64 

68 

4 

66 

35,200 

2 

203 

11:50 

43 

44 

1 

44 

31,500 

3 

101 

1:25 

27 

30 

3 

29 

33,600 

4 

205 

2:40 

39 

51 

12 

45 

32,100 

5 

100 

3:50 

31 

31 

0 

31 

38,000 

6 

102 

4:30 

25 

32 

7 

29 

33,300 

January        5 

u 

1 

102 

9:35 

47 

63 

19 

57 

88,200 

2 

202 

9:42 

92 

103 

11 

98 

85,100 

3 

207 

9:47 

96 

101 

5 

98 

82,600 

October       28 

laboratory 

1 

105 

10:45 

41 

39 

2 

40 

53,300 

2 

102 

11:30 

38 

35 

3 

37 

49,000 

3 

102 

1:00 

34 

36 

2 

35 

45,000 

November    9 

u 

1 

204 

10:30 

67 

70 

3 

69 

55,800 

2 

202 

11:09 

73 

67 

6 

70 

57,400 

3 

202 

1:15 

68 

62 

6 

65 

52,400 

4 

202 

2:20 

60 

60 

0 

60 

47,500 

5 

204 

3:00 

71 

53 

18 

62 

50,000 

6 

202 

3:50 

64 

65 

1 

65 

52,400 

November  10 

a 

1 

205 

10:05 

53 

43 

10 

48 

35,100 

2 

206 

1:00 

56 

52 

4 

54 

40,700 

December  28 

u 

1 

206 

1:00 

62 

70 

8 

66 

52,400 

2 

206 

2:20 

61 

51 

10 

56 

42,700 

3 

205 

3:35 

67 

54 

13 

61 

47,800 

December  31 

u 

1 

102 

10:45 

37 

49 

12 

43 

60,700 

2 

102 

11:15 

45 

31 

14 

38 

50,900 

January       4 

closed  cabinet 

1 

102 

1:10 

31 

34 

3 

33 

41,100 

2 

101 

2:05 

33 

35 

2 

34 

43,500 

in  whic-h  there  was  generally  but  one  oc- 
cupant. If  the  dust  content  of  the  air  were 
absolutely  constant,  our  method  would  not 
permit  us  to  expect  a  better  agreement 
than  the  figures  in  the  table  actually  show. 
With  one  or  two  exceptions,  the  average 
deviation  of  the  number  of  dust  particles 
per  cubic  centimeter  of  air  is  not  more  than 
±4,000  for  100  c.c.  samples,  nor  more  than 


±2,000  for  200  c.  c.  samples.  The  deriva- 
tion of  these  figures  will  readily  be  under- 
stood upon  recalling  that  the  average  count 
for  distilled  water  is  12  ±2.  Owing  to  the 
small  number  of  samples  in  most  of  the 
sefies,  there  is  no  significance  in  the  fact 
that  in  one  or  two  instances  the  above 
limits  are  slightly  exceeded. 

The  results  in  the  table,  therefore,  mean 


MEYER  —  DETERMINATION  OF  FINER  DUST  PARTICLES  IN  AIR    55 


that  the  amount  of  dust  present  in  the  air 
on  any  single  day  was,  in  general,  practi- 
cally constant  under  the  conditions  that 
prevailed  when  the  samples  were  taken. 
When  one  bears  in  mind  the  errors  incident 
to  enumeration  and  the  possibility  of  cer- 
tain influences  disturbing  the  dust  content 
of  the  air,  the  agreement  is  remarkable. 
There  is  a  variation  from  day  to  day  and 
the  figures  for  indoor  air  are  on  the  whole 
higher  than  those  for  outdoor  air,  although 
they  are  not  strictly  comparable,  having 
been  obtained  on  different  days.  On  the 
morning  of  Januarj'  5,  the  atmosphere  was 
unusually  smoky  and  the  counts  are  cor- 
respondingly high.  The  samples  of  air 
from  a  closed  cabinet  free  from  disturbing 
influences  are  practically  identical  in  their 
dust  content. 

Discussion 

Before  the  method  was  actually  tested,  it 
seemed  doubtful  whether  one  could  hope 
for  consistent  results,  i)artly  because  of  the 
possibility  of  the  inclusion  of  particles  be- 
tween the  barrel  and  i)iston  of  the  syringe 
and  partly  because  of  the  exposure  of  the 
piston  to  the  dust  particles  of  the  air.  But 
experience  showed  that  it  makes  no  dif- 
ference whether  samples  of  100,  200,  or 
300  c.  c.  are  taken;  in  other  words,  whether 
the  piston  is  withdrawn  once,  twice,  or 
three  times.  These  factors,  then,  if  they 
operate,  do  not  endanger  the  usefulness  of 
the  method.  In  the  modified  form  of  the 
method  any  error  from  this  source  would 
disappear. 

One  minute's  shaking  is  sufficient  to 
bring  the  particles  into  aqueous  suspen- 
sion. A  more  prolonged  shaking  does  not 
increase  the  count.  This  is  exactly  what 
one  would  anticipate  from  the  work  of 
Katz,  Longfellow,  and  Fieldner  (3)  who 
find  that  Palmer's  apparatus  in  which  the 


air  is  in  contact  with  the  water  for  a  very 
brief  interval  retains  13  per  cent,  of  smoke. 

The  same  objection  applies  to  this 
method  as  applies  to  all  methods  in  which 
water  is  used  as  a  medium.  Water-soluble 
particles  will  not  be  included  in  the  count. 
In  many  cases,  however,  particles  lost  in 
solution  may  be  determined  by  chemical 
methods.  Bill  (5)  i)oints  out  that  the  par- 
ticulate matter  in  the  Palmer  suspensions 
shows  a  tendency  to  form  small  masses  or 
clumps.  The  minute  particles  in  my  own 
suspensions  have  not  shown  any  agglomera- 
tion. Counts  made  of  suspensions  that 
were  allowed  to  stand  for  nearly  two  hours 
were  practically  as  high  as  those  made  in 
the  beginning. 

In  routine  work,  such  as  the  examination 
of  air  in  factories,  where  several  samples 
taken  at  short  intervals  are  desired,  the 
contents  of  the  syringe  may  be  emi>tied 
into  small  25  c.c.  Erienmeyer  flasks  and 
covered  with  rubber  membrane  secured  by 
an  elastic  band.  In  the  modified  form  of 
the  method,  a  series  of  test  tubes  each 
provided  with  a  glass  stopper  perforated 
by  two  glass  tubes  (Figure  2)  nuiy  be  em- 
ployed. 

Conclusion 

1.  A  method  has  been  presented  in  the 
foregoing  pages,  based  on  the  enumeration, 
by  oblique  illumination,  of  minute  i)articles 
in  a  samjjle  of  air  brought  into  aqueous 
suspension  by  shaking  the  sample  with 
water. 

2.  Success  in  the  use  of  the  method  de- 
mands strict  attention  to  cleanliness. 

3.  The  method  requires  but  a  very  small 
sample  of  air  and  yields  consistent  results. 

4.  The  method  ought  to  be  especially 
suitable  for  the  determination  of  smoke 
particles  and  should  also  prove  useful  in 
determining  the  efficiency  of  air-filtering 
devices  in  ventilation  systems. 


56 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


BIBLIOGRAPHY 


1.  Hill,  E.  v.:  Quantitative  Determination  of  Air 
Dust.  Heating  and  Ventilating  Magazine,  1917, 
14,  23. 

2.  Palmer,  G.  T.:  A  New  Sampling  Apparatus  for 
the  Determination  of  Aerial  Dust.  Am.  Jour. 
Pub.  Health,  1916,  6,  54. 

3.  Katz,  S.  H.,  Longfellow,  E.  S.,  and  Fieldner, 
A.  C:  Efficiency  of  the  Palmer  Apparatus  for 


Determining  Dust  in  Air.   JouR.  Indust.  Hyg., 

1920-1921,  2,  1G7. 

Aitken,  J. :  On  the  Number  of  Dust  Particles  in 

the  Atmosphere.   Trans.  Roy.  Soc.  Edin.,  1889, 

35,  1. 

Bill,  J.  P.:  The  Electrostatic  Method  of  Dust 

Collection  as  Applied  to  the  Sanitary  Analysis 

of  Air.    JouK.  Indust.  Htg.,  1919-1920,  1,  323. 


ANILINE  POISONING  IN  THE  RUBBER  INDUSTRY* 


PAUL  A.  DAVIS,  M.D. 

Akron,  Ohio 


A  NILINE  (CeH^NHs),  a  primary  amide 
±\.  of  benzol,  is  a  colorless,  volatile  oil 
which,  when  exposed  to  air  and  light,  is 
very  unstable,  and  rapidly  changes  in  color 
to  dark  brown  and  even  to  black,  leaving  a 
residue.  It  can  be  i)roduced  in  several  ways 
but  the  most  common  commercial  method 
is  l)y  the  action  of  hydrochloric  acid  and 
iron  filings  on  j>ure  nilrobenzol  (C6Hr,X()2). 
It  is  used  principally  in  the  mjinufacture  of 
aniline  dyes,  photographic  materials,  rub- 
ber conij)ounds,  and  shoe  polishes. 

The  aniline  of  conunerce  is  contaminated 
by  very  small  to  large  amounts  of  nitro- 
benzol,  dimethylaniline,  and  its  nitroso 
bodies,  all  of  which  have  a  predilection  for 
action  on  the  blood  and  nervous  system, 
similar  to  all  homologous  derivatives  of 
benzol.  Von  Jaksch  (1)  c-laims  that,  as  far 
as  records  show,  pure  aniline  does  not  ])ro- 
duce  poisoning,  but  that  it  is  the  mixture  of 
amidobenzene,  meta-toluidine,  para-tolui- 
dine  and  ortho-toluidine  and  xylidine 
which  is  poisonous.  It  is  the  ex]jerience  of 
Dr.  Alice  Hamilton  (2),  however,  that 
"cliemically  j^ure  aniline  produces  all  the 
symptoms  and  blood  changes  characteristic 
of  industrial  anilism."  The  experiments  of 
K.  B.  Lehmann  .show  that  pure  aniline  is 
very  toxic  in  even  smaller  quantities  than 
carbon  disulphide,  toxic  symptoms  follow- 
ing the  inhalation  of  0.1  to  0.'-25  gm.  of 
aniline,  while  it  takes  from  1  to  1.1  gm.  of 
carbon  disulphide  to  produce  symptoms  of 
poisoning. 

Methods  of  Absorption 

The  poison  may  enter  the  body  through 
the  skin,  the  respiratory  tract,  the  alimen- 
tary tract,  and  through  a  combination  of 

*  Received  for  publication  Dec.  31,  1920. 


these  three  ways.  Aniline  oil  is  readily 
absorbed  by  the  skin,  and  in  a  very  short 
time  produces  marked  symptoms.  One 
case  is  recorded  in  which  death  resulted 
from  poisoning  due  to  absorption  through 
the  skin  of  the  feet  from  a  pair  of  shoes 
which  had  been  colored  with  aniline  dye 
and  had  been  put  on  l)efore  the  dye  was 
dry.  A  large  proportion  of  the  cases  which 
I  have  seen  have  developed  their  sj-mptoms 
from  skin  ab.sorption. 

Respiratory  absorption  is  also  very  com- 
mon. Individuals  working  in  aniline  or  any 
of  its  derivatives  in  rooms  where  the  venti- 
lation is  poor  and  the  aniline  bodies  are 
subject  to  heat  develop  typical  aniline 
symptoms  after  varying  periods  of  time, 
depending  on  the  concentration  of  the 
gaseous  substance.  Absorption  through 
the  alimentary  system  is  the  smallest  fac- 
tor in  producing  symptoms  of  aniline  poi- 
soning and  one  which  can  be  controlled 
largely  by  education  and  instruction  con- 
cerning the  necessity  for  cleanliness  during 
eating  and  drinking.  The  most  serious  re- 
sults and  the  most  acute  symptoms  are 
jiroduced  by  a  combination  of  all  three 
methods  of  absorption. 

Clinical  Picture 

Symptoms.  —  The  characteristic  symp- 
toms of  aniline  poisoning  in  the  order  of 
their  appearance  as  observed  in  many 
cases  are:  slight  insomnia  or  drow.sj^  feel- 
ing; neurovascular  symptoms,  such  as 
flushed  face,  weariness  and  mental  uncer- 
tainty in  extreme  ca.ses,  and  sometimes  an 
irritable  disposition;  headache,  dizziness 
and  nausea;  beginning  cyanosis,  chilliness 
and  a  sensation  of  cold;  pulse,  rapid  and 
weak,  gradually-  becoming  slower  with  de- 


57 


58 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


creased  blood  pressure;  loss  of  appetite,  in- 
digestion; irregular  respiration;  dryness 
and  choking  sensation  in  the  throat,  burn- 
ing and  stinging  sensation  of  the  eyelids; 
joint  pains,  muscle  pains;  spots  before  the 
eyes;  hematuria  in  rare  cases;  painful  urina- 
tion in  extreme  cases,  and  hyperacidity; 
constipation  or  diarrhea;  skin  eruptions, 
macular  in  rare  cases;  difficulty  in  talking, 
accompanied  by  loss  of  memory;  very  deep 
cyanosis  followed  by  unconsciousness;  and 
in  rare  cases,  hemoptysis.  Each  patient 
does  not,  of  course,  present  all  symptoms, 
but  he  may  have  had  them  at  some  time. 
The  marked  pallor  of  the  skin,  cyanosis  of 
the  lips,  and  a  history  of  work  in  aniline, 
together  with  a  characteristic  odor  of  ani- 
line wliich  is  usually  present,  should  re- 
move any  doubt  about  the  diagnosis. 

There  is  a  class  of  men  who  work  in  ani- 
line who  seem  to  acquire  a  tolerance  for  the 
substance,  in  that  they  remain  cyanotic 
for  years  without  the  development  of  any 
apparent,  serious  symptoms.  Through  a 
change  of  work,  however,  such  mild  symp- 
toms as  do  appear  clear  up,  the  blood  and 
urine  return  to  normal,  and  we  diagnose 
the  cases  as  chronic.  These  patients  have 
some  blood  changes,  of  course,  yet  they 
feel  no  ill  effects  except  for  a  slight  tired 
feeling  at  the  end  of  a  day's  work.  The 
body  attempts  to  maintain  an  equilibrium 
between  intake  and  output  of  aniline,  but 
there  is  a  surplus  amount  which  is  ab- 
sorbed and  which  causes  blood  changes 
that  are  responsible  for  the  marked  cyan- 
otic condition. 

Laboratory  Findings.  —  The  blood 
changes  consist  principally  in  the  forma- 
tion of  methemoglobin  and  a  coincident 
decrease  in  hemoglobin,  with  resulting  de- 
ficient oxygen  supply  to  the  tissues.  There 
is  also  a  decrease  in  the  number  of  red 
blood  cells,  with  anisocj'tosis  and  poikilo- 
cytosis,  and  in  very  acute  cases  there  may 
be  a  slight  leukocytosis  and  basophilic  de- 
generation   of    the    red    cells.     After    the 


removal  of  the  patient  from  contact  with 
aniline  or  its  derivatives,  the  leukocyte 
count  returns  to  normal  and  in  some  cases 
even  a  slight  leukopenia  is  found.  There 
frequently  occurs  a  diminution  of  poly- 
morphonuclears with  a  corresponding  in- 
crease in  small  lymphocytes,  and  a  slight 
eosinophilia. 

In  very  severe  cases  of  poisoning,  some 
embryonic  forms  of  red  cells  appear,  the 
hemoglobin  (Sahli's  method)  is  decreased, 
and  there  is  considerable  formation  of 
blood  dust.  Tallqvist's  scale  cannot  be 
used  with  any  success,  for  as  soon  as  the 
methemoglobin  is  exposed,  the  color  is 
changed.  In  the  advanced  cases,  the  co- 
agulability and  the  viscosity  of  the  blood 
are  diminished. 

x\fter  examining  over  100  urines  from 
cases  ranging  from  those  with  marked 
beginning  symptoms  to  those  with  per- 
sistent symptoms,  I  am  of  the  opinion  that 
no  definite  rule  for  urinary  findings  can  be 
formulated,  except  that  in  the  most  severe 
cases,  if  large  quantities  of  urine  are  tested, 
there  can  be  found  traces  of  hematin,  pre- 
sumably due  to  blood  cell  destruction.  The 
following  is  a  summary  of  the  urinary  find- 
ings from  the  cases  which  I  have  examined : 
specific  gravity,  1.005  to  1.030;  reaction, 
usually  acid,  a  large  amount  of  uric  acid 
being  present;  albumin,  negative,  except  in 
cases  where  extreme  anemia  had  resulted; 
sugar,  negative;  aniline  or  aniline  radicals, 
negative;  phenol,  negative;  acetone,  nega- 
tive; diacetic  acid,  negative,  except  in 
severe  cases.  Nearly  all  cases  showed 
traces  of  hematin  when  twenty-four-hour 
specimens  were  evaporated. 

Microscopic  examination  generally  re- 
vealed large  quantities  of  uric  acid  crystals, 
urates,  and  oxalates.  One  case  showed 
marked  kidney  involvement.  It  could  not, 
however,  be  proved  that  this  was  caused  by 
aniline,  as  this  man's  condition  before  he 
went  to  work  in  aniline  was  not  known.  In 
one  case  the  urine  was  cloudy  and,  on  mi- 


DAVIS  —  ANILINE  POISONING  IN  THE  RUBBER  INDUSTRY        59 

croscopical  examination,  no  formed  ele-  on  the  clothing  or  the  skin;  (g)  protection 
ments  were  found,  but  large  quantities  of  of  the  hands  by  rubber  gloves,  and  of  the 
fat  globules  were  present.  In  another  case,  feet  by  wooden  shoes,  rubber  boots,  or  rub- 
diacetic  acid  was  found,  but  no  trace  of  ber-soled  shoes  in  production  plants  where 
sugar;  while  in  still  another,  there  was  pres-  the  floors  are  wet  with  aniline, 
ent  diacetic  acid  with  a  slight  trace  of  sugar.  Some  employers  furnish  milk  for  their 
Two  cases  showed  bladder  involvement  employees  to  drink,  but  I  see  no  advantage 
which  improved  under  change  of  work  and  in  this;  in  fact,  rather  the  opposite,  for  milk 
treatment.  is  constipating  and  thus  blocks  one  of  the 
Complications.  —  In  severe  cases  espe-  channels  of  excretion.  One  large  manu- 
cially,  there  may  appear  certain  complica-  facturing  company  gives  its  aniline  work- 
tions  such  as  secondary  anemia,  which  it  is  ers  a  teaspoonful  of  vinegar  (acetic  acid) 
difficult  to  clear  up;  an  irritative  cystitis;  before  they  go  to  work,  with  the  idea  of 
and  inhibition  of  the  red-cell  forming  or-  producing  soluble  aniline  compounds  which 
gans  —  a  condition  which  gradually  re-  may  be  excreted  by  the  kidneys.  Per- 
turns  to  normal  when  tlie  patient  is  sonally,  I  have  obtained  very  good  results 
removed  from  contact  with  aniline.  In  from  the  use  of  lemonade  containing  Epsom 
alcoholics  a  predisposition  to  glomerular  salts.  It  furnishes  the  average  worker  with 
nephritis  is  often  noted.  enough  citric  acid  and  salts  in  a  day  to  in- 
Several  cases  of  gastric  involvement,  crease  catharsis  and  diuresis.  The  follow- 
especially    gastric    ulcers,    have    been    re-  ing  is  the  formula  which  I  have  used: 

ported   bv   German   authors,   but   I   have  r\                                          i  *    i  i 

•  '  .  Oranges J  to  1  dozen 

never  seen  a  case  of  gastric  ulcer  develop,  Lomons                                2  to  2i  dozen 

in  which  aniline  was  the  cause.    I  know  of  Water 8  gallons 

one  instance  in  which  a  worker  with  gastric  Saturated  solution   Epsom 

ulcer  claimed  that  it  was  due  to  aniline,  *^** ^^  ounces 

but  investigation  proved  that  he  had  been  ugar  o  as  e. 

...          ...                      ,     ,  nerve  cold. 

exposed  to  very  little  anihiic  and  only  for  a 

period  of  a  few  minutes.  Sometimes  ec-  It  is  advisable  that  all  persons  working  in 
zematous  skin  rashes  appear,  particularly  aniline  should  be  examined  at  frequent  in- 
on  the  covered  parts,  the  scrotum,  the  arm  tervals  and  a  record  of  the  examination 
pits,  and  inguinal  regions,  and  occasionally  made.  The  form  illustrated  in  Figure  1  has 
we  see  a  pustular  erui)tion  resembling  a  been  found  to  be  very  convenient  for  this 
furunculosis.  Examination  of  the  pus  from  ])urpose.  The  foreman  who  has  charge  of 
one  of  these  furuncles  shows  staphylo-  aniline  workers  should  be  instructed  con- 
cocci  and  streptococci.  cerning  the  hazards  of  the  work  and  should 

report  any  men  who  show  symptoms  of 
PREVENTION  poisouiug.   All  aniline  workers  should  have 
The  most  important  factors  in  the  pre-  short  periods  to  work  and  longer  ones  to 
vention  of  aniline  poisoning  are:  (a)  educa-  spend  in  the  open  air.   They  should  abstain 
tion  and  instruction  of  employees  working  from  alcohol  as  it  seems  to  predispose  to 
in  aniline;  (6)  proper  ventilation  (forced);  aniline  absorption,  particularly  in  3^oung 
(c)  handling  of  aniline  compounds  in  closed  men. 
receptacles;   (d)  restricted  length  of  time  ^ 
for  working  in  the  fumes  of  aniline;  (e)  bet- 
ter personal  hygiene ;(/)  an  immediate  bath  Preventive  treatment  is,  of  course,  the 
if  aniline  or  any  of  its  derivatives  are  spilled  best  to  pursue.    When  poisoning  has  al- 


6» 


THE  JOUBNAL  OF  INDUSTRIAL  HYGIENE 


FlGXTHE    1 


SPECIAL  EXAlVnNATION  FOR  ANILINE  WORKERS 

Age        Nationality  M.S.W.  Date 

How  long  have  you  worked  here?  How  long  in  the  department? 

Have  you  felt  perfectly  well  during  the  past  year?  Past  six  months? 

Have  you  ever  had,  or  have  you  now  any  of  the  following: 

Muscle  weakness,  twitching  of  muscles,  or  muscle  pains 

Large  amounts  of  saliva 

Exhausted  or  "tired  out"  feeling 

Fast  or  slow  breathing 

Drowsy  or  sleepy  feeling 

Rapid  heart 

ChUliness  or  cold  feeling 

Nasal  trouble,  catarrh,  discharge  into  back  of  throat  from  nose 

Indigestion     Constipation     Diarrhea     Vomiting     Nausea 


Irritability 


Dizziness 


Nervousness 

Joint  pains 

Unconsciousness 

Difficulty  in  talking 

Spots  before  eyes 

Spitting  of  blood 

Cold  hands  or  feet 

Dryness  or  choking  sensation  in  throat 

Burning  or  stinging  sensation  of  eyelids 

Painful  urination 

Skin  eruption  Duration 

Loss  in  weight  in  the  last  six  months 


Headache 


Loss  of  memory 


Physical  Examination 


General  appearance 

Face  and  head 

Eye  reflexes 

Thorax 

Lungs 

Heart 

Pulse 

Blood  pressure 

Abdomen 

Liver 

Spleen 

Stomach 

Genitalia 

Reflexes 

Xnee  jerk 

Babinski 

Romberg 

Extremities 

Skin 

Areas  of  anesthesia  or  hj-peresthesia 

Blood:  Hemoglobin 

AYhite  cells 

Red  cells 

Pathological  cells 

Urine:  Specific  gravity 

Albumin 

Sugar 

Reaction 

Remarks : 

Examining  Pki/sician 


DAMS  — ANILINE  POISONING  IN  THE  RUBBER  INDUSTRY 


61 


ready  occurred,  however,  the  patient  must 
be  treated  for  oxygen  lack  and  acidosis. 
Very  mild  cases  need  free  ehmination  and 
open  air,  while  the  more  severe  ones  re- 
quire artificial  respiration,  injections  of 
heart  stimulants,  and  blood  transfusion. 

In  acute  cases  the  first  step  is  to  remove 
the  patient  to  the  open  air,  loosen  liis  cloth- 
ing and  examine  it  as  a  possible  source  of 
absorption.  If  it  is  found  to  be  satiu-ated 
with  aniline  fumes,  it  should  be  taken  off  at 
once.  Give  oxygen  inhalation,  if  necessary, 
remove  the  excess  of  aniline  from  the  sur- 
face of  the  skin  with  soap  and  water,  and 
with  a  vinegar  bath  dissolve  the  aniline 
from  the  pores  of  the  skin.  ILse  heart  stimu- 
lants, such  as  caffein,  camphorated  oil,  or 
ether,  but  no  tinctures  because  of  the  al- 
cohol which  they  contain  and  which  should 
be  abstained  from.  An  enema  of  soap  suds 
and  glucose  (2  to  3  ounces)  may  be  given. 
If  the  patient  is  conscious,  give  him  1  ounce 
of  glucose  in  water,  alkalinized  with  sodium 
bicarbonate.  Blood  letting,  transfusion,  or 
possibly  infusion  of  normal  saline  may  be 
necessary.  Lavage  of  the  stomach  has  been 


resorted  to,  but  seems  to  be  more  hazardous 
than  beneficial.  It  is  important  to  promote 
the  excretion  of  the  poison  by  free  diuresis, 
catharsis  and  sweating.  The  various  symp- 
toms should  be  treated  as  they  appear. 

Summary 

Aniline  and  its  immediate  homologues 
are  blood  and  nervous  system  poisons 
which  produce  their  effects  by  internal 
suffocation.  They  cause  destruction  and 
hemolysis  of  the  red  blood  cells  and  marked 
production  of  methemoglobin,  and,  in 
severe  cases,  acidosis.  In  acute  cases,  a 
slight  basophilic  degeneration  of  the  red 
cells  also  takes  place.  Very  little  effect  is 
produced  on  the  white  blood  cells,  the  only 
change  being  a  transitory  Icidcocytosis  in 
the  beginning  of  acute  cases. 

There  are  very  few  complications  except 
in  severe  cases. 

Alcohol  seems  to  be  a  predisposing  factor 
for  early  symptoms. 

Preventive  measures  should  be  instituted 
in  preference  to  after-treatment. 


BIBLIOGRAPHY 


1.  Von  Jaksch,  R.:  Die  Vergiftimgcn.  Second 
Edition.   Wien  u.  Leipzig,  1910,  p.  338. 

2.  Hamilton,  A.:  Industrial  Poisoning  by  Com- 
pounds of  the  Aromatic  Series.  Jour.  Ixdust. 
Hyg.,  1919-1920,  1,  204. 

3.  Luce,  R.  v.,  and  Hamilton,  A.:  Industrial 
Anilin  Poisoning  in  the  L^nitcd  States.  .Jour. 
Am.  Med.  Assn.,  191G,  66,  1441. 

4.  Neisser,  E.  J.:  Internationale  Uebersicht  Uber 
Gewerbehygiene,  nach  den  Berichten,  der  Ge- 


werbe-Inspektionen  der  Kulturlauder.    Berlin, 
1907. 

5.  Rambousek,  J.:  Industrial  Poisoning  from 
Fumes,  Gases  and  Poisons  of  Manufacturing 
Processes.  Translated  by  T.  M.  Legge.  Lon- 
don, Edward  Arnold,  1913. 

6.  Hayhurst,  E.  R.:  A  Survey  of  Industrial 
Health-Hazards  and  Occupational  Diseases  in 
Ohio.  Ohio  State  Board  of  Health,  Columbus, 
Feb.,  1915. 


OIL  FOLLICULITIS* 


CALVIN  G.  PAGE 

Assutant  Professor  of  Bacteriology,  Harvard  Medical  School 

AND 

L.  D.  BUSHNELL 

Professor  of  Bacteriology,  Kansas  State  Agricultural  College,  Manhattan,  Kansas 

{From  the  Bacteriological  Laboratories  of  Harvard,  Medical  School) 


THE  marked  increase  in  our  industrial 
population  makes  a  study  of  the  occu- 
pational affections  of  the  skin  of  special 
importance.  These  affections  will  tend  to 
increase  as  greater  numbers  of  persons  are 
drawn  into  the  industries,  as  new  industries 
are  developed,  and  as  new  products  are  in- 
troduced. This  paper  is  concerned  with 
skin  affections  due  to  oils,  and  particularly 
with  those  due  to  the  use  of  machine  oils, 
an  investigation  of  which  was  undertaken 
to  determine  the  cause  of  an  outbreak  of 
fiu'unculosis  among  the  employees  of  a 
machine  shop. 

Affections  of  the  skin  due  to  petroleum 
and  its  products  have  long  been  recognized, 
various  terms  being  used  to  designate 
them.  By  some  authors  they  are  considered 
as  belonging  to  the  eczemas,  and  by  others 
as  dermatites  or  dermatoses.  There  is,  in- 
deed, a  considerable  amount  of  confusion  as 
to  the  correct  terms  to  be  used  for  all  the 
various  skin  diseases,  and  those  due  to  oc- 
cupations are  not  exceptions.  R.  P.  White 
(1),  in  discussing  the  question  of  termin- 
ology, says  "It  would  seem  that,  as  a  term 
intended  to  express  a  whole  group  of  these 
disorders,  the  word  '  eczema  '  is  both  in- 
correct and  inadequate.  It  would,  there- 
fore, seem  more  convenient  and  logical  to 
use  the  non-committal  term  '  dermatitis.' 
This  will  embrace  all  so-called  trade  ec- 
zemas, as  well  as  other  forms  of  skin  dis- 
ease caused  by  employment,  and  where 
possible  the  name  of  the  offending  agent 
should  be  prefixed  to  it."  Following 
White's   suggestion,    we   might    designate 

*  Received  for  publication  .Ian.  12,  1921. 


skin  affections  due  to  oils  as  oil  dermaiUes. 
This  does  not,  however,  clarify  the  matter 
to  any  extent,  since  the  different  oils  pro- 
duce different  affections.  In  the  case  of 
machine  oil,  the  trouble  seems  to  be  largely 
a  mechanical  plugging,  followed  by  inflam- 
mation and  infection  of  the  follicles.  For 
this  reason  we  suggest  the  name  oil  fol- 
liculitis. 

Historical  Review 

An  exliaustive  study  of  skin  affections 
due  to  occupations  has  been  made  by 
Knowles  (2).  In  the  course  of  his  discus- 
sion, this  author  says  "fully  one-quarter  of 
all  cases  of  eczema  are  of  definite  external 
origin.  Almost  one-sixth  of  all  cases  of  this 
affection  is  caused  by  the  occupation  of 
the  individual.  .  .  .  The  largest  number 
of  cases  of  the  so-called  occupation  eczemas 
are  seen  in  the  workers  in  the  household 
and  next  most  frequently  in  laborers.  Prac- 
tically every  occupation  and  every  irritant 
may  produce  an  eczema."  Knowles'  paper 
reports  fortj'-five  cases  of  eczema  in  in- 
dividuals who  handled  oils,  greases,  carbon, 
graphite,  etc.  Oppenheim  (3)  in  Germany 
examined  1,800  operatives  who  presented 
themselves  in  his  practice,  and  found  that 
400  of  the  cases,  or  2'2.2  per  cent.,  were  due 
to  the  employment  of  the  patients. 

The  earlier  works  upon  the  harmful  ef- 
fects of  petroleum  and  its  products  upon 
the  body  were  confined  largely  to  the  poi- 
sonous or  intoxicating  action  when  these 
substances  were  taken  internally.  Lewin 
(4)  in  an  article  written  in  1888  gives  an  ex- 


62 


PAGE  AND  BUSHNELL  — OIL  FOLLICULITIS 


63 


tensive  bibliography  of  the  earHer  literature 
on  this  subject,  and  also  reports  results  ob- 
tained bj'  feeding  oils  to  animals.  He  refers 
to  two  early  descriptions  of  skin  affections 
due  to  petroleum,  the  first  (5),  designated 
as  "eczematous,"  the  second  (6),  described 
as  consisting  of  small  ulcers  with  erysipela- 
tous red  bases,  or  as  consisting  of  blisters 
with  red  but  not  indurated  bases.  After  the 
latter  type  of  ulcer  had  once  been  lieakHj,  it 
did  not  develop  again,  even  though  the  pa- 
tient continued  in  contact  with  the  product. 

J.  C.  White  (7),  on  the  other  hand,  states 
that  he  has  recommended  petroleum  for 
many  years  for  the  destruc-tion  of  scalp  and 
pubic  lice,  and  has  never  seen  the  slightest 
indication  of  irritation  from  its  use.  He 
also  states  that  he  has  seen  teamsters  wash 
their  faces  and  hands  in  the  oil  without  ill 
effects.  In  conference  with  the  superin- 
tendent of  a  large  refinery.  Dr.  AVhite  foimd 
that  there  was  vi'ry  little  skin  troul)le 
among  the  workmen  and  that  whatever 
irritation  there  was  appeared  mostly  in  hot 
weather,  and  only  among  a  few  of  the  work- 
men handling  i)arafHii  products.  The  lesion 
in  these  cases  consisted  of  a  mild  degree  of 
eczematous  inflannnation  on  the  backs  of 
the  hands  and  forearms,  which  disapjieared 
rapidly  after  the  occupation  was  given  up. 

Lewin  (4)  discusses  at  some  length  an 
outlireak  of  pimples,  boils,  acne,  and  l)lack 
comeilones  on  the  IkukIs.  arms,  and  otlier 
parts  of  the  body  in  a  group  of  workmen 
in  the  petroleum  industry.  This  affection 
continued  for  different  lengths  of  time  ami 
with  varying  severity  in  different  individ- 
uals, in  some  instances  continuing  as  long 
as  the  men  were  employed  in  the  work.  It 
appeared  to  Lewin  that  the  inflannnation 
went  hand  in  hand  with  the  stopping  of  the 
hair  follicles  and  sebaceous  glands.  After 
these  were  closed,  there  was  a  continuation 
of  glandular  secretion,  but  excretion  being 
inhibited,  the  condition  was  gradually 
exaggerated  and  .soon  involved  all  layers  of 
the  skin.   The  longer  the  process  continued. 


the  more  intense  the  inflammation  became, 
finally  spreading  to  neighboring  glands  and 
hair  follicles,  or  to  the  subcutaneous  tissue. 
In  the  course  of  his  study,  Lewin  found 
that  the  heavier  petroleum  products, 
particularly  those  which  distill  at  "250°- 
360°  C,  possessed  the  most  marked  prop- 
erty of  causing  inflammation.  He  tested 
the  action  of  these  products  by  feeding 
them  to  animals,  and  considered  that  the 
action  upon  the  stomach  wall  was  similar  to 
that  on  the  skin.  He  also  noted  that  the 
individuals  of  most  cleanly  personal  habits 
sufl'ered  least  from  this  trouble.  Similar 
.skin  aftections  have  also  been  described  by 
Ogston  (8)  as  due  to  the  paraffin  products 
from  cannel  coal  and  various  other  raw 
j)etr()leum  jjroduets. 

A  folliculitis  and  perifolliculitis  of  spin- 
ners called  boiitoit  dliuile  was  first  de- 
scribed by  Purdon  in  Belfast  in  1867,  and 
by  Leloir  (9)  in  Belgium  in  1889.  This  af- 
fection was  due  to  the  irritating  action  of 
the  oil  used  on  the  machines.  In  England 
sperm  oil  was  the  most  common  lubricating 
agent;  in  Belgiuni,  on  the  contrary,  mineral 
oil  was  largely  used.  The  oils  from  Russia 
were  usually  unmixed,  as  were  those  from 
America,  while  the  shale  oil  from  Scotland 
was  usually  mixed  with  olive  or  colza  oil  in 
the  ])roportion  of  ten  to  fifty  parts  per 
hundred.  Purdon  (10)  in  his  article  dis- 
cusses an  acneform  eruption  of  "dotfers" 
(usually  young  girls  who  remove  the  bob- 
bins and  clean  and  oil  them)  in  flax  spin- 
ning mills.  The  affection  is  evidently  a 
folliculitis  due  to  the  sluggish  action  of  the 
sebaceous  glands,  the  orifices  of  which  are 
choked  by  the  oil  and  irritated  by  the  flax 
water  that  comes  off  the  l)obbins.  The 
eruption,  which  occurs  usually  in  persons 
under  '20  years  of  age,  of  either  sex,  but 
chiefly  in  girls  who  expose  their  arms  by 
wearing  short  sleeves,  may  be  described  as 
follows:  The  acne  eruption  commences 
with  a  small,  dull  red  papule,  shotty  to  the 
touch,    occurring    on    the    forearms    and 


64 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


wrists,  and  when  a  little  matured  has  a 
small  black  speck  in  the  center  of  the  pap- 
ule, like  a  comedo,  showing  the  plugged 
sebaceous  follicle.  Next,  the  papule  in- 
creases in  size,  finally  suppuration  occurs, 
and  the  papule  disappears. 

In  Belfast,  Purdon  did  not  find  eczema- 
tous  conditions  of  the  hands  such  as  those 
described  by  Leloir  in  Belgivim.  In  describ- 
ing the  trouble,  Leloir  says  that  it  is  seated 
in  the  hair  follicles;  these  become  dilated 
and  filled  with  broken  hairs  and  horny  cells 
mixed  with  dirt  and  oil,  thus  setting  up  a 
perifolliculitis.  The  corium  around  the  fol- 
licle becomes  infiltrated  with  round  cells, 
the  vessels  dilate,  and  some  of  the  tissues 
necrose.  Eventually  the  whole  follicle  may 
be  discharged. 

Lefebvre  (11),  writing  in  1888,  states 
that  skin  lesions  of  the  natm-e  described 
above  are  of  fairlj^  common  occurrence,  and 
are  liable  to  arise  wherever  dirty  oil  from 
the  joints  and  gearing  of  the  machinery 
constantly  comes  in  contact  with  the  skin. 
In  spinning  mills  this  may  be  effected 
directly  by  the  fine  spraj-ing  of  the  oils 
from  the  spinners  revolving  in  the  oil  cups, 
or  indirectly  from  saturated  clothing  or 
cleaning  rags.  The  condition  is  easily  rec- 
ognized by  the  stijjijled  ground  of  minute, 
black,  dilated  follicles,  upon  which  the 
typical  rounded,  well-raised,  hard  papules 
of  a  dusky  red  color  are  irregularly  dotted. 
These  papules  vary  in  size  from  that  of  a 
hemp  seed  to  that  of  a  split  pea,  and  are 
centered  by  a  hair.  They  may  become  sur- 
rounded by  a  zone  of  erythema,  or  may  de- 
velop into  an  acute  boil.  Usually,  however, 
they  are  indolent  lesions  which  form  slowly, 
take  many  weeks  to  recede,  and  leave  a 
pitted  scar. 

Collis  (12),  in  England,  reported  fourteen 
cases  of  dermatitis  in  engineering  shops 
among  workers  whose  skin  had  been  much 
irritated  by  cooling  and  lubricating  mix- 
tures consisting  of  turpentine  and  alkaline 
emulsions  of  mineral  oil.  This  disease  failed 


to   appear   when   neither   turpentine   nor 
mineral  oil  was  used. 

R.  P.  White  (1),  discussing  the  effect  of 
petroleum,  says  that  in  all  instances  in 
which  raw  petroleum  is  handled,  the  work- 
ers suffer,  whether  it  be  at  the  mines,  re- 
fineries, pumps,  or  in  the  manipulation  of 
the  raw  petroleum  itself.  He  states  that 
from  1890  to  1893  eighteen  cases  of  petro- 
leum acne  were  reported  in  French  re- 
fineries, and  in  the  official  statistics,  which 
included  1,380  petroleum  workers  in  Rus- 
sia, nine  were  reported  to  be  suffering  from 
general  symptoms,  and  forty-three  from 
petroleum  acne.  Rambousek  (13)  makes 
the  statement  that  opinion  is  unanimous  as 
to  the  injurious  action  of  mineral  oil  on  the 
skin,  and  particularly  that  the  graver  con- 
sequences are  produced  by  the  petroleum 
residues.  The  products  of  the  distillation  of 
petroleum  and  coal  appear  to  have  the 
same  effect. 

Oppenheim  (3)  has  noted  diseases  of  the 
sweat  and  sebaceous  glands  in  paraffin  and 
petroleum  workers,  who  develop  an  "acne 
petrolei"  most  marked  where  the  clothing 
is  saturated  with  the  heavy  oils,  especially 
on  the  "streckseite"  of  the  arms  and 
thighs.  The  heavy  petroleum  products  are 
considered  by  him  to  be  the  most  common 
cause  of  this  trouble.  He  quotes  ISIilliard  as 
stating  that  half  the  men  employed  in  the 
petroleum  refineries  in  Rouen  suffered 
from  acne,  most  of  them  coming  in  contact 
with  the  heavy  oils.  He  maintains  that 
"Batschol"  and  "Juteol"  produce  the  so- 
called  "Weberakne,"  and  that  machine 
workers  may  suffer  from  "Schmierolakne." 

Weichardt  and  Apitzsch  (14)  studied  the 
cause  of  an  outbreak,  among  the  workers  in 
thejnetal  industry,  of  a  skin  disease  con- 
sisting of  small  comedones  and  pustules 
which  developed  first  on  the  hands  and 
forearms,  and  later  on  other  parts  of  the 
body.  This  disease  became  very  serious 
among  the  machine  workers,  usually  de- 
veloping within  approximately  two  weeks 


PAGE  AND  BUSHNELL  — OIL  FOLLICULITIS 


65 


after  employment.  The  authors  consider 
that  the  characteristic  cUnical  picture  may 
be  ascribed  to  different  causes  and  that 
in  the  beginning  the  local  trouble  may  per- 
haps be  due  to  an  effect  of  the  mineral  oil 
which  reduces  the  resistance  of  the  skin 
and  allows  the  entrance  of  secondary  septic 
micro-organisms  or  their  by-products.  In 
studying  their  problem  experimentally, 
Weichardt  and  Apitzsch  found  that  ma- 
chine oils  applied  to  the  ear  of  an  albino 
rabbit  caused  severe  inflammation.  Olive 
oil  rubbed  on  in  the  same  manner  had  no 
such  influence.  Pure  liciuid  ])araflin  was 
without  effect,  although  llie  repeated  ap- 
plication of  pure  mineral  oil  caused  some 
irritation.  On  examination  the  machine  oil 
was  found  to  contain  no  free  acids  and 
alkalies.  Although  it  contained  8  per  cent. 
of  resin,  the  oil  still  retained  its  irritating 
properties  after  the  renioNal  of  this  sub- 
stance; it  also  contained  a  considerable 
amount  of  easily  oxidizable  substances  and 
unsaturated  compounds.  The  authors  used 
several  methods  of  saturating  the  oil  by  use 
of  halogens  but  were  not  able  to  eliminate 
its  irritating  action  upon  the  skin  of  rabbits. 

C.  J.  White  (15)  states  that  "macliinists 
of  all  sorts  have  a  common  enemy  in  dirty 
oil,  which  is  rubbed  into  and  absorbed  by 
the  follicles  of  the  skin;  and  if  boils  don't 
follow,  eczema  may.  The  necessary  clean- 
ing at  the  end  of  the  day's  work  adds  its 
quota  to  the  harm  to  which  these  men's 
skins  are  subjected.  .  .  .  Paraffin  workers 
seem  to  be  particularly  prone  to  skin  dis- 
eases. The  substance  harbors  .  .  .  many 
provoking  ingredients,  mostly  mineral  oils, 
and  constant  contact  with  this  medium, 
with  the  conseciuent  impregnation  of  the 
clothes,  may  produce  eczema,  pustules, 
and  in  the  end  cutaneous  cancer." 

Aliworthy  (16)  mentions  an  acneform 
eruption  of  "doffers"  in  the  flax  spinning 
mills  of  Belfast.  He  states  that  the  erup- 
tion is  probably  produced  bj^  dirt,  sweat, 
and  the  sperm  oil  which  is  used  on  the  ma- 


chinery. In  discussing  this  statement, 
MacLeod  affirms  that  the  acneform  erup- 
tion is  an  example  of  oil  acne,  or  bouton 
d'huile.  "In  it  the  follicles  become  plugged 
with  a  mixture  of  dirt  and  oil  which  causes 
inflammatory  changes  and  produces  the 
acneiform  lesions.  This  condition  is  met 
with,  not  only  in  flax  spinners  but  in  any 
form  of  work  in  which  the  skin  is  liable  to 
be  bespattered  with  oil,  such  as  in  stokers, 
engineers,  mill-hands,  etc.  It  is  a  milder 
form  of  the  dermatitis  from  petroleum, 
shale  oil,  etc.,  which  tends  to  go  on  to 
warty  growths  and  cancer.  It  occurs  on 
the  arms  from  the  drops  of  oil  and  on  the 
legs  from  contact  with  clothes  saturated 
with  oil." 

Oppenheim  (17)  mentions  serious  irrita- 
tions of  the  skin  of  the  face  from  the  use  of 
imi)ure  vaseline  salves  which  he  employed 
in  the  treatment  of  lu])us  vulgaris.  The 
skin  became  rough,  harsh,  uneven,  warty, 
whitish  and  hard.  Some  of  the  softer 
nodules  had  a  yellowish  central  point.  This 
statement  was  discussed  by  Sachs  (18),  who 
affirmed  that  an  acne-like  eruplion  may 
develop  alone  or  associated  with  eczema 
upon  persons  in  contact  with  petroleum, 
tar,  asphalt  or  pitch,  and  that  Wacker 
and  Schmincke  in  the  Borst  Institute  had 
found  forty-nine  different  substances  (fats, 
oils,  paraffin),  which  by  experimental  test 
gave  rise  to  epithelial  proliferation. 

Deeds  (19)  investigated  an  outbreak  of 
furunculosis  among  employees  of  a  steel 
plant  and  found  that  "the  epidemic  ap- 
parently had  its  beginning  in  the  case  of  the 
engineer  at  the  plant,  who  was  wont  to 
clean  his  hands  daily  in  the  barrel  of  paraf- 
fin oil.  Thereafter  the  cases  appeared  until 
each  of  the  fifteen  workmen  had  been  so 
infected."  The  work  done  by  these  men 
was  the  handling  of  steel  bars,  which  were 
coated  with  a  mixture  of  paraffin  oil  and 
petrolatum  to  prevent  rusting,  and  the 
hands  of  the  men  were  constantly  covered 
with  this  grease.  Deeds  considered  that  the 


•66 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


pyogenic  organisms  were  carried  from  one 
man  to  another  by  the  grease.  Staphylo- 
coccus pyogenes  aweus  was  isolated  from  the 
hands  of  the  men  but  not  from  any  of  the 
grease  used. 

Thibierge  (20)  states  that  the  bouton 
d'hiiile  became  so  serious  among  the  "tour- 
neurs  d'obus"  that  it  made  an  actual 
difference  in  the  functioning  of  the  war 
factories.  The  lesions  occurred  in  both  men 
and  women,  most  commonly  on  the  hands 
and  forearms,  or  on  the  face,  if  directly  ex- 
posed to  the  lubricant,  and  on  parts  of  the 
body  exposed  to  oil-saturated  clothing, 
especially  the  anterior  aspect  of  the  thighs. 
This  trouble  was  generally  most  pronounced 
and  extensive  in  individuals  who  had  been 
employed  for  some  time,  and  in  the  case  of 
the  "tourneurs  d'obus"  it  became  a  veri- 
table professional  stigma.  Necessity  re- 
quired the  use  of  products  of  inferior 
quality  and  irritating  nature  (oil  of  petrol, 
etc.),  and  because  of  their  scarcity  it  was 
impossible  to  purify  them.  They  became 
charged  with  dirt  and  debris,  which  were 
deposited  upon  the  skin  and  which  clogged 
the  mouths  of  the  glands.  The  metallic 
particles  were  retained  by  the  lubricating 
bodies,  which  in  themselves  were  more  or 
less  irritating,  and  a  special  form  of  acne 
resulted.  At  this  phase  histological  exam- 
ination showed  nothing  of  the  follicular  re- 
action. Finally  the  products  of  glandular 
secretion  accumulated  and  became  in- 
fected by  pyogenic  bacteria,  and  folliculitis 
and  perifolliculitis  developed. 

Albaugh  (21)  states  that  furunculosis  and 
wound  infection  "are  unusually  connnon  in 
operators  of  lathes  and  cutting  and  milling 
machines,  who  come  in  contact  with  cutting 
compounds  and  cutting  oils,  where  these 
lubricants  are  caused,  by  gravity  or  force, 
to  flow  in  a  steady  stream  on  a  job  at  the 
point  of  application  of  the  tool.  It  has  been 
observed,  also,  that  these  infections  are 
more  prevalent  during  the  sunnner  months, 
the  exact  reasons  being   unknown."    Al- 


baugh is  not  inclined  to  accept  the  idea 
that  these  affections  are  caused  solely  by 
the  bacteria  which  are  present  on  and  in 
the  skin,  and  which  are  allowed  to  set  up 
an  infection  following  injury  by  the  oil;  he 
believes  rather  that  the  oil  itself  may  serve 
as  a  vehicle  of  the  infectious  material  —  a 
surmise  which  is  further  supported  when 
the  different  types  of  skin  affections  are 
scrutinized  as  to  their  relation  with  the  dif- 
ferent substances. 

Records  of  a  three  months'  period  showed 
forty-one  cases  of  furunculosis  and  twenty- 
six  cases  of  wound  infection  occurring  in 
twenty-six  departments  of  a  factory  em- 
ploying 1,365  men,  and  probably  many 
more  cases  were  treated  outside  the  plant. 
Few  of  these  men  had  been  troubled  before 
coming  in  contact  with  cutting  compounds 
or  cutting  oils.  The  men  denied  spitting 
into  the  reservoirs,  although  several  of 
them  were  observed  to  do  so  in  spite  of  in- 
structions to  the  contrary.  As  the  oils  were 
collected  from  the  machines  and  used 
again,  this  was  an  extremely  dangerous 
practice.  Albaugh  goes  on  to  say  that  "due 
to  these  exposures,  pollution  is  almost  cer- 
tain to  follow,  especially  in  those  cases 
where  emjjloyees  have  acne  or  where  they 
have  pus  infections  of  the  skin,  or  mouth, 
or  respiratory  tract.  This  is  most  serious 
where  machines  are  equipped  with  individ- 
ual oiling  systems,  and  where  cuttings  and 
shavings  are  collected  from  the  different  ma- 
chines and  the  oil  drained  off  and  filtered. . . . 
This  is  also  true  of  machined  parts  which 
are  covered  with  oil  and  subsequently 
handled  by  men  in  other  departments." 

In  his  investigation  among  lathe  workers 
of  infections  which  appeared  to  be  true  pus 
infections,  Shie  (22)  states  that  "a  pin- 
prick, if  left  unattended,  developed  into  a 
severe  lymphangitis;  a  slight  scratch  in 
twelve  hours  into  a  linear  mass  of  pus;  a 
slight  abrasion  into  a  suppurating  ulcer; 
and  a  laceration  into  a  mass  of  necrotic 
tissue  and  pus." 


PAGE  AND  BUSHXELL  — OIL  FOLLICLXITIS 


67 


Blum  ('23)  has  recently  submitted  an 
article  on  the  skin  affections  due  to  oil 
which  he  has  called  elaiokoniose  folliculaire 
(bouton  cVhuile).  He  states  that  it  is  not  the 
oil  which  plays  the  most  important  role, 
but  in  reality  the  foreign  bodies  carried  by 
the  oil,  metallic  particles  and  dust,  which 
contribute  to  the  obliteration  of  the  fol- 
licular orifices.  The  oil  is  thus  the  vehicle 
and  not  the  pathogenic  agent.  It  is  to  the 
dermatitis  of  this  type  that  the  author  at- 
tributes the  name  elaiokoniose  folliculaire 
(eXaiov,  huile  and  kopios,  poussiere)  — 
"a  general  name  used  to  designate  the 
special  aiiection  of  the  pilosebaceous  fol- 
licules  observed  in  laborers  whose  skins  are 
greased  by  lubricating  or  other  oils,  or 
whose  pores  are  imjjregnated  and  fouled  by 
dust  in  suspension."  The  trouble  appears 
gradually,  first  generally  on  (he  hands  and 
postero-internal  face  of  the  forearms  and  on 
the  backs  of  the  fingers.  It  appears  occa- 
sionally on  the  thighs  and  abdomen  as  a 
result  of  wearing  clothes  saturated  with  the 
oil,  and  sometimes  on  the  face  and  neck  of 
attendants  on  machines  which  throw  the 
oil  to  some  distance.  More  often  the  lesions 
on  the  face  and  neck  are  due  to  scratching 
or  to  the  worker's  passing  his  hands  and 
forearms  over  his  face  to  remove  the  sweat. 

Type  of  Lesion  Due  to  Oils 

R.  P.  White  (1)  attempts  to  classify  the 
effects  upon  the  skin  of  petroleum  and  its 
distillates  which,  generally  .speaking,  cause 
varying  grades  of  dermatitis,  roughly  cor- 
responding to  the  temperatures  at  which 
they  are  given  off:  («)  Benzine,  or  i)etrol 
naphtha  (boiling  point  150° C.  and  under), 
causes  superficial  inflammation  of  the  skin, 
with  dry,  scaly  conditions,  or  eczematous 
lesions  showing  fine  vesicles,  pimples  or 
pustules.  (6)  Lighting  oil  (boiling  point 
150°  to  300°  C.)  causes  papular  and  pustu- 
lar eczema,  miliary  folliculitis,  with  or 
without    perifolliculitis    (acne),    and    ab- 


scesses, (c)  Residuum  (boiling  point  above 
300°  C.)  causes  erythema,  keratosis  senilis — 
punctiform  folliculitis,  warts,  ulcers,  and 
carcinomata.  "These  appearances  are  not 
necessarily  sequential  the  one  upon  the 
other,  and  mixed  lesions  prevail  amongst 
the  workers,  especially  in  the  distillates 
coming  off  at  the  higher  temperatures." 

Dr.  White  also  states  that  the  existence 
and  intensity  of  a  trade  dermatitis  depends 
upon  three  factors.  In  order  of  importance 
they  are:  (1)  the  potency  of  the  irritant; 
(2)  the  resisting  (pialily;  and  (3)  the  reac- 
tive capacity  of  the  skin. 

According  to  Besnier,  Brocq  and  Jacquet 
(24),  the  acneform  folliculitis,  a  p.seudo- 
comedo.  is  uniquely  an  api)Ondage  of  trades 
in  which  are  handled  tars,  jjetrols  and  the 
residues  of  their  distillation  known  as 
heavy  oils.  They  state  that  the  vesicular 
and  pustular  dermatites  are  very  frequently 
the  origin  of  lymi)hangitis  and  adenitis 
which  may  result  in  suppuration.  These 
complications  are  rare  in  spontaneous 
eczema. 

Pusey  (25)  states  that  in  addition  to  the 
irritants  that  produce  the  usual  inflamma- 
tory reactions,  there  are  certain  substances 
that  produce  lesions  in  the  skin  which  are 
not  of  the  ordinary  inflammatory  type. 
The  sub.stances  which  do  this  especially  are 
tar,  mineral  oils  and  greases,  and  their  de- 
rivatives, and,  i)erliaps,  true  fats.  The 
commonest  lesions  which  these  substances 
])roduce  are  boils  and  large  crops  of  black- 
heads and  pustules.  Such  eruptions  are  seen 
not  infrequently  in  men  habitually  exposed 
to  these  substances  in  their  occupations. 

Bridge  (26)  divides  oil  injuries  into  two 
classes  —  the  first,  the  injury  due  to  the 
plugging  of  the  small  glands  at  the  root  of 
the  hairs;  and  the  second,  the  mechanical 
injury  produced  by  metallic  particles  sus- 
pended in  the  cutting  lubricant.  The 
former  is  primarily  mechanical;  the  mix- 
ture of  dirt  and  oil  blocks  the  opening  of 
the  glands  and,  while  secretion  continues. 


68 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


excretion  is  prevented  and  an  inflammation 
is  caused  (folliculitis) .  The  glands  may  be 
invaded  by  bacteria  and  suppuration  re- 
sults in  a  boil.  Mechanical  injury  due  to 
particles  of  metal  suspended  in  the  oil 
usually  occurs  on  the  hands,  where  two  sur- 
faces are  rubbed  together,  or  on  the  arms, 
from  wiping  with  a  cloth  or  waste  when  the 
skin  is  coated  with  a  film  of  oil  in  which 
metal  particles  are  suspended.  This  injury 
allows  the  entrance  of  bacteria  from  which 
infection  may  result.  Often  the  oils  be- 
come infected  and  thus  spread  the  condi- 
tion among  the  workmen. 

Hubbard  (27)  states  that  an  improper 
practice,  and  one  which  frequently  causes 
skin  diseases  in  mechanics,  is  that  of  spit- 
ting into  oil  receptacles  or  trade  materials, 
which  subsequently  have  to  be  used  or 
handled  by  workmen.  Oil  infected  by  spit- 
tle, especially  when  used  in  lathe  work, 
quite  often  causes  boils.  Grinders  fre- 
quently blame  the  ingredients  of  prepara- 
tions used  by  them,  when  investigation  has 
showTi  that  their  trouble  was  due  to  careless 
workers  spitting  into  the  material. 

The  bouton  (Vhuile  in  its  most  advanced 
stages  is  characterized  by  Thibierge  (20)  as 
a  round  pustule  2  to  6  or  8  mm.  in  diameter, 
generally  little  raised,  with  resistant  walls 
enclosing  a  thick  pus.  This  pustule  is 
habitually  surrounded  by  a  narrow  in- 
flammatory, red,  slightly  infiltrated  zone, 
and  has  little  tendency  to  open  sponta- 
neously. Once  having  been  opened,  how- 
ever, the  orifice  remains  so  for  one  or  two 
weeks  and  the  slight  inflammatory  zone 
surrounding  the  pustule  disappears  slowly. 
Besides  this  type  of  pustule,  there  are 
other  longer  pustules  without  infiltration  at 
the  base,  which  develop  more  rapidly  and 
produce  large  quantities  of  pus.  These 
tend  to  multiply  by  auto-inoculation  and 
present  many  of  the  characteristics  of  a 
streptococcic  erythema.  This  latter  affec- 
tion is  not  considered  the  same  as  the 
bouton  d'huile.    In  many  individuals  there 


develop  large  numbers  of  acne  comedones 
usually  centered  by  a  hair. 

The  affections  described  chiefly  by  Al- 
baugh  were  true  furunculoses  and  wound 
infections,  which  are  apparently  much 
more  severe  than  the  oil  acne,  bouton 
d'/inile  or  elaiokoniose. 

In  his  description  of  the  bouton  d'  huile, 
Blum  (23)  states  that  in  the  beginning 
there  is  a  slight  itching.  Little  by  little 
there  develop  numbers  of  black  points 
which  cannot  be  removed  by  washing, 
many  of  them  presenting  projections  more 
or  less  pronounced,  at  the  center  of  which 
the  hairs  appear  old  or  broken.  This  stage 
corresponds  to  the  obstruction  of  the  fol- 
licles by  dust  (konioses)  mixed  with  oil  and 
develops  into  a  veritable  acne  comedo. 
Later  infection  sets  in,  generally  around 
the  follicle,  causing  a  perifolliculitis  which 
clinically  has  the  appearance  of  a  pustule. 
These  pustular  lesions  are  red,  violet  or 
brown,  sometimes  "jambonne";  they  are 
generally  flattened,  more  rarely  conical, 
and  represent  variable  dimensions,  from 
the  size  of  the  head  of  a  pin  to  that  of  a  pea. 
Some  of  the  pustular  lesions  have  a  raised 
center  containing  a  drop  of  yellowish  pus 
centered  by  a  black  point;  the  papule  has 
become  a  papulo-pustule.  In  other  cases, 
there  are  vesico-pustules  having  a  vesiculi- 
form  aspect.  At  other  points  the  infection 
is  a  true  folliculitis  and  more  deeply  seated, 
and  in  some  cases  true  furuncles  develop. 
There  are  thus,  according  to  Blum,  four 
stages,  all  of  which  may  appear  in  the  same 
patient  at  the  same  time:  (1)  the  stage  of  the 
black  point;  (2)  the  stage  of  acne  comedo; 
(3)  the  pustular  and  papulo-pustular  stage; 
and  (4)  the  furuncle  stage.  It  is  evident, 
then,  from  the  above  references,  that  the 
action  of  oils  will  depend  upon  the  type  and 
grade  of  oil,  the  conditions  under  which  it 
is  employed,  the  length  of  time  it  has  been 
used,  the  kind  and  amount  of  microbial 
contamination  and  the  kind  and  amount 
of  dirt,  dust  and  metal  in  suspension. 


PAGE  AND  BUSHNELL  — OIL  FOLLICULITIS 


69 


Influences  Predisposing  to 
Affection  of  the  Skin 

The  structure  of  the  skin  renders  it  spe- 
cially able  to  resist  the  action  of  agents 
likely  to  injur  it  and  allow  the  invasion  of 
micro-organisms.  Its  toughness  and  elas- 
ticity permit  it  to  resist  mechanical  injury, 
while  the  chemical  nature  of  its  secretions 
prevents  to  a  certain  extent  the  action  of 
chemical  agents.  In  discussing  this  point, 
Jaccjuet  and  Jourdanet  ('28)  make  the 
statement  "that  one  rarely  finds  traumatic 
eczema  on  the  palms  of  the  hands,  where 
the  sweat  and  grease  iire  al)undant  and  well 
mixed;  that  eczema  is  more  conuuoii  in 
winter  [when  the  secretions  are  apt  to  he 
deficient];  and  thai  an  oily  skin  is  less  af- 
fected than  a  dry  skin."  'I'his  is  not  true 
in  the  case  of  affections  due  to  oil,  since 
they  are  more  conunoidy  reported  in  the 
sununer  than  in  tlie  winter.  This  may  l)e 
due  to  the  fact  that  in  liie  sununer  the  fol- 
licles are  more  open  and  more  easily  clogged 
by  the  dirt  carried  by  the  oil,  and  that 
micro-organisms  more  easily  penetrate  into 
the  follicles  under  these  c-onditions. 

There  are  certain  factors  which  may  pre- 
dispose to  infections  of  the  skin,  such  as 
defective  structure  or  function  —  congenital 
or  acquired,  permanent  or  temporary  —  or 
unusual  environmental  conditions.  The 
age  of  the  individual  is  also  important. 
In  the  infant,  t)rtlinary  soap  may  cause 
irritation,  and  in  extreme  age  the  skin  is 
more  easily  injured  and  has  less  recupera- 
tive power  than  at  earlier  periods  of  life. 
Sachs  (18)  has  shown,  however,  that  the 
skin  of  old  rabbits  is  much  more  resistant 
to  the  action  of  certain  irritant  aniline 
colors  than  the  skin  of  young  animals. 

Abnormal  activity  of  the  sebaceous 
glands  may  predispose  to  injurious  effects 
of  certain  substances  such  as  oil,  tar,  and 
petroleum.  Unnaturally  profuse  sweating 
is  undesirable  in  certain  industries,  since 
there  is  increased  tendencv  to  retain  the 


irritant   on   the  .skin   and   to   increase   its 
solubility. 

R.  P.  White  (1)  states  that  an  occupa- 
tional disease  once  induced  may  predis- 
pose to  recurrences  of  skin  diseases  not 
produced  by  the  primary  cause.  Fordyce 
(29)  maintains  that  in  chronic  skin  dis- 
eases one  of  the  most  ]>rominent  features  is 
the  increased  susceptibility  which  the  skin 
either  presents  from  the  beginning,  or 
which  develops  as  the  process  advances. 
This  may  be  referred  to  a  state  of  ana- 
phylaxis. P,ersons  who  show  an  increased 
susceptibility  to  irritants  may,  perhaps,  be 
.sensitized  to  the  toxin  of  pyogenic  or- 
ganisms ju.st  as  patients  with  tuberculosis 
may  be  sensitized  to  tuberculins.  Such 
hyper.sensitive  or  al)normal  .skins  are  sensi- 
tive to  small  amounts  of  irritants  not  affect- 
ing normal  skins  and  this  condition  may 
pave  the  way  for  the  entrance  of  micro- 
organisms normally  ])resent  on  the  skin  or 
added  by  contact. 

The  French  writers  attach  considerable 
importance  to  the  influence  of  constitu- 
tional di.sarrangemeiits  in  skin  disea.ses. 
Thus,  a  skin  poorly  sujjplied  with  blood  is 
more  subject  to  the  action  of  irritants  and 
to  invasion  by  bacteria.  If  is  also  well 
known  that  digestion  and  nervous  dis- 
orders, alcoholism  and  iliai)etes  mellitus 
affect  the  resistance  of  the  skin  to  infection. 
In  .some  clinical  investigations  in  this  con- 
nection, Jacquet  and  Jourdanet  ('•28)  found 
that  the  cure  of  certain  gastric  disorders 
was  followed  by  great  improvement  in  the 
severity  of  local  traumatic  .skin  troubles, 
and  by  the  prevention  of  relajj.ses.  They 
claim  that  the  careless  bolting  of  food,  espe- 
cially if  indigestible,  can  in  itself  exercise 
an  injurious  influence  upon  occupational 
eczema,  proportionate  to  its  .severity.  They 
also  demonstrated  that  irritable  conditions 
of  the  mucous  memliranes,  and  overdis- 
tension of  the  stomach  are  associated  re- 
flexly  with  pathological  states  of  the  skin. 

Alderson    (30),    in   discussing   increased 


70 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


vulnerability  of  the  skin  due  to  systemic 
conditions,  states  that  "in  considering  the 
skin,  we  must  not  forget  that  it  is  an  im- 
portant organ  intimately  connected  with 
and  influenced  by  all  the  various  bodily 
functions,  among  which  the  digestive  sys- 
tem plays  an  extremely  important  part. 
Various  disorders  of  the  nervous  system 
and  internal  gland  system  are  often  the 
cause  of  increased  susceptibility  of  the  skin 
to  injury."  In  discussing  increased  vulner- 
ability due  to  local  conditions  he  declares 
that  "a  person  whose  skin  is  congenitally 
defective,  particularly  in  the  outer  layers, 
is  very  much  more  liable  to  develop  trade 
dermatoses  than  one  with  a  normal  epi- 
dermis. ...  A  deficiency  in  secretion  is 
liable  to  result  in  lowered  tone  and  lowered 
resistance  to  chemical  and  mineral  irritants 
as  well  as  to  atmospheric  and  thermal  con- 
ditions. On  the  other  hand,  an  excessive 
sebaceous  secretion  is  prone  to  clog  the 
follicles  and  the  ducts  resulting  in  increased 
irritation  and  vulnerability.  Skin  of  this 
sort  is  usually  favorable  soil  for  bacterial 
growth.  It  is  particularly  sensitive  to  the 
deleterious  effects  of  various  oils,  tars, 
parafBn,  petroleum  and  allied  substances." 
Skin  diseases  in  general,  and  those  due  to 
oils  in  particular,  are  considerably  in- 
fluenced by  secondary  invasion  by  micro- 
organisms, and  according  to  Besnier,  Brocq 
and  Jacquet  (2-1)  it  is  correct  to  say  that 
the  secondary  micro-organisms  determine 
the  character  of  the  dermatosis. 

Bender,  Bockhart  and  Gerlach  (31)  and 
Bockhart  (32)  studied  the  influence  of  sta- 
phylococci and  their  products  upon  the 
skin  of  man.  They  found  that  "toxin" 
obtained  from  broth  cultures,  when  applied 
to  the  skin,  caused  eczema  alone;  while 
"plasmin"  from  the  cells  of  the  organisms, 
applied  to  the  skin,  caused  pus  formation. 
Bockhart  states  that  the  inactive  sta- 
phylococci in  the  sound  follicles  of  the  skin, 
due  to  some  inner  or  outer  condition  of  the 
body  which  improves  llicir  nutriti\'e  con- 


ditions, increase  their  activity.  This  results 
in  the  excretion  of  the  toxin  which  diffuses 
into  the  epidermis  giving  rise  to  a  serotactic 
action  and  the  formation  of  vesicles  and 
papules.  The  tissues  in  the  immediate 
neighborhood  of  these  lesions  contain  only 
clear  serum  and  no  organisms.  After  a 
time  the  organisms  increase  and  invade 
these  areas.  If  the  organisms  contain  suffi- 
cient "plasmin,"  leukocytes  wander  in  and 
the  process  becomes  pustular. 

The  fact  that  non- virulent  staphylococci 
from  the  skin  can  become  virulent  has  been 
proved  by  Geisse  (33).  He  obtained  three 
strains  which  were  non-virulent,  non- 
hemolyzing,  non-pigment  forming,  and 
which  would  not  agglutinate  with  serum 
agglutinating  pathogenic  strains.  These 
were  placed  in  collodion  capsules  and 
placed  within  the  peritioneal  cavities  of 
guinea-pigs.  After  a  passage  of  three  or 
four  animals  they  acquired  pathogenic, 
hemolyzing  and  pigment-forming  proper- 
ties and  were  agglutinated  by  serum  specific 
for  pathogenic  strains  in  high  dilutions. 

There  is  no  doubt  that  most  of  the  skin 
affections  are  due  to  the  staphylococci, 
although  Weichardt  and  Apitzsch  (14) 
mention  isolating  streptococci  from  the 
lesions  of  machine  shop  workers,  and  Oliver 
and  Schwab  (34)  isolated  from  a  patient 
having  furunculosis  an  organism  which 
they  considered  belonged  to  the  colon- 
typhoid  group. 

Bacteriology  of  Oils 

A  review  of  the  literature  shows  that  very 
little  attention  has  been  given  to  the  bac- 
teriology of  oils.  Deeds  (19)  made  a  bac- 
teriological examination  of  oil,  petroleum, 
and  grease  mixtures,  and  in  five  out  of  six 
examinations  he  found  Bacillus  subtilis,  or 
air-borne  bacteria,  but  succeeded  in  isolat- 
ing no  pyogenic  organisms.  He  also  ex- 
amined these  products  to  determine  their 
effectiveness   as   a   medium   for   bacterial 


PAGE  AND  BUSHXELL  — OIL  FOLLICULITIS 


71 


growth  and  as  germicidal  agents.  A  twenty- 
four-hour  culture  of  Staphylococcus  pyo- 
genes aureus  was  added  and  the  suspension 
allowed  to  stand  at  room  temperature  for 
ten  hours.  Each  hour  a  loopful  of  this  ma- 
terial was  transferred  to  10  c.c.  of  nutrient 
agar  and  plates  were  poured.  The  result  of 
this  test  showed  that  there  was  neither  an 
increase  nor  a  decrease  in  the  number  of 
bacteria  during  that  period. 

Albaugh  ('•21)  reported  the  examination 
of  eight  samples  of  oils  and  cutting  com- 
pounds procured  from  machines,  and  from 
which  cultures  were  made  as  follows: 
"slants  of  glycerine-agar  and  blood-serum 
were  treated  with  a  loop  of  each  sample,  as 
were  plates  of  glycerine-agar.  At  the  end  of 
twenty-four  hours  all  of  the  cultures  had 
visible  bacterial  growths.  These  were 
found  to  be  the  usual  pu.s-forming  or- 
ganisms. One  sample  showed  as  many  as 
110,000  micro-organisms  per  gram  of  oil 
(estimated  from  colonies  in  I'elri  plates 
after  incubation  for  thirty-six  hours) — the 
organism  being  practically  a  pure  culture 
of  Sfaphylococcus  aureus." 

EXPERIMENT.VL   WoRK 

In  the  present  investigation  cultures  were 
first  made  on  plain  agar,  one  set  of  plates 
being  incubated  at  25°  C,  and  the  other  at 
37°C.  The  types  of  organisms  appearing 
on  the  plates  were  tlie  same  in  both  series. 
A  few  loopf uls  of  oil  were  suspended  in  agar 
and  heated  at  80° C.  for  twenty  minutes, 
and  plates  made.  No  growth  occurred. 
Eosin-methylene-blue  plates  were  inocu- 
lated and  one  set  incubated  aerobically, 
the  other,  anaerobically  over  metallic 
phosphorus.  Good  growth  was  observed  on 
the  aerobic  plates  in  forty-eight  hours,  and 
from  these  Types  I  and  II  mentioned  be- 
low were  isolated.  Type  III  did  not  appear 
on  these  plates  for  several  days,  but  grad- 
ually grew  somewhat  scantily.  This  type 
also  grew  somewhat  better  at  room  tem- 


perature than  at  incubator  temperature. 
The  anaerobic  plates  showed  only  Types  I 
and  II,  Type  I  greatly  predominating. 

From  deep,  agar  shake  cultures  only 
Types  I  and  II  were  isolated.  No  obligate 
anaerobes  were  obtained  by  any  of  the 
methods  used.  Cultures  obtained  by  en- 
riching in  dextrose  broth,  lactose  broth, 
and  dextrose  broth  containing  meat,  all 
gave  rise  to  TjT>es  I  and  II.  Type  III  was 
evidently  overgrown  in  these  cases. 

The  organisms  isolated  were  as  follows: 
Type  I,  Bacillus  a'erogenes;  Type  II,  Bacil- 
lus coli  communis;  both  of  fecal  type  as  de- 
scribed in  the  Standard  ^lethods  for  Water 
Analysis  for  1917.  The  former  gives  all  the 
typical  reactions  of  the  Bacillus  aerogenes 
grou]),  is  alkaline  to  methyl  red,  gives  a 
positive  Voges-Proskauer  reaction  and  fer- 
ments adonite.  Type  II  gives  all  the  typi- 
cal reactions  of  Bacillus  coli  communis,  is 
acid  to  methyl  red,  negative  to  the  Voges- 
Proskauer  reaction,  and  does  not  ferment 
adonite.  Type  III  is  a  Gram-negative, 
non-spore  forming,  actively  motile  rod 
with  an  average  of  about  twelve  flagella  of 
I)eritrichic  arrangement.  It  liquefies  gela- 
tin, and  digests  casein  and  Loffler's  blood 
serum  very  rapidly.  It  is  very  similar  to 
the  liquefying  Proteus  vulgaris  strains,  but 
produces  neither  acid  nor  gas  in  any  of  the 
fourteen  carbohydrates  tested.  The  final 
hydrogen  ion  concentration  in  Clark  and 
Lubs'  medium  dextrose  broth  and  peptone 
solution  was  about  8.2.  It  gives  a  negative 
Voges-Proskauer  reacti'on  and  did  not 
produce  indol. 

Tests  were  made  of  the  thermal  death 
point  of  these  organisms  suspended  in  nor- 
mal saline  solution  as  well  as  in  the  oil  from 
which  they  were  originally  isolated.  The 
mixture  was  drawn  into  capillary  tubes, 
which  were  sealed  at  each  end  and  placed 
at  temperatures  indicated  in  Table  1.  At 
the  end  of  the  exposure  the  tubes  were  re- 
moved, placed  in  a  5  per  cent,  solution  of 
phenol  for  fifteen  minutes,  then  in  95  per 


72 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


cent,  alcohol  for  fifteen  minutes,  and  then 
allowed  to  dry  in  a  sterile  Petri  dish.  The 
ends  were  then  broken  off  with  sterile  for- 
ceps and  the  contents  allowed  to  flow  out 
into  sterile  plates  to  which  agar  was  added. 
Table  1  shows  the  results  obtained. 

Bacteria  seem  to  be  able  to  retain  their 
vitality  in  oil  for  long  periods  of  time.  The 
sample  of  oil  investigated  has  been  in  this 

TABLE  1.  —  THERMAL  DEATH  POLNT  OF 
ORGANISMS 


Time  of  H(*ating 
at  60°  C. 

Tj-pel 

TypeH  ■ 

Type  in 

Oil 

minutes 

5 

+ 

+ 

+ 

+ 

10 

+ 

+ 

+ 

+ 

15 

+ 

+ 

- 

+ 

20 

+ 

— 

— 

+ 

25. 

- 

— 

_ 

30 

- 

~ 

- 

- 

Time  of  Heating 
at  70°  C. 

Type  I 

TypeH 

Ts-peHI 

Oil 

minutes 

5 

+ 

- 

- 

+ 

10 

- 

- 

- 

+ 

15 

- 

— 

— 

_ 

20 

— 

— 

— 

- 

laboratory  for  eight  months  and  still  con- 
tains as  many  bacteria  as  when  it  was  re- 
ceived. One  interesting  point  is  that  while 
there  were  typical  fecal  types  of  bacteria 
present  in  the  oil,  yet  no  spore-forming 
types  or  staphylococci  could  be  isolated. 

Kurpjuweit  (35)  studied  the  length  of 
time  that  bacteria  could  retain  their  vitality 
in  olive  oil  and  reported  the  following: 

Staphylococcus  aureus  not  obtained  after  12  days 
Bacillus  coli  "  "  "     14,     " 

Bacillus  diphtheriae        "  "  "       .9     " 

Bacillus  pyocyaneus        "  "  "      14     " 

Micrococcus  ureae  "  "  "     11     " 

Bacillus  typhosus  "  "  "     U     " 

Studies  on  the  influence  of  desiccation  in 
air  and  in  vacuum  were  made  by  Hammer 
(36)   who  found   that   Bacillus  coli  when 


desiccated  in  air  over  sulphuric  acid  died  in 
two  daj's.  When  desiccated  in  vacuum  it 
lived  for  fifty-seven  days  (end  of  test). 
Staphylococcus  aureus  gave  no  growth  in 
two  days  in  air  and  growth  after  fifty-four 
days  in  vacuum.  Bacillus  pyocyaneus  gave 
no  growth  after  four  days  in  air,  nor  after 
seventeen  days  in  vacuum. 

In  the  present  investigation,  tests  were 
made  to  determine  the  length  of  time  these 
organisms  would  retain  their  vitality  upon 
the  ordinary  artificial  media.  The  results 
are  shown  in  Table  2. 

Pathogenicily. — One  c.  c.  of  a  forty-eight- 
hour  broth  culture  of  these  organisms  was 
injected  intraperitoneally  into  guinea-pigs 
of  the  following  weights:  Type  I,  564  gm.; 
Type  II,  509  gm.;  Ty^c  HI,  539  gm.  The 
pig  receiving  Type  I  was  dead  in  twenty- 
four  hours  and  a  pure  culture  of  the  or- 
ganism was  obtained  from  the  peritoneum, 
liver  and  heart  blood.  The  animals  receiv- 
ing Types  II  and  HI  showed  no  ill  effects, 

TABLE    2. —  LENGTH    OF    TIME    ORGANISMS 
RETAIN  VITALITY  UPON  ARTIFICL\L 
MEDL\ 


82  Days 

60  Days 

Medium 

Type  I 

TypeH 

Tj-peln 

Typel 

TypeH 

Typem 

Litmus 

milk 

+ 

- 

+ 

- 

- 

+ 

Dextrose 

broth. .  .  . 

+ 

- 

+ 

+ 

- 

+ 

Peptone  so- 

lution .  .  . 

+ 

+ 

+ 

+ 

+ 

+ 

Agar  slant  . 

+ 

+ 

+ 

+ 

+ 

+ 

excepting  that  the  T^^^e  II  pig  appeared 
sick  for  about  forty-eight  hours. 

Relation  of  On/anisius  Isolated  to  Furuu- 
culosis.  —  The  particular  sample  of  oil  in 
question  was  submitted  to  this  laboratory 
as  it  was  considered  to  be  the  cause  of  boils. 
All  attempts  to  isolate  pyogenic  organisms 
failed,  and  since  the  oil  was  drawn  directly 
from  the  supply  barrel  and  was  not  exposed 
to  dust,  it  is  doubtful  if  any  of  these  or- 


PAGE  AND  BUSHNELL  — OIL  FOLLICULITIS 


73 


ganisms  were  present.  As  it  is  well  known 
that  the  ordinary  staphylococcus  types  are 
quite  highly  resistant  to  external  condi- 
tions, it  is  also  doubtful  if  they  would  have 
disappeared  and  left  the  colon  type  in  such 
large  numbers  and  such  vigorous  condition. 
It  is  indeed  difficult  to  understand  how  such 
tremendous  numbers  of  organisms  of  the 
type  isolated  could  have  been  present  in  the 
oil  without  direct  fecal  contamination. 

From  our  tests  the  oil  could  not  be  in- 
criminated directly  as  being  the  cause  of 
the  disease.  The  tests  are,  nevertheless,  of 
considerable  significance  in  showing  how 
long  organisms  can  live  in  oil  and  still  retain 
their  virulence.  We  may  iiere  again  em- 
phasize the  point  so  often  mentioned  by 
others,  that  workers  should  use  great  care 
not  to  contaminate  the  oils  which  are  to  be 
used  again,  and  not  to  use  waste  and  rags 
with  which  others  have  wiped  their  hands. 

Treatment  of  Oil  to  Reduce  Danger 
OF  Infection 

It  does  not  necessarily  follow  that  infec- 
tion of  the  skin  will  result  from  the  use  of 
oil  contaminated  by  ])us-forming  bacteria. 
As  was  mentioned  in  the  first  part  of  this 
article,  certain  oils  are  uiiturally  somewhat 
irritating  to  the  skin,  while  others  may  con- 
tain particles  of  metal  which  cause  injury. 
Also,  some  individuals  are  predisposed  to 
infections  of  this  tyjie.  In  order  to  elim- 
inate possible  danger  of  infection,  there- 
fore, the  oil  should  be  handled  witli  pre- 
caution. The  workmen  should  be  warned 
against  spitting  into  it  since  pyogenic  or- 
ganisms are  very  common  in  the  mouth 
and  saliva,  and  persons  with  skin  affections 
of  any  kind  should  not  be  allowed  to  come 
in  contact  with  the  oils  or  cutting  com- 
pounds used  by  others.  The  heating  of  the 
oil  to  70° C.  for  twenty  or  thirty  minutes 
will  destroy  all  the  dangerous  types  of  bac- 
teria, and  by  allowing  it  to  stand  for  a  short 
time  the  particles  of  metal  will  settle  out 
and   may   be   discarded.     The   individual 


cleanliness  of  the  worker  himself  and  the 
care  of  his  hands  will  also  reduce  the  danger 
of  infection. 

Boils  cannot  be  entirely  eliminated,  how- 
ever, especially  in  those  who  are  predis- 
posed to  irritation,  and  whose  skins  are 
httle  resistant  to  the  irritating  action  of 
oil  and  bacterial  invasion,  since  organisms 
of  the  tj'pe  commonly  causing  boils  are 
very  common  on  the  skin.  Thus,  irritation 
or  injury  merely  aids  their  entrance. 

Summary 

1.  Oils  of  all  tj-pes  are  likely  to  produce 
skin  affect  ions  if  they  come  in  contact  with 
the  skin  for  some  length  of  time. 

2.  The  most  serious  skin  diseases  are 
pr()l)ably  due  to  the  oil  acting  as  a  carrier  of 
infectious  material  from  one  individual  to 
another. 

3.  Individuals  of  the  most  cleanly 
habits  are,  generally  speaking,  least  liable 
to  skin  affections  due  to  oils. 

4.  Special  care  should  be  exercised  by 
workmen  on  cutting  machines  to  avoid 
contamination  of  the  oil,  especially  by 
spittle. 

5.  Individuals  having  skin  diseases 
should  be  transferred  to  some  other  type  of 
work. 

6.  While  oils  may  be  placed  on  the  mar- 
ket in  a  sterile  condition  and  free  from 
dust,  etc.,  they  will  not  long  remain  so  after 
being  put  into  use. 

7.  By  heating  the  oil  to  70°  C.  for 
twenty  or  thirty  minutes,  it  is  possible  to 
destroy  all  the  dangerous  pathogenic  bac- 
teria likely  to  be  present. 

8.  It  would  seem  very  desirable  to  use 
oil  which  has  been  rendered  free  from  dust, 
and  especially  from  particles  of  metal. 

9.  Workmen  should  not  exchange  waste 
and  rags  used  in  cleaning  their  hands,  and 
should  not  bathe  their  hands  in  the  oil. 

10.  Clothing  saturated  with  oil  should 
not  be  worn,  especially  if  there  is  an  epi- 
demic of  skin  diseases  among  the  workers. 


74 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Note.  —  After  this  paper  was  accepted 
for  iiublication,  the  Editor  called  the  atten- 
tion of  the  writers  to  the  report  of  an  in- 
vestigation by  the  research  staff  of  E.  F. 
Houghton  &  Company  on  the  Causes  of 
Skin  Sores  and  Boils  among  Metal  Workers 
(37) .  Data  are  given  in  detail  and  the  re- 
sults of  the  investigation  are  sunnnarized  in 
non-technical  language.  These  results  show : 

1.  Ichthyol  (0.2  per  cent,  to  1  per  cent.) 
contained  in  certain  oils  produces  skin 
lesions. 

2.  The  oils  pressed  from  crude  solid 
paraffin  also  contain  an  irritating  substance. 

3.  Lard  oil  does  not  irritate  but  may 
contain  bacteria. 


4.  Houghton's  non- irritating  blending 
oil  is  almost  entirely  free  from  ichthyol  and 
from  organically  combined  hydrocarbon 
sulphonate.  It  is  free  from  paraffin  wax 
and  contains  no  other  ingredients  which 
would  irritate  the  skin. 

5.  Daily  filtration  of  used  oil  (140°  F. 
for  thirty  minutes)  combined  with  sterili- 
zation will  reduce  the  number  of  metal 
particles  and  the  danger  of  bacterial  con- 
tamination from  careless  workmen. 

6.  Germicides  added  to  oil  are  not  effi- 
cient or  satisfactory. 

7.  The  cleanliness  of  the  worker  is  of 
first  importance.  Education  in  cleanliness 
is  needed. 


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PAGE  AND  BUSHNELL  — OIL  FOLLICULITIS 


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24 


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36 


37, 


76 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


BOOK  REVIEWS 


Public  Health  and  Insurance:  American  Ad- 
dresses. By  Sir  Arthur  Xewsholme,  K.C.B..  M.D., 
F.R.C.P.,  Lecturer  on  Public  Health  Administration 
at  the  School  of  Hygiene  and  Puiilic  Health,  Johns 
Hopkins  University.  Baltimore,  Maryland;  Late 
Principal  Medical  Officer  of  the  Local  Government 
Board,  England;  President  of  the  Society  of  Medical 
Officers  of  Health  and  of  the  Epidemiological  So- 
ciety; Examiner  in  Public  Health  to  the  University 
of  Cambridge,  in  Preventive  Medicine  to  the  Llni- 
versity  of  Oxford,  and  in  State  Medicine  to  the 
LTniversity  of  London,  Member  of  the  General  Med- 
ical Council,  of  the  Council  of  the  Imperial  Cancer 
Research  Fund,  etc.  Cloth.  Pp.  "270  with  index. 
Baltimore:  The  Johns  Hopkins  Press,  1920. 

In  the  form  of  ten  lectures  Sir  Arthur  News- 
holme  has  brought  together  material  presented 
by  him  in  addresses  to  various  public  audiences 
in  the  United  States  and  Canada,  and  partic- 
ularly to  students  in  the  School  of  Hj'giene  and 
Public  Health  of  Johns  Hopkins  University 
during  the  year  1919-19'-20.  It  is  fortunate  that 
there  are  thus  made  available  to  a  larger  public 
these  expressions  of  the  philosophy  and  wisdom 
of  an  able  and  broad- \'isioned  public  health 
administrator. 

The  lectures  are  concerned  essentially  with 
the  development  of  public  health  activities  in 
England,  and  it  is,  therefore,  inevitable  perhaps 
that  there  should  be  extended  discussion  of  the 
relation  of  public  health  administration  to  the 
Poor  Law  authority  and  of  the  interrelations  of 
poverty  and  disease. 

Dr.  Newsholme's  views  regarding  the  English 
National  Insurance  Act  would  undoubtedly 
interest  any  person  who  has  given  thought  to 
the  problems  of  com[)ulsory  health  insurance. 
"The  chief  justification  of  a  national  system  of 
insurance  against  sickness  is  that  it  shall  be  an 
action  auxiliary  in  the  prevention  of  disease. 
.  .  .  Health  progress  can  only  be  secured  by 
preventing  preventible  illness.  ...  In  securing 
such  a  result  there  will  be  needed  medical  prac- 
titioners who  are  imbued  with  the  ideas  of  pre- 
ventive medicine  in  its  widest  sense.  .  .  . 
There  is  needed  a  reconstruction  of  the  training 
of  each  medical  student  wliich  will  make  pre- 
ventive medicine  in  its  widest  sense  an  integral 
part  of  his  training.  .  .  ." 

This  very  readable  book  well  merits  the  at- 
tention of  all  who  believe  that  "the  real  wealth 
of  a  nation  does  not  consist  in  its  money,  in  the 
volume  of  its  trade,  or  in  the  extent  of  its 
dominion.  These  are  only  valuable  in  so  far  as 
they  help  to  maintain  a  population  —  and  not 


only  a  portion  of  it  —  of  the  right  quality : 
men,  women,  and  children  possessing  bodily 
vigor,  alert  mind,  firm  character,  courage,  and 
self  control ";  and  that  "this  ideal  can  never  be 
realized  unless  and  until  the  medical  men  of  the 
future  train  themselves  for  and  devote  them- 
selves to  their  essential  share  in  its  fulfillment." 
—  Wade  Wright. 

Die  Kohlenoxydvergiftung.  Ein  Handbuch  fiir 
Mediziner,  Techniker  und  Unfallrichter.  By 
Professor  l)r.  L.  LewLn.  Paper.  Pp.  369  and  a 
spectroscope  chart.    Berlin:  Julius  Springer,  1920. 

This  book  is  by  the  well-known  Berlin  to.x- 
icologist,  who  has  written  many  articles  on  car- 
bon monoxide  poisoning  in  current  medical 
literatiu-e.  The  subject  is  dealt  with  exhaus- 
tively under  the  following  headings:  history; 
sources  of  carbon  monoxide;  physical  and 
chemical  properties;  relation  of  carbon  mon- 
oxide to  the  tissues  of  the  body;  qualitative  and 
quantitative  tests;  mode  of  action  on  plants, 
cold-blooded  and  warm-blooded  animals;  role 
of  individual  susceptibility  in  poisoning;  mode 
of  absorption;  sources  of  carbon  monoxide  in 
industry;  acute  poisoning  and  its  sequelae; 
chronic  poisoning;  pathological  anatomy  and 
medico-legal  aspect;  statistics;  prophylaxis  and 
treatment. 

The  chapter  on  history  opens  with  the  state- 
ment that  carbon  monoxide  is  now  and  has 
been  since  the  first  discovery  of  fire  the  most 
widespread  poison  connected  with  human  life 
and  activity.  Aristotle  mentions  coal  gas  as  a 
cause  of  death.  Livy  and  Valerius  Maximus 
describe  wholesale  executions  performed  by 
imprisoning  the  victims  in  the  public  baths  and 
then  starting  the  fires,  and  it  seems  also  to  have 
been  a  common  method  of  painless  suicide  in 
Roman  days.  Julian,  the  Apostate,  describes  a 
very  typical  case  of  poisoning  which  he  suffered 
when  sleeping  in  a  room  with  a  pan  of  glowing 
coals.  Through  the  Middle  Ages  the  history  of 
carbon  monoxide  poisoning  passes  from  one 
extreme  to  the  other.  Sometimes  its  effect  is 
attributed  to  the  work  of  demons  or  witches; 
again,  an  unusually  observant  and  clear- 
headed physician  will  describe  a  case  with  great 
accuracy.  Avicciuui  noted  it  as  a  poison  which 
weakened  the  brain.  Toward  the  latter  i)art  of 
1500,  Donato  of  Mantua  described  practically 
all  the  .symptoms  of  this  form  of  poisoning,  the 
rosy  color  of  the  face  and  the  appearance  of  nor- 


BOOK  REMEWS 


77 


mal  sleep  in  the  coma  of  carbon  monoxide 
victims,  the  fever,  bronchial  irritation,  and 
pneumonia  which  follow,  and  the  different 
manifestations  of  damage  to  the  brain.  ]\Iore 
than  a  hundred  years  later,  Ramazzini  de- 
scribed carbon  monoxide  as  a  common  indus- 
trial poison,  and  the  eighteenth  century  saw 
the  publication  of  several  very  accurate  obser- 
vations, notably  those  of  Friedrich  Hoffmann 
in  1720  and  of  Boerhave  in  llSi. 

The  author  gives  analyses  of  smoke  and  gas 
from  all  possible  sources,  and  the  student  who 
wishes  to  look  up  "gassing"  in  mines,  in  the  use 
of  explosives,  in  blast  furnace  work,  in  the  use 
of  power  gas,  and  in  tlie  manufacture  and  use  of 
illuminating  gas  will  find  much  valuable  ma- 
terial here.  In  the  section  on  the  physical  and 
chemical  properties  of  carbon  monoxide,  I^win 
warns  against  the  fallacy  of  applying  to  human 
beings  the  facts  discovered  in  tiie  laboratory, 
for  in  this  form  of  poisoning,  more  than  in  any 
other,  individual  characteristics  ])lay  an  enor- 
mous r(Me.  The  outcome  of  no  single  case  can 
be  predicted  on  the  findings  with  regard  to  con- 
centration of  carbon  monoxide  or  ab.sence  of 
oxygen;  the  man's  fate  lies  es.sentially  in  his 
own  vital  forces.  Even  the  ca])acity  of  the 
blood  to  bind  carbon  monoxide  varies  in  dif- 
ferent individuals.  A  practical  point  brouglit 
out  by  test  tube  experiments  is  that,  although 
the  blood  gives  up  carbon  monoxide  even  at 
zero  centigrade,  the  surrender  is  much  more 
rapid  at  a  higher  temperature. 

It  is  impossible  to  cover  nearly  all  the  chap- 
ters of  this  book  within  the  compass  of  a  review. 
There  is  space  only  for  the  stand  taken  by 
Lewin  on  various  controversial  points.  He 
finds  carbon  monoxide  excreted  very  rapidly 
during  the  first  hour  after  removal  to  fresh  air, 
then  more  slowly,  but  by  the  end  of  six  hours  it 
is  usually  no  longer  demonstrable,  although  he 
has  satisfied  himself  that  as  little  as  O.'io  per 
cent,  can  be  shown  tlu-ough  the  spectroscope. 
He  is  very  skeptical  about  the  instances  re- 
ported in  the  literature  of  carbon  monoxide  in 
the  blood  after  more  than  twenty-four  hours  in 
pure  air.  The  great  variation  m  the  quantity 
found  in  the  blood  after  death  (from  6  per  cent, 
in  Emile  Zola's  blood  to  83  per  cent,  in  one  of 
Haldane's  cases)  can  only  be  explained  on  the 
ground  of  individual  susceptibility  or  perhaps  of 
difference  in  the  mode  of  administration  of  the 
gas,  or  the  possibility  that  blood  in  different 
parts  of  the  body  contains  different  proportions 
of  carbon  monoxide. 


Lewin  takes  a  very  positive  stand  in  the  con- 
troversy over  the  mode  of  action  of  carbon 
monoxide,  denying  that  there  is  any  direct  ac- 
tion on  the  cells  of  the  central  nervous  system 
or  of  anj^  other  organs.  All  the  manifold  lesions 
found  after  carbon  monoxide  gassing  result 
from  the  injury  caused  by  oxygen  privation. 
The  whole  error  of  those  who  uphold  the  theory 
of  carbon  monoxide  as  a  protoplasmic  poison  is 
that  they  do  not  distinguish  between  the  lesions 
of  acute  poisoning  and  the  later  residts  which 
have  no  direct  connection  with  the  intoxication 
but  are  secondary  and  of  various  origins.  It  is 
absurd  to  say,  when  pneumonia  supervenes 
twenty-four  to  forty-eight  hours  after  the  in- 
toxication, that  carbon  monoxide  has  injured 
the  lung,  for  it  has  no  chemical  or  physical  effect 
on  limg  tissue  nor  does  it  injure  the  blood  ves- 
sels, producing  fatty  changes  of  intinia  and 
media,  any  more  than  does  the  inhaling  of  aniyl 
nitrite.  Carbon  monoxide  poisoning  is  a  special 
kind  of  asphyxia  which  in  general  corresponds 
symptomatically  with  other  forms  of  oxygen 
deprivation.  This  statement  rests  on  the  blood 
changes  noted  and  on  the  impossibility  as  yet  of 
finding  any  other  tenable  theory.  If  the  blood 
changes  are  not  the  essential  and  only  cause, 
tlion  the  action  of  carbon  monoxide  on  the 
brain  nmst  be  relegated  to  the  mysterious  realm 
of  morphine,  hydrocyanic  acid,  cocaine,  etc., 
which  have  nothing  in  common  chemically  and 
yet  affect  the  function  of  the  brain  in  some  un- 
explained way.  With  carbon  monoxide  as  with 
hydrogen  sulphide  and  with  the  poisons  which 
form  methemogloiiin,  there  is  a  causa  proxima 
in  the  blood  changes,  and  this  should  be  ac- 
cepted so  long  as  no  more  cogent  cause  can  be 
found. 

Carbon  monoxide  poisoning  is,  however, 
distinguished  from  all  other  oxygen-deficiency 
or  hemoglobin-alteration  poisons  by  the  occur- 
rence of  sequelae.  In  all  toxicology  no  known 
body  can  compare  with  carbon  monoxide  in  the 
variety  and  extent  of  lesions  following  it,  and 
individual  susceptibility  is  not  enough  to  ac- 
count for  them.  But  to  assume  that  carbon 
monoxide  acts  directly  on  the  brain  and  other 
organs  does  not  help,  for  in  that  case  the  effects 
would  be  more  uniform  and  constant.  Their 
great  variation  and  extent  show  that  very 
special  conditions  must  be  present,  not  ac- 
coimted  for  by  mere  oxygen  deficiency  or  other 
poisons,  and  it  is  these  conditions  that  are  the 
most  puzzling  elements  in  the  problem  of  car- 
bon monoxide  poisoning. 


78 


THE  JOLUNAL  OF  INDUSTRIAL  HYGIENE 


To  the  unsettled  question  of  chronic  carbon 
monoxide  poisoning  Lewin  does  not  contribute 
very  much,  although  he  gives  some  instances  of 
marked  and  undoubted  slow  poisoning.  It 
cannot  be  regarded  as  a  cumidative  effect  of  the 
gas  in  the  body  which,  when  it  reaches  a  certain 
degree,  gives  rise  to  clinical  symptoms.  For 
this,  one  would  have  to  remain  in  the  carbon 
monoxide  atmosphere  continuously,  and  that  is 
never  true;  one  is  always  getting  rid  of  the  gas 
when  one  goes  out  into  pure  air.  A  chemical 
accumulation  cannot  occur,  but  a  functional 
one  can  —  i.  e.,  a  cumulative  effect  of  all  the 
injuries  done  to  the  blood  and  to  the  tissues, 
especially  the  hemopoietic.  This  injury  ma.y  be 
simply  nutritive  —  an  anoxemia  —  but  as  a 
result  poisonous  products  may  be  formed  and 
exert  their  ovm.  secondary  action.  As  in  acute 
poisoning,  individual  susceptibility  varies 
greatly.  There  is  great  difficulty  in  diagnosis, 
for  the  symptoms  are  usually  only  headache, 
anemia,  cardiac  neurosis,  or  general  nervous- 
ness. The  avocations  in  which  this  danger  is 
present  are  these :  cooks,  furnace  tenders,  pres- 
sers,  laundry  workers,  gas  workers,  molders, 
miners,  chemists,  firemen,  garage  workers  and 
housewives.  The  symptoms  which  come  on 
usually  at  the  end  of  the  day's  work  —  head- 
ache, dizziness,  and  disturbance  of  vision  — 
pass  over  quickly  at  first  in  the  open  air,  but 
later  the  natural  recuperative  powers  fail  and 
some  form  of  chronic  poisoning  sets  in,  the  most 
common  of  which  is  anemia,  which  may  be  of 
any  type  up  to  the  severe  pernicious. 

The  treatment  of  acute  carbon  monoxide 
poisoning  must  be  directed  toward  the  restora- 
tion of  normal  response  to  stimuli  on  the  part  of 


the  cerebral  centers,  especially  the  respiratory. 
The  ground  for  administering  oxygen  is  the 
fact  proved  by  experiment  that  the  dissociation 
of  carbon  monoxide  from  the  blood  takes  place 
five  times  as  cjuickly  with  pure  oxygen  as  with 
ordinary  air.  The  administration  must  some- 
times be  prolonged,  but  it  is  necessary  to  re- 
member that  with  the  disappearance  of  carbon 
monoxide  from  the  blood  the  symptoms  caused 
by  its  presence  do  not  always  disappear.  The 
brain  symptoms,  for  instance,  may  not  improve, 
even  after  all  the  carbon  monoxide  has  van- 
ished, and  one  must  assume  either  that  there 
are  other  toxic  substances  present  in  the  blood 
which  continue  to  act,  or  that  the  degenerative 
changes  set  up  by  carbon  monoxide  progress 
after  the  cause  has  been  removed.  Lewin  con- 
demns unreservedly  the  subcutaneous  injection 
of  oxygen  or  hydrogen  peroxide.  He  approves 
of  venesection  as  lessening  the  danger  of  hem- 
orrhage, stimulating  blood  regeneration,  and 
also  as  effecting  a  partial  removal  of  the  poison 
{Teilenfc/iftiing),  which  last  is  hardly  in  har- 
mony with  his  repeated  assertion  that  carbon 
monoxide  is  not  a  poison.  Normal  salt  infusion 
is  of  decided  value,  especially  when  preceded  by 
bleeding,  but  Lewin  objects  strenuously  to 
blood  transfusion,  apparently  under  all  cir- 
cumstances. 

A  colored  chart  of  the  different  spectra  of 
oxyhemoglobin  and  carbon  monoxide  hemo- 
globin before  and  after  reduction  is  appended. 
The  bibliography  is  \'ery  full,  in  fact,  practically 
complete  except  for  the  more  recent  American 
publications  which  were  probably  not  acces- 
sible to  the  author  at  the  time  of  writing.  — 
Alice  Hamilton. 


THE  JOURNAL  OF 
INDUSTRIAL   HYGTENE 


PUBLISHED  MONTHLY 


Volume  III 


JILY.  1921 


NtTMBER  3 


PHYSIOLOr.irAL  EFFECTS  OF  AITOMOBILE  EXHAIST  GAS  AND 
STANDARDS  OF  VENTILATION  FOR  BRIEF  EXPOSURES* 

YANUELL  HENDERSON.  HOWARD  \V.  HAGGARD,  MERWYN  C.  TEAGUE. 
ALEXANDER  L.  PRINCE,  and  RITH  M.  WINDERLICH 


CONTENTS 

Introdmtion 
I.    FuiKlainciital  ('(insidcrntiiin.s 
II.    Experiments  on  Men  in  Six  Culiic  Meli-r  (IuiimImt 

III.  Rate  of  .\l)sor|)ti(in  of  Carbon  Mono\i(lc  and  Maiul- 
ard.s  of  .\llMWal)le  N'ilialion  of  tin'  .\ir 

IV.  Concordance  of  tlic  Standard   Hire  l'ro|iosi(l  willi 
the  Observations  of  Other  liivestij-ators 

V.   Observations  in  Lar>;e  Gassing  Chamber 
VI.   Observations  in  Garages  and  in  the  (irand  Central 
Station,  New  York  City 
VII.    Comparative  Toxicity  of  Pure  Carbon  Monoxide. 
Illuminating    Gas,    Exhaust    Gas    from    Gasoline. 
Exhaust    Gas    from    Coal    Distillate    and    Ga>oline 
Vapor 
VIII.    I'rincipal  ConeUisions 

Introduction 

THE  increasing  irsc  of  the  gasoline  en- 
gine in  a  widening  diversity  of  fields 
has  bronght  with  it  eorresi)on(ling  problems 
concerning  the  influence  of  exhaii.st  gases 
upon  the  health  not  only  of  the  men  in  im- 
mediate charge  of  the  machines  but  of  the 

*  .\n  abbreviation  of  the  report  to  the  Chief  Engineer 
of  the  New  York  State  Rridge  and  Tunnel  Connnission  and 
the  New  Jersey  Interstate  Bridge  and  Tunnel  Commission. 
The  investigations  were  carried  out  under  the  linnau  of 
Mines  at  the  Physiological  Laboratory  of  Yale  Iniversity. 
The  full  reports  on  both  the  engineering  and  the  phys- 
iological a.spects  of  this  problem  will  be  ])ublislied  in  the 
report  of  the  Chief  Engineer  of  the  Connnissions  an<l  l)y  the 
Bureau  of  Mines.  Published  here  by  permission  of  the 
Director  of  the  I  .  S.  Bureau  of  Mines  and  of  the  Chief 
Engineer  of  the  New  York  State  Bridge  and  Tunnel  Com- 
mission and  the  New  Jersey  Interstate  Bridge  and  Tunnel 
Commission.    Received  for  pul)lication  Feb.  ^24.  1!)^21. 


general  ])ublic  as  well.  Rejjorts  u])on  a 
niiniber  of  these  problems  have  already 
been  |)ublished  by  the  Fnited  States  Bu- 
reau of  Mines,  but,  for  the  most  part, 
recent  studies  have  deail  particularly  with 
the  use  of  traction  engines  and  the  vitia- 
tion of  the  air  in  coal  mines,  and  the  de- 
termination of  standards  for  the  allowable 
vitiation  requisite  for  .safety. 

The  plan  to  construct  tunnels  under  the 
Hudson  River  l)etween  New  York  and 
Jersey  City  for  the  use  principally  of  motor 
vehicles  has  raised  several  problems  which 
have  j)reviously,  however,  never  been  exten- 
sively invest  igateil.  Whereas  the  conditions 
in  coal  mines  and  about  gas  jiroducer  plants 
apply  oidy  to  healthy  men.  the  conditions 
which  will  prevail  in  the  tumiel  under  the 
Hudson  Ri\cr  will  affect  the  general  public. 
Not  only  healthy  adults  but  children  and 
even  invalids  on  their  way  to  ho-sjiitals  will 
be  transported  through  it.  and  at  some 
time  it  may  be  necessary  for  .soldiers  to 
march  through.  The  amount  of  traffic  is 
likely  to  be  large,  even  from  the  begiiming, 
and  is  likely  to  increase  in  a  few  years  to  the 
maximum  cajiacity  of  the  roadway.  The 
total  amount  of  exhau.st  gas  discharged 
from  pas.senger  cars  and  trucks  will  there- 
fore be  considerable.   The  distance  between 


79 


80 


THE  JOlTiXAL  OF  INDUSTRIAL  HYGIENE 


the  ventilating  shafts  at  the  pier  heads  on 
the  two  sides  of  the  river  will  be  somewhat 
more  than  3,300  feet  —  a  distance  greater 
than  in  any  existing  tiuinel  used  by  motor 
vehicles  —  and  the  total  length  of  the  tmi- 
nel  about  8,500  feet  between  portals.  The 
ventilation  must,  therefore,  be  ample  to 
prevent  not  only  danger,  but  even  slight 
discomfort,  and  must  be  managed  in  such 
a  fashion  as  to  avoid  excessive  wind  ve- 
locities. The  cost  of  installing  ventilating 
fans  will,  in  any  case,  be  an  appreciable 
item  in  the  initial  construction,  and  the 
maintenance  of  artificial  ventilation  during 
the  operation  of  the  tunnel  is  likely  to  be 
one  of  the  largest  single  items  of  continuing 
expense. 

Accordingly,  the  commissionsof  the  states 
of  New  York  and  New  Jersey  through  their 
Chief  Engineer,  Mr.  Clifford  M.  Holland, 
contracted  with  the  Bureau  of  Mines  to 
undertake  on  their  behalf  the  investigation 
of  two  problems:  (1)  the  amount  and  char- 
acter of  the  exhaust  gas  produced  by  va- 
rious tj'pes  and  sizes  of  passenger  cars  and 
trucks;  and  ('•2)  the  nature  of  the  toxic  sub- 
stances in  exhaust  gas,  and  their  allowable 
concentration  —  that  is,  the  extent  to 
which  the  gas  must  be  diluted  with  air  to 
become  practically  harmless.  The  results  of 
these  two  mvestigations  will  together  af- 
ford the  data  upon  which  plans  and  designs 
for  the  ventilation  of  the  tunnel  may  be 
intelligently  based. 

Problem  1  was  placed  in  the  immediate 
charge  of  Mr.  A.  C.  Fieldner,  supervising 
chemist  of  the  Bureau  of  ^Nlines  at  the  Ex- 
periment Station  of  the  Bureau  at  Pitts- 
burgh. Problem  2,  of  which  the  results  are 
here  published,  was  assigned  to  Dr.  Yandell 
Henderson,  Professor  of  Physiology  in  Yale 
University  and  Consulting  Physiologist  of 
the  Bureau  of  Mines.  The  work  was  carried 
out  by  him  with  a  staff  of  physiologists  and 
chemists  employed  by  the  Bureau  for  this 
purpose  in  the  PliAsiological  Laboratory  at 
Y'ale  University. 


The  investigations  and  formulations  here 
presented  are  of  a  much  wider  scope  than 
the  mere  solution  of  the  problem  raised  by 
the  Hudson  tunnels.  Vehicular  tunnels  are 
bemg  very  generally  considered  both  as 
substitutes  for  bridges  and  as  a  means  of 
decreasing  distances  and  grades  in  high- 
ways in  mountainous  regions.  Further- 
more, the  results  of  these  investigations 
apply  almost  ecjually  well  to  conditions  in 
garages  and  fire  rooms,  to  the  air  around 
gas  producers,  smelters  and  blast  furnaces, 
to  dwellings  in  which  there  is  an  escape  of 
illuminating  gas,  and,  in  general,  to  all 
places  where  men  are  exposed  to  the  gaseous 
products  of  incomplete  combustion. 

Prior  to  this  investigation,  the  stand- 
ards of  allowable  air  vitiation  with  carbon 
monoxide  have  not  been  precisely  defined. 
The  investigations  of  Dr.  J.  S.  Haldane, 
the  eminent  English  authority,  have  dealt 
chiefly  with  questions  of  the  safety  of 
miners  after  mine  explosions  and  fires,  and 
his  attention  has,  therefore,  generally  been 
directed  to  the  amount  of  carbon  monoxide 
which  would  incapacitate  or  seriously  in- 
convenience a  man,  rather  than  to  those 
amounts  which  are  compatible  with  com- 
plete comfort  and  efficiency.  For  the  Lon- 
don underground  railways,  however,  he 
gave  it  as  jiis  opinion  that  a  concentration 
of  not  more  than  one  part  of  carbon  mon- 
oxide in  10,000  of  air  was  desirable.  It  is 
noteworthy,  nevertheless,  that  he  contem- 
plated a  possible  period  of  exposure  suffi- 
cient for  the  blood  to  approach  ecjuilibrium 
with  this  concentration  in  the  air.  The 
standard  hereinafter  i)roposed  by  the  au- 
thors appears  at  first  sight  distinctly  higher 
than  that  originally  suggested  by  Dr.  Hal- 
dane. but  when  the  short  time  of  exposure 
in  the  proposed  vehicular  tunnels  is  taken 
into  consideration  it  will  be  seen  that  the 
figures  reached  by  Dr.  Haldane  and  by  the 
authors  for  the  amount  of  carbon  monoxide 
absorbable  without  appreciable  injury  or 
discomfort  are  in  quite  close  agreement. 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS        81 


It  might  appear  that  the  ventihition  of 
any  closed  space  should  be  such  as  to  fur- 
nish virtually  as  pure  air  as  that  of  the  city 
streets.  In  that  case,  this  investigation 
would  be  unnecessary,  and  a  standard  of 
not  more  than  one  i)art  of  carbon  monoxide 
in  10,000  of  air  might  have  been  adopted. 
To  have  attempted,  however,  to  ventilate 
long  tunnels  like  those  under  the  Hudson 
River,  or  any  similar  closed  space,  so  that 
the  air  would  be  virtually  free  from  carbon 
monoxide,  would  jjcrhaps  have  ])r()ved 
scarcely  practicable.  It  wojild  certainly 
have  been  extremely  expensive.  The  wind 
velocities  necessary  in  moving  such  a  vol- 
ume of  air  would  cause  discoTufort  to  pas- 
sengers and  might  even  prove  ])roliil)itive 
of  traffic. 

The  standards  here  estal>lislicd  will  re- 
duce the  expense  of  ventilation  greatly 
below  that  re(iuired  to  provide  a  carbon 
monoxide  dilution  of  one  to  l(l,0()(t.  not 
only  in  the  Hudson  IumucIs,  l)Mt  in  all 
similar  future  undertakings.  'I'lu-se  stand- 
ards will,  it  is  hoped,  prove  valuable  both 
to  hygienists  interestetl  in  safeguarding  the 
public  health  and  to  engineers  engaged  in 
the  design  of  a  wide  variety  of  i)rojects 
both  above  and  below  grovmd. 

I.     FUNDAMENT.XL    C()XSIDER.\TIONS 

Although  carbon  monoxide  is  the  cause 
of  more  deaths  than  the  total  due  to  all 
other  gases,  a])art  from  a  single  reaction  it 
is  a  physiologically  inert  and  non-poisonous 
substance.  This  reaction  is  its  combinat  ion 
with  hemoglobin,  the  red  coloring  matter 
and  oxygen-carrying  element  of  the  blood. 
To  whatever  extent  hemoglobin  is  so  com- 
bined, it  is  rendered  incapalile  of  trans])ort- 
ing  o.xygen  from  the  lungs  to  the  tissues 
and  organs  of  the  body,  until  the  carbon 
monoxide  is  again  displaced.  It  is  highly 
probable  that  all  of  the  results  of  inhalation 
of  carbon  monoxide  are  due  directly  or  in- 
directly to  oxygen  deficiency.    Even  when 


other  toxic  substances  are  present  —  as  in 
smoke,  in  fumes  from  explosives  and  in 
other  incomplete  combustions  —  carbon 
monoxide  is  usually  the  chief  cause  of  injury 
or  death.    It  acts  wholly  through  asphyxia. 

The  body  of  an  adidt  man  of  average 
weight  contains  enough  hemoglobin  to 
hold  about  600  c.c.  of  oxygen.  If  com- 
pletely saturated,  it  would  hold  the  same 
amount  of  carbon  monoxide,  one  molecule 
of  carbon  monoxide  replacing  one  molecule 
of  oxygen  in  the  blood.  The  absor])tion  of 
6  c.c.  of  carbon  monoxide  from  the  lungs 
produces,  then,  1  per  cent,  of  saturation 
and  abolishes  1  per  cent,  of  the  oxygen 
capacity. 

Tlu'  unit,  in  which  various  concentra- 
tions of  carbon  monoxide  are  commonly 
measured  and  exjjressed  for  purposes  of 
ventilation,  is  one  "part."  or  a  certain 
number  of  "parts."  of  this  gas  mixed  with 
10,000  times  as  much  air.  A  "part"  is  a 
hundredth  of  1  ])er  ccnl.  of  an  atmosphere. 
A  man  at  rest  breathes  al)out  8,000  c.c.  of 
air  per  minute,  of  which  about  0.000  c.c. 
reach  his  lungs,  or  (JO  liters  in  ten  minutes. 
Let  us  suppose  that  this  air  contains  one 
part  of  carbon  monoxide,  or  6  c.c.  in  60 
liters,  and  tiiat  all  of  this  6  c.c.  is  absorbed. 
The  blood  would  then  become  saturated  at 
the  rate  of  1  per  cent,  every  ten  minutes 
per  "part"  of  carbon  monoxide  in  the  air. 
Evidently  the  duration  of  exposure  is  a 
limiting  factor  in  the  amount  absorbed,  for 
one  cannot  absorb  more  than  one  inhales. 

It  appears  that  when  a  man  begins 
breathing  any  low  concentration  of  carbon 
monoxide  mixed  with  air,  absorption  at 
very  nearly  this  rate  does  occur,  but  only 
at  first.  Then  the  rate  becomes  slower. 
Even  if  the  exposure  is  prolonged,  carbon 
monoxide  merel\-  dis])laces  oxygen  from 
the  blood  up  to  a  point  of  equilibrium  de- 
pending upon  the  relative  amounts,  or 
mass  actions,  of  <'arbon  monoxide  and 
oxygen  in  the  air  breathed  and  the  inten- 
sity of  the  affinities  of  the  two  gases  for 


82 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


hemoglobin.  If  thereafter  tlie  pressure  of 
oxygen  is  high  enough  antl  that  of  carljon 
monoxide  is  low,  or  absent  as  in  pure  air, 
oxygen  can  Hkewise  displace  carbon  mon- 
oxide and  thus  completely  restore  the 
oxygen-carrying  power  of  the  hemoglobin. 
The  blood  is  neither  directly  changed  nor 
injured  by  the  process. 

Hemoglobin  attracts  carbon  monoxide 
about  300  times  as  strongly  as  it  does  oxy- 
gen. Thus,  if  To,  and  Tco  are  the  pres- 
sures of  oxygen  and  carbon  monoxide,  and 
Who.  and  Hbco  the  amoiuits  of  oxyhemo- 
globin and  carbon  monoxide  hemoglobin 
in  the  blood,  the  relations  are  expressed  by 
the  formula : 


To. 


Hbo, 


Tco  X  300     Hbco 

Tco  X  300 


percentage  Hbco  = 


To,  +  (Tco  X  300)' 

or  more  specifically,  if  there  are  1,500  parts 
of  oxygen  and  '•2  of  carbon  monoxide,  the 
formula  works  out  to: 

2X300 
1500 -f  (2X300)  =  -^-^  ^'''  """'•    ^^*"^^- 
tion  with  carbon  monoxide. 

The  air  in  the  lungs  contains  about  1,500 
parts  of  oxygen  in  10,000.  (It  is  actually 
somewhat  less  than  15  ])er  cent,  of  oxygen. 
The  affinity  of  hemoglobin  for  carbon 
monoxide  may  also  be  less,  or  more,  than 
300.  We  are  here  using  round  numbers 
merely  to  illustrate  the  princi])le  without 
attempting  mathenuitical  i)recision.)  We 
may  calculate  the  blood  equilibrium  for  an,\- 
concentration  of  carbon  monoxide  in  the 
air,  and  from  such  data  we  may  obtain  the 
carbon  monoxide  dissociation  curve  of  the 
blood  as  shown  in  Figure  1.  This  curve 
indicates  that,  if  air  containing  two  parts  of 
carbon  monoxide  in  10,000  is  breathed  for  a 
time  long  enough  to  attain  ecjuilibrium,  the 
blood  should  become  about  28  per  cent, 
saturated;  with  four  parts,  44  per  cent.; 
with  six  parts,  54  per  cent.:  and  so  on. 
In  the  curve  it  is  to  be  seen  that,  for  in- 


stance, the  equilibrium  value  for  ten  parts 
of  carbon  monoxide  in  10,000  of  air  is  66.6 
per  cent,  saturation,  which  is  a  sufficient 
degree  of  saturation  to  render  a  man  un- 
conscious and  totally  helpless.  If  con- 
tinued, the  asphyxia  might  lead  to  serious 
permanent  injury  or  even  death. 

The  question  of  greatest  practical  im- 
portance is:  How  long  a  time  would  be 
required  to  attain  this  or  any  other  definite 
percentage  of  saturation?  In  other  words, 
what  is  the  i)hysiological  law  defining  the 
rate  of  absorption  of  carbon  monoxide  into 
the  blood .^  From  the  simple  calculation, 
given  previously,  regarding  the  oxygen 
capacity  of  the  body  and  the  volume  of  air 
drawn  into  the  lungs,  it  appears  that  a  man 
breathing  ten  jjarts  of  carbon  monoxide 
would  inhale  enough  of  the  gas  to  become 
66.6  per  cent,  saturated  in  66.6  minutes. 
But,  as  already  indicated,  the  more  carbon 
monoxide  the  blood  contains,  the  greater 
becomes  the  force  with  which  this  gas  tends 
to  diffuse  out  again  into  the  air.  The  more 
nearly  this  tendency  equals  and  counter- 
balances the  pressure  of  the  gaseous  carbon 
monoxide  in  the  lungs,  the  slower  the  ab- 
sorption of  more  carbon  monoxide  becomes. 
Thus,  to  attain  a  condition  of  complete 
blood  equilibrium  nu^ny  hours  would  be 
actually  required:  indeed,  the  time  is  in- 
determinate. Doubtless  other  factors  also 
play  a  part  in  retarding  and  stopping 
absorjjtion. 

It  ajjpeared  to  us,  however,  that  a  definite 
quantity  for  determination  would  be  the  time 
required  for  attainment  of  a  percentage  sat- 
uration of  one-half  the  equilibrium  values. 
Thus,  in  an  atmosphere  containing  two 
paits  of  carbon  monoxide,  for  which  the 
blood  e(|nilibriiiin  is  about  28  percent.,  how 
long  a  time  would  be  rec^uired  for  the  blood 
to  become  14  per  cent,  saturated?  How 
long  with  four  parts  and  an  equilibrium 
value  of  44,  to  attain  22  i)er  cent,  satura- 
tion: er  with  six  parts  and  an  eijuilibrium  of 
54,  to  reach  27  per  cent.?    The  answer  to 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXIL\UST  GAS 


83 


this  question  is  the  principal  practical  con-  oxide   here   to   be   proposed,   the   time   of 

tribution  to  knowletlge  which  we  have  to  exposure  will  be  too  brief  to  allow  an  ab- 

make  —  namely,  that  fhe  time  for  attain-  sorption  sufficient  for  any  considerable  ill 

ment  of  half  equilibri II in  for  per.wii.'i  .sitting  at  effect.     The   second    possibility   has   been 


rest  and  breathing  concent raiitms  of  carbon 
monoxide  up  to  seven  parts  is  nerer  con- 
siderably less  than  one  hour.  This  fact  is, 
we  believe,  of  fundamental  importance  for 
ventilation  engineering.  Wc  have  estab- 
lished it  purely  experimentally.    It  might. 


investigatetl  by  us,  but  has  not  been  found 
to  occur.  (Owing  to  their  highly  technical 
and  space-consuming  character,  these  stud- 
ies are  omitted  here,  but  will  api)ear  in  the 
full  report.) 

There  is  reason  to  believe  that  there  are 


3 

<    25 

r 
I" 


however,  easily  be  correlated  with  the  ox-     individual  differences  in  the  degree  of  the 
ygen  consumption  and  the  carbon  dioxide     ill  effects  induced  by  considerable  oxygen 
elimination,  but  we  have 
not  thought  this  to  be  of 
practical  un])ortauce  to 
the  immediate  object  of      3'° 
this  report .    It  does  not ,      | " 
nor  does  it  aim  to.  express      j '° 
what   the  average  person      |" 
does  under  the  condititins,      '  •" 
for  numy  of  our  subjects      *  " 
fell  much  below  this  rate 
of  absorption.   The  value 
of  the  rule  is  that  it  ex- 
presses the  worst  attain- 
able, or,  .so  to  speak,  (he 
"maximum  load." 

We  may  here  con- 
veniently consitler  the 
question,  often  raised,  of 
po.ssible  extreme  individ- 
ual susceptibility.     Such 

susceptibility  might  conceivably  arise  (1)  deficiency.  Aviators  and  mountain  dimb- 
from  anemia,  that  is,  a  subnormal  amount  ers  exhibit  such  differences,  and  in  our  more 
of  hemoglobin;  ("Z)  from  an  unusual  avidity  exireme  tests  headache  has  occurred  in 
of  the  individual's  hemoglobin  for  carbon  some  persons  at  a  somewhat  lower  percent- 
monoxide;  (;?)  from  uuus\ial  susceptibility  age  .saturation  of  the  blood  than  in  others, 
to  the  ill  effects  of  oxygen  deficiency;  or  (4)  We  have,  however,  found  no  one  who  ex- 
from  a  volume  of  breathing  much  above  the  perienced  this  effect  —  the  first  sign  of  ox- 
ordinary.  The  first  is  unimjjortant  prac-  ygen  deficiency  —  under  the  conditions  of 
tically  inasmuch  as  anemics  need  not  spend  the  standards  which,  we  shall  propose, 
long  periods  in  ill-ventilated  garages,  nor  The  volume  of  breathing  is  by  far  the 

ride  through  tunnels  on  slow  moving  most  important  element  in  the  rate  of 
trucks.  If,  however,  they  are  transjjorted  absorption  of  carbon  monoxide  and,  thus, 
at  the  speed  of  a  passenger  car  or  an  ambu-  in  the  individual  \ariations  in  the  ill  effects 
lance  through  a  two-mile  tunnel  containing  of  inhalation  of  this  gas.  In  general,  the 
the  average  concentration  of  carbon  mon-     expired  air  of  a  healthy  man  contains  4  or 


Kic.   1.  —  Final  or  nuillihriuiii   distrilMilion   of  hemoglobin  between  carbon 
monoxide  and  oNVfjcn   wliiii  various  low  eoiieentralions  of  carbon  monoxide  in 


ir  ari'  inliali-d  for  an  indefinitely  Ion;;  time. 


84 


THE  JOITINAL  OF  INDUSTRIAL  HYGIENE 


5  per  cent,  of  an  atmosphere  less  oxygen 
than  the  inspired  air.  and  this  percentage 
deficit  is  nearly  the  same  during  rest  with  a 
breathing  of  8  liters  and  under  physical 
exertion  with  a  respiration  several  times  as 
large.  In  other  words,  the  volume  of 
breathing  is  roughly  proportional  to  the 
amount  of  the  oxidation  and  energy  libera- 
tion occurring  in  the  boily.  In  our  observa- 
tions, persons  of  vigorous  physique  and 
large  breathing  rates  have  absorbed  carbon 
monoxide  much  more  rapidly,  as  measured 
in  percentage  blood  saturation,  than  those 
of  more  sedentary  habit  and  delicate  phy- 
sique. As  the  standard  which  we  shall 
propose  is  one  adjusted  to  protect  even  the 
strong,  it  will  therefore  afford  an  extra 
safeguard  to  the  weak  and  sick,  who 
breathe  little  (except  in  febrile  cases)  and 
who  would,  accordingly,  absorb  carbon 
monoxide  comparatively  slowly.  Only  in 
the  case  of  children,  whose  active  vitality 
involves  a  relatively  large  food  and  oxygen 
consumption  and  a  corresponding  volume 
of  breathing,  will  this  rule  probably  not 
hold.  But  even  for  the  most  active  child, 
a  period  of  exposin-e  of  only  ten  or  fifteen 
minutes  to  the  concentration  of  carbon 
monoxide  here  approved  will  not  be  long 
enough  for  any  considerable  absorption  of 
the  gas. 

The  particular  problem  before  us  —  that 
of  a  standard  for  the  ventilation  of  the  pro- 
posed vehicular  tunnels  under  the  Hudson 
River  —  may,  therefore,  be  thus  simply 
expressed :  What  percentage  saturations  of 
the  blood  with  carbon  monoxide  cause  ap- 
preciable discomfort  in  healthy  men  sitting 
at  rest,  and  what  percentage  saturations 
do  not.'  The  answer  to  this  question,  the 
probable  duration  of  exposure  of  passengers 
through  the  tunnel,  and  the  law  of  carbon 
monoxide  absorption  as-  above  stated,  are 
the  three  considerations  on  which  any 
sound  standard  must  be  based. 

In  view  of  the  foregoing  discussion  it  is, 
we  trust,  clear  that  standards  of  concentra- 


tion, wliich  will  adequately  protect  men 
exposed  for  the  greater  part  of  an  hour,  will 
afford  an  enormous  factor  of  safety  for 
persons  inhaling  the  vitiated  air  for  only 
ten  or  fifteen  minutes.  We  are  informed  by 
the  engineers  that  all  traffic  through  the 
tunnels  will  be  in  two  distinct  classes  — 
namely,  passenger  cars,  which  will  make 
the  trip  in  ten  or  twelve  minutes,  and 
trucks  which  may  take  as  long  as  thirty- 
five  or  forty  minutes.'  The  standards  which 
we  set  ourselves  to  work  out  are  such  as  will 
afford  not  only  absolute  safety  but  also 
complete  freedom  from  any  trace  of  dis- 
comfort for  healthy  and  vigorous  adults 
exposed  for  periods  of  forty-five  to  sixty 
minutes. 

II.    Experiments  on  Men  in  Six  Cubic 

Meter  Chamber 

The  method  of  stud\ing  the  effects  of 
various  concentrations  of  carbon  monoxide 
upon  which  we  have  chiefly  relied  for 
establishing  our  standard  is  illustrated  in 
Figure  2.  It  involves  a  chamber  of  6.4 
cubic  meters,  or  '226  cubic  feet,  capacity, 
the  walls  and  door  of  which  are  covered 
with  galvanized  sheet  iron  with  soldered 
joints.  The  door  is  easily  made  gas-tight 
by  placing  long  strips  of  broad  (2-inch) 
adhesive  plaster  over  the  cracks  along  lin- 
tel, jambs,  and  sill.  The  chamber  holds  any 
concentration  of  gas  for  a  day  without  ap- 
preciable loss  from  diffusion  through  undis- 
covered leaks.  A  small  hole  in  the  door, 
covered  by  a  piece  of  adhesive  plaster,  al- 
lows the  hand  of  the  subject  to  be  tlu'ust 
outside  for  the  withdrawal  of  blood. 

Into  this  chamber  are  introduced  meas- 
ured amounts  of  pure  carbon  monoxide, 
made  by  tlripijing  formic  acid  into  strong 
sulphuricacid  and  distilling  it  by  gentle  heat 
into  a  large  bottle  filled  with  water,  which 
the  gas  displaces.  The  concentration  of  gas 
desired  in  the  chamber  is  obtained  by  run- 
ning into  the  bottle  640  c.c.  of  water  per 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS        85 


part  of  carbon  monoxide  desired,  and  thus 
displacing  this  vohnne  of  gas  from  the 
bottle  through  a  tube  into  the  chamber. 
An  electric  fan  in  the  chamber  insures  im- 
mediate and  complete  mixing.  In  our  ex- 
periments, two  checks  on  the  concentration 
of  gas  in  the  chamber  were 
obtained:  (1)  by  analysis 
of  the  carbon  monoxide, 
before  it  was  introduced, 
by  means  of  a  modified 
Orsat  apparatus,  and 
ignition  with  an  electri- 
cally heated  platinum 
spiral;  and  (2)  l)y  analysis 
of  a  mi.xed  sample  of  the 
air  from  the  chamber  by 
the  iodine  pentoxide 
method,  or  by  means  of 
diluted  l)lood.  (For  a  de- 
scription of  these  analyt- 
ical methods,  see  biblio- 
graphical references 
1,2,3.) 

In  this  chamber,  in 
turn,  the  memliers  of  the 
staff  of  this  investigation 
and  a  few  other  ]>ersons 
spent  periods  of  one  hour 
after  amounts  of  carbon 
monoxide  from  two  to 
eight  parts,  and  in  one 
case  ten  i)arts,  had  been 
introduced.  While  the 
subjects  sat  and  read  most 
of  the  time,  there  were 
a  sufficient  number  of 
acts — such  as  turning  on 
the  electric  fan,  standing  up  to  look  out  of 
the  window  for  a  moment,  opening  and 
closing  flasks  to  take  air  samples  for  later 
analysis,  etc.  —  to  correspond  fairly  well 
with  the  activity  of  the  driver  of  a  car. 
When  we  speak  of  the  absorption  of  carbon 
monoxide  by  a  person  "sitting  at  rest,"  the 
condition  must,  therefore,  be  understood  as 
only  such  moderate  rest  as  this. 


Blood,  to  the  amount  of  twenty  or 
thirty  drops,  was  drawn  from  a  finger  be- 
fore the  subject  entered  the  chamber;  and 
0.02  c.c.  were  drawn  at  the  middle  of  the 
period  and  at  the  end,  and  usually  once  or 
twice  during  the  next  three  hours.    These 


IMMKlOn  BAO 


JAMPtms  TUBE 


INffRIOR   Of  CMAM6(R 

Fi<i.  i.  —  Six  cubic  meter  cliaiiil)er  ami  apparatus  for  introduciiif;  measured 
amounts  of  earlion  monoxide.  'I'liis  cliamber  consists  of  a  wootlen  fraiuework 
covered  with  sheet  iron.  It  contains  a  chair,  table,  and  electric  fan.  It  can  be 
hermetically  .sealed  by  applying  long  and  broad  strips  of  adhesive  plaster 
over  crevices  between  the  door  and  the  chamber  walls.  The  hand  hole  in  the 
door  is  also  sealed  by  plaster,  'rhrouph  this  hole  the  subject  nia\'  thrust  his 
hand  when  .sami)les  of  blood  are  required  for  analvsis. 

With  the  diH'usion  fan  running,  measured  quantities  of  water  are  introduced 
into  the  funnel.  Hy  opening  the  pinch  clamps  carbon  monoxide  is  displaced 
from  the  bottle  into  the  chamber.  Samples  of  air  for  analysis  may  be  with- 
drawn from  the  chamber  by  means  of  the  samjjling  twljc.  .\  rubber  bag  allows 
for  expansion  or  contraction  of  the  chamber  air  witli  changes  of  temperature. 


blood  samples  were  analyzed  for  carbon 
monoxide  by  the  carmine  method  (.'5). 

After  the  subject  had  been  out  of  the 
chamber  for  a  few  minutes,  the  tension  of 
carbon  monoxide  in  his  lungs,  su[)j)osedly 
in  equilibritun  with  the  blood,  was  deter- 
mined by  breathing  back  and  forth  several 
times,  during  twenty  to  thirty  seconds, 
into  a  rubber  bag.   Football  or  basket  ball 


86 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"bladders"  were  used  for  this  purpose. 
(A  series  of  check  determinations  on  four 
subjects  showed  tliat  the  maximum  con- 
centration of  carbon  monoxide  from  these 
bags  was  reached  in  five  rebreathings  dur- 
ing thirty  seconds.)  This  air  was  then 
analyzed  for  carbon  monoxide  by  the  iodine 
pentoxide  method,  or  by  the  blood  carmine 
method.  The  subject's  volume  of  restmg 
breathing  was  determined  either  in  or  out- 
side of  the  chamber  by  means  of  a  mouth- 
piece, nose  clip,  double  valves,  and  Douglas 
bag  and  gas  meter;  and  the  volume  per 
minute  was  calculated. 

In  some  experiments  the  respiration  was 
increased  by  exercise,  and  the  increase  was 
measured  and  correlated  with  the  corre- 
spondingly greater  absorption  of  carbon 
monoxide.  In  these  experiments  the  sub- 
jects did  "stationary"  walking  or  run- 
ning in  the  chamber  by  lifting  the  feet  and 
stamping.  The  exertion  involved  is  con- 
siderable, but  with  care  it  can  be  kept  quite 
uniform  for  half  an  hour  at  a  time.  The 
pulse  was  comited  in  the  chamber,  and 
before  and  after  the  test.  The  effects  on  the 
pulse  and  resjjiration  of  running  up  and 
dovni  four  flights  of  stairs,  each  12  feet 
vertically,  were  also  determined  before  and 
after  the  period  in  the  chamber. 

In  a  few  cases  the  retinal  fields  were  de- 
termined and  plotted.  With  the  degrees  of 
anoxemia  occurring  in  these  experiments, 
however,  the  effects  on  vision  in  this  respect 
were  unimportant.  The  Romberg  test,  the 
ability  to  stand  erect  with  eyes  closed  with- 
out wavering,  was  also  used,  and  in  some 
cases,  after  an  hour  in  eight  parts  of  carbon 
monoxide,  it  showed  marked  loss  of  equilib- 
rium. 

But  of  all  signs  and  tests,  both  in  the  ex- 
periments in  the  small  chamber  here  imder 
discussion  and  in  tho.se  that  are  to  be 
described  in  the  next  section,  the  typical 
carbon  monoxide,  or  oxygen  deficiency, 
headache  proved  most  definite  and  reliable. 
It   is  a   distinctly   localized    ])ain,   usually 


frontal,  throbbing,  intensified  by  lying 
down  or  by  exertion.  It  is  sometimes  ac- 
companied by  more  or  less  nausea,  readily 
increasing  to  vomiting.  The  mind  is  not 
clear,  except  with  an  effort,  and  one's 
surroundings  seem  a  little  strange.  The 
temper  is  easily  upset,  very  much  as  in 
alcoholic  intoxication,  and  the  judgment  is 
likely  to  be  bad.  There  are  wide  variations 
in  the  degree  of  this  headache,  but  in  the 
experiments  discussed  in  this  section  it  was 
never  ex-treme.  On  the  border  line  it 
verged  merely  into  slight  lassitude.  As  a 
criterion  of  the  effect  of  carbon  monoxide, 
however,  it  is  more  distinct  than  any  arti- 
ficial test.  Concentrations  of  gas  too  weak 
and  periods  of  exposure  too  short  to  induce 
this  sign  in  anyone  may  be  considered 
entirely  harmless. 

From  Table  1,  in  which  the  data  of 
thirty-two  experiments  performed  in  this 
way  on  nine  men  and  one  woman  are  given, 
it  appears  that  no  one  had  an  appreciable 
degree  of  headache  after  a  period  of  one 
hour  in  the  chamber  with  four  parts  of  car- 
bon monoxide  or  less,  and  that  with  six 
parts  the  effect,  if  any,  was  usually  very 
slight.  With  eight  parts  there  was  decided 
discomfort  for  some  hours,  although  not 
enough  to  interfere  with  efficient  work  in 
the  laboratory  or  at  the  desk.  After  an 
hour  in  ten  parts  even  an  unusually  resist- 
ant subject  was  rather  miserable  and  averse 
to  work  for  five  or  six  hours,  and  could  still 
recognize  the  effects  after  twelve  hours. 
Examination  of  these  data  enables  us  to 
reach  a  working  rule  regarding  the  rate  of 
absorption  of  ( arljon  monoxide,  for  we  find 
that  up  to  and  including  concentrations  of 
six  parts  of  carbon  monoxide  in  10,000  of 
air  the  figures  in  cohmm  3  of  Table  1  do  not 
exceed  values  of  about  one-half  those  for 
complete  equilibrium  given  in  Table  '■2  and 
drawn  in  Figure  1. 

In  other  words,  during  one  hour  sitting  at 
rest  in  such  atmospheres,  a  man's  blood 
never  absorbs  appreciably  more  than  half 


HENDf:RSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS       87 


the  amount  of  carbon  monoxide  which  it 
would  take  up  if  he  stayed  in  the  atmos- 
phere indefinitely.  Inactive  and  small 
breathing  persons  absorb  less.  At  concen- 
trations of  eight  and  ten  parts  of  carbon 
monoxide  the  figures  deviate  slightly  from 
this  rule,  but  the  rule  of  half  saturation 
appears  to  be  safe  and  convenient  u\)  to 
seven  parts.    It  ajjpears  further  that  a  man 


under  exertion  even  more.  These  figures 
may  be  directly  applied  to  conditions  as 
they  occur  in  regard  to  absorption  of  carbon 
monoxide.  The  estimation  of  the  time  re- 
quired for  half  equilibrium  must  be  short- 
ened accordingly. 

Elimination  of  Carbon  Monoxide.  —  As 
regards  the  elimination  of  carbon  monoxide 
after  gassing,  our  data  show  that  the  proc- 


T.\BLE  1.  —  PHYSIOLOGICAL  OBSERVATIONS  OX  MEN  IN  SIX  CUBIC  METER 

GASSING  CHAMBER' 


Number  of 
Experiments 

Concentra- 
tion of  CO 
in  Air 

Blood  CO  Percentage 
Saturation 

Alveolar  Air  CO 
Parts  in  10.000 

Pul!« 

Normal 

.\fter  Gashing 

Symptoms 

Parlt 
in  lO.OUO 

After 
One  Hour 

Afirr 
One  flour 

2 

2 

11-12 

70-80 

70-76 

none 

3 

3 

13, 10, 14 

72.  84,  74 

72,  82.  74 

" 

11 

4 

22, 18, 17, 18, 14, 
14,20,21 

1.36.1.33.1.30 

72.  74.  72.  76, 
70,  70,  80 

68.  76,  72,  80, 
72,  74,  82 

u 

1 

5 

0.9 

U 

9 

C 

21,16,16,25,26, 

1..30,  1.26.1.98, 

72,  74,  80,  72, 

72,  74,  82,  72, 

none  in  seven  cases. 

17,  16.  IS.  18 

1.20,1.00.  1.24. 
1.25.2.30 

74,  TS 

74 

slight  frontal  headache 
in  two  cases 

4 

8 

32,  27.8. 34,  26 

2.3,  1.4.2.0 

72,  70,  74 

88,  80,  84 

decided  headache  four 
to  eight  hours 

1 

9 

34 

76 

80 

decided   frontal    head- 
ache;     irritable  for  six 
hours;  insomnia 

1 

10 

38 

78 

90 

throbhin);  frontal  head- 
ache; irritable;  at  limes 
Cheyne-Stokcs"   breath- 
ing 

»  The  figures  in  column  3  of  the  above  table  are  wen  to  be  never  more  than  half  the  equilibrium  values  at  conccntral ions  of  six  parts,  or 
less,  in  10,000  of  iiir.     For  I'quilibrium  values  sec  Tabic  4. 

A  number  of  experiments  on  the  influence  of  exercise  were  also  carried  out  in  the  chamber.  When  the  volume  of  breathing  was  thus  in- 
creased the  rate  of  absorption  of  carbon  monoxide  wa.s  proportionally  increa-M^d. 

who  exercises  .sufficiently  to  double  the  ess  is  not  complete  until  one  or  two  hours, 
volume  of  breatiiing  absorbs  as  much  car-  or  even  longer,  after  return  to  fresh  air. 
bon  monoxide  in  half  an  hour  as  he  does  at  Roughl\-.  the  rale  of  elimination  is  30  to  50 
rest  in  one  hour.    We  have  founil  in  oilier      per  cent,  per  hour,  depending  doubtless  on 

l)odily  activity  and  the  \olume  of  fresh  air 
breathed.    This  evidence  is  summarized  in 
10      Figure  3. 


TABLE  -i.  —  EQIILIBHIUM  VAI.IKS 
OBTAINABLE  FROM  FIGURE  1 

Parts  of  CO  in  .\ir  13        3        4        5        6        7        8 

Percentage  Satura 
tion  of  Blood 


KiO  '28  3  .S7.4  44.4  50.0  54.5  .iS.S  B1.5  B4.;t  tili.fi 


experiments,  which  need  not  be  given  here 
in  detail,  that  when  walking  fast  a  num 
breathes  about  twice  as  much  air  as  when 
sitting  still  and  that  when  luirrying  or 
doing  rather  heavy  manual  labor  he 
breathes  about  three  times  as  much,  and 


III.     Rate  of  Ab.sorptiox   of   Carbon 

Monoxide   and    Standards   of   Allow- 

ABu:  Vitiation  of  the  Air 

The  essential  practical  results  of  the  ex- 
periments in  the  6  cubic  meter  chamber, 
and  indeed  of  this  entire  investigation,  are 


88 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Tine  in  HOURS 

Fig.  3.  —  The  rate  of  elimination  of  carbon  monoxide  after  gassing.    Solid  lines  are  from  analyses 
of  blood,  and  dotted  lines  from  analyses  of  pulmonary  air. 


Fig.  4.  —  Curves  showing  rate  of  absori)tion  of  carbon  monoxide  b.v  the  blood  in  persons  e.xposed 
to  concentrations  up  to  seven  i)arls  of  carbon  monoxitle  in  10,000  of  air,  for  periods  up  to  one  liour, 
during  rest  (sitting),  and  for  shorter  periods  of  walking  and  working.   For  discussion  see  text. 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS 


89 


summed  up  in  Figure  4,  wliich  shows  the 
rate  at  which  carbon  monoxide  may  be  ab- 
sorbed and  the  amounts  at  which  physi- 
ological eflFects  may  occur.  It  is  based  on 
the  data  in  Table  1,  and  is  confirmed  by  the 
evidence  obtained  from  experiments  on  a 
large  number  of  people  in  the  large  gassing 
chamber  —  evidence  which  is  to  be  pre- 
sented in  Section  V.  The  curves  are  drawn 
to  show  the  rate  of  absorption  of  carbon 
monoxide  when  air  with  various  concen- 
trations from  one  to  seven  parts  of  this  gas 
in  10,000  is  breathed.  They  express  the 
absorption  by  the  blood  during  one  hour 
of  one-half  the  amount  of  carlion  monoxide 
that  would  be  taken  up  after  prolonged 
stay  in  each  of  these  atmosj)lieres. 

One  of  the  columns  of  figures  at  the  left 
in  this  diagram  exi)resses  tiw  percentage 
saturation  attained  by  the  blood;  the  other 
column  shows  the  corresponding  tension  of 
carbon  monoxide  in  the  atmosphere  in 
parts  per  10,000  of  air,  with  which  the 
blood  wovdd  be  in  gaseous  e(juilibrium.  In 
other  words,  the  figures  in  column  2  indi- 
cate the  amount  of  carbon  monoxide  that 
should  be  found  in  a  pulmonary  air  sample, 
obtained  by  the  method  of  rel)reathing  into 
a  rubber  bag,  when  the  blood  in  the  lungs 
contains  these  percentages  of  carbon  mon- 
oxide. The  three  lines  below  the  base  line 
show  respectively  the  (minimum)  time  re- 
quired to  reach  these  percentage  satura- 
tions when  the  subject  is  at  rest,  when  he  is 
walking  at  a  moderate  pace  and  breathing 
a  double  volume  of  air,  and  when  he  is  suf- 
ficientlj-  active  to  breathe  threefold,  as  a 
man  at  even  moderate  work  nuiy  do.  Hori- 
zontal dotted  lines  have  been  drawn  at  the 
levels  of  12  and  18  per  cent,  blood  satura- 
tion, corresponding  to  tensions  of  1.0  and 
1.5  parts  per  10,000.  The  lower  line  indi- 
cates the  amount  of  carbon  monoxide  which 
even  after  an  exposure  of  several  hours 
would  not  induce  very  disagreeable  effects. 
The  upper  line  expresses  the  level  above 
which,  in  our  experiments,  slight  discom- 


fort and  headache  have  sometimes  resulted 
after  an  exposure  of  one  hour. 

This  diagram  has  a  very  wide  applica- 
tion. One  may  take  off  from  the  curves,  by 
means  of  a  pair  of  dividers,  the  quantities 
of  carbon  monoxide  which  may  be  ab- 
sorbed by  a  person  passing  through  any 
variety  of  concentrations  of  carbon  mon- 
oxide, as  may  be  the  case  in  different  parts 
of  a  tunnel.  From  the  curves,  one  sees  at  a 
glance  that  if  the  tunnel  is  ventilated  trans- 
versely so  as  to  contain  everywhere  four 
parts  of  carbon  monoxide  in  10,000  — • 
corresponding  to  2,500  cubic  feet  of  fresh 
air  per  minute  per  cubic  foot  of  carbon 
monoxide  jiroduced  by  cars  —  a  passage  of 
three-c|uarters  of  an  hour,  the  rate  for  slow 
trucks,  would  produce  no  appreciable  dis- 
comfort. It  is  also  evident  when  one  j^lots 
the  matter  out,  as  has  been  doue  for  the 
.sake  of  illustration  in  Figures  5a,  5b,  and 
5c,  that  if  the  tunnel  is  ventilated  lon- 
gitudinally and  the  effluent  air  contains  six 
parts  of  carbon  monoxide,  the  physiological 
effect  will  be  at  least  as  good  as  with  a  uni- 
form concentration  of  four  parts  in  10,000. 
In  this  case  the  ventilating  fans  need  supply 
only  10,000  cubic  feet  of  air  for  each  6 
cubic  feet  of  carbon  monoxide  thrown  off 
by  the  cars  in  the  tunnel,  or  1,666  cubic 
feet  of  fresh  air  per  minute  per  cubic  foot  of 
carbon  monoxide.  This  is  true  if  the  air  is 
forced  in  at  one  end  and  out  at  the  other, 
and  it  is  also  true  if  the  tunnel  is  ventilated 
in  sections  so  that  the  air  at  some  points 
contains  only  a  trace  of  carbon  monoxide 
and  at  others  is  contaminated  progres- 
sively with  from  one  to  seven  parts  in 
10,000  of  air.  This  would  be  the  case,  for 
instance,  if  fresh  air  were  driven  in  at  the 
middle  and  ends  of  the  tunnel  and  drawn 
out  at  the  two  intermediate  points;  e.  g.,  air 
shafts  at  the  pier  heads  on  each  side  of  the 
Hudson  River.  This  is  illustrated  in 
Figure  5d. 

It  is  evident  from  this  diagram  that  if  at 
any  point    the  concentration   exceeds    six 


90 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


8 

X 
1— 

z: 
S 

§ 

o 

t: 

ILJ 
X 

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i 

i 

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t 

U-J 

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ex. 

8 

8 
o 

2: 

U_J 

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20- 

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5 

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Ml 

TH  AIR  1 

'ABTS     CO  IN 
lO.OOO  OfAIR 

7 
6 

. 

-; 

.' 

■7 

^ 

PEPni55IBLE 
5ATUPATION 
roc     5MOPT 
EXPOSURES. 

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PERr-ll55IBLE 
SATURATION 
FOP      LONO 
EXP05UPE5. 







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Tl  1  1  ]    1    1   1  1  1   1  1  1   1   1  1   1  1   1  '  1  '1  n  I  M  1  1  1  1   M  1  1  1  1   1  1   M   M I  1   1   1  M   I   M 

niNJTEb  5IMINO      1 

Fig.  5a.  —  Illustration  of  method  for  applying  absorption  curve  data  to  specific  conditions  arising 
in  a  vehicular  tunnel.  Longitudinal  ventilation.  Subject  in  a  sitting  position  travelling  in  direction  of 
air  current.  Duration  of  passage  through  tunnel  thirty-five  minutes.  The  altitudes  of  the  triangles 
express  the  increments  of  saturation  of  the  subject's  blood  while  passing  through  atmospheres  increas- 
ing progressively  in  their  carbon  monoxide  content..  Effluent  air  =  seven  parts  carbon  monoxide 
in  10,000  of  air.' 


7    PARTj   CO    IN 

(3        /O.OOO  OfAIR 


Fig.  5b.  —  Illustration  of  method  for  applying  absorption  curve  data  to  specific  conditions  arising 
in  a  vehicular  tuiuul.  Ixingitudinal  ventilation.  Subject  travelling  against  air  current.  Duration 
of  passage  througli  tunnel  tiiirty  minutes.  The  altitudes  of  the  trian^'les  express  the  increments  of 
saturation  of  the  subject's  blood  while  passing  from  effluent  air  containing  seven  parts  of  carbon 
monoxide  in  10,000  througli  atmospheres  decreasing  progressively  in  their  carbon  monoxide  content. 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS        91 


'     PARTJ  CO    IN 
^    (5         lO.OOO  Of  AlP 


PtUmSSIBLE 
-^,  5ATUPATION 
fOR      5MORT 
CXP05UI5C5. 


PtCniSSIBlE 
SATUPATION 
fOP  LONG 
:XP03UI?E5. 


niMUTC5  WALKINO" 


Kk;.  5f.  —  llliistnitidii  of  iin'lliixl  for  applyin>;  ahsorplion  curve  data  to  specific  conditions  arisinj; 
in  a  veliicular  tunnel.  Lonf-ilnilinal  ventilation.  Snl)ject  wal'ving  in  direction  of  air  current.  The 
altitudes  of  tlie  Irianfiles  as  under  Fifjure  .5a. 


Fig.  ocl.  —  Illustration  of  nietliod  for  apjilying  absorption  curve  data  to  specific  conditions  arising 
in  a  vehicular  tunnel.  Distributc'd  ventilation.  Subject  in  a  sitting  position  travelling  from  .\  to  E. 
Duration  of  passage  through  tunnel  sixty  minutes.  The  dots  indicate  the  percentage  saturation  of 
the  subject's  blood  at  various  stages  of  the  pas.sage.  The  letters  .\.  B,  C,  D,  and  E  indicate  the 
percentage  saturation  of  the  blood  when  the  corresponding  points  in  the  tunnel  are  passed. 


92 


THE  JOITRNAL  OF  INDUSTRIAL  HYGIENE 


parts  of  carbon  monoxide  in  10,000  of  air, 
men  doing  hard  work  for  even  a  short  time 
wall  be  unfavorably  affected.  On  the  other 
hand,  the  curves  show  that  passengers  in 
cars  going  through  the  tunnel  in  ten  or 
fifteen  minutes  will  absorb  very  little  car- 
bon monoxide  —  a  factor  of  safety  which 
is,  we  believe,  sufficient  to  afford  ample 
protection  for  children  and  invalids.  The 
standard  here  proposed  for  exposures  of 
forty-five  minutes  —  four  parts  in  10,000 
or  its  equivalent  in  an  average  of  concen- 
trations from  zero  up  to  six  in  10,000  — 
affords,  in  the  hght  of  our  experiments,  not 
only  complete  safety  but  also  an  assurance 


of  freedom  from  disagreeable  effects.  Risk 
of  considerable  discomfort  would  begin  at 
eight  to  ten  parts  of  carbon  monoxide  in 
10,000  of  air  in  periods  of  one  hour  during 
rest  and  for  shorter  periods  during  exertion. 
Actual  danger  would  begin  with  concen- 
trations not  very  much  higher  and  periods 
not  very  much  longer.  The  point  should  be 
emphasized,  however,  that  we  are  dealing 
only  with  a  standard  of  chemical  purity  of 
the  air.  Other  features  of  tunnel  ventila- 
tion as.  for  example,  wind  velocity,  mois- 
ture, temperature,  etc.,  are  not  included  in 
the  standard  here  defined,  nor  is  comfort  in 
these  respects  assured  by  it. 


{To  be  continued) 


BIBLIOGRAPHY 


Teague,  INI.  C:  The  Determination  of  Carbon 
Monoxide   in   Air   Contaminated   with   Motor 
Exhaust  Gas.   Jour.  Indust.  and  Engin.  Chem., 
1920,  12,  964. 
Kreisinger,  H.,  and  Ovitz,  F.  K.:  Sampling  and 


Analysis  of  Flue  Gases.   U.  S.  Bur.  Mines,  Bull. 
97,  1915,  pp.  n  and  3-2. 
3.    Haldane,  J.  S. :   Methods  of  Air  Analysis.   Lon- 
don, Charles  Griffin  &  Company,  191'2,  pp.  107- 


THE  INFLUENCE  OF  FATIGUE  ON  HEALTH  AND  LONGEVITY* 


H.  M.  ^^R^•ON,  M.D. 

Investigator  fnr  thr  ludimlrial  Fatigue  Research  Board,  London 


THE  final  and  most  important  test  of 
the  fatigue  of  a  man's  calling  is  to  be 
found  in  the  effect  wliicli  it  lias  on  his 
health  and  longevity.  Provided  that  he 
does  not  suffer  more  sickness  than  men  in 
the  healthiest  trades,  and  shows  no  greater 
mortality,  he  has  little  ground  for  com- 
plaint even  if  his  occui)ation  is  such  as  to 
induce  a  considerable  degree  of  fatigue. 
Such  fatigue  must  be  within  physiological 
limits,  and  so  long  as  it  does  not  exceed 
these  limits  and  become  pathological,  it 
does  him  little  or  no  harm. 

ITnfortunately  it  is  a  by  no  means  easy 
problem  to  determine  the  influence  of 
fatigue  on  sickness  and  mortalitj*.  We 
know  that  in  some  occupations,  such  as 
those  of  the  potter,  stone  quarrier,  and  file 
maker,  the  abnormal  sickness  and  mor- 
tality experienced  are  due  largely  to  tiie 
inhalation  of  dust.  In  other  ()ccu])ati()ns, 
such  as  those  of  lead  and  arsenic  workers, 
they  are  due  to  the  poisonous  action  of  the 
substances  handled;  and  in  others,  such  as 
sorting  wool  and  hides,  they  are  due  to 
bacterial  infection.  Again,  we  know  that 
industrial  workers  who  have  spent  all  their 
lives  in  the  crowded  quarters  of  town  dwell- 
ings have,  as  a  rule,  a  poorer  physitjue  than 
those  brought  up  in  more  healthy  surround- 
ings, and  for  this  reason  they  may  show  a 
greater  sickness  and  mortality,  apart  from 
any  occupational  effect.  For  instance. 
Dr.  Arkle  (1)  measured  the  height  and 
weight  of  the  boys  in  the  different  grade 
schools  at  Liverpool,  and  he  found  that 
while  boys  of  14  years  of  age  from  the 
higher,  grade  schools  were  61.7  inches  in 
height  and  weighed  94.5  poimds,  those 
boys  of  the  same  age  from  the  council 

*  Received  for  publication  Jan.  18,  1921. 


schools,  who  were  the  sons  of  unemployed 
and  casual  laborers,  were  6.5  inches  less  in 
height  and  23.4  pounds  less  in  weight. 
Boys  of  intermediate  social  status  showed 
intermediate  measurements. 

Sickness  Records 

It  is,  nevertheless,  of  such  importance 
for  us  to  determine  what  effect,  if  any, 
fatigue  may  have  on  sickness  and  longevity 
that  even  a  preliminary  and  imperfect  at- 
tempt at  its  estimation  is  instructive.  Such 
an  attempt  I  have  recently  made  in  one 
of  the  heaviest  of  our  industries,  the  iron 
and  steel  trade  (2).  Under  the  National 
Health  Insurance  Act  the  sickness  of  all 
industrial  workers  in  Great  Britain  has 
been  systematically  recorded  since  1913, 
and  much  of  this  material  is  in  a  form  suit- 
al)]e  for  statistical  treatment.  Working  in 
conjunction  with  Mr.  E.  A.  Rusher,  F.I. A., 
an  actuary  of  long  experience,  I  tabulated 
the  sickness  and  mortality  records  of  about 
24,000  iron  and  steel  workers  for  a  six-year 
period,  1913-1918,  and  Mr.  Rusher  and  his 
staff  have  worked  up  this  material  accord- 
ing to  ajjproved  actuarial  methods.  My 
object  was  to  se])arate  the  men  into  clearly 
defined  occupational  groups,  the  character 
of  whose  work  was  well  known  to  me  as  the 
result  of  close  observation.  Among  the 
steel  workers,  five  cleiirly  defined  groups  of 
skilled  men  were  thereby  obtained,  while  a 
certain  number  of  other  skilled  men,  whose 
numbers  were  too  small  to  admit  of  their 
consideration  as  separate  groups,  had  to  be 
thrown  into  the  general  group  of  unskilled 
laborers  and  others. 

The  number  of  days  of  sickness  per  year 
suffered  by  these  occupational  groups  are 


93 


94 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


recorded  in  Table  1.  On  an  average  they 
came  to  6.5  working  daA  s  per  year,  and  in 
addition  there  was  a  small  amount  of  time 
(estimated  as  0.6  day)  which  is  not  com- 
pensated for  under  the  Insurance  Act,  and 
which  is  not  included  in  the  recorded 
figures.  The  group  of  steel  inciters  (on 
open  hearth  furnaces),  teemers,  and  pit- 
men head  the  list,  and  show  '23  per  cent, 
more  sickness  than  the  a^'erage  of  all  the 
workers  combined.  Next  come  the  pud- 
dlers  of  wrought  iron,  with  a  '-20  j^er  cent, 
excess;  then,  the  tinplate  mill-men  with  a 


bago,  myalgia,  and  neuritis;  (b)  pneumonia, 
bronchitis,  influenza,  pleurisy,  catarrh,  and 
sore  throat  (but  not  phthisis);  (c)  injuries 
incurred  when  following  employment;  (d) 
sickness  due  to  other  causes,  and  injuries 
incurred  apart  from  emplo^'ment. 

It  will  be  seen  from  Table  1  that  the  ex- 
cess of  sickness  experienced  by  the  puddlers 
was  due  entirely  to  rheumatism  and  re- 
spiratory diseases,  probably  resulting  from 
the  habits  of  the  men.  The  puddlers  gen- 
erally work  in  couples,  and  they  put  in 
alternate  periods  of  about  twenty  minutes 


TABLE   1.  — DAYS  OF  SICKNESS  PER  YEAR  EXPERIENCED   BY  STEEL  WORKERS  AGED 

16  TO  70   (1913-1918) 


Approxi- 
mate 
Number 

of 
Workers 

Days  of  Sickness  per 

Sfear  Due  to 

Percentage  Variation  from  Average  of  All 
Workers  Combined 

Occupation 

Rheu- 
matism 

Respir- 
atory 
Dis- 
eases 

In- 
juries 

Other 

Causes 

All 
Causes 

Rheu- 
matism 

Respir- 
atory 
Dis- 
eases 

In- 
juries 

Other 
Causes 

AU 
Causes 

Steel  melters,  teemers,  and  pitmen.  . 
Puddlers                                     

1,740 

970 

2,090 

2,470 

1,660 
11,740 

1.3 
1.6 
0.9 

0.9 

0.6 
0.8 

2.2 
2.7 
2.1 

2.0 

2.2 
1.9 

1.2 
0.7 
0.8 

0.9 

0.4 
0.5 

3.3 

2.8 
3.5 

3.2 

2.8 
2.7 

8.0 
7.8 
7.3 

7.0 

6.0 
5.9 

-h44 
-f78 

-33 
-11 

-1-10 
-1-35 

4-5 

-1-10 
,-5 

-1-71 

+U 

-1-29 

-43 
-29 

+u 

-3 

-^21 

+  10 

-3 

-7 

+23 
+20 

Tinplate  mill  men.                              .  . 

+12 

Rolling-mill  men,  soaker  men,  hot- 
bank  men.  .  .                        

+8 

Engine  men,  crane  men,  locomotive 

men   .                     

-8 

All  other  workers  (largely  laborers) .  . 

-9 

All  workers  combined      

20,670 

0.9 

2.0 

0.7 

2.9 

6.5 

12  per  cent,  excess;  and  then  the  rolling- 
mill  men,  with  an  8  per  cent,  excess.  All 
of  these  men  work  under  trying  conditions 
of  high  temperature,  especially  the  first 
three  groups  mentioned,  while  the  engine 
men  and  the  general  workers,  who  for  the 
most  part  work  under  ordinary  conditions 
of  temperature,  were  found  to  show  8  or 
9  per  cent,  less  sickness  than  the  average. 
At  first  sight,  therefore,  we  seem  to  have  a 
clear  relationship  between  cause  and  ef- 
fect, but  an  analysis  of  the  time  lost  under 
the  various  categories  of  sickness  does  not 
altogether  bear  out  the  simplicity  of  the 
relationship.  Sickness  was  classified  under 
(a)  rheumatism  (acute  and  chronic),  lum- 


of  very  strenuous  work  at  puddling  their 
molten  iron,  and  of  comparatively  light 
work.  They  j^erspire  freely  during  their 
heavy  work,  and  as  they  sit  about  a  good 
deal  during  their  intermediate  periods, 
usually  in  a  draft,  they  render  themselves 
very  liable  to  chills.  The  tinplate  mill- 
men,  whose  work  is  on  the  whole  as  hot 
and  heavy  as  that  of  the  puddlers,  show 
no  exces.s  of  rheumatism  and  resj)iratory 
disease.  This  is  due,  I  believe,  to  the  fact 
that  these  men  work  continuously  through- 
out their  six  or  eight-hour  shift.  I  kept 
groups  of  them  under  observation  for  sev- 
eral days,  and  I  found  that  they  seldom 
took  rest  pauses  of  more  than  four  minutes' 


\^RNON  —  INFLUENCE  OF  FATIGUE  ON  HEALTH  AND  LONGEMTY    95 


duration,  and  never  rested  more  than  nine 
minutes  (3). 

It  will  be  seen  that  most  of  the  e.\tra  sick- 
ness suffered  by  the  tinplate  mill-men  is  due 
to  "other  causes,"  and  it  is  possible  that 
this  is  the  result  of  fatigue,  which  lowers 
their  resistance  to  disease  in  general.  The 
steel  melters  show  an  excess  of  sickness 
from  rheumatism  and  from  respiratory 
diseases,  as  well  as  from  "other  causes," 
and  this  general  excess  definitely  suggests  a 
fatigue  effect.  The  work  done  by  the  steel 
melters  whenfettling  (i.e.,  mending)  the 
bottom  of  their  furnaces  is  more  strenuous 
and  exhausting  than  any  other  kind  of  in- 


of  55  to  69  years  of  age.  lost  6.3  times  more 
time  from  rheumatism  than  the  young 
men  of  16  to  29.  This  great  increase  was 
specially  observed  in  the  men  working  at 
high  temperatures,  and  the  older  steel 
melters  and  pitmen  lost  no  less  than  7.7 
times  more  time  than  the  young  ones.  On 
the  other  hand,  the  older  engine  men  and 
"other  workers  "  lost  only  3  to  5  times  more 
time  from  rheumatism  than  the  young  men 
in  the  same  occupations.  It  is  true  that  the 
total  number  of  days  lost  by  the  older  men 
in  no  case  exceeded  3.1  days  per  year,  but  it 
is  probable  that  the  efficiency  of  the  men 
would  be  lowered  for  weeks  everv  vear. 


TABLE  2.  —  D.\YS  OF  SICKNESS  PER  YE.\R  .\MONG  BIAST  FURNACE  MEN   BY  AGE  GROUPS 


Days  of  Sickness  per  Vear  by  Age  Groups  Due  to 

Occupation 

Rheumatism 

Uespiratory  Diseases 

All  Causes  Combined 

18-33             3+-»8            49-69 

10-33      1      34-48 

49-89 

1S-.33 

34-48 

49-89 

Barrow  fillers 

1.0 
1.8 

0.4 

1.1              3.8 
1.0              4.0 

2.7 

2.3 
2.3 

2.6 
2.6 
2.0 

4.2 
4.9 
3.6 

8.5 
6.6 
4.4 

7.5 
7.8 
7.9 

12.7 

15.9 

1.3 

2.7 

13.1 

1.0 

1.1 

3.4 

2.4 

2.4 

4.1 

6.8 

7.7 

13.6 

dustrial  labor  with  which  I  am  iK-((uaiiil('(i. 
It  obliges  the  men  to  approach  to  within  a 
few  feet  of  the  partly  open  doors  of  the 
white  hot  furnace,  and  to  ])iish  away  the 
pools  of  molten  steel  with  a  kind  of  rake 
or  "rabble."  Subsequently  the  depressions 
in  the  bottom  have  to  be  filled  up  with 
dolomite  or  other  material.  This  heavy 
work  is  very  intermittent,  and  it  lasts, 
on  an  average,  only  an  hour  or  less  per 
shift.  After  doing  it  the  men  not  infre- 
quently change  their  wet  shirts.  Also,  un- 
like the  puddlers,  they  are  often  provided 
with  shelters  into  which  they  can  retire,  so 
there  is  some  reason  for  thinking  that  their 
excess  of  rheumatism  and  respiratory  dis- 
ease may  be  due  not  only  to  chills  arising 
from  theu"  work,  but  to  lowered  bodily 
resistance,  the  result  of  fatigue. 

On  separating  the  workers  according  to 
age  groups,  it  was  found  that  the  older  men, 


rather   than   for  days,   in   consequence  of 
rheumatic  pains. 

Data  relating  to  blast  furnace  men  are 
recorded  in  Tabic  '■2.  They  were  obtained 
from  a  tliffereiit  ".\i)i)roved  Society" 
(working  under  the  Insurance  Act)  from 
that  of  the  steel  workers,  and  they  are 
classified  in  different  age  groups.  They  re- 
late to  LOO"!  I)last  furnace  men,  and  they 
show  that  men  of  16  to  48  years  of  age  ex- 
perienced one  to  two  days'  more  sickness 
per  year  than  the  steel  workers,  while  men 
of  49  to  69  experienced  about  four  days' 
more  sickness.  The  excess  of  sickness  was 
due  partly  to  respiratory  diseases,  but 
especially  to  rheumatism.  Thus,  the  men 
of  49  to  69  lost  3.4  days  from  this  cause, 
while  steel  workers  of  the  same  age  lost 
only  1.7  days,  or  half  as  much.  It  seems 
highly  probable  that  this  excess  of  sickness 
from  rheumatism  and  respiratory  disease 


96 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


was  due  to  exposure  to  tlie  weather,  for  it 
was  specially  marked  in  the  barrow  fillers 
and  the  laborers,  who  are  almost  always 
working  in  the  open  without  any  kind  of 
protection  from  the  elements.  It  was  less 
evident  in  the  other  and  more  protected 
group  of  men,  which  includes  the  keepers, 
molders,  gas  men,  cleaners,  engine  men,  and 
crane  men. 

Mortality  Records 

It  is  extremely  difficult  to  obtain  ade- 
quate mortality  records,  for  though  very 


The  total  deaths  recorded  among  the 
'■20,670  steel  workers  in  the  six-year  period 
under  observation  came  to  1,023,  and  those 
among  the  blast  furnace  men,  to  337.  The 
mortality  rates  have  been  compared  with 
those  of  all  males  (occupied  and  retired)  in 
England  and  Wales,  in  the  years  1910- 
1912,  and  the  "expected"  numbers  of 
deaths  recorded  in  Table  3  are  calculated 
from  the  Registrar  General's  data  (4). 
From  the  final  columns  of  the  table  it  will 
be  seen  that  while  1,018  deaths  were  "ex- 
pected" between  the  ages  of  25  and  65, 
only  964  deaths  were  observed.    In  other 


TABLE  3.  — TOTAL  DEATHS  AMONG  STEEL  WORKERS  (1913-1918)   COMPARED  WITH  THOSE 
AMONG  ALL  OCCUPIED  AND  RETIRED  MALES  (1910  1912)   BETWEEN  THE  AGES  OF 

25  AND   65 




Respiratory  Diseases 

Tuberculosis 

All  Causes  Combined 

Occupation 

Actual 
Number 

Number 
Expected 

Percentage 
Variation 

from 
Number 
Expected 

Actual 
Number 

Number 
Expected 

Percentage 
Variation 

from 
Number 
Expected 

Actual 
Number 

Number 
Expected 

Percentage 
Variation 

from 
Number 
Expected 

Steel  melters,  teemers  and  pitmen 
Puddlers 

35 
30 

22 

36 

22 
165 

16.0 
11.6 

14.8 

16.7 

13.0 
81.2 

4-119 

-1-159 

-1-49 

-1-116 

-1-69 
-1-103 

15 

7 

7 

11 

10 
55 

20.1 
11.2 
21.0 

24.0 

17.3 
110.3 

-25 

-38 
-67 

-54 

-42 
-50 

125 
66 
69 

114 

77 
513 

104.5 
73.1 
99.3 

112.9 

86.5 
541.6 

-1-20 
-10 

TInnlate  mill  men                        .  . 

-31 

Rolling-mill    men,    soaker   men, 
hot-bank  men                 

-1-1 

Engine  men,  crane  men,  locomo- 
tive men                                      ... 

-11 

All  other  workers 

-5 

310 

153.3 

-H02 

105 

203.7 

-48 

964 

1,018 

-5 

extensive  records  are  collected  and  pub- 
lished at  ten-year  intervals  by  the  Reg- 
istrar General,  they  relate  to  such  large 
occupational  groups  as  to  be  of  little  value 
for  our  special  purpose.  For  instance,  the 
iron  and  steel  workers  whose  sickness  has 
just  been  discussed  are  placed  with  iron 
founders  and  with  the  makers  of  iron  goods 
(such  as  stoves  and  bedsteads)  in  one  com- 
prehensive group,  and  no  separation  into 
individual  occupations  is  possible.  Ac- 
cordingly, I  had  to  fall  back  upon  the 
mortality  records  of  the  steel  workers  al- 
ready referred  to,  but  data  relating  to 
3,540  blast  furnace  men  were  obtained. 


words,  the  steel  workers  showed  5  per  cent, 
less  mortality  than  the  general  male  popu- 
lation. This  must  not  be  taken  to  indicate 
that  steel  manufacture  is  a  healthy  oc- 
cupation, for  the  group  of  "all  males, 
occupied  and  retired,"  includes  many 
weaklings  who  are  unfit  for  any  trade,  or 
only  fit  for  light  work,  while  most  steel 
workers  have  necessarily  to  be  healthy  men 
of  good  i^hysique.  Men  in  the  healthiest 
occupations  have  a  much  lower  mortality. 
The  comparative  mortality  figure,  which 
gives  a  death  rate  in  which  due  allowance 
has  been  made  for  age  distribution  between 
the  ages  of  25  and  65,  is  753  for  the  steel 


VERNON  —  INFLUENCE  OF  FATIGUE  ON  HEALTH  AND  LONGEMTY    97 


workers,  as  compared  with  790  for  all 
males,  occupied  and  retired.  In  the  health- 
iest occupations,  such  as  gardening,  the 
figure  is  -157.  That  of  farmers  and  graziers 
is  495,  while  at  the  other  end  of  the  scale 
come  potters  with  a  mortality  figure  of 
1,196,  and  stone  getters  and  masons  with 
one  of  1,427. 

Again,  there  c^an  be  no  doubt  that  all 
the  mortality  figures  recorded  in  Table  3 
underestimate  the  death  rate.  In  many 
trades,  especially  in  the  heavy  occupations, 
there  is  a  contimial  weeding  out  of  .some  of 
the  less  vigorous  men,  who  drift  into  the 
ranks  of  the  casual  aii<l  unemployed  work- 
ers, and  the  removal  of  the.se  weaker  men 
lowers  the  death  rate  of  those  remaining  in 
the  trade.  The  records  showed  that  about 
1  per  cent,  per  year  of  the  skilled  workers 
aged  54  or  less  disa|)peared,  while  .'5  per 
cent,  of  the  older  men  suffered  the  same 
fate.  Among  the  "other  workers"  class 
the  proportions  were  about  twice  as  great. 
It  follows,  therefore,  that  it  is  impossible  to 
gauge  the  effect  of  industrial  work  u|)()ii 
mortality  with  any  api)roaih  to  accuracy 
unless  the  history  of  all  the  workers  can  l)e 
traced  after  they  have  dropped  out  of  their 
trade.  Nevertheless,  the  data  recorded  are 
roughly  comparable  among  them.selves, 
and  they  show  clearly  that  some  occupa- 
tions are  more  harmful  than  others.  We 
see  that  the  .steel  melters  and  pitmen  head 
the  list,  and  have  a  mortality  "20  per  cent, 
greater  than  that  of  all  males,  or  26  per 
cent,  greater  than  the  average  of  the  whole 
group  of  steel  workers  investigated.  This 
figure  corresponds  closely  with  the  sickness 
figure,  which  was  23  per  cent,  above  the 
average,  and  it  suggests  that  the  fatigue  of 
the  steel  melters'  work  is  responsible  not 
only  for  more  sickness,  but  for  a  loss  of 
several  years  in  the  average  expectation  of 
life.  It  will  be  seen  that  the  steel  melters 
experienced  more  than  twice  the  usual 
mortality  from  respiratory  diseases,  and,  in 
fact,  every  one  of  the  groups  of  men  in  the 


various  occupations  experienced  a  some- 
what similar  excess  from  this  cause.  From 
tuberculosis  (almost  always  phthisis)  the 
steel  melters  experienced  about  three- 
fourths  the  usual  mortality,  while  the  other 
groups  of  men  experienced  only  one-third  to 
two-thirds  as  much.  This  result  was  prob- 
ably due  in  ])art  to  the  fact  that  almost  all 
the  men  were  working  in  the  open  air  or  in 
sheds.  Such  exposure  tends  to  reduce 
phthisis,  though  it  may  increase  the  risk  of 
respiratory  diseases  in  general.    There  can 

T.\BLE   4.  —  MORT.\LITY   OF    BLAST    FURN.\CE 
MEX  (191S-I918) 


\gc  Group 

Percentage  of  Deaths  per 
Year  among 

Blast  Furnace 
Men 

All  Males 

16-33 

0.8 
1.3 

2.7 
5.8 

0.4 

34-48 

0.9 

49-58                

2  0 

59-fi9                          1 

4.4 

be  no  doubt,  however,  that  many  tuber- 
culous workers  drop  out  altogether  from  the 
strenuous  work  recjuired  in  the  iron  and 
steel  trade  before  death  carries  them  off. 

The  ])uddlers,  who  showed  almost  as 
much  sickness  as  the  steel  melters,  had  a 
slightly  lower  mortality  than  the  average, 
but  their  mortality  from  respiratory  disease 
resembled  their  sickness  from  the  same 
cause  in  showing  a  maximal  value.  The 
engine  and  crane  men  showed  a  smaller 
excess  of  deaths  from  res])iratory  disease 
than  any  other  group  excejit  the  tinplate 
mill  men,  ]jresumal)ly  because  they  were 
not  so  much  exposed  to  the  weather  or  to 
high  temperatures.  The  comparative  im- 
munity of  the  tinplate  mill  men  from  fatal 
respiratory  disease  is  presumably  due  to 
their  custom  of  working  continuou.sly  dur- 
mg  their  shift,  without  any  long  rest  pauses, 
and  at  the  end  of  the  shift  going  back 
promptly  to  their  homes,  which  are  usually 
situated  in  the  neighborhood  of  the  works. 


98 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


The  blast  furnace  men  showed  a  con- 
siderably higher  mortality  even  than  the 
steel  melters,  as  can  be  seen  from  Table  4, 
the  data  in  which  relate  to  the  whole  body 
of  blast  furnace  men.  These  figures  sug- 
gest that  moderately  heavy  work,  if  carried 
out  under  ordinary  temperature  condi- 
tions but  with  exposure  to  all  kinds  of 
weather,  is  more  fatal  than  very  heavy 
work,  carried  out  at  high  temperatures  but 
with  shelter  from  the  elements. 

Conclusion 

The  data  as  a  whole  appear  to  indicate 
that  in  men  of  good  physicjue  the  fatigue  of 
heavy  work  has,  as  a  rule,  but  little  direct 
effect  on  sickness  and  longevity.  It  is 
probable  that  the  excessively  exliausting 
work  of  the  steel  melters  forms  an  excep- 


tion to  this  dictum,  but  it  seems  highly 
probable  that  the  heavy  work  of  the  iron 
puddlers,  of  the  tinplate  mill  men,  and  of 
the  rolling-mill  men  has  no  injurious  effect 
on  health  except  indirectly,  when  it  induces 
the  men  to  sit  about  in  damp  clothes.  The 
men  may  be  working  nearly  to  the  limit  of 
their  strength,  but  the  mere  fact  that  they 
have  to  continue  on  the  same  class  of  work 
week  after  week  and  year  after  year  must 
deter  them  from  overstraining  themselves, 
unless  they  do  it  unwittingly.  At  the  time 
these  observations  were  made,  many  of  the 
steel  melters,  rolling-mill  men  and  blast 
furnace  men  were  on  a  twelve-hour  day, 
while  the  puddlers  were  usually  on  an 
eleven-hour  day.  Since  the  spring  of  1919 
they  have  all  gone  on  to  an  eight-hour  day, 
so  their  labor  is  considerably  lightened. 


BIBLIOGRAPHY 


Lord  Leverhulme:  The  Six-Hour  Day  and 
Other  Industrial  Questions.  London,  George 
Allen  &  Unwin,  Ltd.,  1918,  p.  171. 
Vernon,  H.  M.:  Fatigue  and  Efficiency  in  the 
Iron  and  Steel  Industry.  Indust.  Fatigue  Re- 
search Board,  Rep.  No.  5,  London,  19i20. 
Vernon,   H.   M.:    The  Influence   of  Hours   of 


4. 


Work  and  of  Ventilation  on  Output  in  Tinplate 
Manufacture.  Indust.  Fatigue  Research  Board, 
Rep.  No.  1,  London,  1919. 

The  Registrar  General's  Report  for  1910-1912 
is  not  yet  published,  the  data  quoted  being 
supplied  privately. 


SYPHILIS  AND  INDUSTRY* 


ALEC  N.  THOMSON,  M.D. 

Director,  Medical  Department,  American  Social  Hygiene  Association 


THE  objective  of  an  occasional  or  pe- 
riodic physical  examination  is  to  pro- 
tect against  future  disease  and  accident  — 
in  other  words,  to  extend  life  and  promote 
efficiency.  From  the  standpoint  of  the 
state,  this  objective  may  be  more  specif- 
ically described  as  the  protection  of  the 
public  health,  by  the  recognition  of  com- 
municable disease  at  the  time  of  the  exam- 
ination, and  the  safeguarding  of  the  future 
against  dependency  caused  by  depreciation 
of  health  or  through  injury  which  may  re- 
sult in  permanent  or  transient,  j)artial  or 
total,  mental  or  physical  disability,  and 
which  may  possibly  call  for  the  expendilure 
of  public  moneys  for  material  relief. 

For  the  individual,  the  periodic  j)hysical 
examination  fiu'iiishes  a  means  of  protec- 
tion against  communicable  disease  in  his 
fellow  citizen,  as  well  as  a  means  by  which 
defects  that  ma\'  conlribule  to  his  own 
health  depreciation  or  lial)ility  to  injury 
may  be  recognized.  The  employer's  objec- 
tive, on  the  other  hand,  is  the  protection  of 
the  community  in  which  his  industry  is 
located,  of  the  worker  as  an  economic  unit, 
and  of  the  material  and  equipment  of  his 
plant,  through  the  early  recognition  of 
those  contributory  factors  that  tend  to 
cause  health  depreciation  or  accident  oc- 
currence. 

Any  single  factor  that  is  of  considerable 
prevalence,  easy  to  recognize,  and  rela- 
tively simple  to  eliminate,  and  that  is.  at 
the  same  time,  a  known  detriment  to  com- 
munity welfare,  individual  health,  and  in- 
dustrial efficiency,  deserves  greater  thought 
than  has  hitherto  been  given  to  syphilis. 
No  medical  argumeht  is  needed  to  prove 
that  syphilis  is  communicable  and  that,  in 
its  active  stage  with  open  lesions,  it  is  a 
menace  to  people  working  in  close  contact, 

*  Received  for  publication  March  7,  1921. 


with  common  tools  or  utensils.  Nor  is 
proof  required  that  the  late  disaliling  mani- 
festations of  syphilis  of  the  nervous  system 
cause  accidents  and  contribute  to  damage 
of  property.  It  is  evident,  however,  that 
attention  still  has  to  be  called  to  cardiac, 
nephritic,  digestive,  and  other  "diseases" 
as  possible  symptomatic  indications  of  an 
underlying  syphilis,  often  overlooked  in  the 
course  of  the  usual  routine  examination. 

Ain-  short  cut.  if  not  practic-able,  is  of  no 
advantage,  and  a  routine  Wassermann  test 
as  a  short  cut  undeniably  has  its  imprac- 
ticalities.  It  is  relatively  expensive.  It 
hurts  a  little  to  have  .some  one  "stick  a 
needle"  into  one's  arm.  It  prolongs  the 
examination.  Its  mere  mention  still  brings 
forth  much  of  the  old  stigma  of  "venereal" 
disease.  Moreover,  it  requires  careful  in- 
terpretation of  reports  and  often  frequent 
re])etitions.  But  none  of  these  nor  any 
other  of  its  impracticalities  is  insu])erable, 
so  why  not  go  around  the  obstacle  in.stead 
of  standing  by  and  .saying  it  cannot  be 
done  without  a  short  cut  through.  As  a 
matter  of  fact,  the  shortest  way  to  the  ob- 
jective of  recognizing  .syphilis  is  to  be 
found  in  the  longer  i^rocedure  of  the  or- 
dinary physical  examination,  (ireater  spe- 
cializing in  parts  of  the  routine  examination 
for  certain  occupations  makes  for  easier 
recognition  of  si)ecial  defects.  Therefore, 
the  more  value  there  is  attached  to  ex- 
aminations designed  to  detect  such  defects, 
the  more  important  becomes  the  recogni- 
tion of  syphilis. 

The  most  primitive  routine  examination 
for  employment  calls  for  an  "  in.spection " 
of  the  applicant,  which  necessitates,  at 
least,  looking  at  the  individual.  If  the  in- 
spector looks  while  the  person  is  walking, 
his  gait  may  suggest  locomotor  ataxia. 
His  eyes,  also,  by  such  signs  as  irregular, 


99 


100 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


unequal  pupils,  etc.,  may  be  of  significance. 
iSIoreover,  while  conversing  with  the  appli- 
cant, defective  hearing  may  be  detected,  as 
may  also  such  voice  defects  as  monotony, 
harshness,  or  low  pitch.  Cervical  glands 
may  be  palpated  or  an  epitrochlear  gland 
felt  without  actually  doing  more  than  a 
simple  inspection  requires.  These  danger 
signals,  noticed  during  a  very  rapid  inspec- 
tion, call  for  further  examination  for  the 
detection  of  additional  signs  that  may  lead 
to  a  diagnosis  of  "suspected"  syphilis. 

The  average  routine  examination  which 
calls  for  a  simple  history  of  past  illness,  an 
inspection  of  the  head  and  neck,  listening 
to  the  heart  and  lungs,  and  palpation  of 
the  inguinal  region  for  hernia,  markedly 
enlarges  the  opportunity  for  finding  signs 
and  symptoms  of  syphilis.  Not  only  the 
obvious  signals  of  abnormal  gait,  irregular 
and  unequal  pupils,  defective  hearing  and 
voice  abnormality  may  be  detected,  but 
also,  with  practically  no  consumption  of 
time,  the  observant  examiner  may  note  the 
reaction  of  the  pupils  to  light  and  accom- 
modation; the  presence  of  interstitial  glos- 
sitis, leukoplakia,  and  Hutchinson's  teeth; 
glandular  enlargements  (particularly  epi- 
trochlear nodes);  scars  (circular,  pig- 
mented, depressed,  attached  to  underlying 
bone);  and  cardiac  conditions  (especially 
aortic  valve  disease).  The  finding  of  any 
one  of  these  signs  calls  for  further  examina- 
tion; the  presence  of  two  indicates  the  neces- 
sity for  a  Wasserniann  test  for  confirmation 
of  suspected  syphilis. 

Where  nursing  and  clerical  help  are 
available  for  such  work  as  the  taking  of  the 
history,  temperature,  height,  weight,  eye 
tests,  and  hearing  and  voice  tests,  a  com- 
plete physical  examination  can  be  made  by 
the  medical  examiner  in  ten  minutes  or  less 
if  his  routine  procedure  is  thoroughly  sys- 
tematized. With  the  nurse  making  the  eye 
observations  for  i)Uj)illary  irregularity,  in- 
equaUty,  and  reaction  to  light  and  accom- 
modation, the  examiner's  observation   of 


the  applicant's  head,  nose,  and  throat  may 
detect  interstitial  glossitis,  Hutchinson's 
teeth,  leukoplakia,  ulcers  or  scars  of  the 
nasal  septum,  cervical  adenitis,  suggestive 
scars  on  the  forehead,  angles  of  the  mouth, 
and  alae  of  the  nose,  etc.  While  the  ex- 
amination of  the  heart  and  lungs  is  being 
made,  the  examiner  may  exercise  his  powers 
of  observation  to  take  cognizance  of  the 
skin  of  the  chest,  back,  and  arms  for  rash 
and  scars  not  evidently  due  to  injury  or 
acne,  at  the  same  time  that  his  ears  tell  him 
whether  or  not  any  aortic  valve  condition 
exists.  Likewise,  his  examination  of  the 
abdomen  enables  him  to  "double  up"  and 
look  for  the  same  signs  while  palpating.  A 
hard,  palpable  liver  is  one  more  signal.  In 
examining  for  hernia,  the  telltale  syphilitic 
inguinal  glands  may  be  found,  as  well  as 
the  testicle  that  has  become  harder  and 
larger  than  usual.  There  are,  too,  other 
possibilities  in  the  examination  of  the 
genitalia.  Similar  skin  inspection  of  the 
lower  extremity  takes  no  time,  and  but  a 
moment  is  required  for  an  investigation  of 
the  knee  jerks. 

In  making  these  observations,  only  a 
moment  or  two  is  added  to  the  examina- 
tion time,  and,  as  sj-philis  is  an  important 
consideration  for  industry,  it  will  be  sus- 
pected in  a  high  percentage  of  cases.  In 
most  cases  showing  more  than  one  of  the 
above-mentioned  signs,  the  suspicion  will 
be  confirmed  by  a  further  examination, 
including  the  Wasserniann  test.  If  the 
desideratum  is  a  sim]jle  examination  con- 
suming the  least  possible  amount  of  time, 
it  is  possible  to  set  down  a  series  of  syphilis 
signs  that  will  guide  the  average  examiner 
in  culling  out  those  individuals  who  require 
more  detailed  consideration  and  from 
whom  it  is  desirable  to  procure  blood  for  a 
Wasserniann  test.* 

*  When,  as  a  result  of  any  tj^pe  or  form  of  physical  ex- 
amination, evidence  suggestive  of  lues  of  the  nervous  sys- 
tem is  ascertained,  it  should  be  a  routine  procedure  to  do  a 
lumbar  puncture  with  a  serologic  examination  of  the 
cerebrospinal  fluid. 


THOMSON  —  S^THILIS  AND  INDUSTRY 


101 


In  summary,  it  may  be  said  tliat  if  any 
one,  or  any  combination,  of  the  following 
easily  observable  signals  can  be  found, 
further  examination  for  the  detection  of 
syphilis  is  necessary:  ataxic  gait;  mental 
slowness;  defective  hearing;  voice  defects; 
pupils,  irregular,  unequal,  or  reacting  ab- 
normally to  light  and  accommodation; 
enlargement  of  the  lymph  glands,  espe- 
cially of  the  epitrochlear  nodes;  interstitial 
glossitis;  leukoi)lakia ;  Hutchinson's  teeth; 


scars  not  obviously  due  to  injury;  cardiac 
conditions;  and  altered  reflexes,  especially 
knee  jerk. 

The  industrial  physician  is  probably 
justified  in  taking  the  view  that  a  routine 
Wassermann  is  not  possible  at  the  present 
time,  but  he  is  not  justified  in  overlooking 
the  easily  observable  signs  and  symptoms 
that  will  promote  the  health  of  the  em- 
ployee and  protect  the  employer  from 
responsibility    for    preventable    accidents. 


TRINITROTOLUENE  AS  AN  INDI'STRIAL  POISON* 


ALICE  HAMILTON,  M.D. 

Assistant  Professor  of  Industrial  Medicine,  Harvard  Medical  School,  and  Special  Inrestigator  of  Industrial 
Poisons  for  the  V.  S.  Bureau  of  Labor  Statistics 


IN  the  summer  of  1918,  the  National 
Research  Council  undertook  an  inquiry 
into  the  occurrence  of  industrial  poisoning 
in  munition  works,  and  as  one  feature  of 
this  study  they  assigned  to  six  typical 
T.N.T.  plants  medical  students  who  had 
been  trained  in  laboratory  methods  and  in 
making  clinical  observations,  in  order  to 
have  them  collect  important  data  on  the 
spot.  The  work  was  carried  on  in  co- 
operation with  the  U.  S.  Department  of 
Labor,  the  Public  Health  Service,  and  the 
War  Department.  The  plants  which  were 
selected  manufactured  trinitrotoluene,  or 
purified  the  crude,  or  loaded  shell  with  pure 
trinitrotoluene  or  with  the  mixture  of  am- 
monium nitrate  ami  T.N.T.,  known  as 
amatol.  Six  students  spent  from  one  to 
two  months  at  the  plants  assigned  them, 
making  observations  on  selected  groups  of 
the  men  and  women  employed  there.  Al- 
though the  results  of  their  studies,  coming 
as  they  did  in  the  fall  of  1918,  could  not  be 
put  to  practical  use  because  of  the  closing 
down  of  these  plants  when  the  armistice 
was  signed,  it  seems  worth  while  to  pub- 
lish them  because  compounds  very  similar 
to  trinitrotoluene  are  coming  into  increas- 
ing use  in  American  industry.  It  is  not 
likely  that  any  other  derivative  of  the 
benzene  ring  will  ever  be  used  on  so  gigantic 
a  scale  as  was  T.N.T.  during  the  war,  and 
all  the  information  that  was  gathered  dur- 
ing that  great  human  experiment  should  be 
made  knowTi  because  of  its  probable  appli- 
cation to  the  less  well  known  compounds 
which  are  used  in  the  manufacture  of  dyes 
and  drugs. 

At  the  time  this  study  was  made  we  had 
been  able  to  learn  a  good  deal  about  T.N.T. 

*  Received  for  publication  .Jan.  19,  1921. 


poisoning  and  its  prevention  from  the 
British,  but  several  points  were  still  a  mat- 
ter of  controversy,  and  it  was  to  these  that 
we  devoted  special  attention.  A  study  of 
industrial  poisoning  in  the  manufacture  of 
explosives,  which  had  been  published  by 
the  Bm-eau  of  Labor  Statistics  in  1917,  had 
shown  that  in  American  plants,  as  in  the 
British,  all  varieties  of  T.N.T.  poisoning 
were  to  be  found  from  the  so-called  "minor 
T.N.T.  sickness"  to  fatal  toxic  jaundice 
(1).  The  first  death  from  the  latter  in  Eng- 
land was  reported  in  February,  1915,  and 
the  first  death  in  this  country  came  to  light 
just  about  a  year  later  (2). 

T.N.T.  is  made  by  the  nitration  of  tol- 
uene either  by  a  continuous  or  by  an  in- 
terrupted process.  There  is  little  danger  of 
exposure  to  jioison  for  the  workmen  en- 
gaged in  nitration,  but  the  subsequent 
separation  and  purification  of  crude  T.N.T. 
was,  in  this  country,  attended  with  very 
decided  risk  of  poisoning  —  a  risk  actually 
as  great  as  in  shell  loading.  This  was  ap- 
parently not  true  in  England,  for  there  the 
great  majority  of  cases  of  poisoning  de- 
veloped in  the  "filling,"  or,  as  we  call  them, 
loading  plants.  Thus,  there  were  in  Great 
Britain,  in  1916  and  1917,  370  cases  of 
toxic  jaundice  with  ninety-six  deaths,  but 
only  sixteen  of  the  cases  and  two  of  the 
deaths  were  reported  from  the  manufac- 
turing plants  f3).  The  nitration  and  purifi- 
cation of  T.N.T.,  so  prolific  a  source  of 
T.N.T.  poisoning  in  American  munition 
plants,  was  evidently  carried  on  under  far 
greater  precautions  in  England  than  here. 

Commercial  T.N.T.  is  mainly  composed 
of  the  symmetrical  isomer,  a  hard,  crystal- 
line powder,  jiinkish  yellow  if  fairly  pure, 
melting  and  subliming  at  8'-2°  C.    The  im- 

10-2 


HAMILTON  —  TRINITROTOLUENE  AS  AN  INDT^STRIAL  POISON     103 


purities  present  in  crude  T.N.T.  and  to  a 
certain  extent  in  the  purified  T.N.T.  con- 
sist in  insignificant  quantities  of  the  two 
other  isomers  find  a  varying  percentage  of 
mononitrotoluene  and  dinitrotohiene,  and 
also  nitrated  methanes.  Early  in  the  war 
the  question  arose  whether  T.N.T.  poison- 
ing was  caused  by  the  pure  suljstance  or  by 
one  of  the  above  impurities,  and  the  sug- 
gestion was  made  that  cyanosis  and  minor 
T.N.T.  sickness  might  be  caused  by  T.N.T. 
but  that  some  otjier  substances  might  be 
responsible  for  toxic  jaundice  and  aplastic 
anemia.  The  British  (4)  came  to  the  con- 
clusion that  pure  T.N.T.  was  cajjable  of 
setting  up  all  these  varieties  of  jxiisoning. 
while  the  (iermans  (5)  concluded  from  tlicir 
experience  that  toxic  jaimdice  appeared 
only  when  imijure  T.N.T.  was  handled,  and 
that  tetranitromethane  was  jjrobably  the 
compound  re.spon.sible  for  it.  With  this, 
the  French  ((>)  exj)erience  harmonized. 

All  the  early  efforts  in  (Ireat  Britain  to 
prevent  T.N.T.  i)oisoning  were  directed 
against  contamination  of  the  air  by  fumes 
and  vapors.  ^Foore's  experiments  (4) 
threw  doubt  on  this  mode  of  entrance  for 
T.N.T.  and  showed  the  importance  of  skin 
absorption.  Indeed,  he  went  so  far  as  to 
declare  that  there  was  no  need  of  carrying 
off  fumes  from  melting  pots,  and  that  dust 
caused  poisoning  only  because  it  fell  on  the 
skin  and  on  work  benches  ami  objects 
which  the  worki)eople  had  to  handle.  The 
other  British  authorities  took  a  more  con- 
servative stand  on  this  question,  and  llie 
Home  Office  experts  insist etl  on  the  pre- 
vention of  fumes  (8),  but  the  overwhelming 
importance  of  the  skin  as  a  portal  of  entry 
for  T.N.T.  was  generally  admitted. 

A  great  hel])  in  solving  the  fpiestions  of 
absorption,  elimination,  tlie  relative  danger 
of  diftVrent  kinds  of  work  and  of  different 
mixtm-es  containing  T.N.T.  was  found  in 
the  so-called  Webster  test  for  the  urine  (4). 
This  is  a  method  of  detecting  in  the  urine  a 
reduction   product   of    T.N.T.,    dinitrohy- 


droxylamino-toluene,  and  as  it  is  a  color 
reaction  varying  from  a  pale  jjink  to  a  deep 
purplish  pink  according  to  the  quantity  of 
this  reduction  product  present,  there  was 
no  difficulty  in  standardizing  it  and  thus 
bringing  the  observations  of  the  different 
students  into  harmony. 

The  students  assigned  to  the  nitrating, 
])urifying,  and  shell-loading  plants  were 
asked  to  make  observations  on  problems 
of  a  thoroughly  practical  character,  for 
although  the  United  States  had  been  in  the 
war  for  more  than  a  year  the  government 
had  not  yet  formulated  a  .sanitary  code  for 
the  control  of  the  explosives  industry,  and 
all  attempts  to  do  so  met  with  opjjosition  — 
an  o])i)osition  which,  it  was  felt,  might  be 
overcome  if  the  managers  of  these  plants 
were  confronted  with  a  body  of  facts 
gathered  from  American  sources.  The  fol- 
lowing questions  were  assigned  to  the  stu- 
dents: 

1.  Can  T.N.'I\  poisoning  occur  as  the 
result  of  breathing  fumes  or  dust,  without 
skin  contact.'' 

'2.  Is  susceptil)ility  to  poisoning  in- 
fluenced by  race,  sex,  age,  climate? 

;i.  How  long  an  exposure  is  necessary 
before  T.N.T.  can  be  detected  in  the  body? 

4.  How  long  does  it  take  to  get  rid  of  the 
T.N.T.  tiiat  has  been  absorbed? 

5.  Which  is  more  ])oisonous,  crude 
T.N.T.  or  tlie  pure;  unmixed  T.N.T.  or 
amatol? 

(>.  What  are  the  earliest  symptoms  of 
T.N.T.  poisoning? 

7.  What  is  the  practical  value  of  the 
\Vebster  reaction? 

8.  Is  there  any  change  in  blood  or  urine 
which  can  be  depended  on  to  give  warning 
of  danger? 

Of  the  40'-2  workers  who  were  examined 
in  the  six  plants,  only  thirty-six  were 
women.  The  conditions  under  which  these 
people  worked  varied  so  much  that  .some 
description  of  the  i>lants  will  be  necessary 
to   account    for   the   different    results   ob- 


104 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tained  by  the  students.  Plants  1  and  2 
were  assigned  to  Miss  Alice  Hall,  a  third 
year  student  at  Rush  ^ledical  College. 
They  were  situated  not  far  apart  in  north- 
eastern New  Jersey,  in  hot,  shadeless  coun- 
try where  the  August  heat  of  the  summer 
of  1918  was  at  times  excessively  trying. 
Methods  of  work  differed  somewhat  in  the 
two  plants,  but  they  were  both  unusually 
neglected  and  unclean.  The  floors  and 
benches,  especially  in  one  of  the  pouring 
rooms,  were  covered  with  drippings  of  mol- 
ten T.N.T.,  the  rooms  were  crowded  and 
poorly  ventilated,  and  both  fumes  and 
dust  were  allowed  to  escape  into  the  air. 
The  washing  facilities  were  very  inade- 
quate, and,  as  they  were  not  conveniently 
situated  and  time  was  not  allowed  for  the 
men  to  Ijathe,  they  were  not  much  used. 
Even  the  men  who  were  cleanly  in  their 
habits  found  it  very  hard  to  keep  clean, 
and  naturally  the  labor  turnover  was  very 
great  and  the  force  was  for  the  most  part 
recruited  from  the  lowest  class  of  labor.  No 
instructions  were  given  the  workmen,  and 
in  neither  jjlant  did  the  physicians  have 
anything  to  do  with  shop  sanitation.  Their 
duties  were  confined  to  holding  office  hours 
at  stated  times  when  men  who  fell  sick  and 
had  confidence  in  the  plant  doctor  could 
seek  him  out  and  ask  for  care.  They  did 
nothing  to  prevent  sickness  and  not  very 
much  in  the  way  of  treatment,  for  if  they 
thought  a  man  likely  to  develop  a  serious 
case  of  poisoning,  they  jjromjitly  discharged 
him,  for  the  protection  of  the  company. 

Miss  Hall  saw  more  cases  of  severe  poi- 
soning than  did  any  of  the  other  students, 
but  she  was  hampered  in  her  study  of  these 
cases  because  there  was  no  hospital  where 
they  could  be  closely  observed  and  because 
her  notes  of  a  case  were  usually  brought  to 
an  abrupt  end  by  the  man's  discharge  or  by 
his  cjuitting  of  his  own  accord.  She  was 
never  able  to  follow  a  case  over  a  long 
period  as  could  some  of  the  other  students. 

In  Plant  3,   also  in  northeastern   New 


Jersey,  shell  was  loaded  with  amatol  50-50 
and  80-'-20.*  Miss  Jewel  Emery,  laboratory 
technician  from  the  Michael  Reese  Hos- 
pital, Chicago,  spent  a  montli  there.  It  was 
a  LT.  S.  ordnance  plant,  new,  clean,  well 
constructed,  and  carefully  managed,  except 
that  medical  supervision  was  not  thorough 
enough  and  there  were  no  hospital  facilities. 
The  employees  were  of  a  better  class  than 
in  Miss  HalFs  plants,  but  there  was  an  un- 
usually large  proportion  of  young  men 
among  them. 

Plant  4,  which  was  in  Virginia,  was  as- 
signed to  Richard  TeLinde,  a  third  year 
student  in  the  LTniversity  of  Wisconsin 
Medical  School.  Shell  was  loaded  in  this 
plant  with  the  two  varieties  of  amatol.  The 
plant  was  partly  new,  clean,  large  and  well 
ventilated;  ])artly  old,  rather  crowded  and 
dirty,  and  in  some  places  very  dusty.  The 
men  employed  were  negroes  and  southern 
whites,  many  of  them  from  the  North 
Carolina  mountains,  of  poor  physique  and 
anemic.  The  medical  care  given  at  this 
plant  was  by  far  the  best  that  we  found 
anywhere,  and  included  inspection  of  the 
men  and  women  in  their  workrooms,  the 
shifting  of  all  suspicious  cases  from  T.N.T. 
work  to  safe  work,  and  the  treatment  of 
sick  men  in  a  well-ecjuipped  hospital.  Mr. 
TeLinde  was  able  to  make  observations  on 
men  for  long  periods  and  to  follow  a  case  of 
sickness  to  recovery,  but  he  never  saw  as 
serious  cases  as  did  Miss  Hall. 

Plant  5  was  in  northern  Wisconsin  near 
Lake  Superior.  Here  D.N.T.  and  T.N.T. 
were  made,  and  purified  and  packed.  The 
employees  were  decidedly  superior  to  those 
employed  in  the  other  plants.  Conditions 
were  very  good,  there  were  ample  facilities 
for  washing,  and  medical  care  was  good 
but  insufficient,  one  physician  with  a  part- 
time  assistant  not  only  having  about  3,000 
men  under  his  care  but  also  being  respon- 
sible for  the  examination  of  all  applicants 

*  .\mmoniuni  nitrate  50  per  cent.,  T.X.T.  50  per  cent., 
and  ammonium  nitrate  80  per  cent.,  T.N.T.  20  per  cent. 


HAMILTON  —  TRINITROTOLUENE  AS  AN  INDUSTRIAL  POISON     105 


for  employment.  It  was  therefore  impos- 
sible for  the  student  at  this  plant  to  make 
as  careful  observations  as  were  possible  in 
Plant  4,  especially  as  there  was  no  hospital 
on  the  grounds.  Norton  Eversoll,  a  third 
year  student  in  the  University  of  Wisconsin 
Medical  School,  was  assigned  to  this  plant. 
The  work  that  was  done  in  Pl^nt  6  has 
already  been  described  by  Tracy  Jackson 
Putnam  and  \Yilliam  Herman  (7),  the  two 
Harvard  Medical  School  students  who 
spent  a  month  there.  Plant  6  was  a  p^irifi- 
cation,  "finishing"  plant,  situated  in  the 
mountains  of  Pennsylvania.  It  was  a  fairly 
dean  place  except  in  two  departments,  and 
even  those  were  not  excessively  l)ad,  but 
the  men  were  not  given  proper  working 
clothes  nor  were  the  wash  rooms  adequate 
or  comfortable.  The  medical  care  of  sick 
men  who  api)lied  for  treatment  was  good, 
but  there  was  no  preventive  work  and  no 
effort  to  discover  cases  of  poisoning-  Both 
negroes  and  whites  were  employed. 

Mode  of  Entrance  of  T.N.T. 

It  was  impossible  for  us  to  obtain  as  clear 
evidence  on  the  mode  of  entrance  of  T.N.T. 
as  was  gained  by  the  British  in  tlieir 
carefully  regulated  factories.  No  American 
plant  was  clean  enough  to  make  skin  ab- 
sorption even  a  rarity.  Everybody  em- 
ployed in  every  department  came  in 
contact  with  T.N.T.  dust  and  had  his  skin 
more  or  less  covered  with  it.  We  could 
only  make  an  effort  to  determine  whether 
fumes  and  contact  caused  more  poisoning 
than  contact  alone,  and  whether  inhaling 
dust  increased  the  incidence  of  poisoning. 
The  reports  from  certain  plants  seemed 
to  show  that  fumes  and  T.N.T.-laden 
steam  decidedly  increased  the  risk  of  poi- 
soning. For  instance,  the  graining,  pellet- 
ing, and  washing  rooms  of  the  purification 
plants,  where  fumes  mixed  with  steam  were 
niore  or  less  heavy,  gave  rise  to  many  cases 
.  of    sickness,    especially    in    cold    weather. 


when  the  doors  were  closed,  and  also  in 
heavy,  hot,  summer  weather. 

According  to  Putnam  and  Herman,  the 
procedure  most  dreaded  in  their  purifying 
plant  was  cleaning  out  the  bottoms  of  the 
great  tanks  in  which  crude  T.N.T.  had 
been  boiled.  The  heat,  moisture,  and  fumes 
in  the  tanks  were  overpowering  and  many 
men  refused  to  enter  them.  Another  piece 
of  work  which,  accortling  to  the  workmen, 
often  caused  deep  cyanosis  and  fainting, 
was  cleaning  a  room  by  volatilizing  and 
melting  with  live  steam  the  T.N.T.  which 
had  been  spilled  and  splashed  about.  As 
for  dust,  it  was  found  that  pure,  dry  T.N.T. 
dust  (lid  not  cause  poisoning  imless  present 
in  such  quantities  as  to  cover  the  skin  of 
the  workers.  Pressing  pure  T.N.T.  into 
detonator  charges  or  demolition  blocks 
seemed  to  be  harmless  work.  On  the  other 
hand,  small  quantities  of  amatol  (T.N.T. - 
ammonium  nitrate)  dust  proved  distinctly 
]K)isonous,  although  it  contained  only  a 
.small  |)roportion  of  T.N.T. 

A  closer  study  of  these  findings  led  us  to 
indorse  the  British  view  of  the  overwhelm- 
ing importance  of  the  .skin  as  a  portal  of 
entry  for  T.N.T.  because  tiie  .same  condi- 
tions that  make  respiratory  absorption 
jiossible  also  increase  skin  absorption,  and 
the  greater  toxicity  of  amatol  as  compared 
with  pure  T.N.T.  depends  on  its  greater 
absorbability.  The  instances  given  above 
of  poisoning  from  steam  and  finnes  can  also 
be  explained  as  due  to  the  facilitation  of 
skin  absorption  by  heat  and  moisture. 
Grainers,  pelleters  and  tank  cleaners  in 
purification  works  have  their  hands  and 
forearms  more  deeply  stained  with  T.N.T., 
even  after  a  single  day's  work,  than  do 
men  pressing  charges  at  the  end  of  several 
weeks'  work.  The  dust  of  pure  T.N.T.  is 
not  very  readily  absorbed  by  the  skin.  If 
one  looks  at  the  arms  and  hands  of  a  man 
who  is  sifting  or  pressing  dry  unmixed 
T.N.T.,  one  can  see  the  powder  covering 
the  hairs  pf  the  skin,  but  unless  the  day  is 


106 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


hot  enough  to  cause  much  perspiration  this 
powder  is  dry  and  hardly  stains  the  skin  at 
all.  In  the  graining  and  pelleting  rooms  not 
only  is  the  T.N.T.  which  the  men  handle 
warm  and  wet.  but  the  steam  and  fumes 
keep  the  skin  moist  all  the  time. 

The  same  contrast  was  found  by  Te- 
Linde  between  a  drilling  department  where 
there  was  much  amatol  dust  and  a  depart- 
ment in  which  pure  T.N.T.  was  sifted. 
There  was  a  great  deal  of  sickness  in  the 
former  department,  and  almost  none  in  the 
latter.  The  amatol  dust  contained  50  per 
cent,  of  ammonium  nitrate,  and  this,  be- 
cause of  its  hygroscopic  nature,  kept  the 
skin  of  the  workers  moist.  Tiny  droplets  of 
water  could  always  be  seen  on  the  skin  and 
hairs  of  the  men's  hands  and  arms,  and  on 
all  the  metallic  surfaces  in  the  room.  Our 
experience  in  this  country  agreed  with  that 
of  the  British,  who  found  that  there  was 
more  sickness  in  connection  with  80-'-20 
amatol,  containing  only  20  per  cent. 
T.N.T.,  than  with  pureV.N.T.  We  also 
found,  as  the  British  had,  that  oily  sub- 
stances favored  the  absorption  of  T.N.T. 
Two  of  the  earliest  American  cases  of  toxic 
jaundice,  one  of  them  fatal,  were  in  women 
exposed  to  very  small  quantities  of  amatol, 
but  whose  hands  were  smeared  all  the  time 
with  paraffin. 

Although  our  observations  showed  that 
the  skin  is  the  chief  channel  of  absorption 
for  T.N.T.,  and  that  the  prevention  of  poi- 
soning means  j)revention  of  contact,  still 
we  were  not  convinced  that  T.N.T.  fumes 
from  grainers,  washing  tanks  and  melting 
kettles  were  harmless.  Some  of  the  stu- 
dents' case  histories  seemed  to  point  quite 
clearlj'-  to  fume  poisoning,  as,  for  instance, 
that  of  a  new  employee  who  was  set  to  work 
on  a  fairly  cool  day  in  June  stirring  a  kettle 
of  molten  T.N.T.  which  was  poorly  hooded. 
He  became  dizzy  and  faint,  and  went  to  the 
plant  doctor  who  found  him  cyanosed,  with 
weak  and  rajiid  jndse.  He  was  suspended 
from  work  that  day  (Monday)  but  on  the 


following  Friday  he  was  still  feeling  ill  and 
his  urine  was  still  dark  in  color.  Several 
students  reported  cases  of  men  who,  hav- 
ing once  suffered  from  T.N.T.  sickness, 
could  go  back  to  work  with  the  substance, 
but  if  they  were  exposed  to  the  fumes  would 
suffer  a  return  of  the  headache,  dizziness, 
breathlessness  and  weakness  with  which 
they  were  familiar  from  their  former  ex- 
perience. A  very  interesting  report  on  this 
point  was  sent  by  Alice  Hall.  On  two  oc- 
casions she  remained  for  two  or  three  hours 
in  the  pouring  room  where  the  air  was 
heavy  with  T.N.T.  fumes,  being  careful 
not  to  touch  an\i^hing  during  that  time. 
After  both  these  exposures  she  was  able 
to  get  a  positive  Webster  reaction.  The 
superintendent  of  a  department  in  one  pf 
the  Navy  arsenals,  where  depth  charges 
and  mines  were  loaded,  told  me  that  poi- 
soning among  his  men  was  practically  100 
per  cent.,  not  one  of  them  having  been  able 
to  work  as  long  as  three  weeks  without 
some  symjitoms  of  sickness.  The  fumes 
from  pouring  and  from  the  cooling  mines 
and  shell  were  very  heavy.  He  himself 
hardly  ever  came  in  actual  contact  with 
T.N.T.,  but  he  was  frequently  overcome 
with  dizziness,  headache  and  weakness  if 
he  had  to  stay  in  the  fmnes  for  many  hours 
at  a  time.  It  is,  of  course,  by  no  means  cer- 
tain that  these  fumes  contain  only  T.N.T. 
and  not  some  other  substances  equally 
toxic  or  more  so. 

Influence  of  R.\ce 

The  only  students  who  had  any  oppor- 
tunity to  observe  the  difference  between 
whites  and  negroes  in  their  behavior  to- 
ward T.N.T.  were  TeLinde  in  Virginia  and 
Herman  and  Putnam  in  Pennsylvania. 
TeLinde  was  much  impressed  by  the 
greater  susceptibility  of  the  white  men. 
He  did  not  find  one  case  of  T.N.T.  sickness 
among  the  negroes.  Negroes  who  were 
working    alongside    the    whites    handling 


HAMILTON  —  TRIXITROTOLIEXE  AS  AX  INDUSTRIAL  POISON     107 


amatol  sometimes  gave  a  moderate  Web- 
ster reaction,  but  tlieir  urines  were  normal 
in  color,  not  dark,  as  were  the  urines  of 
many  of  the  white  men  in  this  department, 
nor  did  they  com{)lain  of  any  symptoms  of 
])oisoning.  In  sifting  pure  T.N.T.  by 
hand,  only  negroes  were  employed,  and 
although  the  dust  here  was  excessive,  they 
gave  a  slight  Webster  reaction  or  a  nega- 
tive one.  It  is  true  that  this  dust  was  pure 
T.N.T.  but  that  was  also  true  of  the  du.st  in 
I  he  drilling  department  in  one  of  Alice 
Hall's  plants,  yet  she  found  decided  evi- 
dence of  i)ois()ning  among  Ihe  while  men 
employed  there  and  always  got  positive 
Webster  reactions.  On  the  other  hand. 
Herman  and  Putnam,  who  were  able  to 
watch  negroes  and  whites  working  together 
throughout  the  plant,  found  no  difference 
in  susce])tibi]iiy  of  the  two  races.  'IMiey 
examined  thirty-.seven  whites  and  thirteen 
negroes.  Among  the  latter  were  some  who 
showed  marked  poisoning;  indeed,  tiic 
most  typical  case  of  T.N.T.  poisoning  that 
canu'  under  their  observation  was  in  a 
negro.  They  also  found  se\'eral  negroes 
entirely  imaffected  after  comparatively 
long  periods  of  exposure. 

It  was  apparent  from  TeLinde's  report 
that  the  negroes  in  the  Virginia  ])lant  were 
neither  living  nor  working  under  the  same 
conditions  as  the  whites.  'i'lie\'  were,  on 
the  whole,  more  in  tlie  habit  of  taking 
baths  than  were  the  mountain  whites  em- 
ployed there,  and,  living  in  their  own  cal)- 
ins,  they  had  a  diet  rich  in  fresh  vegetables 
and  fruit,  while  the  white  men  ate  in  the 
company  canteen  where  the  diet  jjrovided 
was  largely  meat  and  canned  vegetables, 
with  almost  no  fresh  food.  In  the  Pennsyl- 
vania plant  the  negroes  and  whites  not 
only  worked  in  the  same  departments,  but 
lived  in  company  bunk  houses  and  ate  the 
same  food.  Both  races  had  about  the  same 
standard  of  cleanliness  and  both  had 
T.N.T.  poisoning.  Ther^  is,  therefore,  no 
indisputable  evidence  of  racial  immunity 


toward  T.N.T.  as  a  systemic  poison,  al- 
though negroes  are  distinctly  less  liable  to 
T.N.T.  dermatitis,  as  was  found  in  both 
plants.* 

In  this  respect  our  experience  agrees  with 
that  of  the  French  in  their  nnmition 
plants  (8).  The  French  emjjloyed  three 
races,  white,  yellow  and  black,  in  making 
and  loading  dinitro])henol,  and  at  first 
were  impressed  with  the  greater  resistance 
of  the  Anamites,  the  yellow  race,  and  the 
high  degree  of  susceptibility  of  the  white 
race.  Later,  however,  they  discovered 
that  if  all  conditions  were  taken  into  con- 
sideration the  theory  of  racial  innnunity 
became  decidedly  cjuestionable.  The  white 
men  were  more  intemperate,  more  un- 
cleanly in  their  habits,  and  less  obedient  to 
shop  rules  than  were  the  yellow  men,  and 
in  addition,  the  best  metlical  care,  which 
means  the  most  careful  examination  and 
diagnosis,  was  given  to  the  white  men. 
These  differences  .seemed  to  the  French 
enough  to  account  for  the  difference  in  the 
numbers  of  cases  of  D.X.P.  poisoning  re- 
ported from  the  two  groups. 

Influence  of  Age 

Forty  per  cent,  of  the  employees  in  the 
six  American  jilanls  studied  were  under 
'■25  years  of  age,  and  '■H  per  cent,  under  '■21 
years.  The  largest  proportion  of  mouthful 
employees  —  55  per  cent,  under  -21  years  of 
age  —  was  in  Plant  ;J,  fortunately  one  of 
the  better  plants.  Miss  Hall  reported  a 
very  marked  susceptibility  among  the 
younger  men  under  her  observation.  Only 
a  few  men  under  •■25  years  were  em|)loAed 
in  her  two  plants,  but  the  few  that  were 
under  that  age  showed  a  very  low  resistance 
to  the  poison.    Three  lads  of  19  were  dis- 

*  Marshall,  Lynch,  Smith,  and  Williams  of  the  Chem- 
ical Warfare  Service  tested  the  susceptibility  of  whites  and 
negroes  to  mustard  gas.  A  certain  degree  of  resistance  was 
displayed  by  aljout  20  to  40  per  cent,  of  Ihe  whites,  and  by 
78  per  cent,  of  the  negroes.  Two  per  cent,  of  the  whites 
showed  hj-perseiisitivitv,  but  none  of  the  negroes.  (G.  S. 
Derby,  Arch.  OpIUh.,  1940,  49,  119.) 


108 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


charged  after  three  weeks'  work,  because 
tlie  doctor  was  imwiUing  to  take  the  risk  of 
keeping  them  longer.  One  man  of  21  years, 
who  was  unusually  careful  and  cleanly  in 
his  habits,  sickened  so  seriously,  at  the  end 
of  the  first  week  that  he  was  discharged. 
Of  all  the  men  who  were  discharged  from 
the  worst  of  these  two  factories  during  one 
month  on  account  of  sickness,  one-third 
were  under  ^25  years  of  age,  while  only  one- 
eighth  of  the  entire  force  employed  were 
under  25. 

None  of  the  other  students  had  any  such 
striking  incidents  to  report;  indeed,  they 
were  not  impressed  with  the  oversuscepti- 
bility  of  the  younger  men,  but  a  close  anal- 
ysis of  their  records  demonstrated  it.  For 
instance,  forty-eight  of  TeLinde's  cases 
were  divided  into  two  groups,  one  consist- 
ing of  twenty-nine  lads  under  21  years;  the 
other,  of  nineteen  men  over  30  years.  The 
period  of  exposure  to  T.N.T.  before  the  ap- 
pearance of  the  first  symptoms  of  sickness 
was  noted  in  each  case,  and  it  appeared 
that  while  the  older  men  had  averaged 
forty-nine  days  of  work  before  sickening, 
the  younger  men  averaged  only  ten  and  a 
half  days.  The  young  men  had  for  the 
most  part  reacted  to  the  T.N.T.  with  great 
rapidity,  only  five  out  of  the  twenty-nine 
working  as  long  as  two  weeks  without  feel- 
ing any  effect.  Similar  groups  from  Ever- 
soll's  records  gave  an  even  greater  contrast. 
The  older  men  averaged  fifty-six  days' 
exposure,  the  yoimger  men  only  seven  to 
eight  days. 

Finally,  I  selected  at  random  from  the 
history  sheets  of  these  two  plants  fifteen 
records  of  men  who  had  de\eloped  serious 
symptoms  in  a  very  short  time,  and  on  re- 
ferring to  the  age  lists  I  foimd  that  only  one 
of  these  fifteen  was  over  21  years  of  age, 
and  he  was  only  24  years  old.  Yet  in  these 
two  plants  the  men  imder  2.5  years  con- 
stituted less  than  40  per  cent,  of  the  force. 
The  early  experience  with  T.N.T.  in  Eng- 
land showed  clearly  the  greater  suscepti- 


bility of  the  young  people.  The  general 
mortality  from  toxic  jaundice,  recognized 
and  notified  as  such,  was  25.9  per  cent., 
but  for  persons  under  18  years  of  age  the 
proportion  was  six  deaths  out  of  nine 
cases  (3). 

Influence  of  Sex 

The  British  reports  have  not  shed  any 
light  on  the  question  of  the  influence  of  sex 
in  T.N.T.  poisoning.  Although  the  mor- 
tality among  the  women  was  greater  than 
among  the  men  —  28.6  per  cent,  as  against 
20  per  cent.  —  the  women  were  younger 
than  the  men,  and  the  oversusceptibility  is 
attributed  by  Legge  to  their  youth,  not  to 
their  sex.  We  could  not  come  to  any  con- 
clusion at  all  with  respect  to  the  American 
cases,  since  the  employees  in  our  plants 
were  almost  all  men,  and  the  few  women 
employed  did  relatively  safe  work.  It  was 
possible  to  obtain  records  of  only  thirty- 
six  women  employed  in  four  shell-loading 
and  detonator  departments.  These  women 
were  carefully  examined,  but  the  results 
were  largely  negative.  None  of  them  was 
doing  any  of  the  more  dangerous  work, 
such  as  -preparing  the  charge,  loading  shell 
or  drilling  the  hole  for  the  detonator  charge. 
Indeed  they  would  have  had  little  or  no 
contact  with  T.N.T.  had  they  all  been  em- 
]iloyed  in  well-regulated  plants,  but  sixteen 
were  working  in  the  two  plants  under  Miss 
Hall's  observation  where  T.N.T.  was  so 
recklessly  spilled  and  scattered  about  that 
it  was  impossible  to  avoid  contact  with  it. 
Miss  Hall  examined  a  group  of  seven 
women  whose  hands  were  stained  from 
handling  shell  smeared  with  T.N.T.  Five 
complained  of  mild  symptoms  and  three  of 
these  gave  positive  Webster  reactions,  but 
none  showed  cyanosis,  and  none  had  ap- 
plied for  treatment,  except  one  married 
woman  who  c-omplained  of  nausea  and 
vomiting,  and  whom  the  jihysician  believed 
to  be  pregnant.  Miss  Hall  examined  an- 
other group  of  nine  girls  who  were  pressing 


HAMILTON  —  TRINITROTOLUENE  AS  AN  INDUSTRIAL  POISON     109 


small  quantities  of  dry,  pure  T.N.T.  into 
detonators.  Only  one,  a  girl  of  20  years 
who  had  worked  six  weeks  longer  than  any 
of  the  others,  had  fairly  serious  symptoms. 
A  third  group,  under  TeLinde's  observa- 
tion, working  under  good  conditions  and 
exposed  to  small  quantities  of  fume  and 
dust  had  no  signs  of  ill  health,  although  two 
of  the  women  had  Webster  reactions  of 
medium  intensity.  Miss  Emery  examined 
ten  women  who  were  obliged  to  come  more 
in  contact  with  amatol  than  any  of  the 
other  women,  for  they  were  cleaning  the 
outer  surface  of  loaded  shell,  cleaning  the 
threads  of  the  screw  necks,  and  placing  the 
finished  shell  in  cars.  Six  of  these  ten  suf- 
fered from  T.N.T.  dermatitis  and  slight 
symptoms  of  systemic  poisoning.  One  of 
them,  a  woman  of  .'?!  years,  seemed  un- 
usually suscejjtible.  She  had  an  erujition 
over  her  hands,  arms  and  legs,  and  com- 
plained of  nausea,  loss  of  appetite,  con- 
stipation, sore  throat  and  pains  in  lier 
legs  and  arms.  None  of  these  women  was 
cyanosed. 

Sununiiig  up.  we  may  say  that  it  was  even 
more  impossiljle  to  compare  the  suscepti- 
bility of  the  two  sexes  to  T.N.T.  than  to 
com,pare  the  susceptibility  of  negroes  and 
whites,  for  the  exposMre  of  tlu-  women  and 
the  men  was  altogellicr  diiferent. 

Effect  of  Hot  and  Humid  Weather 

Every  manager  ami  foreman  interviewed 
said  that  T.N.T.  poisoning  was  more  com- 
mon and  severe  in  hot  weather,  especially 
if  the  humidity  was  also  high.  The  students 
in  charge  of  the  inquiry,  with  the  exception 
of  Herman  and  Putnam,  worked  through 
the  intense  heat  of  August,  and  all  of  them 
reported  that  the  number  of  cases  of  sick- 
ness increased  markedly  during  the  hot 
days  and  for  a  few  days  just  following. 
Miss  Hall  wrote  that  only  four  men  came 
for  treatment  during  six  days  when  the 
temperature  was  between  68°  F.  and  89°  P., 


but  in  six  days  of  heat  from  90°  F.  to 
106°  F.  twenty  men  reported  for  treatment, 
and  this  number  did  not  represent  nearly 
all  of  the  sickness,  because  on  the  day  of 
greatest  heat  the  plant  was  obliged  to  close 
down  for  lack  of  men  and  was  greatly  ham- 
pered for  two  days  more. 

Curiously  enough,  heat  does  not  seem  to 
increase  T.N.T.  dermatitis,  contrary  to  the 
general  impression  that  prevails  among  the 
men.  It  is  true  that  summer  is  the  season 
for  "T.N.T.  itch,"  but  tlie  excessively  hot 
weather  of  August  ditl  not  increase  the 
niunber  of  cases  as  it  increased  the  cases 
of  systemic  T.N.T.  poisoning.  There  were 
quite  as  many  cases  in  cool  summer  weather 
as  in  hot,  and  tiie  i)robal)le  explanation  for 
the  increase  of  "itch"  in  summer  is  that  the 
men  expose  more  of  the  skin  by  rolling  up 
their  sleeves  and  leaving  their  shirts  open 
at  the  neck,  or  by  working  in  low-necked 
and  sleeveless  underwear. 

Pehiod  of  Exposure  hefore  Ab.sorption 
T.vKEs  Place 

The  Webster  reaction  may  appear  very 
early,  especially  if  there  is  excessive  expo- 
sure. ^Nliss  Hall  reported  the  most  striking 
cases  of  riipid  absorfjlion  and  elimination  of 
the  poison  and  I  lia\'c  already  spoken  of  the 
apjjearance  of  a  positive  Webster  in  her 
urine  after  a  few  hours'  .sojourn  in  a  badly 
contaminated  department.  Miss  Hall  was 
able  to  get  reactions  of  medium  intensity  in 
the  urines  of  ten  newly  employed  men  at 
the  end  of  their  first  six  hours  of  work. 
Such  excessive  exposure  ditl  not  exist  in  any 
other  plant,  but  the  records  of  133  cases  in 
which  a  maxinmm  Webster  reaction  was 
obtained  showed  that  more  than  a  third  of 
the  men,  39  per  cent.,  had  been  exposed  no 
longer  than  three  weeks. 

There  were  jjlenty  of  records  of  men  who 
felt  the  first  symptoms  of  illness  on  the  first 
or  second  day  of  their  employment,  but 
sometimes  these  symptoms  passed  away 


110 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


and  the  men  felt  quite  well  again  for  a 
short  time;  then,  after  longer  exposure, 
symptoms  of  another  kind  developed. 
TeLinde  and  Herman  and  Putnam  de- 
scribed in  some  cases  a  transitory  disturb- 
ance of  digestion  with  loss  of  appetite,  a 
bad  taste  in  the  mouth,  and  usually  di- 
arrhea with  more  or  less  pain,  but  no  cyano- 
sis or  dizziness  or  headache.  The  more 
characteristic  symptoms  were  breathless- 
ness,  a  feeling  of  tightness  in  the  chest, 
headache,  dizziness,  dullness  and  lassitude, 
pains  in  the  limbs,  weakness  of  the  knees 
and  lividity  of  the  face  with  blue  lips,  and 
these  usually  appeared  soon  after  the  be- 
ginning of  T.N.T.  work.  Even  in  a  well- 
managed  plant  the  men  who  were  at  all 
susceptible  to  T.N.T.  feU  the  first  symp- 
toms fairly  early,  nearly  a  third  of  them 
before  the  first  fortnight  was  over. 

It  is  the  general  belief  of  the  men  who 
have  had  experience  in  T.N.T.  work  and  of 
some  plant  physicians  that  T.N.T.  dernia- 
•  litis  is  quite  (distinct  from  general  poisoning 
and  that  a  man  with  "the  itch"  never  need 
fear  an  attack  of  serious  T.N.T.  sickness. 
The  students  found  severkl  exceptions  to 
this  rule.  Nine  out  of  twenty-eight  pa- 
tients with  dermatitis  in  the  Wisconsin 
plant  had  fairly  serious  general  symptoms 
of  poisoning,  as  did  four  out  of  twelve  in  the 
Virginia  plant.  It  is  clear,  however,  that  an 
attack  of  dernuititis  may  occur  from  a 
purely  local  action  of  T.N.T.  or  its  impuri- 
ties, for  the  majority  of  the  men  with  der- 
matitis had  negative  Welister  reactions  or 
very  slight  reactions. 

Persistence  of  T.N.T.  in  the  Body 

It  was,  of  course,  a  matter  of  great  prac- 
tical importance  to  determine  how  quickly 
T.N.T.  could  be  eliminated  from  the  body, 
and  the  students  were,  therefore,  instructed 
to  make  repeated  Webster  tests  on  the 
m'ines  of  men  who  had  been  shifted  from 
T.N.T.  work  or  who  were  in  the  hospital 


imder  treatment.  They  found  that  the  re- 
action tended  to  disappear  from  the  urine 
within  a  fortnight  after  entire  removal 
from  T.N.T.  work,  but  that  there  were  in- 
stances of  delayed  elimination  quite  as 
striking  as  the  instances  of.  rapid  absorp- 
tion. One  of  Miss  Hall's  patients,  who  was 
seriously  poisoned  and  gave  a  Webster  5, 
was  removed  from  all  exposure  to  T.N.T. 
but  after  twelve  days  it  was  still  possible  to 
get  a  positive  reaction.  TeLinde  reported 
a  case  with  positive  Webster  reaction  five 
weeks  after  removal  from  work. 

EversoU  and  TeLinde  were  the  only  stu- 
dents who  were  able  to  send  full  records 
because  the  plants  under  their  observation 
were  the  only  ones  in  which  there  was  a 
regular  system  of  shifting  men  to  work  free 
from  T.N.T.,  and  keeping  them  under 
observation.  The  most  rapid  instances  of 
partial  and  comjjlete  disappearance  of  the 
Webster  reaction  came  from  TeLinde  who 
was  able  to  observe  men  in  the  plant  hos- 
jjital  where  a  vigorous  eliminative  treat- 
ment was  carried  through.  The  men  with 
T.N.T.  sickness  were  given  a  thorough 
scrub  bath,  a  purge,  an  enema,  and  a 
diuretic,  and  were  encouraged  to  drink 
large  (luantities  of  warm  milk.  lender  this 
treatment  the  poison  was  eliminated  fairly 
rapidly.  One  boy  of  18  years,  who  had 
never  been  sick  before,  was  first  examined 
after  he  had  been  exposed  to  fumes  and 
dust  for  thirty-five  days.  He  had  a  Web- 
ster 3  at  thill  time.  Six  days  later  he  came 
to  the  hospital  with  typical  symptoms  of 
acute  poisoning  and  a  Webster  5.  Under 
the  above  treatment  the  reaction  fell  in 
thirty-six  hours  from  5  to  1.  and  his  symp- 
toms had  improved  greatly,  though  they 
had  not  disappeared.  Another  man  with 
much  the  same  symptoms,  as  well  as  ab- 
dominal pain  and  diarrhea,  had  a  Webster 
■1  which  in  twt'uty-four  hours  fell  to  a 
trace. 

Both  TeLinde  and  EversoU  found  that  a 
transfer  to  work  free  from  T.N.T.  would  re- 


HAMILTON  —  TRINITROTOLITENE  AS  AN  INDUSTRIAL  POISON     ill 


suit  in  a  disappearance  of  the  Webster  re- 
action, but  much  more  slowly  than  under 
hospital  treatment.  One  of  Eversoll's  cases 
was  transferred  to  outdoor  work  on  July 
^1  because  of  slight  symptoms  of  poison- 
ing and  a  Webster  i,  but  he  did  not  give  a 
negative  Webster  till  August  31.  Usually 
the  work  to  which  the  man  was  shifted  in- 
volved some  slight  contact  with  T.N.T.,  in 
which  case  the  reaction  would  persist.  An 
interesting  case  reported  by  Eversoll  was 
in  a  boy  of  18  who.  because  of  decided 
.symptoms  of  poisoning  and  a  maxinuim 
Webster,  was  put  on  outdoor  work  every 
other  night.  On  the  mortiiiig  after  such 
work  the  reaction  would  be  ANcbster  1,  but 
on  the  morning  after  his  shift  of  pouring 
T.N.T.  it  would  be  Webster  3.  A  pelletcr 
who  had  a  Webster  4  was  transferred  to  the 
nitrating  tlepartnu'nt,  where  there  is  very 
little  contact  willi  T.X.T.  The  reaction 
fell  to  3  in  six  days'  time,  tlien  gradually  to 
1,  where  it  persisted.  A  striking  argument 
in  defense  of  the  contention  that  clean 
working  clothes,  clean  gloves,  and  good 
l)athing  facilities  must  l)e  provided  for 
these  men  was  found  in  the  persistence  of 
the  Webster  reaction  in  men  wlio  continued 
to  wear  their  ilirty  gloves  after  being  shifted 
to  T.X.T. -free  work.  TeLinde  had  several 
instances  of  men  with  jH'rsistent  Webster  1 
or  Webster  '•2  reactions,  e\cn  alter  trans- 
ference to  the  em])ty-s]iell  dei)artmcnt,  autl 
he  came  to  the  conclusion  that  they  were 
absorbing  small  quantities  of  T.N.T.  from 
their  soaked  gloves. 

C(>MPAR.\TIVE  I)aX(;?:R  of  CRtDE, 

Pure  and  Mi.xed  T.N.T. 

In  dealing  with  this  (piestion  also  we  were 
greatly  hampered  by  the  varying  conditions 
in  the  different  ])lants.  Miss  Hall  saw 
severer  cases  of  poisoning  in  men  loading 
pure  T.N.T.  than  TeLinde  saw  in  men 
loading  amatol,  but  in  the  one  case  the  ex- 
posure was  excessive,  in  the  other,  slight. 


The  negroes  in  TeLinde's  plant  certainly 
showed  greater  absorption  of  amatol  than 
of  pure  T.N.T.,  those  working  with  amatol 
giving  positive  Webster  reactions  up  to  3, 
while  those  working  with  pure  T.N.T.  gave 
negative  or  !2  as  the  highest  reaction.  We 
were  not  able  to  say  whether  more  poison- 
ing resulted  from  crude  T.N.T.  than  from 
pure  T.N.T.,  or  rice  irr.sa.  .According  to 
the  experiments  of  \'oegtlin  and  his  col- 
leagues (9),  there  is  no  difference  between 
crude  and  purified  T.N.T.  so  far  as  their 
effect  on  animals  was  observed.  The  only 
positive  fact  that  we  were  able  to  establish 
was  that  crude  T.N.T.  is  more  pnxluctive 
of  dermatitis  than  the  purified.  We  had 
looked  for  the  greatest  incidence  of  ec- 
zema and  other  skin  lesions  in  the  dirty, 
loading  plants  in  the  New  Jersey  meatlows, 
where  heat  and  humidity,  excessive  expo- 
sure, and  poor  washing  facilities  would 
seem  to  favor  it.  Instead,  it  was  found  that 
those  very  plants  had  the  snudlest  number 
of  cases  of  T.N.T.  itch,  and  the  largest 
number  occurred  in  the  two  cool  situations, 
the  nitrating  plant  in  northern  Wisconsin 
and  the  purifying  plant  in  the  Pennsyl- 
vania mountains.  Since  the  Wisconsin 
plant  was  not  only  the  coolest,  but  was  one 
of  the  cleanest,  had  excellent  lavatories  and 
employed  an  unusually  high  class  of  labor, 
it  is  ])lain  that  there  nuisl  have  been  some- 
thing in  the  material  handled  that  was  re- 
si)onsible  for  the  high  percentage  of  der- 
matitis. 

The  following  figures  show  the  propor- 
tion of  itch  among  the  men  and  women  in 
these  six  i^lants.  It  is  evident  from  them 
that  crude  T.N.T.  is  worse  than  the  pure, 
and  that  amatol  is  worse  than  the  unmixed. 

Percentage  t>f  Men  with 
T.N.T.  Dermatitis 

Plants  1  an.l  2.  loading  pure  T.N.T. .  3.4 

Plant  3,  loading  amatol 18.0 

Plant  4,  loading  amatol 20.0 

Plant  5,  pnrifying  crude  T.X.T 26.0 

Plant   C,   manufacturing   crude   and 

pure  T.X.T 31.0 


112 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Early  Symptoms  of  T.N.T.  Poisoning 

Most  of  the  students  reported  that  the 
first  symptom  noted  by  the  men  was 
breathlessness  on  exertion,  especially  on 
climbing  a  hill  or  going  upstairs.  A  man 
who  said  that  he  had  not  felt  the  effect  of 
his  work  in  any  way  would  almost  always 
admit  this  s,^anptom  if  he  was  asked.  Next 
in  order  came  dizziness  on  stooping  over, 
and  more  or  less  persistent  headache,  or  the 
man  comjilained  first  of  loss  of  appetite, 
bad  taste  in  the  mouth,  and  a  sensation  of 
nausea  in  the  morning.  Sometimes  the  men 
who  were  exposed  to  dust  complained  of 
running  of  the  eyes,  smarting  and  burning 
in  the  nose  and  throat,  and  nose-bleed. 
Together  with  these  symptoms,  an  early 
case  of  poisoning  is  characterized  by  cramps 
in  the  calves  of  the  legs,  fatigue  dispropor- 
tionate to  the  work  done,  and  a  feeUng  of 
tightness  in  the  chest.  Very  early  in  the 
course  of  poisoning  the  man  notices  a 
change  of  color  in  the  urine.  It  is  a  clear 
brown,  at  first  about  as  dark  as  weak  tea, 
then  increasing  till  it  may  be  as  dark  as 
coffee. 

By  the  time  the  man  feels  ill  enough  to 
go  to  the  doctor  for  treatment,  he  presents 
a  very  characteristic  appearance.  He  has 
an  expression  of  dullness  and  weariness, 
heavy  eyes,  drooj^ing  lids,  sclerotics  slightly 
yellow,  lips  and  mucous  membranes  of  the 
mouth  blue,  the  face  a  leaden  or  ashen 
color.  In  Plant  1,  patients  with  very  livid 
color  and  lips  almost  inky  were  described 
by  Miss  Hall. 

So  far  as  one  can  judge  from  the  notes  of 
the  students,  there  did  not  seem  to  be  two 
clearly  marked  varieties  of  T.N.T.  poison- 
ing, the  gastric  and  the  cyanotic,  such  as 
have  been  described  b^'  some  of  the  English 
writers.  In  Plants  3  and  5  a  mild  gastric 
form  without  cyanosis  was  noted,  but  these 
cases  cleared  up  rapidly.  No  serious  gastric 
case  was  free  from  cyanosis,  and  almost  all 
of  the  patients   with   cyanosis,   dizziness, 


faintness,  headache  and  pain  in  the  limbs, 
showed  gastric  symptoms  also. 

When  no  etfort  was  made  by  the  physi- 
cian in  charge  to  discover  cases  of  sickness 
among  the  men,  it  sometimes  happened 
that  by  the  time  a  workman  applied  for 
treatment  he  was  already  severely  poi- 
soned, for  ai)parently  serious  changes  may 
occur  without  causing  enough  suffering  to 
make  the  man  believe  that  he  is  really  sick. 
Miss  Hall  saw  a  man  in  the  dispensary  who 
had  not  come  to  complain  of  sickness,  but 
of  an  infected  cut.  She  described  him  as 
being  strikingly  pale,  with  a  grayish  yellow 
color,  his  lips,  ears  and  tongue  deeply 
cyanosed,  and  his  sclerotics  distinctly  yel- 
low. He  had  dyspnea  and  a  pulse  of  100. 
His  urine  was  browniish  black  and  gave  a 
Webster  5,  yet  on  cjuestioning  him,  she 
found  that  he  complained  of  nothing  except 
breathlessness  and  a  slight  headache.  He 
was  told  to  return  to  have  the  cut  dressed 
every  day,  but  he  did  not.  and  when  Miss 
Hall  finally  discovered  his  lodging  house  a 
week  later  she  was  told  that  he  had  been 
sick  in  bed  for  four  days  and  had  then  left 
for  the  city.  This  is  a  good  illustration  of 
the  wastefulness  caused  by  poor  medical 
supervision. 

The  effect  of  alcohol  on  T.N.T.  jjoisoning 
was  well  known  to  the  workmen  in  the 
plants  studied.  They  knew  perfectly  well 
that  while  working  with  T.N.T.  they  could 
not  drink  without  risking  serious  sickness. 
Many  stories  were  told  of  men  turning  blue 
in  the  face  and  falling  unconscious  on  the 
floor  of  a  saloon  after  one  or  two  drinks  of 
whiskey.  So  notorious  was  this  that  the 
men  who  wanted  to  keep  on  working  jjrac-^ 
tically  gave  uj)  drink,  or  if  they  decided  to 
go  on  a  spree  they  would  deliberately  lay 
ott'  wor\i.  for  two  or  three  days  before  and 
two  or  three  days  after.  They  described  the 
effect  as  a  sudden,  intense  flushing  of  the 
whole  body,  with  a  sensation  of  heat,  a 
rush  of  blood  to  the  head,  blackness  before 
the  eyes,  and  then  loss  of  consciousness. 


HAMILTON  —  TRINITROTOLUENE  AS  AN  INDUSTRIAL  POISON     113 


Bystanders  reported  that  during  the  period 
of  complete  collapse,  the  affected  man's 
face  was  livid  and  his  lips  an  inky 
blue. 

It  was  a  matter  of  great  surprise  to  us  not 
to  discover  a  single  case  of  typical  toxic 
jaundice  nor  of  aplastic  anemia  in  any  one 
of  these  five  plants  during  the  time  the 
students  were  working  there.  Miss  Hall 
was  told  that  a  young  girl  of  16,  who  had 
been  working  for  three  months,  left  on  ac- 
count of  sickness  and  was  at  that  time  so 
deeply  jaundiced  as  to  attract  attention. 
She  died  two  weeks  later,  but  it  was  impos- 
sible to  trace  this  case  or  to  secure  any  in- 
formation from  the  physician.  It  is  difHcult 
to  explain  the  absence  of  toxic  jaundice. 
During  1916,  I  had  found  records  of  thir- 
teen deaths  from  T.N.T.,  eleven  of  them 
typical  toxic  jaundice,  and  there  was  a 
much  larger  number  of  men  emjiloyed  in 
1918  than  in  1916.  The  only  (>x])hination 
that  can  be  given  is  that  in  three  of  these 
plants  medical  supervision  was  careful 
enough  to  make  it  impossible  for  a  case  of 
poisoning  to  progress  to  the  ])oint  of  .severe 
jaundice,  while  in  two  other  plants,  all  sick 
men  were  promptlj^  discharged,  and  no  one 
knew  what  happened  to  them  afterward. 
It  must  also  be  remembered  that  the  men 
were  usually  exposed  to  T.N.T.  for  a  very 
short  time  only.  Out  of  >'574  men.  onl^■ 
fifty-seven  had  worked  for  nu)r<'  than  three 
months,  and  British  statistics  show  that 
toxic  jaundice  usually  does  not  appear  be- 
fore three  months'  exposure.  In  one  of  the 
plants,  the  proportion  of  those  employed 
as  long  as  three  months  was  only  4  per 
cent.;  in  another,  7  per  cent.;  and  in  all  the 
labor  turnover  was  very  great,  decidedly 
greater  than  in  1916.  Reports  did  indeed 
come  to  me  of  toxic  jaundice  and  of  aplastic 
anemia  in  other  T.N.T.  plants.  I  had  rea- 
son to  believe  that  there  were  twelve  or 
thirteen  cases  during  the  last  year  of  the 
war,  but  none  were  in  the  factories  where 
the  students  were  stationed. 


Significance  of  the  Webster  Reaction 

The  Webster  reaction  seems  to  be  an 
admirable  test  for  the  absorption  of  T.N.T., 
a  very  rapid  and  delicate  one.  The  worse 
the  plant  is,  the  larger  is  the  proportion  of 
positive  Webster  tests.  In  Plant  1  every 
urine  examined  was  positive,  even  if  the 
man  had  been  at  work  only  one  day.  In 
Plant  4,  which  had  the  best  conditions, 
there  were  only  twenty-one  negative  reac- 
tions out  of  ninety-eight  specimens.  As  an 
index  of  absorption  it  is  certainly  valuable. 
Repeatedly,  the  intensity  of  the  reaction 
increased  as  the  days  went  on.  Herman 
an(,l  Putnam  applied  the  tests  in  aliout  half 
their  cases  before  and  after  work,  and  in 
about  90  per  cent,  of  these  cases  the  reac- 
tion was  more  intense  after  an  eight-hour 
shift  than  before  it.  The  work  in  this  plant 
was  continuous,  no  holidays  or  Sundays 
being  observed,  but  in  the  others,  where  the 
Sunday  rest  was  given,  it  was  repeatedly 
found  that  the  Webster  reaction  would  be 
low  on  Monday  and  ri.se  gradually  to  be 
high  on  Thursday,  Friday  antl  Saturday. 

Whether  the  Webster  test  is  of  any  other 
practical  value  is  hard  to  say.  It  could  not 
be  used  as  an  indication  that  an  acute  at- 
tack of  poisoning  was  impending,  nor  was  it 
possible  to  establish  a  correspondence  be- 
tween the  clinical  history  and  the  Webster 
reaction.  While,  as  a  general  rule,  the  in- 
tensity of  the  reaction  increased  with  the 
increasing  severity  of  an  attack,  there  were 
too  many  exceptions  to  this  rule  to  make  it 
of  any  practical  value.  Serious  cases  some- 
times occurred  with  only  a  slight  Webster 
reaction,  while,  on  the  other  hand,  a  Web- 
ster 4  or  even  a  Webster  5  was  found  in  men 
who  had  no  symptoms  of  sickness  at  all. 
One  man  with  a  negative  Webster  had 
gastric  pain,  nausea,  vomiting,  weakness  in 
the  knees,  cramps  in  the  calves  of  the  legs, 
dermatitis  on  hands,  arms  and  ankles,  and 
general  weakness.  According  to  Feldman 
(10),  the  Webster  reaction,  indicating  as  it 


114 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


does  elimination  of  T.N.T.,  should  not  in- 
crease with  the  onset  of  severe  symptoms, 
but  should  diminish  or  disappear,  and 
Feldman  had  an  opportunity  to  observe 
just  this  phenomenon.  The  students  were 
asked  to  bear  this  possibility  in  mind  and 
report  on  it,  but  IMiss  Hall  was  the  only  one 
who  saw  a  case  with  a  droji  from  Webster  3 
to  1  as  symi)toms  of  poisoning  developed. 
A  careful  analysis  of  137  cases  failed  to  bear 
out  Feldman's  theory,  for  in  general  the 
more  intense  Webster  reaction  is  associated 
with  the  more  serious  form  of  poisoning. 
As  a  rule  Websters  -i  and  5  were  found 
among  the  newly  employed,  those  who  had 
worked  less  than  a  month,  while  the  men 
who  had  handled  T.N.T.  for  six  months 
and  more  hardly  ever  had  a  reaction  of 
more  than  2  or  3,  showing  that  a  gradual 
elimination  of  the  more  susceptible  men 
takes  place,  those  that  absorb  the  poison 
readily  dropping  out  while  the  relatively 
immune  remain  at  work. 

Value  of  Blood  and  L^rine  Ex.\mina- 

TIONS    IN    THE    Dl\GNOSIS    OF    T.N.T. 

Poisoning 

The  examinations  made  of  the  blood 
have  been  described  in  detail  by  Dr.  George 
R.  Minot  (11),  who  found  a  blood  picture 
of  enough  definiteness  and  frequency  to 
serve  as  a  valuable  guide  in  the  diagnosis  of 
T.N.T.  poisoning  and  in  the  estimation  of 
the  degree  of  severity  of  poisoning.  As  al- 
ready shown,  the  Webster  reaction  cannot 
give  much  aid  in  this  respect,  but  it  seems 
probable  that  further  studies  on  the  urine 
will  bring  to  light  other  substances  besides 
the  reduction  product  of  T.N.T.  which  is 
responsible  for  the  Webster  reaction.  Cer- 
tainly it  seemed  to  the  students  that  the 
changes  of  color  in  the  untreated  urine  bore 
a  closer  relation  to  the  clinical  history  of 
the  case  than  did  the  varying  intensity  of 
the  Webster  reaction.  This  color  was 
usually  clear  light  brown  to  blackish  brown 


and  was  cjuite  independent  of  the  elimina- 
tion of  T.N.T.  as  shown  by  the  Webster 
reaction.  Nineteen  specimens  of  dark 
brown  urine,  for  instance,  were  either  nega- 
tive to  the  Webster  test  or  almost  negative, 
while  eight  which  gave  a  Webster  3  or  4 
were  normal  in  color.  In  one  of  TeLinde's 
patients,  a  man  who  was  shifted  from 
T.N.T.  work  on  account  of  sickness,  the 
Webster  reaction  fell  from  i  to  a  trace, 
while  the  dark  brown  color  remained  un- 
changed. Two  more  of  his  cases  dropped  to 
a  negative  Webster  with  persistent  dark 
color,  while  a  fourth  had  a  Webster  4  con- 
tinuously with  a  normal  color.  As  was  to  be 
expected,  the  darkest  specimens  came  from 
Plants  1  and  2.  Miss  Hall  reported  twenty- 
five  very  dark  urines,  some  of  them  the 
color  of  tincture  of  iodine.  She  was  never 
able  to  detect  bile  in  these  specimens  nor 
were  Putnam  and  Herman  able  to  do  so  in 
theirs. 

In  some  cases  the  urine  changed  from  a 
brown  to  a  clear  red  color,  while  in  others  it 
was  red  when  the  first  examination  was 
made.  These  red  urines  were  always  asso- 
ciated with  a  high  Webster  and  with  clinical 
symptoms  of  ])oisoning.  Among  seventy- 
four  specimens,  TeLinde  found  fifteen  nor- 
mal, eight  red,  and  fifty-one  browni.  Miss 
I2mery  foimd  ten  normal  among  forty- 
seven,  nine  red,  and  twenty-eight  brown. 
These  observations  should,  of  course,  have 
been  supplemented  by  chemical  and  mi- 
croscopic examinations  but  we  did  not  pur- 
sue them  further  because  the  Hygienic 
Laboratory  of  the  Public  Health  Service 
had  undertaken  an  intensive  study  of 
T.N.T.  urines  and  we  did  not  wish  to  dup- 
licate their  work. 

Summary 

The  studies  made  by  these  students 
served  to  emphasize  certain  practical 
points  in  the  prevention  of  T.N.T.  poison- 
ing which   in   all   probability   apply   with 


HAMILTON  —  TRINITROTOLUENE  AS  AN  INDUSTRIAL  POISON  "  115 


equal  force  to  those  nitro  and  amide  de-  probably  due  to  the  greater  exposure  of  thf 

rivatives  of  the  benzene  ring  that  are  used  skin  in  warm  weather. 

in  the  dye  and  drug  industry.  Young    men    are    more    susceptible    to 

T.N.T.  is  absorbed  chiefly  through  the  T.N.T.  than  fully  grown  men.    They  suc- 

.skin   anil,   therefore,  the  most  important  cunib  more  quickly  and  apparently  suffer 

part  of  the  prevention  of  T.N.T.  sickness  is  more  seriously.    It  seems  poor  economy  to 

the  protection  of  the  worker  against  direct  employ  them. 

contact   with  it.     The  methods  of  nuxnu-  Negroes  are  not   susceptible  to  T.N.T. 

facture,   whether  or  not  they  necessitate  dermatitis  and  may  be  less  susceptible  to 

hand    work,   the   cleanliness   of   the   work  systemic  poisoning  than  whiles,  but  evi- 

bcnches,   apparatus,  trucks,  etc.,  and   the  deuce  on  this  point  is  not  conipletc. 

prevention  of  dust  are  all  of  more  imjjor-  The  application  of  tlic  \>\l)slcr  test  to 

tance  even  than  the  provision  of  good  wash-  the  urines  of   approximately  400  T.N.T. 

ing  facilities.  l)ecausc  a  man  can  wash  only  workers    .showed    that    T.N.T.    is    rapidly 


at  the  noon  hour  and  on  ((uitting  work,  and 
in  the  time  between  these  periods  he  may 
have  his  hands  and  arms  continually 
.smeared  with  T.N.T. 

Next  in  importance  to  cleanliness  of  the 
premises  comes  the  provision  of  clean  work- 
ing clothes,  socks,  and  gloves.  The  stu- 
dents' examination  showed  that  T.N.T. 
could  probably  be  continually  absorbed 
from  dirty  gloves  and  dirty  overalls.  The 
necessity  for  providing  am]>le  washing 
facilities,  hot  and  cold  running  water,  soaj) 
and  towels,  and  the  time  to  use  tlieiii,  is 
em])hasized,  not  because  it  is  not  perfectly 
obvious  in  connection  with  such  a  poison  as 
T.N.T.,  but  becau.se  it  was  ignored  in  sev- 
eral of  the  T.N.'I\  plants  dnring  the  war 
and  is  ignored  in  some  of  the  coal-tar  dye 
works  at  the  ])resent  time. 

Fumes  from  melting  pots  are  apparently 
capable  of  causing  typical  T.N.T.  poison- 
ing, as  is  also  steam  from  washing  and 
pelleting,   but  the  more  serious  forms  of 


absorbed,  but  that  it  can  also  be  rai)idly 
eliminated.  Some  men  could  eliminate 
t)vernight  what  had  been  absorbed  during 
the  (lay;  others  could  get  rid  of  the  week's 
accmiuilation  during  Sunday  and  start  on 
^Monday  with  the  urine  free  from  the  re- 
duction product.  The  danger  of  overtime 
work  ami  of  the  se\en-day  week  was  shown 
b.\-  these  observations  and  also  the  value  of 
an  occasional  vacation  of  two  or  three  ilays. 

By  the  u.se  of  these  same  tests  it  was 
found  that  the  most  economical  way  to  deal 
willi  a  worker  who  had  absorbed  a  large 
aiuount  of  T.N.T.  was  to  sus])cn(l  him  al- 
together from  work  and  subject  him  to 
vigorous  eliminative  treatment.  Siiiii)ly  to 
transfer  him  to  less  dangerous  work  was  to 
postpone  his  recovery. 

No  positive  aid  in  the  diagnosis  of 
T.N.T.  poisoning  was  found  in  the  Webster 
reaction  in  the  urin(>,  but  the  color  changes 
in  the  untreated  urine  seemed  more  signifi- 
cant and  worthv  of  further  study.    The 


T.N.T.  sickness  are  probably  never  caused     blood  changes  found  by  Dr.  Minot  are  im- 


by  fumes  alone. 

Hot,  humid  weather  increases  general 
T.N.T.  poisoning,  but  not  T.N.T.  derma- 
titis. This  last  is  more  prevalent  in  sunnuer 
than  in  winter,  but  is  not  increased  by  very 
hot    weather.     Its   increase  in   summer   is 


])ortant  enough  to  lead  one  to  hope  that 
careful  blood  examinations  made  in  work- 
ers who  are  exposed  to  other  benzene  de- 
rivatives may  give  similar  results,  and  thus 
an  important  aid  be  gained  in  the  diagnosis 
of  similar  forms  of  industrial  poisoning. 


116 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


BIBLIOGRAPHY 


1.  Hamilton,  A.:  Industrial  Poisons  Used  or  Pro- 
duced in  the  Manutacture  of  Explosives.  U.  S. 
Bur.  Labor  Statis.,  Bull.  '219,  May,  1917. 

2.  Martland,  H.  S.:  Trinitrotoluene  Poisoning. 
Jour.  Am.  Med.  Assn.,  1917,  68,  835. 

3.  Legge,  T.  M.:  Trinitrotoluene  Poisoning.  Great 
Britain,  Ann.  Rep.  Chief  Inspect.  Factories  and 
Workshops  for  1917,  p.  23. 

4.  Moore,  B.:  The  Causation  and  Prevention  of 
Tri-Nitro-Toluene  (T.N.T.)  Poisoning.  Nat. 
Health  Insurance,  Med.  Research  Com.,  Special 
Rep.  Series,  No.  11,  London,  1918. 

5.  Koelsch,  F.:  Beitrage  zur  Toxikologie  der  aro- 
matischen  Nitroverbindungen.  Zentralbl.  f. 
Gewerbehyg.,  1917,  5,  60,  05,  98,  109,  and  142. 
Die  Giftwirkung  des  Tetranitromethans.    Ibid., 

185. 

6.  Personal  communication  from  Marcel  Frois  of 
the  Department  of  Labor,  Paris,  May,  1919. 


8. 


9 


Putnam,  T.  J.,  and  Herman,  W. :    A  Study  of 
Fifty   Workers  in   Trinitrotoluene.     Jour.   In- 
DUST.  Hyg.,  1919-1920,  1,  238. 
Perkins,  R.  G.:   A  Study  of  the  Munitions  In- 
toxications m  France.   U.  S.  Pub.  Health  Rep., 

1919,  34,  2335. 

Voegtlm,  C,  Hooper,  C.  W.,  and  Jolmson,  J.  M.: 
Trinitrotoluene  Poisoning.  IT.  S.  Pub.  Health 
Rep.,  1919,  34,  1307. 

10.  Feldman,  I.:  Special  Discussion  on  the  Origin, 
Symptoms,  Pathology,  Treatment,  and  Pro- 
phylaxis of  Toxic  Jaundice  Observed  in  Muni- 
tion Workers.  Proc.  Roy.  Soc.  Med.,  1916- 
1917,  10,  Part  1,  67. 

11.  Minot,  G.  R.:  Blood  Examinations  of  Trinitro- 
toluene Workers.    JouK.  Indust.  Hyg.,  1919- 

1920,  1,  301. 


1 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


Volume  III 


AUGUST,  1921 


Number  i 


DOES  THE   MAGNETIC   FIELD   CONSTITUTE   AN 
INDUSTRIAL  HAZARD?* 

C.  K.  DRINKER,  M.D.,  and  R.  M.  THOMSON 

From  the  Laboratory  of  Applied  Physiology  0/  the  Harcard  Medical  School 


MEN  achieve  undeniable  enjoyment 
and  comfort  from  attrihutinjj  mis- 
fortune and  disease  to  influences  which 
they  do  not  understand.  Thus,  there  is  a 
large  grou])  who  are  quite  satisfied  with 
astrological  explanations  for  an  epidemic 
of  influenza,  and  in  times  past  there  have 
been  even  larger  groups  whose  ideas  of  dis- 
ease rested  upon  a  jumble  of  electromag- 
netism  and  fictitious  forces  of  human  mag- 
netism, all  so  vaguely  considered  as  to  be 
entirely  mystifying  and,  therefore,  entirely 
satisfying.  One  might  write  at  length  of 
individuals  who  thus  are  happy  in  ex- 
planations which  are  not  hampered  by 
efforts  to  seek  the  truth. 

In  view  of  the  frequency  with  which 
mystifying  phenomena  have  been  described 
as  causal  agents,  it  is  not  surprising  that 
even  within  fairly  recent  years  many  ex- 
traordinary physiological  effects  have  been 
claimed  for  the  magnetic  field;  even  in 
serious  discussions  the  possibility  that  the 
field  may  effect  cures  of  nervous  disease  has 
not  been  overlooked.  Our  attention  was 
drawn  to  the  subject  in  the  course  of  in- 
vestigations upon  chronic  poisoning  by 
manganese  (1) .  The  affected  workmen  had, 

*  Received  for  publication  March  30,  1921. 


with  few  exceptions,  been  exposed  to  strong 
magnetic  fields  anil  the  (juestion  —  already 
suggested  by  Casamajor  (2)  —  arose  as  to 
whether  these  ex^posures  might  not  have 
something  to  do  with  causing  the  symp- 
toms observed.  The  poisoning  in  question 
occurred  in  men  working  in  an  atmosphere 
heavily  laden  with  ore  dust,  much  of  which 
was  strongly  attract eil  by  the  magnet,  and 
the  questions  arising  were  of  two  sorts : 

1.  Is  it  possible  that  particles  of  man- 
ganese-bearing mineral  deposited  in  the 
body  are  caused  to  penetrate  more  rapidly 
if  the  individual  carrying  them  passes  in 
and  out  of  strong  magnetic  fit^lds? 

i.  Does  the  magnetic  field  alone  in  very 
great  strengths  produce  any  measurable 
physiological  effects? 

The  first  of  the.se  ciuestions  we  have  never 
attempted  to  answer  since  a  progressive 
reduction  of  dust,  in  the  neighborhood  of 
the  large  magnetic  separators  used  in  the 
mill  involved,  rendered  it  of  no  direct  im- 
portance. The  second  question  offered  an 
opportunity  to  test  the  effect  of  stronger 
magnetic  fields  than  have  ever  been  used  in 
biological  work,  and  we  were,  accordingly, 
interested  in  undertaking  to  find  an  answer 
to  it.  The  results,  though  entirely  negative. 


117 


118 


THE  JOLTRNAL  OF  INDUSTRIAL  HYGIENE 


are  given  in  some  detail  in  order  to  estab- 
lish thoroughly  the  harnilessness  of  work 
in  the  neighborhood  of  extremely  powerful 
electromagnets.* 

Hermann  (3),  in  a  paper  published  in 
1888,  discusses  previous  scientific  work 
with  the  magnetic  field,  together  with  the 
vast  amoimt  of  charlatanry  which  has 
grown  up  around  "magnetism"  as  a  result 
of  the  use  of  magnets  by  hj^pnotists  and 
others,  and  gives  also  an  account  of  phys- 
iological experiments  carried  out  by  him- 
self. Readers  interested  in  the  earlier 
literature  on  the  effect  of  the  magnetic 
field  are  referred  to  this  paper.  Under  ap- 
propriate conditions  Hermann  found  that 
certain  fundamental  properties  of  muscle 
and  nerve  were  unaffected  by  exposure  to 
magnetic  fields.  Unfortunately,  however, 
he  gives  no  information  as  to  the  actual 
field  strengths  operative  in  his  experiments. 
This  same  criticism  applies  to  other  bio- 
logical work  with  the  magnetic  field,  the 
observations  of  Peterson  and  Kennelly  (4) 
being  excepted. 

In  lS9'-2,  Peterson  and  Kennelly  made 
experiments  with  magnets  in  the  Edison 
Laboratory  at  Orange,  New  Jersey,  in 
order  to  test  out  extravagant  claims  then 
current  as  to  the  therapeutic  effect  of  the 
magnetic  field.  A  quotation  from  the  paper 
of  these  investigators  will  illustrate  the 
degree  to  which  magnetism  commanded 
attention  at  that  time  (-i). 

The  status  of  magneto-therapy  in  America  may 
be  inferred  from  some  quotations  from  the  tliinl 
edition  of  Roberts  Bartholow's  Medical  Electricity, 
1887.  Under  the  caption  of  Physiological  Effects  of 
Magnet  Applications  he  says:  "We  know  that  a  cur- 
rent circulates  in  a  magnet.  If  a  jiowerful  horseshoe 
magnet  is  brought  near  to  the  skin,  opposite  elec- 
tricities are  attracted  to  the  poles  and  currents  are 
induced.  About  the  point  of  application,  therefore, 
the  skin  will  be  acted  on  directly  by  the  magnetic 
current  and  by  an  induced  current.    The  proiluction 

*  These  experiments  were  made  possible  by  the  New- 
Jersey  Zinc  Company  through  the  loan  of  one  of  their  large 
electromagnets  of  the  tj-pe  employed  in  the  process  at 
Franklin  Furnace,  New  Jersey. 


of  physiological  effects,  which  can  be  recognized,  is 
therefore  merely  a  question  of  the  magnetic 
strength." 

He  then  quotes  Dr.  Vansant  as  assuming  the  body 
to  be  diamagnetic:  "By  applying  north  and  south 
polarity  to  different  parts,  very  extensive  subjec- 
tive impressions  are  experienced;  they  are  of  two 
classes  —  of  heightened  organic  activity,  and  the 
opposite  condition." 

He  then  adds:  "That  impressions  of  a  very  de- 
cided kind  are  produced  by  the  application  of  strong 
magnets  is  evident  in  the  experience  of  Dr.  Proust 
and  Dr.  Ballet,  who  continued  a  course  of  investiga- 
tion begun  by  Charcot  at  Salpetriere."  They  ascer- 
tained that  magnets  could  not  be  applied  with 
impunity,  for,  if  applications  were  prolonged,  pains 
were  felt  in  the  epigastrium  and  thorax,  making 
respiration  painful,  digestion  was  disordered,  and 
boulimia  brought  on.  These  results  were  so  uniform 
that  there  seemed  to  be  no  doubt  of  their  genuineness 
in  the  minds  of  the  investigators. 

In  their  first  experiments,  Peterson  and 
Kennelly  employed  a  magnet  with  a  field 
intensity  of  5,000  c.g.s.  lines  per  square 
centimeter.  They  tested  this  field  upon 
dried  hemoglobin,  fresh  blood,  ciliated 
epithelium,  and  the  capillary  circulation, 
without  observing  the  slightest  effect. 
They  then  placed  a  dog  for  five  hours  in  a 
field  with  a  strength  of  1,000  to  ^2,000  c.g.s. 
lines  per  square  centimeter  without  observ- 
ing any  change  in  the  animal;  and,  finally, 
they  tested  the  effect  of  field  strengths  of 
2,500  c.g.s.  lines  per  scjuare  centimeter 
upon  themselves.  In  these  latter  efforts  a 
variety  of  types  of  exposure  were  used 
but  all  resulted  negatively,  justifying  their 
conclusion  that  the  human  body  is  apjiar- 
ently  quite  uninfluenced  by  magnetic  fields 
of  moderate  strength. 

Pfeffer  (5),  in  1903,  discussing  the  pos- 
sible actions  of  the  magnetic  field  upon 
growth,  can  find  no  convincing  evidence 
that  any  effect  has  been  obtained.  Ewart 
(5),  in  an  editorial  note,  suggests  that  this 
is  possibly  due  to  Weakness  of  the  fields 
employed  and  that  theoretically  one  should 
be  able  to  affect  living  jirotoplasm  pro- 
vided strong  enough  fields  are  used. 


DRINKER  AND  THOMSON— ISLVGXETIC  FIELD  AS  HEALTH  HAZARD      Hi) 


In  all  the  experiments  mentioned  so  far, 
with  the  exception  of  several  by  Peterson 
and  Kennelly,  a  continuous  current  was 
used  and  the  field  strength  was  steady  and 
unvarying.  This  condition  is  also  true  of 
the  industrial  situation  which  we  have 
cited.  In  the  case  of  solenoids  traversed  by 
alternating  currents  an  interesting  type  of 
actual  physiological  effect  was  noted  first 
by  d'Arsonval  (6)  in  1^93,  and  has  been 
commented  upon  by  several  later  experi- 
menters (7)  (8)  (9)  (10).  Many  of  these  ob- 
servations, as  for  example  those  of  Sylvanus 
P.  Thompson  (11),  are  considered  by  their 
authors  to  be  the  first  note  of  the  phe- 
nomenon ever  made.  That  a  definite  and 
easily  obtainable  physiological  effect  does, 
therefore,  arise  in  the  ncigliborhood  of  a 
sufficiently  powerful  alternating  field  can- 
not be  doubted.  If  the  head  is  inserted  in  a 
coil  or  if  it  is  brought  close  to  a  coil  through 
which  a  strong  alternating  current  is  ])ass- 
ing,  a  flicker  of  light  is  noticed,  and  this  is 
perceived  with  the  eyes  open  or  closed,  and 
in  a  dark  or  a  light  room.  There  is  a])])ar- 
ently  no  doubt  that  a  definite  visual  sensa- 
tion is  induced  and  that  it  can  be  made  to 
vary  with  current  strength  and  the  relation 
of  the  head  to  the  magnet.  Dinda])  (\'2,  p. 
70)  describes  the  sensation  as  follows: 

Witli  -480  amperes  of  '2,5-cyclc  current  (20  volts)  a 
much  more  striking  result  was  obtained.  With  my 
head  below  tlie  level  of  the  coil,  and  with  my  eyes 
open,  the  flicker  was  strongly  noticeable,  although 
the  room  was  brightly  lighted  liy  afternoon  daylight. 
The  whole  visual  field  (juivcrcd  as  if  illuminated  by 
a  rapidly  intermittent  light.  Several  other  subjects 
made  a  similar  observation,  although  in  some  eases 
the  flicker  was  noticed  only  in  the  less  illiuninated 
parts  of  the  visual  field,  as  where  shadows  fell  in  the 
room.  With  the  head  inside  the  coil  the  flicker  was  so 
pronounced  as  to  be  intensely  disagreeable. 

There  is  no  explanation  of  this  eye  effect 
but  at  the  same  time  there  is  no  evidence 
that  it  causes  damage.  We  may  sum  up, 
therefore,  by  saying  that  the  scientific 
literature  upon  the  physiological  effects  of 
the  magnetic  field  is  negative  in  so  far  as 


the  use  of  constant  fields  is  concerned,  and 
in  the  case  of  alternating  fields  does  not 
contain  evidence  of  an  effect  which  is  harm- 
ful even  when  the  experimenters  employ 
much  more  severe  exposures  than  would 
ever  be  experienced  in  any  industrial 
operation. 

ExPERIMENT.\L   ObSERV.\TIONS 

a.  Mdijnetir  Fields.  —  The  magnet  used 
was  a  very  large  one.  The  general  config- 
uration of  the  pole  pieces  and  arrangements 
for  exposure  of  experimental  material  are 
indicated  in  Figure  la.  The  pole  pieces  A 
and  B  are  jjermanent,  but  C  and  D  are  ad- 
justable and  when  in  place  enal)le  one  to 
seciu'c  maxiiiuMu  field  strength  between 
their  tips.  In  Figure  lb  a  muscle  M  lies  to 
the  left  of  the  poles  C  and  D,  and  the  nerve 
N  to  the  muscle  passes  between  the  pole 
ti])s  through  a  gaj)  1  mm.  in  width. 

Field  strengths  were  measured  by  means 
of  a  bismuth  spiral.  Table  1  indicates  the 
field  strengths  at  points  1  to  10  in  Figure  la 
with  pole  pieces  C  and  D  in  |)osition  and 
with  different  amperages.  The  breadth  of 
the  most  intense  field  with  its  center  at 
point  1,  immediately  between  the  tips  of 
the  pole  pieces,  is  indicated  in  Tal)le  'i. 

Two  general  types  of  experimental  ex- 
posiu'e  were  emjiloyed.  In  the  first  of  these, 
blood  and  isolated  nerve-muscle  jjrepara- 
tions  were  exposed  to  the  greatest  field 
strengths  obtainable,  such  fields  obviously 
requiring  use  of  tlie  magnet  under  large 
amperages  with  the  pole  pieces  C  and  D  in 
position.  By  reference  to  the  positions 
covered  in  Tables  1  and  2,  one  can  readily 
arrive  at  a  close  approximation  of  the  con- 
ditions to  which  the  tissues  were  subjected. 
For  example,  if  a  nerve-muscle  preparation 
is  placed  in  a  moist  chamber  K  of  Figiu'e  lb 
with  the  nerve  crossing  the  small  gap  be- 
tween C  and  D,  it  is  clear  that  the  nerve 
impulse  set  up  at  the  tips  of  electrodes  E 
and  F  and  passing  along  the  nerve  to  the 


120 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


muscle  must,  if  the  magnet  is  activated  by 
a  current  of  20  amperes,  pass  a  field  inten- 
sity of  18,725  c.g.s.  lines  per  square  centi- 
meter (Table  1),  and  that  the  field  strengths 
to  which  all  parts  of  the  preparation  are 
exposed  may  be  told  provided  the  lengths 
of  the  muscle  and  the  nerve  are  known. 

The   second   type   of   experimental   ex- 
posure required  the  use  of  entire  animals 


b.  Nerve-Muscle  Experiments.  —  Since 
the  nerve,  when  it  conducts  an  impulse, 
exliibits  an  electrical  change,  and  since  a 
similar  change  occurs  in  muscle  just  prior  to 
actual  contraction,  we  examined  carefully  to 
see  whether  nerve  conduction  or  muscular 
contraction  suffered  as  a  result  of  exposure 
to  the  strong  magnetic  fields  we  could 
supply.    Various  types  of  experiment  were 


/ 


«  {  B  (       O 


— ^ 


Fig.  la.  —  .\rrangement  of  pole  pieces  .\  and  B,  and  C  and  D,  with  moist  chamber  K  in  place.  The 
positions  at  which  magnetic  field  strengths  were  determined  are  indicated  by  numbers  down  the  center 
of  the  field. 

b. — Arrangement  of  nerve-muscle  preparation  in  moist  chamber  K.    M  indicates  muscle;  N, 
nerve;  E  and  F,  stimulating  electrodes. 


and  is  described  in  detail  in  a  later  section 
of  this  paper.  To  provide  room  for  these 
exposures  C  and  D  were  removed,  leaving 
a  large  gap,  12  inches  by  18  inches.  Lender 
these  conditions  the  field  strengths  ob- 
tainable varied  in  different  parts  of  the 
gap.  Table  3  gives  the  field  intensities  at 
15  amperes  through  the  center  of  this  field 
and  indicates  in  an  apj)roximate  manner 
the  conditions  to  which  animals  were  sub- 
jected over  a  considerable  time. 


employed,  the  ordinary  nerve-muscle  prep- 
aration of  the  frog  and  the  nerve  of  the  cat 
being  the  test  objects  used.  Several  ex- 
amples will  suffice  to  indicate  the  innoc- 
uous character  of  the  field. 

Jan.  27,  1919.  —  Two  nerve-muscle 
preparations  (sciatic-gastrocnemius)  were 
made  from  the  same  frog.  One  of  these  was 
placed  in  a  moist  chamber  (Figure  lb) 
fitted  about  the  pole  pieces  C  and  D,  which 
had  been  lightly  coated  with  paraffin,  with 


DRINKER  AND  THOMSON— ]\L\GXETIC  FIELD  AS  HEALTH  HAZARD      121 


the  nerve  on  electrodes  E  and  F  and  the 
muscle  clamped  in  the  position  shown. 
From  the  tendon  of  the  muscle  a  light  silk 
thread  passed  out  of  the  moist  chamber  to 
a  muscle  lever  lightly  weighted  and  ad- 
justed to  write  on  a  large  kymograph.   The 


electrodes  to  the  two  nerves  connected  in 
series  in  the  secondary  circuit  of  an  in- 
duction coil.  The  steadiness  of  the  cur- 
rent used  in  stimulation  was  controlled  by 
the  employment  of  a  milliammeter  in  the 
primary  circuit  of  this  coil.    The  thresh- 


TABLE  1.— MAGNETIC  FIELD  STRENGTHS  IN  C.  G.  S.  LINES  PER  SQU.ARE  CENTIMETER 
AT  VARYING  AMPERAGES  IN  POSITIONS  1  TO  10,  FIGURE  la,  POLE  PIECES 

C  AND  D  IN  POSITION 


Amperage 

Field  Strengths  ia  C.  G.  S.  Lines  in  Positions 

1 

i 

S 

4 

5                     6 

7 

8 

9 

10 

10 

17,450 
18,375 
18,725 
18,975 

8,150 
9.200 

4,825 
5,425 

3,500 
3,900 

2,775     1     2,400 
3,175        2,650 

2,100 
2,375 

1,975 
2,325 

1,825 
1,900 

1,750 

15 

20.                          

1,800 

22 

TABLE  2.  —  MAGNETIC  FIELD  STRENGTHS  IN  C.  G.  S.  LINES  PER  SQUARE   CENTIMETER 

IMMEDI.\TELY  IN  VICINITY  OF  POLE  TIPS  C  AND  D  .\T  TWO  AMPERAGES,  SHOWING 

DETAILS  OF  FIELD  STRENGTH  DECREASE  BETWEEN  POSITIONS  1   .VND  2 


.\mperage 

Field  Strengths  in  C.  G 

.  S.  Lines  in  Positions  * 

1 

la 

lb 

Ic 

Id 

i 

10 

20 

17,450 
18,725 

16,375 
17,950 

12.750 
14,200 

10,100 
12,075 

8.400 
9,625 

8,150 
9,200 

'     Distance  between  1    anri  la  =  0.25  inches 
la  and  lb  =  0.25     " 
lb  and  Ic  =  0.25     " 


Distance  between  Ic  and  Id  =  0.25  inches 
Id  and  2    =  0.125     " 
«  "  1     and  2    =  1.125     " 


TABLE  3.  —  FIELD  STRENGTHS  IN  C.  G.  S.  LINES  PER  SQUARE  CENTIMETER   WITH  POLE 

PIECES  C  AND  D  REMOVED 


Amperage 

Field  Strengths  in  C.  G.  S.  Lines  in  Positions 

1 

i 

3 

i 

5 

6 

7 

8 

9 

10 

IS 

2,800 

2,800 

2,825 

2,825 

2,825 

2,825 

2,800 

2,725 

2,600 

2,400 

control  muscle  was  placed  in  a  second 
chamber  lacking  the  orifices  for  the  pole 
pieces  C  and  D  but  in  other  respects  en- 
tirely similar,  and  through  a  similar  muscle 
lever  was  caused  to  write  upon  the  kymo- 
graph just  above  the  lever  recording  the 
magnetic  field  muscle.  Tight-fitting  lids 
were  placed   on   both   chambers   and   the 


old  stimulus  for  both  preparations  was 
then  obtainable  by  breaking  the  primary 
circuit  while  bringing  the  secondary  coil 
toward  the  primary.  With  tiie  first  con- 
traction of  the  muscles  the  position  of  the 
secondary  coil  was  read,  and  this  repre- 
sented the  minimal  or  threshold  stimulus. 
Further  approximation  of  the  secondary 


\oo 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


To    K>(ino^-,if>K 


To  KymopYiipk 


"E  /Cy^egrapK 


I 


1 


PiQ  2a  — Experiment  of  Jan.  ^7,  l!)iy.  sliowing  position  of  nerve  N,  muscle  M,  and  pole  pieces 
C  and  D.  Eleetrodes  3§  mm.  apart,  at  a  position  between  3  and  i;  gastrocnemius  tendon  at  4;  and 
body  of  muscle  between  4  and  1. 

b.  —  Position  of  nerve  after  experiment  had  been  in  progress  four  hours. 

c.  —  Position  of  stinmlating  electrodes  for  the  last  eight  hours  of  the  experiment. 


DRINKER  AND  THOMSON-]VL\GNETIC  FIELD  AS  HEALTH  HAZARD      123 


coil  increased  the  strength  of  stimulus  and 
by  this  means  the  maximum  response  was 
rapidlj^  obtained. 

Figure  2a  gives  the  positions  of  the  nerve, 
the  muscle,  the  stimulating  electrodes,  and 
the  pole  pieces  of  the  magnet  in  terms  of 
the  positions  in  Table  1.  Figure  2b  shows 
a  slight  variation  caused  by  movement  of 
the  nerve  during  the  experiment,  and  Fig- 
ure 2c,  the  final  position  of  the  stimulating 
electrodes.     In  all  cases  the  positions  of 


c.g.s.  lines  per  square  centimeter.  The 
total  period  of  exposure  was  from  llAQ 
A.M.  to  5.29  P.M.  on  the  next  day,  or  twenty- 
nine  hours  and  forty-three  minutes.  Dur- 
ing this  period  the  threshold  for  conduction 
of  the  nervous  impulse  was  tested  116 
times  and,  although  the  nerve  exposed  to 
the  magnetic  field  ceased  to  conduct  before 
the  control,  the  difference  is  of  no  conse- 
cjuence  in  the  face  of  such  a  long  period  of 
survival.   It  will  be  noticed  bv  reference  to 


Vu,.  4.  —  Fatifiiic  curves  wriltt'ii  In-  companion  norvc-musrle  preparations  undrr  idcntiral  conditions 
of  stimulation.    C  indicates  control  muscle;  M,  muscle  exposed  to  magnetic  field. 


the  electrodes  on  the  nerve  were  duplicated 
in  the  control  preparation. 

Figure  3  (p.  127)  shows  a  series  of  contrac- 
tions taken  simultaneously  under  identical 
strengths  and  conditions  of  stimulation 
during  the  experiment  of  Jan.  27,  1919. 
The  results  of  this  experiment  are  sum- 
marized in  7'able  4. 

Reference  to  Table  1  and  to  Figures  2a, 
2b,  and  2c  will  show  that  the  nerve  at  the 
original  jjoint  of  stimulation  experienced  a 
magnetic  field  intensity  varying  between 
5,4!25  and  3,500  c.g.s.  lines  per  square  centi- 
meter, that  the  nerve  impulse  to  reach  the 
muscle  had  to  cross  a  field  of  18,725  to 
17,-150  c.g.s.  lines  per  square  centimeter, 
and  that  the  contracting  muscle  lay  in  a 
field   varying   between   18,725   and   3,500 


49  and  50,  Figure  3,  that  at  the  end  of 
the  first  twenty-one  hours  and  before  the 
stimulating  electrodes  were  moved  the 
preparation  which  had  been  in  the  mag- 
netic field  was  in  better  condition  than  the 
control.  When  the  electrodes  were  moved 
a  difference  in  behavior  resulted,  but 
throughout  the  experiment  the  entire 
course  of  events  was  not  different  from  that 
obtained  when  two  nerve-muscle  prepara- 
tions are  set  up  under  identical  conditions. 
In  order  to  be  entirely  sure  that  this  inter- 
pretation was  correct  the  experiment  was 
repeated  eighteen  times,  but  no  trace  of 
magnetic  fiekl  effect  was  ever  obtained. 

A  second  type  of  experiment  is  illus- 
trated in  Figure  4.  In  this  case  two  nerve- 
muscle  preparations  were  set  up  as  in  the 


124  THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

T.\BLE  4.  — THRESHOLD  STIMULI  OF  M.\GXETIC  FIELD  .\ND  CONTROL  MUSCLES  DURING 

THIRTY  HOURS 


Temperature 

Current  in 
Primary  Cir- 
cuit Inducto- 
rium 

Magnet 
Circuit 

Observation 

No. 

Threshold  Stimulus 

in  Scale  Divisions 

Time 

Magnetic  Field 
Muscle 

Control  Muscle 

January  27 

A.M. 

11.30-11.32 

17.2 
17.0 

12.2 

Amperes 

0.075 
0.075 

0.075 
0.072 

0.072 
0.072 

0.069 

0.072 
0.072 

0.072 
0.072 

0.072 
0.072 

A  mperes 
20.4 

18.6 

18.6 
18.6 
18.2 

10.0 

15.0 

19.2 
18.9 

18.4 

18.2 

18.0 

1 
2 

4 
5 

30 
31 

49 
50 

51 

95 
96 

109 
110 

120 
121 

21.0 
21.5 

21.0 
21.0 

20.0 
20.5 

19.0 
19.5 

6.5 

9.5 
9.5 

7.5 
7.0 

3.0 
3.0 

29.0 

11  44-11  46          

28.0 

11.46' 

11  51-11  53        

29.0 

11  58-12  00      

28.0 

P.M. 

1.48     

2.56-2.58 

26.5 

3.11-3.13 

26.6 

3.27 

4.10 

4.59 

5.18-5.20 

23.0 

5.25-5.27 

24.0 

5.27' 

January  3S 

A.M. 

8.47 

8.47-8.49  3 

No  contraction 

10.07 

obtainable. 

10.47 

P.M. 
1.28 

2.07-2.09 

10.0 

2.14-2.16 

10.0 

2.30 

3  52-3  55     

9.5 

4  00-4  02  

9.5 

4.52 

5.20-5.22 

8.0 

5.27-5.29 

7.5 

'  Magnet  turned  on.  '  Magnet  circuit  reduced  to  10  amperes  and  left  for  night. 

^  Alagnetic  field  muscle  continued  to  show  threshold  at  6  until  9.40  when  it  became  impossible  to  obtain  contraction 
even  with  maximum  stimuli.     Electrodes  on  both  nerves  were  accordingly  moved  into  the  positions  indicated  in  2c. 

g  in  spite  of  moist  chamber  conditions. 


Both  nerves  were  slowly  drying  : 

previous  experiment  and  were  compelled 
to  contract  repeatedly,  lifting  each  time  a 
70-gram  weight  and  registering  their  work 
through  two  similar  work-adders.  In  this 
particular  instance  the  belly  of  the  muscle 
subjected  to  the  magnetic  field  was  placed 
immediately  above  the  pole  tips  C  and  D 
and  the  magnet  was  held  at  20  amperes. 


The  muscle,  therefore,  was  subjected  to  a 
field  intensity  of  approximately  17,950 
c.g.s.  lines  per  square  centimeter  (Table  2). 
In  this  experiment  the  tracings  written  by 
the  control  C  and  the  magnetic  field  muscle 
M  are  practically  identical,  the  work  done 
by  the  control  being  2,856  gm.  cm.,  and  by 
the  magnetic  field  preparation  2,639  gm. 


DRINKER  AND  THOMSON— MAGNETIC  FIELD  AS  HEALTH  HAZARD      1^25 


cm.  Such  results  fall  within  the  limits  of 
error  in  comparisons  of  two  normal  muscles 
and  indicate  no  harmful 
effect  from  the  magnet. 
The  same  experiment 
repeated  ten  times  never 
gave  evidence  of  any  ac- 
tion whatsoever  on  the 
part  of  the  magnetic  field. 
Figure  5  displays  fa- 
tigue curves  made  by 
two  companion  isolated 
muscle  preparations  stim- 
ulated directly,  the 
electrodes  in  each  case 
beingplacod  in  tliecaj).sulc 
of  the  knee-joint  and  in 
the  gastrocnemius  tendon. 
During  the  period  of  work 
muscle  M  was  subjected 
to  a  magnetic  field  of  ap- 
proximately 17,950  c.g.s. 
lines  per  square  centi- 
meter, the  belly  of  the  muscle  lying  just 
above  the  tips  of  the  poles  C  and  D.  In 
this  case  the  control  muscle  C  did  3,444 
gm.  cm.  of  work  against  ;?,()(i8  gm.  cm.  for 
the  muscle  exposed  to  the  magnetic  field. 


Omitting  details  of  other  experiments,  we 
may  sum  up  our  results  by  saying  that  in 


fl^^^^^^^^^^^^^^^^^^^^^lBllliBlkk. 


KlG.  J.  —  I'atimK' 
idonlkal  conditions 
cxposi'd  to  magnetic 


curves  written  by  coin|)aiiion  gastrucncniii  nuiscles  iiiidiT 
of  stimulation.  C  indicates  control  muscle;  M,  muscle 
field. 


isolated  nerve-muscle  preparations  we  haA-e 
never  been  able  to  observe  any  change  in 
irritability  or  conductivity  of  nerve  nor  in 
the  contractile  i)ower  of  muscle  as  a  result 
of  exposure  to  the  magnetic  field. 


?■  ~  I^'sg'^'D  of  apparatus  for  recording  the  action  current  of  mammalian  nerve. 
E  and  F  indicate  stimulating  electrodes;  C  and  D,  pole  pieces  of  magnet;  L  and  R,  non- 
polarizable  electrodes  leading  to  the  string  galvanometer  G. 


126 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


As  a  final  experiment  to  test  the  effect  of 
the  field  upon  the  nerve  impulse  we  placed 
a  long  section  of  cat  nerve  (popliteal)  in  a 
moist  chamber  under  the  conditions  given 
in  the  diagram,  Figure  6,  in  which  E  and 
F  are  the  stimulating  electrodes  and  L  and 
R  leading  off  electrodes  to  a  string  gal- 
vanometer.*   Figure  7a  is  a  photographic 


'  'I'l   ii>»>iiwwyw)n 


a 


yyiyiiiMiiiitiiiiiiiiiiii 


Fig.  7a.  —  .\ction  current  of  popliteal  nerves  prior  to 
e.xposure  to  magnetic  field. 

b.  —  Action  current  of  same  nerve  after  two  and 
one-half  hours  of  exposure  to  a  field  of  18,725  c.g.s.  lines 
per  square  centimeter. 

record  of  the  action  current  of  this  nerve 
prior  to  magnetic  field  exposure,  and  Figure 
7b  a  record  of  its  action  current  after  two 
and  one-half  hours'  exposure  to  a  field  of 


18,725  c.g.s.  lines  per  square  centimeter. 
As  this  record  shows,  the  magnetic  field 
produced  no  change  in  the  action  current 
which  signals  the  passing  of  the  nerve 
impulse. 

In  addition  to  these  experiments  with 
isolated  nerve  and  muscle,  a  certain  num- 
ber of  experiments  were  done  with  red 
blood  corpuscles  and  blood.  It  was  shown 
that  prolonged  exposure  (two  and  one-half 
hours)  to  magnetic  fields  of  18,725  to 
14,200  c.g.s.  lines  per  square  centimeter 
had  no  effect  upon  the  shape  of  red  blood 
cori>uscles  nor  upon  their  oxygen  combin- 
ing power.  In  the  same  strengths  and 
conditions  of  exposure  complement  and 
hemolytic  amboceptors  were  likewise  unaf- 
fected.f 

c.  Experiments  upon  Animals.  —  The 
exposure  of  living  animals  to  magnetic 
fields  for  short  periods  of  time  and  under 
a  considerable  degree  of  restraint  is  easily 
arranged,  but,  feeling  that  such  a  procedure 
gave  little  promise  of  interpretable  results, 
we  endeavored  to  find  small  animals  of 
active  iype  —  certain  to  make  natiu'al 
movements  in  the  field  — and  to  expose 
them  under  circumstances  permitting  con- 
stant observation  of  their  condition. 
Dancing  mice  were  finally  selected  as  the 
mammal  most  suitable  for  the  experiment . 


.^/\r^ 


Fig.  8.  — Diagram  of  api)aratus  for  exposing  dancing  mice  to  magnetic  field.    A  indicates  aluminum  box; 
M,  manometer;  K,  kymograph;  T,  tambour. 

*  The  observations  involving  the  string  galvanometer  t  For  these  last  observations  we  wish  to  express  our 

were  made  for  us  bv  Dr.  .\lexander  Forbes.  thanks  to  Dr.  \.  Watson  Sellards. 


DRINKER  AND  THOMSON-MAGNETIC  FIELD  AS  HEALTH  HAZARD      127 


128 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


These  animals  are  small,  active,  and  easily 
cared  for  during  a  protracted  experiment. 
Accordingly,  we  exposed  dancing  mice  in 
pairs  to  magnetic  fields,  the  strengths  of 
which  are  given  in  Table  3. 

Figure  8  indicates  the  manner  in  which 
these  animals  were  studied.  An  aluminum 
box  A,  6  by  12  inches,  served  as  a  cage  for  a 
pail-  of  mice.  This  box  was  suspended  by  a 
light  brass  spring  adjusted  to  a  tambour  T 
so  that  every  movement  of  A  acted  upon 
the  rubber  diaphragm  in  T  and  by  air 
transmission  activated  the  oil  manometer 
M  which  wrote  ujjon  a  slowly  moving 
kjanograjih  K.  The  box  A  was  lightly  an- 
chored at  the  corners  by  brass  springs  and 
fitted  into  the  large  gap  in  the  magnet, 
secured  by  removing  pole  pieces  C  and  D. 
A  control  pair  of  mice  occujiied  a  second 
box,  their  movements  being  recorded  upon 
the  same  kymograph  through  exactl.y 
similar  devices.  ]Mice  lived  in  the  box  A 
for  periods  of  three  months,  being  exposed 
to  fields  of  approximately  2,800  c.g.s.  lines 
per  square  centimeter  for  an  average  of 
fifteen  hours  daily  during  this  period.  The 
magnet  was  turned  on  when  we  left  work  in 
the  evening  and  turned  off  next  morning  in 
order  to  avoid  the  annoyance  of  having  it 
active  during  working  hours  in  the  labora- 
tory. The  life  of  the  mice  during  periods  of 
this  sort  was  apparently  entirely  normal. 
Females  became  pregnant,  and  when  killed 
near  term  were  found  to  contain  normal 
young.  No  signs  of  disease  were  observed. 
The  mice  continued  sound  during  the  ex- 
periment and  their  organs,  when  examined 
microscopically  at  the  close  of  the  experi- 
ments, were  found  to  be  normal. 

In  Figure  9a  we  have  a  record  covering  a 
twenty-four-hour  day  for  the  control  pair  of 


mice  and  for  the  pair  exposed  to  the  mag- 
netic field.  The  two  lower  lines  of  tracing 
represent  the  movements  of  the  pairs  of 
animals  in  their  cages  during  the  day 
period,  and  the  two  upper  longer  lines,  the 
activity  during  the  night.  Figure  9b  shows 
a  similar  set  of  tracings  upon  the  same  pairs 
of  mice  after  three  months'  exposure  of  one 
pair  to  the  magnetic  field.  The  top  and 
third  from  the  top  tracings  are  those  for  the 
magnetic  field  mice  and  show  a  normal 
degree  of  activity. 

As  a  final  type  of  experiment  we  fre- 
c}uently  placed  our  own  heads  in  magnetic 
fields  of  as  great  strengths  as  were  obtain- 
able, but  were  never  able  to  appreciate  any 
effect  whatsoever  —  a  result  which  corrob- 
orates the  findings  of  Peterson  and  Ken- 
nelly  (4).  ^Vith  the  magnet  which  we  used 
the  effects  of  alternating  currents  could  not 
be  tested,  and  we  are,  therefore,  not  in  a 
position  to  speak  upon  this  phase  of  the 
subject. 

Conclusions 

1.  The  effect  of  constant  magnetic  fields 
varying  between  18,725  and  2,800  c.g.s. 
lines  per  square  centimeter  has  been  studied 
in  experiments  upon  various  types  of  nerv- 
ous and  muscular  tissue,  upon  blood,  and 
upon  intact  animals. 

2.  None  of  these  experiments  has  given 
the  slightest  evidence  of  physiological  ef- 
fects from  the  magnetic  field. 

3.  The  experiments  cited  have  utilized 
field  strengths  far  greater  than  those  to 
which  workmen  are  subjected,  and,  since 
the  tissues  emj)loyed  were  those  most 
likely  to  show  vulnerability,  it  seems  cer- 
tain that  the  magnetic  field  has  no  signifi- 
cance as  a  health  hazard. 


DRINKER  AND  THOMSON— MAGNETIC  FIELD  AS  HEALTH  HAZARD      129 


BIBLIOGRAPHY 


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The  Occurrence,  Course  and  Prevention  of 
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2.  Casaniajor,  L.:  An  I'nusua!  Form  of  Mineral 
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physik.  Therap.,  1905,  9,  125. 

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siologitjues  produit  par  un  champ  niagneti<iue 
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C8. 


THE  INDUSTRIAL  PHYSICIAN  AND  THE  QUALIFICATIONS 
ESSENTIAL  TO  HIS  SUCCESS  * 

WILLIAM  J.  McCONNELL,  M.D. 

Passed  Assistant  Surgeon  {Reserve),  V.  S.  Public  Health  Sernce 


OF  all  the  specialties  in  the  medical 
field,  perhaps  the  one  which  is  least 
understood  is  that  of  the  industrial  phy- 
sician. To  emphasize  the  importance  of 
this  specialty,  we  have  but  to  recall  some 
instances  of  the  past.  We  are  more  or  less 
familiar  with  the  disastrous  effect,  during 
the  war,  of  the  manufacture  of  the  explo- 
sive, trinitrotoluene,  resulting  in  fatal 
cases  of  toxic  jaundice,  as  described  in  the 
report  of  the  ^linistry  of  ^lunitions,  Lon- 
don. Previously,  this  substance  had  hardly 
been  regarded  as  toxic;  but  when  the  neces- 
sity arose  to  manufacture  it  in  large  quan- 
tities, and  at  a  time  when  the  conservation 
of  the  life  and  health  of  the  worker  was 
of  the  utmost  import,  mortality  from  its 
poisonous  effects  became  alarming.  Had 
it  not  been  for  the  preventive  measures  in- 
stituted by  a  few  men  with  training  in  the 
hazards  of  industry,  based  on  previous 
knowledge  and  experience  of  the  nearest 
analogies,  the  mortality  from  this  poison- 
ing would  have  been  markedly  increased; 
and  had  this  branch  of  medicine  been  de- 
veloped equally  with  other  specialties,  one 
is  justified  in  believing  that  the  mortality 
not  only  from  T.N.T.  poisoning  but  from 
the  large  list  of  other  recognizable  hazards 
would  have  been  appreciably  lowered. 

The  trend  of  modern  thought  is  toward 
conserving  and  preserving  human  life. 
Science  functions  at  its  best  when  it  con- 
quers disease  and  reduces  the  hazards  of 
human  existence.  Industrial  hygiene  shares 
its  place  with  other  welfare  organizations 
designed  to  give  the  youth  of  the  nation  a 
chance  to  develop  mentally  and  physically, 
to  keep  the  body  strong  and  well  and  fitted 

*  Received  for  publicatiuu  May  7,  1  Sl-i  1 . 


for  the  tasks  and  duties  of  the  day,  and  to 
live  long  and  useful  lives.  ^Millions  of  dol- 
lars are  spent,  and  justly  so,  in  the  control 
and  prevention  of  disease,  in  providing 
pure  drinking  water  and  food  products 
from  healthy  stock,  and  in  educating  the 
public  in  health  matters.  Yet,  little  indeed 
is  to  be  gained  by  these  activities  and  by 
the  expending  of  additional  enormous  sums 
of  money  in  the  rearing  and  education  of 
children,  and  in  the  promotion  of  their 
health,  if  their  lives,  at  the  prime,  are  only 
to  be  crushed  out  by  the  unnecessary  haz- 
ards of  industry. 

Oliver  (1)  speaks  of  lads  under  18  years  of 
age  who  were  given  employment  where  the 
lead  hazard  existed.  "These  youths,"  he 
says,  "all  of  good  physique,  well-developed 
and  healthy  looking,  were  examined  medi- 
cally before  entering  the  factory,  and  yet, 
notwithstanding  this  precaution,  so  great 
was  the  amount  of  lead  poisoning  amongst 
them,  and  in  such  a  short  time,  too,  that  the 
employers  were  obhged  to  dismiss  them." 
In  recent  years,  however,  much  has  been 
accomplished,  both  in  foreign  countries  and 
in  America,  toward  eliminating  this  hazard 
which  is  perhaps  the  greatest  of  all  indus- 
trial hazards,  and  which  at  one  time  was 
present  in  about  150  different  industries. 
But  the  hazards  with  which  the  industrial 
physician  nuist  cope  are  still  many  and  re- 
quire constant  vigilance. 

Throughout  every  state  and  virtuallj' 
every  community  in  this  country  costly 
machinery  is  installed  and  maintained  at  a 
high  degree  of  efficiencj',  for  the  purpo.se  of 
increasing  production.  Aside  from  purely 
humanitarian  views,  if  we  conceive  of  the 
workman  as  a  factor  in  production,  we  are 


130 


McCONNELL— QUALIFICATIONS  OF  INDUSTRIAL  PHYSICIAN      131 


in  him  dealing  with  the  most  potentially 
efficient  machine  in  the  universe. 

M.  Amar  (2)  describes  the  human  motor  as  prob- 
ably an  "electro-capillary  "  engine,  the  nature  of  the 
nervous  agent  and  the  origin  of  human  power  being, 
however,  unknown.  Man's  power  is  approximately 
1-7  H.P.,  but  the  efficiency  is  about  30  per  cent.,  or 
very  higli.  Compared  to  a  steam  engine,  the  human 
motor  performs  its  work  on  half  the  fuel  consump- 
tion. The  life  of  the  human  motor  is  greater  than 
that  of  any  inanimate  prime  mover,  which  is  placed 
at  a  maximum  of  20  years  unless  fretjuently  re- 
paired. Till  old  age  sets  in,  the  human  motor  is  self- 
repairing.    Its  control  is  internal.    In  general: 

"The  maintenance  of  the  human  machine  is  as 
difficult  and  important  a  matter  as  the  maintenance 
of  any  inorganic  motor.  We  must  do  our  best  to 
eliminate  all  internal  and  external  conditions  tend- 
ing to  cause  depreciation.  Especially  must  phys- 
iological discomfort  be  avoided  and  removed,  as  far 
as  possible.  In  the  due  proportion  of  eflPort  and 
speed,  in  industrial  labor,  lies  the  key  to  intensive 
production  and  the  well-being  of  the  workman." 

The  uninitiated  may  marvel  that  a 
science  should  exist  for  the  purpose  of  in- 
creasing human  efficiency  and  decreasing 
waste;  yet  it  is  only  by  the  application  of 
the  scientific  principles  of  industrial  hy- 
giene and  sanitation  that  a  man  can  pro- 
duce an  increased  yield  sufficient  to  justify 
a  larger  compensation  for  his  labor,  and  can 
thus  be  enabled  to  live  in  comfort  and  to 
find  new  strength  and  enjoyment  in  his 
work  each  day.  It  is,  therefore,  of  vital 
import  that  the  public  at  large  should  be 
interested  in  those  conditions  which  ma- 
terially affect  the  health  and  welfare  of 
approximately  one-third  of  the  population 
of  enlightened  countries  —  namely,  the 
producers  of  the  world.  To  accomplish 
constructive  improvements,  organization  of 
interests  and  co-operation  with  other 
sciences  are  essential;  but  as  the  human 
factor,  with  which  the  physician  has  to 
deal,  is  the  greatest  of  all  factors  in  the 
activities  of  life,  all  other  factors  should 
revolve  around  it  as  a  center. 

Unfortunately,  the  term  "industrial  phy- 
sician"  has  been  erroneously  applied  to 


general  practitioners  who  spend  part  time 
in  treating  cases  of  sickness  and  injury 
sent  to  them  from  industrial  plants.  Even 
contract  physicians  have  been  at  times 
classified  under  the  same  head.  The  re- 
stricted conception  of  the  industrial  phy- 
sician limits  the  appellation  to  the  man 
who  has  specialized  in  the  field  indicated 
in  this  paper.  He  is  no  longer  the  practising 
physician  who  makes  an  hoiu-ly  trip  to  the 
plant  in  order  to  dress  minor  injuries,  or 
who  is  called  when  a  worker  suddenly  be- 
comes ill  or  is  hurt.  On  the  contrary,  he  is 
a  trained  specialist  in  industrial  hygiene 
and  occupational  disea.ses,  and  does  not 
engage  in  the  general  practice  of  medicine 
nor  of  surgery  any  more  than  does  the 
specialist  in  other  branches  of  medicine. 

It  is  true  that  little  oi)portunity  is  offered 
the  industrial  physician  to  prejjare  for  his 
specialty,  and  he  must  of  necessity  accu- 
nuilate  his  knowledge  from  promiscuous 
sources.  An  atteni])!  has  been  made  to 
merge  this  all-important  specialty,  as  a 
branch,  with  preventive  medicine  or  social 
medicine,  but  the  field  of  industrial  hygiene 
and  sanitation  is  sufficiently  broad  and 
sufficiently  well  defined  to  constitute  in  it- 
self a  specialty,  and  the  demand  for  trained 
men  is  imperative.  A  few  medical  schools 
are  now  recognizing  the  importance  of 
training  men  for  this  work  and  are  offering 
special  courses  for  it.  Much  remains  to  be 
accomi)lished  in  this  direction,  however, 
and  a  more  comprehensive  course  including 
actual  field  work  is  desirable. 

Diagnosis  of  ordinary  occupational  dis- 
eases is,  to  be  sure,  not  difficult,  but  early 
recognition  of  them,  which  is  all  important, 
is  quite  so.  It  is  unfortunate  that  the  in- 
dustrial physician  must  for  the  most  part 
recognize  the  early  diagnostic  symptoms 
of  many  industrial  diseases  through  expe- 
rience and  from  the  perusal  of  special 
articles,  for  the  reason  that  textbooks 
usually  emphasize  only  the  more  advanced 
symptoms.    It  is  obvious,  therefore,  that 


132 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


to  become  qualified  for  his  task,  the  indus- 
trial physician  must  have  special  training 
and  special  qualifications  as  well. 

In  the  first  place,  the  question  arises  as 
to  the  specific  position  of  the  industrial 
physician  in  industry  —  whether  he  serves 
the  employees  or  those  who  employ  him. 
The  physician  who  serves  either  to  the  ex- 
clusion of  the  other  fails  in  the  high  pur- 
pose of  his  mission.  I  know  of  physicians 
who  are  employed  mainly  for  the  protection 
of  the  management  against  lawsuits,  and 
who  are  expected,  no  matter  what  the 
cause  of  the  ailment  or  injury,  to  convince 
the  patient  that  his  trouble  is  the  result  of 
his  own  carelessness  and  is  in  no  way 
caused  by  his  working  conditions.  Such 
policies  among  physicians  are  soon  recog- 
nized by  employees,  and  have  a  tendency 
to  cause  them  to  resent,  and  with  some  de- 
gree of  right,  the  aid  offered  them  by  fair 
and  conscientious  physicians. 

The  task  of  the  industrial  physician  is  by 
no  means  easy.  He  occupies  the  position  of 
liaison,  as  it  were,  between  management 
and  employees.  His  duties  toward  the 
former  are  to  increase  the  efficiency  of  the 
workers,  in  order  to  secure  and  maintain  a 
high  rate  of  production;  to  prevent  wast- 
age; to  minimize  labor  turnover;  and  to 
interpret  the  workers  to  the  management, 
by  pointing  out  causes  of  dissatisfaction 
among  them  and  suggesting  remedies  for 
it.  His  duties  toward  the  employees  are  to 
promote  health,  sanitation,  personal  liy- 
giene,  and  contentment;  to  maintain  cli-an- 
liness  and  order;  to  lessen  the  ])ossibiht\'  of 
accidents  and  disease;  to  ])rotect  against 
dust,  industrial  poisons,  inadecjuate  ven- 
tilation and  illumination,  over-fatigue, 
draught,  extremes  of  heat  and  cold,  danger 
of  fire;  to  advise  in  the  selection  of  jobs 
suitalile  to  the  physical  capacity  of  in- 
dividuals; to  improve  tlie  morale;  and  to 
interpret  the  management  to  the  workers. 

In  order  to  accomplish  these  ends,  the 
industrial  i)hysician  should  be  character- 


ized first  of  all  by  fairness,  tactfulness,  and 
a  sympathetic  attitude,  which  will  enable 
him  to  secure  effective  co-operation.  He 
must  evaluate  statements  of  both  em- 
ployer and  employed;  must  discriminate 
between  facts,  opinions,  bias,  and  prejudice, 
through  observation  of  actual  conditions; 
and  wherever  possible  must  base  his  judg- 
ment upon  facts  instead  of  upon  opinions. 

In  making  the  initial  physical  examina- 
tion of  the  worker,  the  physician  should  be 
guided  by  the  mental  as  well  as  the  phys- 
ical fitness  of  the  individual,  and  should 
assist  the  management  in  hiring  advan- 
tageously and  in  giving  each  new  man  such 
work  as  he  can  best  perform.  When  we 
consider  the  fact  that,  as  measured  by 
mentality  tests,  the  greater  number  of  men 
in  the  army  were  of  average  or  less  than 
average  intelligence  —  which  is  probably 
true  today  of  the  men  of  the  country  as  a 
whole  —  it  is  evident  that,  in  spite  of  some 
limitations,  each  man  according  to  his 
grade  of  mentality  and  intelligence  may  be 
assigned  a  part  in  the  whole  organization 
that  will  lead  to  his  success  and  hajjpiness. 

Again,  the  ability  of  the  industrial  phy- 
sician and  his  value  to  industry  are  meas- 
ured largely  by  his  knowledge  of  and 
familiarity  with  the  needs  of  the  plant. 
Before  he  can  recommend  or  even  suggest 
changes  for  improvement,  he  must  have  at 
least  a  working  knowledge  of  the  materials 
used,  tiie  products  and  by-products  manu- 
factured, tlie  jnocesses  involved,  and  the 
possilile  hazards  existing. 

Tiie  industrial  ])hysician's  first  duty  on 
assignment  to  any  plant  is  to  make  a  com- 
prehensive survey  of  conditions,  including 
an  analysis  of  each  dejiartment  into  its 
various  jobs  and  a  study  of  the  processes  of 
each.  The  paramoimt  idea  of  such  a  sur- 
vey is  "seeing  with  trained  eyes"  and 
utilizing  the  collected  facts  to  establish  a 
basis  for  recommendations.  No  alteration 
or  iiiipn)\cnicnl  should  be  recommended 
witliout  sulficii'nt  reason,  and  the  physician 


McCONNELL— QUALIFICATIONS  OF  INDUSTRIAL  PHYSICIAN      133 


should  guard  against  staggering  the  man- 
agement with  recommendations  requiring 
large  expenditures  of  money.  A  survey 
likewise  fails  if  the  investigator  is  unable  to 
interpret  his  findings. 

It  may  be  well  to  review  briefly  the  most 
important  factors  which  may  constitute 
hazards  in  industry  and  which  are  of  in- 
terest to  the  industrial  physician.  Let  us 
first  consider  the  subject  of  ventilation. 
While  the  task  of  providing  adecjuate 
ventilation  in  the  larger  plants  is  the  duty 
of  a  ventilating  engineer,  the  maintenance 
of  the  ventilation  system  and,  in  some  in- 
stances, the  installation  of  the  system  rest 
upon  the  industrial  i)hysician.  The  essen- 
tial factors  to  l)e  considered  in  ventilation 
are  temperature,  degree  of  moisture,  and 
air  movement.  The  air  may  be  vitiated  by 
impurities  which  ari.se  from  manufacturing 
processes,  from  floors  of  the  rooms,  from 
persons,  from  lights  burning,  and  from  ac- 
cidental sources,  such  as  effluvia  from 
drains,  escape  of  gas,  or  impure  outside  air. 
The  industrial  physician  should  know  the 
composition  of  pure  air,  and  its  value.  He 
should  be  familiar  with  methods  of  remov- 
ing im])urities,  ])ollulion,  dust,  and  damp- 
ness of  surrounding  surfaces,  and  .should 
see  that  there  is  sufficient  cubic  ca])acity, 
with  absence  of  overcrowding,  constant 
movement  of  the  air,  proper  and  rightly 
placed  inlets  and  outlets  for  the  air,  cross- 
ventilation,  and  moderate  temperature  and 
humidity.  The  objectionable  featm-es  of  an 
inadefjuately  ventilated  room  are  more 
frequently  thermal  tlian  chemical. 

No  less  important  is  the  problem  of  aile- 
quate  illumination,  and  a  thorough  knowl- 
edge of  the  subject  is  particularly  essential 
for  the  successful  industrial  ]>hysician. 
With  proper  illumination  over  the  working 
areas,  the  safety  and  skill  of  the  worker 
may  be  maintained  at  a  high  standard, 
and  production  increased  in  quantity  and 
improved  in  quality.  Distinction  must  be 
drawn  in   regard  to  illumination,   surface 


brightness,  and  glare.  The  physician 
should  not  only  be  familiar  with  the  unit  of 
measure  for  general  illumination  and  the 
methods  employed  to  test  it,  but  should 
also  know  the  number  of  units  necessary 
for  the  performance  of  different  kinds  of 
work.  The  effectiveness  of  illumination 
cannot  always  be  measured  in  terms  of  the 
vertically  downward  component  of  the 
light  as  it  is  sometimes  of  advantage  to 
light  the  work  plane  from  the  side.  For 
larger  plants,  at  least,  the  engineer  should 
l)e  consulted  in  order  that  the  fundamental 
])rinciples  of  effective  illumination  —  suf- 
ficiency, continuity,  and  diffusion  —  may 
be  fulfilled. 

The  problem  of  illumination  is  by  no 
means  solved  simply  by  the  installation  of 
an  efficient  system.  Indeed,  the  main- 
tenance of  the  system  is  of  ecjual  impor- 
tance, because  frec[uently,  through  neglect 
of  proper  upkeep,  one-half  of  the  light 
which  a  system  is  capable  of  supplying  may 
l)e  lost  to  the  worker.  The  change  from 
sufficient  to  insufficient  light  is  very  grad- 
ual and  is  often  overlooked.  Dust  and  dirt 
accumulate  slowly,  reflectors  break,  ceil- 
ings become  darkenetl  by  degrees,  here  and 
there  is  an  empty  socket  or  a  lamj)  of  in- 
correct voltage.  Thus,  it  fre(|uently  hap- 
pens that  the  cumulative  etlVcl  of  these 
needed  repairs  is  noticed  only  after  the 
workmen  complain  of  eyestrain. 

The  proper  method  of  using  h'ghting 
e(juii)nient  so  that  it  may  be  suitable  to  the 
needs  of  a  plant  is  as  important  as  the  wise 
choice  of  a  system.  Whether  direct,  in- 
direct, or  semi-indirect  light  is  best,  de- 
pends upon  the  purpose  for  which  the  light 
is  to  be  used.  It  should  also  be  remembered 
that  faulty  reflectors  may  do  more  harm 
than  none  at  all. 

That  certain  occupations  are  more  fa- 
tiguing than  others  is  common  knowledge, 
and  the  physician  is  not  interested  in  fatigue 
in  the  ordinary  acceptation  of  tHe  term; 
but  he  is  deeply  concerned  with  the  effects 


134 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


produced  by  over-fatigue,  the  boundary 
line  between  fatigue  and  over-fatigue,  and 
the  length  of  time  necessary  to  recover  from 
fatigue.  There  is  no  uniform  method  of 
treating  this  problem,  and  the  physician 
must  work  it  out  to  the  best  of  his  ability 
for  each  individual  industry,  for  both 
sexes,  and  for  different  climates.  Other 
problems,  with  which  he  is  concerned  and 
for  which  he  should  bear  the  responsibility, 
are  personal  service  facilities,  rest  periods, 
welfare  work,  and  effective  methods  of 
cleaning  the  plant. 

As  an  aid  in  predicting  the  effects  of  cer- 
tain reactions  upon  the  worker,  a  knowl- 
edge of  chemistry  is  of  great  advantage  to 
the  industrial  physician,  particularly  as  the 
substances  used  in  industry  are  many  and 
varied,  and  their  effects  multiple.  For  in- 
stance, it  is  an  interesting  fact  that  there 
are  about  300  substances  used  in  industry, 
which  cause  skin  diseases  and  in  dealing 
with  which  a  knowledge  of  chemistry 
would  clearly  be  exceedingly  valuable. 

Too  much  stress  cannot  be  placed  upon 
the  importance  of  careful  records.  While 
it  cannot  be  expected  that  every  indus- 
trial physician  should  be  a  statistician, 
he   should   at   least   understand   the  fun- 


damental principles  of  statistics,  and  if,  in 
addition,  he  possesses  the  ability  to  inter- 
pret them  accurately,  it  is  a  distinct  asset 
to  him.  For  record  keeping,  he  should 
employ  a  standard  form  in  general  use, 
such  as  that  suggested  by  the  U.  S.  Public 
Health  Service. 

In  conclusion,  I  wish  to  emphasize  the 
value  of  the  industrial  physician  in  the 
mitigation  of  industrial  unrest,  which  in 
large  part  is  the  reaction  to  unfavorable 
environment.  Insanitary  working  condi- 
tions lower  physical  resistance;  monoto- 
nous labor,  discontentment,  and  continued 
long  hours  increase  those  physical  defects 
which  are  soon  acquired  when  resistance 
is  lowered,  and  in  turn  the  worker  who 
has  lost  his  former  strength  and  vigor  must 
accept  lower  wages,  and  povertj',  with  its 
many  evils,  is  the  result. 

Diminished  output  is  a  danger  sign  of 
diminished  physical  energy.  Desire  to 
work  cannot  exist  without  good  health. 
A  healthj'  and  contented  laboring  force  is 
the  greatest  economic  asset  that  capital  can 
have,  and  such  a  force  should  be  so  pro- 
tected and  so  guided  that  the  greatest  pos- 
sible benefits  may  accrue  to  both  employer 
and  employee. 


BIBLIOGRAPHY 


1.  Oliver,    T. :     Diseases    of    Occupation.      New 
York,  E.  P.  Dutton  and  Company,  1916,  p.  Hi. 

2.  Amar,  J. :  The  Human  Motor,  or  the  Scientific 
Foundations   of   Labour   and   Iniiustry.     New 


York,  E.  P.  Dutton  and  Company,  1920. 
Quoted  from  Industrial  Information  Service, 
Jan.  20,  1921,  p.  15. 


AN  INTERCHANGE  OF  PHYSICAL  EXAMINATIONS 

IN  INDUSTRY* 

HARRY  MYERS,  M.D. 

Personnel  Superintendent,  The  Ohio  Brass  Company,  Mansfield,  Ohio 


A  GREAT  deal  has  been  written  con- 
cerning the  many  advantages  of  the 
compulsory  physical  examination  in  indus- 
try, but  only  once  in  a  while  is  anything 
WTitten  —  and  then  but  a  line  or  two  —  in 
regard  to  the  objections  that  are  advanced 
by  the  employer  or  the  employee.  The  ob- 
jections given  by  the  employer  are  usually 
concerned  with  the  cost  of  the  service, 
while  those  of  the  employee  are  based  upon 
some  personal  reason,  such  as  his  natural 
dislike  for  anything  which  he  feels  is  being 
forced  upon  him  and  which  may  in  some 
way  abuse  his  private  rights,  or  for  any 
procedure  which  entails  extra  bother.  Or 
perchance,  as  I  have  frecjuently  known  to 
be  the  case,  he  may  object  on  the  ground 
that  he  has  recently  been  examined  by  a 
good  doctor  who  said  that  he  was  all  right, 
and  therefore  he  does  not  care  to  be 
examined  again. 

We  can  oftentimes  learn  something  from 
the  other  fellow  even  though  his  training 
may  lead  us  to  believe  that  he  really  has  no 
right  to  an  opinion  on  the  subject  in  ques- 
tion, and  I  think  that  on  the  subject  of 
compulsory  physical  examination,  if  we 
care  to,  we  can  undoubtedly  learn  some- 
thing from  our  apjilicants.  While  for  the 
most  part  compulsory  ph;\-sical  examina- 
tion is  basically  right,  there  are  some  re- 
spects in  which  it  may  be  basically  wrong, 
and  it  is  on  this  side  of  the  question  that  I 
wish  to  sermonize  a  little. 

When  an  order  is  issued  in  an  organiza- 
tion it  is  exactly  comparable  to  an  order  in 
the  regular  army  —  it  must  be  carried  out, 
right  or  wrong.  When  it  is  ordered,  how- 
ever, that  "Every  man  must  have  a  com- 

*  Received  for  publication  May  6,  1921. 


plete  physical  examination  before  he  can 
be  given  a  job,"  the  order  is  so  general  and 
so  broad  that  it  may  easily  include  some 
things  that  are  not  right,  and  which  give 
rise  to  unfortunate  conditions,  as  I  have 
witnessed  many  times  during  the  past  two 
years.  Indeed,  who  has  not  seen  this 
particular  incident  occur  time  without 
mention:  A  great  big  fellow  —  the  i)ictiire 
of  health  —  who  has  recently  been  pro- 
nounced physically  fit  by  a  regular  army 
officer  or  some  industrial  physician,  applies 
for  work.  By  reason  of  an  order  in  the  or- 
ganization, the  doctor  must  make  a  com- 
plete jjhysical  examination  before  the 
aj)plicant  can  be  accepted.  lender  these 
circumstances  two  unfavorable  things  often 
hai)pen.  First,  the  tloctor  feels  in  his  own 
mind  that  the  man  is  normal  and  that  he 
most  certainly  needs  no  complete  examina- 
tion, and  the  result  is  that  the  work  is  often 
carelessly  done  and  time  is  consiuned  that 
costs  the  company  money  without  bringing 
any  returns.  Second,  the  applicant  himself 
feels  that  he  does  not  need  a  complete  ex- 
amination, and  consequently  the  procedure 
appeals  to  him  as  a  mockery,  with  the  result 
that  he  is  annoj^ed  and  has  a  lower  regard 
for  medicine  in  industry. 

In  order  that  the  many  advantages  of  the 
physical  examination  may  be  conserved, 
we  should  now  concern  ourselves  with  im- 
proving its  modus  operandi  by  ironing  out 
wrinkles  wherever  possible.  In  this  con- 
nection, why  should  institutions  which  re- 
quire physical  examinations  not  adopt  the 
policy  of  giving  an  applicant  a  card  show- 
ing his  physical  condition  ?  Within  a 
limited  time,  this  card  plus  an  examination 
for  acute  diseases  should  be  accepted  in 


135 


136 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


lieu  of  another  complete  physical  examina- 
tion. These  cards  could  easily  be  stand- 
ardized and  interchanged  between  any 
shops  carrying  on  good  medical  work. 

I  can  see  several  excellent  results  from 
such  a  system.  First,  it  would  rule  out 
many  of  the  normal  cases  that  require  no 
complete  physical  examination,  and  would 
thereby  render  two  distinct  benefits  —  the 
doctor's  work  would  become  less  monot- 
onous, and  much  time  would  be  saved. 
I  believe  that  many  of  the  industrial  phys- 
ical examinations  have  degenerated  into  a 
monotonous  routine.  Indeed,  I  know  of 
nothing  more  uninteresting  to  an  intelligent 
doctor  than  an  examination  of  numerous 
normal  cases.  The  time  saved  could  be 
spent  to  most  excellent  advantage  in  dis- 
cussing personal  or  organization  affairs, 
shop  conditions   or  other  subjects  which 


aid  in  determining  the  employees'  ideas  of 
life  and  industry,  and  help  so  much  in 
establishing  pleasant  personal  relations 
between  the  dispensary  and  the  plant. 
Second,  I  think  that  the  importance  and 
use  of  the  physical  examination  would 
appeal  much  more  strongly  to  the  applicant 
if  some  written  statement  accompanied  it. 
It  would  help  make  the  intangible  benefits 
of  the  examination  more  tangible.  Do  you 
not  think  that  almost  any  man  would  re- 
gard with  considerable  jiride  a  card  stating 
that  he  was  in  sound  physical  condition,  or 
can  you  not  easily  imagine  that  the  written 
card  might  help  impress  upon  the  applicant 
the  seriousness  of  some  existing  defects.^ 
Might  it  not  lend  a  personal  touch  that 
would  help  us  immensely  in  selling  medical 
ideas  to  employees.^ 


PHYSIOLOGICAL   EFFECTS   OF  AUTOMOBILE   EXHAUST 

GAS  AND  STANDARDS   OF   VENTILATION 

FOR   BRIEF   EXPOSURES 

Continued 

YANDELL  HEXDERSOX,  HOWARD  W.  HAGGARD,  MERWYX  C.  TEAGUE, 
ALEXAXDER  L.  PRIXCE,   and  RUTH  M.  WUNDERLICH 


IV.  Concordance  of  the  Standard  here 

Proposed    with    the    Observations    of 

Other  Investigators 

THE  standiird  defiiu'd  in  Figure  4*  may 
seem,  from  the  work  of  otliers.  e.s])e- 
cially  tliat  of  Haldaiie,  unduly  hif;li,  if  one 
fixes  attention  upon  the  concentration  of 
carbon  monoxide  in  the  air  breathed;  or  it 
may  ajjpear  unnecessarily  low,  if  stated  in 
terms  of  the  uuiximum  percentage  satura- 
tion—  i.e.,  complete  efiuilihrium  of  the 
blood  and  the  corresponding  tension.  The 
work  of  Haldane  is  so  i)re-eminent  in  this 
field,  alike  in  amount,  thoroughness,  and 
jjracticality,  that  discordance  between  the 
conclusions  drawn  from  his  investigations 
and  the  standard  liere  proposed  would  re- 
quire elaborate  explanation  and  ilefence. 
In  fact,  however,  we  believe  that  when  all 
aspects,  of  the  question  are  taken  into 
consideration  our  observations  and  con- 
clusions, although  differing  in  detail,  are 
essentially  concordant  with  those  of  Hal- 
dane (4)  (o).  Briefly  stated,  his  principal 
conclusions  were  as  follows: 

The  symptoms  caused  by  carbon  mon- 
oxide depend  u])on  the  extent  to  which  the 
hemoglobin  lias  been  satvu-ated.  The  symp- 
toms are  due  solely  to  the  deficiency  of  the 
oxygen  percentage  in  the  blood. 

When  air  containing  carbon  monoxide  is 
breathed,  about  half  of  the  carbon  mon- 
oxide actually  inhaled  is  absorbed,  except 
toward  the  end  of  the  process  when  ab- 
sorption is  coming  to  a  standstill. 

*  For  figures,  see  the  first  part  of  tliis  article  in  the 
preceding  issue  of  the  JotjRN.\L  of  Industrial  Hygiene. 


The  rate  of  absorption  and  time  required 
for  .symptoms  to  ai>pear  is  proportional  to 
the  respiratory  exchange  and  may  be  very 
much  shortened  by  the  increased  breathing 
of  exercise. 

The  symptoms  do  not  become  a|)pre- 
cial)le  during  rest  until  the  blood  is  about 
a  third  saturated.  An  individual  in  this 
condition  suffers  from  jialpitation  and 
thn)l)l)ing  in  the  head  and  is  liable  to  be- 
come faint  or  dizzy  on  any  e.xertion,  such 
as  that  of  ascending  a  stair,  or  on  sudden 
exposiu'e  to  cold  air. 

In  experiments  on  himself  Haldane  (fi) 
foinid  tliat,  when  ,50  ])er  cent,  .saturated,  he 
could  scarcely  stand  and  could  not  walk 
alone  without  falling  down.  There  was 
giddiness,  dullness  of  the  .senses,  distinct 
shortness  of  breath,  and  labored  iM-eathing. 
In  the  course  of  two  or  three  hours  after 
leaving  the  contaminated  air  he  foimd  that 
nearl\"  all  the  carbon  monoxide  disapj)eared 
from  the  blood,  w'hich  had  then  retiu-ned  to 
its  normal  condition.  A  headache  lasting 
for  some  hours  was  likely  to  ensue  from  the 
ex])osure  if  the  latter  were  sufficiently  long. 

In  reporting  on  the  conditiotis  which 
should  be  maintained  in  the  I'ndergroimd 
Metroijolitan  Railways  of  London  (7),  he 
said: 

Rouglily  spealcing,  tlie  probable  action  on  a 
liealtliy  person  of  varying  percentages  of  carbon 
monoxide  in  ttie  air  may  be  stated  as  follows:  2.5 
volumes  per  10,000  would  suffice  after  a  sufficient 
time  (after  an  hour  and  a  half  during  rest,  but  very 
much  less  during  even  slight  exertion)  to  cause  symp- 
toms just  distinctly  appreciable  on  exertion.  Five 
volumes  per  10,000  wouUl  cause  marked  dizziness  or 
fainting   on  exertion,   9   volumes  would   cause   in- 


137 


138 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ability  to  walk,  and  about  15  volumes  might  produce 
death.  .  .  .  Considering  the  enormous  number  of 
people  in  various  states  of  health  who  use  the  rail- 
way, ...  it  seems  desirable  that  not  more  than 
one  volume  per  10,000  of  this  gas  should  be  present 
in  the  air. 

To  these  statements  may  be  added  the 
fact  that  Burrell  (8)  found  that  after 
breathing  air  containing  twenty-five  parts 
of  carbon  monoxide  per  10,000  of  air  for 
twenty  minutes  he  had  at  first  only  a  shght 
headache,  but  later  became  ill.  The  illness 
lasted  for  several  hours  and  was  accom- 
panied by  nausea  and  headache. 

The  agreement  of  these  statements  with 
our  conclusions  is  sufficiently  close  to  need 
no  further  discussion,  until  the  question 
of  the  allowable  concentration  of  carbon 
monoxide  —  a  concentration  producing  no 
appreciable  effects  in  any  one  —  is  reached. 
On  this  point  Haldane  recommended  one 
part  in  10,000,  while  we  approve  concen- 
trations up  to  four  parts,   or,   with  lon- 
gitudinal ventilation,  even  six.    It  is  to  be 
noted,    however,    that   the   conditions   to 
which  Haldane's  recommendations  applied 
were  in  some  respects  different  from  those 
which  will  occur  in  a  vehicular  tunnel.  The 
motive  power  in  the  London  Underground 
Railways  was  at  that  time  (1897)  furnished 
by  steam  engines  burning  coke.  The  engine 
drivers  and  train  crews  and  even  some  pas- 
sengers might  be  exposed  for  considerable 
periods  of  time  —  much   longer  than   we 
have  figured  on.    Haldane  seems  to  have 
had  in  mind  the  possibility  that  exposure 
might  be  so  long  that  the  blood  would  come 
nearly  into  equilibrium  with  the  tension  of 
carbon  monoxide  in  the  air  breathed  and 
reach  a  corresponding  percentage  of  satura- 
tion.   We,  on  the  contrary,  are  basing  our 
estimates  on  times  of  exposure  too  short  for 
the    attainment    of    more    than    half    the 
equilibrium  degree  of  saturation. 

The  apparent  discrepancy  between  the 
two  standards  lies  in  the  figures  for  the  con- 
centration of  carbon  monoxide  in  the  air 


breathed.     If,   however,   we  turn   to   the 
more  fundamental  physiological  condition 
—  namely,  that  of  the  percentage  satura- 
tion of  the  blood  —  the  discrepancy  largely 
disappears.    Thus,  a  glance  at  Figure  4 
shows  that  thirty-five  minutes  in  an  at- 
mosphere containing  four  parts  of  carbon 
■  monoxide  in   10,000  could  imluce  12  per 
cent,  blood  saturation.  Now  blood  which  is 
12  percent,  saturated  is  in  equilibrium  with 
one  part  of  carbon  monoxide  in  10,000  of 
air.   In  other  words,  a  stay  of  several  hours 
in  an  atmosphere  of  one  part  of  carbon 
monoxide  in  10,000  would  involve  the  same 
percentage  saturation  as  a  stay  of  thirty- 
five  minutes  in  four  parts  per  10,000.    In- 
deed,  as   the   development   of   symptoms 
from  carbon  monoxide  is  wholly  a  question 
of  oxj'gen  deprivation,  it  is  safe  to  assert 
that  a  saturation  of  the  blood  up  to  16  per 
cent,  lasting  for  only  a  short  period  would 
invoh'e  less  physiological  effect  than  a  pro- 
longed period  of  saturation  at  12  per  cent. 
On  these  grounds  we  have  indicated  in 
Figure  4  two  standards:  (1)  for  the  blood  at 
12  per  cent,  saturation,  or  one  to  10,000 
tension,  for  exposures  of  some  hours;  and 
(2)  at   16  per  cent,  saturation,  or  1.5  to 
10,000  tension,  for  brief  exposures.    The 
whole  matter  may  be  even  more  simply 
siunmed  up  in  a  single  expression  involving 
the  time  measured  in  hours,  the  concen- 
tration of  carbon  monoxide  in  the  air  in 
parts  in  10,000,  and  a  constant  for  each 
degree  of  physiological  effect.    The  phys- 
iological effects  of  all  concentrations  and 
times   (within  reasonable  limits)   may  be 
then  defined  as  follows: 

1.  Time  X  concentration  =    3,  no  perceptible  ef- 
fect. 

2.  Time  X  "  =    6,  a  just  perceptible 
effect. 

3.  Time  X  "  =9,  headache  and  nau- 
sea. 

4.  Time  X  "  =  15,  dangerous. 

Physical  exertion  and  increased  breath- 
ing would  reduce  the  constant  in  the  first 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS        139 


equation  from  3  to  2,  1,  or  even  less,  and 
would  affect  the  other  equations  corre- 
spondingly. Any  standard  for  any  special 
conditions  of  time  or  concentration,  within 
.  reasonable  limits,  based  on  these  formulae, 
is  sufficiently  concordant  both  with  the  rec- 
ommendations of  Haldane  and  with  the 
summary  of  our  observations  and  con- 
clusions contained  in  Figure  4. 

Finally,  we  may  here  quote  from  a  letter 
recently  received  from  Dr.  Haldane,  which 
was  in  answer  to  a  letter  from  us  stating  the 
general  trend  of  our  observations  and  find- 
ings and  in  which  Dr.  Haldane  says: 

In  the  report  on  the  Underground  Railway  the 
chemical  standard  which  I  recommended  if  steam 
traction  was  continued  was  .15  per  cent,  of  carbon 
dioxide,  and  I  pointed  out  that  this  would  contain 
about  .01  i)ercent.  carhon  monoxide.  But  tlie  stand- 
ard was  not  based  primarily  on  the  carbon  monoxide, 
but  on  the  general  impleasantness  of  the  air.  There 
was  no  definite  evidence  of  jieople  being  upset  by  the 
carbon  monoxide,  though  there  was  often  .03  to  .05 
per  cent,  at  certain  i)arts  of  the  tunnels  and  stations; 
and  I  even  found  .000  per  cent,  of  carbon  monoxide 
(with  .89  per  cent,  of  carbon  dioxide)  on  the  plat- 
form of  Gower  Street  Station  (near  I'niversity  Col- 
lege). Passengers  were  never  exposed  long  enough  for 
ill  effect,  and  the  men  at  the  stations  were  probably 
more  or  less  acclimatised. 

At  that  time  I  did  not  know  nearly  so  much  about 
small  percentages  of  carbon  monoxide  as  I  do  now. 
Lorrain  Smith  and  I  made  a  lot  of  experiments  on 
ourselves  (to  determine  oxygen  tension  of  arterial 
blood)  (Jour.  Physiol.,  XX,  1890,  and  XXII,  1897) 
and  came  to  the  conclusion  that  anything  less  than 
.00  per  cent,  producetl  no  symptoms  after  several 
hours"  exposure  except  some  shortness  of  breath  on 
exertion.  Our  blood  saturations  only  went  to  about 
28  per  cent,  (in  about  one  and  one-half  hours),  and  no 
further  absorption  occurred  up  to  five  hours.  .Vbout 
a  year  later  we  tried  a  similar  experiment  and  found 
.06  per  cent,  far  too  much  for  us.  I  tried  again  at 
Oxford  later,  and  now  found  that  even  with  about 
.03  per  cent,  the  saturation  gradually  crept  up  during 
four  or  five  hours  to  over  30  per  cent.  It  became 
clear  afterwards  that  in  the  first  experiments  we  had 
both  got  acclimatised  and  were  thus  abnormally 
resistant  to  carbon  monoxide. 

What  I  should  now  say  is  that  with  long  exposures 
of  several  hours  anything  more  than  .02  per  cent, 
should  be  avoided.    For  exposures  of  less  than  an 


hour  .05  per  cent,  would  not  be  really  objectionable. 
.\s  regards  gases  from  motors,  however,  the  smoke 
and  smell  might  possibly  be  worse  than  the  carbon 
monoxide.  On  this  point  I  have  no  experience, 
though  I  have  run  across  cases  of  poisoning  where 
there  does  not  seem  to  have  been  much  smoke  or 
smell. 

You  will  see  from  the  above  that  my  ideas  about 
carbon  monoxide  coincide  very  closely  witli  what 
your  experiments  point  to.  Lorrain  Smith  and  I  had 
not  the  least  idea  that  by  our  daily  experiments  we 
had  become  acclimatised  and  ready  to  secrete  oxygen 
as  soon  as  our  blood  saturation  rose  to  about  25  per 
cent.  The  absorption  was  simply  stopped  short  as 
soon  as  oxygen  secretion  began;  but  an  ordinary  per- 
son does  not  secrete  at  this  level,  so  the  absorption 
goes  creeping  up  for  hours. 

V.  Observ.\tions  in  Large  G.\ss[ng 
Chamber 

The  experiments  detailed  in  Section  II 
involve  exact,  but  rather  artificial  condi- 
tions. Exhaust  gas  is  not  pure  carbon 
monoxide  and  the  number  of  persons  who 
could  be  tested  in  the  G  cubic  meter  cham- 
ber was  quite  limited.  It  appeared  essen- 
tial, therefore,  to  obtain  confirmatory 
observations  imder  as  nearly  real  conditions 
and  on  as  many  persons  as  possible.  For 
this  purpose  a  brick  building,  30  feet 
square,  with  walls  12  feet  high  at  the  side, 
and  a  hip  roof,  was  erected.  Its  cubic 
capacity  was  aj)proximately  12,000  cubic 
feet  of  air,  which  is  about  the  volume  of  a 
section  of  the  vehicular  tunnel  which  will 
contain  one  car  when  the  traffic  is  active. 

A  Ford  car  was  installed  near  the  middle 
of  this  chamber,  with  a  continuous  stream 
of  water  running  into  and  out  of  its  radiator 
to  prevent  over-heating.  The  axles  were 
supported  on  a  wooden  framework  so  that 
the  rear  wheels  turned  clear  of  the  grovmd. 
Against  them  were  pressed  two  large 
wooden  pulley  wheels  on  a  piece  of  heavy 
shafting,  at  the  ends  of  which  were  wooden 
paddle  wheels.  The  engine  of  the  car, 
therefore,  ran  with  a  fair  load,  and  the 
power  was  expended  in  mixing  the  air  in  the 
chamber.    The  paddle  wheels  did  this  so 


140 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


effectively  that  in  a  number  of  tests  prac- 
tically uniform  concentrations  of  exhaust 
gas  were  found  simultaneously  in  all  parts 
of  the  chamber. 

The  exhaust  of  the  car  was  connected  to 
a  2-inch  iron  pipe  with  a  T  and  two  valves. 
From  one  ^•alve  a  pipe  led  to  a  large  iron 
can  (to  equalize  pressure)  and  to  a  gas 
meter,  and  discharged  close  to  one  of  the 
paddle  wheels,  which  drew  in  and  distrib- 
uted the  gas.  The  pipe  from  the  other 
valve  led  outside  of  the  building.  Thus,  by 
adjusting  the  valves,  all  or  any  part  of  the 
exhaust  gas  could  be  discharged  into  the 
chamber,  and  its  volume  read  on  the  meter. 
Samples  of  the  exhaust  gas  unmixed  with 
air  were  taken  and  analyzed  for  carbon 
monoxide  in  an  Orsat  apparatus,  using 
ammoniacal  cuprous  chloride  as  the  ab- 
sorbent. The  percentage  ranged  between 
5.5  and  6.8  per  cent.,  with  an  average  of 
about  6  per  cent.  The  engine  discharged  a 
total  of  about  25  cubic  feet  of  exhaust  gas 
per  minute,  from  which  we  calculated  that 
approximately  1.5  cubic  feet  of  carbon 
monoxide  were  produced  by  the  car  per 
minute. 

Diffusion  frona  the  chamber  through  the 
walls  and  roof,  and  through  cracks  around 
the  doors  and  windows,  was  considerable. 
^Mienever  the  engine  was  stopped,  there 
was  thus  a  drop  of  about  one-third  of  the 
concentration  of  carbon  monoxide  in  fifteen 
minutes.  Usually  the  entire  exhaust  of  the 
engine  was  discharged  through  the  meter 
into  the  chamber  until  the  desired  concen- 
tration of  carbon  monoxide  was  approxi- 
mately reached.  Thereafter,  a  i)art  of  the 
gas  was  discharged  out  of  doors,  and  only 
enough  was  passed  into  the  chamber 
through  the  meter  to  compensate  for  loss 
by  diffusion.  Samples  of  the  air  in  the 
chamber  were  taken  at  intervals  during  the 
period  of  exposure,  and  the  amount  of  car- 
bon monoxide  determined  either  l)y  means 
of  iodine  pent  oxide  (with  a  correction  for 
vaporized    gasoline),     or    by    the    blood 


carmine  method,  or  in  both  ways.  Some 
discrepancies  will  be  found  in  the  analytical 
data,  but  it  must  be  kept  in  mind  that  the 
methods  are  difficult  and  the  amounts  of 
the  substance  are  minute  far  beyond  the  . 
range  of  ordinary  gas  analysis. 

With  practice,  considerable  facility  in 
controlling  the  concentration  of  carbon 
monoxide  in  the  chamber  was  attained. 
The  experimental  conditions  were  quite 
realistic.  The  car  was  old  and  had  had 
rough  treatment,  and  the  engine  was  some- 
what irregular  in  action.  The  exhaust  gas 
was,  therefore,  contaminated  with  at  least 
as  much  gasoline,  oil  and  soot,  and  other 
substances,  in  addition  to  water  vapor, 
carbon  monoxide  and  carbon  dioxide,  as 
may  be  met  with  in  any  well-regulated 
vehicular  tunnel.  Owing  to  the  fact  that 
vaporized  gasoline  and  other  constituents 
of  exhaust  gas  beside  carbon  monoxide  act 
upon  iodine  pentoxide,  the  figure  0.6  was 
determined  as  the  factor  by  which  it  was 
necessary  to  multiply  the  iodine  liberated  in 
analysis  of  chamber  air  for  the  estimation 
of  the  carbon  monoxide. 

In  this  chamber  groups  of  a  dozen  or 
more  jjersons  at  a  time  sat  or  moved  about 
for  periods  of  one  hour.  In  addition  to  the 
staff  of  this  investigation  a  number  of  stu- 
dents of  the  Yale  Medical  School  served  as 
subjects.  We  take  this  opjiortunity  to 
recognize  the  intelligent  interest  mani- 
fested, and  the  valuable  service  rendered 
liy  these  yoimg  men  and  women. 

After  the  tests  the  general  condition  and 
feelings  of  the  subjects,  particularly  the 
occurrence  or  absence  of  headache,  were 
noted.  When  the  subjects  had  breathed 
fresh  air  for  five  minutes  after  leaving  the 
chamber,  samples  of  lung  air,  obtained  by 
having  them  rebreathe  repeatedly  into  a 
small  rubber  bag,  were  analyzed  for  carbon 
monoxide.  In  such  analyses  the  gas  found 
is  that  which  has  diffused  out  of  the  blood 
into  the  hmg  air,  and  the  analytical  data 
indicate,  therefore,  the  tension  of  the  car- 


I 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS       Ul 


bon  monoxide  in  the  l^lood.  The  effect  of 
running  up  and  down  four  flights  of  stairs 
was  also  noted,  as  exercise  markedly  in- 
tensifies asphyxial  symptoms. 

Only  a  few  typical  protocols  of  these 
tests  can  be  given  in  this  abbreviation  of 
our  report,  but  the  whole  of  the  data  may 
be  summarized  by  the  statement  that,  so 
long  as  the  standard  worked  out  in  the  pre- 
vious section  was  not  exceeded,  no  appre- 
ciable ill  effects  were  induced  in  any  of  the 
numerous  subjects.  Above  this  standard, 
however,  headache  resulted  in  nearly  all 
cases,  and  in  some  persons  nausea  and 
vomiting  also  occurred. 

Details  of  Observations  in  Tunnel 
Gassing  Chamber 

Protocol  1.  —  Fob.  4,  19'iO.  The  ciiKinr  of  the 
car  was  startoil  ami  iiuiiiitaiiifil  at  a  uniform  speed 
for  twenty  niiinites.  Determinations  were  made  of 
the  carl)on  monoxide  percentasf  in  tlie  exhaust  from 
the  engine  (analyzed  with  Orsat  apparatus),  and  of 
the  concenlratitni  of  the  gas  in  various  |)arts  of  the 
chamher  (hy  the  iodine  pentoxide  method).    For  the 

T.\HLE  3.  — EXrKKIMKNT.VL  CONDITIONS 
AND  PHYSIOLOGICAL  DATA  (Protocol  1) 


Time 

Conceotr 
COinP 

1 

ntion<i  of 
ositions 

i 

Remarks 

Minutes 

Parh  ill 
IV.IKM) 

ParU  in 

iO.OOO 

0 

0.5 

0.3 

engine  started. 

5 

3.0 

3.0 

exiiaust  gas  =  5.6  per  cent.  CO 
(by  Orsat). 

10 

5.5 

5.0 

15 

6.5 

7.0 

smoke  very  unpleasant. 

20 

8.0 

8.0 

engine  stopped;  smoke  in  cham- 
ber extremely  irritating  lo  eyes. 

30 

6.0 

6.0 

pulmonary  air  of  H.  W.  II.,  a 
few  minutes  after  leaving  cham- 
ber, contained  3.1  parts  CO;  se- 
vere headache  and  some  nausea 
for  four  hours;    insomnia  later. 

90 

1.5 

gas  slowly  diffusing  out  of 
chamber. 

At  the  end  of  twenty  minutes  the  smoke  in  the 
chamber  had  become  quite  disagreeable  and  the 
engine  was  stopped.  The  dispersing  fans  were,  how- 
ever, continued  in  operation  by  means  of  an  electric 
motor,  and  air  samples  were  taken  at  intervals.  The 
pulmonary  air  of  H.  W.  Haggard,  who  had  been  in 
the  chamber  up  to  this  time  and  who  had  been 
actixely  at  work  on  the  car,  was  taken  a  few  moments 
after  he  left  the  chamber  and  analyzed.  The  data 
obtained  are  given  in  Table  3. 

Pkotocol  '2.  —  Feb.  11,  19'20.  The  procedure 
was  similar  to  that  described  in  Protocol  1.  Con- 
tinuous and  snap  samples  of  air  were  taken  during 

TABLE  4.  —  EXPERIMENTAL  CONDITIONS 

(Protocol  3) 


Concentration  of  CO  in  Positions 

Time 

1 

i 

S 

Minutes 

Parli  in  10.000 

Parl3  in  10.000 

PaHi 

in  Ul.mo 

12 

3.0 

4.0 

3.5 

24 

4.0 

4.0 

4.0 

34 

4.0 

4.0 

4.0 

46 

4.0 

4.0 

4.0 

latter  purpose,  two  positions  were  chosen:  No.  1,  6 
feet  to  the  west  of  the  exhaust;  and  No.  2,  9  feet  to 
the  north  of  the  exhaust. 


the  |)erioil  of  gassing  in  tiuee  places:  position  1, 
northwest  corner;  position  '2,  northea.st  corner;  and 
[wsition  3,  middle  of  south  side  of  chamber. 

The  number  of  persons  in  the  chamber  was  eight- 
een —  fifteen  men  and  three  women.  Four  subjects 
were  seateil  about  position  1,  four  about  position  '2, 
five  about  position  3,  ami  the  last  five  were  ambula- 
tory. The  normal  pulse  and  respiration  were  ob- 
served on  each  subject  some  time  before  gassing,  and 
the  same  data  obtained  again  soon  after  gassing. 
The  air  analyses  were  made  by  the  iodine  pentoxide 
method.  The  engine  was  allowed  to  exhaust  into  the 
chamber  for  six  minutes  initially,  and  the  gas  was 
then  shunted  to  the  outsi<le  for  eight  minutes. 
Thereafter,  the  exiiaust  gas  was  discharged  into  the 
chamber  for  one  ami  one-half  minutes  in  each  ten 
minutes.  Table  4  gives  the  conditions  in  the  cham- 
ber as  shown  by  analyses,  and  Table  H  presents  the 
physiological  data  obtained  from  eight  subjects  — 
two  tx^pical  of  each  group. 

Protocol  3.  —  March  13,  19-20.  The  arrange- 
ment of  the  engine  exhaust  previously  described  was 
altered  by  the  introduction  of  a  baffle  can  and  a  large 
gas  meter  into  that  portion  of  the  piping  which  ad- 
mitted the  gas  to  the  chamber.  The  volume  of  gas 
admitted  into  the  chamber  was  thus  more  accuratel.y 
controlled.  A  survey  experiment,  identical  with  the 
gassing  procedure  carried  out  in  Protocol  2,  was  per- 


14'2 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


TABLE  5.  —  PHYSIOLOGICAL  DATA  (Protocols) 


Subject 


Sex 


Position  in 
Chamber 


Duration  of 
Exposure 


CO  in  Pulmonary 
Air  after  Gassing 


Pulse 


Normal 


After 
Gassing 


Symptoms 


C.  Pepe 

E.  Shorr 

E.  Waters.  . . 
M.  Hotchkiss 

M.  BeU 

E.  Hilton 

E.  Levj- 

M.  Snow.  .  . . 


male 

u 
tt 

female 

« 

male 


1 

1 
2 
2 
3 
3 
ambulatory 


Hours 
1 
1 
1 
1 
1 
1 
1 
1 


Parts  in  10,000 
1.12 
0.99 
1.35 
1.16 
1.21 
1.06 
0.99 
1.27 


90 

75 

108 


74 
80 
82 


formed.  Determinations  •nere  made  upon  the  air  in 
the  chamber  and  the  pulmonary  air  of  the  subjects 
by  the  Haldane  blood  method.  Observations  were 
made  on  seventeen  men  and  one  woman.  The  sub- 
jects were  for  the  most  part  quite  active  during  this 
experiment. 

The  concentrations  found  by  these  methods,  those 
estimated  from  meter  readings,  and  analyses  of  ex- 

TABLE  6.  —  EXPERIMENTAL  CONDITIONS' 

{Protocol  S) 


Time 

Exhaust  Gas 
through  Meter 

Exhaust  Gas 
by  Orsat  Analysis 

Concentration  of 
CO  in  Chamber 

Minutes 

CMc  Feet 

Fer  Cent. 

Parts  in  10,000 

0 

300 

6.4 

10 

80 

15 

6.8 

20 

75 

30 

82 

9.0 

35 

6 

6 

40 

78 

8.6 

50 

78 

60 

9.3 

1  From  the  figures  in  column  4,  the  mean  concentration  of  carbon 
monoxide  breathed  for  one  hour  may  be  estimated  to  have  been  at  least 
nine  parts  per  10,000  of  air,  and  from  the  Orsat  figures,  column  3, 
perhaps  two  or  three  parts  higher. 

haust  gas  by  the  Orsat  apparatus,  allowing  for  loss 
by  diffusion,  are  shown  in  Table  6;  the  physiological 
data,  which  were  obtained,  in  Table  7. 

Exposure  of  Horses  to  Exhaust  Gas.  —  A 
few  observations  were  made  on  two  U.  S. 
Army  artillery  horses.  They  were  of  the 
Percheron  breed  and  weighed  between 
1,400  and  1,800  pounds,  one  bay  and  the 
other  white.  We  are  greatly  indebted  to 
Colonel     R.  E.  D.     Hoyle,     Commanding 


Officer,  Field  Artillery  Unit,  R.  O.  T.  C, 
stationed  at  Yale  University,  for  the  loan 
of  the  animals. 

The  car  and  motor  were  taken  outside  of 
the  tunnel  gassing  chamber  and  the  exhaust 
gas  piped  to  the  inside.  The  horses  were 
not  hitched,  but  were  allowed  to  move 
about  freely  inside  the  chamber.  In  each 
experiment  a  blood  sample  was  drawTi 
from  the  ear  before  and  after  gassing.  The 
results  of  the  three  experiments  are  shown 
in  Table  8. 

Owing  to  the  fact  that  the  dispersing 
fans  were  not  in  operation  we  believe  that 
the  concentration  of  gas  was  quite  variable 
in  different  parts  of  the  chamber;  and  it  is 
probable  that  the  atmosphere  which  the 
horses  actually  breathed  contained  con- 
siderably higher  concentrations  of  carbon 
monoxide  than  the  figures  given  in  the 
table. 

VI.    Observations  in  Garages  ant)   in 

THE  Grand  Central  Station,  New 

York  City 

The  occiu-rence  of  fataUties  in  small  pri- 
vate garages  during  cold  weather  has  be- 
come so  frequent  an  item  of  news  that  the 
public  is  becoming  aware  of  the  danger. 
Evidently  if  a  car,  while  warmmg  up,  gives 
oflf  1  cubic  foot  of  carbon  monoxide  per 
minute  in  a  room  10  X  10  X  20  feet,  the 
atmosphere    will,    apart    from    diffusion. 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS       U3 


TABLE 

7.  — PHYSIOLOGICAL  DATA  {Protocxil  3) 

Sex 

CO  in  Pul- 
monary 

Air  after 
Gassing 

Pulse  at  Rest 

Subject 

Normal 

After 
Gassing 

Symptoms 

G.  Gildersleve 

A.  Vanderberg 

A.  Dreher 

male 

u 

u 
u 

u 
u 
u 
u 
u 
u 
a 

u 
u 

female 
male 

u 
u 
u 

Parts  m 
10.000 

2.7 
2.9 

2.2 
1.9 

1.8 
3.0 

2.7 
2.7 
2.7 
2.5 
1.9 

2.5 
1.6 

2.2 

1.8 
2.0 

2.2 
1.8 

Per 
Minute 

82 
72 

82 
82 

74 
72 
86 
82 
60 
76 
72 

74 
75 

72 

50 
54 
80 

72 

Per 
Minute 

96 

90 

105 
102 

100 
130 
130 
120 

84 

90 
120 

116 

80 

108 

60 

68 

120 

dizziness,  extreme  headache  and  some  nausea. 

throbbing  headache  for  several  hom-s,  general  lethargy  for 

24  hours. 

headache,  nausea,  chill. 

dizziness  immediately  after  gassing,  sharp  headache  for  9 

hours. 

throbbing  headache  for  9  hours. 

frontal  headache  for  6  hours. 

severe  headache,  vomited,  in  bed  5  hours. 

severe  headache  for  20  hours,  legs  weak. 

severe  headache  lasting  5  hours. 

severe  occipital  headache  for  8  hours. 

severe  headache,  dizzy,  nauseated,  ringing  in  ears,  for  7 

hours. 

persistent  headache  and  nausea  for  8  hours. 

severe  headache  and  nausea  for  6  hours. 

pounding  in  ears,  violent  headache  and  nausea,  headache 

for  48  hours. 

severe  headache,  faintness  for  several  hours. 

headache  and  nausea. 

severe  headache  and  vomiting. 

very  faint  and  weak,  severe  headache  for  72  hours. 

J.  Olean 

L.  Peroff 

M.  O'ConncIl 

J.  Fleming 

E.  Waters 

M.  Glazer 

H.  Farrell 

E.  Tolstoi 

E.  Shorr 

H.  Bailey 

H.  Langner 

E.  Wakeman 

A.  Wakeman 

P.  Susman 

J.  Sigal 

reach  the  dangerous  concentration  of  fif- 
teen parts  in  10,000  in  three  minutes.  Ow- 
ing to  the  insidious  and  usually  accidental 
character  of  carbon  monoxide  poisoning  in 
such   garages,   however,    nothmg   bearing 

TABLE  8. —  RESULTS  OF  EXPOSURE  OF 
HORSES  TO  EXHAUST  GAS 


Time 

Concen- 
tration of 

coin 
Chamber 

Percentage 
Saturation  of  Blood 

Date 

White 
Horse 

Bay 

Horse 

Remarks 

Hours 

Parts  in 

10,000 

3/17/20 

1 

2.5 

11 

no  symptoms 

3/17/20 

1 

5.0 

20 

20 

u 

3/19/20 

1 

5.0 

23 

25 

a 

particularly  on  our  problem  is  to  be  learned 
from  them  which  could  not  be  more  ac- 
curately determined  in  our  experimental 
chamber. 

At  first  it  would  appear  that  important 
information  might  be  obtained  from  the 


conditions  occurring  in  large  public  garages 
and  repair  shops.  On  investigation  of  a 
number  of  such  places  we  found  that,  even 
in  those  recently  built  and  supplied  (usually 
more  or  less  imperfectly)  with  artificial 
ventilation,  the  employees  frequently  have 
slight  headaches,  while  severe  headache, 
nausea  and  emotional  disturbances,  rang- 
ing from  mere  unreasonableness  up  to 
hj'sterical  mirth,  anger  or  grief,  or  even 
maniacal  manifestations,  are  not  very  un- 
usual. There  seems  to  be  a  general  recogni- 
tion that  "it  is  not  gasoline  but  the  burnt 
gas"  which  produces  these  conditions.  Our 
inquiries  have  also  elicited  information  re- 
garding an  occasional  death  in  which  the 
victim  had  crawled  imder  a  car  when  its 
engine  was  running,  or  when  the  engine  of 
a  standing  car  ahead  was  "idling."  When 
it  came  to  getting  samples  of  air  for  analy- 
sis from  garages,  however,  we  soon  found 
that  we  could  get  anything  that  we  wanted, 


144 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


high  or  low,  and  that  the  figures  had,  there- 
fore, little  value  without  more  elaborate 
supervision  of  the  personnel  than  we  could 
provide. 

Conditions  such  as  may  occur  in  tminels 
appear  to  be  afforded  in  the  taxicab  drive- 
way and  stand  below  the  Grand  Central 
Railwaj'  Station,  New  York  City.  The 
general  public  passes  through  this  place, 
many  thousands  per  day.  The  taxicab 
drivers  sometimes  wait  half  an  hour  for  a 
passenger,  and  the  starters  and  markers  are 
on  duty  for  four  or  five  hours  at  a  time. 

We  learned  on  inquiry  that  up  to  a  few 
months  before  this  investigation  a  type  of 
car  had  been  in  use  which  produced  a  con- 
siderable amount  of  smoke  and  that  at  that 
time  headache  and  nausea  were  common. 
Recently,  however,  another  type  of  car 
producing  very  little  smoke  has  been  intro- 
duced and  symptoms  of  gassing  appear 
now  to  be  rare. 

In  order  to  define  the  conditions  at  the 
taxicab  driveway  and  stand,  members  of 
the  staff  of  this  investigation  spent  several 
hours  near  the  starters'  position  and  took  a 
number  of  samples  of  air  for  analysis,  with 
the  following  results: 

March  I'i,  lO'-iO.  A  mild,  damp  afternoon  and 
evening.  3.45  P.M.  A  sample  of  air  taken  soon  after 
a  number  of  cars  had  gone  through  contained  0.36 
parts  carbon  monoxide  in  10,000. 

O.i.j  P.M.  A  sample  taken  after  forty  cars  had 
gone  through  in  fifteen  minutes  contained  1.30  parts 
carbon  monoxide  in  10,000. 

10.35  P.M.  After  three  cars  had  passed  in  ten 
minutes,  the  carbon  monoxide  concentration  was 
O.-lo  parts  in  10,000. 

11.30  P.M.  Fifteen  cars  passed  through  in  five 
minutes.  A  sample  taken  ten  minutes  later  contamed 
1.78  parts  in  10,000. 

On  another  occasion  a  series  of  samples  were 
taken  and  yielded  the  following  figures:  0.45,  1.78, 
0.36,  i.Vl,  and  l.i7. 

It  appears  from  these  data  that  the  air  is 
occasionally  vitiated  for  a  time  with  as 
much  as  two  parts  of  carbon  monoxide  in 
10,000,  but  that  with  the  ventilation  pro- 


vided by  large  fans  the  concentration  of 
carbon  monoxide  soon  falls  again  decidedly 
below  one  part  in  10,000.  There  are  now, 
so  far  as  we  can  learn,  no  complaints  from 
the  public,  and  the  taxicab  drivers  have 
only  an  occasional  headache,  when  a  line 
of  cars  stands  for  a  long  time  with  engines 


VII.  CoMPAR.\TivE  Toxicity  of  Pure 
Carbon  Monoxide,  Illumin.\ting  Gas, 
Exhaust  Gas  from  Gasoline,  Exh.\ust 
Gas  from  Coal  Distillate  and  Gasoline 
Vapor 

The  general  agreement  between  the  ex- 
periments with  pure  carbon  monoxide 
mixed  with  air  in  Section  II  and  the  results 
with  exliaust  gas  in  Section  IV  indicates 
strongly  that  in  the  concentrations  occur- 
ring in  the  large  chamber  carbon  monoxide 
was  the  only  substance  of  sufficient  toxicity 
and  present  in  sufficient  amount  to  have 
any  considerable  physiological  effect.  All 
of  the  data  in  both  of  these  series  of  ex- 
periments were,  however,  based  upon  low 
concentrations  of  the  gas  and  the  deduc- 
tions from  them  might  not  apply  ecjually  to 
high  and  lethal  concentrations. 

We  have,  therefore,  thought  it  well  to 
check  these  results  by  means  of  observa- 
tions on  animals  in  high  concentrations  of 
gas.  For  this  jjiu'pose  dogs  were  used.  The 
animal  in  each  case  was  placed  in  a  cube- 
shaped  plateglass  chamber  measuring  about 
3  feet  on  a  side.  The  gas  to  be  tested  was 
mixed  with  air  in  a  gasometer  of  several 
hundred  liters  capacity,  so  that  the  carbon 
monoxide  concentration  was  about  0.3  to 
0.4  i)er  cent.,  or  thirty  to  forty  parts  in 
10,000.  From  the  gasometer  the  gas  mix- 
ture was  passed  into  the  chamber  through 
a  tube  by  a  small  electrically  driven  air 
blower.  Another  tube  from  the  chamber 
led  outdoors.  I^sually  the  gas  was  run  in  at 
such  a  rate  that  the  animal  was  at  the  point 
of  death  in  thirtv  to  thirtv-five  minutes. 


HENDERSON  —  PHYSIOLOGICAL  EFFECTS  OF  EXHAUST  GAS       145 


The  animal  was  then  removed  from  the 
chamber  and  a  sample  of  blood  was  drawn 
for  analysis  by  the  carmine  titration 
method. 

The  technical  details  of  the  analysis  of 
carbon  monoxide  in  air  and  in  blood  will  be 
fouiid  in  the  full  report. 

(a)  Experiments  with  Pure  Carbon  Monoxide 
Mixed  with  Air.  —  In  this  atmosphere  the  animals 
became  unconscious  with  no  more  apparent  discom- 
fort than  if  anesthetized  witii  ether.  The  hhxxl  of 
five  dogs  at  the  point  of  death  contained  the  foHovv- 
ing  percentages  of  carbon  monoxide:  87,  82,  84,  79, 
88;  average  8-1. 

(6)  Experiment.^  irilli  Illiiiiiiimting  Ga.s  Mixed 
with  Air.  —  In  such  an  atmosphere  the  s\-mptoms 
during  intoxication  differed  in  some  respw-ts  from  tiie 
preceding  group.  There  occurred  in  all  cases  more 
rapid  C(>lla|)se  and  distinctly  greater  rcsi)irat(>ry  ex- 
citement. Nausea  and  vomiting,  wliich  were  lacking 
in  the  experiments  with  pure  carbon  monoxide,  oc- 
curred in  all  the  animals  of  this  second  group.  These 
observations  and  the  fact  that  death  ensued  though 
a  lower  percentage  of  carbon  monoxi<le  existed  in  the 
blood  indicate  that  illuminating  gas  contains  some 
substance,  or  substances,  which  render  it  distinctly 
more  toxic  than  an  e(|Ual  amount  of  pure  carbon 
monoxide.  Tlie  blood  of  the  five  dogs  u.sed  in  these 
experiments  contained  at  the  point  of  death  the 
following  percentages  of  carbon  monoxide:  74,  ()7,  76, 
71;  average  70. 

(f)  Experiment.^  with  Exhaii.it  Ga.s  from  a  Car 
Using  Ga.ioline.  —  P'or  these  tests  the  three  com- 
monest varieties  of  gasoline  sold  locally  were  used 
successively.  A  large  rul>ber  bag  was  attached  to  the 
exhaust  of  a  car  (one  in  good  condition,  with  an 
efficient  and  smooth  running  engine),  while  it  was 
standing  with  the  engine  running  "idle."  This  gas 
was  analyzed  for  carbon  monoxide  by  means  of  an 
Orsat  ap])aratus  in  the  usual  way.  The  gas  was  then 
mixed  with  air  in  the  large  gasometer  to  approxi- 
mately the  same  concentration  of  carbon  monoxide 
as  in  the  previous  experiments  and  was  then  ad- 
ministered to  animals  in  the  glass  chamber.  In  these 
experiments  the  animals  were  at  the  point  of  death  in 
approximately  the  same  time  as  in  the  first  series  of 
ex-periments  under  (a)  above.  The  symptoms  were 
similar  to  those  from  pure  carbon  monoxide  and 
unlike  those  from  illimiinating  gas.  The  percentages 
of  carbon  monoxide  in  tlie  blood  were  also  similar  to 
the  first  series,  but  liigher  than  the  second.  Evi- 
dently carbon  monoxide  was  here  practically  the  only 
toxic  substance.    The  blood  of  the  five  dogs  used  in 


this  group  of  experiments  contained  at  the  point  of 
death  the  following  percentages  of  carbon  monoxide: 
84,  8(),  83.  81,  81;  average  83. 

(d)  Experiments  with  Exhaust  Gas  from  a  Car 
Using  Coal  Distillate.  —  For  the  opportunity  to 
make  these  tests,  we  are  indebted  to  the  New  Haven 
Gas  Company  which  very  kindly  sent  a  car  charged 
with  coal  distillate  to  the  laboratory  and  allowed  us 
to  obtain  a  bag  of  exhaust  gas  as  in  the  preceding 
experiments.  Two  dogs  were  exposed  to  this  gas, 
exactly  as  the  animals  had  been  exposed  in  the  pre- 
vious ex|)eriments  to  exhaust  from  gasoline,  and 
died  with  symptoms  like,  but  more  marked  than, 
those  of  the  dogs  poisoned  with  illuminating  gas. 
The  blood  of  these  two  animals  had  a  decided  brown- 
ish tinge  indicating  a  marked  destructive  influence 
upon  the  hemoglobin  of  the  blood.  It  is  known  that 
benzol  has  such  an  rffect. 

The  composition  of  the  coal  distillate,  according 
to  figures  kindly  furnished  by  the  chemist  of  the  Gas 
Company,  was: 

Benzol 09.0  per  cent. 

Toluol 15.5     " 

Solvent  naphtha 13.5     "        " 

Heavy  naplitha 2.0     " 

Total 100.0     " 

The  blood  of  the  two  dogs  used  in  these  experi- 
ments containe<l  at  the  point  of  death  the  following 
percentages  of  carbon  monoxide:  (iO,  04;  average  Gi. 
(<■)  Experiments  with  Gasoline  Vapor.  —  The 
results  of  our  experiments  with  gasoline  vapor  are 
given  in  The  .Anesthetic  and  Conrulsant  Effects  of 
Gasoline  Vapor,  by  Howard  W.  Haggard  (9). 

VHI.  Principal  Conclusions 

The  general  standards  at  which  we  arrive 
(pp.  80  89*  and  l;58)  are:  When  the  time 
in  hoiu's  multi])lied  by  the  concentration 
of  carbon  monoxide  in  parts  per  10,000  of 
air  equals  3,  there  is  no  perceptible  physi- 
ological effect.  When  it  etiuals  6,  there  is  a 
just  perceptible  effect.  When  it  equals  9, 
headache  and  nausea  are  induced.  When  it 
equals  15  or  more,  the  conditions  are  dan- 
gerous to  life. 

If  the  volume  of  breathing  is  increased  by 
exercise  (even  by  slow  walking,  and  cor- 
respondingly more  by  physical  work)  the 
rate  of  absorption  of  carbon  monoxide  is 
increased  proportionally. 

*  See  the  preceding  issue  of  this  Journ'.^l. 


146 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


After  return  to  fresh  air,  the  elimination 
of  carbon  monoxide  through  the  lungs  pro- 
ceeds at  a  rate  of  30  to  60  per  cent,  reduc- 
tion of  the  blood  saturation  per  hour. 

In  the  exhaust  gas  from  gasoline,  carbon 


monoxide  is  the  only  considerable  toxic 
constituent.  In  the  exhaust  gas  from  coal 
distillate  (benzol,  etc.),  and  in  illuminat- 
ing gas,  there  are  present  accessory  toxic 
substances. 


BIBLIOGRAPHY 

(The  following  is  a  list  of  references  which  have  been  consulted  during  the  preparation  of  this  report. 
References  1,  2,  and  3  accompany  the  first  part  of  this  article,  wljich  appeared  in  the  preceding  issue  of 

this  JOUHNAL.) 


4.  Douglas,  C.  G.,  Haldane,  J.  S.,  and  Haldane, 
J.  B.  S.:  The  Laws  of  Combination  of  Haemo- 
globin with  Carbon  Monoxide  and  Oxygen. 
Jour.  Physiol.,  1912-1913,  44,  275. 

5.  Haldane,  J.  S.,  and  Lorrain  Smith,  J. :  The  Mass 
and  Oxygen  Capacity  of  the  Blood  in  Man. 
Joiu-.  Physiol.,  1899-1900,  25,  331. 

6.  Haldane,  J.  S. :  The  Action  of  Carbonic  Oxide 
on  Man.   Jour.  Physiol.,  1895,  18,  430. 

7.  Report  of  the  Board  of  Trade  on  the  Ventilation 
of  the  Metropolitan  Railway  Tunnels.  Parlia- 
mentary Paper  C8684,  1897. 

8.  Burrell,  G.  A.:  The  Use  of  Mice  and  Birds  for 
Detecting  Carbon  Monoxide  after  Mine  Fires 
and  Explosions.  U.  S.  Bur.  Mines,  Tech. 
Paper  11,  1912. 


9.  Haggard,  H.  W. :  The  Anesthetic  and  Convul- 
sant  Effects  of  Gasoline  Vapor.  Jour.  Phar- 
macol, and  Exper.  Therap.,  1920,  16,  401. 

10.  Henderson,  Y. :  Carbon  Monoxid  Poisoning. 
Jour.  Am.  Med.  Assn.,  1916,  67,  580. 

11.  Henderson,  Y.,  and  Haggard,  H.  W.:  The 
Elimination  of  Carbon  Monoxide  from  the 
Blood  after  a  Dangerous  Degree  of  AsphjTcia- 
tion  and  a  Therapy  for  Accelerating  the  Elim- 
ination. Jour.  Pharmacol,  and  Exper.  Tlierap., 
1920,  16,  11. 

12.  Haggard,  H.  W.,  and  Henderson,  Y. :  Papers 
to  appear  in  Jour.  Biol.  Chem.,  Am.  Jour. 
Phvslol.,  and  Jour.  Am.  Med.  Assn. 


I 
I 


BOOK  REVIEWS 


147 


BOOK  REVIEWS 


The  Community  Health  Problem.  By  Athel 
Campbell  Biirnham,  M.D.,  Health  Service,  Atlantic 
Division,  American  Red  Cross;  Attending  Surgeon, 
Volunteer  Hospital,  New  York  City;  Lieutenant 
Colonel,  Medical  Reserve  Corps,  U.  S.  Army;  Fel- 
low New  York  Academy  of  Metlicine.  Cloth.  Pp. 
149  and  index.  New  York:  The  Macmillan  Com- 
pany, 1920. 

This  book  is  a  brief  and  readable  presenta- 
tion of  public  health  material,  well  suited  for 
non-technical  courses  in  general  hygiene.  The 
author  has  desired  to  give  his  readers  a  concej)- 
tion  of  the  various  fields  into  which  preventive 
medicine  has  crept  and  the  maiuier  and  success 
with  which  it  has  operated.  Industrial  hygiene 
is  included  in  this  group  and  receives  brief  but 
di.scerning  treatment. 

It  is  unfortunate  that  a  chapter  is  not  devoted 
to  the  varicHis  types  of  workers  necessary  in 
the  diH'ercnt  branches  of  connnunity  health, 
together  with  a  certain  amount  of  information 
as  to  their  training.  The  j)ractical  usefulness  of 
the  book  for  elementary  students  would  be 
augmented  by  such  an  addition.  —  Cecil  K. 
Drinker. 

Human  Efficiency  and  Levels  of  Intelligence. 
By  Henry  Herhert  (ioddanl.  Director  of  the  Bureau 
of  Juvenile  Researcii  of  t)lii(>.  Cloth.  Pp.  l-'8. 
Princeton:  i'rinceton  L'niversity  Pres.s,  1920;  Lon- 
don :  O.vford  University  Press,  1920. 

It  is  no  exaggeration  to  say  that  this  short 
series  of  lectures,  delivered  at  Princeton  Uni- 
versity in  April,  1919,  enunciates  a  point  of 
view  that  sliould  not  only  be  understood  by 
everyone  interested  in  efficiency  and  hygiene 
problems,  but  also  by  every  citizen  who  wishes 
to  cast  an  intelligent  vote.  Although  no  ori^^inal 
work  is  published  in  the  book,  it  brings  to- 
gether evidence  from  various  sources  in  such  a 
convincing,  even  dramatic  way,  that  the  reader 
finds  himself  awakened  to  the  realization  that 
the  doctrine  of  mental  levels  is  a  social  conception 
of  the  first  magnitude. 

The  doctrine  stands  mainly  on  two  well- 
established  facts:  first,  that  the  intellectual 
development  is  largely  independent  of  what  we 
call  learning  or  knowledge;  second,  that  not  all 
persons  develop  to  the  highest  level  or  even 
near  to  it;  many  stop  at  some  one  of  the  lower 
levels  of  childhood. 

The  important  thing  for  us  to  learn  from  the 
book  is  that  the  number  of  people  of  relatively 


low  intelligence  is  vastly  greater  than  is  gen- 
erally appreciated,  and  that  this  mass  of  low 
level  intelligence  is  a  menace  to  democracy 
unless  it  is  recognized  and  proj^erly  treated. 
The  data  are  obtained  from  several  sources  — 
the  experience  at  institutions  for  the  feeble- 
minded, the  Bureau  of  Juvenile  Research  in 
Ohio,  the  statistics  of  the  Department  of  Labor, 
school  statistics  from  the  Department  of  Edu- 
cation, and  the  report  of  the  General  Staff  on 
Psychological  Tests  in  the  Army.  The  sources 
are  authoritative,  and  the  fact  that  remarkably 
similar  figures  are  obtained  from  each  .source 
forces  us  to  accept  the  statements  as  proven 
facts,  however  upsetting  these  facts  may  be  to 
our  preconceived  ideas  that  we  are  all  born 
equal.  The  army  figures  show  that  70  per  cent, 
of  the  1,700, 000  men  examined  were  below  the 
mental  age  of  fifteen,  and  that  "io  per  cent,  were 
morons.  These  figures  being  from  the  drafted 
army  must  certainly  be  a  fair  sample  of  our 
whole  male  population.  The  school  figures 
from  the  Department  of  Kdui'ation  show  th.at 
()7  per  cent,  of  schoolchildren  do  not  finish  the 
eighth  grade,  and  that  '-26  per  cent,  do  not  finish 
the  fifth  grade  —  a  result  remarkably  parallel  to 
the  army  figures.  The  Department  of  Labor 
tells  us  that  (58  per  cent,  of  wage  earners  get  less 
than  $15  a  week  —  at  least,  an  analogous 
observation. 

Can  we  hope  to  have  a  successful  democracy 
when  the  average  mentality  is  thirteen?  The 
answer  is  that  the  social  efficiency  of  a  grouj)  of 
human  beings  depends  upon  recognizing  the 
mental  limitations  of  each  one  and  of  so  or- 
ganizing society  that  each  person  has  work  to 
do  that  is  wuthin  his  mcntid  capacity  and  at  the 
same  time  calls  for  all  the  ability  that  he  pos- 
sesses. In  .short,  whenever  the  4  per  cent,  at 
the  top  of  the  scale  choose  to  devote  their 
superior  intelligence  to  undersUmding  the 
lower  mental  levels  and  to  the  problems  of  the 
comfort  and  happiness  of  the  other  96  per  cent., 
they  will  be  elected  the  rulers  of  the  realm  and 
then  will  come  perfect  government.  But  that 
4  per  cent,  must  have  what  we  call  the  "human 
quality"  and  must  learn  to  take  seriously  the 
responsibility  of  their  position  —  they  must 
have  the  desire  to  make  all  people  happy. 
Then,  in  a  democracy  where  every  person  has 
the  right  to  vote  for  those  who  shall  rule  over 
him,  the  masses  wiU  vote  for  the  best  and  most 


148 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


intelligent  if  they  are  made  to  feel  that  these 
same  intelligent  people  have  the  welfare  of  the 
masses  at  heart. 

The  failure  to  appreciate  the  facts  upon 
which  the  doctrine  of  mental  levels  is  based  has 
resulted  in  a  vast  amount  of  delinquency,  and 
such  delinquency  impairs  the  efficiency  of  the 
total  group  to  an  extent  little  appreciated.  It 
is  no  longer  to  be  denied  that  the  greatest 
single  cause  of  delinquency  and  crime  is  low 
grade  mentality.  Apart  from  delinquency  these 
people,  in  their  present  disorganized  state,  are 
extremely  inefficient.  It  is  their  history  (so 
constant  as  to  be  almost  diagnostic)  that  they 
are  constantly  changing  jobs.  We  have  made 
no  serious  attempt  to  fit  the  man  to  the  job. 
No  attempt  has  ever  been  made  to  ascertain 
what  grade  of  intelligence  is  required  of  any  of 


the  multitude  of  occupations.  Some  progres- 
sive employers  in  industries  have  inaugurated  a 
sort  of  tryout  system;  but  this  is  a  crude  make- 
shift in  comparison  to  the  results  of  a  scientific 
determination  of  the  mental  level  of  the  individ- 
ual, coupled  with  a  study  of  the  amount  of 
intelligence  required  for  particular  work. 

"When  one  contemplates  the  enormous  pro- 
portion of  misfits  that  must  exist  in  the  indus- 
trial world  and  that  such  misfits  mean  dis- 
content and  unhappiness  for  the  employee,  one 
can  but  wonder  how  much  of  the  present  unrest 
in  such  circles  is  due  to  this  fact.  A  man  who  is 
doing  work  that  is  well  within  the  capacity  of 
his  intelligence  and  yet  that  calls  forth  all  his 
ability  is  apt  to  be  happy  and  contented  and  it 
is  very  difficult  to  disturb  any  such  person  by 
any  kind  of  agitation."  —  Stanley  Cobb. 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


Volume  III 


seitemi{?:r,  1921 


Number  j 


FATIGUE  AND  ERROR  IN  A  :\IENTAL  OCCUPATION* 

J.  p.  BAUMBERGER 

(From  the  Laboratory  of  Physiology,  Stanford  University) 


RECENTLY  some  doubt  has  been 
thrown  upon  the  use  of  output  studies 
as  a  criterion  of  fatigue  in  inchistrial  occu- 
pations (1).  The  data  reported  in  (liis 
paper,  however,  show  thai  the  number  of 
errors  as  well  as  the  out])ut  varies  during 
the  day  in  a  manner  typical  of  fatigue 
curves.  Link  ("2)  in  his  investigations  has 
used  psychological  tests  as  a  methotl  of 
studying  fatigue,  but  although  the  tests 
were  given  at  various  times  during  the 
day,  they  showed  very  little  indication  of 
fatigue.  In  this  paper  output  rate  and 
error  in  a  normally  recurring  routine 
operation  of  short  diualion  are  used  as  a 
measure  of  fatigue. 

Process 

Permission  to  work  in  the  auditing  de- 
partment of  a  large  railroad  company  was 
obtained  through  the  courtesy  of  the  su- 
perintendent, and  the  records  of  eighteen 
women  clerks  were  compiled.  The  proc- 
esses studied  were  the  writing  in  of  names 
on  pay  checks  with  pen  and  ink,  and  the 
typing  in  of  amounts  using  a  machine,  in 
each  case  the  name  or  amount  being  ob- 

*  The  author  wishes  to  acknowlerlse  his  indebtedness  to 
Dr.  E.  G.  Martin  for  advice  and  to  Miss  Edna  Perry  for  as- 
sistance in  connection  with  this  paper.  Received  for  publi- 
cation April  26,  1921. 


tained  from  the  payroll.  Six  women  were 
engaged  in  writing  in  amounts,  and  twelve 
in  writing  in  names.  ""I'hree  of  the  clerks 
worked  on  both  processes. 

It  is  the  rule  in  this  company  that  all  pay 
checks  must  be  numbered  con.secutively, 
and  that  the  numbers  of  all  checks  on 
which  mistakes  are  made  must  be  re- 
corded. Eurthermore,  the  following  data 
are  kejjt  in  tal)ular  form  l)y  the  head  clerk: 
time  consumed  in  writing  and  comparing 
l)ayroll  vouchers  —  name  of  clerk,  com- 
mencing number,  closing  number,  number 
of  names  of  payees  written  in  with  pen  (or 
amounts  tyjjcd  in  by  machine)  —  time  com- 
menced, time  finished,  minutes,  number  of 
checks  canceled. 

Tkeat.mext  of  Data 

Erom  the  mass  of  data  on  the  time  con- 
sumed in  writing  and  comi)aring  payroll 
vouchers,  I  cojjied  all  the  records  for  each 
of  eighteen  women  clerks  for  the  month  of 
September,  1919.  The  total  number  of 
checks  involved  was  114,314.  During  this 
month  the  clerks  had  worked  on  pay  checks 
on  about  fifteen  to  twenty  days,  but  only 
for  a  few  hours  on  each  of  these  days,  as  a 
transcription  from  our  data  clearly  shows. 
(Table  1.)    The  remainder  of  the  time  was 


149 


150 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


spent  in  the  routine  work  of  the  auditing 
department. 

The  data  were  treated  as  follows :  All  the 
output  records  for  one  individual  for  one 
process  were  grouped  together  by  hours. 
When  a  period  extended  into  two  hours  the 


process.  The  advantage  of  the  data  thus 
obtained  is  its  freedom  from  differences 
due  to  skill  and  to  the  different  sjieeds  of 
the  two  processes  of  writing  names  and 
amounts.  The  percentage  output  for  each 
hour  for  the  whole  group  was  found  by  ob- 


TABLE  1.  — SAMPLE  OF  DATA  SHOWING  TIME  CONSUMED  IN  WRITING  AND  COMPARING 

PAYROLL  VOUCHERS 


Name 

Date 

Number  of 
Names  by  Pen 

Number  of 

Amounts  by 

Machine 

Number  of 
Checks 
Canceled 

Time 
Commenced 

Time 
Finished 

Minutes 

H 

9/5/19 

143 

7 

1:00 

1:35 

35 

125 

1 

11:10 

11:40 

30 

125 

0 

(12)11:55 

1:00 

25 

151 

6 

3:00 

3:50 

50 

156 

3 

(2)      1:40 

2:35 

55 

156 

i 

2:35 

3:00 

25 



172 

6 

(4)     3:50 

4:30 

40 

record  was  assigned  to  the  hour  nearest  the 
center  of  the  period  —  e.  q.,  1.40-2.35  was 
put  in  the  2-3  hour,  and  11.55-1.00  in  the 
12-1  hour.  The  output  rate  per  hour  was 
then  calculated  for  each  hour  of  the  day  and 


100 

- 

eo 

- 

M 

40 

eo 

0 

9-9        9-10   lO-ll    11-ia        12-1      1-2 


2.Z       3-4      i-e 


Fig.  1.  —  Solid  line  =  percentage  output  rate  by  hours. 
Broken  line  =  percentage  error  output  rate  by  hours. 

compared  with  the  grand  arithmetical 
mean  of  all  the  hourly  records  of  the  clerk. 
Calling  the  latter  figure  100.  by  a  simple 
proportion  the  figures  of  the  individual 
hours  were  reduced  to  percentages  of  the 
grand  average.  This  statistical  treatment 
was  gone  through  for  each  clerk  and  each 


taining  the  true  mean  of  a  frequency  curve 
in  which  the  percentage  outputs  for  the 
hour  for  each  indi\'idual  were  the  quanti- 
ties, and  the  number  of  checks  on  which 
each  quantity  had  been  based  were  the 
frequencies.  This  method  was  followed  on 
the  assumption  that  the  percentage  out- 
puts having  the  largest  number  of  checks 
as  a  basis  were  the  most  reliable. 

Checks  were  canceled  when  errors  were 
made;  therefore  a  record  of  the  canceled 
checks  for  each  hour  and  each  individual 
gives  the  number  of  errors  made.  The  per- 
centage of  error  for  each  individual  for 
each  process  and  each  hour  was  calculated 
and  compared  with  the  day's  average  errors 
as  100,  and  these  figures  were  considered  as 
quantities  in  a  frequency  distribution  with 
the  number  of  checks  as  frequencies,  and 
the  true  mean  obtained  for  each  hour. 

Output  and  Error 

The  percentage  output  rate  by  hours  is 
shown  in  Table  2  and  Figure  1.  It  will  be 
seen  that  the  outimt  rate  starts  at  106.8, 
falls  to  100.5  in  the  second  hour,  goes  up  to 
111.1  in  the  third,  and  falls  at  noon  to  94.2. 
Lunch  is  had  between  12  and  1  with  fortv 


BAUMBERGER  — FATIGUE  AND  ERROR  IN  MENTAL  OCCUPATION      151 


minutes  allowed,  therefore  the  output  rate 
of  94.8  for  this  hour  may  not  be  significant. 
The  output  rate  at  1  p.m.  is  96.7  and  in- 
creases to  100  by  3  o'clock,  falling  only 
slightly  (to  98.8)  at  the  end  of  the  day.  The 
output  curve  is,  therefore,  not  very  typical 


110.3  at  noon.  At  1  o'clock  it  starts  at  111.8 
(the  highest  for  the  day),  falls  in  the 
second  hour  to  99.9,  then  goes  up  to  109.4 
at  the  end  of  the  day.  The  morning  aver- 
age is  93.6,  and  the  afternoon  average 
105.3    Not  considering  the  12-1  hour,  the 


TABLE  2.  —  HOURLY  OUTPUT  RATE  AND  RATE  OF  ERRORS 


Time 


8-9 


9-10 


10-11 


11-14 


1*-1 


Hour 


Output 

Mean 

Standard  deviation .... 
Probable  error  of  mean . 


106.8 

22.1 

0.4 


100.5 

11.8 

0.2 


111.1 

8.2 
0.12 


94.2 
7.3 
0.12 


94.8 
7.6 
0.06 


96.7 
4.9 
0.04 


97.3 
15.8 
0.34 


100.0 
16.5 
0.19 


98.8 
10.5 
0.12 


Difference 

Probable  error  of  difference 

Number    of    times    P.  E.  D.     is 
contained  in  difference 


6.3 
0.44 

14.3 


10.6 
0.42 

25.7 


16.9 
0.17 

99.4 


0.6 
0.22 


2.7 


1.9 
0.23 

8.3 


0.6 
0.35 


2.7 
0.35 

7.7 


1.2 
0.5 

2.4 


A.M.  Average  103.1 


P.M.  Average  97.6 


Error 

86.1 
34.2 
0.21 

76.6 

101.6 

110.3 

101.9 

1U.8 

99.9 

103.7 

109.4 

20.0 
0.1 

20.4 
0.12 

28.4 
0.14 

34.1 
0.25 

33.8 
0.27 

25.6 
0.18 

28.9 
0.21 

37.3 

Probable  error  of  mean 

0.42 

Difference   

9.5 

25  0 

8,7 

8-4 

9.fl 

11  9 

3.8 

HT 

Probable  error  of  difference 

Number   of    times    P.  E.  D.    is 
contained  in  difference 

0.2J 
41.3 

1 

a 

167 

15 
0 

0 
48 

18 
3 

0 
30 

28 
0 

0 
26 

37 
8 

0 
37 

32 
2 

0.28 
13.6 

0.47 
12.1 

A.M.  Average  93.6 


PJtf'.  Average  105.3 


Quality  of  n'ork 116.0 


131.0 


88.4 


98.2 


84.8 


99.9 


96.5 


91.3 


A.M.  .iverage  108.5 


P.M.  Average  9i.l 


Efficiency . 


124.0 


131.0 


109.5  85.3 


93.0 


86.5 


97.3 


103.7 


90.3 


A.M.  Average  112.i- 


P.M.  Average  9i.3 


of  fatigue;  it  shows,  however,  the  char- 
acteristic higher  output  of  morning  (103.1) 
over  afternoon  (97.5). 

The  percentage  output  rate  of  errors  by 
hours  is  also  shown  in  Table  2  and  in 
Figure  1.  The  percentage  rate  of  errors 
starts  at  86.1  falls  to  76.6,  then  goes  up  to 


curve  of  percentage  error  output  is  the  con- 
verse of  a  typical  output  curve.  This  is 
shown  if  we  plot  the  reciprocals  of  the  per- 
centage error  output,  i.  e., 

1  

» 

percentage  error  output 

which  we  will  call  quality  of  work.     This 


152 


THE  JOLTINAL  OF  INDUSTRIAL  HYGIENE 


is  sliowTi  in  Table  2  and  in  Figure  2.  The 
quality  is  good  to  start  (116),  better  in 
the  second  hour  (131),  but  then  falls  off  to 
88.4  at  noon.  It  starts  low  in  the  afternoon 
(84.8),  climbs  to  99.9  in  the  second  hour, 
and  falls  off  to  91.3  at  the  end  of  the  day. 
The  morning  quality  average  is  108.5  as 
compared  with  94.1  for  the  afternoon. 

The  efficiency  of  the  workers  for  each 
hour  is  determined  by  their  output  and  the 


120 

100 

"1 

80 

«0 

40 

20 
0 

6-i 

S-ifl 

1.6- 

J.I 

11-14 

T7 


n. 


Fig.  2.  —  Solid    line  =  efficiency 
Hue  =  quality  of  work  by  hours. 


\-t    'J-S    'i-i 
by    hours. 


Broken 


quality  of  the  work  and  may  be  obtained 
by  dividing  the  percentage  output  rate  by 
the  percentage  error  output,  for  each  hour. 
This  is  called  the  efficiency  curve  and  is 
showTi  in  Figure  2  and  in  Table  2.  The 
efficiency  starts  high  at  124  and  climbs  in 
the  second  hour  to  131,  then  falls  by  noon 
to  85.3.  At  1  P.M.  it  starts  at  80.5,  climbs  to 
103.7  in  the  third  hour,  and  falls  to  90.3  by 
the  end  of  the  day.  The  morning  average 
is  112.4  and  the  afternoon  94.2.  Tliis  curve 
has  also  most  of  the  characteristics  of  a 
fatigue  curve. 

Discussion 

The  data  in  Table  2  show  that  produc- 
tion is  maintained  more  evenly  throughout 


the  day  than  quality.  Thus,  the  difference 
between  the  highest  and  lowest  percentage 
output  hours  is  only  16.9,  as  compared  with 
35.2  for  percentage  error  output.  It  is  prob- 
able that  the  wTiting  or  typing  is  an  auto- 
matic movement  (3)  in  which  the  individ- 
ual is  unconscious  of  the  figures  read  but 
conscious  of  the  (voluntary)  movements  re- 
quired to  write  the  name  or  the  number. 
In  order  to  be  aware  of  errors  made,  a 
higher  form  of  consciousness  —  attention 
—  is  required.  It  would  seem  that  the  out- 
put is  maintained  by  the  lower  type  of 
consciousness,  but  the  quality  varies  with 
the  higher  type  of  attention  which  is  more 
readily  subject  to  fatigue.  Attention  is 
more  easih'  diverted  than  unconscious 
volition,  and  this  may  explain  why  the  per- 
centage output  of  error  is  more  variable 
then  the  percentage  output. 

In  this  connection  Spaeth  (1,  p.  32)  says: 

.  .  .  The  question  now  arises  as  to  what  light  the 
output  curve  throws  on  the  occurrence  of  fatigue. 
We  may  say  at  once  that  if  by  fatigue  we  mean  a 
lowered  capacity  for  work,  and  the  tlrop  in  output 
indicates  a  lowered  capacity  for  work,  it  must  simul- 
taneously indicate,  by  definition,  the  presence  of 
fatigue.  How  much  of  this  fatigue  is  due  to  the 
work  and  how  much  to  other  conditions,  output 
curves  do  not  tell. 

From  the  data  above  it  would  seem  that 
even  though  the  percentage  output  of  the 
individual  does  not  follow  a  fatigue  curve 
very  closely,  the  quality  of  the  work  does 
so  to  a  very  decided  degree.  It  appears, 
therefore,  that  the  decline  in  output  at  the 
end  of  the  morning  and  the  lower  output  of 
the  afternoon  are  really  indicative  of 
fatigue  —  that  is,  if  it  is  admitted  that  les- 
sened attention  is  due  to  fatigue.  The  fact 
that  production  is  maintained  at  so  near  a 
level  througliout  the  day  would  indicate 
that  the  workers  are  endeavoring  to  keep 
up  their  output;  in  .spite  of  this,  however, 
the  errors  increase.  It  would  seem,  there- 
fore, that  real  fatigue  is  the  cause  of  the 
lowered  output. 


BAUMBERGER  — FATIGUE  AND  ERROR  IN  MENTAL  OCCUPATION      153 


Link  (S)  made  a  study  of  the  quality  of 
the  work  done  in  a  munition  factory  and 
concluded  that  "there  was  not  enough  dif- 
ference in  the  quality  of  the  work  done  at 
various  times  of  the  day  to  justify  reduc- 
ing the  number  of  hours."  He  gives  the 
following  table  (Table  3)  showing  the  per- 
centage of  scrap  that  had  escaped  rejection 
by  inspectors  at  various  times  of  the  day. 
The  figures  in  parentheses  in  the  table  are 
mine   and   show   the   percentage   of   each 


tests  are  entirely  too  short  for  reliability,  even  if 
carried  on  five  times  a  day  for  a  period  of  three 
weeks.  Moreover,  as  has  since  been  discovered  in 
connection  witli  the  development  of  psychological 
tests  for  aviators,  the  human  mind  is  able  to  con- 
centrate for  short  periods  even  when  it  is  almost  on 
the  point  of  exhaustion  and  render  for  such  a  time  a 
performance  which  compares  favorably  with  those 
done  under  the  most  favorable  conditions. 

From  Figure  1  on  page  235  of  Link's 
paper,  however,  it  appears  that  the  number 
of  errors  in  the  5.40  p.m.  test  was  about  25 


TABLE  3.  —  PERCENTAGE  OF  SCRAP  FOUNT)  BY  REINSPECTION  {AFTER  LINK  (2)) 


Time  of  Original  Inspection 


7-8  A.M. 


1-«:S0  P.M. 


5-6  P.M. 


Number  of  boxes  iiispeeterl 

Percentage  of  total  .scrap  found  by  reinspection 

Perceiitat't'  of  scrap  (l)ase(i  on  total  number  of  shells  in- 
spectedj  found  by  reinspection 


47.0 

U.i     (101.0) 

3.9     (  99.0) 


iG.O 
8.5     (70.0) 

2.0     (66.0) 


37.0 

15.5     (129.0) 

5.3     (135.0) 


figure  of  the  average  for  the  whole  day  as 
determined  from  the  Ihree  figures  given  in 
the  lal)le.  Tlic  percentage  comparison  (in 
parenliiesesj  shows  Ihal  the  inspection  work 
in  the  5-6  hour  is  about  30  per  cent,  in- 
ferior to  that  of  the  morning  hour.  There- 
fore, Link's  conclusion  that  "this  increase 
is  comi)aratively  slight"  (page  234)  seems 
unwarrantetl. 

Link  gave  a  number  of  jisychological 
tests  at  different  periods  during  the  day 
from  which  he  concludes  (p.  237) : 

Tiic  results  in  llio  tests,  in  so  far  as  they  were  in- 
dicative, coincided  iarHcly  witii  the  results  of  the  re- 
inspection and  production  study.  However,  the 
variations  in  the  quantity  and  quality  of  the  work 
done  in  these  tests  were  altogether  too  slight  to 
justify  using  them  as  an  index  of  fatigue.  On  the 
other  hand,  the  variations  due  to  practice  were  so 
marked  as  to  make  all  other  variations  seem  insig- 
nificant. This  is  not  necessarily  a  repudiation  of  the 
psychological  method,  but  rather  an  in<lication  of  the 
difficulties  involved.   It  would  seem  that  two-minute 


per  cent,  more  than  in  the  LIO  p.m.  test. 
As  Link  points  out,  a  psychological  test 
arouses  the  individual  to  unusual  concen- 
tration of  attention  which  may  mask  the 
effects  of  fatigue.  Our  use  of  a  normally 
recurring  routine  occujiation  of  a  duration 
of  only  a  few  minutes  as  a  measure  of 
fatigue  is  therefore  valuable  in  that  it 
escapes  the  danger  of  arousing  unusual 
attention  by  its  nature. 

Conclusion 

1.  Output  in  clerical  work  shows  signs  of 
fatigue. 

2.  The  error  output  in  clerical  work  is 
the  converse  of  an  output  curve. 

3.  The  efficiency  of  clerical  workers  as 
measured  by  oul])ut  and  errors  made 
varies  like  a  typical  fatigue  curve. 

4.  A  normally  recurring  routine  occupa- 
tion of  a  few  minutes'  duration  is  a  valu- 
able criterion  of  fatigue. 


BIBLIOGRAPHY 

Spaeth,  R.  .\.:  The  Problem  of  Fatigue.  Jour.        3.    Griinbaum,  A.:  Volonte  et  Mouvement. 
Indust.  Hyg.,  1919-19'^0,  1,  '12.  neerl.  de  physiol.,  19-20,  4,  367. 

Link,  H.  C:   A  Practical  Study  in  Industrial 
Fatigue.  .Iour.  Ixdust.  Hyg.,  1919-19'20,  1,'233. 


Arch. 


A  WORK  CHAIR* 


ARTHUR  B.  EMMONS,  2d,  M.D. 

Director,  Harvard  Mercantile  Health  Work,  Boston,  Mass. 

AND 

JOEL  E.  (JOLDTHWAIT,  M.D. 

Orthopedic  Surgeon,  Boston,  Mass. 


SURVEYS  of  twenty  stores  have  dis- 
closed a  number  of  hygienic  faults,  one 
of  the  most  evident  of  which  is  unnatural 
seating.  Unnatural  posture  causes  fatigue, 
reduces  vitality,  tends  to  deformity,  and 
always  results  in  reduced  production  and 
earning  power.  A  careful  search  of  chair 
salesrooms  has  disclosed  the  fact  that  no 
suitable  chair  is  in  stock  which  can  be  said 
to  meet  the  anatomical  and  practical  needs 
of  the  employee  whose  work  is  done  at  a 
desk  or  table. 

In  the  past,  chairs  were  evidently  de- 
signed for  resting,  not  for  working.  The 
common  bent  wood  chair  shown  in  Figure 
1  supports  only  the  shoulders  when  one 
leans  back,  and  is  an  instance  in  point. 
The  cane  seat  of  this  chair  weakens  rapidlj' 
so  that  the  worker  is  soon  sitting  on  a 
wooden  ring  crossing  under  the  middle  of 
the  thighs. 

A  casual  glance  at  any  group  of  clerical 
employees  at  work  will  show  a  large  propor- 
tion of  them  sitting  forward  on  the  front 
part  of  their  chairs,  as  illustrated  in  Figure 
2.  This  is  an  attempt  to  get  comfortable. 
The  back  of  the  chair  is  used  onlj'  during 
intervals  of  rest  from  fatigue  i5 reduced  by 
sitting  with  no  support  to  the  back.  (See 
Figiu-es  1  and  3.)  Where  does  one  need 
support  when  sitting  at  desk  work?  Try 
tliis  experiment  and  see  for  yourself.  Sit 
erect,  and  then  gradually  relax,  letting  the 
back  bend  naturall^^  You  will  find  at  once 
that  the  small  of  the  back  bulges  directly 
backward.  Here,  then,  is  the  need  for  sup- 
port to  maintain  the  erect  position  —  the 
natural  position  for  work.    The  weight  of 

*  Received  for  publication  May  31,  19:21. 


the  body  should  be  supported  by  a  seat 
directly  under  the  body  and  not  at  the  mid- 
thigh.  To  meet  these  requirements  of  na- 
ture the  chair  shown  in  Figure  4  was  made. 
It  possesses  a  shallow  seat  and  a  back 
curved  forward  to  fit  the  small  of  the  back, 
and  is  of  rigid  construction  in  order  to  give 
support  and  steadiness.  This  chair  has 
proved  to  be  a  generally  useful  work  chair 
and  considerable  search  has  failed  to  dis- 
cover any  other  which  approaches  it  in 
essential  requirements.  Adjustable  chairs 
may  still  be  necessary  for  special  work,  such 
as  that  of  the  telejihone  switchboard  opera- 
tor, but  adjustability  is  not  an  unmixed 
good.  It  nearly  always  results  in  unstead- 
iness and  the  chair  is  rarely  correctly 
adjusted  to  the  individual.  Moreover, 
adjustability  requires  frequent  repairs  and 
results  in  a  short-lived  chair. 

To  introduce  successfully  any  radical 
change  in  an  individual's  working  environ- 
ment —  and  a  new  work  chair  constitutes 
such  a  change  —  requires  tact  and  care. 
It  is  suggested  that  at  first  a  few  samples 
be  introduced,  with  careful  explanations  as 
to  the  object  of  the  chair  and  with  the  sug- 
gestion that  a  fair  trial  be  made  before 
judgment  is  ])as.sed. 

The  work  chair,  which  we  have  de- 
scribed, was  especially  designed  by  a  com- 
mittee com])osed  of  Dr.  Joel  E.  Goldthwait 
(chairman).  Dr.  Lloyd  T.  Brown,  and  ^Ir. 
Ford,  of  Massachusetts  Institute  of  Tech- 
nology, to  meet  the  needs  of  a  large  tech- 
nical educational  institution.  It  has  proved 
entirely  satisfactory',  when  used  at  a  table 
or  desk.  Another  similar  chair,  with  arm 
rest  added,  was  constructed  for  ordinary 


154 


EMMONS  AND  GOLDTHWAIT  —  WORK  CHAIR  1 


155 


Fig.  1.  —  Resting  posture  in  common  bent 
wood  cliair. 


Fig.  2.  —  Correct  working  posture  in  common 
bent  wood  chair. 


Fig.  3.  —  I'usliire  wlicii  mUihi;  Uai  k  in  common 
bent  wood  chair. 


I'lG.  i.    -  Correct  working  posture  in  work  chair. 


I  i ; 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Fig.  5.  —  Correct  resting  posture  in  work  chair. 


■vfftyt*. 


i 

^V^'"-"^^'           --v^^     iH 

Fig.  7. — Manufacturer's  measuremeiils  for  work  chair. 


Flu.  0.  —  Work  chair. 

class  room  or  lecture  work.  The  sturdy 
construction  of  the  chair  is  testified  to  by 
the  fact  that  several  hundred  have  been  in 
constant  use  for  five  years  and  are  reported 
to  have  received  no  repairs.  Inspection  of 
them  at  the  present  time  shows  that  the 
glue  has  given  way  and  needs  replacement 
in  about  one  in  five  to  ten  chairs;  other- 
wise the  chairs  are  in  good  condition. 

The  chair  has  had  industrial  use  in  a 
large  clothing  factory  where  many  ma- 
chines are  used  at  tables.  The  jiersonnel 
director  of  this  establishment  reports  as 
follows : 

\Ve  liave  found  that  tlie  four  different  licights  of 
the  chair  (17",  18",  19",  -20")  we  use  liave  l)cen  suffi- 
cient for  all  but  one  or  two  exceptional  cases.    The 


EMMONS  AND  GOLDTHWAIT  —  WORK  CHAIR 


157 


l'"iti.  8.   —  Correct  working  posture  in  work  cliair. 


l'ii>.  i).       Correct  resting  posture  in  work  chair. 


Fig.  11).  —  Incorrect  working  posture  in  common 
office  chair. 


Fig.  11.  —  Resting  posture  in  office  chair. 


158 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


chair  has  worn  \ery  well  indeed  and  is  giving  great 
satisfaction  to  the  workers.  As  for  its  preventing 
fatigue,  I  cannot  furnish  statistics  on  this  matter,  but 
I  do  know  that  any  chair  which  supports  the  back  as 
this  one  does  and  which  does  not  interfere  with  circu- 
lation must  have  a  great  deal  to  do  witli  reducing  the 
fatigue  of  our  workers.  I  have  used  this  chair  myself 
ever  since  we  first  introduced  it  in  the  factory,  and  I 
wouldn't  use  any  other  as  a  desk  chair.  I  feel  that  it 
has  helped  me  to  maintain  correct  posture,  and  that 
I  am  very  mucli  more  comfortable  in  it  than  in  any 
chair  I  have  used  as  a  work  chair. 


When  we  take  into  consideration  the 
fact  that  many  workers  in  stores,  offices, 
and  factories  spend  nearly  a  third  of  the 
twenty -four  hours  of  a  day  in  a  chair,  the 
importance  of  correct  posture  in  prevent- 
ing fatigue  during  working  hours  is  evident . 
It  is  hoped  that  emploj'ees  whose  work 
must  be  done  at  a  table  or  desk  may  be 
given  the  opportunity  to  use  the  work  chair 
described  in  this  article  and  to  enjoy  the 
comfort  which  it  insures. 


THE  PRACTICAL  HYGIENIC  EFFICIENCY  OF  THE  PALMER 
APPARATUS  FOR  DETERMINING  DUST  IN  AIR  * 

HEXRY  FIELD  SMYTH,  M.D.,  Dr.P.H.,  and  MIRIAM  ISZARD.  MA. 

From  the  School  of  Hygiene,  Unifersily  of  Pennsylvania 


IN  view  of  the  recent  publication  of  two 
rather  severe  criticisms  of  the  efficiency 
of  the  Pahiier  water  spray  method  of  dust 
sampling,  it  has  seemed  to  us  that  it  would 
be  advantageous  to  publish  the  results  of 
some  actual  studies  of  dustj^  air  made  with 
the  Palmer  apparatus  as  compared  with 
studies  of  sections  from  lungs  of  animals 
exposed  to  tlic  same  dusty  air  and  willi 
counts  made  directly  from  saTn])les  of  the 
dust  used  in  the  tests.  The  criticisms  re- 
ferred to  were  those  of  Bill  in  his  paper  on 
The  Electrostatic  Method  of  Dust  Collection 
fl)  and  of  Ivatz  ct  cil.  on  the  Efficienc!/  of  the 
Palmer  Apjxirafiis  for  Drtrnniiiiiu/  Dust  in 
Air  (2).  Bill  claims  a  relative  efficiency-  of 
61.6  per  cent,  by  weight  and  .59.9  per  cent, 
by  count  of  the  Palmer  api)aratus  as  com- 
pared with  the  electrostatic  metliod,  which 
later  method  he  found  to  retain  82.3  per 
cent,  by  weight  of  the  dust  passing  through 
his  ai)paratus.  Katz  and  his  co-workers 
claim  only  a  70  per  cent,  efficiency  for  the 
electrostatic  method  and  an  efficiency  of  30 
per  cent,  or  less  for  the  Palmer  apparatus. 
It  seems  to  us  that  the  tests  used  by 
Katz  and  his  co-workers  were  entirely  too 
severe  and  not  at  all  comjiarable  to  indus- 
trial conditions  under  which  either  appa- 
ratus is  likely  to  be  used.  They  start  with 
the  premise  that  the  finest  air-suspended 
particles  are  the  most  injurious  to  the  lungs 
—  a  fact  that  has  never  been  proved  and 
that  seems  to  us  to  be  doubtful.  Hoffman 
in  a  recent  article  (3)  also  conveys  this  idea 
when  he  speaks  of  "extremely  fine  dust,  the 
ultramicroscopical  particles  of  which  are 
most  harmful  to  the  lungs."  With  all  mac- 
roscopic foreign  bodies,  other  things  being 

*  Received  for  publication  April  ^3,  1921. 


equal,  the  larger  the  body  the  greater  the 
irritation  produced,  and,  of  course,  with 
soluble  toxic  particles  the  larger  the  i)ar- 
ticle  the  more  toxic  it  is.  It  would  seem  to 
us  that  the  largest  particles  that  would 
actually  reach  the  lung  tissue  would  be 
most  liarmfid  and  the  particles  that  were 
most  numerous  in  the  lungs  would  be  those 
most  apt  to  produce  gross  lesions.  Katz 
employed  two  methods  of  testing  the  a])- 
paratus,  one  with  filtered  tobacco  smoke 
containing  particles  (droplets)  of  uniform 
size  ranging  from  O.'iOSl  to  0.2779  microns 
in  diameter.  Efficiency  was  tested  by  the 
Tyutlall  i)lieuomenou  of  luminosity  of  the 
particles  floating  in  a  current  of  air  travers- 
ing a  beam  of  light.  Air  passed  through  the 
Palmer  apparatus  was  compared  with  air 
l)y-passed  around  the  apparatus,  percent- 
age of  suspended  matter  removal  being 
c-alculated  from  the  amount  of  filtered 
dust-free  air  required  to  dilute  the  latter 
sample  so  as  to  make  the  two  beams  of 
light  of  equal  luminosity.  This  is  a  very 
ingenious  method  and  the  complicated  ap- 
paratus required  to  make  the  test  is  most 
interesting,  but  the  long,  narrow,  more  or 
less  tortuous  tubing  through  which  the 
samples  are  passed  offers,  as  the  authors 
state,  abundant  opportunity  for  precipita- 
tion of  particles  on  the  sides  of  the  tubes. 
The  test  showed  about  13  per  cent,  re- 
moval of  these  very  minute  droplets  of 
liquid.  Similar  tests  with  finely  divided 
dried  silica  dust  showed  a  removal  effi- 
ciency of  30  per  cent,  bj^  the  Tyndall 
method. 

The  second  method  employed  by  Katz 
was  to  collect  the  silica  dust  passing  the 
Palmer  apparatus  in  a  small  Cottrell  elec- 


159 


160 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


trostatic  precipitator.  The  dust  collected 
by  the  Cottrell  precipitator  was  filtered 
through  an  analytic  filter  and  weighed  on 
the  filter,  the  dust  in  the  filtrate  being 
estimated  by  a  turbidity  reading  of  the 
filtrate  as  compared  with  the  turbidity  of 
suspensions  of  known  weights  of  the  finest 
air-floated  silica  dust.  This  does  not  seem 
as  accurate  a  method  as  that  used  by  Bill 
and  by  Miller  and  Smyth  (4)  for  determin- 
ing the  weight  of  dust  collected  by  the 
Palmer  apparatus.  Just  why  the  suspended 
water  sample  was  not  evaporated  and  the 
residue  weighed,  does  not  seem  clear  from 
the  article.  No  direct  measurements  are 
given  of  the  size  of  the  silica  particles  used, 
but  it  is  stated  that  those  that  pass  through 
the  analytical  filter-paper  average  0.25 
microns  in  diameter.  This  method  showed 
an  efficiency  of  45  per  cent,  by  weight  with 
this  very  fine  dust.  These  tests  show  un- 
doubtedly that  the  Palmer  apparatus 
allows  manj'  minute  particles  to  pass 
through,  but  they  throw  no  light  on  the 
efficiency  of  the  apparatus  for  sampling  the 
average  industrial  dust  clouds  that  contain 
many  particles  of  much  larger  size  which, 
as  will  be  shown  later,  are  still  within  the 
range  of  those  that  reach  the  lungs  and  re- 
main lodged  in  the  tissues. 

In  Katz's  experiments,  air  was  passed 
through  the  Palmer  bubbler  at  the  rate  of 
4  cubic  feet  per  minute.  Tests  at  a  slower 
rate  showed  less  efficiency,  and  tests  at  5 
cubic  feet  per  minute,  as  recommended  by 
Palmer,  carried  water  through  the  appara- 
tus. Bill,  in  his  tests,  used  the  same  rate  for 
the  same  reason.  The  work  reported  by 
Miller  and  Smyth  (4)  was  mostly  done  at 
the  5  cubic  foot  per  minute  rate,  the  appa- 
ratus used  being  mounted  in  a  dress  suit 
case  as  originally  designed  and  described  by 
Palmer  (5).  The  collecting  l)ulb  in  this 
apparatus  is  larger  than  tiiat  in  the  later 
designs  and  has  an  extra  bend  in  the  outlet 
tube,  and  this  is  connected  with  several 
inches  of  upright   and   horizontal   tubing 


before  the  fan  is  reached.  With  this  original 
apparatus  we  have  never  known  water  to  be 
carried  over  to  the  fan  at  the  5  cubic  foot 
rate,  and  we  always  use  this  rate  of  sam- 
pling provided  we  have  sufficient  current 
for  the  fan  motor.  Many  industrial  plants 
manufacturing  their  own  current  use  a  210 
to  220-volt  current,  and  by  the  introduc- 
tion of  a  110-volt  lamp  in  parallel  circuit 
and  a  four-point  switch  we  have  been  able 
to  use  the  same  apparatus  for  tests  in  these 
plants  and  in  plants  using  the  usual  110- 
volt  current. 

Bill  compared  the  Palmer  apparatus 
with  an  apparatus  of  his  own  design,  using 
a  small  Cottrell  precipitator  and  running 
both  types  of  apparatus  for  sixty  minutes, 
which  seems  a  much  better  sampling  time 
than  the  one-minute  periods  of  Katz.  Bill 
used  dusts  passing  a  100-mesh  sieve  which 
would  much  more  nearly  apjjroach  the 
average  industrial  dust  than  does  tobacco 
smoke  or  the  cotton-filtered  silica  dust  of 
Katz,  and  would  include,  as  will  be  shown 
later,  the  largest  jjarticles  ever  found  in 
lung  tissue.  Bill  found  an  actual  efficiency 
of  his  own  apparatus  of  82.3  per  cent,  by 
weight  and  a  comparative  efficiency  of  the 
Palmer  aj^paratus,  as  compared  with  his 
own,  of  59.9  per  cent,  by  count  and  61.6  by 
weight,  making  an  absolute  efficiency  by 
weight  of  50.69  per  cent.  Bill  claims  that  in 
counting  ])artieles  in  Palmer  samples  he 
was  much  more  troubled  by  the  clumping 
of  smaller  particles  into  masses  which  he 
often  counted  as  units  than  he  was  with 
water  suspensions  of  electrically  precipi- 
tated dusts.  ^liller  and  Sm,^^h  and  later 
we  ourselves  found  that  sufficiently  vigor- 
ous shaking  of  samijles  and  sufficiently  high 
dilutions  with  filtered  distilled  water  re- 
sulted in  breaking  up  iiractically  all  of  these 
chnn])s.  In  our  counting  work  we  dilute 
very  turbid  sanii)les  from  1  in  10  to  1  in  100, 
so  as  to  have  counts  of  under  100  particles 
per  one-fourth  field.  This  jirobably  ma- 
terially  increases   total   counts   and   espe- 


SMYTH  AND  ISZARD  — EFFICIENXY  OF  PAOIER  APPARATUS      161 


cially  counts  of  smaller  particles,  and  shows 
a  greater  percentage  efficiency  by  count 
than  was  found  by  Bill,  though  even  the 
approximate  50  per  cent,  efficiency  of  the 
Palmer  apparatus  as  demonstrated  by  Bill 
does  not  materially  affect  its  usefulness 
provided  this  percentage  efficiency  is  rea- 
sonably constant  and  provided  the  ap- 
paratus gives  a  representative  sample  of 
particles  of  the  most  effective  size.  Bill's 
apparatus,  while  undoubtedly  giving  a 
decidedly  greater  percentage  efficiency  by 
count  and  by  weight  than  does  the  Palmer 
apparatus,  rcciuires  more  d(>licafe  and  skil- 
ful mani])ulati(>n  and  more  technical  knowl- 
edge in  order  to  run  it  and  is  as  yet  far 
from  a  j)()rtable  and  practical  apparatus 
for  routine  industrial  tlust  .sain])ling.  It  is 
greatly  to  be  ho|)ed,  however,  as  Bill  him- 
self suggests,  that  these  latter  difficulties 
nuiy  be  ovel-conic  and  that  I  here  may  soon 
be  designed  and  put  on  the  market  a  small 
portal)le  ajiparatus  which  can  be  used  with 
rea.sonable  facility  and  accuracy  by  tlie 
average  field  worker. 

EXPERIMENT.VL   WoRK 

For  over  a  year  we  have  been  doing  ex- 
jierimental  work  along  the  lines  followed 
by  Alavrogordato  (6),  exposing  groups  of 
guinea-pigs  to  measured  clouds  of  fine  dust 
for  given  periods  at  given  intervals.  After 
given  periods  of  time,  the  animals  were 
killed  and  tlie  efl'ects  of  dust  iuliala^ions  on 
the  lungs  were  studied,  tiie  method  of  entry 
of  dust  to  the  lung  tissue,  the  location  of 
permanent  deposits,  the  rate  of  invasion, 
and  the  route  and  rate  of  elinu'nation  of 
dust  particles  from  the  lungs  all  l)eing 
noted.  It  is  not  the  purpose  of  this  paper  to 
rejjort  on  this  work  other  than  in  one  par- 
ticular —  that  of  the  size  of  particles  lodg- 
ing in  lung  tissue.  For  this  work  a  dust 
box  was  constructed  similar  to  that  de- 
scribed by  IVIavrogordato,  a  small  electric 
fan  being  used  to  keep  dust  in  sOspension. 


A  hole  was  so  placed  in  the  box  that 
samples  could  be  taken  by  the  Palmer  ap- 
paratus from  alongside  the  exposed  ani- 
mals. Counts  were  made  accordiug  to  the 
method  suggested  b}^  one  of  us  (7),  par- 
ticles much  over  40  microns  in  diameter 
being  ignored  and  those  counted  being 
divided  into  three  groups  based  on  their 
greatest  diameter  rather  than  on  their  esti- 
mated area.  The  ])articles  in  group  I 
averaged  -10  microns,  being  sufficiently  large 
so  that  their  area  could  be  easily  estimated. 
Group  II  particles  averaged  from  5  to  .SO 
microns  in  diameter  and  were  large  enough 
for  their  shape  to  be  iletermined  l>ut  many 
were  too  small  for  their  area  to  be  esti- 
mated. Group  ITT  particles  averaged  1 
micron  and  appeared  umler  the  low  ])ower 
as  dots  too  small  to  permit  us  to  determine 
their  form. 

Table   1   gives   the   size  distribution   of 
j)articles  in  watery  suspensions  of  samples 


T.VBLE  1. 


-SIZE  DISTRIRUTIOX  OF  PARTICLES 
L\  DUSTS  USED  IX  TESTS 


Kiud  of 
Dust 

Site  I 
Av.  40 
Microns 
Diameter 

Sizen 

s-so 

Microns 
Diameter 

si»tn 

Av.  1 
Micron 
Diameter 

Number 

of 
Particles 
Counted 

Relative 

Weight  of 

Equal  Bulk 

of  Dust 

Coal 

% 
2.9  + 

% 
16  + 

% 
81  + 

549 

1.0 

Stone 

0.78 

9  + 

90  + 

2,529 

1.8 

Flint  .... 

0.3 

2  + 

97  + 

4,385 

1.4 

.\verage  . 

1.3  + 

9  + 

89+          

of  the  three  dusts  used  up  to  the  present 
time  in  these  tests  —  i.  e.,  crushed  coal 
used  for  fuel  in  cement  kilns,  crushed  raw 
cement  rock  and  crushed  flint  used  in  jjot- 
tery  manufacture.  These  dusts  were  com- 
mercial products  obtained  from  a  cement 
plant  in  the  Lehigh  Valley  and  from  a  flint 
mill  in  Trenton,  X.  J.,  and,  as  will  be  seen 
in  Table  2,  averaged  smaller  particles  than 
those  entrained  in  the  Palmer  apparatus  in 
tests  made  several  years  ago  of  air  dustiness 


162 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


in  the  mills  from  which  these  samples  were 
obtained.  Tables  2  and  3  give  the  percent- 
age distribution  as  shown  in  Palmer  samples 
of  all  particles  small  enough  to  enter  the  fine 

TABLE  2.  —  SIZE  DISTRIBUTIOX  OF  PARTICLES 

IN  INDUSTRIAL  DUST  TESTS  WITH 

PALIVIER  APPARATUS 


Av. 
Number  of 

Particles 

per  Cu.  Ft. 

of.\ir 

Number 
of  Tests 

Av. 

Weight  of 

Dust  per 

100  Cu. 

Ft.  ot  Air 

Percentage  of  Particles 

Kind  of 
Dust 

Under  5        Oyer  5 
Microns        Microns 
Size  III         Sizes  I 
and  II 

Coal.... 

8,881,200 

2 

0.2286 

53 

47 

Stone. . . 

8,609,866 

3 

0.1681 

55 

45 

Flint  . . . 

844,040 

3 

0.0459 

65 

35 

bronchioles  and  reach  the  lungs.  Table  3 
gives  the  results  of  counts  of  samples  taken 
from  the  dusting  box  in  which  the  animals 
were  exposed  and  shows,  by  comparison 
with  Table  1,  that  the  Palmer  apparatus, 
regardless  of  its  total  efficiency,  seemed  to 
take  a  fairly  representative  sample  of  the 
dangerous  sized  particles  in  these  dusts. 

Paraffin  sections  of  portions  of  the  lungs 
of  guinea-pigs  that  had  been  exposed  to  the 

TABLE  3.  — SIZE  DISTRIBUTION  OF  PARTICLES 

IN  DUST  TO  WHICH  GUINEA-PIGS 

^\■ERE  EXPOSED 

(As  Determined  by  Palmer  Apparatus) 


Av. 

Number  of 

Particles 

per  Cu.  Ft. 

of  Air 

Number 
of  Tests 
Sampled 

with 

Palmer 

Apparatus 

Av. 

Weight  of 

Dust  per 

100  Cu. 

Ft.  ot  Air 

Percentage  of  Particles 

Kind  of 
Dust 

Under  5 
Microns 
Size  UI 

Over  5 
Microns 
Sizes  I 
and  II 

CoaL... 

24,074,000 

6 

ffm, 
0.164 

% 
84.0 

16^0 

Stone . . . 

4,719,000 

12 

0.046 

93.25 

6.75 

Flint  . . . 

15,009,000 

6 

0.0504 

96.68 

3.32 

dusts  for  different  periods  and  then  killed 
by  gas  immediately  after  exposure,  or  at 
increasing  intervals  after,  were  stained  and 
examined  under  the  microscope.     Simple 


alum-carmine  staining  permits  the  dust 
particles  in  the  lungs  to  be  seen  clearly. 
The  sections  were  examined  under  the  oil 
immersion  lens,  and  camera  lucida  draw- 
ings were  made  of  a  number  of  groups  of 
intracellular  particles.  By  this  means  a 
2,000-diameter  magnification  was  obtained 
and  particles  |  micron  in  diameter  and  over 
could  be  measured.  Table  4  gives  the  re- 
sults of  the  measurement  by  these  means  of 
over  1,200  particles  of  the  three  dusts  used; 
Table  5  gives  the  percentage  distribution  of 
particles  grouped  as  over  5  microns  (cor- 
responding to  sizes  I  and  II)  and  under  5 
microns  (corresponding  to  size  III) .     The 

TABLE  4.  — SIZE  DISTRIBUTION  OF  DUST 

PARTICLES  IN  LUNG  TISSUE  OF 

GLTINE.\-PIGS 

(Stained  Sections) 


Number 

ot 
Particles 
Counted 

Greatest  Diameter  of  Particles 
in  Microns 

11 

8 

7 

5 

4 

3 

i 

1 

0.5 

Coal 

616- 

1 

1 

3 

14 

4 

41 

87 

117 

S48 

Stone          

378 

1 

4 

21 

76 

'?76 

Flint    

295 

3 

19 

61 

919 

Total       particles 
counted 

1,289 

1 

1 

3 

15 

4 

48 

127 

254 

836 

latter  are  again  divided  into  those  under  1 
micron  and  those  from  1  to  4  microns.  This 
division  shows  that  apparently  over  (54  per 
cent,  of  the  particles  are  under  1  micron, 
over  33  per  cent .  from  1  to  4  microns,  with 
over  98  per  cent,  in  the  third  class  according 
to  the  Palmer  count,  while  tiie  dust  it.self 
showed  an  average  of  over  91  per  cent,  in 
the  third  class.  Tables  4  and  5  show  also 
an  apparently  decided  difference  in  size  dis- 
tribution of  particles  of  the  ligliter  coal  du.st 
and  the  heavier  stone  and  flint  dust.  Over 
43  per  cent,  of  the  particles  of  coal  dust 
found  in  the  lungs  were  1  micron  or  over  in 
diameter,  and  particles  as  large  as  11 
microns  were  found,  while  less  than  30  per 


SMYTH  AND  ISZARD  —  EFFICIENCY  OF  PALMER  APPARATUS      163 


TABLE  5.  —  PERCENTAGE  DISTRIBUTION'  OF 

DUST  PARTICLES  IN  LUNG  TISSUE 

OF  GllNEA-PIGS 

(Stained  Sections) 


cent,  of  particles  of  either  stone  or  flint  micron  and  72  + per  cent,  under  1  micron, 
were  as  large  as  1  micron.  The  relative  as  against  the  30  and  70  per  cent,  respec- 
weights  of  the  three  dusts  are  shown  in  the  tively  counted  by  McCrae  in  miners'  lungs, 
last  column  of  Table  1.  Watkins-Pitchford  and  Moir  (9)  counted 

McCrae  (8),  in  his  .studies  on  the  lungs  of     the  doubly- refracting  particles  in  sections 
South   African    hard    rock    miners,    found     of   silicotic   lungs   ranging   from    1    to    13 

microns  in  diameter  with  a  mean  size  of 
6.13  by  2.18  microns,  witli  particles  up  to 
13  microns  actually  seen  as  intracellular. 
Later,  by  a  method  of  cold  digestion  with 
strong  nitric  acid  of  the  paraffin  .sections 
fixed  on  microscopic  slides,  they  found  that 
they  had  overlooketl  many  ])articles  and 
underestimated  the  size  of  others.  After 
this  treatment  they  counted  and  carefully 
measured  120  particles  ranging  from  I 
micron  up  to  5.5  microns  in  diameter,  3,5.8 
per  cent,  being  under  1  micron,  ■i8+  per 
cent,  from  1  to  2  microns,  and  oNcr  1.5  per 
cent,  above  2  microns  in  dianieler,  1  micron 
being  the  most  frecjuenl  size. 

Sections  from  some  of  the  same  blocks 
of  tissue  from  which  stained  sections  were 
counted  were  treated  by  us  according  to  the 
Watkins-Pitchford  method  of  cold  nilric 
acid  digestion.  Table  6  gives  the  results  of 
these  counts  which  compare  closely  with 
those  of  Watkins-Pitchford  aiul  Moir.  We 
counted  more  large  particles  by  this 
method  than  we  did  in  stained  sections,  as 
did  they.  Altliougli  this  method  showed  a 
surprisingly  high  i)ercenlage  of  large  par- 


Number 

of 
Particles 
Counted 

Percentage  of  Particles  in  Size  Groups 

Kind  iif  Dust 

Over  5 
Microns 

Microns 

Under  1 
Micron 

Total 
under  5 
Microns 

Coal 

616 

% 
3  + 

% 

40 

% 
56  + 

96  + 

Stone 

S78 

0.2  + 

20  + 

73  + 

99  + 

Flint 

295 

0.0 

28  + 

71  + 

100 

Total      parti- 
cles counted 

1,289 

1.5  + 

33  + 

64  + 

98  + 

that  by  acid  digestion  of  lung  ti.ssue  he 
could  recover  silica  particles,  70  per  cent,  of 
which  were  under  1  micron  in  diameter, 
with  .30  per  cent,  ranging  from  1  to  10 
microns  in  diameter.  These  results  com- 
pare very  closely  with  the  counts  made  by 
us,  as  will  be  seen  by  referring  again  to 
Table  5  in  which  flint  and  stone  dusts 
averaged  27  + per  cent,  of  particles  above  1 


TABLE  fi.  —  SIZE  DISTRIBUTION  OF  DI^ST  P.\RTICLES  IN  LUNG  TISSUE  OF  GUINE.\-PIGS 
AS  DETERMINED  BY  COLD  ACID  DIGESTION 

(Watkins-Pitchford  Method) 


ToUl 

Particles 
Counted 

Greatest  Diameter 

of  Particles  in  Microns  i 

Per 

Cent, 
over  li 
Microns 

Per 

Cent. 

over  5 

Microns 

Per 

Cent. 

l-l 

Microns 

Per 

Cent 

Kind  of  Dust 

«S 

17 

It 

9 

8 

7 

6 

5 

4 

3 

* 

1 

0.6 

under  1 
Micron 

Coal 

506 

1 

2 

1 

4 

4 

16 

78 

331 

69 

1.5  + 

8i  + 

13  + 

Stone 

477 

1 

1 

2 

2 

4 

7 

20 

58 

298 

84 

0.4  + 

1.6  + 

80  + 

17  + 

Flint 

204 

•• 

1 

1 

2 

3 

4 

11 

20 

115 

47 

3  + 

73  + 

23  + 

Total 

1,187 

1 

1 

1 

3 

1 

.6 

1 

11 

15 

47 

156 

744 

200 

0.1  + 

1.9  + 

81  + 

16  + 

I  Most  frequent  size  of  all  three  dusts,  1  oiicron  diameter. 


164 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tides  of  stone  and  flint,  yet  the  same  rela- 
tive distribution  of  smaller  particles  is 
seen.  Coal  dust  showed  only  13  +  per  cent, 
of  countable  particles  under  1  micron,  and 
65  + per  cent,  averaging  1  micron  in  diam- 
eter; stone  showed  17  + per  cent,  under  1 
micron,  and  6'-2  per  cent,  averaging  1  mi- 
cron; and  flint  23  + per  cent,  under  1  mi- 
cron, and  56  +  per  cent,  averaging  1  micron. 
With  all  three  dusts  the  most  frequent  size 
found  in  the  lungs  was  1  micron  (62  + per 
cent,  average),  and  there  was  an  average  of 
81  + per  cent,  from  1  to  4  microns.  The 
same  relatively  high  percentage  of  larger 


some  clumping  of  very  minute  unmeasur- 
able  particles,  yet  these  clumps  were  not 
very  numerous  and  evidently  were  not  the 
predominating  factor,  and  hardly  seem  to 
be  the  factor  apt  to  be  responsible  for  much 
tissue  damage.  This  would  indicate  that 
an  average  of  97  +  per  cent,  of  the  countable 
particles  were  among  those  counted  as  size 
III  in  the  Palmer  method  according  to 
Smyth's  modification,  as  compared  with 
91  per  cent,  of  the  same  size,  counted  in 
Palmer  samples  of  the  dust  to  which  ani- 
mals were  exposed,  and  89  per  cent,  in 
samples  taken  directly  from  the  dust.   The 


TABLE  7.  —  COMPARATIAT:  SIZE  DISTRIBUTION  OF  DUST  PARTICLES  AS  SHOWN'  BY 

COUNTS  OF  DUST,  OF  DUST  CLOUT)S,  OF  ST.\INED  LUNG  SECTIONS,  AND  OF 

ACID-DIGESTED  LUNG  SECTIONS' 


dust 

Av.  40  Microns 

5-SO  Microns 

Av.  1  Micron 

1 

2 

3 

4 

1 

2 

3 

* 

1 

i 

3 

4 

Coal 

2.9  + 

1.5 

% 

0 

% 

0 

% 
16  + 

14 

tpr 

3  + 

1.0°  + 

C7 

81  + 

84  + 

% 

96  + 

98  + 

Stone 

0.78 

1.5 

0 

0 

9  + 

5  + 

0.2  + 

2  + 

90  + 

93  + 

99  + 

97  + 

FUnt 

0.3 

0.07  + 

0 

0 

2  + 

3  + 

0.0 

3  + 

97  + 

96  + 

100  + 

96  + 

Average     

1.3  + 

1  + 

0 

0 

9  + 

7  + 

1  + 

2  + 

89  + 

91  + 

98  + 

97  + 

I  1  =  Dir 
i  =Pal 

ect  count 

mer  samp 

5  from  di 
les  of  diL 

1st. 
it. 

S  =St* 
4  =  .\ci 

ined  lung 
d-digestec 

sections. 
1  lung  sec 

lions. 

sized  coal  particles  as  compared  with 
heavier  stone  and  flint  particles  is  seen 
here  as  is  obtained  by  the  direct  counting 
of  stained  sections,  though  the  difference  is 
not  so  marked.  Evidently,  in  the  stained 
sections,  many  large  particles  of  stone  and 
flint  appeared  to  be  smaller  than  they 
reallj'  were,  or  probably  were  counted  as 
more  than  one. 

Table  7  is  a  comparison  of  percentage 
comits  by  all  methods  and  shows  a  very 
close  paralleling  of  size  distribution  of  the 
countable  particles  under  40  microns  in  the 
original  dust,  the  Palmer  sampled  dust, 
and  the  dust  in  the  lungs  of  the  exjjosed 
animals.  While  the  tissue  sections  gave 
evidence   by    both    counting   methods    of 


irregularity  of  the  counts  of  particles  over 
5  microns  in  the  different  methods  is  ex- 
plained by  their  relative  infrequency  in  all 
tests. 

These  methods  seem  to  indicate  that  a 
fair  efficiency  test  of  a  dust  sampling  ap- 
paratus would  include  manj'  particles  of  1 
micron  in  diameter  and  larger,  and  that 
failure  to  retain  a  high  percentage  of  par- 
ticles under  0.5  microns  in  diameter  does 
not  materially  reduce  its  practical  efficiency 
as  a  hygienic  test.  This  is  in  practical  agree- 
ment with  and  helps  to  confirm  the  opinion 
of  the  American  Public  Health  Association 
Committee  on  Standard  Methods  for  the 
E.xamination  of  the  Air  (10). 

^^  e  are  constantly  e.xi)osed  to  and  inhale 


SIVIYTH  AND  ISZARD  — EFFICIENCY  OF  PALMER  APPARATUS      165 


ultramicroscopic  dust  which  is  present  in 
more  or  less  degree  in  all  air  of  inhabited 
regions.  It  is  this  tj^je  of  particle  that 
gives  us  our  diffuse  daylight  and  our 
beautiful  sunsets,  and  that  is  responsible 
for  much  mist  and  cloud  formation.  These 
extremely  minute  particles  remain  in  sus- 
pension indefinitely,  as  long  as  there  are 
any  air  currents,  being  precipitated  only  in 
perfectly  still  air.  In  the  bronchioles  they 
would  be  the  last  i)articles  to  be  deposited 
on  the  mucus,  would  float  longest  on 
the  surface  of  the  mucosa,  would  be  the 
easiest  to  be  swept  up  and  out  by  the  cur- 
rents kept  in  motion  by  the  cilia,  and  would 
be  the  least  irritiiting  when  phagocylized. 
Ultramicroscopic  particles  are  more  apt  to 
be  spherical  and  less  apt  to  be  spiculate  or 
to  have  sharp  angles,  and  hard,  si)iculate  or 
angular  dusts  are  generally  conceded  to  be 
most  irritating  and  most  apt  to  cause 
fibrosis.  Es])('cially  with  moderate  degrees 
of  dustiness,  il  would  seetn  from  the  above 
considerations  that  the  largest  particles 
reaching  the  l)ronchioles  would  be  the  most 
irritating,  and  that  of  these  larger  i)articles 
the  most  dangerous  would  be  the  size  oc- 
curring most  frequently.  Tliis  dejiends  on 
the  specific  gravity  and  nature  of  the  dust, 
and  the  efficiency  of  a  dust  sampling 
method  should  depend  on  its  ability  to  re- 
tain a  large  percentage  of  these  particles 
rather  than  of  tliose  of  ultramicroscopic 
size. 

As  previously  stated,  both  Bill's  and 
Katz's  tests  with  the  Palmer  apparatus 
were  run  at  -l  cubic  feet  per  minute,  while 
we  usually  employ  a  5  cubic  foot  rate  with 
our  type  of  ajjparatus.  Katz  states  that  he 
and  his  co-workers  found  a  .SO  per  cent, 
efficiency  by  the  Tyndall  test  when  running 
at  4  cubic  feet  per  minute,  as  against  a  20 
per  cent,  efficiency  at  3  cubic  feet  —  a  ratio 
of  1.5  for  the  -1  cubic  foot  rate  to  1  for  the  3 
cubic  foot  rate.  Three  comparative  tests 
were  run  by  us  for  five-minute  periods 
against  a  very  heavy  cloud  of  coal  dust 


which  at  the  5  cubic  foot  rate  showed 
1.3448  gm.  of  dust  per  100  cubic  feet  of  air. 
The  tests  were  all  run  on  the  same  day,  the 
dust  being  freshly  stirred  up  before  each 
test  so  as  to  have  as  nearly  as  possible  the 
same  amount  of  dust  in  the  air.   There  was 

TABLE  8.— RELATI\T:  EFFICIENCY  TESTS  OF 
PALIVIER  APPARATUS  \VHEX  RUN'  TO  SAMPLE 
3,  4,  AM)  5  CLTBIC  FEET  OF  AIR  PER  MINUTE 

a.  By  Weight 


Dust 
Employed 

Dura- 
tion of 
Test 

Rate  of 
Air  Flow 

jnoute 

Total 

Air 

Sampled 

Weight         Calculated 
of  Dust  i  Weight  Dust 
Washed       per  Cu.  Ft. 
from  -Air           of  .Air 

Coal 

milt. 
S 

cu.fl. 
3 

eu./l. 
15 

0.1004 

gm. 
0.66264 

u 

5 

4 

20 

0.2012 

1.006 

(( 

5 

5 

25 

0.3362 

1.3448' 

6.  By  Count 


RateoF 
Dust          Air  Flow 
Employed     1       per 
Minute 

Per  Cent. 
Size  I, 
Av.  40 

Microns 

Percent. 
Size  II. 

J-30 
Microns 

Per  Cent. 

Size  III, 

Av.  1 

Micron 

Calculated 

Number 

of  Particles 

per  Cu.  Ft. 

of  Air 

Coal 

cu.fl. 
3 

6.4 

34.4 

59.2 

37,333,300 

U 

4 

1.1 

27.0 

71.9 

66,800,000 

ii 

5 

0.52 

8.6 

90.8 

66.800,000 ' 

1  Both  count  and  weight  should  have  been  higher  for  the  5  cubic  foot 
rate  sample  but  there  w.is  so  much  coal  iti  the  collrctinir  bulb  that  over 
100  c.c.  of  sample  was  obtained  before  the  bulb  was  completely  rinsed 
out.  Some  of  the  coal  remained  in  the  bulb  and  was  not  included  in  the 
count  or  in  the  weighing  test. 


absolutely  no  evidence  of  any  w;iter  being 
carried  tlu-ough  the  apparatus,  and  with  the 
very  heavy  content  of  coal  dust  in  the 
water  this  could  not  have  escaped  ol).serva- 
tion.  These  tests  show  (see  Tal)le  8a)  the 
same  relative  efficiency  as  that  found  by 
Katz  for  the  4  cubic  foot  rate  as  compared 
with  the  3  cubic  foot  rate,  and  a  ratio  of 
1.33-1-  for  the  5  cubic  foot  rate  as  com- 
pared with  the  4  cubic  foot  rate.  This 
seems  to  indicate  that  if  Bill  had  used 
the  older  type  of  apparatus  at  a  5  cubic 


166 


THE  JOLTRNAL  OF  INDUSTRIAL  HYGIENE 


foot  rate  he  would  have  found  it  to  have 
a  relative  efficiency  of  81.8  per  cent,  by 
weight  as  compared  with  his  apparatus; 
and  with  the  same  apparatus  at  the  same 
rate,  Katz  would  have  found  an  absolute 
efficiency  of  approximately  59.85  per  cent., 
instead  of  45  per  cent,  at  the  4  cubic 
foot  rate. 

Table  8b  shows  that  the  5  cubic  foot  per 
minute  rate  also  gives  a  greater  efficiencj^ 
by  count  than  does  the  slower  rate,  and 
that  the  more  active  bubbling  fountain  en- 
trains and  holds  back  a  great  proportion  of 
the  smaller  particles  most  apt  to  be  harm- 
ful (size  III). 

Summary  and  Conclusions 

Oiu-  findings  as  to  size  distribution  of 
dust  particles  in  guinea-pig  lungs  agree 
closely  witli  those  of  iNIcCrae  and  of  Wat- 
kins-Pitchford  and  Mou'  in  human  lungs. 

The  most  frequent  sized  dust  particles 
lodging  in  the  lungs  of  men  or  animals  are 
those  about  1  micron  in  diameter,  and 
from  GO  to  80  per  cent,  of  the  countable 
particles  are  from  1  to  5  microns  in  diam- 
eter. There  is  no  evidence  of  a  great  ac- 
cumulation of  ultramicroscopic  particles  in 
the  lung,  and  these  particles  are  not  so  apt 
to  reach  the  lung  cells  as  are  those  which 
are  somewhat  larger. 

Dust  particles  seen  in  stained  sections  of 
the  lungs  are  apt  to  appear  smaller  than 
they  really  are,  as  is  shown  by  the  AYatkins- 
Pitchford  method  of  cold  acid  digestion. 

The  Tyndall  phenomenon,  depending 
largely  on  the  presence  of  ultramicroscopic 
particles  in  the  air.  although  the  liest  abso- 
lute test  of  complete  ^emo^•al  of  particulate 
matter,  is  too  severe  a  test  of  the  practical 
hygienic  efficiency  of  a  dust  sampling  ap- 
paratus. Efficiency  tests  for  such  apparatus 
should  be  made  with  dusts  containing 
particles  at  least  as  large  as  10  microns 
in  diameter,  and  the  most  frequent  size  in 


such  test  dusts  should  be  1  micron  in  diam- 
eter. 

With  dusts  having  particles  ranging  up 
to  40  microns  in  diameter,  and  with  an 
average  of  over  89  per  cent,  of  particles 
under  5  microns  in  diameter,  the  Palmer 
apparatus  run  at  5  cubic  feet  per  minute 
collects  representative  samples  with  nearly 
the  same  size  distributions.  A  five  cubic 
foot  per  minute  rate  is  the  most  efficient 
for  the  Palmer  apparatus  as  originally  de- 
signed, and  does  not  carry  any  water 
through  the  apparatus.  At  this  rate,  it  is 
at  least  1.33  times  as  efficient  as  is  the  new 
design  run  at  the  4  cubic  foot  per  minute 
rate,  as  was  done  by  Bill  and  Katz.  At  the 
5  cubic  foot  per  minute  rate  the  Palmer  ap- 
paratus should  ha\'e  an  efficiency  of  almost 
82  per  cent,  by  weight  as  compared  with 
the  Bill  electrostatic  apparatus.  At  this 
rate  the  increase  in  numerical  efficiency 
and  the  percentage  of  smallest  sized  par- 
ticles are  both  decidedly  greater  than  at  the 
4  cubic  foot  per  minute  rate. 

The  electrostatic  method  of  dust  sam- 
pling as  used  b\-  Bill  would  undoubtedly  be 
the  best  method,  provided  a  simple,  easilj' 
manipulated,  portable  apparatus  were  de- 
vised. 

The  clumping  of  minute  particles  in 
Palmer  dust  samples  as  objected  to  by  Bill 
can  usually  lie  overcome  by  sufficient  dilu- 
tion and  shaking,  which  will  greatly  in- 
crease the  numerical  efficiency  of  the 
method.  At  present  the  Palmer  apparatus 
is  the  most  efficient  practical  dust  sampling 
apparatus  at  our  disposal  for  hygienic  tests 
in  industry. 

The  Kotze  konimeter  (10)  was  not  con- 
sidered in  the  above  comparisons  because, 
regardless  of  its  absolute  efficiency  or  its 
efficiency  for  sampling  dangerous  sized 
particles,  it  collects  too  small  a  sample  over 
too  short  a  period  to  give  an  idea  of  the 
amount  of  dust  to  which  a  laborer  is  ex- 
posed in  his  daily  work. 


SMYTH  AND  ISZARD  — EFFICIENCY  OF  PALMER  APPARATUS      167 


BIBLIOGRAPHY 


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Collection  as  Applied  to  the  Sanitary  Analysis 
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2.  Katz,  S.  H.,  Longfellow,  E.  S.,  and  Fieldner,  A. 
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3.  Hoffman,  F.  L. :  The  Mortality  from  Respira- 
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4.  Miller,  T.G.,  and  Smyth,  H.F.:  The  Dust  Haz- 
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5.  Palmer,  G.  T.,  Coleman,  L.  V.,  and  Ward,  H.  C. : 
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6.  Mavrogordato,  A.:  Experiments  on  the  Effects 
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7.  Smyth,  H.  F.:  Suggested  Modifications  of  the 
Standard  Method  for  the  Study  of  the  Dust 
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8.  McCrae,  J.:  The  Asli  of  Silicotic  Lungs.  Me- 
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9.  Watkins-Pitchford,  W.,  and  Moir,  J.:  On  the 
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Vol.  7,  Sept.  14,  1916. 

10.  Fourth  Supplementary  Report  of  the  Com- 
mittee on  Standard  Methods  for  the  E.vamina- 
tion  of  the  Air.  \m.  Jour.  Pub.  Health,  1920, 
10,  450. 


PHYSICAL  EDUCATION  FROM  THE  STANDPOINT  OF  THE 
INDUSTRIAL  PHYSICIAN  * 

RALPH  W.  ELLIOTT,  M.D. 

Manager,  Medical  Department,  National  Lamp  Works  of  General  Electric  Company,  Nela  Park,  Cleveland 


ONE  of  the  chief  functions  of  an  indus- 
trial medical  clinic  is  that  of  a  "diag- 
nostic clearing  house."  Yet,  too  often,  this 
real  opportunity  for  service  is  lost  sight  of 
in  the  routine  treatment  of  trivial  cases 
and  the  dressing  of  minor  injuries.  Even 
physical  examinations  are  made  in  a  me- 
thodical manner  and  the  cards  filed  with- 
out any  attempt  being  made  to  cull  out  the 
cases  which  could  be  benefited  by  simple 
hygienic  measures.  An  applicant  is  re- 
jected or  employed  with  little  or  no  thought 
beyond  the  fact  that  he  is  either  fit  or  unfit. 
Too  often  he  is  not  even  told  why  he  is 
rejected,  and  as  a  result  he  drifts  from  one 
industry  to  another  until  he  finally  gets  a 
job  in  a  factory  that  does  not  require  the 
physical  examination  of  applicants. 

In  many  of  our  better  organized  indus- 
tries, physical  examinations  are  required  of 
all  applicants  for  employment.  Re-exami- 
nations are  made  at  periodic  intervals,  at 
least  once  a  ^'ear,  and  more  frequently 
if  it  seems  advisable  to  the  examining 
phj'sician  or  to  the  foremen  or  super- 
intendents of  departments.  Re-examina- 
tion is  beneficial  to  the  employer  because 
it  gives  him  eflScient  workers;  to  the  em- 
ployee because  it  serves  to  keep  him  in  good 
physical  condition;  and  to  the  examining 
phj^sician  because  it  gives  him  valuable 
information  as  to  conditions  under  which 
certain  defectives  do  well.  Very  often 
applicants  and  old  employees  who  are 
manifestly  physically  below  par  jn-esent 
themselves  for  examination,  and  yet  it 
would  be  a  simple  matter  to  raise  them  to 
an  average  standing  of  physical  fitness  if 
a   physical    education    department,    thor- 

*  Received  for  public.ition  June  3,  1921. 


oughly  organized  under  efficient  leader- 
ship, were  available,  as  it  were,  to  fill  the 
prescription  of  the  examining  physician. 
I  believe  that  one  of  the  most  important 
functions  of  the  present  day  industrial 
physical  training  department  is  to  carry 
out,  under  the  direction  of  the  medical 
department,  such  measures  as  may  help 
to  restore  the  applicant  or  the  employee 
to  normal  health.  Then,  too,  there  are  the 
abnormal  cases  which  require  special  care 
—  persons  with  defective  hearts,  those 
with  arteriosclerosis  and  high  blood  pres- 
sure, those  who  are  greatly  overweight  or 
underweight,  or  those  who  are  poorly 
nourished  and  whose  resistance  is  mani- 
festly low.  We  industrial  physicians  are 
comparatively  helpless  without  someone 
to  assist  us  in  the  upbuilding  of  these 
bodies  which  need  individual  care  rather 
than  routine  work  in  gymnasium  classes. 
It  would  be  foolish  to  prescribe  the  same 
drug  in  all  cases  of  illness  with  the  thought 
that  it  would  be  a  cure-all.  Is  it  not  equally 
absurd  to  expect  the  same  form  of  exercise 
to  benefit  individuals  irrespective  of  their 
physical  defects?  The  physician  and  the 
physical  director  should  hold  a  consulta- 
tion over  each  individual  case  in  order  that 
the  physical  director  may  be  fully  informed 
in  regard  to  the  condition  which  he  is  to 
try  to  remedy.  Otherwise,  a  heart  only 
.slightly  involved  may  be  permanently 
damaged,  or  an  overtaxed  circulation 
])roken  down  l)y  misdirected  efforts. 

In  .several  industrial  institulions  groups 
of  employees  are  assembled  on  a  gymna- 
sium floor  or  an  adjacent  field  and  put 
through  a  series  of  exercises.  Calisthenics 
are  a  bore  to  the  majority  of  jieople,  and 


168 


ELLIOTT  —  PHYSICAL  EDUCATION 


169 


apparatus  work  is  too  difficult  or  monot- 
onous for  the  average  person  to  approach 
with  any  degree  of  enthusiasm.  Glowing 
reports  of  the  success  of  these  group  classes 
are  received  but  individually  the  employees 
say:  "We  have  to  do  it  because  the  boss 
does.  We  would  rather  be  playing  ball." 
Play!  That  is  the  answer  —  the  spirit  of 
competition,  the  elemental  desire  in  each 
heart  to  excel  the  other  fellow. 

The  tendency  in  some  industrial  phys- 
ical training  departments  is  to  develop 
teams  very  closely  verging  on  i)rofessional- 
ism.  In  many  of  our  industrial  leagues  the 
sole  object  seems  to  be  to  organize  such 
teams  for  advertising  purposes.  In  fact, 
many  ex-professional  athletes  are  given  a 
nominal  place  on  the  payroll  merely  so 
that  they  may  participate  in  athletics. 
This  is  closely  analogous  to  the  old  cus- 
tom of  hiring  i)rofessional  athletes  to  at- 
tend college  and  giving  them  tiieir  tuition 
and  board  in  return  for  their  participation 
in  certain  forms  of  athletics.  In  a  recent 
conference  a  grouj)  of  men  engaged  in  in- 
dustrial physical  training  deplored  this 
tendency  and  agreed  with  the  physicians 
present  that  this  should  not  be  the  sole 
object  of  physical  training  in  industry. 
On  the  other  hand,  there  is  the  human 
factor  that  nuist  be  considered  —  that  is, 
the  reluctance  which  most  of  us  have  to 
engage  publicly  in  a  sport  in  which  we  real- 
ize that  we  are  not  very  proficient.  We 
would  rather  sit  on  the  side  lines  and  watch 
others  play  ball  or  tennis,  or  engage  in 
field  events,  than  to  go  in  and  try  them 
ourselves  and  be  laughed  at  because  we 
are  "dubs." 

There,  I  think,  is  the  important  problem 
to  be  solved.  How  are  we  to  get  the  bench 
warmers  out  on  the  field.'  Certainly  not 
by  encouraging  the  development  of  so- 
called  professional  industrial  teams,  but 
rather,  it  seems  to  me,  by  the  development 
of  playground  activities.  ,  In  one  factory 
which  I  recently  visited  the  building  was 


locked  during  the  noon  hour  and  all  the 
employees  went  out  of  doors  as  soon  as 
they  had  finished  lunch.  I  saw  more  people 
playing  volley  ball  at  one  time  in  that 
yard  than  I  have  ever,  before  or  since,  seen 
playing  the  game.  Besides  volley  ball 
there  were  several  games  of  indoor  base- 
ball and  two  games  of  ordinary  baseball 
going  on,  while  over  in  one  corner  of  the 
yard  a  number  of  fellows  were  pitching 
horseshoes.  Nearly  everybody  was  doing 
something  and  but  few  were  looking  on. 
Some,  it  is  true,  had  left  the  grounds  and 
gone  for  a  walk,  but  no  one  returned  to  the 
factory  directly  after  luncheon. 

A  point  that  should  be  emphasized  as 
essential  to  the  success  of  outdoor  recrea- 
tion is  that  the  playground  should  be  close 
to  the  factory,  preferably  on  the  same  lot, 
in  order  that  it  may  be  reached  with  no 
loss  of  time  and  in  order  that  there  may 
be  a  feeling  of  greater  freedom  among  the 
employees  because  they  are,  so  to  speak, 
{)layiiig  in  their  own  l)ack  yard.  If  this 
scheme  of  playground  activities  coukl  be 
still  further  perfected  by  being  organized 
under  the  direction  of  a  playground  leader, 
nuich  more  might  be  accomplished  than 
under  the  present  system. 

There  is  one  beneficial  result  of  play- 
ground activities  that  is  permanent;  when 
the  weather  becomes  inclement  these  young 
people,  who  have  become  accustomed  to 
play  for  a  half  or  three-quarters  of  an  hour 
during  each  noon  recess,  will  miss  tiieir 
play  time  and  will  naturally  drift  into  the 
gymnasium  during  the  winter  months. 
The  gymnasium,  therefore,  is  in  this  way 
secondary  to  the  playground,  and  with 
bowling,  basket  ball  and  other  indoor 
sports  will  continue  the  beneficial  habits 
formed  by  play  in  the  open.  One  serious 
drawback  to  gynmasium  work,  however, 
is  that  so  few  can  enjoy  it  at  one  time, 
and  therefore  our  problem  is  again  to  make 
the  spectator  play.  This  may  be  accom- 
plished by  providing  as  means  of  recreation 


170 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


other  amusements  which  require  Httle  or 
no  equipment,  such  as  dancing,  for  which 
only  a  phonograph  is  necessary;  indoor 
quoits;  checkers;  and  singing,  which .  is 
extremely  good  breathing  exercise.  Not 
long  ago  I  heard  two  or  three  hundred 
young  people  sing  in  a  factory  dining- 
room  after  lunch.  One  of  the  foremen 
acted  as  leader  and  one  of  the  girls  ac- 
companied them  on  the  piano.  And  how 
they  did  enjoy  it!  Yes,  I  sang  too,  as  did 
everyone  else. 

Practically  all  outdoor  sports  and  re- 
creational activities  that  have  been  par- 
ticipated in  by  women  and  girls  are  but 
adaptations  of  sports  and  games  indulged 
in  by  men  and  boys.  Baseball,  for  ex- 
ample, is  not  a  natural  game  for  a  girl  to 
play  and  very  few  girls  make  good  ball 
players.  The  same  may  possibly  be  said 
of  basket  ball.  It  seems,  therefore,  that 
there  is  a  large  field  still  open  for  the 
development  of  games  especially  applicable 
to  the  needs  of  women. 

It  is  not  the  purpose  of  this  paper  to  go 
into  the  great  subject  of  fatigue,  nor  to 
point  out  the  methods  of  measuring  fa- 
tigue, but  we  must  acknowledge  that  it 
constitutes  the  most  difficult  problem  to 
solve  in  all  industrial  relations.  Fatigue 
is  the  most  common  cause  of  breakage,  of 
wastage,  of  poor  quality  of  product,  of 
accidents,  and  of  lessened  production. 
Some  writers  say  that  there  is  no  such  thing 
as  fatigue,  that  it  all  resolves  itself  into  an 
antipathy  aroused  by  monotonous  occu- 
pation. Manifestly  this  is  not  so.  How- 
ever we  may  approach  this  subject,  how- 
ever skeptical  we  may  be  from  a  medical 
standpoint,  we  do  see  evidences  of  fatigue 
among  workers.  This  is  especially  true 
among  those  engaged  in  piecework  in  shops 
where  there  is  a  long  working  day.  If  you 
doubt  this,  try  it  yourself.  Pick  out  some 
simple  manufacturing  process  that  is  easy 
to  learn  and  then  sit  down  and  do  that  bit 
of  work  for  four  successive  hours.    Then 


eat  a  light  lunch  and  go  back  to  work  after 
half  an  hour  for  another  four  or  five  hours. 
As  a  result  you  will  be  very  tired,  nervous 
or  unstrung  and,  undoubtedly,  irritable. 
It  has  been  said  that,  if  fatigue  causes  a 
net  loss  of  five  cents  a  day  to  each  worker 
in  the  United  States,  in  a  year  it  will 
amount  to  the  stupendous  sum  of  $300,- 
000,000.  There  must  be  some  remedy  for 
fatigue,  but  it  is  not  a  universal  remedy 
and  therefore  cannot  be  applied  as  a  gen- 
eral rule,  but  must  be  adapted  to  each 
process  of  manufacture  after  an  exhaus- 
tive study  of  that  particular  industry. 

Many  processes  in  industry  are  in  them- 
selves fatiguing  either  because  of  the 
monotony  of  the  operation  or  because  of 
the  physical  effort  required  to  do  them  well. 
Among  the  workers  engaged  in  such 
processes  there  are  always  some  who  for 
no  apparent  reason  lag  behind  in  produc- 
tion, especially  if  they  are  doing  piece- 
work. Sometimes  this  is  so  apparent  that 
it  is  manifestly  due  to  some  inlierent  de- 
fect in  the  technic,  too  long  hours  or  poor 
hygienic  surroundings.  Personally,  how- 
ever, I  believe  that  it  is  monotony  which 
has  this  effect,  and  that  in  order  to  over- 
come this  and  thereby  decrease  spoilage 
and  accidents  and  increase  jiroduction  it 
is  necessary  to  have  recess  periods  during 
the  working  hours.  No  definite  rule,  how- 
ever, can  be  laid  down  for  these  recesses. 
In  office  work  it  is  a  simple  matter.  All 
that  is  necessary  is  an  opportunity  to  move 
about  and  if  possible,  under  suitable  direc- 
tion, to  take  some  simple  relaxing  or  cor- 
rective exercises  with  the  windows  open. 
I  have  seen  this  exjjeriment  tried  out  in 
one  office,  and  the  manager  says  that  ex- 
ercises are  now  an  accepted  part  of  the 
day's  work.  Certain  trade  unions  have 
specified  in  their  agreements  with  their 
employers  that  a  definite  amount  of  time 
be  given  each  day  during  the  working 
hours  for  relaxation.  They  have  found 
this  necessarv  because  of  the  nature  of  the 


ELLIOTT  —  PHYSICAL  EDUCATION  171 

process  of  manufacture.  On  the  other  a  community,  a  disgrace  to  industry  and 
hand,  there  are  a  vast  majority  of  workers  a  shame  to  the  medical  profession.  They 
who  need  these  recess  periods  but  who  do  should  be  eliminated,  and  they  can  be  l)y 
not  realize  their  need,  and  whose  employers  co-operation  between  the  physical  edu- 
are  also  oblivious  to  this  cause  of  fatigue,  cation  department  and  the  medical  de- 
Physical  relaxation  and  exercise  during  partment.  But  you  say  that  methods  for 
working  hours  are  of  great  importance  and  the  relief  of  these  deformities  are  expensive, 
should  be  given  careful  consideration  by  that  the  cost  is  prohibitive  for  anv  one 
each  plant  manager  after  he  has  made  a  factory.  True,  but  why  should  not'  coni- 
careful  survey  of  physical  conditions  of  the  bined  industry  contribute  toward  local 
operators  and  processes,  with  the  aid  of  hospitals  and  see  that  a  ward  or  building 
his  medical  staff.  Conditions  vary,  and  is  suitably  ecjuipped  and  maintained  for 
remedies  must,  therefore,  be  cho.sen  to  the  care  of  this  class  of  patients.^  Imagine 
meet  existing  conditions.  the  tremendous  saving  not  only  of  dollars. 

In  the  large  cities  where  man\  workers  but  of  thousands  of  dollars,  annually  if 
must  spend  from  one  hour  to  three  hours  the  stiffened  fingers  ami  hands  could  be 
each  day  going  to  and  from  the  factory,  treated  and  kept  limber  and  functioning, 
the  ((uestion  of  games  and  sports  outside  After  it  is  too  late,  after  adhesions  have 
of  working  hours  must  often  be  limited  b\-     formed  and  the  need  is  only  too  apparent, 

a  belated  attempt  is  made  to  correct  the 
impossible.  Treatment  should  follow  im- 
mediately upon  the  surgical  procedure; 
the  injured  fingers  should  never  be  allowed 
to  become  stiffened  and  contraction  should 
never  be  allowed  to  occur.    But  it  is  onlv 


the  time  available.  It  is  practically  mi- 
possible  to  induce  anybody  to  remain  for 
an  hour  or  so  after  work  to  take  uj)  any 
form  of  recreational  activity.  A  few  may 
stay  and  play  baseball  or  bowl,  but    the 

majority   choose   to  go   home.     They   are .v,  ^^^u..    ^ul  n  la  uiu^ 

tired  and  hungry,  and  they  want  to  get  by  individual  care  and  by  constant  super 
out  of  their  working  clothes.  It  is  appar-  vision  and  manipulation  of  these  crippled 
ent,  tlu'refore,  that  if  exercise  out  of  work-  members  everyday,  sometimes  every  two 
ing  hours  is  to  be  indulged  in  by  the  or  three  hours,  that  successful  results  can 
nuijority  of  workers,  it  must  be  arranged  be  obtained.  In  a  certain  city  of  a  million 
for  in  the  nu'ddle  of  the  day.  If  the  work-  inhabitants,  with  :5.()0(»  industries,  there  is 
ing  day  is  eight  hours  long,  there  should  not  even  one  well-eciuijjped  hospital  or  dis- 
be  at  least  one  hour  at  noon  for  a  light  pensarytohandle  thevast  nmilitudeof  such 
luncheon  and  recreation.  Again  games  cases  that  present  themselves  each  year, 
are  the  best  means  of  relaxation,  but  these  Perhaps  it  is  not  the  function  of  a  paper 
games  should  be  simple;  first,  in  order  of  this  character  to  mention  the  beneficial 
that  all  may  play  and,  secondly,  in  order  effects  of  preventative  measures  applicable 
that  they  may  be  completed  in  the  brief  to  club  feet,  flat  feet,  and  other  acquired 
tune  allotted.  Naturally,  the  physical  in-  or  congenital  deformities  that  are  occa- 
structor  should  here  become  the  play-  sionally  seen  in  industrial  clinics,  and  yet 
ground  director,  and  it  is  his  duty  to  we  know  that  many  of  these  conditions 
arouse  the  interest  of  the  bench  warmers  even  could  be  helped  or  prevented  by 
and  keep  things  moving.  simple  measures  similar  to  those  which 
In  all  of  our  industries  one  encounters  the  have  been  mentioned  above  for  the  treat- 
sad  spectacle  of  twisted  hands  and  fingers,  ment  of  occupational  deformities, 
ugly  deformities  and  scars  with  resulting  The  chief  criticism  that  has  been  made 
contractions.    I  believe  these  are  a  blot  on  of  this  rather  extensive  program  for  phys- 


172 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ical  education  is  that  it  would  be  expen- 
sive to  put  into  operation.  It  would  re- 
quire the  services  of  a  man  well  trained 
in  gymnasium  and  playground  activities, 
and  would  necessitate  the  installation  of 
more  or  less  expensive  equipment.  There 
is  no  reason  why.  a  beginning,  however 
small,  could  not  be  made  in  almost  all 
industries.  The  first  requisite  is  a  vacant 
lot.  The  tendency  is  for  young  people  to 
play  wherever  there  is  a  vacant  piece  of 
property'.  They  may.  be  interested  in 
baseball  or  some  other  outdoor  sport,  but 
in  any  event,  they  tend  to  gather  together 
and  to  play  something.  If  somebody  can 
be  secured  to  direct  them,  even  though  it 
be  a  volunteer  from  among  their  own 
numbers,  it  will  be  a  beginning  which  is 
sure  to  bear  fruit  in  the  long  run.  I  do 
not  believe  it  is  the  province  of  industrial 
organizations   to   try   to   reach   the   high 


standard  of  equipment  which  has  been  in- 
stalled in  some  places  and  which  is  so  ela- 
borate that  the  expense  is  prohibitive  to 
most  companies.  But  at  any  rate  let  us 
make  a  beginning.  The  workers  themselves 
will  take  care  of  the  rest  as  the  spirit  of 
play  becomes  a  part  of  the  routine  of  their 
day's  work. 

The  industrial  executive  has  three  prob- 
lems always  before  him  —  production, 
quality,  and  people.  He  feels  that  it  is  the 
function  of  the  medical  department  to 
provide  him  with  workers  physically  able 
to  give  him  the  maximum  production,  and 
realizes  that  the  quality  of  output,  too, 
is  inseparable  from  good  health  and  good 
spirits.  The  medical  dej^artment  and  the 
physical  education  department  cannot  fail 
to  succeed  if  they  will  work  together  and 
strive  to  co-operate  with  executives  on  the 
one  hand,  and  the  workers  on  the  other. 


n3 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


Volume  III 


OCTOBER,  1921 


Number  6 


HEADACHE* 

STANLKY  COBB.  M.D. 

Axxislaiil  Professor  of  Xeiiropathology,  Ilarrard  Medical  School,  and  Asii.tlanf  Neurologist,  ilassachiisctls  General  Hospital 

AND 

D.  C.  I'AUMKNTKU.  M.I). 

Assistant  in  Industrial  Hygiene,  Ilarrard  Medical  School,  and  Instructor  in  Hygiene,  Ilarrard  Vnieersity 


KADACIIE"  is  crrtainly  one  of  tlu> 
most  ire(|uent  coiiiplaiiits  among 
industrial  workers  —  any  i)hysician  work- 
ing in  an  industrial  community  knows  this 
fact  in  a  general  way.  This  pajx'r  is  written 
to  focus  our  attention  on  lieadaclie  as  a 
s,\Tnj)tom,  and.  by  giving  brief  data  col- 
lected in  factories  and  department  stores,  to 
stinnilate  other  workers  in  the  field  to  make 
more  extensive  studies. 

In  a  factory  industrial  unit  employing 
l'-2,()00  workers.  Mock's  (1)  analysis  of  the 
cases  of  time  lost  in  a  year  showed  that  in 
approximately  23  per  cent,  the  complaint 

TABLE  1.  — NUMBER  OF  LOST  TIME  CASES 

DUE  TO  HE.\DACHE  AISIONG  12,000 

FACTORY  WORKERS 


Sex 

No.  of  Cases  of 

Lost  Time  in 

a  Year 

No  of  Cases       Per  Cent.  Due 
Due  to              (o  Headache 
Headache       ] 

Male .  .  . 

6,420 
15,244 

1,255 
3,778 

19 

Female 

24 

was  headache  (Table  1).   One  of  us,t  work- 
ing in  mercantile  industrial  units,  found 

*  Received  for  publication  .\ugust  13,  1921. 
t  D.  C.  P. 


that  from  10  fo  I.')  per  cent,  of  all  enii)l6yees 
asking  for  medical  attention  comj)lained  of 
headac-he.  One  department  store  had  an 
average  of  1,500  employees.   Table  2  shows 

TABLE  2.  — NUMBER  OF  C.\SES  OF  ILE.\D.\CHE 
AMONG  1,500  DEPARTMENT  STORE  EMPLOYEES 


Month 

Total  Cases 
Eiamined 

Headaches 

Number 

Per  Cent. 

1st 

670 

64 

9.5 

2d 

554 

5!) 

10.6 

3d 

767 

05 

8.4 

4th 

1,000 

145 

14.5 

5th 

775 

84 

10.8 

Cth 

685 

09 

10.0 

the  number  of  cases  seen  each  month  and 
the  number  and  percentage  of  these  cases 
complaining  of  headache.  In  a  .smaller  store 
employing  about  800,  with  a  greater  num- 
ber of  women,  a  tabulation  for  four  months 
.showed  even  a  larger  percentage  of  head- 
aches (Table  3).  In  both  establishments 
more  women  than  men  were  employed,  and 
in  the  smaller  store,  where  there  was  a  larger 
percentage  of  female  employees,  the  num- 
ber of  headaches  was  greater.  Mock's  fig- 
ures also  showed  that  more  women  com- 


173 


174 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


plained  of  headache  than  men,  in  the  ratio 
of  24  to  19.  This  is  j)robabIy  due  to  sexual 
differences  —  for  examijle,  menstrual  diffi- 
culties and  "nervous  instability"  —  al- 
though the  contention  that  women  as  a 
group  are  less  stable  than  men  cannot  be 
shown  conspicuously  by  any  statistics  with 
which  we  are  familiar. 

Fraiicis  A.  Brugman  f^),  in  the  beginning 
of  his  recent  paper,  Etiology  of  Chronic 
Headaches,  says  that  there  are  so  many 
factors  entering  into  the  causation  of  head- 
aches, and  so  manj'  different  ways  in  which 

TABLE  3.  —  NUMBER  OF  CASES  OF  HEADACHE 
AMONG  800  DEPARTMENT  STORE  EMPLOYEES 


Month 

Total  Cases 
Examined 

Headaches 

Number 

Per  Cent. 

1st 
2d 
3d 
4th 

651 
502 
541 
691 

100 
73 
80 
85 

15.3 
13.9 

13.7 
10.2 

the  pain  may  present  itself,  that  no  particu- 
lar pathological  condition  can  be  said  to 
cause  any  particular  kind  of  headache.  He 
further  says  that  some  idea  may  be  had  of 
the  problem  confronting  the  diagnostician 
when  one  observer  has  given  a  list  of  160 
conditions  which  may  cause  headache. 
Hence  only  the  more  common  conditions 
can  be  referred  to  here. 

Most  authors  make  painstaking  classifi- 
cations of  the  different  forms  of  headache; 
for  example,  Brugman's  division  into  reflex, 
congestive,  toxic  and  neurotic  is  better  than 
most  classifications;  but  in  all  fairness  we 
must  admit  that  we  know  so  little  of  the 
physiological  jjathology  that  to  use  the 
words,  reflex,  toxic  and  neurotic,  is  simply 
to  cover  our  ignorance  of  the  mechanism 
involved  with  vague  names.  Congestion 
we  can  easily  demonstrate,  for  we  know 
that  a  tight  collar  will  cause  a  headache, 
and  we  can  show  in  the  laboratory  that 
pressing  on  the  jugular  veins  causes  cere- 


bral congestion  and  raises  intracranial 
pressure. 

Even  though  we  know  little  definite 
about  etiology,  clinical  experience  has 
clearly  indicated  certain  factors  in  the 
causation  of  headache,  and  additional  evi- 
dence has  been  gained  by  therapeutic  ex- 
periments. Therefore  we  will  classify  these 
headaches  according  to  their  probable  eti- 
ology, considering  first  those  causes  which 
were 'most  commonly  met  with  in  the  de- 
partment stores  above  mentioned. 

The  most  frequent  cause  seems  to  have 
been  the  onset  of  an  acnie  infection,  usually 
of  the  upper  respiratory  tract  —  the  com- 
mon "cold"  or  "grippe."  A  liberal  use  of 
the  clinical  thermometer  and  a  few  ques- 
tions will  make  the  recognition  of  this  type 
a  simple  matter.  Constipation  was  next  in 
importance.  Here  the  headache  is  usually 
dull  and  diffuse,  and  the  diagnosis  is  gener- 
ally made  from  the  history.  But  constipa- 
tion is  seldom  an  isolated  cause;  it  is  usuallj' 
associated  with  poor  hygiene  —  e.  g.,  lack  of 
drinking  water  and  other  faults  of  diet, 
lack  of  sleep,  and  work  at  home  as  well  as 
at  the  store,  all  contributing  to  make  a 
picture  of  general  fatigue.  Frequently  this 
is  the  forerunner  of  some  incipient  disease. 
Anemia  may  be  an  important  factor. 

This  class  of  headaches,  however,  cannot 
be  sharply  di^'ided  from  the  great  group 
of  psychoneurotic  headaches,  for  faulty 
mental  hygiene  usually  leads  to  bad  physi- 
cal hygiene  or  rice  rersa,  and  a  vicious  circle 
is  easily  formed,  from  which  the  patient 
finds  it  impossil)le  to  escape.  Advice  as  to 
regular  habits,  followed  up  by  supervision, 
is  often  all  that  is  necessary  to  break  the 
circle.  With  the  physical  condition  thus 
improved,  the  mental  sjTiiptoms  ma^•  be- 
come inconspicuous.  While  no  one  cause 
can  be  given  in  such  a  case,  the  combination 
of  various  circumstances  at  a  given  time 
burdens  the  patient  to  the  breaking  point. 
For  relief  it  is  not  necessary  to  remove  all 
the  untoward  circumstances,  in  fact  it  is 


COBB  AND  PAR:\IEXTER  —  HEADACHE 


175 


impossible — for  we  all  carry  some  burdens, 
physical  or  mental — but  a  removal  of  part  of 
the  burden  will  usually  allow  the  patient  to 
get  rid  of  the  symptoms  that  are  interfering 
with  economic  efficiency  and  happiness. 

Many  cases  will  be  encountered,  how- 
ever, particularly  in  department  store 
work,  where  simple  rules  of  hygiene  will  do 
little  good.  These  cases  can  be  considered 
p.sychiatric,  and  a  careful  study  will  elicit 
emotional  factors,  poor  adaptations,  dis- 
satisfaction with  life,  worry,  or  other  en- 
vironmental difficulties.  For  example,  an 
employee  may  be  worrying  over  decreased 
sales  and  fear  of  reprinuinds  by  superiors; 
another  may  be  having  difficulties  in  his 
_  home  life,  causing  emotional  instability;  in 
P  both  cases  there  is  a  resulting  lack  of  energy 
and  poor  ])hysical  hygiene,  lor  when  our 
spirits  are  d('j)ressed  our  l)odies  feel  "tired" 
and  we  do  not  have  the  energy  to  follow  a 
healthful  routine.  The  headache  is  a  de- 
fence against  irksome  effort;  the  jjatient  is 
unhappy,  vaguely  dissatisfied,  and  craves 
attention,  pity,  relii'f  from  monotony.  A 
slight  headache,  which  in  another  indi- 
vidual (or  in  this  ])atient  at  another  time) 
would  cause  no  disability,  is  seized  on  as  a 
means  of  escape  from  the  situation  and  is 
exaggerated  until  the  patient  obtains  the 
relief  desired.  These  mental  mechanisms 
are  largely  sul)conscious,  and  to  tell  such  a 
patient  that  the  headache  is  "inuigination" 
is  not  only  to  show  gross  ignorance  of  the 
psychology  involved,  but  it  is  bad  thera- 
peutics, since  the  jiatient  is  antagonized 
and  can  never  be  led  to  understand  the  real 
cause.  Success  is  only  obtained  by  sympa- 
thetic investigation  of  all  the  mental  fac- 
tors, followed  by  frank  talks  in  explanation 
of  the  s^^nptoms.  In  obtaining  the  facts 
in  these  cases,  which  are  usually  of  a  per- 
sonal nature,  a  well-trained  and  tactful 
social  worker  is  an  invaluable  adjunct  to 
the  medical  staff. 

INIany  psychoneurotic  headaches  are  di- 
rectly caused  by  neuromuscular  tension. 


Whenever  we  are  over-stimulated,  uncon- 
trolled and  useless  energy  is  likely  to  be 
spent  by  contracting  the  muscles  of  our 
neck,  face,  scalp,  or  even  of  our  extremities. 
Common  examples  are  seen  in  the  set  jaw 
and  the  dra^^^l  face.  Such  muscular  tension 
long  continued  may  set  up  definite  head- 
ache; indeed,  it  is  a  common  cause  since 
the  ovei'-stimulation  responsible  for  the 
tension  may  come  either  from  external 
sources,  such  as  continuous  noise,  or  from 
internal  emotional  conflicts.  Perfectly  nor- 
mn\  i)eoj)le  subjected  to  stress  often  suffer 
thus,  but  the  supersensitive  i)sychoneurotic 
is  much  more  susceptible. 

In  our  experience,  eyestrain  was  a  fre- 
(|uent  cause  of  headache.  Clarke  (3)  con- 
siders it  by  far  the  commonest  (quoting 
Lauder  Brunton  as  saying  that  90  per  cent, 
of  all  headaches  are  due  to  eyestrain),  but 
this  would  seem  to  be  an  exaggerated  state- 
ment, unless  we  accept  Charles'  (4)  theory 
tiiat  local  eyestrain  causes  headache  only 
when  the  patient  is  neurotic.  These  cases 
then  wc)uld  be  classed  with  the  great  group 
of  psychoneurotic  headaches,  and  would  be 
l)est  explained  by  ])ostulating  that  most 
normal  jjeople  have  slight  feelings  of  pres- 
sure or  other  cranial  discomfort  after  eye- 
strain, but  that  it  is  only  in  unstable  people 
that  this  degree  of  pain  amounts  to  dis- 
al)ility.  By  what  mechanism  eyestrain  pro- 
duces headache,  we  do  not  know.  Manj'^ 
elaborate  theories  have  been  advanced,  the 
most  reasonable  of  which  seems  to  be  that 
(he  effort  of  accommodating  with  a  refrac- 
tive error,  or  of  converging  in  spite  of  a 
nuiscular  imbalance,  causes  a  muscular 
tension  analogous  to  those  described  above. 
Even  this  theory  gives  little  clue  to  the 
actual  mechanism  involved,  although  the 
fact  that  those  headaches  which  are  most 
relieved  by  glasses  are  usually  frontal  or 
orbital  suggests  that  local  muscular  tension 
maj'  be  a  factor. 

The  last  group  of  headaches  which  could 
be  considered  common  among  these  em- 


176 


THE  JOUENAL  OF  INDUSTRIAL  HYGIENE 


ployees  was  the  group  arising  from  infec- 
tions of  the  nasal  sinuses.  The  pain  in  these 
cases  is  intense,  and  tenderness  can  usually 
be  elicited  over  the  offending  sinus.  The 
history  of  rhmitis  and  examinations  by 
transillummation  and  X-ray  will  aid  in  the 
diagnosis. 

Before  going  on  to  a  discussion  of  the 
kinds  of  headaches  less  frequently  encoun- 
tered in  this  group  of  workers,  it  would  be 
well  to  discuss  a  vague  but  important  entity 
—  the  fatigue  headache.  This  is  such  a  mild 
symptom  in  most  people  that  it  seldom  is 
brought  to  the  attention  of  the  physician. 
In  psychoneurotic  patients  it  is  often  the 
central  sjanptom.  It  is  a  common  experi- 
ence that  excessive  work  will  cause  a  feeling 
of  pressure  about  the  head,  as  if  the  temple 
were  clamped  in  a  vice,  or  as  if  an  iron  band 
were  pressing  about  the  forehead.  The 
precipitating  cause  of  such  discomforts  may 
be  either  physical  or  mental  strain.  When 
arising  from  physical  strain,  fatigue  head- 
ache usually  occurs  in  an  individual  who  is 
not  accustomed  to  labor  and  who  leaves  his 
sedentary  occupation  to  take  a  strenuous 
day  in  the  open  air.  He  feels  well  all  day, 
but  goes  to  bed  with  a  slight  headache  and 
may  wake  up  the  next  morning  with  a  se- 
vere one.  On  the  other  hand,  similar  head- 
aches arise  from  excessive  indoor  work  — 
overtime  —  especially  if  the  worker  stimu- 
lates himself  to  keep  up  his  task  with  coffee, 
tea,  alcohol,  or  tobacco.  These  drugs,  of 
course,  complicate  the  picture,  as  any  one 
of  them  may  cause  headache  with  its  own 
toxin.  Another  thing  to  be  considered  is 
the  environment  in  which  the  person  is 
working:  Is  the  room  stuff ^•?  Is  it  noisy? 
Is  the  Ught  trying  to  the  eyes?  In  fact, 
are  there  any  stimuli  which  in  an  ordinary 
eight-hour  day  would  cause  no  sjmiptoms, 
but  which  in  excess  may  be  important 
sensory  irritants? 

It  is  our  experience  that  persons  who 
have  unstable  vasomotor  systems  are  the 
ones  most  affected  in  this  way  —  i.  e.,  those 


individuals  who  blush  and  sweat  easily, 
whose  heart  rate  and  blood  pressure  vary 
quickly,  and  who  in  addition  show  active 
pupillary  and  tendon  reflexes.  Rest  in- 
variably brings  about  relief,  or  a  dose  of 
"salts"  may  more  quickly  cure.  These 
facts,  taken  with  the  observation  that  the 
face  is  usually  flushed  and  the  temporal 
artery  conspicuously  tortuous  and  tense 
during  the  attack,  direct  our  attention  to 
the  vasomotor  mechanism,  and  make  us 
believe  that  cerebral  congestion  is  the  prob- 
able cause.  The  fact  that  the  administra- 
tion of  a  hypertonic  solution  in  the  form  of 
a  dose  of  salts  gives  quick  relief  corrob- 
orates this  theory,  because  it  is  known  that 
such  solutions  quickly  reduce  intracranial 
tension  (5).  This  explanation  seems  more 
material  than  the  one  frequently  given 
that  "fatigue  toxins"  cause  the  headache, 
but  it  must  be  admitted  that  the  physi- 
ological products  of  fatigue  in  the  sensory 
nervous  mechanisms  and  in  the  muscles 
may  well  initiate  the  vasomotor  changes. 

Closely  allied  to  these  common  but  mild 
headaches  is  migraine.  This,  unlike  many 
headaches,  is  not  merely  a  s\anptom,  but 
seems  to  be  a  clearly  defined  disease  entity 
characterized  by  periodic  paroxysmal  at- 
tacks accompanied  by  nausea  or  vomiting. 
The  disease  is  strongly  inherited,  90  per 
cent,  of  the  cases  showing  antecedents  or 
descendants  with  tlie  same  trouble  (6). 
The  onset  is  almost  invariably  during  child- 
hood or  youth.  Less  imj)ortant  symptoms 
are  the  unilateral  distribution  of  the  pain 
in  about  two-thirds  of  the  cases,  and  the 
ocular  prodromal  jihenomena  in  about  one- 
fourtli.  At  present  there  is  no  accepted  ex- 
planation of  the  symptoms,  but  the  most 
satisfactory  theory  seems  to  be  that  vaso- 
motor changes  cause  an  increase  in  the  bulk 
of  the  cranial  contents,  thus  putting  painful 
tension  on  the  dura. 

Three  other  common  causes  of  headache 
should  be  given  sj^ecial  mention.  In  the 
first  place,  syphilis  must  be  thought  of  in 


i 


COBB  AND  PARAIENTER  —  HEADACHE 


177 


cases  where  the  pain  is  chronic,  and  a  Was- 
serniann  test  should  alwaj's  be  made  on  the 
blood;  even  if  this  test  proves  negative  a 
hnnbar  puncture  and  examination  of  the 
s])inal  fluid  is  advisable  whenever  the  case 
is  difficult  to  diagnose.  Secondly,  brain 
tumor  is  much  more  common  than  is  gener- 
ally supposed  and  severe  headache  may  be 
the  first  symptom,  vomiting,  choked  disc 
and  neurological  signs  appearing  later.  The 
third  is  rheumatic  headache,  also  called  "in- 
durative" or  "nodular."  This  tyi)e  has 
been  well  described  by  Patrick  (7)  and 
Auerbach  (8).  The  cardinal  features  are 
persistent  headache  with  fluctuations,  us- 
ually in  ])cople  ov(>r  40  years  of  age,  and 
primarily  located  in  I  lie  suboccipital  region 
but  radiating  to  tlie  neck,  shoulders,  and 
vertex.  Changes  in  the  weather  often  in- 
crease the  ])aiu.  Palpation  of  the  scalp 
reveals  snudl  tender  nodules,  and  in  the 
muscles  of  the  neck  indurated  areas  may 
be  felt.  During  an  «'xacerbation.  however, 
the  neck  nuiscles  are  so  sjjastic  that  nothing 
is  palpable.  General  examination  may  re- 
veal arthritis,  low  fever,  leukocytosis  and 
focal  infection  usually  in  the  head.  Massage 
and  heat  a])plied  to  the  head  and  neck  give 
relief  —  procedures  which  increase  the  pain 
in  most  other  forms  of  headache. 

It  is  not  ])ertinent  to  continue  enumerat- 
ing the  causes  of  headache,  but  having 
drawn  attention  to  those  types  most  fre- 
quently met  with,  we  may  summarize  with 
the  following  table,  modelled  on  I'able  1  in 
Auerbach's  book. 

T.\BLE  4.  — CLASSIFICATION'   OK   THE   DIFFER- 
ENT FORMS  OF  HEADACHE 

.-1.     The  More  Independent  Forms  of  Headache 

1.  Migraine 

2.  Fatigue  headaclie 

3.  Rlieumatic  lieadache 

B.  Headaches  Associaied  with  Diseases  of  Individual 
Organs 

1.  Brain  disease  (meningitis,  encephalitis,   tu- 
mor) 

2.  Organs  of  special  sense  (eyestrain,  otitis) 


3.  Digestive  tract  (constipation,  hunger,  gas- 
tric lu^eracidity,  jaimdice) 

4.  Kidney  (nephritis) 

5.  Vascular  (congestion  from  tight  lacing,  tight 
collars,  lumbar  puncture,  sunstroke  or  menstruation; 
h^-pertension ;    arteriosclerosis) 

C.  Headaclie  in  General  Diseases 

1 .  ."Vcute  infections 

2.  Clironic  infections  (syphilis,  paresis,  rheuma- 
tism) 

3.  Intoxications  (alcoliol,  lead,  toliacco,  ether, 
carbon  monoxide,  sulphuretted  hydrogen,  opium, 
iodoform,  iodides) 

4.  Constitutional  diseases  (anemia,  diabetes, 
endocrine  disorders) 

D.  Psychoneurotic 

E.  Combinations  of  Difcrent  Forms 

From  the  foregoing  discussion  it  is  ai>- 
parent  that  the  iliagnosis  of  headaclie  is 
far  from  simple;  the  examination  of  the 
patient  must,  therefore,  be  painstaking  and 
prolonged.  It  would  be  impossibl(>  to  out- 
line a  reasonably  comi)lete  examination  to 
co\-er  all  cases,  but  a  brief  account  of  what 
should  be  done  in  crcri/axse  can  l)e  sketched, 
leaving  to  the  discretion  of  the  examiner 
the  "leads"  which  are  worth  while  follow- 
ing u|)  by  special  examinations  as  indica- 
tions may  arise. 

In  the  first  place,  a  careful  history  must 
be  taken,  especially  in  regard  to  inheritance, 
exact  occupation,  home  conditions  and  ])ast 
illnesses.  The  importance  of  looking  into 
the  home  conditions,  such  as  family  and 
marital  relations,  financial  worries,  etc., 
cannot  be  over-emphasized,  since  the  group 
of  psychoneurotic  headaches  dejjends 
largely  on  these  factors;  and  psychoneu- 
rosis  is  one  of  the  most  frequent  causes  of 
{he  symptom.  The  history  of  the  present 
illness  should  be  taken  in  detail  in  order  to 
obtain  the  facts  concerning  onset,  duration, 
periodicity,  and  precipitating  causes. 

Next,  the  physical  examination  is  taken 
uj),  and  the  organism  studied  in  a  thorough 
routine  way,  with  special  interest  in  a  neu- 
rological examination  which  should  include : 

I.  Cranial  nerves,  with  ophthalmoscopic  inspec- 
tion of  the  fundus 


178 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


2.  Motor  system,  witli  inspection  of  muscular 
strength,  gait,  co-ordination  and  tremor 

3.  Reflexes,  especially  the  knee  jerks,  ankle  jerks 
and  abdominals 

4.  Sensory  system  —  wliich  can  usually  be  judged 
of  by  asking  about  subjective  sensation,  with  quick 
tests  of  the  cornea,  pharynx  and  Romberg's  sign 

5.  Sympathetic  system  —  heart  rate  and  pupil- 
lary reflexes  to  light  and  accommodation,  with  in- 
spection of  the  skin  for  flushing  and  sweatmg 

6.  Endocrine  system  —  thyroid,  sex  glands,  skele- 
ton, skin  texture,  and  hair  distribution 

7.  Temperature 

8.  Urine  analysis 

With  a  brief  outline  of  this  sort  posted  on 
the  office  wall,  it  adds  remarkably  little  to 
the  time  of  examination  to  note  the  posi- 
tive findings,  and  in  writing  up  the  exami- 
nation afterwards  it  is  a  great  aid  to  have  a 
list  to  remmd  one  of  omissions.  The  spe- 
cial examinations  which  will  be  foiuid  of 
most  value  are  the  Wassermann  test;  lum- 
bar puncture;  ophthalmological  examina- 
tion with  special  reference  to  visual  fields; 
blood  counts  of  red  and  white  cells ;  X-ray 
of  the  skull,  teeth  and  sinuses;   transillu- 


mination; and  stool  examination.  These 
procedures  should  be  advised  freely  on  the 
slightest  indication,  for  the  diagnosis  is 
difficult  at  best  and  success  often  comes 
from  unexpected  sources. 

SXJMMART 

Headache  is  a  common  complaint  among 
industrial  workers,  causing  in  some  units 
as  much  as  '•23  per  cent,  of  the  cases  of  lost 
time,  and  an  average  of  10  to  15  per  cent. 
in  the  mercantile  establishments  studied 
by  us.  The  causes  of  headache  are  many, 
but  among  the  employees  whom  we  ex- 
amined acute  infection,  constipation,  poor 
hygiene,  psychoneurosis,  and  eyestrain,  in 
the  order  named,  were  the  commonest.  A 
careful  history  with  interest  in  jjersonal  and 
occupational  problems  is  essential  to  diag- 
nosis. The  physical  examination  must  be 
thorough  and  orderly,  with  emphasis  on 
neurological  findings,  but  it  need  not  be 
time-consuming  if  carried  out  according  to 
schedule. 


BIBLIOGRAPHY 


1.  Mock,  H.  E.:  Industrial  Medicine  and  Sur- 
gery. Philadelphia,  W.  B.  Saunders  Company, 
1920,  pp.  403  and  422. 

2.  Brugman,  F.  A.:  Etiology  of  Chronic  Head- 
aches.   Journal-Lancet,  1920,  2,  516. 

3.  Clarke,  K. :  Notes  on  the  Common  Causes  of 
Persistent  Headache  and  Their  Differential 
Diagnosis.    Practitioner,  1919,  102,  274. 

4.  Charles,  J.  W.:  Ocular  Headache.  Jour.  Am. 
Med.  Assn.,  1918,  71,  1711. 


5.  Weed,  L.  H. :  Experimental  Alteration  of  Brain 
Bulk.    Am.  Jour.  Physiol.,  1919,  48,  531. 

6.  Moebius,  P.  J.:  Die  Migraine.  Wien,  Alfred 
Holder,  1903. 

7.  Patrick,  H.  T. :  Indurative  Headache.  Jour. 
Am.  Med.  Assn.,  1918,  71, 82. 

8.  Auerbach,  S. :  Headache,  Its  Varieties,  Their 
Nature,  Recognition  and  Treatment.  London, 
H.  Frowde  and  Hodder  and  Stoughton,  1913. 


MEDICAL  SUPERVISION  IN  INDUSTRY  * 


C.  W.  J.  BRASHER,  M.D. 

Bristol,  England 


Millions  Sacrificed  in  Lost  Time 

An  educational  campaign  is  now  lieing  carried  on 
to  bring  home  to  the  large  manufacturing  employers 
the  value  of  medical  supervision  in  in<lustry. 

The  loss  to  Britisli  industry  tlirougli  diminislied 
effort  due  to  indifferent  health  or  actual  illness  is  cal- 
culated at  something  like  £'-2,()00,000  a  week.  It  is 
difficult  to  credit  such  a  stupendous  figure,  but  that, 
I  am  assured,  is  the  Industrial  Welfare  Society's  esti- 
mate of  the  fiiKtuation  of  lal)i)ur  thus  involve<i. 


ical  supervision  described  in  this  comimuii- 
cation  has  been  in  use  for  twenty-one  years 
and  has  been  adopted  by  a  number  of  large 
employers  of  labor.  It  has  the  advantage  of 
being  easily  carried  out,  and  by  careful  ex- 
amination of  all  candidates  for  factory  em- 
ployment many  early  cases  of  disease  may 
be  detected  and  dealt  with  liefore  irremedi- 
able damage  has  been  clone  to  a  growing 


Dr.  E.  L.  Collis,  late  Director  of  AVelfare  and     boy  or  girl,  placed  in  an  imsuitablc  euvirou- 
Health  to  the  Ministry  of  Munitions,  is  not,  how-      nient 


€ver,  dismayed  by  this  figure,  for  he  declares  that  by 
projjcr  niedi('al  supervision  it  could  be  reduced  by 
70  per  cent.  —  Evening  Standard,  London,  June  25, 
1921. 


It  has  been  objected  that,  by  the  applica- 
tion of  what  may  be  termed  "recruiting 
methods"  to  candidates  for  employment  in 
large  factories,  those  who  are  rejected  will 

THE  above  i)aragraphs  are  of  great  in-  be  driven  to  seek  employment  in  other 
terest  and  importance  at  the  present  smaller  factories  or  worksho])s  wheri>  con- 
time  when  the  proportion  of  the  physically  ditions  are  worse.  This  argument  would 
fit  of  the  male  population  has  been  reduced  apply  equally  to  all  attempts  to  improve 
to  a  lower  ])oint  than  at  any  i)revious  period  the  hygienic  condition  of  the  hidustrial 
by  the  ravages  of  the  (ireat  War.  We  are  classes.  For  exam]3le,  it  may  be  argued 
accustomed  to  think  of  the  law  of  "con-  that  because  the  hygienic  standards  of 
servation  of  energy"  in  its  narrow  i>hysical  large  cities  have  not  been  enforced  hitherto 
sense,  but  in  human  life  there  is  also  the  by  the  health  authorities  of  smaller  urban 
possibility  of  the  conservation  of  energy  in  districts  and  rin-al  areas,  these  standards 
industry.  In  the  present  world-crisis  it  be-  should  be  lowered;  or,  to  take  another  ex- 
hooves   us  to  do  our  utmost   to  ])revent     ample,   because   the   Overseas   Dominions 


waste  in  all  directions  and  especially  in  the 
direction  of  conservation  of  human  life,  in 
which  too  little  has  been  done  in  the  past. 

Although  the  British  government,  work- 
ing through  the  local  authorities,  has  done 


and  the  United  States  insist  rightly  upon 
a  rigorous  medical  examination  of  all  immi- 
grants in  order  to  protect  their  popidations 
from  the  undesirables  of  Europe,  that  these 
barriers  should  be  lowered  lest  the  undesir- 


niuch  to  promote  the  effective  treatment  of  able  and  the  unfit  be  driven  back  to  their 

known  cases  of  tuberculosis,  no  organized  place  of  birth. 

effort  has  been  made  to  i)revent  persons  in  In  the  present  day,  when  the  Great  War 

the  early  stages  of  tuberculosis,  of  heart  has  caused  the  death  or  disablement  of  sev- 

disease,  and  of  ejulepsy  from  entering  in-  eral  millions  of  the  most  robust  of  the  male 

dustrial  life,  and,  in  the  case  of  tuberculous  i)opulation,  the  paramount  importance  of 

patients,  to  prevent  them  from  infecting  conserving    the   health    of    the   remaining 

their  fellow-workers.    The  system  of  med-  workers  by  protecting  them  from  infection 

*  Received  for  publication  July  20,  1921.  and  by  finding  suitable  employment  for 

179 


180 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


those  who  show  signs  of  disease  which  will 
incapacitate  them  for  factory  life  in  a  few 
years,  will  readily  be  admitted. 

The  examination  of  the  greater  part  of 
the  male  ])opulation  of  Great  Britain  be- 
tween the  ages  of  18  and  41  by  medical  re- 
cruiting boards  during  the  Great  War  re- 
vealed a  large  amount  of  disease  and  of 
physical  defects  among  the  industrial 
classes.  Dr.  Carey  Coombs  has  recently 
stated*  that  "examination  of  the  war 
office  records  shows  that  10  per  cent,  of  the 
total  rejections  were  for  '  V.  D.  H.'  "  The 
Prime  Minister,  in  characteristically  pic- 
turesque language,  said  a  few  months  ago, 
"You  cannot  run  an  A I  empire  with  a 
C  III  population."  Although  school  med- 
ical officers  and  school  clinics  have  done 
much  to  improve  the  physique  of  children 
in  the  public  elementary  schools,  no  such 
supervision  is  exercised  generally  after 
these  children  leave  school  and  enter  in- 
dustrial life.  If  they  choose  factory  em- 
ployment, they  are  examined  prior  to  entry 
by  the  certif J'ing  factory  surgeon,  and  if  he 
passes  them  as  fit  for  employment'  they 
may  have  no  further  medical  examination 
except  on  applying  to  a  panel-doctor  for 
admission  to  his  panel.  The  choice  of  em- 
ployment is  usually  left  to  the  individual 
boy  or  girl,  guided  more  or  less  by  their 
parents,  and,  as  Dr.  Carey  Coombs  ob- 
serves, there  has  been  no  concerted  attempt 
to  find  suitable  employment  for  patients 
who  lune  suffered  from  rhemnatism  or 
from  tuberculosis  during  school  life.  Many 
of  these  patients  who  have  reached  adoles- 
cence enter  factories  and  may  work  for  a 
few  years  before  they  finally  break  down. 

There  is  no  system  in  general  use  by 
which  employers,  managers,  and  heads  of 
workshops  can  be  interested  in  the  detec- 
tion of  active  or  latent  disease  among  their 
employees.  The  system  about  to  be  de- 
scribed was  introduced  in   1900  in  some 

*  Coombs.  C. :  British  Medical  Association  Branch 
Meeting,  Bristol,  March  31,  19^1. 


large  cocoa  and  chocolate  factories  in  which 
over  4,000  persons  of  both  sexes  are  em- 
ployed. All  candidates  for  employment  are 
examined,  as  for  life  assurance,  in  regard  to 
the  condition  of  their  teeth,  hair,  eyes,  ton- 
sils, heart,  lungs  and  vaccination.  Any  de- 
fects are  noted  on  an  index  card  and  the 
ai)plicant  is  referred  for  treatment  to  his 
doctor  or  sent  to  a  hospital.  In  the  case  of  a 
girl,  the  mother  attends  with  the  superin- 
tendent, and  the  importance  of  treatment 
of  any  defects,  such  as  carious  teeth,  defec- 
tive sight,  or  very  enlarged  tonsils,  is 
•pointed  out.  It  has  been  found  that  over 
60  per  cent,  of  girls  coming  from  public 
elementary  schools  have  the  nits  of  pedicu- 
Ins  capitis  in  their  hair,  and  in  these  cases 
the  mother  is  instructed  in  the  method  of 
removing  them.  If  the  parents  are  willing 
to  have  necessary  treatment  carried  out, 
the  boy  or  girl  is  re-examined  after  this  has 
been  done,  but  in  case  of  refusal  to  undergo 
treatment.  Ihe  applicant  is  rejected.  All 
persons  with  serious  heart  disease  or  tuber- 
culosis are  consistently  rejected. 

In  addition  to  this  system  of  medical  ex- 
amination, the  forewomen  or  superintend- 
ents are  instructed  to  bring  any  girl  to  the 
medical  offi.cer  for  examination,  if  they 
think  she  is  out  of  health.  To  this  end, 
periodical  short  lectures  on  infectious  dis- 
eases, and  particularly  on  tuberculosis,  are 
given  to  the  heads  of  departments  and 
workrooms.  If  an  emjiloyee  develops 
.symj)toms  of  tuberculosis  he  is  suspended 
(at  full  wages)  pending  admission  to  a  sana- 
torium or  hosjjital,  and  on  discharge  from 
the  institution  patients  are  assisted  to 
obtain  suitable  outdoor  employment,  but 
unless  there  is  evidence  of  complete  arrest 
of  the  disease  after  repeated  examinations, 
and  unless  tubercle  bacilli  have  disappeared 
from  the  sputum,  they  are  not  permitted  to 
return  to  the  factories. 

The  adoption  of  this  system  of  prelimi- 
nary medical  examination  and  subsequent 
supervision  reduced  the  annual  death  rate 


BRASHER  —  INDUSTRLIL  MEDICAL  SUPERVISION 


181 


among  over  2,000  women  and  girls  from 
6  per  cent,  to  less  than  1  per  cent.,  and  dur- 
ing several  years  no  deaths  from  any  cause 
occurred.  Prior  to  the  adoption  of  medical 
examination  and  supervision,  four  or  five 
employees  died  annually  from  tuberculosis, 
and  before  they  became  too  ill  to  work  these 
patients  had  inevitably  infected  others  in 
their  worki'ooms  as  well  as  in  their  own 
homes. 

On  March  2:5,  1921,  the  Minister  of 
Health  stated  in  the  House  of  Commons 
that  the  deaths  from  all  forms  of  tuberculo- 
sis during  tlie  last  six  years  (1915-1920, 
inclusive)  reached  a  total  of  311,017 — i.  e., 
an  average  annual  death  rate  of  It.oS  i)er 
mille.  In  other  words,  the  deaths  from  all 
forms  of  tuberculosis  during  these  six  years 
amounted  to  141.88  per  diem,  and  if  these 
])atients  had  been  coiled ed  in  one  center  a 
population  approximating  that  of  Bath 
would  have  disappeared  every  year. 

Dr.  Addison  observed  that  the  figures  for 
the  last  two  years  (46.;{12  deaths  in  1919, 
and  4.2,505  deaths  in  1920)  were  "the  most 
encouraging  since  the  inception  of  the 
scheme  for  the  treatment  of  tuberculosis." 
It  must,  however,  be  remembered  that, 
owing  to  the  war  and  the  subsequent  wave 
of  commercial  i)rosperity,  wages  were 
high  and  unemployment  had  almost  dis- 
a})peared.  Past  experience  shows  that 
all  great  wars  have  been  followed  by 
commercial  depression,  with  an  inevitable 
increase  in  unemployment  and  its  concom- 
itants, underfeeding,  underclothing,  and 
overcrowding  in  ill-ventilated  dwellings. 
There  is  reason  to  fear,  therefore,  that  the 
annual  death  rate  from  tuberculosis  will 
quickly  reach,  if  it  does  not  actually  exceed, 
the  pre-war  figure,  unless  steps  are  taken 
speedily  to  deal  more  effectively  with  tu- 
berculous patients  among  the  industrial 
classes. 

It  must  be  admitted  that,  in  spite  of  all 
that  has  been  done  during  the  last  thirty 
years,  the  annual  death  rate  from  tuber- 


culosis is  a  reproach  to  civilization.  Under 
present  conditions  the  majority  of  tuber- 
culous patients  are  permitted  to  be  em- 
ployed in  factories  and  offices  until  too  ill 
to  work.  When  they  seek  treatment  it  is 
found  usually  that  the  disease  has  reached 
so  advanced  a  stage  that  there  is  no  hope  of 
cure,  while  at  the  same  time  they  have 
freciuently  infected  other  members  of  their 
families  and  their  fellow-workers.  The 
following  histories  illustrate  this  point: 

Case  1.  —  Harry    P ,    aged    54,    was    chief 

clerk  to  a  firm  of  engtaeers.  His  youngest  cliild 
(aged  H)  died  of  tuberculous  meningitis  in  190(1. 
Although  there  was  a  history  of  tuberculosis  on  both 
sides,  neitlier  he  nor  his  wife  nor  their  two  surviving 
children  showed  any  signs  of  the  disease.  In  1910, 
a  clerk  working  opposite  him  died  oi  pulmonary 
tuberculosis  after  a  short  illness.  Although  suffering 
from  a  severe  cougii  witli  i)rofuse  exix'ctoration,  he 
was  permitted  to  work  until  within  a  few  weeks  of 
his  deatli.  In  ^9V2.  II.  P.  developed  an  extensive  in- 
filtration of  tile  upper  lol)e  of  the  right  lung  with 
pleurisy  at  the  right  base.  He  was  sent  to  a  sana- 
torium in  the  Cotswolds  for  several  months,  and  was 
tlien  pensioned  by  his  enijiloyers.  A  few  months  ago 
he  was  reported  to  be  in  goo<l  health. 

C.\SE  2.  —  Wilfrid  S ,  aged  26,  was  a  clerk  in 

one  of  the  largest  stores  in  London.  When  seen,  he 
had  returned  to  his  home  in  Bristol  in  the  last  stage 
of  pulmonary  tuberculosis.  He  stated  that  three  of 
his  fellow-clerks  working  in  one  office  had  died  of  the 
same  (lisease  within  two  years. 

Case  3.  —  Rose  W ,  aged  17,  worked  in  a 

chocolate  factory.  She  had  been  examined  on  leav- 
ing school  two  years  earlier  and  remained  in  good 
health  imtil  six  weeks  before  she  was  brought  to  the 
meilical  officer  by  her  mother.  She  had  extensive  in- 
filtration of  the  apices  of  both  lungs  with  typical 
spulmn  containing  numerous  bacilli  of  bovine  type. 
Her  mother,  who  was  very  distressed,  stated  that  her 
father  had  died  recently  after  being  an  inpatient  at 
the  Bristol  General  Hospital  under  Dr.  George 
Parker,  to  whom  the  writer  is  indebted  for  the  par- 
ticidars  of  his  patient's  last  illness. 

The  father  was  a  butcher  employed  at  Avon- 
mouth  Docks.  He  came  to  the  hospital  with  a  diffuse 
cellulitis  of  the  palm  of  the  left  hand,  giving  a  history 
of  having  scratched  himself  when  cutting  up  an  ox. 
The  hand  was  freely  incised  but  the  celhditis  did  not 
subside,  and  a  section  of  tissue  showed  giant  cells 
with  numerous  tubercle  bacilli  of  bovine  tj^pe.    He 


182 


THE  JOLTRNAL  OF  INDUSTRIAL  HYGIENE 


quickly  developed  signs  of  massive  infiltration  of 
both  lungs  and  was  discharged  as  incural>le.  Before 
he  could  be  sent  to  a  sanatorium  he  committed  sui- 
cide, when  delirious,  by  jumping  from  his  bedroom 
window. 

Rose  W died  within  three  months  of  the  on- 
set of  the  disease,  and,  to  complete  this  tragic  family 
history,  her  brother  (aged  l-l)  died  from  tuberculous 
meningitis  in  the  Bristol  Royal  Infirmary  in  1913. 
The  only  satisfactory  point  in  this  case  was  that  al- 
though Rose  W 's  illness  proved  fatal,  she  was 

sent  home  before  any  of  the  other  persons  in  the 
room  in  which  she  worked  became  infected.  The 
forewoman  was  instructed  to  bring  anyone  who 
showed  suspicious  symptoms  for  immediate  exam- 
ination, but  no  other  case  occurred. 

Although  the  detection  and  segregation 
of  tuberculous  patients  has  been  empha- 
sized on  account  of  the  wide  distribution 
and  serious  results  of  tuberculosis  among 
the  population  at  large,  it  is  obvious  that  a 
system  which  has  proved  successful  in  re- 
ducing the  death  rate  from  tuberculosis  in 
a  faciory  population  of  over  4,000  to  less 
than  1  per  mille  per  annum,  will  be  also  ap- 
plicable to  the  detection  of  cases  of  heart 
disease,  epilepsy  and  other  diseases,  which, 
while  affecting  seriously  the  health  and 
earning  capacity  of  the  person  himself,  are 
not  direct  sources  of  danger  to  his  fellow- 
workers.  The  method  is  capable  of  wide 
application    and    development.     For    ex- 


ample, one  company,  emjjloying  over 
10,000  workpeople,  has  adopted  this  system 
and  insists  on  all  "recruits"  being  vacci- 
nated before  commencing  work  in  their 
factories  and  reciuires,  in  addition,  that 
they  sign  an  agreement  to  be  revaccinated 
at  any  time  that  the  company  may  require 
their  workpeople  to  do  so.  Although  it  has 
been  objected  that  this  constitutes  a  tech- 
nical "interference  with  the  liberty  of  the 
subject,"  it  has  materially  increased  the 
percentage  of  the  effectively  vaccinated 
among  the  civil  pojiulation  of  Bristol,  and 
has  therebj'  assisted  the  health  department 
in  preventing  the  spread  of  smallpox  in 
several  recent  outbreaks  which  might  have 
been  serious  among  an  imperfectly  pro- 
tected population. 

In  conclusion,  it  is  satisfactory  to  learn 
that  steps  are  now  being  taken  by  the  Brit- 
ish government  to  introduce  a  system  of 
medical  supervision  in  industry.  Hitherto 
this  matter  has  been  left  to  the  unaided 
efforts  of  a  few  far-seeing  and  enlightened 
employers,  but  it  may  be  hoped  that  when 
the  system  is  adopted  on  national  lines 
those  employers  who  have  not  hitherto 
realized  the  paramount  importance  of  this 
subject  will  fall  into  line  and  aid  the  propa- 
ganda of  the  government. 


THE   FRAMIXGHAM  HEALTH   DEMOXSTRATIOX  AND 
INDUSTRIAL  MEDICINE  * 

D.  B.  .\RMSTROXG,  M.D. 

Executive  Officer,  Framinghdm  Community  Health  and  Tuberculosis  Demonstration 


THE  industrial  relationsliips  and  con- 
tacts of  the  Franiinghain  Community 
Health  and  Tuberculosis  Demonstration 
have  been  extremely  important  in  the  de- 
velopment of  the  Framinj,diam  tuberculosis 
j)rogram.  These  industrial  factors  consti- 
tute the  chief  consideration  of  this  pajjer. 
P('r]iai)s  a  preliminary  word,  however,  with 
rcft-rence  to  the  character  of  the  demonstra- 
tion in  general  may  be  helpful. 

The  Framingham  experiment,  or  demon- 
stration, has  now  l>een  under  way  for  nearly 
five  years,  under  the  auspices  of  the  Na- 
tional Tuberculosis  Association,  financed 
by  a  special  contribution  of  from  $lo(),()()0 
to  $''2()(),0()0  to  this  association  from  the 
^letropolitan  IMv  Insurance  Company. 
This  demonstration  has  aimed  to  answer 
certain  ])ertincnt  cpiestions  in  the  tubercu- 
losis field,  such  as:  How  much  tuberculosis 
is  there.*  What  is  the  best  way  to  treat  it? 
How  best  can  a  community  be  organized 
for  the  eventual  control  and  elimination  of 
the  disease?  Naturally,  the  demonstration 
has  had  an  inten.se  interest  in  industry,  as 
it  is  in  the  industrial  age  group  that  the 
highest  tuberculosis  death  rates  are  usually 
found.  Certainly,  tuberculosis  is  in  part, 
at  least,  an  industrial  disease. 

The  chief  activities  of  the  demonstration 
were  briefly: 

1.  A  general  and  sanitary  sur\ey,  in- 
'cluding  a  survey  of  industrial  hazards. 

'2.  Extensive  medical  examination  cam- 
paigns, covering  a  large  fraction  of  all  age 
groups,  including  industrial  workers. 

*  Read  before  the  General  Session  on  Health  and  Sani- 
tation of  the  National  Safety  Council,  Tenth  Annual 
Safety  Congress,  Boston,  Sept.  29,  1921.  Received  for 
publication  Aug.  31,  1921. 


3.  An  expert  considtation  service  for  the 
diagnosis  of  tuberculosis,  offered  to  ]irivate 
physicians,  factory  medical  and  niu-sing 
staffs,  etc. 

4.  The  thorough  organization  of  the 
community  itself,  not  only  for  tulierc-ulosis 
control  but  for  general  health  and  disease 
preventive  work,  including  the  fields  of 
general  commimity  sanitation,  infant  hy- 
giene, .school  hygiene,  and  industrial  hy- 
giene. 

Among  the  most  important  results  of 
these  activities,  from  the  general  as  well  as 
from  the  special  industrial  viewpoint,  the 
following  may  be  mentioned : 

1.  The  examination  of  a  representative 
jiopulation  indicates  that  about  1  per  cent, 
is  suffering  from  ac1i\e  tuberculosis. 

i.  A  thorough  search  for  tuberc-idosis 
cases  indicates  that  there  are  nine  or  ten 
active  cases,  in  an  average  community,  to 
every  annual  death  from  tuberculosis. 

3.  Adequate  medical  machinery  in 
schools,  factories,  and  elsewhere  is  essential 
to  the  detection  of  tuberculosis.  A  full- 
time  physician  for  every  2,500  school- 
children or  factory  workers  is  essential. 
The  first  consistent  medical  examination 
work  of  the  school  jjojiulation  of  Framing- 
ham  (about  3,000)  disclosed  eleven  cases 
of  active  tuberculosis  and  sixty-nine  sus- 
picious cases  hitherto  undetected.  The 
establishment  of  adequate  medical  ma- 
chinery in  the  factories  increased  the  per- 
centage of  new  cases  annually  discovered 
through  factory  medical  machinery  from 
0  to  27  per  cent,  over  a  period  of  three 
years. 

4.  The  average  community  does  not  re- 
port more  than  55  per  cent,  of  its  active 


183 


184 


THE  JOLTRNAL  OF  INDUSTRIAL  HYGIENE 


tuberculosis  in  an  early  stage.  Framing- 
ham  experience  has  indicated  that  this 
percentage  may  be  raised  to  85. 

5.  The  percentage  of  active  tuberculosis 
cases  receiving  institutional  care  has  been 
raised  from  13  to  42  jier  cent. 

6.  The  total  health  appropriations  from 
both  public  and  private  sources  have  in- 
creased from  -10  cents  to  about  $2  per  capita 
per  year,  the  latter  figure  being  set  as  an 
approximate  standard  for  adequate  com- 
munity health  work. 

7.  What  will  adequate  machinery  ac- 
complish toward  tuberculosis  control  and 
mortality  reduction.^'  Starting  with  a  cor- 
rected tuberculosis  mortality  rate  of  121 
per  hundred  thousand  as  the  average  for 
the  ten  years  preceding  the  demonstration, 
the  rate  fell  to  about  one-half  of  that  figure 
(64  per  hundred  thousand)  in  1920,  and 
present  indications  forecast  a  rate  possibly 
in  the  neighborhood  of  one-fourth  of  the 
pre-demonstration  rate  for  the  current 
year  (1921).  This  would  indicate  that  the 
same  measures,  ap]>lied  throughout  the 
United  States,  would  result  in  a  saving  of 
nearly  100,000  lives  a  year. 

To  return  to  the  more  important  indus- 
trial considerations,  it  may  be  stated  that 
there  are  in  Framingham,  at  the  outside, 
approximately  5,000  industrial  workers. 
By  far  the  largest  industry,  employing  ap- 
proximately one-half  of  this  total,  is  a 
paper  products  plant  where  tags,  boxes, 
and  crepe  paper  articles  are  produced. 
Other  industrial  interests  include  carpet 
manufacturing,  boiler  construction,  foun- 
dries, and  the  manufacture  of  shoes  and 
automobile  bodies. 

The  demonstration's  approach  to  the 
solution  of  the  tuberculosis  problem  has 
included  two  main  efforts:  first,  a  thorough 
survey  of  the  industrial  hazards  of  the  com- 
mimity,  carried  out  with  the  co-operation 
of  the  Massachusetts  Board  of  Labor  and 
Industry,  ;the  former  New  York  ^luseum 
of  Safety,  and  the  New  York  State  Com- 


mission on  Ventilation,  followed  by  an 
effort  to  correct  the  fundamental  dangers 
to  industrial  workers;  and  second,  an  effort 
to  encourage  the  local  industries  them- 
selves, with  necessary  co-operation  and  aid 
at  the  start,  to  proA'ide  an  adequate  medi- 
cal, nursing,  clinic  and  dental  service  and 
personnel  for  the  industrial  employees. 

On  the  side  of  personnel,  when  the  work 
started  there  were  employed  by  industries 
in  the  community  one  nurse  and  one  part- 
time  safety  engineer.     As  a  result  of  the 
co-operation   which   the   industrial   plants 
have  given  the  demonstration  during  the 
past  four  years,  it  is  now  safe  to  say  that 
between  70  and  80  per  cent,  of  the  indus- 
trial workers  are  under  reasonably  adequate 
medical,    nursing    and    clinic    supervision. 
The   experience   in    the    largest    plant    in 
the  community,  employing  approximately 
3,000  workers,  is  particularly  illuminating 
from  the  point  of  view  of  employee  interest 
in,  enthusiasm  for,  loyalty  to,  and  sym- 
pathy with  the  purpose  and  objectives  of 
the  medical  and  nursing  program.     This 
plant  now  employs  a  full-time  physician 
and   two  nurses,   and    maintains    an    ex- 
cellent clinic  and  first-aid  establishment. 
The  plant  is   organized   on  an   advanced 
democratic    profit-sharing    and    manage- 
ment-sharing basis,  with  considerable  par- 
ticipation   in    control    by    employees    of 
different  grades,  through  industrial  part- 
nership,   industrial    associates,    and    shop 
committee  devices. 

This  relationship  between  management 
and  employees  introduces  certain  novelties 
into  the  development  of  medical  and  nurs- 
ing policies  which  might  have  seemed  to  a 
short-sighted  view,  in  the  beginning,  to  be 
obstacles,  but  which  have,  in  reality,  only 
the  more  firmly  established  the  foundation 
for  the  program  as  a  whole.  Take,  for  in- 
stance, the  matter  of  compulsory  examina- 
tion of  new  employees.  It  was  not  impos- 
sible to  convince  the  management  in  this 
plant  of  the  validity  of  the  emplojinent  of 


ARMSTRONG  —  FRAISIINGHAM  HEALTH  DEMONSTRATION        185 


its  medical  and  nursing  machinery  for  this 
purpose.  After  the  management  was  con- 
vinced, however,  it  was  then  necessary  to 
convince  the  shop  committee.  Fortunately, 
the  expert  consultant  of  the  health  demon- 
stration. Dr.  P.  C.  Bartlett,  has  always 
worked  in  close  co-operation  with  the 
members  of  the  medical  department  in 
this  plant,  and,  with  their  help,  was  able, 
by  effective  case  histories  of  individuals  ill 
with  dangerous  comnnmicable  diseases  as 
found  in  this  industr\-,  to  illustrate  the 
importance  of  detecting  such  affections  at 
the  time  of  initial  employment.  Tiie  prin- 
ciple of  compulsory  examination  was  ap- 
proved and  was  put  through,  with  the 
backing  of  the  management  and  of  the 
men. 

The  members  of  the  shop  comniittee, 
emplo.yees  in  general,  and  the  management, 
are  now  enthusiastic  over  the  operation  of 
this  rule.  It  was  not  long  after  its  applica- 
tion that  the  men  themselves  were  asking: 
"If  this  is  good  for  new  emi)loyees,  why 
isn't  it  good  for  all  employees  on  a  regular 
basis?"  In  fact,  the  next  slej)  has  now 
been  taken,  and  a  system  of  regular 
periodic  medical  examinations  for  all  em- 
ployees, graded  on  the  basis  of  age  and 
period  of  employment,  is  now  being  ex- 
perimented with. 

Two  or  three  other  clinics  with  full-time 
nursing  and  part-time  medical  arrange- 
ments—  in  one  instance  with  comjiulsory 
examination  of  new  employees  —  have 
been  developed  in  the  connnimity,  and  a 
plan  promoted  for  the  provision  of  a  co- 
operative medical  and  nursing  service  for 
several  of  the  smaller  jilants  unable  to  pro- 
vide full-time  service  for  themselves.  The 
actual  establishment  of  this  service  is  now 
dependent  upon  the  more  extensive  revival 
of  industrial  activities. 

While  the  Framingham  experience  has 
been  on  a  relatively  small  scale,  it  has, 
nevertheless,  been  an  intensive  experience 
and  may  perhaps  be  legitimately  used  to 


suggest  certain  tentative  standards  for  in- 
dustrial medical  work  at  large.  It  may 
even  be  possible  to  propose  certain  quan- 
titative as  well  as  qualitative  standards. 
For  instance,  for  an  industrial  unit  of 
2,500  people  it  would  seem  that  there  would 
be  required  at  least  one  full-time  physician 
and  two  full-time  nurses,  an  adequate  clinic 
equipment,  some  provision  for  dental  serv- 
ice and  at  least  part-time  arrangements 
for  safety.  While  the  work  of  the  medical 
and  nursing  staff  may  with  advantage  be 
organized  as  a  fairly  autonomous  unit,  it 
should,  of  course,  be  very  closely  related 
to  certain  other  factory  interests,  such  as 
the  employment  management  service,  the 
personnel  division,  the  insurance  or  pension 
department,  educational  work,  and  welfare 
or  recreation  activities.  Some  of  the  func- 
tions of  the  medical  and  nursing  staff  would 
be: 

1.  The  n)utine  operation  of  the  first-aid 
facilities  ami  clinic,  including  the  care  for 
minor  injuries  and  ills. 

'•2.  The  diagnosis  of  chronic  affections, 
with  their  reference  to  outside  physicians 
of  the  individual's  own  choosing  for  con- 
tinued treatment. 

3.  General  health  education  by  means 
of  literature,  lectures,  bulletins,  etc. 

4.  General  safety  work,  machine  guard- 
ing, etc. 

5.  General  plant  sanitation,  including 
such  matters  as  ventilation,  cleanliness, 
water  supply,  etc. 

6.  Special  class  instruction,  as,  for  in- 
stance, for  groups  of  girls  working  on  special 
types  of  machines,  for  whom  group  teach- 
ing in  personal  hygiene  may  be  provided, 
covering  such  matters  as  posture,  diet, 
clothing,  and  recreation. 

7.  Particular  medical  advice  with  refer- 
ence to  working  and  living  adjustments  for 
department  heads  and  more  responsible 
employees  in  the  managerial  class  —  a  sort 
of  local,  intensified  life  extension  service. 

8.  The  regular  examination  of  all  new 


186 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


employees,  in  co-operation  with  the  em- 
ployment department . 

9.  The  regular  periodic  re-examination 
of  permanent  employees. 

As  previously  indicated,  it  is  our  belief 
that  medical  and  nursing  facilities  in  in- 
dustry can  only  be  used  to  their  full  ad- 
vantage if  they  are  developed  and  operated 
in  close  co-operation  with  the  labor  groups 
concerned.  These  facilities  must  be  used 
with  a  primary  object  of  fitting  the  man  to 
the  job,  and  not  as  a  device  for  the  rigid 
elimination  of  the  unfit  from  industry.  It 
must  be  recognized  by  all  that  through  the 
adaptation  or,  possibly,  the  elimination  of 
a  few  will  come  the  protection  of  many.  It 
is  probably  unnecessary  to  say  that  such 
medical  and  nursing  provision  is  a  legiti- 
mate routine  charge  upon  the  industry,  is, 
indeed,  a  thoroughlj^  profitable  investment, 


and  should  not  be  considered  at  all  as  a  phi- 
lanthroi:)y  wliiclj  the  employer  provides  for 
his  employees. 

Properly  organized  and  promoted,  an 
adecjuate  medical  and  nursing  service  in 
industry  will  substantially  decrease  loss  to 
the  industry  as  a  result  of  illness  prevented, 
labor  turnover  reduced,  etc.  If  the  indus- 
try is  intelligently  organized  on  the  basis 
of  purposeful  service,  with  the  rational 
fundamental  distribution  of  authority  and 
responsibility,  and  with  the  necessary  con- 
comitant participation  of  workers  in  con- 
trol, the  medical  service  will  be  as  useful  as 
any  other  single  device  for  enhancing  the 
loyalty  and  devotional  morale  of  the  entire 
industrial  group  concerned.  Adequate  in- 
dustrial medicine  is  an  integral  part  of  any 
decent  physical  foundation  for  a  righteous 
industrial  democracv. 


STUDY  OF  ACCIDENT  RECORDS  IN  A  TEXTILE  MILL* 


PREPABED  UNDER  THE  DIRECTION  OP 

AMY   HEWES 

BY 

RUTH  FEAK,  EDITH  GRAVES,  MARJORIE  L.\ WHENCE,  FLORENCE  METZ,  AND  HELEN  F.  SMITH 

Students  in  the  Course  in  Statistics  at  Mount  Holyoke  College 


UNTIL  about  thirty  years  ago,  indus- 
trial accidents  were  regarded  as  a 
part  of  tlie  day's  work,  and,  as  such,  were 
looked  upon  as  largely  inevitable.  With 
the  growth  of  the  workmen's  compensation 
laws  in  the  various  countries  and  states,  a 
new  mass  of  material  on  industrial  acci- 
dents has  been  culled  from  the  records 
which  the  states  required  to  be  kept. 
Through  the  study  of  this  material  the 
waste  of  accidents  has  been  made  apparent 
and  the  safeguarding  of  life  and  limb  has 
become  an  industrial  issue.  In  the  words 
of  Miss  Ida  INF.  Tarbell,  accident  preven- 
tion has  become  a  "gospel  which,  defended 
as  a  sound  economic  policy,  is  practiced 
with  the  whole-heartedness  and  zeal  of  a 
religion." 

The  development  of  the  idea  of  preven- 
tion of  accidents  through  a  study  of  records 
in  which  the  underlying  causes  might  be 
discovered  followed  the  appreciation  of 
the  magnitude  of  the  waste.  Accidents 
are  expensive.  They  mean  loss  of  time, 
idle  machinery,  and  retarded  production 
to  the  emploj^er,  as  well  as  time  out  of 
work,  suffering,  and  hardship  to  the  em- 
ployee. The  prevention  of  accidents  has 
become  a  matter  of  national  interest  as  is 
evidenced  by  the  organization  of  the 
National  Safety  Council,  the  i)rogram  of 
which  is  devoted  to  the  stimulating  of 
interest  in  industrial  safety  work,  and  by 
the  fact  that  several  states  and  many  of 
the  leading  cities  of  the  country  have 
inaugurated  campaigns  along  the  same  line. 

In  1884,  Germany  adopted  a  compre- 
hensive system  of  accident  compensation 
*  Received  for  publication  June  11,  1921. 


on  a  national  scale.  Since  it  was  the  first 
country  to  adopt  such  a  system,  and  one 
of  the  first  to  require  the  reporting  of  hours 
of  incidence  of  accidents,  it  now  furnishes 
the  most  valuable  and  comjilete  statistics 
of  industrial  accidents.  The  Imperial 
Offices  in  1887,  1897,  and  1907  ])ul)lished 
valuable  reports  of  specific  studies  of  in- 
dustrial accidents.  The  United  States  has 
been  much  slower  in  the  investigation  of 
industrial  accidents.  Among  the  earliest 
reports  in  the  field  is  one  published  by  the 
Wisconsin  Bureau  of  Labor  in  1909-1910, 
giving  a  brief  table  of  accidents  distributed 
according  to  the  hours  of  occurrence.  To- 
day records  of  accidents  are  kept  by  i)rac- 
tically  all  large  establishments,  but  the,y 
vary  widely  in  the  fullness  and  care  with 
which  the  information  is  entered.  Ex- 
amples of  comi)anies  foremost  from  the 
point  of  view  of  the  accuracy  and  care 
with  which  records  are  made  are  the  In- 
ternational Harvester  Company,  Cheney 
Brothers,  and  the  General  Electric  Com- 
pany. 

Scope  of  the  Study 

The  material  for  the  present  study  was 
obtained  from  the  records  of  the  Cheney 
Brothers  Silk  INIills  in  South  Manchester, 
Connecticut.  This  company  is  deeply  in- 
terested in  preventive  measures,  and  re- 
gards accident  expense  as  a  part  of  the 
cost  of  production.  It  has  a  comprehen- 
sive system  of  recording  accidents,  and 
requires  reports  made  of  every  accident, 
no  matter  how  slight. 

The  study  covers  1,221  accidents  which 
occurred  during  the  year  1920.    This  year 


187 


188 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


was  considered  to  be  fairly  representative, 
and  the  fact  that  the  numbers  employed 
by  the  company  suffered  no  marked  de- 
crease shows  a  contrast  to  the  general 
depression  which  was  reflected  in  many 
other  establishments  as  the  year  progressed. 
The  data  were  transcribed  from  the  com- 
pany's records  to  the  schedule  sho-mi  in 
Figure  1.  The  information,  except  that 
concerning  age,  marital  condition,  and 
number  of  children,  was  obtained  from  the 


Labor  Statistics  Meeker.*  The  number  of 
accidents  is  therefore  related  simply  to  the 
numbers  emploj'ed  on  the  date  specified. 

Charactkr  of  Accidents 

It  is  clear  that  the  manufacture  of  silk 
does  not  necessarily  carry  a  hazard  of 
serious  accident.  For  the  most  part,  the 
accidents  listed  in  Table  1  were  of  minor 
importance.  The  majority  were  slight  cuts, 
abrasions,  and  bruises;    the  more  serious 


Figure  1 


ACCIDENT  REPORT  —  CHENEY  BROS. 


Name.. 


Age.. 


M.\BR1ED         NO.  OF  DEPENDENT 
SINGLE         CHILDREN  UNDER    16.. 


Occupation 

Date        houk day.. 

Nature  and  Extent   


MONTH vear 


Cause 

Surgical  Aid Time  with  Co. 

Accident  Due  to 

Cakelessness  of  Injured  Person 
Haz.vbd  of  Trade 
Carelessness  of  Fellow-Workmen 
Defect  in  JVIachinehy,  Tools  or  Prehuses 


During  Necessary  Performance  of  Work  

Understands  Eng Tot.a.l  Expense  .. 


original  records  made  at  the  time  of  the 
occurrence  of  the  accident.  The  data  for 
the  additional  items  were  transcribed  from 
the  records  of  the  employment  bureau. 
The  number  of  persons  injured  appears  in 
the  summaries  as  smaller  than  the  number 
of  accidents  —  a  fact  which  should  be  kept 
in  mind  in  studying  the  tables  which 
follow.  The  scope  of  the  study  did  not 
permit  obtaining  records  of  number  of 
man-hours  and  the  total  number  of  days 
worked  for  all  of  the  emi)loyees,  and  con- 
sequently it  was  not  possible  to  present 
accident  rates  according  to  the  method 
advocated    by    former    Commissioner    of 


accidents,  such  as  scalp  wounds  and  frac- 
tures, occurred  more  rarely.  The  contrast 
in  the  percentage  of  men  and  women  work- 
ers who  suffered  from  the  various  accidents 
is  largely  attributable  to  the  different  oc- 
cupations requiring  the  use  of  different 
tools.  In  1921  there  were  2,891  men  em- 
ployed in  the  manufacturing  operations 
in  this  factory,  of  whom  30.0  per  cent, 
were  injured,  and  1,819  women,  of  whom 
only  19.4  per  cent,  were  injured.  The 
higher  percentage  of  accidents  to  men  is 
probably  largely  due  to  the  fact  that  in  silk 

*  Tliis  method  is  described  in  the  IJuUetin  of  the  United 
States  Bureau  of  Labor  Statistics,  Whole  Number  iSi, 
1918,  pp.  oiSG. 


HEWES  —  TEXTILE  ACCIDENTS 


189 


manufacture,  as  in  most  other  industries, 
men  are  employed  in  more  hazardous  oc- 
cupations than  women. 

The  minor  character  of  the  accidents  is 
shown  in  another  way  in  Table  2,  which 
gives  the  amount  of  time  lost  through 
accident.  There  were  only  ninety-six  cases 
reported  in  which  any  time  was  lost,  and 
fifty-seven     of    these    incapacitated    the 


expense  ($807.58)  was  a  compensation 
case  following  the  amputation  of  an  index 
finger  injured  by  a  picker  stick. 

Table  4  indicates  that  more  than  three- 
fourths  (79.5  per  cent.)  of  all  the  accidents 
which  occurred  in  the  mill  were  injuries 
to  the  hands  (including  fingers  and  thumbs) 
and  arms.  This  obviously  results  from  the 
greater    exposure    of    these    members    in 


TABLE  1.  — X.\TURE  OF 

.\CCIDENTS 

Number  of  Accidents 

Nature  of  AccidenU 

ToUl 

To  Men 

To  Women 

Number 

Per  Cent. 

Number 

Per  Cent. 

Number 

PerCenL 

Total                                 

1,221 

100.0 

868 

100.0 

353 

100.0 

Cuts                    ■ 

238 

196 

175 

13S 

91 

77 

03 

62 

35 

25 

21 

10 

10 

7 

7 

6 

5 

4 

3 

48 

19.5 
16.1 
14.3 
11.3 
7.5 
0.3 
5.2 
5.1 
2.9 
2.0 
1.7 
0.8 
0.8 
0.6 
0.6 
0.5 
0.4 
0.3 
0.2 
3.9 

152 

155 

104 

103 

61 

59 

57 

41 

26 

23 

7 

8 

10 

4 

6 

6 

5 

4 

3 

34 

17.5 
17.8 
12.0 
11.9 
7.0 
6.8 
6.6 
4.7 
3.0 
2.6 
0.8 
0.9 
1.2 
0.5 
0.7 
0.7 
0.6 
0.5 
0.3 
3.9 

86 
41 
71 
35. 
30 
18 

6 
21 

9 

2 
14 

2 

3 

1 

14 

24.4 

11.0 

20.1 

Rniisp?  and  abrasions  or  lacerations 

9.9 

8.5 

Strains  and  sprains    

5.1 

Foreitrn  b()(iies  in  eves 

1.7 

Punctures               

5.9 

2.0 

0.6 

4.0 

0.0 

Blisters               .           

0.9 

0.2 

Miscellaneous                 

3.9 

worker  for  less  than  two  weeks.  In  945 
cases,  or  77.4  per  cent,  of  the  total,  there 
was  no  loss  of  time.  The  majority  of  acci- 
dents studied  were  of  minor  importance 
from  a  financial  standpoint  as  well  as  from 
the  point  of  view  of  the  amount  of  time 
lost  (Table  3).  In  the  case  of  nearly  one- 
half  (581)  of  the  whole  number  of  accidents, 
no  financial  outlay  or  compensation  was 
reported.  More  than  one-third  (38.9  per 
cent.)  of  the  640  involving  expense 
amounted  to  less  than  $5,  and  nearly  two- 
thirds  (65.6  per  cent.)  to  less  than  $10. 
The  case  which  resulted  in  the  maximum 


operating  the  tools  and  machines.  When 
one  considers  that  the  weaver's  hands  may 
at  any  moment  come  in  contact  with  the 
knife  of  the  loom  and  the  picker  stick, 
that  agility  is  required  of  a  doflPer  to  keep 
from  injuring  his  hands  in  changing  the 
bobbins,  and  that  many  times  a  day  a 
knife  must  be  used  to  clean  the  silk  waste 
from  a  bobbin,  it  is  not  surprising  that 
the  hands  and  arms  bear  the  brunt  of  the 
injuries.  The  number  of  accidents  to  the 
eyes  is  large,  but  is  explained  by  the  fact 
that  even  a  tiny  particle  of  dust  lodging 
there  was  reported  as  an  accident,  though 


190 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


TABLE  2. —LENGTH  OF  TIME  LOST 
BECAUSE  OF  ACCIDENTS 


TABLE  3.  — EXPENSE  OF  ACCIDENTS 


Time  Lost 

Number  of 
Accidents 

Total 

1,221 

No 

time  lost 
s  than  1 T 

Less  tha 
1  day 

945 

Tp<- 

i-eek 

111  t 

29 

lay. 

2 

4 

2  days 

7 

3  davs 

7 

4  davs 

2 

5  days    . 

6 

6  days . . 

1 

1  1 

veek  and 

((       li 

U             it 

u          u 
u         u 
u         u 

U             tl 
It            u 

u         u 

il            u 
it            u 

a         u 
u          u 
u         u 

u         u 

u          u 
u          u 

11          a 

reported 

ess 

11 

a 

it 
u 
u 
u 
u 
u 
u 
u 
u 
li 
a 
u 
li 
li 

than 

u 
u 
11 

it 
(( 
(( 
li 
it 

u 
u 
u 
li 
it 
It 

i 

28 

9 

3               

9 

S 

4               

9 

4 

5   

4 

5 

6       

3 

6 

7       

4 

7 

8     

3 

8 

9 

0 

q 

10 

2 

10 

11 

0 

11 

12 

1 

}9 

13 

1 

IS 

14 

0 

14 

15 

1 

T) 

16      .... 

0 

Ifi 

17 

0 

17 

18 

1 

18 

19 

0 

iq 

20 

1 

Not 

180 

it  may  have  occasioned  discomfort  for  a 
few  moments  onlj\ 

Cause  and  Responsibility 

A  large  proportion  of  the  accidents  oc- 
curred in  connection  with  the  use  of  ma- 
chinery, a  fact  which  is  a  natural  conse- 
quence of  the  extensive  emploj'ment  of 
machinery  in  textile  industries.  More  than 
one-third  (36.0  per  cent.)  of  the  accidents 
were  so  classified  (Table  5).  Hand  tools, 
including  such  instruments  as  knives, 
scissors  and  hooks,  were  responsible  for 
one-fifth  of  the  whole  number,  but  it 
should  be  remembered  that  the  majority 


Expense 

in  Dollars 

Accidents 

Number 

Per  C<;nt. 

Total       

640 

100.0 

lesst 
u 

It 

u 

tl 

tl 

tl 

it 

(( 

u 

over 

hac 
It 

a 
u 
u 
li 
it 
It 

249 

171 

75 

40 

20 

17 

7 

12 

4 

5 

40 

38.9 

5     " 

10 

26.7 

10     " 

15 

11.7 

15     " 

20 

6.3 

20    " 

25            

3.1 

25    " 

30              

2.6 

30    " 

35              

1.1 

35    " 

40      

1.9 

40    " 

45 

0.6 

45    " 

50 

0.8 

50  and 

6.3 

of  these  were  slight  injuries.  This  is  also 
true  of  the  remainder  of  the  accidents, 
many  of  which  were  not  hazards  peculiar 
to  the  manufacture  of  silk. 

In  Table  6  the  accidents  are  shown  classi- 
fied as  they  were  reported  in  the  factory 
record  according  to  the  responsibility  for 
their  occurrence.  Two-thirds  of  the  acci- 
dents (67.1  per  cent.)  were  attributed  to 
hazard  of  trade,  and  include  such  accidents 
as  injuries  to  the  hands  incurred  while 
putting  belts  on  rollers,  cutting  the  hands 
when  working  with  reed  wires,  or  contact 
with  moving  bobbins.    The  carelessness  of 

TABLE  4. —  PART  OF  BODY  INJURED 


Location  o 

Injur}' 

Injuries 

Number 

Per  Cent. 

ToUl 

1,221 

100.0 

Hands 

834 

451 

210 

173 

136 

126 

71 

55 

38 

32 

31 

15 

9 

68.3 

Fingers 

36.9 

Thumbs 

17.2 

Palms  and  backs 

14.2 

11.2 

Head  and  face 

10.3 

5.8 

Other 

4.5 

Feet 

3.1 

Torso 

2.6 

Letrs 

2.5 

1.2 

0.8 

HEWES  —  TEXTILE  ACCIDENTS 


191 


the  injured  person  was  the  source  of  a 
second  large  group  (24.7  per  cent.).  In 
order  to  show  the  full  extent  of  individual 
responsibility  as  a  factor,  there  must  be 
added  to  the  above  the  cases  caused  by 
the  carelessness  of  the  fellow-worker  and 
the  cases  in  which  carelessness,  together 
with  defective  machinery,  was  responsible, 
making  a  total  of  335  cases,  or  27.5  per 

TABLE  5.  — CAUSES  OF  ACCIDENTS 


Cause 


Per  Cent. 


Total  Accidents 


Machinery 

Tools 

Falling,  Irippiii);,  and  slipping .  .  . 

Slivers,  nails,  tin,  etc 

Lifting  and  moving 

Flying  particles 

Rolling  and  falling  bodies 

Collisions  with  stationary  bodies . 

Materials 

Liquids 

Glass 

Miscellaneous 

Not  reported 


cent.  There  is  often  disagreement  as  to 
whether  carelessness  has  actually  been 
shown.  In  the  above  case  the  judgment 
taken  was  that  of  the  foreman  reporting  at 
the  time  of  the  accident .  The  large  number 
of  accidents  due  to  these  causes  indicates 
roughly  the  extent  to  which  the  accidents 
might  be  prevented  by  the  education  of 
the  worker  in  the  importance  of  safety 
methods. 

Time  of  Occurrence 

Practically  all  studies  of  accidents  have 
shown  a  marked  clustering  in  the  latter 
part  of  the  morning  and  afternoon  periods. 
In  the  accidents  grouped  according  to  hour 
of  occurrence,  in  Table  7  and  Figure  2, 
peaks  occurred  between  10  and  11  o'clock 
in  the  morning,  and  between  3  and  4  in 
the  afternoon.    Similar  peaks  have  usually 


been  attributed  to  the  fatigue  of  the  worker 
which  brings  with  it  increased  hazard  in 
the  worker's  failing  alertness.  In  the 
present  instance,  an  explanation,  which 
has  not  been  hitherto  emphasized  in  the 
literature  of  fatigue,  was  suggested  by  an 
official  of  the  company  and  commended 
itself  to  the  writers  as  an  exlremely 
reasonable  one.    He  said: 

The  facts  are  that  the  foremen  are  so  rushed  with 
supervisory  duties  in  the  early  hours  of  the  morning 
and  afternoon,  and  the  employees  are  so  bent  upon 
getting  their  work  started  and  well  in  hand,  that 
the  minor  accidents,  which  constitute  a  very  large 
proportion  of  the  whole,  do  not  get  attention  until 
the  breathing  spell  comes,  about  half  past  ten  and 
half  i)ast  three. 

In  the  last  hours  of  both  periods  fewer 
accidents  occurred.  A  similar  recovery  has 
been  noted  in  other  accident  studies  and 
is    attributed    by    Miss    Josephine    Gold- 

TABLE   6.  —  RESPONSIBILITY   FOR   ACCIDENTS 


Responsibility  for  Accidents 

Number 

of 
Accidents 

Per  Cent. 

Total    

1,221 

100.0 

820 

301 

35 

25 

11 

5 

4 

3 

17 

G7.1 

Carelessness  of  injured  person. 

l)efe<'t  in  niachinerv    

24.7 
2.9 

Carelessness  of  fellow- workman 

2.1 
0.9 

Carelessness  of  injured  person  and  de- 
fect in  machinery,  tools,  or  premises. 

Carelessness  of  injured  person  and  of 
fellow-workman    

0.4 

0..'{ 

Defect  in  tools   

0.2 

1.4 

mark  *  to  the  decreased  number  at  work 
during  the  last  hours  and  to  the  fact  that 
the  worker,  having  reached  a  high  point  of 
fatigue,  unconsciously  slows  down  in  the 
last  hour  and  in  this  way  decreases  the 
risk.  Anticipation  of  the  coming  rest 
period  has  also  been  suggested  as  a  cause 
of  decrease   in  the   number  of   accidents 


*  Goldmark,  J.:  Fatigue  and  Efficiency. 
Russell  Sage  Foundation,  1912,  pp.  77,  78. 


New  York, 


192 


THE  JOLTRNAL  OF  INDUSTRIAL  HYGIENE 


during  the  last  hour  of  work.  Conversely, 
the  large  number  of  accidents  at  the  peak 
hours  has  been  attributed  to  the  fact  that 
as  the  work  progresses  the  employee  be- 
comes more  accustomed  to  it  and  works 
at  a  higher  speed,  and  when  this  high 
speed  is  attained,  the  increased  repetition 
of  an  act  gives  increased  opportunity  for 
accident.  A  slightly  different  point  of 
view  was  held  at  the  Cheney  Mill,  where 
the  rapid  falling  off  toward  noon  and  4 
o'clock  was  attributed  to  the  unwilling- 
ness of  the  workers  to  take  time  off  just 
before  they  were  going  home.  This,  and 
"not  any  psychological  state  of  mind  or 
condition  of  fatigue,"  was  advanced  as 
the  cause  of  the  character  of  the  curves 
noted. 

The  accident  risk  does  not   appear  so 
great   in  the  first  and  last  hours  of  the 

Humber  of 

accidents 

180 

160 


140 


120 


too 


TABLE   7.  —  OCCURRENCE   OF   ACCIDENTS   BY 
HOURS 


Accidents 

Number 

Per  Cent. 

Total 

1,221 

100.0 

7-  8  A.M 

48 
102 
134 
154 
113 

15 

90 
123 
130 
107 

15 

7 

183 

3.8 

8-  9 

8.4 

9-10 

11.0 

10-11                                     

12.6 

11-12                                    

9.3 

12-  1  Lunch  Hour 

1-  2  P.M.                           

1.2 
7.4 

2-3              

10.1 

3-  4 

10.6 

4-  5 

8.8 

5-  6 

1.2 

0.6 

Not  reported 

15.0 

I.  —  Occurrence  of  accidents  by  hours. 

morning  and  afternoon  because  it  is  usu- 
ally not  possible  to  make  allowance  in  the 
first  hour  for  the  number  who  are  late, 
and  in  the  last  hour  for  the  employees 
who  usually  spend  the  last  few  minutes 
in  getting  ready  to  go  home  and  who  are, 
consequently,  not  exposed.    The  first  hour 


of  the  afternoon  has  a  higher  percentage 

than  the  first  hour  of  the  morning,  which 
may  be  partly  due  to  the 
fact  that  the  fatigue  is 
then  greater. 

In  a  similar  investiga- 
tion* of  accidents  in 
textile  mills  covering  the 
calendar  years  1918  and 
1919,  the  peak  hours  were 
found  to  be  9  in  the 
morning  and  3  in  the 
afternoon.  The  author 
suggests  that  regularly 
recurring  psychological 
and  physiological  cycles, 
such  as  mid-morning  and 
mid-afternoon  drowsiness 
as  a  consequence  of  eat- 
ing, may  also  be  impor- 
tant factors,  as  well  as 
the   increased   risk    with 

the  higher  speed  following  the  low  mental 

period. 

A  marked  variation  in  the  number  of 

accidents  on  different  davs  of  the  week  is 


jjrobably  accountetl  for  as  much  by  out- 

*  Gates,  D.  S. :  A  Statistical  Study  of  .Accidents  in  the 
Cotton  Mills.  Print  Works,  and  Worsted  Mills  of  a  Textile 
Company.    Jodr.  Indust.  Hyg.,  192(>-1!)21,  2,  287. 


HEWES  —  TEXTILE  ACCIDENTS 


193 


Number  of 
accidents 


side  factors  causing  fluctuation  of  the 
attention  as  by  differing  degrees  of  fatigue. 
In  a  study  of  the  accidents  in  the  Bur- 
roughs Adding  Machine  factory  for  the 
years  1919  and  1920,  the  disturbing  effect 
of  pay  day  is  stressed. 

In  the  year  1919  the  factory  day  force  was  paid 
Saturday  noon  and  the  night  force  Friday  evening; 
consequently,  it  is  found  that  more  accidents  re- 
sulted on  Fridays  and  Saturdays  than  on  any  other 
day  of  the  week.  In  19'^0,  pay  day  was  so  arrange<l 
that  certain  sections  of  the  factory  were  paid  on 
different  days  of  the  week;  a  lowering  of  accidents 
per  day  was  at  once  noticed.* 

In  the  present  study,  Monday,  Wednes- 
day and  Friday  stand  out  as  days  when 
more  accidents  occurred.  (Tabk'  8  and 
Figure  3.)  The  high  percentage  on  Mon- 
day may  be  occasioned  by  the  fact  that  it 
is  difficult  to  settle  down 
to  tlie  routine  of  work 
after  tlie  Saturday  after- 
noon and  Sunday  break. 
Possibly  the  Wednesday 
peak  is  to  be  attributed 
to  the  facts  that  Tuesday 
is  pay  day  and  the  stores  2oo 
in  the  town  are  ojien  on 
Tuesday  night.  The 
sequence  is  repeated  on 
Thursday  and  Friday.  It 
is  reasonable  to  assume 
that  many  of  the  workers 
go  out  on  Thursday  eve- 
nings since  that  is  the 
night  for  the  change  of 
feature  at  the  moving 
pictures.  After  Friday 
the  drop  in  the  Saturday 
accident  rate  is  not  so 
great  as  the  drop  from 
the  high  rates  of  IVionday  and  Wednesday, 
when  the  fact  that  Saturday  is  only  a 
half-day  is  allowed  for.  Saturday  morning 
is   a  period   of   anticipation   of   Saturday 

*  State  of  Mind  the  Largest  Contributor  to  Safety. 
Burroughs  Magazine,  April,  1921,  p.  5. 


TABLE  8.  —  OCCLTIRENXE  OF  .ACCIDEXTS 
BY  DAYS 


Days 

Acddents 

Number 

Per  Cent. 

Total 

1,221 

100  0 

Monday 

227 
190 
229 
194 
220 
106 
17 
32 

18  0 

Tuesday 

15  0 

18.8 

Thurs<lay 

15.9 

Friday • 

18.5 

Saturday  ' 

8.7 

Sunday 

1  3 

Not  reported 

2  6 

■ 

Saturday  is  a 

half-da>-. 

afternoon  good  times;  the  worker's  mind 
is  occupied  jiartly  with  [)lans  for  the  after- 
noon and  is  not  wholly  devoted  to  his 
work.  Another  cause   for   the   accumula- 


3W 

200 

\, 

y 

\, 

V- 

N 

A 

X 

\ 

* 

\ 

\ 

I'io 

\ 

\ 

100 

\ 

\ 

\ 
\ 

\  \ 

SO 

\  v 

\\ 

0 

Mon. 


Tue.       Wed. 


ThM, 


Pri. 


Sat. 


Sun. 


Fig.  3.  —  Occurrence  of  accidents  by  days.  Tlie  doited  line  is  carried  to  a 
point  which  indicates  twice  the  number  of  accidents  which  actually  occurred, 
since  Saturday  is  a  half-holiday. 


tion  of  accidents  near  the  end  of  the  week 
is  probably  the  haste  of  the  pieceworkers, 
in  their  attempt  to  catch  up  after  "taking, 
it  easy"  at  the  beginning  of  the  week.  In 
their  haste  they  are  liable  to  become  care- 
less and  are  subject  to  a  greater  accident 


194 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


risk.    Added  to  these  causes  is  the  cumu- 
lative fatigue  of  the  week's  work. 

Age  and  Sex  of  Injxjeed  Peeson 

The  findings  of  this  study  show  clearly 
that  age  is  an  important  factor  in  the 
accident  rate.  The  employees  under  20 
years  of  age  met  with  a  larger  proportion 
of  accidents  than  did  those  in  any  other 


than  one  injury  is  ignored  in  the  table 
itself.  The  strikingly  larger  proportion  of 
men  than  women  among  the  injured, 
already  noted,  holds  for  almost  every  age 
group. 

Table  9  shows  not  only  the  high  accident 
rate  for  the  younger  employees,  and  especi- 
ally the  younger  men,  but  also  the  signifi- 
cant fact  that  the  decrease  of  risk  with 
increasing  age  is  to  some  extent  regular. 


TABLE  9.  — ACCIDENT  EXPOSURE  BY  AGE  AND  SEX 


All  Employees 

Men 

Women 

Number  ^ 

Accidents 

Number 

Accidents 

Number 

Accidents 

Age  of  Injured 

Number 

Rate  per 

100 
Workers 

Number 

Rate  per 

100 
Workers 

Number 

Rate  per 

100 
Workers 

Xotal         

4,710 

1,221 

25.9 

2,891 

868 

30.0 

1,819 

353 

19.4 

35 
671 
772 
763 
681 
533 
384 
305 
241 
157 
114 

54 

13 

288 

216 

161 

136 

120 

78 

64 

41 

29 

12 

6 

57 

37.1 
42.9 
27.9 
21.1 
19.9 
22.5 
20.3 
20.9 
17.0 
18.4 
10.5 
11.1 

7 
305 
393 

474 
458 
343 
257 
211 
182 
122 
92 
47 

8 

181 

145 

113 

109 

98 

66 

47 

29 

24 

10 

5 

33 

114.3 
59.3 
36.9 
23.8 
23.8 
28.6 
25.7 
22.3 
15.9 
19.7 
10.9 
10.6 

28 

366 

379 

289 

223 

190 

127 

94 

59 

35 

22 

7 

5 

107 

71 

48 

27 

22 

12 

17 

12 

5 

2 

1 

24 

17.9 

1 5  and  less  than  20 

29.2 

20    "       «        "      25        

18.7 

25    «        «      "      30        

16.6 

30    «         "      "      33        

12.1 

35    «         "      "     40   

11.6 

40    "         "      "      45 

9.4 

45    "         «      "      50 

18.1 

50    "         "      "      55 

20.3 

55    «         "      «      60 

14.3- 

60    "        "      "      65        

9.1 

14.3 

Nimiber  of  persons  employed  January  1,  1920. 


age  groups  —  a  fact  which  supports  the 
statements  in  the  study  of  textile  accidents 
made  by  Mr.  Donald  S.  Gates,  referred 
to  above,  to  the  effect  that  the  younger 
employees  (in  the  latter  instance  those  18 
years  of  age)  were  subject  to  the  greatest 
accident  risk. 

Table  9  and  Figure  4  show  the  age  dis- 
tribution of  the  injured  persons  and  the 
relationship  of  the  number  of  injuries  in- 
curred by  employees  of  the  various  age 
groups  to  the  total  numbers  of  those  ages 
employed.  It  must  be  remembered  that 
the  accident  figures  used  in  this  table  refer 
to  the  mnnher  of  accidents,  and  the  fact 
that  numbers  of  individuals  suffered  more 


with  the  exception  of  the  fact  that  the 
employees  from  30  to  35  j'ears  fared  better 
than  their  fellow-emplojees  who  were 
slightly  older.  The  numbers  of  employees 
who  were  past  middle  age  were  so  small 
that  no  attempt  can  be  made  to  interpret 
the  figures  which  pertain  to  them. 

The  peculiar  suscci)tibility  of  young 
people  to  accidents  is  probably  due  to  a 
combination  of  influences,  of  which  in- 
experience and  unfaniiliarity  with  the 
work  and  the  necessary  precautions,  care- 
lessness and  a  form  of  bravado,  lack  of 
attention  and  concentration  due  to  lack 
of  training,  as  well  as  possible  greater 
exposure  to  the  objective  dangers  of  their 


HEWES  —  TEXTILE  ACCIDENTS 


195 


^cident  rate 
per  100  employed 
SO 


trades  play  a  part.  For  the  most  part,  the 
accidents  to  the  younger  persons  were  not 
disabling. 

An  examination  of  the  individual  records 
also  showed  that  the  young  people  tended 
to  encounter  more  than  one  injury  to  a 
greater  degree  than  did  older  persons. 
Approximately  one-  lialf 
(47.''2  per  cent.)  of  the  2h2 
persons  who  had  more 
than  one  accident  were 
between  14  and  25  years 
old,  though  this  group 
constituted  less  than  one- 
third  (31.4  per  cent.)  of 
the  whole  number  of  em- 
ployees, 'i'he  individual 
who  had  the  maximum 
number  of  accidents  dur- 
ing the  year  —  eleven  — ■ 
was  also  a  member  of  this 
younger  group.  'J'he  fact 
that  the  majority  of  t  he  ac- 
cidents were  of  small  con- 
sequence prevented  the 
experience  from  having 
much  of  the  quality  of  a 
warning  which  would  teach 
more  caution  next  time. 

The  study  offers  evidence  to  prove  that 
a  carefid  system  of  reporting  accidents  and 
immediate  care  of  injuries  are  effective 
factors  in  a  program  of  accident  preven- 
tion. There  is  little  room  for  doubting  that 
the  practice  of  giving  jiromjjt  attention  to 
even  the  slightest  injuries  is  one  of  the 
best  reasons  why  so  few  accidents  at 
the  Cheney  plant  entailed  serious  conse- 
quences.   It  is  safe  to  say  that  treatment 


of   an   insignificant   cut   has   many   times 
prevented  serious  infection. 

Accident  rates  in  many  states  have  been 
reduced  by  laws  compelling  the  guarding 
of  machines,  but  the  passing  of  state  laws 
can  do  little  to  eliminate  human  careless- 
ness.   In  the  study  of  accidents  made  at 


40 


90 


20 


10 


•15      ee      25      30      35      4«      45      So      5^ 


66^ 


Fia.  i. - 


Atfc  la  years 

-  -Vcciilcuts  acconliug  to  age. 


the  Binroughs  Adding  ^fachine  factory  it 
was  contended  that  "state  of  mind"  was 
the  largest  contributor  to  safety.  Since 
evidence  of  carelessness  is  particularly 
marked  in  the  workers  under  20  at  the 
Cheney  plant,  it  becomes  api)arent  that 
special  attention  should  be  directed  to  the 
younger  workers  and  perha]>s  particularh' 
to  the  young  men  in  a  campaign  for  the 
further  prevention  of  industrial  accidents. 


196 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


BOOKS   RECEIVED 

Books  received  are  acknowledged  in  this  column,  and  such  acknowledgment  must  be  regarded  as  a 
sufficient  return  for  the  courtesy  of  the  sender.  Selections  will  be  made  for  review  in  the  interests  of  our 
readers  and  as  space  permits. 


Government  Control  and  Operation  of  Industry 
in  Great  Britain  and  the  United  States  During  the 
World  War.  By  Charles  Whiting  Baker,  C.E. 
Carnegie  Endowment  for  International  Peace.  Pre- 
liminary Economic  Studies  of  the  War,  No.  18. 
Edited  by  David  Kinley,  Professor  of  Political 
Economy,  University  of  Illinois;  Member  of  Com- 
mittee of  Research  of  the  Endowment.  Paper.  Pp. 
138  with  index.  New  York:  Oxford  University  Press, 
19iil. 

Government  War  Contracts.  By  .J.  Franklin 
Crowell,  Ph.D.,  LL.D.  Carnegie  Endowment  for 
International  Peace.  Preliminary  Economic  Studies 
of  the  War,  No.  -25.  Edited  by  David  Kinley,  Pro- 
fessor of  Political  Economy.  University  of  Illinois; 
Member  of  Committee  of  Research  of  the  Endow- 
ment. Paper.  Pp.  357  with  index.  New  York:  Ox- 
ford University  Press,  ID'^O. 

The  Control  of  Sex  Infections.  By  J.  Bayard 
Clark,  M.D.,  Fellow  of  the  New  York  Academy  of 
Medicine;  Fellow  of  the  .\merican  College  of  Sur- 
geons; Member  of  American  Urological  Association; 
American  Association  Genito  Urinary  Surgeons; 
International  Surgical  Society;  Sometime  jNIajor 
Medical  Corps  U.  S.  .\rniy,  etc.  Cloth.  First  Edi- 
tion. Pp.  13'i  without  index.  New  York:  The  Mac- 
millan  Company,  19:il. 


Nerves  and  the  Man.  .\  Popular  Psychological 
and  Constructive  Study  of  Nervous  Breakdown.  By 
W.  Charles  Loosmore.  ]\I..\.,  Brown  Scholar  at  Glas- 
gow University.  Cloth.  Pp.  iiS  with  index.  New 
York:  George  H.  Doran  Company,  lO'il. 

Epidemic  Respiratory  Disease.  The  Pneu- 
monias and  Other  Infections  of  the  Respiratory 
Tract  .Vccompanving  Lifluenza  and  Measles.  By 
Eugene  L.  Opie.  M.D.,  Colonel,  ]\I.R.C.,  U.  S.  Army; 
Professor  of  Pathology,  Washington  University 
School  of  Medicine:  and  Francis  G.  Blake,  M.D., 
Major,  M.R.C.,  U.  S.  .\rmy;  .\ssociate  Member  of 
the  Rockefeller  Institute  for  Medical  Research;  and 
James  C.  Small,  M.D.,  Formerly  First  Lieutenant, 
M.C.,  U.  S.  .\rmy;  Bacteriologist,  Philadelphia  Gen- 
eral Hospital;  and  Thomas  M.  Rivers,  M.D.,  For- 
merly First  Lieutenant,  M.C.,  V.  S.  Army:  Associate 
in  Bacteriology,  Johns  Hopkins  L'niversity.  Cloth. 
First  Edition.  Pp.  4()'-2  with  illustrations,  index,  and 
appendix.    St.  Louis:  C.  \'.  Mosby  Company,  19'21. 

Henley's  Twentieth  Century  Formulas,  Recipes 
and  Processes.  Containing  Ten  Thousand  Selected 
Household  and  Workshop  Formulas,  Recipes,  Proc- 
esses and  Money  Saving  Methods  for  the  Practical 
Use  of  ]\Ianufacturers,  Mechanics,  Housekeepers  and 
Home  Workers.  Edited  by  Gardner  D.  Hiscox,  M.E. 
Cloth.  liP2\  Edition,  Revised  and  Enlarged.  Pp. 
807  with  index.  New  York:  The  Norman  W.  Henley 
Publishmg  Company,  19'il. 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


VoLUMr;  III 


NOVEMBER.  19-21 


Number  7 


WHEN   ARE    DISABILITIES   OF    TIIK    HA(  K    ARISING    OUT   OF 
PATHOLO(;iCAL  CONDITIONS  REPORTABLE  ACCIDENTS?* 

RUFUS  B.  rUAlN.  M.D..  and  BENJAMIN  J.  SLATER,  B  S..  M.D. 
Medical  Department,  Eaxtman  Kodak  Company,  Roche.<'lcr.  \.  Y. 


OF  all  the  prohh'iiis  that  confront 
the  industrial  surgeon  (here  is  none 
niori'  difficult  to  handle  than  the  familiar 
"strained  back.  "  Osfjood  (1),  in  jiis  article 
read  before  the  meeting  of  indu.strial  sur- 
geons at  Atlantic  City  in  June,  1919,  has 
shown  a  very  proper  conce])tion  of  the 
perplexity  of  the  situation,  and  his  article 
represents  as  good  a  medical  resume  of  the 
subject  as  maj'  be  found. 

Alnio.st  every  day  the  industrial  surgeon 
is  consulted  by  a  workman  who  says,  "I 
believe  I  have  .strained  my  back."  Broadly 
speaking,  such  casi's  fall  into  two  groups, 
the  first  of  which  is  composed  of  strains 
which  dale  from  a  definite  experience,  such 
as  a  slij)  or  a  fall,  or  the  lifting  of  some  un- 
usually heavy  object.  These  cases  usually 
conform  to  oin-  conception  of  what  is  meant 
by  an  accident  as  set  forth  by  the. Work- 
men's Compensation  Law  of  New  York 
State.  When  a  workman  is  able  to  jioint 
to  a  particular  trauma  at  a  certain  time  of 
the  day,  which  is  unusual  and  not  a  part  of 
his  routine  work,  there  is  no  problem  in- 
volved. The  ca.se  is  always  reportable,  i)ro- 
vided  there  is  loss  of  time  or  more  than 
first-aid  treatment.   The  second  class,  how- 

*  Received  for  publication  Sept.  1,  19'21. 


eviT.  i>  far  more  numerous  and  difficult  to 
handle.  Cases  in  this  grou])  differ  from 
tho.se  in  the  first  in  that  they  are  reiVrable 
to  no  definite  time  or  unusual  experience. 
The  workman  presents  himself  for  an  ex- 
amination comi)laining  of  "lumbago"  or 
"rheumatism,"  with  or  without  .some  rise 
in  lem|)erature.  Ilis  usual  statement  is, 
■  Doc,  I  believe  I  have  strained  myself  lift- 
ing boxes  in  Department  X." 

"When  did  it  hai^pen?" 

"Two  or  three  weeks  ago,  I  can't  say 
exactly  when." 

"Did  anything  umisual  hapiien?" 

"\o,  I  was  simply  stoo])ing  over  (or 
lifting  some  boxes)  and  felt  no  jiain  at  the 
time." 

"When  did  the  ])ain  develop?" 

"It  came  on  today." 

I^'uither  c(uestioning  will  generally  reveal 
the  fact  that  the  workman  was  doing  his 
regular  work  in  a  routine  manner  without 
the  occurrence  of  a  single  incident  which 
might  l)e  thought  to  be  apart  from  the  ordi- 
nary routine  of  his  work.  We  have  found 
that  the  on.set  in  this  particular  type  of 
case  is  not  so  dramatic  as  that  in  class  one. 
The  consequences,  however,  may  be,  and 
frequently  are,  quite  as  serious.    It  was 


197 


198 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


formerly  our  custom  to  report  all  of  these 
cases  as  accidents.  They  have,  however, 
become  so  serious  and  so  numerous,  and 
have  shown  such  a  large  variety  of  etio- 
logical factors,  when  carefully  studied,  that 
we  now  hesitate  before  reporting  them  as 
accidents.  Fortunately,  under  the  existing 
state  compensation  law  we  are  permitted 
ten  days  in  which  to  report  an  accident,  and 
it  is  during  this  time  that  we  investigate 
thi-ough  the  workman's  dej^artment  the 
circumstances  attending  the  disability  and 
make  a  thorough  medical  examination  of 
the  case,  including  X-ray  examination, 
Wassermann,  and  a  thorough  jihysical  ex- 
amination. 

It  is  our  opinion  that  of  this  latter  type 
of  case  each  has  developed  from  some  focus 
of  infection.  Only  occasionally  have  we 
been  unable  to  demonstrate  such  a  focus. 
Certainly,  nine  cases  out  of  ten  are,  in  our 
opinion,  not  reportable  accidents  within 
the  meaning  of  the  workmen's  compensa- 
tion law.  The  mOst  common  causes  in  this 
group  of  cases  have  been  thought  to  be 
faulty  posture,  infected  teeth  or  tonsils, 
syphilis,  tuberculosis,  weak  feet,  etc.  In- 
deed, it  is  really  svu'prising  to  find  the  num- 
ber of  cases  of  chronic  disease  which  are 
encountered,  in  which  a  workman  feels  that 
his  condition  is  due  to  some  slight  injury, 
and  it  is  in  the  handling  of  these  chronic 
diseases  that  we  are  confronted  with  our 
most  serious  problems.  Often  the  only  com- 
plaint which  a  workman  will  have  is  a 
strained  back,  and  upon  thorough  exami- 
nation some  other  condition  will  be  dis- 
covered. It  is  not  uncommon  to  hear  a 
workman  say,  "I  have  not  been  so  well 
since  I  was  hurt,"  when  he  is  really  suffer- 
ing from  advanced  tuberculosis,  syphilis, 
or  some  other  chronic  disease.  A  great 
many  workmen  are  entirely  unfamiliar 
with  the  workmen's  compensation  law  and 
regard  themselves  as  \ictims  of  an  acci- 
dent without  any  consitleration  of  what  is 
really  wrong  with  them,  or  of  the  manner 


in  which  their  disaVjility  has  developed. 
The  following  three  cases  taken  from  a 
much  larger  group  are  illustrative  of  the 
points  under  discussion: 

Case  1. — L.  H.,  female,  37  years  of  age,  and 
weighing  l-tO  poimds,  at  3  p.m.  on  April  6,  1918,  in 
the  course  of  her  ordinary  employment,  reached  to 
pick  up  from  a  basket  placed  on  the  floor  a  small 
object  weigliing  al)out  'i  ounces.  This  was  a  part  of 
her  routine  work.  On  this  particular  occasion,  she 
felt  something  slip  in  her  back,  became  unable  to 
move  her  right  leg,  and  three  or  four  days  later  be- 
came almost  completely  disabled.  She  did  not  slip 
or  fall,  and  there  apjieared  to  be  nothing  unusual 
about  the  manner  in  which  her  disability  developed. 
The  case  was  reported  as  a  right  sacro-iliac  strain, 
and  the  woman  was  referred  to  a  specialist  who  ap- 
plied a  cast  and,  later,  a  brace.  Her  case  dragged 
along  for  two  years,  during  the  greater  part  of  which 
period  she  did  not  work.  In  her  particular  case,  it 
seemed  as  though  there  was  some  malbigering,  inas- 
much as  she  was  often  seen  to  walk  in  a  perfectly 
normal  manner,  whereas,  before  the  Industrial  Com- 
mission, she  would  appear  almost  a  complete  invalid. 
A  contest  was  raised,  after  two  years,  that  an  acci- 
dent was  never  sustained.  The  Industrial  Com- 
mission closed  the  case  on  the  ground  that  there  was 
no  accident. 

The  interesting  feature,  which  this  case 
illustrates,  is  that  an  employee  may  de- 
velop a  disabled  condition  of  the  back 
which  is  not  a  reportable  accident  and 
should  not,  be  rejiorted  as  such. 

C.iSE  2.  —  E.  M.,  male,  46  years  of  age,  and 
weighing  186  pomids,  on  December  12,  1918,  leaned 
forward  in  the  course  of  his  ordinary  employment 
and  lifted  from  one  stall  to  another  a  jar  of  liquid 
weighing  al)out  .50  pounds.  The  vertical  lift  was 
2  feet,  and  the  horizontal,  about  I2  feet.  He  had 
been  performing  this  particular  operation  for  many 
years,  but  on  this  particular  occasion  was  seized  with 
a  terrific  pain  in  the  region  of  the  right  sacro-Uiac 
jomt,  became  incapacitated,  and  was  taken  home. 
There  is  no  record,  in  this  case,  of  the  man's  having 
slipped  or  fallen,  or  of  Jiis  having  been  struck.  He 
was  api>arently  l)erforming  a  routine  operation  in  a 
routine  way.  His  case  was  reported  as  a  sacro-iliac 
strain.  During  the  course  of  treatment  by  a  spe- 
cialist, he  developed  a  phlegmasia  alba  dolens  and, 
later,  cystitis  and  varicose  ulcers  of  the  right  leg. 
He  has  drawn  comijcnsalion  at  intervals  since  the 
period  of  injury.    While  the  final  award  has  not  been 


GRAIN  AND  SLATER— BACK  STRAINS  AS  REPORTABLE  ACCIDENTS    199 


made  in  this  case,  it  is  easy  to  see  that  the  amount 
involved  is  very  considerable,  and  it  is  difficult  to 
understand  how  tliis  can  he  called  an  accident  even 
though  it  was  so  ruled  bj'  the  Industrial  Commission. 

This  case  differs  from  that  of  L.  H.  in 
only  one  resiicct ,  namely,  that  the  weights 
lifted  were  ditierent.  NeA^ertheless,  very 
considerable  compensation  has  been  i)aid 
and  the  case  is  still  on  the  c-alendar.  It  is 
not  uncommon  to  have  three  or  four  such 
cases  a  month  —  cases  in  wliicli  there  is  a 
sudden  seizure  in  the  rejjion  of  the  sacro- 
iliac joints  with  disability  for  a  short  time. 
It  is  not  often,  however,  tlwit  cases  are  as 
prolonged  as  was  the  case  of  E.  M.,  but 
they  are  occasionally  seen.  The  thin!  ca.se 
is  somewhat  ditfereni  from  the  two  wliich 
we  have  already  deseriljed. 

Case  3.  —  G.  A.,  male,  36  years  old,  weighing 
14(i  pounds,  was  reported  to  have  sustained  an  acci- 
dent at  4  p.  M.  on  January  -t,  li)'21  iu  the  following 
manner.  Previous  to  the  accident  he  was  trans- 
ferred from  inside  machine  work  to  the  yard.  Tiie 
weatlier  was  rather  severe  and  at  tlii.s  ))articular  lime 
'there  were  high  winds.  On  I  lie  day  mentioneil, 
while  he,  with  three  other  men,  was  using  a  crowbar 
to  roll  a  heavy  Jjipe  into  i)lace,  he  felt  a  sudilen  ])ain 
below  the  aufjle  of  the  left  scapula.  He  was  pulliuf; 
rather  hard  at  the  crowbar,  l>ut  was  not  using  his 
full  strength  nor  working  harder  or  in  a  more  strained 
position  than  his  assistants.  On  the  following  day 
he  did  not  report  for  work,  and  on  visiting  his  home 
we  found  that  his  temperature  was  1(W°,  ami  his 
jMilse  10(5.  He  was  perspiring  profusely.  His  tem- 
perature gradually  came  ilown  and  in  three  weeks 
he  came  back  to  work.  The  oidy  local  physical  sign 
was  tenderness  hi  the  angle  of  the  scapula.  There 
was  no  redness  and  no  swelling.  Motion  of  the  right 
arm  was  limited  but  only  in  so  far  as  the  scapular 
action  was  brought  into  play.  It  was  evident  that 
this  was  not  allogether  an  accident,  l)ut  just  how 
much  of  tlie  .syndrome  was  aeeiilent  and  how  nuich 
disease,  is  very  difficult  to  say.  The  patient  de- 
manded a  diagnosis,  and  when  he  w'as  informed  that 
it  was  "lumbago"  he  remarked,  "Doc,  I  cannot 
collect  on  an  accident  policy  for  that."  The  case 
was  reported  as  an  accident  and  so  carried  by  the 
Industrial  Commission  even  though  we  felt  tliat 
disease  played  perhaps  the  most  promment  r6le. 

In  this  case  we  have  a  disal)led  back  due 
to  an  acute  febrile  condition.    In  all  proba- 


bility the  strain  was  nothing  more  than  a 
coincitlence,  yet  this  case  was  reported  as 
an  accident.  During  certain  seasons  of  the 
year,  mostly  in  the  spring  and  autumn 
when  there  are  frequent  changes  in  the 
weather,  we  have  "crops"  of  cases  similar 
to  the  last  two.  Following  an  abrupt 
change  in  the  weather  from  warmer  to 
colder  we  are  alwavs  certain  to  find  such 


cases. 


In  each  of  the  three  cases  cited,  the  em- 
ployee felt  that  he  was  hurt  and  was  willing 
to  hold  the  employer  resjionsible.  Indeed, 
there  ai)pears  to  be  a  growing  tenilency  on 
the  part  of  employees  to  hold  the  employer 
resi)onsible  for  all  manner  of  cases. 

.V  review  of  Bulletin  '27'2  of  the  V.  S. 
Bm-eau  of  Labor  Statistics  ('•2),  covering 
compensation  cases  in  various  states  of  the 
United  States  and  in  Canada,  shows  llie 
greatest  diversity  of  opinion  in  parallel 
ca.ses  as  to  what  c-onstitutes  an  acc-itlent, 
and  how  and  when  sub.se(|uent  disease  or 
dcalh  may  be  considered  a  result  of  acci- 
diiit.  The  tendency  seems  to  be  gradually 
to  broaden  the  classification  of  conditions 
for  wliich  comjiensation  m;iy  be  paid.  Out 
of  the  confusion  wliicli  has  arisen,  as  to 
what  are  really  re])()rtal)le  injuries,  we 
have  adopted  the  following  rule  of  action: 
As  .soon  as  possible  after  the  injvuy.  real  or 
imaginary,  we  fill  in  a  blank  similar  to  the 
questionnaire  .shown  in  Figure  1.  This  will 
tell  exactly  what  happened,  and  it  will  later 
be  foimd  of  very  great  value  to  have  re- 
corded the  exact  statement  of  what  actually 
hapi)ened  as  given  by  the  employee  at  the 
very  earliest  moment  following  examina- 
tion by  the  doctor.  Lacking  this  clear, 
definite  statement  from  the  patient,  the 
industrial  physician  will  find  himself  at  a 
very  great  disadvantage  when  jiresenting 
the  case  before  the  Industrial  Commis- 
sion. The  borderline  between  accident  and 
disease  is  so  indefinitely  drawii  that,  when 
a  contest  is  arranged  and  the  employee  has 
been  instructed  by  his  attorney,  he  may 


200 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


easily,  intentionally  or  unintentionally,  by 
inserting  a  few  simple  words  such  as 
"slipped"  or  "fell,"  change  the  entire 
complexion  of  the  case. 

It  seems  highly  desirable  that  the  em- 
ployer, before  assuming  responsibility  for 
the    many    questionable    injuries,    shoidd 


instance  of  G.  A.  {vide  supra).  Because  of 
the  fact  that  the  ph^^sician  who  has  done 
much  industrial  work  will  not  care  to  go 
frequently  before  theCommission  to  testify, 
it  is  not  desirable  to  hold  too  many  hear- 
ings, since  they  tend  to  break  down  the 
close  co-operation  which  should  exist  be- 


FlGURE    1 

QUESTIONNAIRE  REGARDING  INJURY 

Name 

Address ' Dept 

How  long  with  company? When  did  accident  occur? 

\Miat  happened? 


What  were  you  actually  doing  when  the  accident  occurred? 


Is  this  your  regular  work?  

Did  you  slip  or  fall,  or  were  you  struck?   

If  you  lifted  an  object,  what  was  the  weight? 

Did  you  have  any  assistance? 

Witnesses  to  accident  


Did  anything  unusual  liappeii  which  you  helieve  caused  this  injury: 


Whom  do  you  blame?  

Have  you  ever  had  any  injuries  or  accidents  before?  ... 
Did  you  report  accident  to  anyone? 

Dale 

request  a  hearing  before  the  Inchistrial 
Commis.sion  in  order  to  determine  the  re- 
sponsibility in  the  particular  case  in  ques- 
tion. This  is  a  long,  tedious  and  tiresome 
method,  and  oni"  which  we  seldom  employ 
because  of  the  fact  that  it  tends  to  destroy 
the  confidence  of  the  patient  in  the  phy- 
sician if  there  is  any  contest  before  treat- 
ment is  imdertaken. 

The  nature  of  the  case  often  makes  it 
difficult  or  impossible  to  request  a  hearing 
before  the  Industrial  Commission,  as  in  the 


M.D. 


tween  a  jihysician  and  his  patient.  There 
is  also  a  great  deal  of  difficulty  due  to  the 
fact  that  it  may  take  weeks  or  months  for 
the  Commission  to  arrive  at  a  decision  after 
the  ca.se  has  be<"n  given  a  hearing.  During 
this  time  the  ])atient  is  witliout  treatment 
unless  the  employer  wishes  to  assume  re- 
si)onsil)ility  before  the  decision  is  made.  If 
he  adopts  this  method,  it  really  offsets  the 
purpose  of  having  a  hearing. 

In  answer  to  the  question,  "When  are 
di.sabilities  of  the  back  arising  out  of  patho- 


CRAIN  AND  SLATER— BACK  STRAINS  AS  REPORTABLE  ACCIDENTS   201 


logical  conditions  called  reportable  acci- 
dents?" we  are  frank  to  admit  that  in 
many  instances  we  are  unable  to  decide. 
It  is  our  belief,  however,  that  many  cases 
now  reported  as  accidents  need  not  be  so 
carried.  We  feel  that,  by  the  api)lication 
of  the  methods  already  outlined,  we  have 
been  able  to  diminish  the  number  of  re- 
portable cases.  Inasmuch  as  in  this  state 
the  power  of  deternnning  what  is  an  acci- 
dent lies  in  the  hands  of  the  Industrial 
Commission,  the  logical  thing  to  do  seems 
to  be  to  bring  the  case  early  to  the  atten- 
tion of  the  Connnission  and  ask  for  a  de- 
cision. 'J'he  physician  who  has  at  hand  a 
careful  detailed  record  of  the  events  attend- 
ing the  so-called  "accident,"  togetlier  with 
his  physical  findings,  will  always  be  in  a 
better  {)osition  to  furnish  satisfactory  testi- 
mony before  tlic  Commission  than  the 
physicians  who  fail  to  have  suc-h  a  record. 
When  an  emi)loyec  has  gone  on  record  as 
having  .stated  that  the  disability  developed 
in  this  or  that  way,  he  is  not  so  apt  to 
change  his  mind  later,  especially  if  he 
knows  that  his  physician  has  a  tyjiewrilten 
sheet  at  hand  on  which  is  contained  the 
statement  wiiicli  lie  made  at  the  time  of 
injury.  It  is  only  rea.sonable  to  feel  that 
such  a  .statement  must  have  .some  weight 
before  the  Commission,  in  view  of  the  fact 
that  it  was  taken  at  the  time  of  the  injury. 
Before  rei)orting  any  borderline  cases, 
however,  it  is  of  greatest  benefit  to  have  a 
thorough  physical  examination  and  labora- 
tory study  of  the  case.  As  pointetl  out 
above,  these  studies  will  frequently  reveal 
some  chronic  condition  as  the  underlying 
cause  of  the  disabilitv.     It  is  much  nu)re 


satisfactory  and  conclusive  to  have  at 
hand  the  information  which  these  studies 
bring  to  light,  than  to  report  a  borderline 
case  to  the  Commission  as  an  accident  and 
be  compelled  to  furnish  such  information 
at  a  later  date. 

I'nder  the  existing  compensation  law  in 
New  York  State,  the  employer  will  gradu- 
ally- be  comi)elled  to  have  a  complete  physi- 
cal survey  of  all  new  employees.  There 
would  be  many  fewer  deaths  from  sj-philis 
aggravated  by  back  injury  if  there  were 
more  routine  Wassermann  tests;  X-ray 
.studies  of  the  chest  woidd  help  to  reveal 
pulmonary  tuberculosis;  and  urine  exami- 
nations would  disclose  diabetes  and  ne- 
phritis. These  chronic  diseases  contribute 
to  the  greatest  mnuber  of  death  claims  in 
our  experience.  Each  one,  we  believe, 
could  have  been  avoided  if  our  ])reliminary 
entrance  I'xaminatiou  had  been  stifficiently 
thorongh,  and  often  enough  re])eated. 

If  the  emjjloyer  will,  by  job  analysis, 
inform  the  medical  department  what  is 
ex])ected  from  a  new  empl().\-e<',  and  will 
sui)i)ly  the  department  witii  ade(iuate  pt'r- 
xiuncl,  laboratories  and  other  facilities,  he 
may  hope  to  cut  down  the  number  of  ileath 
claims  and  borderline  back  injuries.  In 
this  way  only  can  he  succeed  in  reducing 
these  cases  to  a  minimum.  Laboratory 
examinations  can  necessarily  be  done  more 
cheajjly  and  more  effectively  in  great  num- 
bers of  cases  than  they  can  be  done  by  a 
l)hysician  working  on  an  individual  case. 
It  is  in  .such  work  as  this  that  the  industrial 
])hysician  can  nuike  his  greatest  contribu- 
tion to  the  employer,  the  employee,  and 
the  comnumitv. 


BIBLIOGRAPHY 


Osgood,  R.  B.:  Back  Strain  —  An  Accident  or 
a  Disease.  Proc.  Fourth  Ann.  Meeting  Am. 
Assn.  Indust.  Physicians  and  Surgeons,  June  9, 
1919,  p.  88. 


3.  Clarlv,  L.  D.,  and  Frincl^e,  ^I.  C,  Jr.:  Work- 
men's Compensation  Legislation  of  the  L'nited 
States  anfi  Canada.  U.  S.  Bur.  Labor  Statis., 
Bull.  -27^2,  Jan.,  1921,  pp.  lOe-l.S.J. 


PICRIC  ACID   IN  INDUSTRIAL  SURGERY* 


ALFRED  G.  BOLDUC,  M.D. 

Company  Physician.  The  Babcock  &  Wilcox  Company,  Bayonne,  N.  J. 


PICRIC  acid.  CsHo  (X02)3  (OH),  or 
trinitroi)lienol,  is  an  odorless  substitu- 
tion jjroduct  of  phenol,  and  occurs  in  light 
yellow  crystals  or  needles.  Heretofore,  it 
has  had  very  limited  use  in  the  practice  of 
medicine,  being  chiefly  employed  in  a  1 
per  cent,  aqueous  solution  as  a  dressing  for 
superficial  biu^ns.  for  erysipelas,  and  as  an 
anthelmintic.  During  the  World  War, 
however,  the  British  Army  Medical  Corps 
(1)  used  a  5  per  cent,  solution  of  picric 
acid  in  95  per  cent,  alcohol  as  an  antisep- 
tic in  ojjen  wovuids  and  for  preparing  the 
skui  preceding  minor  and  major  operations, 
and  had  very  gratifying  results. 

During  the  last  two  years  I  have  treated 
approximately  4,000  cases  of  minor  cuts, 
severe  lacerations,  punctured  wounds,  com- 
pound fractures  (principally  of  the  bones  of 
the  hands  and  feet)  and  other  cases  com- 
mon in  an  industrial  plant,  and  have  used 
as  the  antiseptic,  in  all  these  cases,  a  5  per 
cent,  solution  of  picric  acid  in  95  per  cent, 
alcohol.  In  fact,  I  have  entirely  di.scarded 
tincture  of  iodine.  Practically  all  wounds 
that  were  sutured  healed  l>y  j^rimary  in- 
tention and  without  infection,  and  better 
results  were  obtained  with  the  use  of  picric 
acid  in  cuts  and  lacerations  than  were 
formerly  obtained  with  the  use  of  iodine. 
The  woiuid,  as  a  rule,  remains  clean  and 
heals  more  quickly.  From  my  i-xperience, 
I  think  tliat  I  am  justified  in  saying  that 
picric  acid  (5  per  cent.)  can  be  a])plied  to 
any  part  of  the  body,  excepting  the  eye, 
without  any  untoward  results.  It  can  be 
used  as  an  antiseptic  for  any  condition  for 
which  iodine  is  used,  and  willi  belter  re- 
sults. It  is  less  irritating  to  the  skin  than 
iodine;    it  has  mild  anesthetic  qualities; 

*  Received  for  ptil>licatii>n  Aug.  17,  10^1. 


it  is  staple:  it  is  less  toxic;  and  last,  but 
not  of  least  importance,  it  is  comparatively 
cheap. 

It  has  been  demonstrated  that  the  pene- 
trating power  of  i)icric  acid  on  the  skin  is 
about  the  same  as  that  of  other  germicides, 
i.  e.,  it  penetrates  only  as  far  as  the  stratum 
corneum.  The  tanning  qualities  of  picric 
acid  are  an  important  factor  in  the  treat- 
ment of  wounds.  Pedicles  of  tanned  skin 
form  over  areas  which  are  painted  with  it, 
and  in  this  tanned  area  are  emmeshed  the 
bacteria,  which  are  prevented  from  enter- 
ing the  wound  and  spreading  over  the  ad- 
jacent area  of  skin.  This  is  theoretical,  of 
course,  but  the  principle  is  sound  and  jjlau- 
sible.  The  main  fact  is  that  in  the  cases 
mentioned  above  jjicric  acid  was  an  efficient 
antiseptic. 

I  have  j)rei)arc(i  the  skin  preceding  minor 
operations  wifli  the  alcoholic  5  per  cent, 
picric  acitl,  and  have  seen  very  few  cases 
of  infection.  In  at  least  one  large  New 
York  hospital  {'i)  picric  acid  is  u.sed  ex- 
clusively in  preparing  the  skin  preceding 
major  o])erations.  Cauze  saturated  with 
a  o  per  cent,  aqueous  solution  of  picric  acid 
has  the  advantage  over  sterile  gauze  in 
that  it  is  antiseptic  and  can  be  made  abso- 
lutely sterile  by  live  steam  sterilization. 
If  the  gauze  is  then  allowed  to  dry,  an  ideal 
surgical  dressing  results. 

I'here  is,  however,  one  great  objection  to 
picric  acid  which  should  be  mentioned 
here  —  namely,  the  tenacity  with  which 
the  stain  clings  to  the  .skin.  I  have  as  yet 
found  no  reagent  that  will  entirely  remove 
it  from  the  skin,  although  it  is  easily  re- 
mo\ed  from  clothing  and  dressings  by 
simply  washing  them  in  water.  As  i)icric 
acid  in  the  crystal  .state  is  highly  inflam- 


ii)i 


BOLDUC  —  PICRIC  ACID  IN  INDUSTRIAL  SURGERY 


203 


mable,  care  must  be  taken  to  keep  it  away 
from  open  flames. 

In  conclusion,  I  wish  to  give  the  follow- 
ing list  of  the  advantages  of  picric  acid  over 
iodine  and  other  similar  antiseptics,  as  ob- 
served in  my  clinical  exj)erience  and  as 
substantiated  by  laboratory  findings: 

1 .  Its  comparative  cheapness 

2.  Its  mild  anesthetic  ((ualities 

3.  Itsstabilitv 


4.  The  fact  that  it  does  not  irritate  the 
parts  to  which  it  is  applied 

5.  Its  non-toxic  qualities  (even  when 
used  in  large  amounts  over  extensive 
areas) 

6.  Its  power  of  hastening  liealing,  the 
wound  resulting  in  a  smooth  cicatrix 

7.  The  fact  that  it  can  be  applied  to  any 
part  of  the  body,  excepting  the  eye.  with 
absolute  safetv. 


miJLKX.UAl'llV 


1.    Farr,  C.  E.:    Picric  Acid  in  Operative  Surgerj'. 
-Vnu.Surg.,  1921,73, 13. 


Oflisner,    A.    J.:     (ieiieral    Suriicrv.      Vol. 
Cliicago,  The  Year  Book  ruhlisliers,  l!)-20. 


SUGGESTIONS  FOR  CUSPIDORS  IN  INDUSTRIAL  PLANTS* 


H.  F.  SMYTH,  M.D.,  Dr.P.H. 

Assistant  Professor  of  Industrial  Hygiene,  School  of  Hygiene,  University  of  Pcnnsyleania 


WHILE  attending  the  recent  annual 
meeting  of  the  National  Association 
of  Industrial  Physicians  and  Surgeons  the 
author  was  asked  by  an  industrial  phy- 
sician for  a  large  rolling  mill  if  he  could 
give  him  any  suggestion  for  solving  the 
problem  of  cuspidor  location  in  the  mill. 
There  seems  to  be  no  suitable  place  for  the 
ordinary  metal  cuspidor;  it  is  always  get- 
ting in  the  men's  way  and  becoming  bat- 
tered and  banged  beyond  usefulness,  or 
being  upset  and  its  contents  spilled.  If 
no  cuspidors  are  provided,  however,  the 
workmen  are  constantly  expectorating  pro- 
miscuously on  the  rolling  floor  or  in  ac- 
cumulations of  dirt  and  dust,  and  the 
partially  dried  sputum,  if  it  contains  infec- 
tious micro-organisms,  becomes  a  menace 
in  the  form  of  dust.  As  the  suggestion 
given  by  the  author  seemed  to  the  plant 
physician  to  be  a  practical  solution  of  this 
problem,  it  is  given  here  in  the  hope  that 
it  may  be  of  service  to  others  and  adapt- 
able in  other  industrial  locations. 

The  suggestion  made  was  to  have  the  or- 
dinary trumpet-mouthed  metal  cuspidor  or 
a  modified  two-piece  fiber  cuspidor  set  in 
a  concrete  pit  (Figures  1,  2  and  3)  so  that 
its  to])  is  level  with  the  floor  and  conse- 
quently does  not  offer  an  obstruction  to  the 
worker  nor  get  in  the  way  of  working  nui- 
terials  or  tools.  A  location  can  certainly  be 
found  for  the  placing  of  such  pits  not  too 
far  from  the  place  of  work  and  yet  where 
the  open  mouth  of  the  cusjiidor  will  not 
offer  an  accident  hazard  to  the  worker's 
heel  or  toe.  If  this  cannot  be  done,  the  top 
of  the  opening  may  be  covered  with  a 
coarse  grating  which  can  be  swabbed  off 
periodicall\-  witli  a  disinfectant. 

•  Received  for  publication  .Tuly  22,  1921. 


The  opening  for  the  cuspidor  should  be 
in  the  center  of  a  3-foot  circular  or  square 
steel  or  concrete  plate  which  should  be  kept 
free  from  dust  or  clutter  and  should  be 
swabbed  off  daily  when  the  cuspidors  are 
removed  for  cleaning.  Removal  of  the  cus- 
pidors for  cleaning  can  be  conveniently  and 


Fig.  1.  —  Cross  section  of  metal  cuspidor  in  concrete  pit. 


Fig.  2.  —  Top  view  of  Figure  1 . 

safely  accomplished,  without  touching  any 
contaminated  surface,  with  the  use  of  ex- 
l)anding  metal  tongs.  If  a  two-piece  fiber 
cuspidor  is  used,  the  flare  top  must  extend 
several  inches  beyond  the  sides  of  the  bowl 
so  as  to  give  a  surface  to  engage  the  edges 
of  the  pit. 

For  many  other  shop  locations  the  same 
idea  can  ])e  used  of  having  a  stationary,  per- 
manent location  for  a  cuspidor  so  placed  as 
to  be  free  from  any  danger  of  upsetting  or 
denting.  Where  feasible,  the  cuspidors  can 
be  sunk  in  a  raised  concrete  block  just  a  few 


204 


SMYTH  —  CUSPIDORS  IX  INDUSTRIAL  PLANTS 


205 


I'iG.  3.  —  Two-piece  fiber  cuspidor  in  its  pit. 


inches  larger  in  diameter  than  the  opening     dor  may  be  dispensed  with  entirely  and  re- 
for  the  cuspidor,  or  possibly,  better  still,  the     placed  by  metal  or  concrete  funnels  set  in 
cuspidor  can  rest  in  an  iron  ring  attached  to     the  floor  and  draining  into  the  sewage  sys- 
the  side  of  a  press,  lathe,  or  other  machine. 
(See  Figure  4.) 

Where  many  cuspidors  are  used  in  a  large 
plant,  the  cjuestion  of  a  safe  and  efficient 
means  of  cleaning  them  is  not  an  unim- 
portant one.  Cuspidors  should  contain  a 
small  amount  of  li<|uid,  preferably  .some 
cheap  disinfectant  as  ly.sol,  creolin,  or  other 
cresol  preparation.  They  should  be  col- 
lected daily,  if  much  used,  and  should  be 
thoroughly  clcaiicd  hcforc  rei)lacing.  In  a 
large  plant,  a  hand  truck  can  be  provided 
to  carry  clean  cuspidors  and  remove  soiled 
ones  for  cleaning.  'J'iiis  truck  may  also 
have  a  place  for  a  jar  of  disinfectant  with 
a  swab  for  cleaning  tiie  surface  surrounding 
the  pits  and  the  gratings,  wlicn  these  are 
necessary.     Cuspidors   can    be   easily   and 

simply  sterilized  by  inverting  over  a  steam  tern  or  into  sand  pits.  Tlic  funnel  should  be 
jet  such  as  is  used  in  many  dairy  farms  for  swabbed  out  regularly  and  thoroughly  with 
sterilizing  large  milk  sliijjping  cans.    They     disinfectant  solution. 

may  be  placed  over  hoppers  draining  into  The  accompanying  drawings  may.  pcr- 

the -sewage  system.  liajjs,  give  a  ck-arer  idea  tlian  the  text  of 

In  some  instances  the  removable  cuspi-     some  of  the  suggestions  made  above. 


Fig.  4. — Strap  iron  ring  to  bo  l)olleil  to  niacbinc  as 
support  for  metal  cuspidor. 


I 


SPRAY  INFECTION* 


S.  R.  DOUGLAS  .^nd  LEONARD  HILL 

{From  the  National  Institute  for  Medical  Research,  Hampstead,  London) 


IN  the  crowding  together  of  human  beings 
in  factories,  pubHc  conveyances,  restau- 
rants, cinemas,  etc.,  one  of  the  factors  that 
tells  against  health  is  massive  infection 
with  organisms  sprayed  out  from  the 
mouth  and  nose  by  the  carriers  of  patho- 
genic germs.  In  the  open  air  such  infection 
is  negligible  and  good  ventilation  and 
proper  spacing  out  can  largely  mitigate 
the  massiveness  of  infection  in  places  where 
people  congregate  indoors.  The  following 
research  has  been  directed  toward  finding 
out  how  certain  conditions  affect  the  mas- 
siveness of  spray  infection. 

I.   The  Effect  of  Humidity  of 
THE  Am 

Trillat  and  ^Nlallein  (1)  compared  the 
influence  of  humidity  and  dryness  of  the 
air  on  the  duration  of  the  suspension  of  a 
spraj'  of  microbes  by  spraying  into  bell 
glasses  4  eg.  of  an  emulsion  of  microbes. 


tion  of  the  culture  medium  which  coated 
the  dishes.  Their  figures  show  a  greater 
number  of  colonies  in  air  with  60  per  cent, 
humidity  than  in  dry  air,  a  much  greater 
number  in  supersaturated  air.  and  a  still 
greater  number  in  air  sprayed  with  some 
food  substance,  such  as  bouillon.  They 
suggest  that  the  microbes  grow  and  mul- 
tiply in  the  droplets  of  bouillon  when  sus- 
pended in  air.  The  method  is  obviously 
open  to  error,  as  there  is  no  guarantee 
that  the  spray  in  each  bell  glass  is  of  the 
same  order  and  distribution.  We  have 
failed  to  confirm  their  results  in  the  case 
of  relatively  humid  and  drj^  air. 

The  method  which  we  emploj-ed  in  our 
experiments  was  as  follows:  Two  bell 
glasses  were  selected  of  equal  size  and  with 
a  groimd  flat  edge  at  the  bottom,  and  a 
tubulure  at  the  toj).  The  edges  were  vase- 
lined  and  brought  into  apposition,  and 
the  nozzle  of  a  spray  inserted  through  one 
of  the  tubulures  (Fig.  1).    The  bell  glasses 


/f= 


Jh= 


< 


^ 


Fig.  1.  ■ 


=^17= 


Dingram  showing  the  two  bell  glasses  held  in  apposition  horizontally,  anil  nozzle  of  spray  inserted 
through  one  of  the  tubulures. 


the  emulsion  being  made  by  diluting  1  eg. 
of  a  solid  culture  with  50  c.c.  of  water. 
Petri  dishes  were  e\']iosed  after  three  and 
ten,  or  fifteen  and  twenty  minutes,  and  the 
number  of  colonies  counted  after  incuba- 

*  Received  for  publication  .Inly  5,  1921. 


were  placed  in  a  horizontal  position.  Three 
strokes  of  th(>  spraying  pumj)  were  then 
made  and  the  tulmlure  closed.  The  two 
bell  glasses,  now  held  in  apposition  verti- 
cally, were  inverted  four  times  at  intervals 
of  thirty  seconds,  so  as  to  mix  the  suspen- 


inr. 


DOUGLAS  AND  HILL  — SPRAY  INFECTION 


207 


sion  equally.  They  were  then  gently  sep- 
arated and  each  one  placed  on  a  glass 
plate  (Fig.  2)  for  transport,  and  then  over 
the  central  orifice  in  the  cover  of  one  of 
the  two  chambers  in  which  the  Petri 
dishes  were  exposed  (Fig.  3).  These 
chambers  were  cylindrical  and  made  of 
glazed  earthenware.   The  Petri  dishes  were 


-ci 


I 

1 

I 
I 


h::^ 


: ^    ' : 

Fig.  2.  —  Bell  glass  on  a  plate  ready  for  transport. 

placed  on  a  stand  about  (>  inches  from  the 
bottom  of  the  chamber.  The  covers  of  the 
cylinders  were  glass  and  their  apposition 
secured  to  the  fiat-topped  edge  by  vaseline. 
A  central  circular  orifice  cut  in  the  glass 
cover  was  closed  by  another  glass  plate 
curved  on  one  side  to  fit  the  edge  of  the 
bell  glass  and  so  arranged  that  it  could  be 
pushed  aside  when  the  bell  glass  was  sl'd 
into  position.  To  the  cover  of  each  Petri 
dish  was  affixed  a  lump  of  hard  wax  to 
which  a  string  was  attached.  The  strings 
passed  through  pinholes  in  the  glass  cover 
closed  by  plasticine,  so  that  by  pulling  on 
the  strings  the  lids  of  the  Petri  dishes  were 
raised  and  the  culture  medium  exposed. 
One  of  the  chambers  was  dried  by  a  cur- 


rent of  dry  air,  and  basins  of  sulphuric 
acid  and  phosphorous  pentoxide  were 
placed  on  the  floor  in  order  to  keep  the  air 
dry.  In  the  other  chamber  which  had  been 
kept  closed  with  a  basin  of  water  on  the 
floor,  the  air  was  damp. 

In  the  first  experiment  of  this  kind  plates 
were  exposed  for  two,  five,  and  ten  minutes 
after  the  bell  glasses  had  been  put  in  posi- 
tion. The  result  was  that  crowded  colo- 
nies develo])('(l  all  over  the  i)lates  in  both 
the  wet  and  the  dry  chambers  In  the 
next  (■x])eriiiuMit  we  exposed  the  plates 
for  two  minutes  at  times  shown  in  Table  1, 
with  the  result  that  the  difference  between 
I  lie  wet  and  dry  chambers  was  found  to 
be  insignificant.  The  temperature  of  the 
chambers  was  1;}°C.  antl  the  relative  hu- 
midity of  one  90  per  cent.,  of  the  other  4i4 
percent.,  taken  by  wet  and  dry  bulbs  in- 
troduced at  the  (>nd  of  the  observation. 

TI.   The  Effect  of  Cold 

Trillat  and  Mallcin  found  that  mice  were 
much  more  readily  infected  when  placed 
in  a  cold  chamber  and  exposed  for  from 
one  to  three  minutes  to  a  suspension  of 
the  infecting  microln's,  than  was  the  case 
when  the  chamber  was  warm.  Moreover, 
they  carried  out  the  following  ex])eriment: 

A  chamber  A  of  50  liters'  capacity  was 
connected  to  a  chamber  B  of  20  liters' 
capacity  by  a  tube  10  in.  long  and  2  cm. 
in  diameter.  Into  ,1  the  spray  of  microbes 
was  made;  in  B  mice  were  i^laced.  If  B 
were  cooled  the  mice  became  infected,  but 
no  infection  occurred  if  B  were  kept  at 
the  same  temperature  or  warmer  than  A. 
Obviously  the  infection  was  due  to  con- 
densation by  cold  of  the  air  in  B,  and  con- 
sequent drawing  of  the  infected  air  from 
.1  into  B. 

We  spread  a  microbic  spray  uniformly 
through  two  bell  glasses  A  and  B  as  in  our 
jjrevious  experiment,  and,  after  .separating 
them,  placed  them  on  glass  plates  so  that 


208 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tliey  could  be  carried  about  without  dis- 
turbing the  contained  spray.  Bell  glass  A 
was  then  placed  over  the  perforated  cover 


FL 


Fig.  3.  — •  Diagram  sliowiiig  bell  glass  placed  over  the  orifice  in  the  cover  of 
a  chamber  in  which  Petri  dishes  containing  culture  media  are  exposed. 


of  a  chamber  which  had  been  placed  in 
the  hot  room  at  37.5°C.  some  hours  pre- 
viously, while  B  was  placed  over  a  chamber 
in  the  cold  room  at  3°C.   Table  2  gives  the 


results.  We  suggest  that  more  microbes 
became  at  once  affixed  by  the  cold  walls, 
together  with  the  moisture  which  was  con- 
densed out,  but  the  few  organisms  which 
escaped  contact  with  the  walls  continued 
to  float  for  a  long  time. 

To  test  the  suggestion  of  Trillat  and 
Mallein  in  regard  to  condensation,  we 
twined  an  iron  wire  in  a  sgries  of  bands 
round  the  outside  of  each  of  several  test 
tubes,  which  were  then  sterilized  inside 
paper  covers.  Some  of  the  tubes  were  then 
filled  with  water  at  body  temperature,  and 
some  with  iced  water,  and  after  the  paper 
covers  had  been  removed 
were  ]ilaced  on  a  stand 
near  the  bottom  of  the 
chamber.  A  microbic 
spray  was  then  made  in 
a  bell  glass  as  before,  and 
the  spraj^  allowed  to 
settle  from  this  into  the 
chaniber.  After  exposure 
for  five  minutes,  a  piece 
of  wire  was  cut  from  each 
test  tube  and  dropped 
into  melted  agar  medium, 
and  this,  being  shaken 
with  the  wire,  was  floated 
out  into  Petri  dishes. 
Figures  4  and  5  show  the 
difference  in  the  results; 
many  less  colonies  grew 
from  the  warm  wires  than 
from  the  cold  wires. 

In  order  to  obtain  a 
more  exact  idea  of  the 
difference  in  the  number 
of  organisms  settling  on 
the  warm  and  cold  wires, 
the  following  method  was 
employed:  After  the 
tubes  had  been  exposed, 
the  wires  were  carefully  removed  with  sterile 
forceps  and  dropped  into  a  knowTi  volume 
(20  c.c.)  of  broth.  The  broth  containing  the 
wire  was  then  thoroughly  shaken  so  as  to 


DOUGLAS  AND  HILL  — SPRAY  IXFFXTIOX 


209 


loosen  the  organisms  from  the  wire  and  dis- 
tribute them  in  the  broth.  Measured  quan- 
tities of  the  broth  were  then  added  to  melted 
agar  which,  after  thorough  mixing,  was 
poured  into  Petri  dishes.  These  plates  were 
incubated  at  37°C.  and  the  colonies  were 

TABLE  1.  —  RESULT  OF  EXPOSURE  OF  PLATES 
IN  WET  AND  DRY  CHAMBERS 


Dry  Air 

Humid  Air 

Exposure  after 

No.  of  Colonies 

Exposure  after 

No.  of  Colonies 

hours 

hourt 

1 

17 

1 

38 

2 

8 

2 

11 

3 

5 

3 

.'> 

4 

0 

4 

1 

5 

0 

5 

0 

6 

2 

6 

1 

counted  after  forty-eight  hours.  Taking 
the  average  of  several  exi)erinu'nts,  the 
number  of  organisms  (staphylococcus) 
found  in  a  cubic  centimeter  of  the  broth, 
after  it  had  been  shaken  witli  the  wire,  was 
29  per  c.e.  in  the  case  of  the  warm  wire,  and 
120  per  c.c.  in  the  case  of  the  chilled  wire. 
It  seems  probable,  then,  tliat   on  coming 

TABLE  4.  —  RESULT  OF  EXPOSURE  OF  PL.VTES 
IN  WARM  AND  COLD  AIR 


Warm  Air 

Cold  Air 

Exposure  after 

No.  of  Colonies 

Exposure  after 

No.  of  Colonics 

hours 

hours 

1 

400 

1 

■id 

2 

30 

2 

0 

3 

0 

3 

2 

>    4 

0 

4 

3 

5 

1 

5 

3 

6 

0 

6 

0 

into  a  crowded,  warm  room  on  a  frosty 
day,  hair,  moustache,  clothes,  etc.,  will, 
owing  to  their  lower  temperature,  affix 
microbes  upon  their  surfaces  in  greater 
numbers  than  would  be  the  case  if  the 
temperature  were  higher.  Thus,  too,  Tril- 
lat's  mice  may  have  been  more  massively 
infected  in  the  cold  chamber. 


The  effect  of  a  cold  surface  on  suspended 
particles  is  shown  in  tlie  following  experi- 
ment: We  took  a  glass  tube  3  cm.  in 
diameter  and  1  m.  long  and  inserted  into 
either  end  of  it  a  short  U-tube  through 


Fig.  4.  —  Number  of  loloiiios  growing  from  warm  wires 
after  five  minutes'  exposure  to  niicrobic  spray. 


Fig.  5.  —  Colonies  growing  from  cold  wires  after  five 
minutes'  exposure  to  microbic  spray. 

which  circulated  in  one  case  iced  water, 
and  in  the  other  case  water  at  body  temp- 
erature. We  then  drew  tobacco  smoke 
through  the  tube  so  as  to  fill  it  with  a  cloud 
of  smoke  from  end  to  end.  We  found  the 
smoke  cleared  round  the  end  fitted  with 
the  cold  U-tube  and  particularly  round  the 


210 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


end  of  this  tube,  leaving  a  space  as  shown 
in  Figure  6.  Smoke  eddies  could  also  be 
seen  at  this  place.  At  the  end  fitted  with 
the  test  tube  containing  warm  water  no 
change  appeared.  The  condensation  of 
moistin-e  of  the  air  by  the  cold  surface 
leads  to  many  more  particles,  such  as 
smoke   and   microbes,    coming   in   contact 


Fig.  6.  —  The  smoke-free  space  at  the  end  of  the  U- 
tube  shows  the  effect  of  the  cold  surface  of  the  U-t«be  on 
the  suspended  particles  of  smoke. 

with  the  surface,  and  they  become  fixed 
thereon,  whether  because  they  are  carry- 
ing an  opposite  electrical  charge,  or  other- 
wise, we  cannot  say. 


III.   The  Effect  of  a  Current  of 

Saturated  or  Dusty  Air  on 

Transport  of  Microbes 

Trillat  and  INIallein  state  that  either 
water-saturated  or  dusty  air  carries  away 
from  the  .surface  of  a  culture  many  more 
organisms  than  does  dry  air.    This  state- 


ment we  have  confirmed.  Dry  air  from  a 
compressed  air  cylinder  was  passed  over 
a  culture  of  stajjliylococciis,  which  grew 
along  the  floor  of  a  tube  ^1  placed  horizon- 
tally. In  sequence  to  this  tube  was  another 
tube  B  lined  with  .sterilized  agar  culture 
medium.  Air  flowed  through  the  two 
tubes  for  two  and  one-half  minutes  at  the 
rate  of  10  liters  per  minute.  Onlj'  one  or 
two  colonies  grew  subseciuently  in  B.  The 
experiment  was  repeated,  but  this  time 
with  air  first  bubbled  through  warm  water 
to  satiu'ate  it.  Some  of  the  water  condensed 
in  B:  this  was  grossly  infected. 

In  a  third  experiment,  the  dry  air  passed 
tln-ough  a  bottle  in  which  some  dry  sterile 
talc  was  shaken  to  make  a  dust.  Many 
more  colonies  appeared  in  B  under  these 
conditions  than  when  dry  air  alone  was 
passed  over  the  culture.  In  a  fourth  ex- 
periment, saturated  and  dusty  air  was 
passed  over  the  culture  and  this  caused 
gross  infection  in  B.  AYe  conclude,  there- 
fore, that  particles  of  water  or  dust  in 
moving  air  on  hitting  infected  surfaces 
carry  away  the  microbes  from  these  sur- 
faces and  in  this  manner  help  to  spread 
infection. 

IV.  Experiments  Made  to  Investigate 

THE  Effects  of  Ventilation  in  Rooms 

Massively  Infected  with  a  Spray' 

of  Cultxjre 

We  made  a  spray  in  an  empty  room 
(21  by  161  by  13i  feet)  heated  by  steam 
radiators,  and  exposing  Petri  dishes,  usu- 
ally five  for  each  observation,  compared 
the  number  of  colonies  formed,  first,  when 
the  room  was  comfortably  ventilated  by 
open  windows  so  that  it  felt  fresh,  and 
secondly,  when  the  windows  were  all  shut 
and  the  room  felt  close. 

Seven  and  a  half  c.c.  of  a  broth  culture 
of  a  eoliform  bacillus  (from  a  rabbit's  in- 
testine), diluted  1  in  5,  were  sprayed 
across  the  blast  from  a  fan  directed  toward 


DOUGLAS  AND  HILL  — SPRAY  INFECTION 


211 


TABLE  ;i.  — AVERAGE  NUMBER  OF  COLONIES     closelj"    the  average  number  of  colonies 
RESULTING  FROM  EXPOSL-RE  IN  FRESH  being  shown  in  Table  3.    The  area  of  cul- 

AND  CLOSE  ROOMS  1^^^.^  jj^gji^  exposed  was  very  nearly  equal. 

Figures  7,  8,  and  9  are  from  photographs 


No.  of  Plate 

Exposure  for 

Two  Minutes 

after 

1                   No.  of  Colonies 

Fresh  Room 

Close  Room 

minutes 

1 

immediate 

1,593 

1,468 

i 

5 

446 

634 

S 

U) 

54 

Hi 

4 

Ij 

38 

118 

5 

20 

1 

76 

the  ceiling  .so  that  the  organisms  might  be 
equally  distril)uted  througliout  the  air.  The 
original  culture  c-ontained  about  .'500.000,000 
living  organisms  per  cubic  centimeter,  and 
it  was  found  that  bv  the  above  technic  a 


Fig.  7.  —  Photograpli  of  plalc  1  after  exposure,  iniiiie- 
dialel.v  after  spra.viiif;.  in  close  room  (upper  half),  anil  in 
ventilated  room  (lower  half). 


verj^  even  distribution  of  the  organism 
was  obtained.  In  the  fresh  room  the  dry 
bulb  read  17.2°C.,  the  wet  bulb  12.8°c"., 
and  the  dry  kata-lhermomcter  reading 
was  (5°.  In  the  close  room,  the  dry  bulb 
read  21.4°,  the  wet  bulb  15.5°,  and  the 
dry  kata-thermometer  4.2°.  The  Petri 
dishes  were  exposed  for  two  minutes  im- 
mediately, and  at  intervals  of  five,  ten, 
fifteen  and  twenty  minutes  after  making 
the  spray.  The  number  of  colonies  in  the 
five  plates  after  each  exposure  agreed  very 


Fig.  8.  —  Photograph  of  plate  3  after  exposure,  ten 
niiniitos  after  s|. raying,  in  close  room  (upper  half),  and  in 
ventilated  room  (lower  half). 


Fig.  9.  —  Photograph  of  plate  5  after  exposure,  twenty 
minutes  after  spra.ving,  in  close  room  (upper  half),  and  in 
ventilated  room  (lower  lialf). 

of  plates  1,  3,  and  5;  the  close  room  plate 
being  shown  in  the  upper  half  in  each  case. 
It  is  clear,  then,  that  opening  the  window 
enough   to   change    close    conditions    into 


21'-2 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


those  which  feel  fresh  k'sseiis  massive  spray 
infection  greatly. 

We  next  repeated  the  experiment  in  the 
close  room,  first,  with  the  fan  running  so 
as  to  keep  the  air  in  constant  movement, 

TABLE   4. —  AVERAGE   XLMBER   OF   COLONIES 

RESILTING  FROM  EXPOSURE  I\  CLOSE 

ROOM   WITH  FAX  RUXXIXG  AXD   WITH 

FAX  AT  REST 


Exposure  for 

Two  Minutes 

after 

No.  of  Colonies 

Fan  Off 

FanOn 

mit^lites 

1 

immediate 

1,750 

1,700 

2 

5 

OHO 

510 

3 

10 

4-25 

230 

4 

15 

300 

84 

5 

20 

97 

40 

and,  secondly,  with  the  fan  at  rest.  With 
the  fan  at  rest  the  dry  bulb  read  2'2.5°, 
the  wet  bulb  14.5°,  and  the  dry  kata- 
thermometer  4.1°.  With  the  fan  running 
the  readings  were  22°,  14°,  and  5.6°. 
Table  4  gives  the  average  number  of 
colonies  formed.  This  experiment  shows 
that  the  movement  of  the  air,  caused  by 
the  fan,  takes  away  more  than  double  the 
number  of  microbes,  probably  by  bringing 
them  in  contact  with  walls  and  other  sur- 
faces and  by  driving  them  out  of  the  room 
through  crannies. 

Lastly,  we  tried  the  experiment   in  the 
relatively  dry  close  room,  and  in  the  same 


room  made  moist  by  a  number  of  baths  of 
water  kept  boiling  by  Bunsen  burners, 
and  by  water  scattered  over  the  floor  and 
walls.  In  the  dr^■  close  room  the  dry  bulb 
read  21.2°,  the  wet  bulb  12°,  and  the  dry 
kata-thermometer  4.3°;  in  the  moist  close 
room  the  readings  were  23.5°,  20.5°,  and 
4.0°,  respectively.  The  number  of  colonies 
is  recorded  in  Table  5.  In  the  moist  room 
the  number  of  microbes  was  notably  more 
reduced,  partly,  we  suggest,  owing  to  their 
condensation  together  with  water  vapor 
on  the  walls  and  other  surfaces,  partly 
owing  to  stronger  outward  currents  being 
set  up  through  crannies  because  of  the 
greater    lightness    of    the    moist    air,    and 

TABLE   5.  —  AVERAGE    XUMBER   OF   COLOXIES 

RESULTIXG  FROM  EXPOSURE  IX  DRY  AXT) 

MOIST  CLOSE  ROOM 


No.  of  Plate 

Exposure  for  Two 
Minutes  after 

Dry  Close 
Room 

Moist  Close 
Room 

minutes 

1 

immediate 

1,540 

2,610 

2 

5 

090 

1,025 

:! 

10 

540 

452 

4 

1.5 

215 

157 

5 

20 

1-21 

08 

partly  owing  to  the  fact  that  a  large  num- 
ber of  organisms  must  have  been  de- 
stroyed by  the  twelve  or  more  Bunsen 
burners  which  were  employed  in  heating 
the  water  used  to  saturate  the  air. 


BIBLIOGR.VPm' 


Trillal.  .v.,  and  Mallcin:  Sur  le  .sort  des  pro- 
jections niicrobionne.s  dans  I'air.  Influence  de 
rinimidite.  Compt.  rend.  Acad.  d.  sc,  1920, 
170,   1'291.     Experiences  de  tran.smi.ssion  d'une 


epideniie  cliez  le.s  animaiix  liar  rinierniediaire 
de  I'air.  Influence  de  la  temperature.  Ibid., 
152!). 


CARBON  IMONOXIDE,  ILLUMINATING  GAS,  AND  BENZOL: 
THEIR  EFFECT  ON  BLOOD  COAGULATION  TIME  * 

HENRY  S.  FORBES  and  LOUISE  HOMPE 
From  the  Laboratory  of  Applied  Physiohgy,  Hareard  Medical  School 


IN  carbon  monoxide  poisoning,  pathol- 
ogists describe  hemorrhages  in  the 
brain,  muscles,  lungs,  and  other  organs  (1). 
Some  authors  state  that  the  blood  post- 
mortem remains  fluid  in  the  vessels  much 
longer  than  usual  and  does  not  readily  clot 
when  withdrawn  i'i).  Others  say  that  car- 
bon monoxide  favors  coagulation  (3).  On 
account  of  these  diverse  findings  and  be- 
cause of  differences  of  opinion  regarding 
the  mode  of  action  of  the  gas,  it  si-enied 
worth  while  to  determine  carefully  the 
coagulation  lime  of  the  blood  of  animals 
gassed  with  carbon  monoxide  and  to  note 
any  evidence  of  blood  destruction  (c.  g., 
hemolysis) . 

Convincing  proof  has  been  brought  for- 
ward by  the  i)hysiologists  that  this  gas  has 
no  direct  harmful  action  upon  nerve  cells  or 
other  tissues,  but  injures  solely  by  robbing 
these  tissues  of  oxygen  through  the  forma- 
tion of  a  conii)(>und  witli  licinoglobiu  which 
is  not  stable  but  which  can  be  replaced  by 
oxygen  under  suitabl<>  tension  (4)  (5). 
Many  of  the  cases  described  in  the  liter- 
ature as  carbon  monoxide  poisoning  are 
in  reality,  however,  due  to  illuminating  gas. 
The  pathological  |)ictures  in  poisonings  by 
these  two  gases  may  well  differ.  Illumin<it- 
ing  gas  is  complex  and  has  been  .shown  to  be 
more  toxic  than  is  pure  carbon  monoxide, 
the  chief  additional  poi.son  being  benzol  (6) 
(7).  The  otlier  toxic  constituents  — xylene, 
ethylene,  etc.  —  appear  to  be  much  less 
important  .so  far  as  is  known  at  present.  It 
has  been  shown  by  Hurwitz  and  Drinker 
(8)  that  repeated  subcutaneous  injections 
of  benzol  can  cause  delayed  coagulation, 

*  The  authors  wish  to  express  their  thanks  to  Dr.  Cecil 
K.  Drinker  and  Dr.  Katherine  R.  Drinker  for  vahiable  sug- 
gestions and  help.    Received  for  publication  Sept.  12,  1941. 


l)ul  this  does  not  happen  immediately. 
According  to  their  figures,  the  change  is 
slight  after  four  days  from  the  first  injec- 
tion, and  is  not  marked  till  the  tenth  day; 
therefore,  a  change  is  hardly  to  be  expected, 
even  from  intensive  gassing,  within  the 
time  limits  of  the  present  experiments.  We 
have  tried  to  find  out  in  these  experiments 
whether  or  not,  under  controlled  condi- 
tions, pure  carbon  monoxide,  illuminating 
gas,  and  |)ure  l)enzol  have  any  measurable 
effect  on  coagulation  time. 

Method 

Cats  anesthetized  with  urethane  or 
ether  supplied  control  .sam])les  of  blood. 
With  urethane  the  dosage  was  10  c.c.  of  a 
'25  per  cent,  solution  per  kilo  weight  of  cat 
given  by  stomach  tube.  One  carotid  was 
exposed  and  2  c.c.  samples  *  were  drawn 
directly  into  a  cannula-tipped  pipette. 
This  was  ])reviou.sly  coated  with  a  .sat- 
urated ether  solution  of  vaseline,  tiie  ether 
being  afterwards  carefully  expelled.  From 
the  pipette  1  c.c.  of  blood  was  delivered 
into  the  bottom  of  each  of  two  test  tubes, 
which  were  thoroughly  clean  and  dry,  and 
of  uniform  diameter.  These  tubes  were 
kept  in  a  water-bath  at  31°  to  S2°  C.  After 
standing  ten  minutes,  they  were  tilted 
slightly  once  every  five  minutes.  The  end 
point  was  the  firm  holding  of  the  clot  .so 
that  the  blood  did  not  run  down  the  side 
when  the  test  tube  was  inverted.  Time  was 
taken  from  the  moment  the  blood  entereil 
the  pipette.  A  few  determinations  were 
made  on  blood  oxalated  and  recalcified 
after  the  method  of  Howell  (9). 

*  Occasionally  3  c.c.  samples  were  taken  and  put  into 
three  test  tubes. 


■i\S 


214 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


After  control  samples  had  been  taken 
from  the  urethanized  animal,  the  gas  was 
given  from  a  Donglas  bag  by  a  tracheal 
cannula,  fitted  with  inspiratory  and  ex- 
piratory valves.  In  the  different  experi- 
ments the  duration  of  gassing  varied  from 
thirty  minutes  to  seven  and  one-half  hours. 
For  the  longer  periods,  instead  of  being 
permitted  to  inhale  the  gas  by  tracheal 
tube,  the  animal  was  placed  in  a  box  of 
760  liters'  capacity,  to  which  a  measured 
amount  of  gas  was  added.  An  electric  fan 
kept  the  air  in  motion,  and  the  excess  of 
carbon  dioxide  and  moisture  was  absorbed 
by  soda  lime. 

The  carbon  monoxide,  which  we  used, 
was  made  from  formic  acid  and  sulphuric 
acid  heated  to  70°  to  80°C.,  and  the  gas 
passed  tlirough  strong  sodium  hydrate 
solution  and  collected  in  a  bottle  by  dis- 
placement of  water.  The  illuminating  gas 
was  taken  from  the  laboratory  gas  jet.  It 
was  supplied  by  the  Boston  Consolidated 
Gas  Company,  and  the  figures  giving  the 
average  monthly  percentage  of  carbon 
monoxide  were  obtained  through  the  cour- 
tesy of  the  chief  chemist  of  the  company. 
The  benzol  used  was  "Benzene  (Benzol) 
Merck."  The  percentage  of  vajjor  inhaled 
by  the  animals  was  not  determined  but  was 
of  sufficient  concentration  to  keep  them 
unconscious. 

Experimental  Data 

Eleven  experiments  have  been  chosen 
from  the  total  number  performed.  A  num- 
ber were  discarded  because  of  lack  of 
uniformity  among  the  controls  before  a 
constant  temperature  bath  was  used.  In 
the  prothrombin  tests,  uniformity  was 
obtained  without  the  use  of  a  water-bath, 
and  it  was,  therefore,  omitted. 

The  accompanying  protocols  show  the 
extent  of  the  individual  variations  in 
coagulation  time. 


Protocol  1.  —  Cat  1.  Weight  3.1  kg.  Ilrethane 
31  c.c.  25  To  solution  given  2  hours  and  22  minutes 
before  gas  started.  Gassed  82  minutes  with  0.5  '"c  CO. 


Sample 

Normal  Blood 

Coagulation  Time 

Tube  1    Tube  2    Tube  S 

min.         min.        min. 

A 

25 
20 

25        25 

B 

20        26 

CO  Blood 

A  taken  21  minutes  after  starting  gas 

20 

20        25 

B      "      38 

U 

U                   it                 u 

20 

20 

C      "      55 

u 

U                     ((                   (( 

20 

20 

D      "      72 

a 

((                 u               u 

20 

20 

E      "      82* 

u 

u              a             u 

20 

20 

*  Heart  had  stopped  when  sample  was  taken. 

Protocol  2.  —  Cat  2.  Weight  2.9  kg.  Urethane 
29  c.c.  25%  solution  given  if  hours  before  gas 
started.    Gassed  61  minutes  with  0.5  Tc  CO. 


Sample 

Normal  Blood 

Coagulat  i 
Tube  1 
min. 

ion  Time 
Tube* 
min. 

A 

.     35 
.     30 

35 

B 

26 

CO  Blood 

A  taken 

I  10  minutes  after  starting  gas 

30 

30 

B      " 

24        " 

tl                     it                   it 

35 

31 

C      " 

40        " 

a                ii              u 

30 

26 

D     " 

48 

u                u              u 

25 

20 

E      " 

56        " 

u                u              u 

35 

35 

F      " 

61*       " 

u               u              u 

20 

30 

*  Heart  stopped  5  minutes  before  sample  was  taken. 

Protocol  3.  —  Cat  3.  Weight  3  kg.  Urethane 
30  c.c.  25%  solution  given  ll  hours  before  gas 
started.   Gassed  47  minutes  with  0.6  %  CO. 


Prothrombiu 

TeM 

Oxalated  Blood 
drops 

fi  CaCl: 
drops 

Coagulation  Time 
Control             CO  Sample 
min.                     min. 

5 

1 

9 

8 

5 

2 

9 

10 

5 

3 

11 

11 

5 

4 

12 

n 

Oxalated  Plasma 
drops 

1%  CaC!, 
drops 

Control 
min. 

CO  Sample 

min. 

5 

1 

20 

22 

5 

2 

21 

20 

5 

3 

20 

20 

5 

4 

20 

20 

FORBES  AND  HOISIPE— EFFECT  OF  CO  ON  COAGULATION  TIME       215 


Protocol  4.  —  Cat  4.  Weight  .2.2  kg.  Urethane 
18  c.c.  25  %  solution  given  2|  hours  before  gas 
started.  Gassed  39  uiinutcs  with  0.7  TJ  CO  (in  two 
periods  with  two  G9-niiiiuto  intervals). 

Prothrombin  Teat 


Oxalated  Blood 
drops 

1%  CaCli 
drops 

6 

1 

fi 

2 

6 

3 

5 

4 

Coagtitation  Time 

Control             CO  Sample 

min,                      mm. 

4 

S 

5  . 

3 

6 

4 

7 

4 

Protocol  5. — Cat  5.  Weight  2  kg.  Urethane 
20  c.c.  25  %  solution  given  24  hours  Ijefore  gas 
started.   Gassed  30  minutes  with  0.6  •;;  CO. 

■       Prothrombin  Teat 


Oxalatcd  Blood 
drops 

1%  CaCl. 
drops 

Coagulat 
Control 
min. 

oD  Time 
CO  Sample 
min. 

6 

1 

« 

6 

6 

2 

6 

4 

5 

3 

7 

5 

6 

4 

9 

6 

Protocol  6.  —  Cat  C.  Weight  2.5  kg.  Urethane 
30  c.c.  25  %  solution  given  1  hour  Ijefore  gas  started. 
Gassed  34  minutes  with  2%  illuminating  gas  (con- 
taining approximately  0.5  %  CO). 


Normal  Blood 


Sample 

A.... 
B... 


Coa^ulalion  Time 

Tuhf  I        Tube  i 

min.  min. 


30 
25 


Ilium inatimj  Gas  Blood 

A  taken    8  minutes  after  .starting  gas  21 

B      "      15        "  "  "  "  20 

C       "      23         "  "  "  "  25 

D      "      28        "  "  u  u  25 

E      "      34        "  "  u  u  30 


30 
30 


25 
25 
25 
30 
30 


Protocol  7.  —  Cat  7.  Etherized  40  minutes  till 
gas  started.  Gassed  5  hours  in  box  with  0.5  %  illu- 
minating gas  (containing  approximately  0.12  %  CO). 


Sample 

Normal  Blood 

Coagulation  Time 

Tube  I         Tube  « 

min.            min. 

A 

15              10 

B,  ... 

20              10 

C 

15              15 

Illuminating  Gas  Blood 

A  taken  4*  li 

ours 

after  starting  gas  ....      15             10 

B      " 

H 

" 

'*           "    ....      20              10 

C      " 

4i 

u 

"    ....      25              10 

D      " 

5 

u 

"    ....      20             20 

E      " 

5 

u 

"    ....      20              10 

Protocol  8.  —  Cat  8.  Etherized  So  minutes  be- 
fore taking  control  samples.  Exposed  to  benzol 
\'apor  in  box  for  3  hours.    Unconscious. 

Normal  Blood 

Coagulation  Time 
Tube  1  Tube  i  Tube  S 
Sample  min.       min.        min. 

A 25         20 

B 25         20         20 

Benzol  Blood 

A  taken  3  hours  after  starting  gas 30         20 

B      "      3  hrs.  and  5  m.  after  starting  gas  30        30 
C*    "      8    "       "10  "       '•  "  "    -iO        40        50 

*  Taken  1  i  minutes  after  heart  stopped. 

A  utopmj.  —  Blood  as  dark  in  arteries  as  in  veins. 
Right  lung  congested,  hemorrhagic,  edematous;  in- 
testinal vessels  appear  contracted  and  pale,  showing 
marked  contrast  to  those  of  CO  animals,  wliich  are 
alwaxs  greatly  dilated. 

Protocol  9.  —  Cat  9.  Etherized  before  taking 
control  samples.  Exposed  to  benzol  vapor  in  box 
for  3  hours.     Unconscious. 

Normal  Blood 

Coagulation  Time 
Tube  I      Tube  « 
Sample  mtn.  min. 

A 20  25 

Benzol  Blood 

A  taken  3  hours  after  starting  gas 15  15 

B      "      3      "         "  "  "    15  15 

Prothrombin  Teat 

Coiigulalion  Time 
Oxnlnted  Blood  l%CaCl2  Control         Benzol  Sample 

drops  drops  min.  min. 

6  1  3  3 

5  2  3  3 

5  3  4  3 

5  4  4  4 

Protocol  10.  — Cat  10.  Etherized  before  taking 
control  samples.  Chilled  by  wetting  and  exposure  to 
fan  for  53  minutes.  Rectal  temperature  reduced  to 
29.5°C.  Exposed  to  benzol  vapor  in  lx)X  for  31  hours 
after  being  warmed.   Rectal  temperature  33.5°C. 

Normal  Blood 

Coagulation  Time 
Tube  I        Tube  i 
Sample  mjn.  min. 

A 25  25 

B  after  exposure  to  cold 20  20 

Benzol  Blood 

.\  taken  after  1    hour  of  gas 20  30 

B      "         "1       "      "    "   20  15 

C      "         "     3i 17  17 

D      "         "     3',      "      "    "    20  20 


216 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Protocol  11.  —  Cat  11.  Gassed  preceding  day 
for  71  hours  witli  benzol  vapor.  Unconscious  most  of 
that  time.  Appears  normal  on  day  of  experiment; 
no  sign  of  paralysis.  No  ether  or  urethane  given. 
No  control  samples  taken.  Exposed  in  box  to  benzol 
vapor  for  7?  hours.  Red  blood  count  8,000,000; 
white  blood  count  13,000;  blood  smear  shows  poly- 
nuclears  and  platelets  increased. 

Benzol  Blood  ^^e'l'th':"?^ 

Sample  mm.       min. 

A  taken  after  6  hours  and  24  minutes  of  gas  25  25 
B  "  "6  "  "  45  "  "  "  20  15 
C      "         "6      "         "    54        "  "    "        25         25 

D*    '•         "     7      "         "     30        "  "    "        20         20 

*  Taken  from  abdominal  aorta  3  minutes  after  heart  stopped. 

Discussion 

The  experiments  which  we  have  re- 
ported show  no  constant  change  of  coag- 
ulation time  in  the  blood  of  cats  gassed 
with  any  one  of  the  three  gases  tested,  and 
the  prothrombin  content  was  apparently 
unaltered.  Evidence  of  hemolj'sis  was 
lacking.  Clear  serum  was  always  obtained 
unless  mechanical  injury  to  the  red  cells 
had  occurred.  The  urine  was  never  dark  or 
smoky.  Since  no  hemorrhages  were  found 
postmortem,  it  is  apparent  that  the  exact 
conditions  of  human  poisoning  were  not 
reproduced,  even  by  five  hours  of  deep 
coma  in  the  gas.  The  one  po.ssible  excep- 
tion is  seen  in  Protocol  8  where  the  lungs 
showed  some  extravasation  of  blood.  This 
animal's   blood   showed  a   lengthening   of 


coagulation  time  in  the  last  sample, 
though  it  is  doubtful  if  this  is  significant, 
for  the  sample  taken  only  five  minutes 
before  showed  a  normal  time.  Protocol  9, 
on  the  other  hand,  with  the  same  duration 
of  exposure  to  benzol  showed  a  slight 
shortening  of  coagulation  time,  but  this 
again  can  be  disregarded  because  the 
prothrombin  test  taken  at  the  same  time 
was  normal. 

In  fatal  human  cases  of  illuminating  gas 
poisoning  the  patient  often  lingers  in  coma 
for  one  or  two  days  before  death.  This 
condition  we  were  unable  to  duplicate  in 
animals.  They  either  died  in  the  gas  or 
recovered  entirely.  The  most  probable 
explanation  of  this  failure  to  reproduce 
hemorrhages  or  prolonged  coma  after  re- 
moval from  the  gas  is  either  that  it  affects 
animals  differently  from  human  beings  or, 
more  probably,  that  the  period  of  gassing  is 
shorter  in  these  experiments  than  in  the 
human  cases. 

Conclusions 

Under  the  conditions  of  these  experi- 
ments no  measurable  effect  upon  the  coag- 
ulation time  of  the  blood  was  found  in  cats 
gassed  with  carbon  monoxide,  illuminating 
gas,  or  benzol. 

No  evidence  of  hemolysis  or  of  blood 
destruction  was  observed. 


BIBLIOGRAPHY 


1.  Kober,  G.  M.,  and  Hanson,  W.  C:  Diseases  of 
Occupation  and  Vocational  Hygiene.  Philadel- 
phia, P.  Blakiston's  Son  and  Company,  1916, 
p.  57. 

2.  Glaister,  J.,  and  Logan,  D.  D.:  Gas  Poisoning 
in  Mining  and  Other  Industries.  New  York, 
William  Wood  and  Company,  1914,  p.  340. 

3.  Rambousek,  J. :  Industrial  Poisoning.  London, 
Edward  .\rnold,  1913,  p.  199. 

4.  Haggard,  H.  W. :  Effects  of  Carbon  Monoxide  on 
Neuroblasts.   To  appear  in  Am.  Jour.  Physiol. 

5.  Haldane,  J.  S.:  The  Relation  of  the  Action  of 
Carbonic  Oxide  to  Oxygen  Tension.  Jour. 
Physiol.,  189,5.  18.  '201. 

6.  Henderson,   Y.,   and   Haggard,   H.    W.:    The 


Elimination  of  Carbon  Monoxide  from  the 
Blood  after  a  Dangerous  Degree  of  Asphyxia- 
tion, and  a  Therapy  for  Accelerating  the  Elim- 
ination. Jour.  Pharmacol,  and  Exper.  Therap., 
1920,  16,  11. 

7.  Henderson,  Y.,  and  Haggard,  H.  W.:  Personal 
Communication. 

8.  Hurwitz,  S.  H.,  and  Drinker,  C.  K.:  The  Fac- 
tors of  Coagulation  in  the  Experimental  .\plas- 
tic  .Vnemia  of  Benzol  Poisoning,  with  Special 
Reference  to  the  Origin  of  Prothrombin.  Jour. 
Exper.  Med.,  191.5,  21,  401. 

9.  Howell.  W.  IL:  The  Condition  of  the  Blood  in 
Hemoi)hilia.  Thrombosis  and  Purpura.  Arch. 
Int.  Med.,  1914,  13,  76. 


BOOK  REVIEWS 


217 


BOOK  REVIEWS 


The  Assessment  of  Physical  Fitness  by  Corre- 
lation of  Vital  Capacity  and  Certain  Measure- 
ments of  the  Body.  By  (icorgt-s  Dreyer,  C.B.E.. 
M.A..  M.I)..  FcIIdu  of  l>iric()lii  Coilcgi',  Professor  of 
Pathology  in  the  I  iiivorsity  of  O.xfonl,  Ctjrrospond- 
ing  Monihcr  of  tiio  Royal  Danish  Academy  of  Letters 
and  Sciences, and  (ieorge  Fiilford  Han.soii.  Late  Lieu- 
tenant I  .S..V.  Medical  Corps,  .Vir  Service.  With  a 
foreword  i)y  Charles  IL  Mayo.  ^L1)..  Rochester, 
Minn.  Ciotli.  Pp.  1'27  with  illustrations  and  inde.v. 
New  York:  Paul  R.  Hoeber.  1921. 

Thi.s  l)ook  is  a  coiipction  of  tables  tliroiiiiii 
the  u.sc  of  wliich  il  is  iicld  |)ossii)!c'  to  arrange 
individiuils  in  tlie  order  of  tiieir  j)hysical  fitness. 
The  auliior  has  establislied  certain  relations  be- 
tween weight,  silling  iieigiit,  chest  circuni- 
ference,  and  \ital  (•ai)acily,  whicli  are  indi<-ative 
of  good  healtii.  Jle  does  not  inchide  any  of  liis 
data  iii)on  the  validity  cf  these  relations  but  in- 
cliuies  references  to  previous  pajiers  in  which  he 
has  discussed  the  devcli>])incnt  of  his  concep- 
tions. 

The  reader  is  given  a  series  of  tables  witii 
thorough  directions  as  to  their  use  for  the  fol- 
lowing pur|)o.scs: 

"1.  Tiie  dctcrniinalioii  of  what  are  the  nor- 
mal proportions  between  the  weight,  the  trunk- 
length,  and  the  circumference  of  the  chest. 

"■2.  To  gain  evidence  as  to  underfeeding  or 
malnutrition  during  different  stages  of  adoles- 
cent or  adult  life,  as  well  as  in  \arious  classes 
and  occui)ations  of  the  population. 

"iJ.  For  the  stuily  of  the  difl'erent  asiM-cts  of 
physical  fitness  as  measured  by  vital  ca])acity 
in  its  relation  to  weight,  trunk-length,  and 
chest-circumference;  for  the  comparison  of 
adolescents  with  adults,  and  of  the  male  sex 
with  the  female;  for  the  comparison  of  diH'erent 
trades,  occupations,  and  cla.s.ses  one  with  an- 
other, referring  all  to  a  definite  common 
standard. 

"-i.  The  ai)plication  of  these  various  mea- 
surements to  |)aticnts  with  organic  disease  — 
e.g.,  pulmonary  tuberculosis — as  well  as  to  i)er- 
.sons  with  functional  disorders  —  <'.;/.,  indus- 
trial fatigue,  the  fatigue  of  aviators,  aiul  so  on." 


Since  the  usefulness  of  Drej'er's  tables  can 
only  be  established  through  experience  with 
them,  no  opinion  can  be  expres.sed  as  to  the 
soundness  of  the.se  contentions.  The  whole 
subject  is  of  such  vital  interest  to  industrial 
physicians  that  it  is  hoped  they  will  at  once 
begin  to  utilize  and  criticize  the  methods  and 
standards  which  the  ai'.thor  has  finnisheil.  — 
('.  K.  Drinker. 


Occupational  Affections  of  the  Skin.  Their  Pre- 
vention and  Treat nient.  with  an  .Recount  of  the 
Trade  Processes  and  .\genls  Which  (iive  Rise  to 
Them.  By  R.  Prosser  White.  M.I).  E<1.,  M.R.C.S. 
Ja)IuI.,  Life  Vice-President,  Dermatologist,  Senior 
Physician  and  Knthetie  Odicer,  Royal  .Vlliert  Ed- 
ward Infirmary,  Wigan:  \'ice-President  .Vssociation 
Factory  Surgeons;  Life  Fellow  London  Derma- 
tologists' S(x-iety;  Member  Manchester  Mc<lieal  and 
Dermatologists'  Societies;  Hun.  J^ife  Member  St. 
.John  .Vmliiilance  .Vssociation;  .\ssociatc  Editor, 
.Journal  of  Industrial  Hygiene.  Cloth.  Second  Fldi- 
tion.  Pp.  .'i(i(l  with  illustrations  and  inde.v.  New 
York:  Paul  B.  Iloeber.  1!KM). 

The  first  edition  of  this  book,  published  in 
]'.)\.').  proved  it.self  of  great  worth  in  a  compara- 
tively ncglecteil  and  dillicult  field.  In  this,  the 
sccoiul  edition,  which  is  greatl.\-  amplified,  use- 
ful material  has  been  added  to  almost  every 
chapter.  Deserving  of  es|)ecial  mention  are  the 
chapters  on  dermatitis  venenata  and  the  der- 
matoconioses.  The  added  illustrations  are 
excellent  and  the  numerous  references,  which 
have  been  carefully  and  ])ainstakingly  coni- 
])iled,  will  ])rove  a  great  help  to  in\cstigators  in 
this  line  of  work. 

It  is  a  book  which  fills  a  long  felt  want  and 
deserves  a  prominent  place  in  the  library  of 
every  worker  in  industrial  hygiene,  while  the 
dermatologist  who  reads  it  will  soon  di.scover 
that  to  him  it  is  not  a  luxury  but  a  necessity. 
It  is  to  be  hoi)ed  that  in  the  future  there  will 
follow  other  editions  to  add  to  the  literature 
in  this  comi)lex  and  ever-widening  field.  — - 
E.  La irrence  Oliver. 


218  THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

HEALTH  INSTITUTE  OE  THE  AMERICAN  PUBLIC 
HEALTH  ASSOCIATION 

One  of  the  features  of  the  Fiftieth  Annual  Meeting  of  the  American  Pubhc  Heahh 
Association  is  to  be  a  Health  Institute  which  will  be  held  in  New  York  City  from  Novem- 
ber 8  to  11,  the  convention  itself  taking  place  the  following  week,  November  14  to  18. 
The  Institute  is  ojien  to  non-members  of  the  American  Public  Health  Association. 

Among  the  demonstrations  tentatively  included  in  the  program  for  the  Industrial 
Hj'giene  Section  of  the  Institute  are: 

Industrial  Hygiene  and  Welfare  Work  of  the  New  York  Telephone  and  Telegraph 

Company. 
Industrial  Hygiene  Work  of  the  New  York  City  Health  Department. 
Industrial  Hygiene  Work  of  the  American  Telephone  and  Telegraph  Company. 
National  Industrial  Conference  Board  Exhibit  of  Charts  and  Discussion  of  Cost  of 

Industrial  Welfare. 
Industrial  Welfare  Work  of  the  Metropolitan  Life  Insurance  Company. 
Industrial  Hygiene  Work  of  the  New  York  City  Health  Department. 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


Volume  III 


DECEMBKR.  liHl 


Number  8 


THE   PROBLEM    OF   HEART   DISEASE   IX  THE 
INDI'STRLVL  \VORKER  * 

PAUL  D.  WHITE,  M.D. 
Boston,  Mass. 

HEART  disease  and  industry  are  not  disease  overshadows  all  the  rest  of  his  let- 

ineonipatible.   An  individual  may  be  ter.   He  is  a  champion  of  their  cause. 
productive    even     while    })edriddcii     with  There  are  two  prohlcTus  of  heart  disease 

heart  trouble  a  large  part  of  the  time.    The  in   industry:  first,   that  of  tin-  individual 

active  trained  mind  of  a  cardiac  cripple  worker;  and  second,  that  of  1h<' attitude  of 

may  be  more  valuable  in  industrial  prog-  indu.stry  in  general.    My  subject  is  con- 


ress  than  a  body  in  perfect  health  con- 
trolled by  a  dull  intellect.  In  general,  we 
have  been  inclined  to  shelter  too  much 
our  yoiuig  patients  with  heart  disea.se. 
They  can  usually  do  more  than  we  have 
permitted.  An  example  of  the  interest  ex- 
pressed in  their  own  future  as  a  group  is  a 
letter  which  I  received  recently  from  a 
young  man  -20  years  of  age  who  has  been  ease  is  a  ijroblem  in  him.self.  The  solution 
crippled  since  childhood  by  rheumatic  of  each  problem  depends  on  the  answers  to 
heart  disease,  and  for  that  reason  unable  to     two  short  (|ue.stions:   How  much  work  can 


ccrncd  particidarly  with  the  j)roblem  of  the 
individual,  but  in  closing  I  shall  di.scuss 
briefly  the  general  relation  of  industry  to 

heart  disease. 

'VnV.   IXDIVIDl'.VL   WOKKEU 

Everv  industrial  worker  with  heart  dis- 


obtain  all  the  education  which  he  desired, 
and  who  is  now  facing  the  need  of  support- 
ing himself  without  the  best  training  for  a 
clerical  job.  He  is  unable  to  do  hard  phys- 
ical work   and   cannot  obtain  even   light 


the  individual  do?  What  is  his  future?  If 
we  can  puzzle  out  the  answers  to  these 
([uestions,  we  can  solve  the  problem  of 
heart  disease  in  the  individual  indu.strial 
worker.    The  first  question  is  a  relatively 


work  because  of  the  stigma  of  his  heart  easy  one  —  to  be  ascertained  at  once  by 
disease.  His  plea  for  the  future  of  the  ((uestioning  the  subject,  by  suitable  tests, 
whole  group  of  j'oung  people  with  heart     or  Ity  observing  the  subject  while  at  work. 

The  question  would  be  better  put  as  fol- 


*  Read  before  tlie  Health  Service  Section  at  the  Tenth  _        •    •  j 

Annual  Meeting  of  the  National  Safety  Council,  Boston,       loWS:    HoW  mUch  WOrk  Can  the  individual 
Mass.,  Sept.  29,  1921.    Received  for  publication  Oct.  17 
1921. 

219 


do  without  discomfort?  —  for  sometimes  a 


220 


THE  JOITRNAL  OF  INDUSTRIAL  HYGIENE 


person  will  force  himself  to  do  work  often 
very  distressing  and  even  injurious  to  him- 
self. 

The  other  question  at  times  is  a  very 
difficult  one  to  answer  for  the  future  of  the 
individual  depends  on  a  number  of  factors. 
In  the  first  place,  a  correct  diagnosis  is  of 
prime  importance,  and  yet  is  very  often 
neglected.  Symptoms  of  heart  disturb- 
ance, such  as  paljiitation  (that  is,  the 
disagreeable  sensation  of  the  heart  beat), 
pain  in  the  region  of  the  heart,  and  short- 
ness of  breath,  do  not  by  any  means  al- 
ways signify  heart  disease.  Nor  do  fainting 
attacks  or  weakness  indicate  heart  disease. 
Nor  do  murmurs  or  rapid  heart  action 
mean  a  diseased  heart.  And  yet  I  have 
often  seen  patients  diagnosed  by  them- 
selves, by  their  relatives  or  friends,  or,  not 
infrequently,  even  by  their  physicians  as 
having  heart  disease,  when  to  all  methods 
of  examination  their  hearts  appear  normal. 
This  has  been  true  in  60  out  of  250  cases 
which  I  have  seen  in  consultation  (24  per 
cent.)  in  the  last  two  years.  To  be  sure, 
some  of  these  people  are  incapacitated  by 
their  symptoms  even  though  their  hearts 
are  normal;  the  nervous  system  or  thyroid 
gland  may  be  at  fault.  Though  it  may  be 
impossible  for  such  individuals  to  carry  on 
ordinary  work,  the  heart  should  not  be 
blamed  and  treated,  and  cardiac  statistics 
padded  by  these  thousands  of  cases.  The 
very  first  step  in  our  problem,  therefore,  is 
to  make  a  proper  diagnosis.  This  having 
been  made  in  its  entirety,  the  rest,  even  the 
forecast  of  the  future,  is  not  difficult.  The 
other  important  point  in  answering  the 
question  as  to  the  future  of  a  given  case  is 
the  study  of  the  individual's  reaction  to 
medical  treatment  or  to  a  definite  te-st  of 
work  over  a  given  interval  of  time.  An 
hour,  a  day,  or  a  week  may  suffice  to  answer 
this. 

Diagnosis.  —  Let  me  now  take  up  these 
two  steps  —  diagnosis  and  reaction  to 
work  —  in  more  detail,  since  thev  are  so 


vital  in  judging  a  case.  Recently,  diagnosis 
in  heart  disease  has  been  put  upon  a 
sound  basis,  and  I  shall  discuss  briefly  the 
system  as  it  is  now  in  use  in  the  Heart 
Clinic  at  the  ]Massachusetts  General  Hos- 
pital and,  in  somewhat  similar  form,  in 
some  other  hospitals  and  cities.  Because  it 
is  not  widely  used  and  because  it  has 
proved  so  useful,  I  wish  to  emphasize  it  in 
its  value  in  the  industrial  health  problem. 

In  former  times,  and  not  so  far  back 
either,  as  any  one  who  received  his  medical 
diploma  ten  years  or  more  ago  will  testify, 
heart  disease  consisted  of  mitral  regurgita- 
tion and  other  such  valve  damage.  A  little 
was  said  about  enlargement,  myocarditis, 
and  pericarditis.  Disturbances  of  rhythm 
were  beginning  to  be  recognized  in  a  hazy 
way,  very  shortly  to  flash  up  and  take  the 
lead  for  a  while,  with  such  diagnoses  as 
heart  ])lock  and  auricular  fibrillation  (abso- 
lute arrhythmia)  sufficing  as  diagnoses  of 
heart  trouble.  At  this  same  time  Mac- 
kenzie's teaching  of  myocardial  capacity 
was  filtering  in  hei'e  and  there,  taught  in  a 
very  disjointed  way,  unconnected  with 
structiu'al  or  etiological  condition.  Now, 
more  than  e\'er  before,  we  see  the  tremen- 
dous importance  of  the  cause  of  heart  dis- 
ease as  a  vital  part  of  our  estimate  of  the 
heart's  condition  and  particularly  of  its 
future.  Finally,  at  the  present  moment  the 
best  diagnosis  we  can  make  comprises  all 
three  factors  —  the  cause  of  the  trouble  (or 
etiology),  the  degree  of  anatomical  dam- 
age, and  the  extent  of  functional  imi)air- 
nicnt.  I'nless  all  these  three  ])oints  are 
studied  and  stated,  I  consider  the  diagnosis 
of  a  case  of  heart  di.sease  inade({uate.  By 
using  this  method  .not  only  do  we  have  a 
clear  jjicture  of  the  individual  at  the  pres- 
ent time  but  also  a  very  solid  foundation 
for  a  pr()])lu'cy  as  to  his  future. 

Eac'h  diagnosis  should  include,  then,  all 
available  information  as  to  etiology,  struc- 
ture and  function.  If  the  cause  of  the 
heart  disease  is  unknown,  it  should  be  so 


^^^^ITE  — HEART  disease  in  industrial  workers 


221 


stated.  Such  a  declaration  of  our  ignorance 
will  stimulate  us  to  study  the  individual 
further  and  to  search  more  deeply  into  the 
causes  of  heart  diseases  in  general. 

The  most  common  causes  of  heart  dis- 
ease are  arteriosclerosis  and  rheumatic 
fever  with  its  allied  infections,  such  as 
chorea  and  tonsillitis.  Syphilis  and  thyroid 
disease  are  other  inijjortant  causes.  It  is  of 
much  value  in  estimating  the  future  of  a 
person  willi  heart  disease  to  know  what 
caused  tiic  disease.  For  <'xami)le,  given 
three  hearts  willi  organic  defects  of  equal 
degree,  the  future  is  as  a  rule  much  hrighter 
if  the  cause  is  rheumatic  fever  than  if  it  is 
arteriosclerosis  or  sy])liilis.  Until  recently 
syphilitic  heart  disease  carrie<l  with  it  an 
esj)ecially  had  outlook  iiuh-ed,  it  was 
often  only  a  question  of  a  few  more  months 
of  life.  Now,  under  better  treatment,  the 
future  is  not  quite  so  dark. 

The  next  stej)  in  diagnosis  is  the  ilcter- 
mination  of  llu-  actual  degrct-  of  anatomical 
change  so  far  as  possible  —  the  size  of  llir 
heart,  tlu-  \-al\'e  changes,  the  involvement 
of  the  pcric-ardium  and  the  presence  of  dis- 
ease in  the  aorta.  Careful  ])hysical  ex- 
amination, supplemented  if  necessary  by 
X-ray  and  electr()cardiograi)luc  studi<'s, 
will  give  a  fairly  good  answer  to  this  part  of 
the  problem. 

And  then  finally  we  come  to  a  very  vital 
part  of  the  diagnosis  —  the  functional  con- 
dition of  the  heart.  Are  there  actual  signs 
of  heart  failure,  such  as  swelling  of  the 
feet,  or  is  there  severe  heart  pain  or  short- 
ness of  breath  in  the  i)resence  of  a  dam- 
aged heart.'  If  so,  there  is  heart  failure  — 
that  is,  decrease  in  cardiac  capacity  far  be- 
low what  it  should  be.  We  speak  of  the 
type  of  failure  with  the  shortness  of 
breath  and  edema  as  the  congestive,  and  the 
type  of  failure  with  heart  pain  as  the 
anginal.  Both  are  significant  of  serious 
heart  damage  and  weakness.  Of  course, 
there  may  be  much  heart  disease  without 
failure,  but  sooner  or  later  in  such  hearts 


failure  is  apt  to  appear.  All  gradations  of 
functional  limitation  of  the  heart's  cai)ac- 
ity  exist,  and  following  more  or  less  one  of 
the  classifications  of  the  New  York  Asso- 
ciation of  Cardiac  Clinics  we  may  speak  of 
five  grou|)s  of  individuals  with  heart  dis- 
ea.se  as  follows: 

1.  Those  at)lo  to  carry  on  tlieir  lial)itual  activi- 
ties (williout  syinptonis  of  distress); 

2.  Tliose  alitc  to  carry  on  sliijlilly  curlailccl  ac- 
tivities; 

.'5.  Tliose  al)te  to  carry  on  moilcrately  decreased 
activities; 

4.  Tliose  al)lc  to  carry  on  only  f;'"''atly  di- 
niinislicd  activity: 

.>.  Tliose  luiable  to  carry  on  any  of  their  habitual 
activities. 

i'iiuill.N .  under  tlic  lieading  of  functional 
(liagnt)sis  are  to  l)e  included  the  disturb- 
ances of  rhythm,  rate  and  i)ressnre,  such  as 
heart  block,  auricular  fibrillation,  hyper- 
tension and  pulsus  alternans. 

A  few  exami)les  will  suffice  to  show  the 
usefulness  of  this  scheme  of  diagnoses. 
I'jike  first  a  man  35  years  of  age  who  has  a 
crijipled  heart  following  tonsillitis  and 
rheumatic  iVver  twelve  years  liefore.  His 
heart  condition  has  been  diagnosed  as  a 
leaky  \alve.  After  he  has  been  carefully 
exauiiiu'd  the  following  diagnosis  is  made: 
"Rheumatic  heart  disease  with  aortic 
regurgitation  and  .slight  mitral  involve- 
ment, cardiac  enlargement,  with  normal 
rhythm  and  able  to  carry  on  habitual  ac- 
tivities without  symptoms."  Now  such  a 
young  man,  although  he  has  a  loud  nuu- 
nnn-,  may  be  able  to  live  an  active,  usefid 
life  of  many  years;  only  late  in  life  may 
symptoms  of  heart  failure  appear.  The 
fact  that  rheumatic  fever  was  the  cause  of 
his  disease,  the  fact  that  his  aortic  valve  is 
involved  with  little  danuige  to  his  mitral 
valve  (mitral  stenosis  would  be  more 
serious),  the  fact  that  he  has  a  regular 
ptilse,  and,  finally,  the  fact  that  he  has  no 
.symptoms  of  heart  failure  make  such  a 
yoimg  man  a  good  risk  for  the  future.  The 
only  things  which  we  must  do  with  regard 


222 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


to  him  are  to  be  sure  that  his  tonsils  are 
removed  if  they  are  in  the  least  diseased  or 
if  there  is  the  slightest  doubt  as  to  their 
condition,  and  to  avoid  so  far  as  possible 
further  rheumatic  infections  (as  a  matter  of 
fact  best  done  by  the  tonsillectomy  itself). 
There  are  many  young  people  with  heart 
trouble  who  are  now  being  condemned  as 
invalids  and  useless  because  they  happen 
to  have  loud  mm-murs,  about  whom  one 
may  be  as  optimistic  as  I  have  indicated 
above. 

Take  another  man,  42  years  of  age,  who 
is  beginning  to  have  heart  pain  on  exer- 
tion. He  boasts,  perhaps,  that  he  never 
was  sick  m  his  life,  but  on  careful  ques- 
tioning he  admits  that  he  had  a  venereal 
sore  fifteen  years  before.  On  examination 
one  finds  his  heart  enlarged,  with  a  slight 
but  definite  degree  of  aortic  regurgitation, 
and  a  positive  Wassermann  reaction.  His 
case  is  diagnosed  as,  "Sjqihilitic  heart  dis- 
ease with  aortitis,  aortic  i-egurgitation, 
cardiac  enlargement  and  normal  rhythm, 
able  to  carry  on  slightly  limited  activity." 
In  spite  of  the  fact  that  he  may  appear  to 
be  a  robust  man  and  may  have  only  a  slight 
aortic  murmur,  his  future  is  very  serious 
at  the  present  stage  of  our  medical  knowl- 
edge. This  is  all  due  to  the  fact  that  syphilis 
is  the  cause  in  this  instance,  and  not  rheu- 
matism. Once  upon  a  time  both  of  these 
men,  the  one  of  35  and  the  one  of  42,  would 
have  been  classed  simply  as  cardiacs  with 
aortic  regurgitation,  the  younger  man  with 
more  marked  valve  damage  than  the  older. 

Finally,  let  us  suppose  another  man,  one 
27  years  of  age,  with  shortness  of  breath 
and  palpitation  on  moderate  exertion  and 
occasionally  when  excited.  His  symptoms 
are  worse  than  those  present  in  either  of  the 
two  cases  already  cited.  He  gives  a  past 
history  of  the  usual  children's  diseases 
without  rheumatic  fever  or  chorea.  He  has 
always  been  high-strung  as  his  father  was 
before  him.  His  father  is  alive  and  well  at 
the  age  of  64  years.    The  patient  broke 


down  at  the  front  during  the  war  after  a 
long  bombardment  of  his  trench  by  the 
enemy.  He  was  said  at  the  time  to  have 
"disordered  action  of  the  heart,"  and  has 
been  more  or  less  incapacitated  since. 
People  are  afraid  to  give  him  work  because 
of  his  symptoms  and  history;  yet  he  is  well 
educated  and  bright.  His  diagnosis  is, 
"Nervous  heart  with  no  evidence  of  heart 
disease."  He  has  a  rapid  heart  beat  at 
times  of  examination,  and  under  strain  is 
unable  to  carry  on  his  ordinar;^-  activities  as 
well  as  normallJ^  Now  such  a  man  may  be 
very  valuable  in  industry.  He  is  apt  to  be 
very  quick  to  learn  some  delicate  or  intri- 
cate work  and  may  accomplish  much  more 
in  the  end  than  his  husky,  stolid  comrade 
who  can  do  a  hard  day's  work  with  the  pick 
and  shovel  but  who  rarely  has  an  idea  pass 
through  his  brain.  Let  us  remember  this 
large  group  of  keen,  nervous  individuals 
who  cannot  stand  a  hard  strain  but  who 
are  able  none  the  less  to  accomplish  a 
great  deal.  Such  young  men  and  women, 
in  spite  of  their'  symptoms,  will  un- 
doubtedly outlive  the  men  with  syphilitic 
and  rheiunatic  heart  disease.  Our  chief 
concern  in  such  cases  is  to  protect  the  sen- 
sitive nervous  system.  The  heart  is  sound 
enough. 

These  three  examples  are,  I  believe, 
enough  to  show  the  great  importance  of 
establishing  a  correct  and  complete  di- 
agnosis in  each  employee  with  heart  dis- 
ease. Sometimes  a  case  is  baffling,  but  if 
so,  let  us  confess  it  and  closely  follow  the 
individual  until  we  can  arrive  at  the  correct 
conclusion,  if  it  be  possible. 

Functional  Tests.  —  After  the  diagnosis 
has  been  determined,  the  other  essential 
point  in  the  ))roper  estimation  of  a  person's 
capacity  and  future  is  the  actual  test. 
Many  articles  have  been  written  about 
testing  the  heart's  function  and  some  facts 
of  value  can  be  extracted  from  them.  We 
must  realize,  however,  that  in  a  given  case 
it  is  not  the  cardiac  function  that  we  meas- 


WHITE  —  HEART  DISEASE  IN  INDI'STRIAL  WORKERS 


223 


ure  with  all  our  tests  but  the  physical  fit- 
ness of  the  individual  as  a  whole.  His 
nervous  system  plaj's  a  part  in  his  response 
to  the  tests  as  well  as  his  heart  and  other 
muscles.  The  reaction  of  the  pulse  rate, 
blood  pressure,  respiratory  rate  and  gen- 
eral condition  to  measured  exercise,  such 
as  stair  climbing,  hopping  on  one  foot, 
running  a  given  distance  and  .swinging 
dumb-bells,  has  been  studied  and  all  these 
exercises  have  Iheir  advocates.  Dr.  May 
Wilson  (1)  of  New  ^Ork  has  been  attempting 
to  find  the  "ecpiivalent  of  ordinary  exer- 
tion" by  standard  tests  —  particularly 
dumb-l)ell  swinging.  Two  iron  dunili-ljells 
swung  from  the  door  (o  full  stretch  of  arms 
overhead  and  back  again  between  the  legs 
at  a  constant  rate  of  two  seconds  for  each 
swing  were  used  in  testing  children  from  (> 
to  15  years  of  age.  The  weight  of  the  tlumb- 
bells  varied  from  3  to  20  pountls,  and  tiie 
nmnl)er  of  swings  from  ten  to  thirty.  Thus, 
in  lu-r  ciassilicatioii,  niiki  exercise  for  the 
children  of  from  6  to  8  years  consisted  in 
swinging  two  IJ-pound  dumb-bells  ten 
times,  while  .stremious  exerci.se  for  chil- 
dren of  from  12  to  15  years  consistcil  in 
swinging  two  10-pound  dumb-bells  tliirl\- 
times.  Now  by  carrying  this  or  some 
similar  test  a  stej)  furtiicr  we  may  roughly 
correlate  it  to  industry.  If  the  measure- 
ment of  physical  action  in  a  certain  occu- 
pation can  be  figured  in  foot-ixiunds  or 
kilogram-meters  per  unit  of  time,  we  nuiy 
be  able  to  arrive  at  some  sort  of  estimate  of 
the  cardiac  al)ility.  alwai/s  iiichidcd  in  the 
general  fiiiiciis  of  the  individual,  by  the  test 
of  a  like  amount  of  work  in  a  unit  of  time 
in  dumb-bell  lifting. 

Papers  by  Barringer  (2)  (3),  Rapport 
(4),  and  ^lanu  (5)  have  in  the  last  few 
years  taken  up  the  question  of  the  signif- 
icance of  blood  pressure  and  pulse  rate 
changes  in  man  after  exercise  tests,  par- 
ticularly   the    dumb-bell    te.st.*      C'onclu- 

*  Lifting  a  23-pound  bar  over  the  head  is  a  useful  varia- 
tion of  the  dumb-bell  test. 


sions  to  be  drawn  from  their  work  are  that 
the  pulse  rate  changes  following  exercise 
are  unreliable  as  evidence  of  circulatory 
condition,  but  that  the  systolic  l)lood  ])res- 
sure  curve  is  of  some  value  in  juilging 
limitations  of  physical  capacity,  not  of 
cardiac  cajnicity.  Rapport,  in  working 
with  Ix'wis,  showed  that  "as  an  immediate 
se(|uence  of  accomjilished  exercise,  whether 
that  e.xercise  is  moderate  in  degree,  or 
whether  it  calls  forth  a  full  effort  on  the 
l)art  of  the  person  who  performs  it,  there 
is  a  rise  of  systolic  blood  pressure."  In 
criticizing  Barringer 's  reliance  on  a  de- 
layed ri.se  as  indication  of  limitation  of 
cardiac  capacity.  Rapport  quite  rightly 
says : 

To  speak  of  tlie  rise  ("delaywl  rise")  itself  as  an 
iiidi'x  of  a  chanjif  in  liio  circulatory  reaction  is,  in  the 
liglit  of  our  experiences,  unsound;  to  spealv  of  a  delay 
in  tlie  full  development  of  the  rise  ["delayed  sum- 
mit") with  .severe  effort,  is  usually  to  speak  cor- 
rectly. .  .  .  The  work  done  l)y  the  heart  in  the 
intact  and  sentient  animal  at  rest  has  never  been 
accurately  computed;  still  less  has  the  capacity  of  the 
heart  for  work  in  circumstance  of  overload.  It  has 
become  fashionable,  nevertheless,  to  express  the 
capacity  of  the  heart  for  work  in  terms  of  measure, 
terms  which  do  not  measure  that  capacity,  but  some- 
thing which  is  quite  different.  ...  A  curve  of 
systolic  blooil  pressure  during  or  following  exercise 
ma.v  be  an  exact  expression  of  real  events;  l)ul  these 
events  are  blood  pressure  events  ami  the  measure  is 
of  blood  pressure  and  not  of  cardiac  work  [or  cardiac 
cai)acity]. 

Nevertheless,  it  is  true  that  as  the  degree 
of  exercise  done  ajijiroaches  the  limit  of  an 
individual's  physical  capacity,  whether  he 
be  normal  or  affected  with  heart  disease,  the 
rise  in  blood  pressure  following  the  test 
shows  a  more  and  more  delayed  summit. 
With  the  extreme  in  delayed  sununit  in  a 
given  person  go  symptoms  of  distress  — 
dyspnea  and  exhaustion.  Right  here  it 
should  be  said  that  a  healthy  person  un- 
trained may  show  this  sign  and  these 
symptoms  with  considerably  less  exercise 
than  a  person  with  heart  disease  who  shows 


224 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


no  failure  and  who  has  excellent  reserve 
power. 

Two  examples  of  the  systolic  blood  pres- 
sure exercise  test  will  make  clear  some  of 
the  points  just  mentioned.  The  man  35 
years  of  age  (and  150  pounds  in  weight) 
with  rheumatic  heart  disease  and  aortic 
regurgitation,  whom  we  have  already  cited, 
is  examined  at  rest  for  fifteen  minutes 
before  the  exercise.  His  blood  pressure,  at 
first  130  mm.  Hg.  systolic,  becomes  on  the 
second  measurement '  120  mm.,  and  is 
thereafter  fixed  at  120  mm.  His  pulse  rate 
before  the  exercise  is  steady  at  76.  He  is 
then  put  through  the  test  consisting  of 
swinging  two  lO-j^ound  dumb-bells  thirty 
times  from  the  floor  above  the  head  at  the 
rate  of  one  swing  every  two  seconds.  He 
shows  slight  breathlessness  and  weariness 
at  the  end  of  the  exercise;  his  pulse  rate  is 
108  and  his  systolic  blood  pressure  140  mm. 
Hg.  thirty  seconds  after  the  exercise  is 
stopped.  (Tenseconds  after  the  exercise  the 
systolic  pressure  is  130  mm.)  One  minute 
after  the  exercise  the  blood  ])ressure  tie- 
comes  135  nun.,  and  the  pulse  rate  90;  and 
at  the  end  of  two  minutes  the  pressure  is 
125  mm.  and  the  pulse  rate  70.  This  is 
quite  a  normal  reaction. 

For  the  second  case  let  us  take  the  man 
42  years  of  age  with  the  syphilitic  heart 
disease  and  aortic  regurgitation,  whom  we 
have  also  cited.  He  is  put  through  exactly 
the  same  exercise  as  the  previous  man  but 
com]>lains  of  considerable  precordial  pain 
and  is  very  breathless  at  the  end  of  the 
exercise.  His  systolic  pressure  has  gone  up 
from  his  normal  pressure  of  130  mm.  to 
145  mm.  at  the  end  of  one-half  minute,  to 
160  mm.  at  the  end  of  one  minute,  and 
stays  at  that  j)oint  after  one  and  one-half 
minutes.  At  two  minutes  the  jjressure  is 
150  mm.,  and  at  three  minutes  140  mm. 
His  pulse  rate,  at  first  80,  becomes  imme- 
diately after  the  exercise  160,  at  the  end  of 
one  minute  140,  and  at  the  end  of  two 
minutes  100.    It  is  ol)vious  that  the  test 


more  than  taxed  the  strength  of  this  man. 
The  delayed  summit  of  the  systolic  blood 
pressure  is  here  well  marked. 

"Certain  factors  enter  into  such  exercise 
tests,  however,  that  render  them  imper- 
fect. In  the  first  place,  muscles  may  be  in 
use  quite  different  from  those  exercised  in 
the  particular  occujjation;  secondly,  there 
is  an  added  strain  due  to  nervous  excite- 
ment at  the  time  of  the  test;  and,  thirdly, 
the  test  lasts  but  a  few  minutes  at  the  most, 
while  the  job  in  question  lasts  several  hours 
every  day.  Thus,  only  a  very  rough  esti- 
mate of  individual  ])]iysical  and  cardiac 
al>ility  can  be  made  from  such  tests.  Stair- 
climljing,  running  and  hopping  are  all  open 
to  the  same  objections. 

There  are  no  short  cuts  to  determining 
the  heart's  jiower  that  I  know  of  wliich  are 
of  universal  value.  Respiratory  tests  have 
been  suggested,  such  as  the  length  of  time 
the  breath  can  be  held,  the  height  to  which 
a  mercury  column  can  be  blown,  the  length 
of  time  the  mercury  column  can  be  main- 
tained at  a  certain  height,  and  the  vital 
capacity.  As  in  the  case  of  the  exercise 
tests,  if  these  are  normal  the  individual's 
heart  cannot  be  in  a  very  bad  condition. 
The  vital  capacity  test,  which  is  the  meas- 
urement of  the  amount  of  air  that  can  be 
expired  after  a  full  inspiration,  and  the  test 
of  holding  the  l)reath  are  useful  measures  of 
the  degree  of  heart  failure  present.  Vital  ca- 
pacity and  the  power  of  liolding  the  breath 
are  also  reduced  in  marked  psychoneurosis 
(6).  Similarly  in  these  conditions  the  car- 
bon dioxide  rel)reathing  test  shows  a 
capacity  below  normal.  But  the  only  sure 
way  to  determine  whether  a  man  with 
heart  di.sease  can  stand  a  certain  job  is 
actually  to  try  iiim  out  al  it.  No  two  jobs 
are  exactly  alike  and  no  two  individuals 
have  exactly  the  same  kind  or  degree  of 
heart  disease.  A  few  minutes,  a  few  hours, 
or  a  few  days  at  the  most  will  answer  our 
question.  Having  by  observation,  exam- 
ination and  some  simjile  test  roughly  deter- 


WHITE  — HEART  DISEASE  IN  INDUSTRIAL  WORKERS 


O'-lr 


mined  the  fitness  of  the  individual,  the 
exact  measurement  of  his  strength,  cardiac 
and  general,  in  relation  to  a  certain  joh 
must  come  from  the  job  ilself.  We  must 
remember,  moreover,  that  it  is  possible  to 
train  a  man  for  a  job  ])hysically  as  well  as 
mentally  though  he  appear  incapable  at 
the  first  trial.  'I'here  arc  occupations  for  all 
kinds  of  cardiac  crip])les.  A  man  unable  lo 
climb  a  flight  of  stairs  without  shortness  of 
breath  is  obviously  unfit  to  work  as  a 
freight  handler,  but  he  nuiy  ])ro\-c  very 
useful  in  keeping  the  office  files.  A  conci.se 
folder  has  been  published  recently  by  the 
Association  for  the  Prevention  and  Relief  of 
Heart  Disease  (7)  giving  lists  of  occupa- 
tions-both  skilled  and  unskilled — ^gen- 
erally suitable  for  peo])le  with  heart  disease. 
This  folder  can.  I  believe,  be  obtained  on 
request  from  the  office  of  the  Association  at 
.'5^25  East  .57th  Street,  New  ^'ork  City. 

General  Relation  of  Heart 
Disease  to  Industry 

Ha\iug  (iuishe<l  this  brief  discussion  of 
the  problem  of  heart  di.sease  in  the  individ- 
ual worker,  I  should  like  to  conchule  with  a 
few  remarks  on  the  problem  of  the  relation 
of  heart  disease  to  industry  in  general.  In 
the  first  i)lace  there  is  not,  so  far  as  I  know, 
any  industrial  heart  di.sea.se.  There  is,  of 
course,  effort  syndrome,  but  for  that  indus- 
try is  not  to  blame.  The  relation  of  intlus- 
try  to  the  production  of  arteriosclerosis  is 
still  a  (piestion  to  be  solved.  Arterioscle- 
rosis is  a  very  iini)orlaiit  cause  of  heart  dis- 
ease as  I  have  saitl,  and  if  years  of  hard 
work  produce  arteriosclerosis,  then  indus- 
try may  be  accu.sed  of  causing  heart  disease. 
The  factors  of  the  individual's  su-scejiti- 
bility  to  arteriosclerosis,  of  the  exciting 
effect  of  hard  physical  or  mental  work,  and 
of  the  time  element  of  hours  of  work  ])er 
day  or  week  must  eventually  be  studied  and 
weighed  before  we  can  point  out  how  indus- 
try may  be  relieved  of  the  possible  blame  of 
inducing  arterio-sclerosis. 


In  helping  to  eradicate  heart  disease,  in- 
dustry should  insist  on  the  jiroper  physical 
examination  of  the  worker.  If  the  tonsils 
are  di.sea.sed,  their  early  removal  may  i)re- 
vent  rheumatic  heart  di.sease  or  i)rcvent 
the  increase  of  such  disease  if  already  ])res- 
ent.  It  is  very  worth  while  to  try  to  eradi- 
cate rheumatic  fever  for  it  is  one  of  tlu- 
serious  .scourges  of  the  youth  of  the  land. 
If  there  is  a  history  of  .syphilis,  or  if  the 
^^'ass«"rmann  reaction  is  i)Ositivc,  projjcr  in- 
tensive treatment  may  prevent  .sy])hilitic 
heart  disease.  Projier  education  and  cam- 
paigning against  \-encreaI  disease  (including 
the  adoption  of  ]iroi)li\laxis  if  necessary) 
will  also  help,  for  syphilitic  hc.irt  disease, 
as  I  have  already  said,  is  a  very  serious 
matter.  Early  recognition  and  treatment 
of  thyroid  disea.se  may  avert  thyroid  heart 
complications.  Avoidance  of  long-sus- 
tained excessive  i)hysical  or  mental  «'fforl , 
and  the  insistence  on  regular  jjcriods  of 
relaxation  should  reduce  the  degree  of 
])reseuiic  arteriosclerosis. 

l'eoi)le  shouUl,  on  the  averag<',  live  far 
longer  than  they  do,  though  the  .'5(K)  years 
of  age  advocated  by  the  Barnabas  Brothers 
in  Shaw's  Back  to  Meihusduh  is  a  bit  too 
great  a  jumi)  from  our  modest  three  score 
and  ten  to  accompli.sh  at  the  moment.  To 
increase  the  average  life,  infectious  disease 
nnist  be  eradicated,  cancer  overcome,  and 
accidents  and  the  strain  of  work  reducetl. 
There  is,  in  general,  too  high  a  tension  in 
American  life,  both  in  work  and  in  i)lay. 
We  do  not  sit  long  enough  at  the  breakfa.st 
table  or  over  the  teacups  —  we  might  do 
well  here  to  take  a  leaf  from  the  leisurely 
ways  of  the  European.  An  engine  run  at 
high  speed  all  the  time  wears  out  too 
((uickly.  The  human  machine,  too,  is 
liable  to  break  down  eventually  with  ac- 
cident to  the  heart  or  l)rain. 

Not  only  may  indu.stry  do  its  share  in  the 
prevention  of  heart  disease  but  it  may  also 
do  its  part  in  the  prevention  of  heart  failure 
in  the  individual  worker  who  has  heart  dis- 


226 


THE  JOUENAL  OF  INDUSTRIAL  HYGIENE 


ease.  The  tremendous  improvement  in  the 
care  of  the  health  of  workers  carried  out  by 
industrial  concerns  all  over  the  country 
makes  it  possible  to  check  up  frequently  the 
physical  condition  of  the  worker  with  heart 
disease.  By  examinations  given  weekly  or 
monthly  or  at  intervals  as  circumstances 
demand,  the  earliest  symptoms  or  signs  of 
failure  may  be  detected  and  proper  recom- 
mendations as  to  treatment  given.  Rest  in 
bed  for  a  day  or  two  at  such  a  time  may 
save  the  individual  weeks  of  illness  and  loss 
of  income  later.  It  may  prove  to  be  very 
valuable  insurance.  Some  of  the  cardiac 
clinics  in  New  York  meet  on  Friday  even- 
ings so  that  their  patients  may  be  advised 
to  stay  in  bed  for  the  week-end  if  necessary, 
with  little  or  no  loss  of  time  from  their  work. 
A  word  should  be  added  concerning  the 


need  of  special  vocational  training  of 
young  people  with  heart  disease  so  that 
they  may  be  able  to  support  themselves 
comfortably  later  in  life  in  occupations 
which  will  not  involve  physical  or  mental 
strain.  Special  classes  have  already  been 
instituted  in  connection  with  the  public 
school  system  of  New  York  City  with  this 
aim  in  view. 

Finally,  let  me  repeat  that  heart  disease 
and  valuable  product  i\-e  ability  may  co- 
exist in  the  same  individual.  We  must 
know  the  kind  and  degree  of  the  heart 
damage.  Knowing  this,  we  should  be  able 
properly  to  place  the  worker  by  using  our 
common  sense,  by  tests  for  a  rough  esti- 
mate of  the  physical  capacity  of  the 
individual,  and,  finally,  by  the  actual  test 
of  the  work  itself. 


BIBLIOGR.\PHY 


1.  WUson,  M.  G.:  The  Equivalent  of  Ordinary 
Exertion.  Jour.  .4m.  Med.  Assn.,  1921,  76,  1213. 

2.  Barringcr,  T.  B.,  Jr.,  and  Tesclmer,  J.:  The 
Treatment  of  Cardiac  Insufficiency  by  a  New 
Method  of  Exercise  with  Dumb-Bells  and  Bars. 
The  Circulatory  Reaction  to  Exercise  as  a  Test 
of  the  Heart's  Functional  Capacity.  Arch.  Int. 
Med.,  1915,  16,  795. 

3.  Barringer,  T.  B.,  Jr.:  The  Circulatory  Reaction 
to  Graduated  Work  as  a  Test  of  the  Heart's 
Functional  Capacity.  Arch.  Int.  Med.,  191C, 
17,  3(JS;  Studies  of  the  Heart's  Functional  Ca- 
pacity as  Estimated  by  the  Circulatory  Re- 
action to  Graduated  Work.    Ibid.,  070. 


i.  Rapport,  D.  L.:  The  Systolic  Blood  Pressure 
Following  Exercise;  with  Remarks  on  Cardiac 
Capacity.  Arch.  Int.  Med.,  1917,  19,  981. 

5.  Mann,  H.:  Circulatory  Reactions  to  E.xercise 
during  Convalescence  from  Infectious  Disease. 
Arch.  Int.  Med.,  1918,  21,  682. 

6.  White,  P.  D.:  Obser\ations  on  Some  Tests  of 
Physical  Fitness.  Am.  Jour.  Med.  Sc,  1920, 
169,  866. 

7.  Occupations  for  Cardiacs.  Association  for  the 
Prevention  and  the  Relief  of  Heart  Disease, 
New  York. 


CARDIAC  DISEASE  AND  ITS  RELATION  TO 
INDUSTRIAL  EFFICIENCY  * 

CAREY  F.  COOMBS.  M.D.,  F.R.C.P.  Lond. 

Cotifulling  Physician  for  Diseases  of  the  Heart,  Ministry  of  Pensiorts  (S.  W.  Rfgion) 

{FromJhe  Department  of  Medicine,  University  of  Bristol) 


AT  a  time  when  we  are  taking  stock  of 
±\_  our  resources  and  looking  for  means  of 
increasing  the  national  output  by  reducing 
our  losses  from  disease,  it  behooves  us  to 
study  not  only  the  mortality  records  but 
also  such  figures  as  are  availal)le  to  tell  us 
what  diseases  cripple  men  and  women  and 
lower  their  standard  of  efficiency.  The 
best  figures  to  which  we  can  turn  for  such 
information  are  those  supj^lied  by  the 
Ministry  of  National  Service  and  drawn 
from  their  recruiting  experiences.  From 
the  tables  which  they  have  published,  it 
appears  that  about  10  per  cent,  of  the  men 
rejected  as  imfit  for  military  service  were 
rejected  on  account  of  valvular  disease  of 
the  heart.  In  some  districts,  indeed,  this 
kind  of  disability  was  responsible  for  more 
rejections  than  any  other.  This  figure  is  to 
some  extent  discounted  by  the  fact  that 
cardiac  murmurs  were  too  readily  received 
as  evidence  of  valvular  disease  by  recruit- 
ing authorities,  the;  result  being  that  many 
men  who  might  have  made  efl^cient  .soldiers 
were  rejected  on  inadequate  groimds.  On 
the  other  hand,  we  have  to  recollect  that  of 
the  four  great  causes  of  organic  heart  dis- 
eases—  to  wit,  rlieumatic  infection,  .sy])h- 
ilis,  high  arterial  tension,  and  "senile" 
arteriosclerosis  —  the  first  alone  finds  a 
large  proportion  of  its  victims  among  per- 
sons of  military  age.    The  others  fall  with 

heavier  incidence  on  men  past  the  age  of 
40.  Moreover,  it  must  be  remembered  that 

rheumatic   heart   disease   attacks    women 

rather  oftener  than  men.    It  is  therefore 

*  Received  for  publication  May  2,  1921. 


clear  that  cardiac  disease  is  responsible 
for  a  very  great  wastage  of  the  nation's 
strength. 

It  is  scarcely  necessary  to  impress  upon 
the  medical  profession  the  need  for  a  more 
concerted  plan  of  attack  upon  these  dis- 
eases. Already,  in  America  at  all  events, 
there  are  signs  of  such  a  movement.  Nor 
should  we  expect  or  wish  the  profession  to 
regard  this  attack  on  disease  primarily 
from  the  commercial  standpoint.  Our 
chief  motive  for  such  an  attack  is,  and  al- 
ways ought  to  be,  the  prevention  and  relief 
of  suffering.  But  it  is  nevertheless  needful 
to  impress  upon  tho.se  wiio  must  find  the 
money  essential  to  such  a  campaign,  that 
the  .study  of  disea.se  and  its  cau.ses  will  pay 
its  own  way,  not  at  once,  of  cour.se,  but  as 
the  years  and  decades  go  by,  with  unfailing 
certainty. 

What,  then,  is  to  be  our  plan  of  cam- 
paign? Let  us  first  review  the  objectives, 
and  then  pass  to  a  brief  consideration  of 
strategy.  In  any  attack  upon  disease  the 
first  objective  must  always  be  out-and-out 
prevention.  Where  prevention  is  not  pos- 
sible, we  must  fall  back  upon  plans  for  the 
arrest  of  disea.se.  Finally,  in  cases  of  severe 
and  established  disease,  we  must  have  plans 
for  treatment,  and  these  must  include 
economic  treatment. 

First,  how  is  cardiac  disease  to  be  pre- 
vented.' There*  is  no  disease  that  needs 
more  time  and  energy  devoted  to  the  study 
of  its  causes  than  does  cardiac  disease. 
Even  if  the  belief,  which  I  share,  in  the 
streptococcal  origin  of  rheumatic  Reart  dis- 


227 


228 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ease  be  accepted,  we  are  still  far  from 
knowing  much  about  the  influence  of  such 
matters  as  climate,  soil,  density  of  popula- 
tion, and  so  forth,  on  its  initiation.  Thanks 
to  a  grant  from  the  University  of  Bristol 
Colston  Research  Society,  and  to  the  help 
of  Dr.  D.  S.  Davies  and  his  clerk,  Mr.  W. 
N.  Brown,  I  have  been  able  to  make  an 
investigation  into  the  incidence  of  rheu- 
matic heart  disease',  based  on  the  mortality 
records  of  Bristol.  The  results  of  this  re- 
search have  already  been  published,*  and 
I  am  looking  forward  to  an  extended  in- 
quiry into  the  same  matter  on  a  basis  of 
data  more  reliable  than  those  furnished  by 
death  certificates.  Even  in  cardiac  sy])h- 
ilis,  where  so  much  is  known  as  to  the  excit- 
ing cause,  how  little  is  known  as  to  tho.se 
factors  which  predispose  to  the  incidence 
of  the  infection  on  the  heart  rather  than  on 
some  other  organ!  And  when  we  turn  to 
those  forms  of  cardiac  disease  which  are 
related  to  high  arterial  tension  or  arterial 
degeneration,  or  both,  it  mu.st  be  confessed 
that  our  study  of  their  causation  is  little 
better  than  a  mass  of  conjectures. 

I  do  not  believe  that  we  can  get  far  in 
these  researches  into  the  factors  predispos- 
ing to  disease  without  enlisting  the  help  of 
every  medical  practitioner.  Before  this  can 
be  done,  however,  medical  men  must  be 
trained  to  think  etiologically  in  the  matter 
of  heart  disease.  If  we  consult  any  of  our 
textbooks  of  medicine,  we  find  that  the 
pages  devoted  to  cardiac  disease  are  divided 
into  paragrajjhs  on  "mitral  regurgitation," 
"heart  block,"  and  so  forth  —  titles  which 
describe  sym])toms,  not  diseases.  Not  until 
they  are  replaced  by  such  headings  as  "car- 
diac rheumatism,"  "cardiac  syi)hilis,"  and 
so  forth,  shall  we  gel  students  and  practi- 
tioners to  think  of  cardiac  disea.se  as 
something  with  a  tangible  beginning,  a 
plant  which  ought  not  merely  to  be  nipped 

*  Coombs,  C.  F.:  Tlie  Incidence  of  Katal  Hlieuinatic 
Heart  Disease  in  KristuI,  1876-1913.  Lancet,  l!)-.'(l, 
2,  240. 


in  the  bud,  but  actually  to  be  prevented 
from  getting  any  place  whatever  in  the 
ground. 

This  kind  of  description  of  cardiac  dis- 
ease can  on\y  be  built  up  on  a  systematic 
study  of  the  whole  subject.  What  is  wanted 
is  exhaustive  examination  of  a  large  num- 
ber of  cases  of  cardiac  disease,  with  careful 
records  of  the  features  of  each,  and  classifi- 
cation into  such  etiological  groups  as  I  have 
already  indicated.  For  example,  we  ought 
not  to  be  content  with  recording  such  cases 
of  cardiac  syphilis  as  manifest  evidences  of 
heart  block;  every  case  of  the  disease  ought 
to  be  studied  with  the  electrocardiograph, 
and  the  presence  or  absence  of  block  in  its 
various  grades  noted.  When  all  such  in- 
formation has  l>een  duly  collected,  it  will 
be  possible  to  write  a  connected  account  of 
each  of  the  forms  of  cardiac  disease,  classi- 
fied under  headings  which  bear  reference  to 
causation.  Then  the  medical  profession  will 
be  armed  with  the  information  essential  to 
a  study  of  factors  i)redisposing  to  cardiac 
disease,  and  we  shall  be  able  to  get  on  with 
our  task  of  finding  out  what  those  causes 
are.  As  I  have  already  said,  this  can  only 
be  carried  out  by  the  general  co-operation 
of  the  whole  profession,  and  some  better 
plan  nuist  be  devised  than  the  present  one, 
by  which  family  doctor,  laboratory  worker, 
and  medical  officer  of  health  work  sepa- 
rately from  each  other. 

As  to  the  second  line  of  objective  — — 
arrest  of  disease  in  an  early  stage  —  there 
is  little  enough  to  be  said,  with  one  excep- 
tion, and  that  relates  to  rlieumatic  heart 
disease  in  its  childhood  stage.  The  course 
of  this  disease  is  one  of  progress,  not  sus- 
tained or  interrupted,  but  marked  by  a 
series  of  active  ])hases,  each  lasting  a  few 
days  or  several  weeks.  In  a  certain  ])er- 
centage  of  cases  the  child  is  killed  by  the 
first  of  these  phases.  In  a  very  few  there  is 
but  one  such  pha.se,  from  which  the  child 
recovers,  without  further  recurrence.  In 
most  cases  the  active  phase  of  the  disease 


COOMBS  —  CARDIAC  DISEASE  AND  INDUSTRIAL  EFFICIENCY     2^29 


recurs  from  time  to  time,  each  attack  leav- 
ing the  heart  more  damaged  than  before,  so 
that  the  patient,  if  fortunate  enough  to 
survive  into  adolescence  or  adult  life,  finds 
himself  handicaii]>od  at  the  outset  of  his 
wage-earning  career  hy  a  crippled  heart. 
Only  too  often  his  education  has  been  so 
interrupted  by  the  active  phases,  which 
keep  him  away  from  school,  that  he  is  fit 
for  nothing  but  general  labor.  Ill  e(|ui]iped 
in  mind,  and  dangerously  crippled  in  liody. 
he  has  little  chance  of  doing  any  useful 
work.  It  would  be  well  worth  while  to 
make  some  i)rovision  for  his  education  to  be 
carried  on  quietly  during  his  jjeriods  of  ill- 
ness or.  at  all  events,  of  convalescence  - 
such  jirovision  as  is  being  furnished  in  the 
analogous  case  of  (lie  iul)er(ulous  cripple. 
There  is  no  reason  wli\-  the  same  building 
that  hou.ses  the  latter,  ])ro\iding  both 
treatment  and  education,  should  not  be 
used  for  the  rheuuiallc  child  nNo.  Indeed.  I 
belie\-e  thai  this  is  actually  done  at  the 
Liverpool  Country  Hospital  for  children. 
The  number  of  beds  needed  in  each  large 
city  would  not  be  great;  one  nu'glil  begin 
with  a  dozen  in  Bristol,  for  exani|)le. 

Arrest  of  other  forms  of  cardiac  disease 
in  an  early  stage  does  not  at  present  seem 
practicable,  though  it  is  jjossible  that  c'loser 
study  of  cardiac  .syphilis  might  disct)ver  evi- 
dences earlier  than  those  at  jiresent  known 
to  us.  Unfortunately,  this  and  the  arterial 
types  of  cardiac  disea.se  attack  the  patient 
when  he  has  alread\-  reachcil  or  ])asse(l  the 
watershed  of  life,  so  thai  his  chance  of  ef- 
fecting successful  repair  is  small. 

The  third  line  of  objective  —  better 
treatment  of  established  di-sease  —  comes 
within  the  scope  of  this  article  only  in  its 
relation  to  the  patient's  capacity  for 
work.  One  of  the  lessons  of  the  war  has 
been  that  many  people  with  severe  cardiac 
lesions  can  nevertheless  do  a  surprising 
amoiuit  of  work  with  impunity.  Unfor- 
tunately, however,  it  is  difficult  for  such 
people  to  compete  in  the  open  labor  mar- 


ket with  those  whose  hearts  are  .sound. 
Employers  are  surprisingly  considerate  in 
such  cases,  but  it  is  impossible,  under  the 
industrial  conditions  of  the  moment,  to 
arrange  for  the  interrupted  work  of  these 
cripjiles  in  workshops  and  factories  that  are 
geared  to  run  continuously  at  a  high  rate  of 
efficiency'.  On  the  other  hand,  during  the 
periods  which  many  of  them  spend  in  the 
iiospital.  under  observation,  they  have 
nothing  to  do.  and  this  dctes  no  good  to 
their  morali'.  They  would  be  belter  in 
e\ery  way  if  they  had  some  kind  of  occupa- 
tion. Workshops,  similar  to  those  i^rovided 
for  cri])])led  ex-service  men,  ought  to  be 
attached  to  the  hospitals  .so  that  these  jia- 
tients  nu'glit  be  given  an  op])ortunity  of 
combining  productive  work  with  institu- 
tional trealmeiit. 

In  order  to  bring  into  being  lln-.se  pro- 
posals, little  or  no  expenditure  on  building 
would  be  needful.  .\.ll  that  is  recjuired  in 
each  large  city,  in  each  unixcrsily  city  at 
all  events,  is  that  there  slu)ukl  lie  such  a 
rearrangement  of  the  existing  resources  as 
to  ])ro\ide  the  team  of  practitioners  spe- 
cially interested  in  cardiac  disease  with  a 
consultative  out-patient  dei)arlinent,  hos- 
pital beds  for  the  treatment  of  severe  cases, 
and  ])reniises  for  the  housing  and  treatment 
over  long  periods  of  such  cases  as  I  have 
alluded  to  in  the  two  preceding  paragraphs. 
The  team  must  also  have  at  its  disposal 
such  electrocardiographic  and  other  appa- 
ratus as  is  neetlful  for  tiie  I'areful  and 
systematic  study  of  cardiac  disease.  By 
t  his  means  knowledge  will  be  gained  which 
will  be  imparted  to  the  students  —  the 
practitioners  of  the  immediate  future. 
Last  but  not  least,  this  central  organization 
must  be  in  touch  with  the  practitioners  of 
the  area.  This  will  confer  benefit  in  both 
directions  —  on  the  cardiac  specialists, 
who  would  gain  the  breadth  of  view  and 
sense  of  proportion  that  close  attention  to 
one  branch  of  medicine  is  apt  to  impair; 
and    on    the    general    practitioners,    who 


230  THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

would  assimilate  and  apply  each  new  dis-  but  also  to  effect  such  an  economy  of  man- 

covery  as  it  was  made.  power  as   amply  to  repay  the  moderate 

As  an  outcome  of  such  co-operation  it  outlay    necessary   for   the   initiation    and 

should  be  possible  not  only  to  diminish  ap-  maintenance    of    the    organizations    pro- 

preciably  the  sum  total  of  human  suffering,  posed  in  this  article. 


CHRONIC  MANGANESE  POISONING:   TWO  CASES* 

GEORGE  G.  DAVIS,  M.D. 
Chicago,  Illinois 

AND 

WALTER  B.  HUEY,  M.D. 
Jctifi,  lUinois 


IT  is  the  purpose  of  this  paper  to  call  at- 
tention to  two  cases  of  manganese  poi- 
soning occurring  in  steel  workers  who  were 
engaged  in  handling  manganese  in  the 
Bessemer  process  of  making  steel. 

Manganese  poisoning,  though  a  com- 
paratively rare  finding,  presents  a  symptom 
complex,  definite  and  constant  enough  to 
be  readilj'  diagnosed,  and  should  be  sus- 
pected in  workers  handling  manganese. 
This  metal  is  used  in  the  chlorine  industry 
and  to  aid  in  liberating  chlorine  gas,  in  tlie 
liberation  of  oxygen,  in  dyeing,  coloring 
glass,  charging  galvanic  cells,  in  making 
lacquer,  varnish  and  oil  paints,  enamel 
and  linoleum,  and  in  marl)ling  soap.  ]\Ian- 
ganese  poisoning  is  also  noted  in  workers  in 
industries  dealing  with  other  metals  or 
their  ores,  in  which  manganese  exists  as  an 
impurity,  and  it  was  under  such  conditions 
that  Casamajor  (1)  met  his  cases.  Man- 
ganese is  used  extensively  as  an  alloy  with 
nickel  and  steel. 

The  nmnber  of  cases  of  manganese  poi- 
soning is  not  large  nor  is  there  an  extensive 
literature  on  the  subject.  Coujjer  ("2),  in 
1837,  described  characteristic  symptoms  in 
workmen  in  a  chemical  factory  where  man- 
ganese dioxide  was  ground  in  the  manu- 
facture of  chlorine  for  bleaching  powder. 
In  1901  (October  7),  R.  von  Jaksch  (3) 
described  similar  sjTiiptoms  in  three  work- 
men employed  as  grinders  of  manganese 
dioxide,  but  diagnosed  the  findings  as 
atypical  cases  of  multiple  sclerosis.  H. 
Embden  (4),  in  an  article  also  published  in 
1901  (October  15),  described  characteristic 
*  Received  for  publication  Sept.  19,  1921. 


sjTnptoms  in  men  employed  in  grinding 
manganese  dioxide,  and  correctly  di- 
agnosed chronic  manganese  poisoning.  In 
1903  and  1904,  rbspectively,  Friedel  (5)  and 
SeifTer  (6)  rejjorted  cases  which  presented 
characteristic  s\nnptoms.  Several  years 
later  von  Jaksch  (7)  (8)  and  Seelert  (9) 
sununed  up  the  fifteen  cases  of  manganese 
poisoning  in  Europe  described  in  the  above- 
mentioned  articles,  and  in  1913,  Casa- 
major reported  nine  cases  occurring  in  this 
country.  In  1919,  Edsall,  Will)ur  and 
Drinker  (10)  summarized  the  literature  to 
date  and  reported  the  details  upon  three  of 
tiie  tliirty  cases  wiiicli  they  examined. 

Etiology 

The  chief  etiological  factor  by  means  of 
which  manganese  enters  the  system  is  un- 
doubtedly coarse  dust,  though  in  the 
writers'  cases  fumes  must  have  played  a 
role.  It  has  been  pointed  out  by  Oliver  and 
others  that  most  of  our  industrial  poison- 
ings are  taken  in  the  form  of  du.st,  and  not 
so  much  the  dust  which  is  inhaled  as  that 
which  is  swallowed  in  the  saliva.  In  his  re- 
ports, von  Jaksch  stated  that  no  new  cases 
developed  when  the  dust  was  abolished. 
Embden  likewise  ascribed  his  cases  to 
manganese  dioxide  dust,  as  did  also  Casa- 
major and  Edsall,  Wilbur,  and  Drinker. 

In  order  to  supplement  these  clinical 
findings  by  analytical  data,  Reiraan  and 
Minot  (11)  made  a  study  of  the  absorption 
and  elimination  of  manganese  ingested  as 
oxides  and  silicates,  in  which  they  came  to 
the  following  conclusions : 


231 


23^2 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Ores  containing  manganese  as  oxides  and  silicates 
are  soluble  in  gastric  juice.  Manganese  is  absorbed 
in  the  blood  stream  causing  in  most  cases  a  slight 
temporary  rise  in  manganese  concentration  fol- 
lowed by  a  quick  return  to  normal.  In  none  of  the 
cases  studied  was  the  manganese  content  of  the 
blood  increased  by  the  ingestion  of  manganese  ores 
to  a  value  more  than  double  the  normal  level,  and  in 
some  of  the  subjects  no  increase  was  noted.  We  sug- 
gest that  individuals  of  the  first  group  would  prob- 
ably be  more  susceptible  to  manganese  poisoning 
than  those  of  the  latter. 

Even  prolonged  feeding  of  large  amoimts  of 
manganese  ore  to  dogs  failed  to  produce  significant 
changes  in  manganese  content, of  blood  and  tissues 
or  to  cause  any  pathological  symptoms.  Manganese 
ores  are  thus  very  non-toxic  and  in  order  to  produce 
symptoms  of  poisoning  must  be  ingested  by  individ- 
uals who  are  jieculiarly  susceptible.  Clinical  expe- 
rience [10]  has  demonstrated  that  such  persons  are 
extremeh'  rare. 


Symptoms 

Edsall,  AVilbur  and  Drinker  (10).  who 
have  made  a  careful  review  of  the  subject 
of  manganese  poisoning  and  have  reported 
cases  of  their  own,  summarize  the  symp- 
tomatology thus: 

As  we  have  seen  chronic  manganese  poisoning  the 
following  findings  make  the  syndrome.  We  have 
numljered  them  in  the  most  common  order  of  ap- 
pearance. It  is  ilifficult  to  emphasize  in  any  written 
description  the  clearness  with  which  the  symptoms 
come  out  and  the  ease  with  which  the  diagnosis  can 
be  made. 

1.  A  historx'  of  work  in  manganese  dust  for  at 
least  three  months. 

2.  I>anguor  and  sleepiness. 

3.  Stolid,  mask-like  facies. 

4.  Low  monotonous  voice.     Economical  speech. 

5.  Mu.scular  twitching,  varying  in  degree  from 
a  fine  tremor  of  the  hands  to  gross  rhythmical  move- 
ments of  the  arms,  legs,  trunk  and  iiead. 

6.  Cramps  in  the  calves  and  a  complaint  of 
stiffness  in  the  muscles  of  the  legs,  the  cram[)s  usually 
coming  on  at  night  and  becoming  worse  after  a  day 
of  exertion. 

7.  Slight  increa.se  in  tendon  reflexes. 

8.  .\nkle  and  patellar  clonus.  Frequently  by 
Stretching  any  of  the  muscles  of  the  body  it  is  pos- 


sible  to   elicit   rhythmical   contractions.     Romberg 
sign  is  inconstant;  there  is  no  incoordination. 
9.    Retropulsion  and  propulsion. 

10.  A  peculiar  slapping  gait.  The  patient  keeps 
as  broad  a  base  as  possible,  endea^•oring  involun- 
tarily to  avoid  propulsion.  The  shoes  are  worn 
evenly  and  we  have  not  been  able  to  convince  our- 
selves of  the  pronounced  tendency  to  walk  on  the 
region  of  the  raetatarso-phalangeal  joints,  a  feature 
strongly  emphasized  l>y  von  .laksch  [7]. 

11.  Occasionally,  uncontrollable  laughter;  less 
frequently,  crying. 

12.  Uniformly  absent  are  any  disturbances  of 
deep  or  superficial  sensation,  eye  changes,  rectal, 
genito-urinary  or  gastro-intestinal  disturbances,  re- 
actions of  degeneration,  blood,  urine,  and  .spinal 
fluid  alterations.  It  is  significant  that,  unlike  lead, 
manganese  produces  no  life-shortening  degenera- 
tions. Seriously  poisoned  men  are  long-lived  cripples. 
The  metal  apparently  makes  a  very  definite  attack 
upon  some  non-vital  portion  of  the  neuromuscular 
system,  destroys  it  thoroughly,  if  time  for  action  is 
permitted,  and  leaves  the  victim  ciuite  well  in  every 
other  respect. 

We  have  never  seen  either  the  salivation  or  edema 
described  in  foreign  cases. 

Pathology 

The  pathology  of  this  condition  is  not 
clear.  Yon  Jaksch  reported  that  he  never 
foinid  any  pathological  lesions  postmor- 
tem, but  he  does  not  state  the  details  of  his 
investigation.  Casamajor  had  an  autopsy 
in  but  one  of  his  cases.  He  reported  the 
appearance  of  degeneration  in  the  longitu- 
dinal fibres  of  the  pons  in  isolated  bundles 
lying  mostly  close  to  the  raphe.  This  degen- 
eration was  seen  only  in  the  pons.  He  was 
luiable  to  reproduce  it  in  rabbits  or  dogs. 

Furtlier  autopsy  studies  of  these  cases 
would  be  desirable,  but  as  the  patients  do 
not  die  of  manganese  poisoning  per  se,  and 
as  cases  of  the  poisoning  are  comparatively 
rare,  little  is  known  of  the  pathology. 

Tre.\tmen"t 

Prophylaxis  is  the  only  hope  in  the  treat- 
ment of  chronic  manganese  poisoning.  In- 
asmuch as  dust  was  the  means  t)v  which 


DAVIS  AND  HlTiY  — CHROXK'  MAX(;AXESE  POISOMXC. 


iS^ 


poisoning  occurred  in  the  writers'  cases,  it 
is  clear  that,  in  order  to  remove  all  possibil- 
ity of  poisoning,  dust  must  l)e  eliminated 
from  processes  in  which  workers  handle 
manganese.  If  this  cannot  he  afconi])lished, 
the  process  should  be  rearranged  or  discon- 
tinued, as  it  was  in  the  plant  in  cpiestion. 

General  eliminative  measures  by  means 
of  the  kidneys,  skin  and  intestines,  etc.,  are 
indicated,  but  little  is  to  be  looked  for  in 
the  way  of  im])rovenient  luider  such  treat- 
ment. 

Prognosis 

In  ])atients  manifesting  niiiior  s\nip- 
toms,  recovery-  may  take  |)la(H'.  If,  how- 
ever, the  patient  has  progressed  to  more 
advanced  stages,  the  disca.se  may  be  ar- 
rested, but  a  cure  will  not  be  forthcoming. 
'I'lie  disease  is  not  fatal,  an<l  the  condition 
of  the  i)alient  continues  for  months  or 
years  without  change. 

Report  of  C.vses 

The  writers'  two  cases  occurred  in  work- 
men who  were  occupied  in  the  ])rocess  of 
nuiking  manganese  steel.  A  few  words  con- 
cerning the  process  may  elucidate  the  en- 
vironment in  which  they  worked. 

In  the  Bessemer  process  for  making  steel, 
molten  iron  from  the  blast  furnaces  is  car- 
ried in  large  ladles  to  the  converters,  which 
are  retorts  sha])ed  like  an  egg  with  a  i)or- 
tion  of  the  small  end  cut  off.  These  con- 
verters are  i)ivoted  near  the  center  and  are 
so  made  that  there  are  openings  in  the 
lower  end  from  which  heated  gases  may  be 
blown  through  the  molten  iron,  for  the 
purpose  of  oxidizing  a  part  of  the  carbon 
which  is  in  solution  in  the  molten  iron. 
When  this  carbon  is  oxidized  to  a  certain 
point,  the  resulting  mixture  is  known  as 
steel. 

The  molten  iron  from  the  blast  furnace  is 
poured  directly  into  the  opening  in  the  top 
of  the  converter,  after  which  the  blast  is 


turned  on  and  the  gases  are  forced  through 
the  molten  iron.  When  the  oxidation  has 
progressed  sufficiently,  the  blast  is  shut  off 
and  the  converter  is  tilted  so  that  the  mol- 
ten steel,  which  remains,  runs  from  the 
opening  in  the  top  into  a  large  ladle  which 
is  suitably  placed  to  receive  the  steel  as  it 
pours  from  the  converter.  From  lliis  ladle 
the  steel  is  withdrawn  into  moulds,  and, 
after  cooling,  forms  what  is  known  as  an 
ingot.  The  ingot  is  then  made  into  the 
various  shai)es  desired. 

In  the  ])rocess  of  making  manganese 
steel,  manganese  is  added  to  the  steel  in  a 
definite  proportion  and  it  immediately  dif- 
fuses through  the  mass  of  steel.  When  the 
manganese  is  fused  in  the  electric  furnace, 
a  definite  amount  of  molten  numganese  is 
adilcd  to  the  steel  and  there  results  a  prod- 
uct. I  lie  composition  of  which  is  uniform. 
Previous  to  the  use  of  the  electric  furnace 
the  .solid  manganese  was  addcil  lo  I  lie 
molten  iron  as  it  canu'  from  the  bla.st  fur- 
nace, and  in  the  oxidation  process  a  portion 
of  the  manganese  was  al.so  oxidized,  so  that 
the  resulting  composition  of  the  steel  was 
not  so  definite  nor  so  uniform. 

In  the  operation  of  the  electric  furnace 
there  are  three  large  carbon  electrodes,  and 
the  electric  arc  between  these  electrodes 
generates  the  heat  which  causes  the  fusion 
of  the  manganese.  The  electric  furnace  in 
use  at  the  i)lant  in  (|Ucstion.  when  the  two 
cases  of  manganese  poisoning  occurred,  was 
a  large  steel  chamber  lined  with  firebrick 
and  provided  with  two  openings  —  one  a 
sliding  door  (Figure  1«)  through  which  the 
solid  chunks  of  manganese  were  shoveled 
into  the  interior,  the  other  a  snudl  opening 
connected  with  a  spout  (Figure  lb)  from 
which  the  molten  manganese  was  poured 
into  a  small  ladle.  The  molten  manganese  in 
this  small  ladle  was  poured  into  the  molten 
steel  which  had  just  been  poured  from 
the  converter  into  the  large  ladle.  When  the 
sliding  door  was  open  for  recharging  the 
furnace,  the  heat  within  the  furnace  was 


234 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


so  intense  that  a  considerable  quantity  of 
brown  manganese  fumes  from  the  furnace 
escaped  from  the  door  into  the  surrounding 
atmosphere  and  entered  the  mouth,  throat, 
and  knigs  of  any  person  who  was  in  the 
vicinity.     Mr.    S.,    superintendent   of   the 


Fig.  1.  —  Electric  furnace  which  was  located  in  a  room 
about  25  feet  square. 

(a)  Charging  door,  into  whicli  the  manganese  was 
shoveled.  At  each  charge  the  floor  was  open  long  enough  to 
allow  150  poiuids  to  be  shoveled  in  —  about  fifteen  seconds 
—  and  dujing  this  time  the  fumes  escaped  freely. 

(6)  Spout  from  which  liquiil  manganese  was  poured  and 
from  which  fumes  escaped  in  large  (luantities. 


Bessemer  department,  stated  that  there 
was  the  same  taste  to  iW  smoke  that  he  had 
experienced  when  manganese  had  pre- 
viously been  ground  and  the  dust  had  en- 
tered his  mouth,  and  he  believed  that  there 
was  a  considerable  amount  of  manganese 
in  the  smoke  whicli  escaped.  At  his  sugges- 
tion, therefori',  tlie  fumes  from  the  electric 


furnace  were  analyzed,  and  were  found  to 
contain  a  high  percentage  of  manganese, 
as  did  also  the  dust  on  the  ledges  in  the 
same  room.    (See  Table  1.) 

TABLE  1.  —  ANALYSIS  OF  COARSE  DUST  AND 
FUMES  FROM  ELECTRIC  FURNACE 


Substance 

Analysis  of  Coarse 

Dust  from  Electric 

Furnace 

Analysis  of  Fumes 

from  Electric 

Furnace 

Si02 

% 
17.14 

17.18 
9.46 
6.36 

38.16 
1.40 
5.28 

0.13 

23.38 

Si 

8.87 

19.30 

Fe203    

2.26 

AI2O3 

Mn 

6^54 
18.72 

CaO 

4.56 

MgO 

15.80 

Phosphorus  \ 

As / 

Such  was  the  environment  in  which  were 
employed  the  two  workmen  whose  his- 
tories are  given  below. 

Case  1.  History.  —  N.  V.,  an  Italian,  25  years 
old,  was  examined  first  on  Feb.  1,  1916,  and 
subsequently  at  various  times  during  the  early 
months  of  that  year.  He  gave  the  history  of  always 
being  well  and  ne\er  having  liad  any  accidents  or  in- 
juries or  bad  habits.  He  did  not  drink  or  smoke.  He 
had  been  in  this  country  ten  years.  He  liad  been 
married  four  years;  liis  wife  had  been  previously 
married  but  had  never  had  any  children.  He  began 
working  for  the  Steel  Company  on  Sept.  25,  1912,  as 
a  laborer,  and  continued  as  a  laborer  until  Feb.  16, 
1914,  when  he  was  transferred  to  work  as  a  charger 
at  the  electric  furnace  where  ferro-manganese  w^as 
fused  before  it  was  added  to  the  converter  to  make 
manganese  steel.  He  continued  in  this  work  until 
the  time  of  examination  when  his  foreman  found  it 
necessary  to  change  his  employment  on  account  of 
increasing  mental  dullness. 

Conversation  with  the  patient  and  his  wife  brought 
out  the  facts  that  early  in  October,  1915  he  began 
to  be  sleepy  and  indifferent,  and  that  during  Christ- 
mas week  he  took  no  interest  in  the  festivities,  which 
he  ha<l  greatly  enjoyed  in  previous  years.  Shortly 
after  Christmas  his  wife  noticed  that  he  was  often 
tremulous,  especially  at  the  table,  that  this  condi- 
tion persisted  during  sleep,  and  that  he  was  rather 
disposed  to  stagger  on  his  feet  as  though  he  were 


DAMS  AND  HUEY  —  CHRONIC  MANG.\NESE  POISONING 


235 


<irunk.  Moreover,  about  the  same  time  he  would 
walk  backwards  and  occasionally  would  fall  back- 
wards. Two  or  three  times  in  succession,  while  try- 
ing to  put  up  some  window  shades,  he  lost  his  bal- 
ance, finally  falling  backwards  to  the  floor. 

Sometimes  his  wife  noticed  that  his  face  was  very 
red,  and  she  said  that  it  looked  different  —  meaning 
that  his  expression  was  different.  She  also  noticed 
that  he  would  laugh  frequently  without  any  appar- 
ent cause,  contrary  to  his  former  way  of  doing. 
Sometimes  he  would  laugli  at  whatever  was  said  to 
him.  She  noticed,  too,  that  he  had  difficulty  in 
coughing  and  that  he  did  not  seem  to  be  able  to 
cough  up  the  accumulations  in  his  throat. 

The  patient  complained  of  weakness  in  his  hands 
and  legs  since  Christmas  of  191.5,  and  noticc<l  that 
when  going  downstairs  his  legs  trembknl  and  he  felt 
insecure.  He  always  staggered  backwards  when  he 
lost  his  l)alance.  He  made  no  comjjlaint  of  loss  of 
sphincter  control  or  of  sexual  ilisabilily. 

His  wife  said  tliat  his  iiieinory  was  all  riglit.  She 
notice<l  that  his  neck  gradually  became  larger  and 
that,  although  formerly  he  had  worn  a  size  15  collar 
with  comfort,  a  number  10  now  seemeil  rather  tiuht 
for  him.  He  did  not  coniplaiii  of  headache,  ami  his 
appetite  remained  gotxl  and  his  liowels  were  regular. 
She  stated  that  at  times  his  speech  was  normal  but 
that  often  it  was  necessary  to  ask  a  question  several 
times  and  even  to  speak  sliarply  before  an  answer 
was  obtained.  She  also  notice<l  that  in  friendly 
scuffles  she  was  stronger  than  her  husband,  whereas 
formerly  the  reverse  was  true.  His  disposition,  she 
said,  was  becoming  ugly  and  he  had  attacks  of  vio- 
lent temiier  wliich  were  (piite  short  in  duration.  In 
one  of  these  fits  of  anger  he  threw  a  piece  of  soap  at 
her,  striking  her  side  and  bruising  it.  Innnediately 
after  tliis  he  .showed  that  he  was  sorry  that  he  had 
hurt  her. 

Examination  of  Paiieni.  —  The  i)alient  was  a  very 
strong  muscled,  thick-set  Italian.  His  face  was  ex- 
pressionless and  mask-like.  (Figure  i.)  Over  the 
nose  and  each  cheek,  somewhat  in  the  common  dis- 
tribution of  hipus,  there  was  distinct  erythema, 
which  whitened  to  finger  pressure,  and  on  the  left 
cheek  there  was  some  scaliness.  He  closed  his  e.ves, 
moved  all  his  facial  mu.scles,  protruded  his  tongue  in 
the  middle  line,  and  the  tongue  was  not  tremulous. 
He  held  his  lips  firmly  under  expiratory  effort.  He 
gave  a  short  whistle  but  no  longer  whistled  con- 
tinuously as  he  had  been  in  the  habit  of  doing.  He 
had  difficulty,  apparently,  in  taking  a  deep  insjjira- 
tion;  repeated  efforts  failed  of  the  desired  result,  and 
dm-ing  the  examination  he  seemed  to  be  disturbed  at 
times  with  an  accumulation  of  mucus  in  his  throat. 
Finger  to  nose  test  was  accurate  but  irregularly 


tremulous.  The  patient  stood  well  with  his  eyes 
closed,  but  not  so  well  on  his  left  foot  as  on  his  right. 
He  walked  in  a  rather  uncertain  fashion,  though  not 
in  a  definitely  atypical  way.  Reflexes  were  normal 
throughout. 

The  patient  signed  his  name  and  wrote  his  street 
number  with  comparative  readiness,  but  his  writing 


T1 


Fio.  2.  — (Case  1.)    Showing  the   cliar.irtcrislic  expres- 
sionless and  mask-like  facies. 


was  cramped  and  his  wife  said  that  it  was  different 
from  what  it  used  to  be.  His  arterial  pressure  was 
70-9'.J,  with  a  pulse  of  80.  His  tremor  was  not  much 
exaggerated  on  volition;  he  poured  water  from  one 
test  tube  to  another  fairly  well.  There  was  no  body 
tremor,  no  tremor  at  rest.  He  articulated  every  word 
but  not  clearly,  and  his  speech  was  muffled  and 
difficult  to  understand,  seemingly  because  of  the 
motionless  condition  of  his  lips  and  mouth  parts  in 
the  effort  of  speech.   At  times  during  the  interview 


236 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


he  did  a  little  laughing  without  its  being  apropos, 
and  at  other  times  he  laughed  at  something  that  was 
said  which  he  may  have  considered  anuising  (Figure 
3).  Voluntary  strength  and  grasp  and  resistive 
movements  at  the  elhow  and   slundder  and  in  the 


Fk;.  ;;.  —  (Case  1.)    Liiiiidtive  laughter  «as  a  proiniricnt 
symptom  in  this  case. 


lower  extremity  seemed  to  he  very  great,  in  spite  of 
his  complaints  of  weakness. 

During  the  examination  tlu'iiatient  stejiped  otV  the 
scales  hackward  and  was  unable  to  stop  imtil  he  hiul 
walked  backward  to  the  opposite  wall,  a  distance  of 
about  \i  feet.  Then  it  was  noted  that  if  he  were 
given  a  slight  push  in  a  backward  direction  he  would 
walk  back  several  steps  In^fore  reco\'ering  his  bal- 
ance. He  expressefl  no  sense  of  fear  of  falling  and 
smiled  as  he  walked  back. 

While  the  patient  was  in  the  hospital  for  observa- 


tion it  was  noted  that  he  slept  a  great  deal  during  the 
day  as  well  as  at  night.  His  pulse,  temperature  and 
respirations  were  normal. 

An  X-ray  examination  failed  to  reveal  any  pa- 
thology in  the  lungs  or  gastro-intestinal  tract.  His 
urine  was  normal.  His  feces  and  urine  were  examined 
for  traces  of  manganese,  but  none  was  found.  A 
Wassermann  test  on  the  patient's  blood  gave  a  frank 
negative  reaction.  Blood  examination  showed 
hemoglobin  85  per  cent.,  white  cells  7,250,  red  eoimt 
5,640.000.  As  a  probable  explanation  of  this  un- 
usually higli  erythrocyte  count,  it  should  be  under- 
stot>d  that  there  was  added  to  the  ferro-manganese  at 
intervals  a  certain  amount  of  limestone  and  coke, 
and  it  is  possible  that  there  was  a  sufficient  amount 
of  carbon  monoxide  given  off  from  this  coke  —  there 
being  no  air  supiily  to  the  interior  of  the  furnace  — 
to  produce  a  mild  form  of  carbon  monoxide  poisoning. 

Case  2.  History.  — S.  K.,  a  Hungarian,  aged  32, 
a  married  man,  without  children,  had  been  in  the 
employment  of  the  Steel  Company  since  Feb.  17, 
1900,  but  he  was  laifl  off  on  accomit  of  lack  of  em- 
ployment on  March  6,  1908,  and  he  returned  to  work 
on  Oct.  20,  1908.  During  this  time  he  was  employed 
as  a  runner  ni  the  converter  until  May  7,  1913,  when 
he  became  a  weigher  at  the  electric  furnace,  weigh- 
ing the  manganese  in  the  ladle  as  it  was  poured  from 
t  he  furnace.  He  was  doing  this  work  until  the  latter 
])art  of  1915,  when  he  found  that  he  was  unable  to 
continue.  On  Jan.  31,  1910,  Mr.  S.,  the  superinteud- 
eut  of  the  Bessemer  department,  stated  that  this 
man  had  for  some  time  past  been  a  very  able  and 
efficient  workman  but  that  he  had  noticed  a  gradual 
decrease  in  his  energy  and  mental  acuteness,  and 
iiad. thought  that  he  was  becoming  lazy.  Mr.  S.  said 
that  the  man  seemed  to  be  dull  mentally  and  that  his 
movements  were  sluggish,  and  that  when  asked  why 
his  work  was  so  poor  he  responded  that  he  did  not 
know,  and  .seemed  indifferent. 

This  i)atient  was  examined  first  on  Feb.  1,  1910, 
and  has  been  under  observation  at  \arious  times 
since.  When  (luestioned,  he  stated  that  he  never  had 
any  .serious  illness,  accidents,  or  dissipated  habits. 
.V  little  over  a  year  before  the  first  examination,  he 
began  to  notice  that  he  was  having  some  flifficulty  in 
walking  —  a  tendency  to  trot  forward  or  backward 
when  first  starting  off,  and  a  little  trouble  in  going 
down  hill  or  downstairs.  He  lunl  no  feelings  of 
dizziness,  however.  He  said  also  that  he  had  some 
numbness  in  his  fingers  and  his  toes,  .\bout  this 
time  his  si>eech  became  muffled  and  indistinct.  He 
became  weak,  and  had  continued  so  up  to  the  time  of 
examination. 

Examination  of  Patient.  —  At  the  time  of  the  first 
examination,  the  patient  presented  a  peculiar  facial 


DAVIS  AND  HUEY  —  CHRONIC  I\L\NGANESE  POISONING 


237 


expression,  a  mask-like  face  (Figure  4),  commonly 
witli  the  contours  and  appearance  of  a  fixed  smile 
which  showed  his  teeth.  This  was  not  invariable,  but 
was  frequently  present  and  tended  to  be  rather  per- 
sistent.   He  walked  fairly  well,  but  said  that  he  had 


Cranial  nerves  seemetl  to  be  all  normal  as  to  vol- 
untary control  and  as  far  as  reflexes  were  concerned. 
The  deep  reflexes  were  also  all  present  and  about 
normal,  certainly  not  at  all  exaggerated.  This  was 
true  of  liccl  jerks,  knee  jerks,  wrist  and  elbow  jerks. 


I'ui.  4.  —  i('a!,f  i.)  'I'liis  putieiit  prt'sijiUil  a  peculiar 
facial  expression,  niask-Uke  face,  willi  the  appearance  of  a 
slight,  continual,  fi.xed  smile. 

an  inclination  to  hurry  ahead  and  he  did,  as  a  matter 
of  fact,  walk  with  rather  short,  hastening  steps.  He 
also  indicated  that  at  times  he  ran  liackwards.  He 
said  that  he  sle|)t  well,  had  a  good  appetite,  good 
digestion,  good  bowel  action,  entire  control  of  the 
bladder,  and  a  rcasonalile  amount  of  sexual  ability. 
He  said  that  he  had  no  sensory  disturbance,  but  his 
hands  were  cold  and  cyanotic,  and  the  nutrition  of 
the  cuticle  about  the  nails  did  not  seem  to  be  good  — 
that  is,  there  was  a  suggestion  of  glossiness  about 
the  skin. 


Kii;.  5.  —  (Case  i.)  I  nmotive  laughter  was  a  prominent 
symptom  in  this  case  also. 

The  paticnt'if  writing  was  small  and  cramped  and 
attempts  to  write  a  larger  script  even  with  a  pencil 
failed.  He  wrote,  however,  with  readiness  ami  even 
with  a  fair  amount  of  speed  for  a  laboring  man.  He 
said  that  he  could  read  and  write  but  that  he  did  not 
si)end  any  time  in  reading.  His  speech  was  par- 
ticularly peculiar.  He  talked  with  lips  slightly  re- 
tracted and  motionless,  teeth  almost  together,  tongue 
ai)parentl\-  immobile,  and  his  voice  was  low  and 
monotonous,  the  enunciation  deliberate  and  ob- 
scured.   He  tenrled  to  answer  in  monosyllables,  and 


238 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


seemed  to  ha^•e  great  difficulty  in  formulating  a  sen- 
tence. When  asked  how  long  he  had  worked  on  the 
furnace,  he  undertook  to  say  that  he  had  worked  two 
years  and  eight  months,  and  after  a  long  pause  one 
could  understand  the  "two,"  and  he  drawled  "aaaa" 
for  a  long  time  until  it  seemed  that  it  would  be  im- 
possible for  him  to  enunciate  an^'thing  at  all,  and  at 
the  end  of  a  continuous  drawling  "a,"  dropped  out 
"eight  months"  rather  abruptly.  It  was  impossible 
to  understand  him  when  he  attempted  to  explain 
anything,  and  anything  besides  "yes"  and  "no" 
could  be  understood  only  with  considerable  uncer- 
tainty and  guessing,  yet  he  seemed  mentally  clear 
though  apathetic. 

No  decided  tremor  was  observable,  but  upon  hav- 
ing the  patient  extend  his  fingers  one  could  see  and 
feel  a  tremulousness  in  the  hands  and  arms,  with 
some  lack  of  co-ordinate  control  of  the  phalanges  of 
the  fingers.  He  poured  water  from  one  tube  to  an- 
other with  steadiness  and  precision.  He  made  all 
sorts  of  indicated  voluntary  movements  with  readi- 
ness. His  grasp  was  greatly  weakened  in  both  hands, 
and  his  ability  to  resist  passive  movements  com- 
municated to  his  arms,  especially  at  the  elbows  by 
the  contraction  of  the  biceps,  was  reduced.  The  leg 
muscles  also  seemed  somewhat  weakened.  The  eye 
grounds  were  normal. 

Examination  of  the  blood  showed  hemoglobin  90 
per  cent.,  leukocytes  8,000,  erythrocytes  6,400,000. 
This  unusually  high  red  cell  count  was  the  result  of 
a  mild  form  of  carbon  monoxide  poisoning,  the  ex- 
planation of  which  is  noted  in  the  preceding  case. 
A  Wassermann  examination  of  the  blood  was  nega- 


tive. A  chemical  analysis  of  the  urine  and  feces 
showed  no  trace  of  manganese.  The  urine  examina- 
tion was  otherwise  negative.  An  X-ray  examination 
of  the  lungs  showed  no  evidence  of  manganese  in- 
filtration. The  patient's  temperature,  pulse  and 
respirations  were  normal.  A  tendency  to  sleep  and 
unmotive  laughter  were  marked  symptoms  (Figure 
5). 

In  May,  1917,  it  was  noted  that  there  was  a 
marked  falling  out  of  the  patient's  hair,  and  on  the 
right  side  along  the  hair  line  above  and  behind  the 
right  ear  for.  a  length  of  5  inches,  there  was  an  area 
about  1  inch  wide  which  was  entirely  denuded  of 
hair.  The  hair  in  other  parts  of  the  scalp  was  easily 
removed  by  slight  pulling. 

The  diagnosis  of  chronic  manganese 
poisoning  in  these  two  cases  was  first  inade 
by  Dr.  Hney.  The  neurological  examina- 
tions were  later  made  by  Dr.  Archibald 
Church  who  confirmed  the  diagnosis. 

The  operation  of  the  electric  furnace, 
which  was  used  to  melt  the  manganese 
compounds,  was  discontinued  when  it  was 
established  that  these  men  were  suffering 
from  chronic  manganese  poisoning.  This 
was  done  because  no  practical  way  was 
found  to  eliminate  entirely  the  dust  and 
fumes  from  the  fiu-nace  when  it  was  in 
operation. 


BIBLIOGRAPHY 


1.  Casamajor,  L.:  .\n  Unusual  Form  of  Mineral 
Poisoning  Affecting  the  Nervous  System :  Man- 
ganese?  Jour.  Am.  Med.  Assn.,  1913,  60,  ()4(j. 

2.  Couper:  Jour,  de  chim.  med.  de  phann.  ct  de 
toxicol.,  1837,  3,  Second  Series,  '-2'-23. 

3.  Von  .Jaksch,  R. :  Ueber  gehaufte  diffuse  Er- 
krankimgen  des  Gehims  und  RUckenmarks,  an 
den  Typus  der  multiplen  Sklerose  mahnend, 
welche  durch  eine  besondere  Aetiologie  gekenn- 
zeichnel  sind.  AVien.  klin.  Rundschau,  1901, 
15,  7-29. 

4.  Embden,  H.:  Zur  Kemitnis  der  metallischen 
Nervengifte  (Uelier  die  chronische  Manganver- 
giftung  der  Braimsteinmliller).  Deutsch.  med. 
AVclmschr.,  1901,  27,  795. 

5.  Friedel:  Ztschr.  f.  Med.-Beamte,  1903,  16,  614. 

6.  Seiffer:  Manganvcrgiftimg.  Berl.  klin.  Wclin- 
schr.,  1904,  41,  371. 


7.  Von  .laksch,  R.:  Ueber  Mangantoxikosen  imd 
Mangaiio])liobie.  Miinchen.  med.  Wclmschr., 
1907,  54,  969. 

8.  Von  Jaksch,  R.:  Die  Vergiftungen.  Second 
Edition.  Wien  u.  Leipzig,  Alfred  Holder,  1910, 
p.  231. 

9.  Seelert,  H. :  Ein  Fall  chroni.scher  Manganver- 
giftung.  Monatschr.  f.  Psychiat.  u.  Neurol., 
1913,  34,  82. 

10.  Edsall,  1).  L.,  Wilbur,  F.  P.,  and  Drinker,  C.  K.: 
The  Occurrence,  Course  and  Prex'ention  of 
Chronic  Manganese  Poisoning.  Jour.  Indust. 
Hyg.,  1919-1920,  1,  183. 

11.  Reiman,  C.  K.,  and  Minot,  A.  S.:  Absorption 
and  Elimination  of  Manganese  Ingested  as 
Oxiiles  and  Silicates.  Jour.  Biol.  Chem.,  1920- 
1921,  45,  133. 


TRINITROTOLUENE  POISONING  —  ITS  NATURE,  DIAGNOSIS, 

AND  PREVENTION* 

CARL  VOEGTLIN,  CHARLES  W.  HOOPER,  and  J.  M.  JOHNSON 
From  the  Dirision  of  Pharmacology,  Hygienic  Laboratory,  C.  S.  Public  Health  Service 


iNTEODrrCTION 

WITH  the  entrance  of  the  United 
States  into  the  World  War,  the  pre- 
vention of  poisoning  among  American 
munition  workers  presented  a  public  health 
problem  of  consideraV)le  imjjortance.  Pre- 
vious experience  in  other  countries  had 
demonstrated  that  the  productiveness  of 
munition  plants  was  dependent,  to  a  large 
extent,  on  the  prevention  of  such  poisoning. 
Protection  of  the  health  of  thousands  of 
workers  engaged  in  this  industrj'  was  also  a 
matter  of  much  concern.  Our  allies.  Great 
Britain  in  particidar,  had  fortunately  given 
this  matter  serious  thought  and  consitler- 
able  scientific  work  had  been  done  with  a 
view  to  reducing  the  health  hazards  in 
munition  plants. 

The  most  important  explosives  used  for 
the  manufacture  of  shells  belong  to  the 
group  of  nit ro  derivatives  of  aroniat  ic  hydro- 
carbons, aniline  and  jjlicnol.  Among  these 
nit  ro- compounds,  trinitrotoluene  (com- 
monly called  T.X.T.,  triton,  or  trotyl)  was 
predominantly  used  in  this  country  and  in 
England  on  a  very  large  scale.  Inasmuch  as 
the  experience  with  this  explosive  in  (ireat 
Britain  had  called  attention  lo  tlu-  serious 
health  hazards  connected  with  its  manu- 
facture, and  especially  its  handling  in  the 
filling  of  high  ex])l()sive  shells,  there  aj)- 
l)eared  soon  after  the  entry  of  the  United 
States  into  the  war  several  articles  dealing 
with  this  subject. 

In  the  Public  Health  Report  of  Nov.  16, 
1917,  Surgeon  J.  \V.  Schereschewsky  (1),  of 
the  United  States  Public  Health  Service, 
gave  an  ejqpose  of  the  practical  aspects  of  the 

*  The  details  and  the  methods  used  in  this  investiga- 
tion will  be  found  in  Hygienic  Laboratory  Bulletin  No.  121). 
Received  for  publication  Sept.  i\,  19-21. 


problem  as  ascertained  by  an  inspection  of 
the  plants  where  T.X.T.  was  manufactured 
or  used  in  the  filling  of  shells.  W.  G.  Hud- 
son ("2)  (3),  medical  director  of  the  Du  Pont 
Company,  anil  Alice  Hamilton  (4),  of  the 
United  States  Dejjartment  of  Labor,  also 
contributed  pi»{3ers  dealing  with  T.N.T. 
poisoning  in  factories  in  this  country. 
H.  S.  Martland  {5}  described  the  first  fatal 
case  of  T.N.T.  poisoning  which  had  oc- 
curred in  the  United  States. 

Although  no  accurate  .stati.stics  were 
available  on  the  incidence  of  T.N.T.  ])oison- 
ing  in  this  country,  inspection  of  various 
factories  engaged  in  this  industry  had 
shown  that  the  health  of  a  considerable 
lumiber  of  workers  was  affected  by  the  con- 
stant contact  with  T.N.T.  Being  charged 
by  Congress  with  tlu'  safeguarding  of  the 
licaltii  of  the  civil  population,  it  became  the 
tluty  of  the  United  States  Public  Health 
Service  to  undertake  an  investigation  of 
the  best  ways  and  means  for  the  prevention 
of  T.X.T.  poisoning,  inasiuuch  as  it  was 
evident  that  the  available  information  was 
not  ade(iuate  enough  to  lay  down  safe  rules 
for  this  jnn-pose.  For  instance,  no  satisfac- 
tory data  were  known  as  to  the  production 
and  characteristics  of  T.N.T.  poisoning  in 
animals,  data  which  were  obviously  needed 
to  serve  as  a  firm  Ijasis  for  the  under.stand- 
ing  of  the  nature,  diagnosis,  and  prevent  ion 
of  T.X.T.  i)oisoning  in  man.  Accurate  ob- 
servations were  also  lacking  in  regard  to  the 
degree  of  contamination  of  factory  air  with 
T.X'.T.  under  various  conditions,  data 
which  are  essential  for  purposes  of  proi)er 
ventilation  of  these  plants.  For  these  rea- 
sons the  Hygienic  Laboratory  undertook  a 
co-operative  investigation,  the  Division  of 
Chemistry  concerning  itself  with   (1)   the 


239 


240 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


determination  of  the  vapor  pressure  of 
T.N.T.  at  various  temperatures  and  the 
amoimt  of  T.N.T.  present  in  the  air  of 
various  parts  of  a  shell-filling  plant,  and  (2) 
the  quantitative  determinationof  T.N.T.  or 
its  derivatives  in  the  urine.  The  Division  of 
Pharmacology  was  charged  with  the  study 
of  the  pharmacological  aspects  of  the  prob- 
lem, with  particular  reference  to  (1)  the 
elaboration  of  reliable  and  simple  tests  for 
the  diagnosis  of  mild  poisoning,  (2)  the  in- 
vestigation of  the  channels  of  absorption  to 
the  poison  by  the  animal  bo'dy,  (3)  the  dis- 
covery of  prophylactic  methods,  etc.  It 
was  in  the  nature  of  the  jirolilem  that  the 
practical  aspects  dealing  with  the  recogni- 
tion and  prevention  of  T.N.T.  poisoning 
shoidd  receive  the  major  attention,  al- 
though a  number  of  very  interesting  obser- 
vations were  made  which,  as  will  be  seen, 
have  an  important  bearing  on  the  subject  of 
blood  destruction  and  regeneration. 

The  data  included  in  this  report  deal 
with  the  work  done  by  the  Division  of 
Pharmacology.  They  are  divided  into  two 
parts,  the  first  one  dealing  with  experi- 
mental T.N.T.  poisoning  as  produced  in 
dogs,  and  the  second  with  the  investigation 
of  T.N.T.  poisoning  in  a  large  shell-filling 
plant.  The  results  obtained  by  the  Division 
of  Chemistry  will  be  published  elsewhere. 

Experimental  T.N.T.  Poisoning  in 

Aniil\ls 

As  ])reviously  stated,  the  literature  con- 
tams  little  satisfactory  information  con- 
cerning the  production  of  t\-pical  T.N.T. 
poisoning  in  animals.  White  and  Hay 
(6),  on  the  l)asis  of  a  few  experiments  on 
cats  and  ral)l)its,  considered  T.N.T.  "as 
not  poisonous  under  ordinary  use."  Moore, 
Webster,  and  A\yon  (7)  state  that  they 
were  not  successful  in  producing  toxic  symp- 
toms in  guinea-pigs  expo.sed  for  several 
weeks  to  T.N.T.  fumes  in  factories,  whereas 
.  kittens   under   similar  conditions   showed 


evidence  of  poisoning  (cyanosis).  The 
animal  work  of  these  investigators  was 
largely  confuied  to  rabbits  and  guinea-pigs, 
which  were  given  one  or  a  few  large  doses, 
ranging  from  10  to  9,000  mg.  per  kilo  body 
weight.  The  British  report,  while  contain- 
ing extremely  valuable  information,  does 
not  include  any  really  satisfactory  informa- 
tion on  T.N.T.  poisoning  in  animals.  This 
is  due  to  the  fact  that  the  species  of  animals 
selected  for  the  work  hapjjened  to  be  highly 
resistant  to  the  toxic  action  of  T.N.T.  It  is, 
of  course,  possible  to  kill  even  a  highly  re- 
sistant animal  with  massive  doses  of  the 
poison,  but  it  is  questionable  as  to  whether 
the  symptoms  and  j)athological  changes 
thus  produced  correspond  to  those  found  in 
T.N.T.  workers  who,  according  to  clinical 
observers,  must  be  exposed  to  T.N.T.  for  at 
least  four  weeks. 

During  the  jjrogress  of  our  work  a  brief 
abstract  of  the  work  of  Kramer  and  ^leier- 
hof  (8)  appeared,  in  which  these  authors 
reported  some  experiments  dealing  with 
T.N.T.  poison  in  dogs.  They  noted  the 
following  symptoms:  vomiting,  diarrhea, 
depression,  and  weakness.  Examination  of 
the  blood  revealed  the  presence  of  a  leuko- 
cytosis, polychromasia,  and  an  increase  in 
nucleated  red  blood  cells.  The  necropsy 
findings  were  negative,  with  the  exception 
of  a  moderate  degree  of  central  degenera- 
tion in  the  liver  and  an  increase  of  blood 
pigment  in  the  bone  marrow,  lym])h  nodes, 
and  spleen.  They  called  attention  to  the 
absence  of  any  lesions  which  might  explain 
the  death  of  the  animals,  particularly  the 
absence  of  acute  yellow  atrophy  of  the 
liver. 

It  was  therefore  necessary  to  find  a 
highly  susceptil)le  animal. 

General  Plan  of  Investigation 

Preliminary  experiments  with  guinea- 
pigs  and  albino  rats  confirmed  the  pre- 
viouslv   noted   statements   of   the   British 


YOEGTLIX  ~  TRINITROTOLUENE  POISONING 


241 


investigators  that  these  animals  are  highly 
resistant  to  T.N.T.  That  the  animals  ab- 
sorbed the  i^oison  was  evident  from  the 
change  in  the  color  of  the  lU'ine  and  the 
positive  Webster  test.  In  rats  the  urine 
contains  a  bright  pink  pigment  after 
T.N.T.  is  given  either  by  month  or  sub- 
cutaneou.sly.  The  first  few  experiments 
with  dogs  and  cats,  however,  showed  that 
the.se  animals  (U'vclop  tlie  typical  symp- 
toms which  are  seen  in  T.X.T  poisoning  in 
man.  Dogs  were  finally  chosen  for  this  in- 
vestigation as  these  animals  seemed  to  be 
sensitive  to  T.N.T.  and  as  they  were  of 
sufficiently  large  size  to  permit  tlie  fre<iuenl 
withdrawal  of  small  (|uaiililics  of  l)lood  for 
examinatiou. 

In  vi«'w  of  the  fact  tliat  T.X.T.  ])oi.soning 
in  munition  workers  is  essentially  of  a 
chronic  nature  recpiiring  .several  weeks  or 
even  months  for  its  full  de\('lo])iiient.  it  was 
desirable  to  produce  an  analogous  condition 
in  dogs  by  the  rejjeated  administration  of 
relatively  small  do.ses  of  T.N.T.  over  a  long 
period  of  time.  A  small  numlx-r  of  experi- 
ments dealt  with  a  study  of  acute  poison- 
ing. For  this  jjurpose  a  single  large  dose 
(100  mg.  p«'r  kilo)  of  the  i)oison  was  given. 
For  the  ])roduclion  of  ciu'onic  poisoning 
the  doses  ranged  from  5  to  33  mg.  ])er  kilo 
body  weight  given  every  day  except  on 
Sundays  and  Iiolidays.  The  T.X.T.  used  in 
this  iiut'stigalioii  was  ol)taine(l  from  va- 
rious shell-filling  plants  and  represented  a 
product  of  average  jmrity.  A  chemically 
piu'c  T.X.T.  was  pre])aretl  for  us  by  Dr. 
Marcus  of  this  laboratory.  In  most  of  the 
experiments  the  poison  was  administered 
either  by  mouth  in  the  form  of  gelatin 
capsules  or  subcutaneously  dissolved  in 
olive  oil.  A  small  number  of  animals  re- 
ceived the  T.N.T.  in  the  form  of  fine  dust 
directly  into  the  lower  air  passages.  For 
this  purpose  the  animals  were  anesthetized. 
A  small  catheter  was  inserted  through  the 
trachea  into  the  left  bronchus  and  the  fine 
T.N.T.  dust  was  then  blown  into  the  lungs. 


this  being  followed  l)y  the  innnediate  with- 
drawal of  the  catheter,  care  being  taken 
that  none  of  the  j)oison  should  couk'  into 
contact  with  the  animal's  mouth.  A  few 
animals  received  the  poison  dissolved  in  oil 
intraperitoneally. 

The  condition  of  the  animals  was  care- 
fully watched  and  the  kind  and  severity  of 
symptoms  observed  were  recorded  dail.w 
A  siiecinu'u  of  urine  was  secured  each  da\- 
(except  Sundays)  by  means  of  catheter- 
ization, and  these  urines  were  submitted  to 
various  tests  for  the  presence  of  abnormal 
constituents,  such  as  sugar,  protein,  bile 
])igment,  and  T.X.T.  and  its  (l(Ti\atives. 

Particular  altcution  was  al.so  ])ai(l  to 
changes  in  tlie  blood  in  this  condition.  For 
this  |)urpo.se  the  blood  of  <'acli  animal  was 
carefully  examintHl  prior  to  aud  following 
the  administration  of  the  jwisoii.  In  a  con- 
sidrral)le  number  of  tlw  auiuials  a  complete 
blood  study  was  made,  including  a  (|uan- 
titative  estimation  of  llie  hemoglol)in,  the 
total  blood  volume,  i)lasma  volume,  and 
pigment  volume,  the  number  and  char- 
acter of  the  red  cells,  a  leukocyte  and  dif- 
fer<Mitial  count,  the  nunilicr  of  r*>ticulatetl 
aud  nucleated  red  cells,  the  coagulation 
time  of  the  blood,  and  the  presence  or 
absence  of  bile  pigments  and  T.N.T.  de- 
rivatives in  the  serum. 

In  view  of  the  fact  tliat  the  work  of 
lliuit  (9),  of  Opie  and  All'ord  (10),  and  of 
Salant  and  Swanson  (11)  had  shown  that 
tlie  character  of  the  diet  has  a  marked  in- 
iluenee  on  the  toxicity  of  various  sub- 
stances, and  as  Hooper  and  Wliii)])le  (12) 
had  tlemonstrated  that  blood  regeneration 
is  uiat<>rially  influenced  by  the  com])osition 
of  the  iliet,  it  seemed  important  to  study 
the  effect  of  various  diets  on  the  course  of 
the  T.N.T.  poi.soning.  Three  diets  were 
chosen  for  this  purpose:  (1)  a  bread  and 
milk  diet,  composed  of  approximately 
equal  parts  per  weight  of  pasteurized  milk 
and  white  bread;  (2)  a  meat  diet,  consist- 
ing of  medium  fat  beef  with  or  without  the 


242 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


addition  of  calcium  phosphate;  and  (3)  a 
mixed  diet  containing  white  bread,  pas- 
tem-ized  milk,  and  medium  fat  beef  in  the 
proportion  of  3,  3  to  1.  The  relative  propor- 
tions of  protein,  fat,  and  carbohydrates  in 
these  three  diets  were  as  follows : 

Protein  Fat        Carbohydrate 

Bread  and  milk     15  7  78 

Mixed 20  14  66 

Meat 45  65  0 

These  figures  show  that  the  bread  and 
milk  diet  is  rich  in  carbohydrates  and  rela- 
tively poor  in  fats  and  proteins.  The  meat 
diet,  on  the  other  hand,  is  rich  in  fat  and 
protein,  and  the  mixed  diet  occupies  an 
intermediate  position. 

Inasmuch  as  the  British  report  had  called 
attention  to  the  probable  conversion  of 
T.N.T.  within  the  body  into  certain  re- 
duced compoimds,  particularly  a  hydrox- 
ylamine  derivative,  a  number  of  reduction 
and  oxidation  products  of  T.N.T.  were  pre- 
pared, and  their  pharmacological  action 
compared  wnth  that  of  T.N.T.  The  solu- 
bility of  these  compounds  in  oil  and  water 
was  also  determined.  This  phase  of  the 
work  is  of  interest  with  resjject  to  its  bear- 
ing on  the  fate  of  T.N.T.  in  the  body  and 
the  mechanism  of  the  toxic  action  of  the 
substance  on  the  tissues  and  particularly 
the  red  blood  corpuscles.  A  careful  necrojisy 
was  made  on  all  animals  which  died  and 
all  the  tissues,  with  the  exception  of  the 
central  nervous  system,  were  subjected  to 
histological  examination. 

Explanation  of  Charts.  —  The  charts  and 
their  legends  contain  the  essential  informa- 
ti6n  relating  to  and  the  results  obtained  by 
the  ex]3eriments.  The  ninnber  and  time  of 
administration  of  the  doses  of  T.N.T.  are 
indicated  by  the  arrows  at  tlie  bottom  of 
the  charts.  The  figures  immediately  above 
represent  the  number  of  nucleated  red  cells 
per  200  white  cells  coimted.  The  curves 
were  obtained  by  [)lotting  the  initial  value 
obtained  before  the  animal  received  T.N.T. 
as    100    per    cent.     The    curves   therefore 


represent  the  percentage  fluctuations  and 
give  a  clear  picture  of  the  course  of  the 
poisonmg  as  determined  by  the  body 
weight  and  the  blood  changes. 

Discussion 

(a)  Symptomatology.  —  In  munition 
workers  various  symptoms,  such  as  derma- 
titis, gastro-intestinal  pain,  constipation, 
bleeding  from  the  nose,  giddiness,  cyanosis, 
breathlessness  after  slight  exertion,  anemia, 
and  jaundice,  have  been  attributed  to  the 
toxic  action  of  T.N.T.  The  sjTnptom-com- 
plex  varies  with  the  individual.  In  the 
mildfer  form  of  poisoning,  which  is  spoken 
of  as  "minor  T.N.T.  sickness,"  there  may 
be  present  cyanosis,  dermatitis,  nose  bleed- 
ing, constipation  and  giddiness.  The  severer 
forms  of  poisoning  have  been  divided  into 
toxic  jaundice  and  aplastic  anemia. 

Doses  of  T.N.T.  ranging  from  5  mg.  to 
100  mg.  per  kilo  body  weight  produced  a- 
more  or  less  severe  grade  of  intoxication, 
the  severity  of  the  latter  being  somewhat 
dependent  on  the  size  of  the  dose.  After  the 
larger  doses  the  animals  showed  marked 
symptoms  within  a  few  hours,  whereas  the 
lowest  dose  used  (5  mg.  per  kilo)  did  not 
always  lead  to  recognizable  clinical  mani- 
festations. 

The  striking  feature  of  T.N.T.  poisoning^ 
in  dogs  is  the  fact  that  individual  suscep- 
tibility ])lays  a  very  imi)ortaiit  ])art.  Cer- 
tain animals  receiving  a  fairly  large  dose 
may  not  show  as  marked  sjanptoms  as 
others  receiving  50  to  75  per  cent,  less 
T.N.T.  This  difference  in  individual  suscep- 
tibility is  very  probably  not  due  to  differ- 
ences in  the  rate  of  absorption  of  the  poison, 
as  T.N.T.  is  absorbed  fairly  rai)idly.  It  is 
more  likely  that  different  inilividuals  deal 
differently  with  the  jjoison  after  the  poison 
is  absorbed,  a  point  which  will  be  dealt 
with  later  on. 

Most  of  the  animals  developed  within 
the  first  daj'  after  the  administration  of  the 
T.N.T.    a    very    pronounced    cyanosis,    a 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


243 


symptom  which  is  very  common  in  T.N.T. 
workers.  The  mucous  membrane  and 
tongue  of  the  dogs  assumed  a  dark  purpHsh 
color.  This  cyanosis  was  observed  in  some 
dogs  as  early  as  four  hours  after  the  admin- 
istration of  a  fairly  large  dose.  In  a  few 
animals  which  had  received  one  large  dose 
or  repeated  small  doses  this  symptom  was 
entirely  lacking,  in  sjjite  of  the  fact  that 
these  animals  finally  died  from  the  effects 
of  the  poi.son.  In  animals  receiving  the 
poison  over  a  long  j)eriod  of  time  the 
cyanosis  usually  cleared  up  after  the  first 
two  weeks,  giving  place  to  an  anemic  ap- 
pearance of  the  mucous  menil)ran«'s.  At 
its  height  the  cyanosis  may  be  associated 
with  a  marked  dyspnea,  and  the  blood 
always  contains  considerable  met  hemoglo- 
bin and  is  chocolate-l)ro\vn  in  color.  Oxy- 
gen inhalation  has  no  effect  whatever  on  the 
cyanosis,  a  fact  which  proves  that  the  latter 
is  essentially  due  to  the  larg<'  amounts  of 
methemoglobin  of  the  blood.*  It  is,  how- 
ever, possible  to  lower  the  increased  pulse 
rate  and  respiration  observed  in  this  condi- 
tion by  allowing  the  animal  to  breathe  a 
mixture  of  air  and  oxygen. 

In  some  of  the  experiments  a  very 
marked  incoordination  was  noted,  which 
first  appeared  on  the  second  or  third  day. 
\Mien  this  occurs,  the  animal  staggers  and 
is  apt  to  fall  when  attempting  to  walk 
downstairs.  The  incoordination  is  usually 
associated  with  a  marked  cyanosis  antl  dis- 
appears in  the  later  stages  in  chronic  poi- 
soning. It  appears  as  if  this  symptom  is 
due  to  a  temporary  functional  abnormality 
of  the  cerebellar  centers. 

Vomiting  and  salivation  were  observed  in 
a  number  of  aninuils  during  the  stage  of 
acute  intoxication.  Constipation  was  some- 
times noted,  though  as  a  rule  the  animals 
suffered  from  diarrhea.    The  body  weight 

*  This  methemoglobin  formation  is  due  to  the  reduction 
of  T.N.T.  to  a  hydroxylamine  derivative,  the  latter  acting 
on  the  hemoglobin.  Letsche  (13)  in  ZUchr.f.  physiol.  Chcm., 
1912,  Vol.  80,  p.  419,  has  shown  that  hydroxylamine  con- 
verts oxyhemoglobin  completely  into  methemoglobin. 


and  nutrition  were  maintained  in  a  satis- 
factory manner  in  a  considerable  number 
of  experiments  of  long  duration. 

All  animals  developed  an  (ineniia,  the 
princij)al  features  of  which,  and  its  causa- 
tion, will  be  discussed  separately.  In  six 
dogs  a  marked  icterus  was  observed,  this 
being  j)receded  by  the  excretion  of  a  con- 
sideral)le  amount  of  bile  i)igment  with  the 
urine.  Dermatitis  occurs  in  T.N.T.  work- 
ers, but  was  never  ob.served  in  these  ani- 
mals. Ulceration  of  the  mucous  membrane, 
which  was  observed  in  the  dogs  on  a  bread 
and  milk  diet,  has  no  relation  to  T.N.T. 
]K)i.soning,  but  is  due  to  a  dietary  defect. 

U>)  Paths  of  Absorption  of'  T.X.T.— 
From  a  j)ractical  point  of  view  it  was  im- 
])ortant  to  determine  by  what  channels 
T.N.T.  can  gain  access  to  the  blood  and 
tissues.  Under  the  conditions  prevailing  in 
the  factories,  the  T.N.T.  workers  may  come 
int..  contact  witli  l)()tli  T.N.T.  vapor  and 
dust,  thus  exi)osing  the  skin  and  the  respira- 
tory and  gastro-intestinal  tracts  to  the 
poison.  It  was,  therefore,  necessary  to 
determine  whetluT  these  organs  absorbed 
TXT. 

Experiments  which  are  not  reported  in 
detail  have  sho\\Ti  that  dogs  and  cats 
which  had  received  T.N.T.  duist  directly 
into  the  lower  air  passages  developed  a 
marked  cyanosis  within  twelve  hours,  and 
their  urine  revealed  the  presence  of  a 
T.N.T.  derivative.  T.N.T.  is  evidently 
very  readily  absorbed  by  the  epithelial  cells 
of  the  bronchi.  On  account  of  the  i)roba- 
bility  of  producing  a  pneumonia  by  this 
method  of  administration,  no  attempts 
were  made  to  cause  chronic  poisonmg  in 
this  way. 

T.N.T.  is  also  very  readily  absorbed 
from  the  gastro-intestinal  tract  when  it  is 
given  in  the  form  of  gelatin  capsules.  As 
T.N.T.  is  verj'  readily  soluble  in  fat,  it 
might  be  expected  that  fat  would  favor  its 
absorption.  The  comparison  of  the  results 
obtained  in  animals  fed  either  on  a  diet 


244 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


poor  in  fat  (bread  and  milk)  or  on  a  fat-rich 
diet  (fat  meat),  however,  shows  that  the 
presence  of  a  considerable  anioinit  of  fat  in 
the  food  does  not  favor  the  absorption  in 
any  way.  Within  six  honrs  after  the  feed- 
ing of  T.N.T.,  the  urine  yields  a  positive 
test  for  the  presence  of  a  T.N.T.  derivative 
(Webster  test),  and  cyanosis,  incoordina- 
tion and  dyspnea  are  observed. 

The  poison  is  also  absorbed  with  great 
ease  when  injected  subcutaneously  in  the 
form  of  a  3  jier  cent,  solution  in  olive  oil. 
These  injections,  even  when  repeated  daily 
over  several  weeks,  do  not  seem  to  lead  to 
any  local  irritation  at  the  site  of  injec- 
tion. Kramer  and  ]Meierhof  (8)  state  that 
they  have  been  able  to  produce  T.N.T. 
poisoning  in  dogs  with  great  regularity  by 
means  of  skin  inunction.  W^e  have  not  used 
this  method,  jirincipally  on  account  of  the 
impossibility  of  ascertaining  the  amount  of 
T.N.T.  actually  absorbed.  T.N.T.  is  also 
readily  absorbed  from  the  peritoneal  cavity. 
In  conclusion,  it  is  safe  to  say  that  T.N.T. 
is  readily  absorbed  from  the  respiratory 
and  gastro-intestinal  tracts,  the  subcu- 
taneous tissue,  the  peritoneal  cavity,  and 
the  intact  skin. 

(c)  Fuie  of  T.N.T.  in  Body.  — Moore 
and  his  associates  of  the  British  Medical 
Research  Committee  (7)  briefly  state  in 
their  report  that  T.N.T.  is  reduced,  within 
the  animal  body,  to  2,  6-dinitro-4-hydroxyl- 
aniinotohiene,  which  is  readily  converted 
into  2,  (>-dinitro-4-azoxytoluene.  The 
chemical  relation  of  these  three  compounds 
is  brought  out  by  the  following  formulae: 

CH,  CHs  CHs  CH3 

I    ,.,v^,        \02|AnO,        XC\,An02        N0;|^;.N0. 

v..  V  y   /o^ 


N02ANO, 


NOo 


N 


The  hydroxylamine  tlerivative  is  Ihcn 
conjugated  with  glycuronic  acid  and  ex- 
creted in  this  form  in  the  urine.  Although 
the  announced  paper  on  this  subject  has 
not  appeared  uj)  to  this  date,*  it  seemed  of 

*  See  British  Medical  Research  Council,  Special  K.purt 
Series,  No.  58,  1921. 


considerable  interest  to  consider  this  ques- 
tion of  the  fate  of  T.N.T.  From  previous 
work  on  the  metabolism  products  of  toluene 
and  aromatic  nitro-compounds,  it  is  a  priori 
jiossible  that  Ijoth  oxidation  and  reduction 
might  play  a  role  in  the  modification  of 
T.N.T.  According  to  Nencki  and  Giacosa 
(14)  toluene  is  oxidized  in  the  body  to 
benzoic  acid.  Jaffe  (15)  isolated  from  the 
urine  of  dogs  which  had  received  large 
doses  of  paranitrotoluene  a  substance 
which  he  identified  as  paranitrobenzoic 
acid,  part  of  which  was  conjugated  with 
glycocoll  to  nitrohippuric  acid.  Meyer  (16) 
was  able  to  isolate  paraaminophenol  from 
the  urine  of  a  case  of  nitrobenzene  poison- 
ing. He  also  confirms  some  older  obser- 
vations of  Lewin  (17),  who  claims  that 
azoxybenzene  occurs  in  the  urine  of  ani- 
mals poisoned  with  iihenylhydroxylamine. 
Walko  (18)  rei)urts  experiments  which  in- 
dicate that  picric  acid  is  reduced  in  the 
body  to  picramic  acid. 

That  trinitrotoluene  does  not  occur  as 
such  in  the  urine  of  T.N.T.  workers  was 
shown  l)y  ^Nloore  and  confirmed  by  us  in 
the  case  of  the  urine  of  dogs  poisoned  with 
T.N.T.  The  so-called  Webster  test,  which 
is  used  for  this  purpose,  is  based  on  the  fact 
that  an  ethereal  solution  of  T.N.T.  as- 
sumes a  purplish-red  color  after  the  addi- 
tion of  an  alcoiiolic  solution  of  potassium 
hydroxidi'.  This  test  is  always  negative  in 
the  dog's  urine  if  the  fresh  urine  is  directly 
extracted  with  ether.  According  to  Web- 
ster it  is  essential  to  acidify  the  urine  with 
20  per  cent,  sulphuric  acid  before  the  ether 
extraction.  The  ether  extract  so  obtained 
then  yieUls  a  dark  purplish-red  color  upon 
the  addition  of  an  alcoholic  potash  solution. 
When  carried  out  in  this  latter  way,  the 
test  is  usually  positive  in  the  extract  ob- 
tained from  the  urine  of  dogs  which  have 
received  T.N.T.,  indicating  that  unchanged 
T.N.T.  is  ali.sent,  but  that  a  derivative 
giving  the  same  test  is  present.  This  de- 
rivative, according  to  Moore,  is  the  above- 


VOEGTLEv  —  TRIXITROTOLL^NE  POISOXING 


245 


mentioni'd  liydroxylaniine  conijjound  whicli 
has  to  be  split  off  from  its  combination  with 
gylcuronic  acid  by  the  acid  treatment.  We 
foimd  tliat  tlie  only  derivative  of  T.X.T. 
which  yields  the  same  color  as  T.X/1\  itself 
is  the  liydroxylaniine  compound.  It  is, 
therefore,  very  probal)le  that  the  hydroxyl- 
amine  comjjoimd  is  one  of  the  metal)- 
olism  pi'odiicls  of  T.X.T.  We  have 
repeatedly  examined  the  feces  of  our  ani- 
mals for  the  presence  of  T.X'.T..  but  iiave 
never  been  able  to  get  a  positive  Webster 
test.  I'he  bile,  however,  very  often  yields 
positive  tests.  Here  also,  as  in  I  he  case  of 
urine,  it  is  necessary  to  atid  acid  before 
carrying  out  the  etlier  extraction,  a  fact 
which  indicates  that  T.X.T.  as  such  is  not 
present  and  that,  therefore,  the  test  is  jirob- 
ably  due  to  the  hydroxylauiine  derivative. 

As  to  the  ((uantity  of  tlu-  hydroxylaiuine 
compound  which  is  excreted  with  the  urine 
very  little  can  be  said,  except  that  the 
method  described  by  Elvove  (1!))  when 
apjilied  to  tlog's  urine  accounts  for  oidy 
from  !)  to  43  per  cent,  of  the  T.X.T.  given 
to  the  animals. 

An  imporlant  fad  whirii  we  wish  to  em- 
phasize particularly  is  the  absence  of  any 
relation  between  the  urinary  Webster  test 
and  the  severity  of  the  intoxication,  as 
determined  by  the  clinical  sym])toms  and 
the  grade  of  the  anemia.  The  data  pre- 
.sented  in  this  rejiort  conclusively  show  that 
the  Webster  test  may  be  persistently  nega- 
tive in  spite  of  the  presence  of  marked 
cyanosis  and  incoordination,  and  that,  on 
the  other  hand,  it  may  be  strongly  positive 
in  animals  in  which  the  symptoms  are  not 
especially  pronounced. 

W'V  have  also  frecpiently  made  the  ob- 
servation that  during  the  first  month  of 
chronic  poisoning  the  urine  of  the  dog 
yields  a  very  marked  Webster  test,  but 
that  this  test  nearly  always  becomes  nega- 
tive in  the  later  stages  of  poisoning,  and 
this  in  spite  of  the  fact  that  the  animal  still 
receives  the  poison  and  shows  evidence  of  a 


l)rogressing  anemia.  We  believe  that  tliis  is 
an  indication  of  a  change  in  the  disposition 
of  the  poi.son  by  the  body,  in  the  sense  that 
the  liydroxylaniine  comixtund  is  further 
reduced  to  the  mono  or  diamino  derivative 
of  T.X'^.T.,  substances  which  do  not  give 
the  Webster  test  but  which  jio-ssess  the 
same  jiharmacological  action  as  T.X'.T. 

If  is  also  ]H)s.sil>le  that  i)art  of  the  T.X.T. 
is  oxidized  to  trinitrobenzoic  acid,  which 
would  combin(>  with  glycocoll  to  form 
trinitrohippuric  aci<l.  We  have  l)een  able 
to  show  that  trinitrobenzoic  aciil.  when 
gi\t'n  in  doses  of  the  same  order  as  those 
re(|uireil  for  the  production  of  'l\X.'l\  poi- 
soning, has  no  e\idenl  effect  on  dogs.  This 
substance  is,  to  say  the  least,  much  less 
toxic  than  either  T.X.T.  or  its  reduction 
products.  This  diH'erence  in  toxicity  of 
T.X.T.  and  trinitrolx-nzoic  acid  is  very 
likely  due  to  the  greater  wafer  solubility  of 
the  latter,  a  fact  which  fa\'ors  its  rajjid  re- 
moval from  the  body  through  the  kidney. 
1 1  is  (|uite  possible  that  the  difference  in  the 
resistance  of  different  individuals  to  T.N.T. 
poisom'ug  may  be  exi)laiiied  ]n-  assuming 
that  the  more  resistant  animals  oxidize  \\\v 
meth.\l  group  of  T.X.T.  moi'i'  rea(lil\'  than 
the  more  su.sceptible  indi\iduals. 

There  remains  much  to  be  learned  al)out 
the  fate  of  T.X^T.  and  other  aromatic  nitro 
derivatives  in  the  body.  May  it  suffice  here 
to  state  that  the  marked  variation  in  the 
resistance  to  the  poi.son  may  be  easily  ex- 
plained on  the  basis  of  the  assumption  that 
the  reactions  involved  in  the  transforma- 
tion of  T.X.T.  in  the  botly  may  differ  both 
qualitatively  and  quantitatively  in  dif- 
ferent animals  of  the  same  and  different 
species. 

Trinitrotoluene  or  some  of  its  deriva- 
tives are  retained  in  the  tissues  for  a  con- 
siderable time,  as  shown  by  the  progressive 
anemia  observed  in  dogs  after  a  single  dose 
of  the  poison  and  the  slow  recovery  after 
the  animal  is  taken  off  T.N^.T.  This  reten- 
tion of  T.X.T-  or  its  reduction  products  is 


246 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


probably  due  to  the  fact  that  these  com- 
pounds are  very  insohible  in  water,  render- 
ing their  ehminat ion  with  the  urine  difficult. 

(d)  Necropsy  Findings.  —  All  of  the  ani- 
mals that  died  from  chronic  T.N.T.  poison- 
ing were  anemic  and  showed  the  following 
characteristic  pathological  changes  which 
must  be  attributed  to  the  action  of  this 
poison : 

The  endothelial  phagocj'tes  of  the  spleen 
pulp,  bone  marrow,  and  liver  contained 
engulfed  red  cells  and  a  varying  amount  of 
granular  hemosiderin.  These  pigment 
granules  were  frequently  as  large  as  red 
corpuscles.  The  pigmentation  was  most 
striking  in  the  spleen  and  bone  marrow. 
(Fig.  1.)  The  liver  pigment  was  usually 
confined  to  the  swollen  Kupffer  cells  within 
the  liver  capillaries.  At  times  groups  of 
hemosiderin-containing  phagocytes  were 
found  about  the  portal  spaces.  The  liver 
cells  rarelv  contained  even  a  small  amount 


'    Fig.  1.  —  Spleen  pulp  in  chronic  poisoning  containing 
maximum  amount  of  hemosiderin.     Perl's  reaction. 


of  finely  granular  hemosiderin.  (Fig.  2.) 
The  mesenteric  li^Tiiph  glands  occasionally 
contained  a  few  hemosiderin-holding  phag- 
ocji:es. 

A  mild  icterus  was  foimd  in  six  of  the 
tliirty-nine   animals.     In   these   cases   the 


subcutaneous  fat  and  the  intima  of  the 
aorta  yielded  a  positive  test  for  bile  pig- 
ment. 

A  myeline  degeneration  of  the  sciatic 
nerve  occurred  in  the  majority  of  the  ani- 


FiG.  i.  —  Liver  in  chronic  poisoning  showing  the  hemo- 
siderin in  the  swollen  Kupfler  cells  within  the  liver  capil- 
laries. The  liver  cells  do  not  contain  hemosiderin.  Perl's 
reaction. 


mals  in  which  this  nerve  was  examined 
histologically,  irrespective  of  diet. 

In  some  of  the  dogs  fed  on  medium  fat 
beef  the  liver  showed  a  definite  fatty  change 
chiefly  confined  to  the  liver  cells  surround- 
ing the  efferent  veins.  Hyaline  necrosis 
was  not  found,  although  in  a  few  cases 
small  areas  of  focal  necrosis  were  detected. 

Animals  sacrificed  within  a  few  days  after 
administration  of  relatively  large  doses  of 
T.N.T.  showed  a  varying  degree  of  splenic 
tumor.  In  these  animals  the  endothelial 
l^hagocytes  of  the  spleen  pulp,  bone  mar- 
row, and  the  Kupffer  cells  of  the  liver  con- 
tained many  engulfed  red  corpuscles,  ap- 
parently intact,  and  a  small  amount  of 
granular  hemosiderin.    (See  Figs.  3,  4,  5.) 

A  hyperplastic  bone  marrow  was  found 
in  all  of  the  animals  except  those  sacrificed 
within  a  few  days  after  the  administration 
of  the  first  dose. 

In  addition  to  the  above  changes  a  num- 
ber of  the  animals  with  a  complicating  in- 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


247 


tercurrent  infection  showed  bronchopneu- 
monia, acute  nephritis,  cloudy  swelling  of 
the  liver,  and  splenic  tumor.  I'wo  dogs  of 
the  mixed  diet  series  and  five  dogs  of  the 


Via.  ;i.  —  Mimoiiiiclfar   plia^ocylcs   willi    eiidiilfcil    timI 
cells  from  the  spleen  piilp  in  niiile  piiis<iniii^. 


Fig.  i.  —  Kiipffer  cells  eoiitainiiiK  red  cells  and  pigment 
from  the  liver  eapillarics  in  aetile  poi.soiiing. 

bread  and  milk  diet  series  showed  an  ex- 
tensive su])erficial  ulceration  of.  the  oral 
mucous  nu'uibraiu',  changes  brought  abt)ut 
by  the  deficient  diet  and  not  by  T.N.T. 

(e)    Pathogoiesis  of  Anemia  and  Icterus. 
—  The  salient  feature  of  chronic  T.N.T. 


poisoning  in  dogs  is  the  anemia  so  con- 
stantly present  and  the  mechanism  of  this 
red  cell  destruction.  On  reviewing  the 
literature  on  physiological  blood  destruc- 
tion it  is  evident  that  a  certain  proportion 
of  the  erythroc.^•tes  are  continuously  broken 
liown  and  replaced.  Ashby  ('20)  showed 
that  the  leugth  of  life  of  transfused  blood 
corpuscles  in  man  is  thirty  days  and  more. 
As  to  the  fate  of  the  erythrocytes,  present 
knowledge  is  still  inadequate.' 

As  long  ago  as  1!)U1,  Hunter  stated  that 
I  wo  different  processes  of  blood  destruction 


I'lc.  .1.  —  Bone  marrow  in  chronic  poisoning.  Note  Uic 
amount  of  lieinosiderin  within  the  phagocytic  cells.  Perrs 
re.'ietion. 


may  be  dislinguished  —  one  in  which  the 
red  corpuscles  are  phagocytosed  without 
loss  of  hemoglobin,  the  other  in  which  the 
red  corpu.scles  undergo  hemolysis  with  the 
liberation  of  hemoglobin  within  the  blood 
stream.  I'he  first  process  is  characterized 
by  a  gradual  decay  of  the  red  corpu.scles 
whili-  still  circulating.  They  become 
spherical,  deeper  in  color,  and  retain  their 
hemoglobin  until  they  are  enclosed  within 
the  active  cells  of  the  spleen,  or  leukocytes 
of  the  blood,  and  are  stored  tip  within  the 
spleen  or  in  the  capillaries  of  the  liver. 
Within  these  cells  the  whole  of  the  hemo- 
globin of  the  corpuscle  is  converted  into 


248 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


hemosiderin.  The  pigment  so  formed  is 
characterized  generalh'  by  the  varying  size 
of  its  granules,  some  of  which  correspond  in 
size  to  that  of  the  original  red  corpuscles. 
In  the  liver,  the  pigment  is  found  within 
the  caj)illaries  and  never  within  the  liver 
cells.  The  second  process  is  marked  by  the 
liberation  of  hemogloliin  from  the  red  cell 
within  the  blood  stream.  The  hemoglobin 
escapes  from  the  corpuscle,  either  alone  or 
in  combination  with  thealbuminous  stroma. 
It  is  carried  to  the  li^'er  and  is  broken  up  by 
the  liver  cells. 

Recently  Rous  and  Robertson  (21) 
showed  that  a  hemolytic  process,  in  the 
ordinary  sense  of  the  term,  at  most  plays  a 
very  minor  part  in  normal  blood  destruc- 
tion. They  state  that  phagocytosis  will  not 
suffice  as  a  general  explanation  of  normal 
blood  destruction  and  that  the  red  cor- 
puscles, in  those  species  in  which  phago- 
cytosis is  negligible,  are  fragmented  one  liy 
one,  while  still  circulating,  to  a  fine  hemo- 
globin-containing dust  which  is  eventually 
removed  from  the  blood  by  the  spleen,  and 
under  exceptional  conditions  by  the  bone 
marrow. 

In  certain  anemias,  on  the  other  hand, 
such  as  those  produced  by  hemolytic  im- 
mune serum  and  by  certain  poisonous  sub- 
stances (toluylenediamine,  sodium  oleate, 
phenylhydrazine,  arseniated  hydrogen, 
etc.),  the  destruction  of  the  red  corpuscles 
takes  place  by  hemolysis  within  the  cir- 
culating blood.  The  hemoglobin  escapes 
from  the  corpuscles  into  the  plasma  and  a 
hemoglobinemia  ensues.  If  the  concentra- 
tion of  hemoglobin  in  the  plasma  is  great 
enough,  it  will  escape  through  the  kidneys 
into  the  urine.  The  liver  cells  contain  an 
excess  of  hemosiderin  in  consequence  of 
hemolysis,  not  of  phagocytosis  of  red  cells. 
The  hemosiderin  granules  so  arising  are 
small  and  more  or  less  uniform  in  size. 

According  to  Pearce,  Austin,  and  JMsen- 
brey  (22),  hemoglobin  escapes  into  the 
urine  of  normal  dogs  when  the  concentra- 


tion of  free  hemoglobin  in  the  blood  plasma 
is  approximately  0.06  gm.  of  hemoglobin 
per  kilo  of  body  weight.  The  blood  of  the 
dog  contains  approximately  16  per  cent,  of 
hemoglobin,  so  that  it  would  require  the 
hemolysis  of  the  red  corpuscles  contained 
in  only  4  c.c.  to  cause  a  hemoglobinemia  in 
an  animal  weighing  10  kilos. 

The  anemia  produced  in  dogs  by  T.N.T. 
is  characterized  by  a  very  rapid  destruction 
of  the  red  corjjuscles.  The  percentage  of 
hemoglobin  in  the  luiit  of  blood  diminishes. 
The  pigment  vohmie,  representing  the  total 
amount  of  hemoglobm  in  the  circulating 
blood  at  the  time  of  the  blood  volume  de- 
terminations, drops  in  certain  animals  to 
50  per  cent,  or  less  within  fifteen  days, 
especially  in  those  on  a  bread  and  milk  diet. 
Coinciding  with  this  decrease  in  pigment 
volume  there  is  a  marked  diminution  in  the 
total  blood  volume  corresponding  roughly 
to  the  exient  of  the  reduction  of  the  red 
blood  cell  volume.  This  rajiid  blood  de- 
struction is  not  accompanied  by  the  ap- 
pearance of  hemoglobin  in  the  blood 
pla.sma  or  urine.  In  many  cases  there  is 
also  a  complete  absence  of  bile  pigment  in 
the  blood  plasma  and  urine.  The  number 
of  red  corpuscles  is  usually  markedly  de- 
creased. In  a  few  cases,  however,  the 
erythrocytes  have  fragmented  to  such  a 
degree  that  their  actual  number  per  cubic 
millimeter  of  blood  is  considerably  in- 
creased abo\-e  normal,  while  the  total  pig- 
ment volume  and  red  blood  cell  volume 
show  a  very  marked  decrease.  (See  Fig.  6.) 
Fragment  at  ion  of  red  cells  has  been  most 
marked  in  dogs  on  a  bread  and  milk  diet. 
Anisocytosis,  poikilocji;osis,  and  polychro- 
matophilia  were  common  findings,  the 
degree  of  such  abnormalities  usually  cor- 
responding to  the  degree  of  the  anemia. 
The  detailed  examination  for  disintegrating 
red  corpuscles  in  dogs  acutel\-  jioisoned  re- 
vealed tlie  jjresence  of  considerable  num- 
bers of  these  cells  in  the  blood,  spleen,  bone 
marrow,  and  li\-er.    'I'liev  were  often  small. 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


249 


Sometimes  they  were  as  large  as  and  even 
larger  than  the  normal  red  cell.  Most  of 
them  were  characterized  by  a  translucent 
blister-like  elevation  extending  from  a  por- 
tion of  the  cell  and  having  at  times  a 
somewhat  irregular  outline.  The  hemo- 
globin mass  within  these  cells  stained 
uniformly  and  deeper  than  the  surrounding 


scopic  examination.  The  met  hemoglobin 
is  confuied  exclusively  within  the  red 
corjiuscles  and  does  not  occiu-  in  the 
plasma. 

As  stated  above,  in  the  necropsy  findings, 
the  spleen  ])ul]),  bone  marrow,  and,  at 
times,  the  mesenteric  lymph  glands  con- 
tain numerous  large  mononuclear  phago- 


NuMBtRZ  niTH  %=  Nucleated  red  corpuscles. 

Fig.  ().  —  AHiilt  niali-  SUhIiI  cyanosis,  salivation,  and  incoordination.  Food  consumption  fair.  Slight  icterus  of 
conjunctivae  between  tlie  4(>tli  and  (i.")tli  days  and  between  SStli  and  il.'id  days,  accompanied  by  an  increa.se  in  bile 
pigments  in  tlie  urine,  U-ukocyles  varieil  between  4,^01)  and  -i'i,  KID.  Ketieulated  cells  \i  to  9j  during  the  first  71 
days.    Nucleated  reds  from  none  to  7.     .Vnisoi'vtosis  and  l)as(ipliilia. 

'Ant(r\mi.  —  Emaciation.  Kxlensive  sn|)erticia'l  idceratiori  of  oral  nnieons  membranes.  Bone  marrow  hyperplastic. 
Spleen  pulp,  liver  capillaries,  bone  marrow,  and  mesenteric  lymph  ulands  contain  liemosiderin-holding  phagocytes. 

NoU  the  increased  fragmentation  of  erythrocytes  between  the  12th  and  ohth  days. 


red  corpuscles.  Other  cells  were  found  in 
which  the  hemogloV)in  was  apparently 
divided  by  a  clear  jjortion.  (See  Fig.  7.) 
Hemolyzing  red  corpuscles  or  red  cor- 
puscle shadows  were  not  encountered. 

Blood,  aspirated  from  the  external  jugu- 
lar vein  within  a  few  hours  from  animals 
given  a  moderate  dose  of  T.N.T.,  is  choco- 
late-brown in  color  and  contains  large 
amounts    of    methemoglobin    on    spectro- 


cytes  loadetl  with  granular  hemosiderin  — 
some  of  the  granules  are  as  large  as  the  red 
cori)iiscles  —  and  in  acute  ])oisoning,  espe- 
cially, the  phagocytes  contain  engulfed  red 
corpuscles.  The  Kupffer  cells  of  the  liver 
are  swollen  and  contain  hemosiderin  and 
red  corpuscles.  At  times  there  are  groups  of 
hcmosiderin-containing  phagocytes  about 
the  portal  areas.  The  liver  cells  rarely 
contain  hemosiderin. 


250 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


A  further  important  obser\'ation  in  de- 
termining the  mechanism  of  the  blood  de- 
struction is  that  T.N.T.  does  not  produce 
hemolysis  in  vitro  when  addeil  directly,  or 
dissolved  in  olive  oil,  to  defibrinated 
blood,  citrated  blood,  or  washed  red  cor- 
puscles. From  these  experiments  it  is 
evident,  however,  that  T.N.T.  is  absorbed 
by  the  red  corpuscles,   sincf-  part   of  the 


#1    ^  ^ , 
3o  /«.<- 


Fig.  7.  —  Disintegrating  red  corpuscles  from  the  blood 
of  an  acutely  poisoned  T.N.T.  dog     Wright's  stain. 


oxyhemoglobin  is  changed  into  methemo- 
globin  within  twenty  minutes  at  37°  C. 

On  the  basis  of  these  observations  the 
following  explanation  may  be  made  of  the 
meclianism  responsible  for  the  blood  de- 
struction in  T.N.T.  poisoning.  T.N.T.  or 
some  of  U.s  derivatives,  being  lipoid  .soluhle, 
are  absorbed  by  the  red  corpuscles  and  change 
part  of  the  oxyhemoglobin  into  methemo- 
globin.  Di.iintegration  of  the  red  corpuscles 
follmrs  irithonf  the  liberation  of  hemoglohin 
or  methemoglobin  into  the  blood  plasma.  The 
injured  cells  are  then  engulfed  by  the  en- 
dothelial phagocytes  of  the  spleen.,  of  the  bone 
marrouu  of  the  lymph  glands,  to  a  certain  e.v- 
tent,  and  by  the  endothelial  Kupjfer  cells  of 
the  liver.    The  engulfed  red  cells  are  in  turn 


broJcen  doivn  within  the  endothelial  phago- 
cytes with  the  formation  of  bile  pigment  and 
hemosiderin. 

The  bile  pigment  which  at  times  occurs 
in  the  lu'ine  of  dogs  poisoned  with  T.N.T. 
without  the  apjiearance  of  icterus  can  be 
easily  explained  when  it  is  remembered 
that  the  dog's  kidney  excretes  bile  pig- 
ment very  readily  and  that  normally  the 
blood  plasma  does  not  contain  any  bile 
pigment.  A  trace  of  bile  pigment  in  the 
urine  of  normal  dogs  is  commonly  found, 
especially  when  the  animals  are  consti- 
pated or  during  fasting  periods.  On  the 
other  hand,  the  threshold  value  of  the 
hinnan  kidne^'  for  bile  jjigment  is  relatively 
high  and  plasma  contains  a  considerable 
amount  of  bile  ]Mgment  before  it  appears  in 
the  lU'ine.  (iilbert  and  Herscher  (23) 
showed  that  the  normal  human  serum 
contains  from  25  to  35  mg.  of  bilirubin  per 
liter.  Panton  (24)  studied  the  blood  of  100 
munition  workers  exposed  to  T.N.T.  and 
found  that  20  pev  cent,  had  an  increase  of 
bile  pigment  in  the  serum  without  its  ap- 
])earance  in  the  urine.  The  increase  of  bile 
pigment  foimd  at  times  in  the  urine  of 
poisonetl  dogs  corresponds  to  the  increase 
of  bile  pigment  in  the  plasma  of  muni- 
tion workers  —  probably  brought  about  in 
either  case  by  the  increased  destruction  of 
red  corpuscles  by  the  endothelial  phago- 
cytes and  the  consequent  formation  of  bile 
pigment  within  these  phagocytes. 

Six  dogs  out  of  thirty-nine  showed  slight 
but  definite  clinical  icterus  of  the  mucous 
membrane  of  the  mouth  and  conjunctiva, 
accomi)ani('d  by  the  apjiearance  of  bile 
pigment  in  the  blood  jilasma  and  consider- 
able amounts  in  tlie  urine.  In  four  of  these 
dogs  the  icterus  ap])eared  several  days  be- 
fore death.  At  necropsy  the  intinui  of  the 
aorta  and  the  subcutaneous  fat  were  def- 
initely bile  stained  and  gave  positive  tests 
for  bile  pigment .  The  kidneys  in  two  of  the 
animals  were  normal.  The  .slight  fatty 
changes  occasionally  found  in  the  liver  can- 


VOEGTLIX  -  TRIXITROTOLl-EXE  POISONING 


251 


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252 


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not  be  held  responsible  for  the  icterus.  The 
bile  in  all  four  cases  was  very  dark  and 
viscous.  Special  attention  is  called  to  the 
transient  nature  of  the  icterus  observed  in 
two  of  the  dogs.  In  these  animals  the 
icterus  coincides  with  periods  of  very  ac- 
tive blood  destruction.  Furthermore,  five 
out  of  the  six  animals  that  develojjed  icterus 
were  fed  on  meat,  a  diet  which  stimulates 
blood  regeneration.  On  this  diet  the  num- 
bfr  of  red  corpuscles  formed,  and  possibly 
the  number  undergoing  disintegration,  is 
greater  than  on  a  bread  and  milk  diet, 
which,  as  already  pointed  out,  is  not  as 
satisfactory  for  blood  regeneration. 

Possibly  the  icterus  of  these  animals  was 
of  an  obstructive  type  and  hepatogenous 
in  origin  due  primarily  to  the  viscid  bile 
which  led  to  obstruction  in  the  smaller  bile 
ducts,  with  consecjuent  absorption  of  the 
bile  by  the  hepatic  capillaries  and  without 
definite  liver  injury.  Another  possibility  is 
a  functional  disturbance  of  the  liver  cells, 
.rendering  them  incapable  of  dealing  with 
the  bile  pigment,  as  normally 

The  primary  rapid  blood  destruction  ob- 
served in  tlie  dogs  chronically  poisoned  is 
followed  by  an  evident  blood  regeneration, 
as  seen  by  the  increase  in  tlie  number  of 
nucleated  and  reticulated  *  red  corpuscles 
in  the  circulating  blood  and  by  a  pol;y^nor- 
phonuclear  leukocytosis  in  most  cases.  In 
some  animals  blood  regeneration  tem- 
porarily overcame  blood  destruction,  fol- 
lowed by  a  partial  return  to  normal  of  the 
pigment  volume  and  the  total  blood  vol- 
ume. (See  Fig.  8.)  Then,  unless  the 
T.N.T.  was  discontinued,  a  recidivation 
followed  the  period  of  active  blood  regen- 
eration which  was  associated  with  a  grad- 
ual fall  in  the  pigment  volume  and  a 
reduction  in  the  number  of  nucleated  and 
reticulated  red  corpuscles. 


All  of  the  animals  which  had  received  the 
poison  up  to  the  time  of  death  invariably 
showed  a  hyperplastic  bone  marrow  at 
necrospy  in  spite  of  the  presence  of  a  very 
severe  anemia. 

(/)  Influence  of  Diet.  —  On  account  of 
the  considerable  difference  in  the  individual 
susceptibility  to  chronic  T.N.T.  poisoning, 
it  is  rather  difficult  to  determine  the  exact 
influence  of  various  diets  on  this  intoxica- 
tion. The  niunber  of  experiments  which 
would  have  to  be  carried  out  in  order  to 
obtain  reliable  data  on  this  point  would  of 
necessity  be  very  large.  For  this  reason, 
the  results  obtained  in  this  investigation, 
while  not  absolutely  conclusive,  are  at 
least  highly  suggestive.  It  is  seen  that  the 
animals  on  a  mixed  or  meat  diet  seem  to  be 
more  resistant  than  the  dogs  fed  on  bread 
and  milk.  The  animals  belonging  to  this 
latter  group  as  a  rule  show  a  more  acute 
and  severer  anemia,  and  die  sooner. 

ig)  Importance  of  Impurities  in  Crude 
T.N.T.  —  The  T.N.T.  used  for  the  manu- 
facture of  high  explosive  shells  is  not  a 
chemically  pure  substance,  although  it  is  a 
fairly  pure  product  consisting  of  approx- 
imately 99  per  cent.  2,  i,  6  trinitrotoluene 
(T.N.T.).t 

Various  writers  have  attributed  the  toxic 
action  of  T.N.T.  to  the  impurities  con- 
tained therein,  among  which  may  be  men- 
tioned traces  of  (3  and  y  trinitrotoluene  and 
especially  tetranitromethane. 

The  results  reported  in  this  paper  clearly 
demonstrate  that  there  is  no  qualitative 
nor  quantitative  difference  in  the  phar- 
macological action  of  the  ordinary  T.N.T. 
obtained  from  sliell-filling  plants  and  chem- 
ically i)ure  2,  4,  6  trinitrotoluene.  This 
latter  substance  was  prepared  bj'  Dr. 
Marcus  of  this  laboratory.  Dr.  Marcus  also 
tried  to  isolate  the   impurities,   but  suc- 


*  An  increased  number  of  relieulaleti  red  corpuscles  in 
the  circulating  blood  is  considered  by  Vogel  and  McCurdy 
(25),  Lee,  Minot,  and  Vincent  (i(ii,  and  Robertson  (■il)  to 
be  very  good  evi<lence  of  increased  activity  of  the  erythro- 
blastic system. 


t  For  literature  relating  to  the  manufacture  of  T.N.T., 
the  reader  is  referre<i  to  .Artlmr  Marshall's  "  Kxplosives," 
.1.  &  .\.  Churcliill,  London.  England:  and  G.  Smith's 
"T.N  T.  Manufacture,"  New  York,  Van  Nostrand  Com- 
pany, 1918. 


VOEGTLIN  —  TRINITROTOLITENE  POISONING 


253 


ceeded  only  in  obtaining  a  few  milligrams  The   icterus   is   caused   primarily   by   the 

of  /3  trinitrotoluene  from  785  gm.  of  the  enormously  increased  breakdown  of  hemo- 

commercial  product.     The  fact  is,  there-  globin  within  the  phagocytic  cells  of  certain 

fore,  well  established  that  the  toxic  action  organs  and  in  this  respect  is  hematogenous 

of  the  commercial   product   is  essentially  in  origin.   Acute  yellow  atrophy  of  the  liver 


due  to  2,  4,  6  trinitrotoluene. 

Summary 

The  results  obtained  in  this  work  may  be 
briefly  summed  up  as  follows: 


was  never  observed  in  any  of  the  animals. 

The  toxic  action  of  T.N.T.  is  essentially 
due  to  2,  4,  G  trinitrotoluene.  T.N.T.  is 
changed  in  the  body  and  is  not  excreted  as 
such.    Reduction  and  oxidation  mav  take 


A  condition  may  be  produced  in  dogs  jiart  in  tliis  transformation.    The  reduction 

which  in  tlie  most  essential  respects  very  products  have  the  same  pharmacological 

clo.sely  resembles  T.N.T.  poisoning  in  tlie  action  as  T.N.T.    Trinitrobenzoic  acid,  the 

human.      'I'he     symptoms     observed     are  only  oxidation   product   studied,   is  much 

cyanosis,    methemoglobinemia,    choluria.  less  toxic  than  either  T.N.T.  or  its  reduc- 

dyspnea,   inco-ordination,   and    salivation,  lion  products.    A  marked  variation  in  in- 

An  anemia  appeared  in  all  animals  and  in  dividual    and    species    susceptibility    was 

six  a  definite  icterus  was  noted.    The  blood  observed,  which  is  probalily  de[)endeut  on 

destruction  is  due  to  an  injury  of  the  red  the   nature  of   the  change   undi'rgone   by 

blood  corpu.scles  leading  to  increased  phag-  T.N.T.  in  the  body.   A  definite  tolerance  to 

ocytosis  of  these  cells  in  the  spleen,  liver,  the  poison  was  never  established, 

and    bone    marrow    fphagoc-vtic    anemia).  The  coniijosition  of  the  diet  s('<-ms  to  be  a 

Blood  regcncralion  usually  proceeds  very  factor  inlluencing  the  susceptibility  of  the 

slowly  after  the  withdrawal  of  the  poison,  animals  to  T.N.T.  poisoning. 

{To  be  continued) 


BIBLIOGRAPHY 


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0.  White,  R.  P.,  and  Hay,  J.:  Some  Recent  In- 
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7.  Moore,  B.,  Webster,  T.  A.,  and  Wyon,  G.  A.: 
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Kramer,  R.,  and  Meierhof.  H.:  Experimental 
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10.  Opie,  E.  L.,  and  Alford,  L.  B.:  The  Influence  of 
Diet  on  Hepatic  Necrosis  and  Toxicity  of 
Chloroform.  Jour.  .\m.  Med.  Assn.,  1914,  62, 
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stances which  Prorluce  Lesions  of  the  Liver  or 
tlu-  Ki<lney.   Ibid.,  1914,  63,  136. 

Salaiit,  W'.,  and  Swanson,  A.  M.:  The  Protec- 
tive Action  of  Diet  against  Tartrate  Nephritis. 
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43. 

Hooper,  C.  W.  and  Whipple,  G.  H.:  Blood  Re- 
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Regeneration  Influenced  by  Dietary  Factors. 
Am.  Jour.  Physiol.,  1917-1918,  45.  573. 


II 


12 


254 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


13.  Letsclie,  E.:  Ueber  die  Einwirkung  von  Hy- 
droxylamiii  auf  den  Blutfarhstoff.  (Eln  Beitrag 
zur  Kenntnis  des  Methiimoglobins.)  Ztsclir.  f. 
physiol.  Chem.,  191^2,  80,  iU. 

14.  Nencki,  M.,  and  Giacosa,  P. :  Ueber  die  Oxyda- 
tion  der  aromatischen  Kohlenwasserstoffe  im 
Thierkorper.  Ztschr.  f.  physiol.  Chem..  1880.  4, 
325. 

15.  Jaflfe,  M.:  Ueber  das  Verhalteu  des  Nitro- 
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16  Meyer,  E.:  Ueber  das  Verhalten  des  Nitro- 
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19.  Elvove,  E.:  The  Detection  and  Estimation  of 
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20.  Ashby,  W.:   The  Determmation  of  the  Length 


of  Life  of  Transfused  Blood  Corpuscles  in  Man. 
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21.  Rous,  P.,  and  Robertson,  O.  H.:  The  Normal 
Fate  of  Erytlirocytes.  I.  The  Fmdings  in 
Healthy  Animals.  Jour.  Exper.  Med.,  1917,  25, 
651. 

22.  Pearce,  R.  M.,  Austin,  J.  H.,  and  Elsenbrey, 
A.B.:  Tile  Relation  of  the  Spleen  to  Blood  De- 
struction and  Regeneration  and  to  Hemolytic 
Jaundice.  II.  The  Relation  of  Hemoglo- 
binemia  to  Hemoglobinuria  and  Jamidice  in 
Normal  and  Splenectomized  Animals.  Jour. 
Exper.  Med.,  1912,  16,  375. 

23.  Gilbert,  A.,  and  Herscher,  M. :  Sur  la  teneur  du 
sang  normal  en  bilirubine.  Compt.  rend.  Soc.  de 
bioL,  1905,  58,  899. 

24.  Panton,  P.  N.:  The  Effect  of  Trinitrotoluene 
upon  the  Blood.    Lancet,  1917,  2,  77. 

25.  Vogel,  K.  M.,  and  McCurdy,  U.  F.:  Blood 
Transfusion  and  Regeneration  in  Pernicious 
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26.  Lee,  R.  I.,  Minot,  G.  R.,  and  Vincent,  B.: 
Splenectomy  in  Pernicious  Anemia.  Studies  on 
Bone  ^larrow  Stimulation.  Jour.  .\m.  Med. 
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Med.,  1917,  26,  221. 


BOOK  REVIEWS 


The  Human  Motor  or  the  Scientific  Foundations 
of  Labor  and  Industry.  By  Jules  .\mar,  D.Sc, 
Director  of  the  Research  Laboratory  of  Industrial 
Labour  at  the  Conservatoire  National  des  Arts  et 
Metiers,  Paris.  Translated  by  Elsie  P.  Butterworth 
and  George  E.  Wright.  Cloth.  Pp.  470  with  illustra- 
tions and  index.  London:  George  Routlcdge  & 
Sons,  Ltd.;  New  York:  E.  P.  Dutton  &  Companv, 
1920. 

Before  the  puhlioation  of  the  present  volume 
in  English,  Amar's  work  had  already  become 
well-known  in  this  country  through  his  Phy- 
siology of  Industrial  Organization  and  the  Re- 
employment of  the  Disabled,  which  appeared  in 
191!),  and  in  wliich  frequent  references  were 
made  to  his  more  fundamental  wt)rk.  The  Hu- 
man Motor.  The  present  volume  is  tiius  re- 
ceived with  great  interest. 

Since  the  book  is  addressed  to  the  practical 
man  in  industry  as  well  as  to  the  investigator, 
the  author's  wisdom  is  at  once  evident  in  be- 
ginning with  a  consideration  of  the  general 
principles  of  mechanics  most  obviously  con- 


cerned in  the  movement  and  work  of  the  human 
machine.  In  the  subsequent  chapters  which 
comprise  the  first  part  of  the  book,  the  following 
subjects  are  considered:  the  structure  of  the 
body;  neuromuscular  action  and  the  energy 
exchanges  in  rest  and  work,  and  the  relation  of 
diet  thereto;  human  energy,  including  the  con- 
sideration of  si)eeds,  loads,  and  effort;  fatigue; 
the  internal  environment  and  the  physico- 
chemical  ct)nditions  within  the  body;  and  ex- 
ternal environment.  The  second  half  of  the 
book  is  devoted  to  experimental  methods  of 
measurement  applicable  to  industrial  labor  and 
to  the  results  that  have  been  obtained  by  these 
methods. 

There  is  sufficient  reason  for  devoting  a  large 
section  of  the  volume  to  general  physical  and 
pliysiological  principles  as  a  matter  of  conven- 
ience for  the  general  reader.  ()p|)ortunity  may 
thus  be  Uiken  to  emphasize  aspects  of  the  sub- 
ject more  directly  related  to  industrial  physi- 
ology.   .\raar's  treatment  of  general  physiolog- 


BOOK  REMEWS 


255 


ical  matters  bearing  upon  work  is  stimulating 
and  suggestive,  but  it  is  questionable  whether 
the  general  reader  would  obtain  an  adequate 
conception  of  the  subject  in  such  a  brief  treat- 
ment. 

Any  reviewer  would  perhaps  find  objections 
to  some  views  of  any  writer  upon  the  general 
subject  of  i)hysiology,  and  it  sliould  not,  there- 
fore, detract  from  the  merit  of  the  work  as  a 
whole  to  criticize  certain  statements  and  con- 
ceptions. The  work  quoted  on  the  syst»lic 
blood  ])rcssure  for  the  different  ages  does  not 
agree  with  the  general  views  at  the  present 
time  as  regards  normal  blood  pressure,  the 
average  pressure  for  the  ages  between  iO  and  40 
being  given  by  .\mar  as  170-100  nmi.  Hg. 

As  to  the  chemical  plicnonicna  occurring  in 
fatigue,  the  statements  that  toxins  are  pro- 
duced in  the  muscle,  and  that  "the  blood  by 
circulating  more  cjuickly  during  work  washes 
the  {joisons  out  of  the  tissues  and  carries  them 
to  the  su])rarenai  glands  which  secrete  adrenalin 
by  which  they  are  neutralized;  it  oxidizes  them 
itself  by  the  oxygen  which  it  contains,"  do  not 
represent  the  best  ojiinions  on  the  subject.  Of 
the  -same  ty])e  is  the  following  statement: 
"...  sweat  is  ii  toxic  waste  and  is  produced 
during  fatigue.  The  poisons  which  it  eliminates 
in  '■24  hours  would  be  sufficient  to  endanger  an 
adult  subject.  Poisoning  sometimes  takes  place 
in  a  hot,  humid  atmosphere  if  the  sweat  has  not 
been  able  to  leave  the  body."  This  erroneous 
view  is  frequently  encountered  among  people  in 
industry.  The  statements  that  the  blood  of 
obese  subjects  is  less  rich  in  red  corpuscles;  that 
senile  decay  affects  tall  people  most;  that  one  of 
the  effects  of  an  electrified  environment,  as 
after  a  violent  thunder-storm,  is  anemia;  that 
the  ajjplication  of  a  moderate  current  a|)i)ears  to 
increase  tlie  power  of  nmscles  fc^r  se\-eral  days; 
that  "chloride  of  sodium  intervenes  in  the 
metabolism  of  the  body  to  protect  the  pro- 
teids,"  should  not  be  allowed  to  pass  without 
question.  Reference  is  made  to  creatinin  in 
connection  with  muscular  activity,  but  evi- 
dently creatin  is  referred  to. 

The  translation  is  not  altogether  good,  and 
as  a  result  miconventional  expressions  are 
occasionally  used,  and  the  author's  meaning  is 
sometimes  obscure.  As  an  example  of  the 
former,  we  find  in  the  index  a  reference  to 
"renal  force,"  with  a  test  for  renal  force  illus- 
trated, the  test  being  a  measure  of  the  strength 
of  the  lumbar  muscles  by  means  of  the  dynamo- 
meter.   As  an  instance  of  obscure  meaning,  the 


following  sentence,  which  occurs  in  the  discus- 
sion of  nerves,  may  be  cited:  "They  emanate 
from  determined  centers,  these  centers  being 
cellular,  but  the  'nervous  cell"  emits  a  very 
long  prolongation  to  the  centrifugal  function, 
the  cylindric  axis,  and  short  appendices,  'the 
dendrites,'  which  connect  it  with  the  neighbor- 
ing cells"  (p.  '00).  Moreover,  through  some 
mistake  of  labeling  or  shading  the  drawing  of 
the  knee  joint,  an  entirely  erroneous  impression 
of  tliis  structure  is  given  (p.  lOii). 

The  autlior  makes  several  references  to  dif- 
ferences associated  with  .sex,  but  does  not  un- 
dertake a  general  discussion  of  these  differences 
as  bearing  u]X)n  fitness  for  various  kinds  of 
work.  The  female  suffers  in  the  conventional 
maimer  through  comi)aris()ii  but  it  seems  ;i  bit 
unfair  to  her  to  draw  attention  to  slight  dif- 
ferences in  the  water  content  and  density  of  her 
nervous  matter.  She  is  foimd  to  possess  less 
muscular  strength,  aiul  this  is  more  important. 
In  view  of  more  recent  results  of  Martin,  how- 
ever, and  the  same  criticism  api)lies  to  com- 
parisons of  the  strength  of  different  races,  the 
effect  of  occupation  |)r()bably  has  not  been  duly 
taken  into  account. 

The  real  contribution  of  Aniar  is  in  pointing 
out  the  applications  of  physiological  methods  to 
the  study  of  labor,  the  results  obtained,  and 
those  to  be  exjjected.  His  own  work  has  con- 
sisted of  investigations  of  j)ressurc  and  speed  of 
movements  by  means  of  Marcy  tambours  and 
recording  devices,  following  the  lead  of  Imbert 
in  this  teclmic,  and  of  correlating  these  re- 
sults with  observations  upon  the  oxygen  con- 
sumption, respiratory  rhythm  and  heart  beat. 
l}y  means  of  tliis  teclmic  he  has  determined 
the  work  accomj)lished  in  relation  to  the  energy 
exi)ended  in  .several  kinds  of  labor,  at  various 
time  rates.  Interesting  and  valuable  results  are 
given. 

.Vmar's  chief  incentive  is  apparently  found  in 
the  shortcomings  of  the  methods  of  Taylor  and 
his  followers  through  their  failure  to  take  into 
account  the  physiological  principles  concerned 
in  hinnan  work.  The  same  criticism  has  been 
freciueiitly  made,  and  indeed  with  justice. 
Industrial  engineers  have  frequently  stated 
speeds,  loads  and  percentage  of  time  in  func- 
tional activity  in  relation  to  lengths  of  rest, 
without  taking  into  account  the  physiological 
factors  already  known,  and  without  making 
physiological  research  where  such  knowledge  is 
inadequate.  While  Amar  must  surely  convince 
even  the  practical  engineer  of  the  richness  of 


256 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


this  field  of  investigation  he  demonstrates,  per- 
haps more  than  he  realizes,  its  present  short- 
comings. He  is  least  of  all  to  be  criticized  in 
this  respect  since  he  is  actively  working  in  this 
field.  In  making  this  criticism  it  is  not  my  pur- 
pose to  defend  any  continued  neglect  upon  the 
part  of  industrial  engineers  to  ignore  physi- 
ological facts  and  methods  in  their  studies,  but 
rather  to  stimulate  greater  effort  on  the  part  of 
physiologists. 

The  two  salient  deficiencies,  in  so  far  as 
scientific  management  is  concerned,  are  briefly: 
first,  inadequate  methods  of  determining  and 
stating  the  work  of  the  human  machine;  and, 
secondly,  inadequate  means  of  determining  the 
effects  of  work  upon  the  human  machine,  i.  e., 
fatigue.  In  the  determination  of  work,  Amar  em- 
ploys the  customary  methods  used  in  the  past. 
For  example,  a  man  uses  both  hands  in  filing 
and  makes  both  vertical  and  horizontal  pressure 
upon  the  file.  The  pressure  in  both  directions  is 
determined  in  kilograms.  He  moves  the  file  a 
certain  distance  in  the  horizontal  plane.  The 
work  which  he  accomplishes  is  determined  by 
multiplying  the  horizontal  pressure  by  the  dis- 
tance tlu-ough  which  the  file  is  moved.  The 
dowaiward  pressure  is  disregarded.  From  a  cer- 
tain standpoint  this  may  be  of  value  —  pos- 
sibly, in  comparing  the  efficiency  of  the  human 
machine  with  other  types  of  machines — but  from 
the  standpoint  of  determining  quantiUitively  the 
physiological  activity  involved  in  the  work  as  a 
basis  of  reckoning  daily  functional  activity,  it  is 
inadequate.  Total  muscular  activity,  however, 
may  be  inferred  from  studies  on  oxj'gen  con- 
sumption. This  was  done  in  the  case  of  filing. 
It  must  be  recognized,  however,  that  the  oxygen 
consiunption  gives  no  indication  of  the  de- 
mands made  upon  particular  muscle  groups 
and,  furthermore,  that  it  does  not  indicate  the 
demands  made  upon  the  special  senses  and 
nervous  system.  Our  technic  must,  therefore, 
be  extended  to  include  measurements  of  the 
physiological  activity  of  particular  nuisfle 
groups  and  other  structures  concerned  in  work, 
if  we  are  to  obtain  measurements  indicative  of 
the  demands  made  ujjon  tiic  human  machine. 
In  connection  with  nniscular  activity  it  has  long 
seemed  to  me  that  more  fruitful  results  would 


be  obtained  by  expressing  this  in  terms  of  ten- 
sion midtiplied  by  time  rather  than  of  weight 
times  distance. 

In  the  matter  of  determining  the  effect  of 
work  upon  the  human  organism,  Amar  offers 
little  assistance  to  the  engineer.  In  the  ex- 
amples given,  he  recognizes  fatigue  produced  in 
the  work,  by  irregularities  in  respiration,  pain 
in  a  muscle  group,  unusually  high  performance 
in  terms  of  kilogrammeters,  and  by  oxygen 
consumption,  and  as  we  know  these  are  not 
reliable  criteria  of  fatigue.  His  contribution  to 
the  energy  exchanges  in  the  work  of  an  appren- 
tice as  compared  with  a  skilled  worker  is  an 
additional  plea  for  a  detailed  study  of  move- 
ments in  occupation  and  standardization  of  the 
most  efficient  movements,  which,  it  should  be 
noted,  may  not  be  those  of  the  shortest  paths  or 
necessarily  those  recjuiring  the  lowest  oxj'gen 
consumption.  The  method  suggested,  which 
involves  a  study  of  the  movements  of  the  most 
efficient  workers,  is  likely  to  prevent  falling  into 
such  errors. 

Amar  indicates  the  advantages  to  be  gained 
through  proper  selection  of  workmen  but  does 
not  discuss  this  aspect  of  the  subject.  His 
classification  of  men  into  four  types  —  the 
digestive,  the  muscular,  the  respiratory,  and 
the  nervous  types,  each  suited  especially  to  cer- 
tain types  of  activity  —  seems  far-fetched;  also 
the  statement  that  subjects  with  a  stronger  will 
have  more  endurance  hardly  admits  of  practical 
application. 

Under  external  environment  there  is  a  brief 
discussion  of  atmospheric  pressure,  the  effects 
of  gases  and  vapors,  etc.  In  connection  with 
high  altitudes  the  work  of  English  investigators 
is  not  mentioned,  and  in  connection  with  cais- 
.son  sickness  tlie  advantage  of  gradual  decom- 
jjression  of  the  air  pressure  is  not  referred  to. 
Moreo-\-er,  the  work  referred  to  in  connection 
with  the  occurrence  of  diabetes  following 
exposure  to  alumiiunn  fumes  should  be  ques- 
tioned. 

Amar  is  a  pioneer  and  his  excellent  book 
should  stimulate  both  the  practical  man  in  in- 
dustry and  the  laboratory  worker  to  a  fuller 
realization  of  the  fruits  which  may  be  reaped 
through  endeavor  in  this  field.  —  ^i.  H.  Ryan. 


THE  JOURNAL  OF 
INDUSTRIAL   HYGIENE 


PUBLISHED  MONTHLY 


Volume  III 


JANTARY,  1!)'2'2 


N'rxiij 


DUST  IN  PRINTERS'   WORKROOMS* 

C.  B.  KOOS.  B.Sc,  F.I.C. 
//.  M.  Inspector  of  Factories 


DISCT^SSIOX  liaving  arisen  in  Ihe 
I)ress  as  to  the  possible  relationship 
between  tubereulosis  in  printers  and  iiili;il;i- 
tion  of  silica  dusl,  I  was  instructed  to  in- 
vestigate tlie  (|uantity  and  nature  of  the 
dust  in  th<'  air  of  workrooms  in  whicli 
jirinting  jjroeesses  are  carried  on.  Some 
silica  is  found  in  "printer's  list,"  a  black 
fluffy  substance  which  collects  in  com- 
positors' cases,  and  its  existence  tin  re  has 
been  attributed  to: 

1.  Sand  used  in  casting  and  moulding 
iron  "chases"  (the  metal  frames  into  which 
the  type  is  locked).  When  these  rust,  the 
sand  is  loosened  and  on  releasing  the  type, 
silica  and  oxide  of  iron  are  shaken  out. 

2.  Silica  shaken  off  the  chases  by  vibra- 
tion in  machines. 

S.  The  "dross"  which  arises  from  the 
"list"  when  used  type  is  melted  down. 
This  dross  is  skimmed  oft'  and  often  stored 
in  open  chests  in  workrooms  for  months 
until  sold. 

It  was  suggested  that  the  silica  was  car- 
ried from  the  compositors'  cases  into  the 
air  by  floating  vegetable  fibres  prodvtced  by 
the  paper.  The  paper  fibre  was  clogged 
into  the  type  in  the  machines:  when  the 

*  Reprinted  from  the  Annual  Report  of  the  Chief  In- 
spector of  Factories  for  WHO  by  permission  of  the  Con- 
troller of  His  Majesty's  Stationery  Office. 


tyi)e  was  relea.sed,  the  fibre  was  distributed 
with  the  silica  into  the  cases,  then  thrown 
out  into  the  air,  and  iidialed  while  the 
compositor  was  jjicking  out  the  type  he 
wanted. 

It  appeared  therefore  that  to  test  these 
theories  information  on  the  following  points 
would  be  usefid:  (1)  (luaiititi/  of  diisf  in  the 
air  of  printers'  composing  and  machine 
rooms,  and  particularly  as  to  whether  the 
amount  was  in  excess  of  that  foimd  in  the 
air  of  ordinary  rooms;  and  ('■2)  nature  and 
size  of  dust  particles. 

Determinations  of  the  dust  were  made 
both  in  old-fashioned  works,  where  con- 
ilitions  of  air  space  and  ventilation  were 
usually  indifferent,  and  in  up-to-date 
works,  imtler  the  best  conditions  obtain- 
able. Altogether  eight  works  were  visited, 
four  "good,"  and  four  "indifferent."  In 
every  case  the  air  was  drawn  in  at  the 
breathing  level  of  the  workers,  either  in  the 
centre  of  the  room,  or  in  the  most  crowded 
part. 

These  determinations  were  made  by  a 
special  apparatus  designed  by  Mr.  G.  E. 
Duckering  (1).  Briefly,  the  method  con- 
sists in  drawing  a  measured  volume  of  the 
air  of  the  workroom  through  a  weighed 
filter-paper    and    weighing    the    dust    col- 


as? 


258 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


lected  on  the  paper.  From  these  results  a 
figure  representing  the  dust  content  of  the 
air,  known  as  the  "dust  figure,"  is  calcu- 
lated, and  can  be  used  for  purposes  of 
comparison.  The  dust  figure  is  the  number 
of  milligrams  of  dust  in  10  cubic  metres  of 
air,  this  being  a  convenient  standard  to 
adopt . 

The  dust  collected  on  the  filter  was  sub- 
mitted to  microsco])ical  examination  (with 
polarised  light)  with  a  view  to  determining 
the  size  and  character  of  the  constituent 
particles.  The  results  of  these  determma- 
tions  are  given  in  Table  1.  The  dust 
figures  may  be  compared  with  those  in 
Table  2,  which  were  obtained  (1)  in  the 
open  air;    (2)  in  a  laboratory. 

In  view  of  the  different  suggestions  as  to 
the  sources  of  the  silica,  samples  of  dust 
were  collected  from  (a)  fluff  and  dust  from 
compositors'  trays  and  cases;  (h)  dross 
from  melting  pots  in  casting  rooms;  and 
(c)  paper  fibre  from  machine  rooms.  Dur- 
ing the  investigation  another  possible 
source  of  dust  was  evident,  namely,  the 
French  chalk  used  in  the  moulding  process; 
a  sample  of  this  was  also  taken.  These 
samples  were  analysed  at  the  government 
laboratory,  and  the  results  of  the  analysis 
appear  in  Table  3.  They  can  be  compared 
with  an  analysis  of  a  "domestic"  dust. 

Conditions  in  Printing  Works 

Composing  Rooms.  —  In  general,  these 
rooms  are  not  particularly  well  ventilated. 
Although  in  most  cases  plenty  of  windows 
(to  open)  are  provided,  they  are  usually 
found  to  be  closed.  The  workers  seem  to 
prefer  a  warm  atmosphere  and  object  to 
windows  being  open.  In  some  rooms,  espe- 
cially those  used  for  news]iaper  work,  there 
is  much  traffic,  and  in  such  cases  the  dust 
figure  is  higher  than  in  rooms  where  traffic  is 
restricted. 

The  dust  in  the  trays  is  a  woolly,  felted, 
fluff \-  substance;  but  if  the  type  is  removed 


there  is  also  found  a  fair  quantity  of  fine 
black  dust  underneath  the  fluff.  It  is  only 
to  be  expected  that  the  trays,  which  are 
divided  into  small  compartments,  and  only 
occasionally  cleaned,  will  accumulate  dust. 
When  not  in  use  the  trays  are  stored  away 
in  a  sort  of  cabinet,  into  which  they  fit  like 
drawers.  When  an  old  case  is  taken  into 
use  after  being  disused  for  some  length  of 
time,  an  attempt  is  usually  made  to  clear 
the  dust  from  the  small  compartments. 
The  old  method  of  doing  this,  still  used  in 
many  works,  is  to  take  the  tray  into  the 
open  air  and  blow  the  dust  away  with 
hand  bellows.  The  more  modern  firms 
have  installed  dust  extractors  for  this  pur- 
pose.   These  are  of  two  kinds : 

1.  A  closed  box  with  a  fan  and  duct, 
known  as  the  "Clements'  Case  Dust  Ex- 
tractor." The  tray  is  placed  inside  the  box, 
and  the  motor  started.  The  action  is  tliree- 
fold;  the  tray  is  agitated  so  as  to  stir  up  the 
type,  the  dust  is  blo-rni  up  into  the  air  in- 
side the  box,  and  drawn  away  by  the  fan 
through  the  duct  into  a  special  compart- 
ment, from  which  it  can  be  cleared.  The 
time  taken  to  clear  a  tray  by  this  method  is 
about  thirty  seconds,  as  against  fifteen  to 
twenty  minutes  by  the  hand  bellows,  be- 
sides which  there  is  no  chance  of  the  worker 
breathing  the  dust.  Each  comiiositor 
usually  clears  his  own  trays,  as  he  requires 
them. 

2.  A  vacuum  cleaner,  similar  to  those 
used  for  domestic  purposes.  A  special 
worker  is  employed  to  go  round  the  com- 
posing room,  and  keep  all  trays  clean.  Its 
disadvantages,  as  compared  with  the  Clem- 
ents' Extractor,  are  that  there  is  no 
device  for  shaking  up  the  tjT)e  and  so  re- 
moving the  dust  underneath,  and  that 
light,  thin  pieces  of  type  are  liable  to  be 
lifted  up  with  the  dust  by  the  suction,  and 
carried  inside  the  cleaner. 

Machine  Rooms.  —  Conditions    in    the.se        ! 
rooms  vary  within  very  wide  limits.   Some 
are  large  and  well  ventilated,  on  the  ground 


ROOS  — DUST  IN  PRINTERS'  WORKROOMS 


259 


floor,  with  good  natural  or  mechanical 
ventilation.  In  many  cases,  however,  the 
machine  rooms  are  in  the  basement  with 
artificial  light  constantly  in  use.  They 
often  appear  to  be  overcrowded  with  ma- 
chinery, their  free  ventilation  being  thereby 
restricted. 

A  certain  amount  of  paper  du.st  is  usually 
found  on  the  machines,  the  quantity  vary- 
ing with  the  kind  of  paper  used.  The  prin- 
cipal varieties  of  paper  met  with  are  as 
follows,  in  tlie  order  of  llicir  dusliness: 

1.  Antique  wove.  —  This  is  the  dustiest 
paper  on  the  market.  It  is  used  almost  en- 
tirely for  printing  high-class  novels. 

2.  Antique.  —  Used  for  chea])  magazine 
work. 

3.  Neu\i.  —  IT.sed  for  cheap  newspapers, 
weekly  periodicals,  etc. 

4.  Thin  antique.  —  Used  for  books. 

5.  Smooth  or  calendered  antique.  —  Used 
for  high-class  newsi)a|)er.s,  books,  «'1c.,  and 
for  tile  outside  of  weeklies  and  clieap  maga- 
zines. A  fairly  smooth  paper  giving  only  a 
little  dust. 

6.  Calendered.  —  Good  smooth  surface, 
giving  very  little  dust. 

7.  Super-calendered.  —  Gives  practically 
no  dust . 

In  machine  work  wiiere  a  dusty  paper  is 
used,  the  type  has  to  be  wiped  fre(|uently, 
as  a  bad  impression  is  niaile  in  printing  if 
the  dust  collects.  The  "clogging"  of  the 
type  by  dust  and  ink  is  therefore  kept 
dowii  to  very  small  limits,  to  avoid  spoiling 
the  work,  ^[oreover,  after  tyi)e  is  finislied 
with  and  while  it  is  still  in  the  frame,  or 
chase,  it  is  usually  washed  with  strong 
caustic  ])ota.sli  solution,  to  remove  the  ink 
and  paper  fibre,  before  being  broken  up. 

Moukling  Rooms.  —  The  chief  character- 
istic of  these  rooms  is  the  high  temperature 
from  the  steam  presses  in  use.  The  only 
possible  source  of  dust  is  the  French  chalk 
used  for  dusting  forms  before  and  after 
moulding.  Most  firms  use  very  little 
French  chalk;   in  one  case  where  a  fair 


amount  was  used  a  suction  fan  was  pro- 
vided to  assist  in  keeping  the  room  clear  of 
dust. 

Ca.s'ting  Shops.  —  The  processes  carried 
on  in  these  shops  are: 

1 .  ^ felting  down  of  type  (old  and  new). 
This  is  done  in  large  pots,  ])rovided  with 
hoods  and  duels  to  carry  olf  the  fumes. 
The  dross  rises  to  the  surface  and  is  skim- 
med off.  It  is  generally  left  until  the  next 
day  to  cool,  wiien  it  is  either  placed  in 
sacks  or  in  a  s])e(ial  closed  metal  bin,  kept 
outside  the  workroom.  It  is  disposed  of  to 
lead  smelters  (for  recovery  of  the  metal) 
and  carted  away  weekly.  Table  S  shows 
that  dross  contains  no  silica. 

'2.  Pouring  of  molten  tyi)e  into  moulds. 
This  process  gives  rise  to  no  dust. 

;{.  \'arious  trimming  processes,  e.  g., 
"routing,"  "shaving,"  etc.  None  of  these 
is  a  dusty  ojjcration. 

Linoti/pc  and  Monotype  Machine  Rooms. 
—  'I'lie  machines  give  ri.se  to  little  du.st; 
the  fumes  given  off  by  the  melting  pots  are 
in  most  cases  efficiently  removed  by  ex- 
hau.st  ventilation. 

CoNSIDER.\TION   OF  RESULTS 

In  Table  1  the  results  have  been  ar- 
ranged so  that  the  amounts  of  dust  in  the 
air  for  the  various  processes  are  grouped 
together. 

Composing.  —  Table  1  seems  to  show 
that  the  following  factors  have  a  deter- 
mining influence  on  the  size  of  the  dust 
figure : 

1.  Size  of  room,  in  relation  to  the  num- 
ber of  workers,  i.  e.,  amount  of  cubic- space 
for  each  worker. 

2.  Amount  of  traffic  in  room. 

;5.  Amount  of  ventilation,  i.  e.,  rate  of 
change  of  air  in  the  room. 

Number  100  has  the  highest  figure 
(24.4)  for  all  composing  rooms,  the  room 
being  rather  crowded,  with  much  traffic. 
Number  107  is  next,  with  a  figure  of  19.5; 


260 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


1 

Large  room,  few  workers.  Air 
very  still,  no  traffic.  All 
windows  closed. 

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traffic. 

Large  room,  well  ventilated. 
Fair  amount  of  traflic. 

Windows  all  closed.  Air  op- 
pressive. Several^  platen 
machines  in  room. 

Well-ventilated  room,  all  win- 
dows open.    Little  traffic. 

Large  room,  few  workers.   No 

traffic. 
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composing   room.      Good 

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ROOS  — DUST  IN  PRINTERS'  WORKROOMS 


261 


the  ventilation  was  jjoor,  and  the  presence 
of  platen  machines  raised  the  dust  con- 
tent of  the  air.  Number  115  (18.2)  was  a 
well-ventilated  room,  but  was  somewhat 
crowded,  and  nuich  traffic  was  going  on. 
Numbers  99  and  105  have  the  same  figure 
(14.6);  in  one  case  all  windows  were  closed 
and  there  was  no  traffic,  and  in  the  other 
case  there  was  good  ventilation  and  much 
traffic.  The  lowest  figure  of  all  is  7.;i,  ob- 
tained in  two  ca.ses  in  which  all  the  factors 
contributed  to  a  low  dust  content.  The 
average  figure  for  the  eight  samples  is  14.1. 

Machine  Work.  —  Here,  besides  the  air 
space  and  ventilation,  the  kind  of  paper  in 
use  is  .seen  to  infiuence  the  figiur.  NiuiilxT 
108  is  highest  (31.7),  the  ventilation  being 
indifferent  and  the  pai)er  dusty.  Number 
112  was  taken  in  the  least  satisfactory 
room  encoimteretl,  but  the  i)aper  used  was 
of  a  smooth,  calendered  tyi)e,  so  that  the 
dust  figure  (18.;})  is  moderat*-.  Number 
114  was  taken  under  what  might  be  termed 
ideal  conditions  —  a  large,  lofty,  well- 
ventilated  machine  room,  and  a  smooth 
calendered  pajx'r.  The  dust  figure  (1.0)  is 
practically  negligible.  The  average  figure 
for  the  seven  samples  is  13.1 

Moulding  and  Casting.  —  Tlu'  dust  figure 
in  these  rooms  (24.4)  is  somewhat  in  excess 
of  the  average  figure  for  nuichine  and  com- 
posing rooms.  This  is  explained,  in  tiie 
ca.se  of  the  moulding  room,  by  the  (|uanfity 
of  French  chalk  in  use,  and,  in  the  case  of 
the  casting  room,  by  the  relatively  large 
amount  of  traffic  at  the  time  of  sampling. 

Results  of  Microscopical  E.ramination 
{Tabic  1).  —  This  examination  was  carried 
out  by  Dr.  H.  H.  C.  Thomas,  D.Sc,  at  the 
Geological  Survey  and  ^Nlusemn,  Jermyn 
Street.  The  results  show  that,  in  all  print- 
ing processes,  the  quantity  of  silica  in  the 
dust  of  the  air  is  extremely  small  —  in 
some  cases  so  small  as  to  escape  detection. 
It  appears,  therefore,  that  the  workers 
breathe  very  little,  if  any,  silica.  The  dust 
consists   for  the   most   part   of   vegetable 


fibre  and  carbonaceous  matter.  In  one  case 
(No.  108),  in  which  a  rough  "news"  paper 
was  being  used,  the  vegetable  fibre  is  de- 
scribed as  having  "good  vegetable  tissue 
with  cell  structure.  The  tissue  and  struc- 
ture indicate  straw  or  grass  particles." 
Possibly  some  variety  of  straw  or  gra.ss  had 
been  used  in  the  manufacturing  of  the 
l)aper.  In  all  cases  the  vegetable  fibre  is 
described  as  being  "not  such  as  woukl  be 

TAHLK  2.  — RESULTS  OF  DETERAHN.^TIONS  OF 

DUST  IN  .\IR  AND  IN  ROOMS  \\'HERE 

ATMOSPHERE  WAS  NOT  DUSTY 


Point  at  Which  Determinations  Were  Made 


Centre  of  garden,  Edgbaston,  after  three  fine 
days 

Same  point  after  four  days  of  fine  weather  .  .  . 

Same  point  after  thirty-six  hours  of  heavy  rain 

(enlre  of  study,  Edgbaston 

Open  air  outside  laboratory.  Stoke,  centre  of  a 
nianufaclurinj;  district 

Centre  of  hiboratory,  Stoke 

Side  of  hiboratory.  Stoke 

Side  of  laboratory,  Oxford 


Milligrams 

of  Dust  in 

10  Cubic 

Metres  of 

Air 


2.1 

2.8 
0.7 

7.7 

9.4 
18.5 
10.8 
12.6 


yielded  by  filter  iiaper,"  ?'.  e.,  by  the  ma- 
terial on  which  the  samples  were  collected. 

'liable  2  shows  the  results  of  determina- 
tions of  dust  in  the  open  air  and  in  rooms 
where  the  atmosphere  was  not  du.sty. 

The  dust  figure  of  the  atmosphere  ap- 
pears from  these  determinations  to  vary 
from  0.7,  under  ideal  conditions  (open  air 
after  heavy  rain),  to  18.5,  this  being  the 
figure  in  a  laboratory  in  a  manufacturing 
town.  Out  of  eight  samples  taken  in  com- 
posing rooms,  in  only  two  cases  is  this  latter 
figure  exceeded,  and  out  of  seven  samples 
taken  in  machine  rooms,  in  only  one  case, 
while  the  average  figure  for  both  these 
classes  of  work  (14.1  and  13.1  respectively) 
is  well  below.  Moreover,  the  figure  18.5 
represents  the  dust  in  the  air  of  an  empty 
room  with  no  traffic  of  any  sort.    A  com- 


262 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


parison  of  Tables  1  and  2,  therefore,  shows 
that  prmters'  worki-ooms  are  by  no  means 
dusty. 

Table  3  shows  the  results  of  analyses 
made  at  the  government  laboratory  of  nine 
samples  of  dust  taken  from  printing  works. 
This  table  gives  the  analysis  of  the  sources 
from  which  it  has  been  alleged  that  silica 
may  get  into  the  dust  of  the  air.  The  high- 
est percentage  of  "  free  "  silica  found  is  6.31, 
the  average  being  3.35.   Silica  dust  is  com- 


metal   and   occasionally   a   little   metallic 
oxide. 

"Total  silica"  in  dust  from  printing 
works,  when  compared  with  that  of  Lon- 
don "domestic"  dust  taken  from  the  top 
of  a  wardrobe,*  comes  out  much  the  lower 
of  the  two. 

Conclusions 

1.  Printing  cannot  be  described  as  a 
"dusty"  trade.    The  average  quantity  of 


TABLE  3.  — RESULTS  OF  ANALYSES  OF  DUST  SAMPLES  FROM  PRINTING  WORKS 


Sample 
No. 

Firm 
No. 

When  Taken 

Organic 

Matter 

and 
Moisture 

Lead 

Other 
Heavy 
Metals 

Total 
Silica 

Other 

Inorganic 
Substances 

Total 

"Free" 

Silica 
ancluded 
in  ToUl 

SiUca) 

1 

2 
3 
4 

1 
1 

2 
2 
2 
5 
9 
4 

Type  cases,  composing  room 

Inside  Clements'  dust  extractor .  . 
Inside  Clements'  dust  extractor.  . 
Machine  room                         

66.00 
59.00 
40.00 
71.00 
47.00 
68.00 
56.00 
74.00 

2.80 

8.92 

23.75 

0.51 

4.68 

4.39 

traces 

3.20 
4.08 
6.25 

traces 
0.49 
1.32 
1.61 

traces 

8.95 

9.96 

8.63 

11.45 

13.23 

8.48 

13.72 

12.00 

19.05 
18.04 
21.37 
17.55 
38.77 
17.52 
24.28 
14.00 

100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 

4.33 
6.31 
1.32 
2.50 

5 
6 

7 
8 

Inside  fan  in  moulding  room 

Tj-pe  cases,  composing  room 

Inside  dust  extractor 

Machine  room 

3.16 
3.21 
4.24 
1.78 

paratively  heavy,  so  that  the  percentage 
of  silica  actually  breathed  by  the  worker  is 
probably  much  lower  than  this.  The  re- 
mainder of  the  silica  in  the  samples,  in- 
cluded from  the  heading  of  "total  silica," 
is  present  in  the  combined  form,  as  silicates, 
in  which  form  it  is  considered  to  be  in- 
nocuous ('i). 

The  following  is  an  analysis  of  a  sample 
of  "dross";  antimony,  16.49;  lead,  68.23; 
tin,  12.50;  copper,  0.12;  iron,  0.09;  zinc, 
0.26;  arsenic,  0.09;  oxygen,  2.22;  total, 
100.00.  It  shows  that  dross,  which  is  one  of 
the  alleged  sources  of  silica,  is  entirely  of 
metallic  constH iition.  When  type  is  melted 
dowii,  the  oil  and  other  organic  matter  rise 
to  the  surface  and  are  vaporised,  the 
vapours  passing  into  the  hood  above  the 
casting  pot.  A  c-ertain  amount  of  the  metal 
separates  from  the  alloy  in  a  granular  con- 
dition and  is  skimmed  off.  These  skim- 
mings are  the  dross  and  consist  entirely  of 


dust  in  the  air  is  no  higher,  and  in  some 
cases  considerably  less,  than  that  in  the  air 
of  many  occupied  rooms. 

2.  The  dust  in  the  air  contains  very 
little  silica  —  in  some  cases  a  negligible 
quantity. 

3.  The  dust  in  compositors'  cases,  in 
machine  rooms,  and  in  other  dust-produc- 
ing sources  contains  less  silica  than  dust 
collected  from  a  living  room. 

4.  On  the  grounds  of  the  presence  of 
lead  alone  in  the  dust  of  the  type  cases,  it  is 
desirable  that  some  apparatus,  such  as  the 
Clements'  Case  Dust  Extractor,  should  be 
used.  ])articiilarly  in  large  works,  for  re- 
moving the  dust  from  the  trays  and  cases. 
Such  apparatus  should  be  so  constructed 

*  The  analysis  of  this  is  given  by  Sir  J.  Crichton- 
Browne  in  the  Times  of  Nov.  3,  1920,  as  follows:  moisture, 
4.4;  organic  matter,  52.6;  silica  and  insoluble  silicates,  21.0; 
iron  oxide  and  alumina,  9.7;  lime  (CaO),  0.2;  carbonic  acid, 
with  traces  of  sulphuric  and  phosphoric  acids,  6.1;  total, 
100.0. 


ROOS-DUST  IN  PRINTERS-  WORKROOMS  263 

that  the  dust  does  not  escape  into  the  air  me  at  the  South  Western  PoKtechnic  In- 

dunng  the  process  of  removal.  stitute,    Clielsea,   and   the   thinks   of   the 

Ihe  hil,oratory  work  in  connection  with  Department  are  due  to  the  authorities  for 

the  dust  determmations  was  carried  out  by  tlie  facihties  given. 

BrBLIOGR.\PHY 

1.    puckering    G.E.:    Methods  of  Determination  2.    Collis,    E.    L.:     Industrial    rneunmn.K.onioses. 

of  Dust  and  Lead  m  the  A.r  of  W.,rkr»o.ns.  with  Sp^^-ial  Reference  to  Dust-Phthisis.     MQ- 

Ann.  Rep.  Ch.ef  Inspect.  Factories,   1910.  p.  roy  Let-tures.  1915,  p.  32.    Pub.  Health,  1915- 

'^^^-  191C,  29,  16. 


INFLUENCE   OF  INDUSTRIAL   NOISES* 


D.  J.  GLIBERT,  M.D. 

Chief  Medical  Inspector  of  Factories,  Brussels 


THIS  memoir  —  a  resume  of  all  that 
was  known  in  1914  in  regard  to  the  in- 
fluence of  industrial  noises — was  originally 
written  at  the  request  of  the  Third  Inter- 
national Congress  on  Occupational  Diseases 
due  to  be  held  at  Vienna  in  the  later  half  of 
August,  1914,  and  was  intended  to  open 
the  debate  on  the  subject.  As  the  author 
lived  in  the  occupied  part  of  Belgium  dur- 
ing the  war,  he  had  no  access  to  new 
work,  but  nothing  new  appears  to  have 
been  discovered,  except  that  we  have 
since  learned  of  the  idea  that  deafness  fol- 
lowing an  explosion  is  usually  temporary 
except  when  the  auditory  nerve  is  affected. 
It  seems  wise,  however,  to  re-introduce  so 
important  a  subject  in  order  to  stimulate 
research  on  the  part  of  ear  specialists.  The 
influence  of  noise,  which  is  at  times  deafen- 
ing, has  been  little  studied  in  spite  of  the 
fact  that  it  is  present  in  nearly  all  indus- 
tries. The  author,  although  not  an  ear 
specialist,  feels  justified  in  writing  this 
resume  because  it  states  the  present  po- 
sition; because  there  is  confusion  among 
ear  specialists;  and  because  of  his  twenty 
years'  experience  in  factory  work  which 
has  enabled  him  to  bring  out  the  etiological 
factor  in  questions  on  which  industrial 
doctors  rcc(uire  a  solution  from  ear  spe- 
cialists. 

Deafness  as  an  Occupational 
Disease  or  Accident 

Deafness  as  an  occupational  disease 
should  be  studied  separately  from  deafness 
caused  by  traumatic  lesions  due  to  explo- 
sions, gun  fire,  blasting,  etc.,  which  cause 

*  TraiKslated  from  Hulletin  dii  Serrice  Medical  du  Tra- 
vail, Jan.,  1920,  No.  1,  by  Dr.  S.  A.  Henry,  H.  M.  Medical 
Inspector  of  Factories,  Manchester,  England.  Received 
for  publication  May  i,  1941. 


immediate  lesions,  although  the  difference 
is  perhaps  somewhat  subtle.  Save  in  spe- 
cial cases  where  initial  lesions  are  clearly 
recognized  as  immediate,  it  is  only  after 
repeated  injuries  that  ear  affections  be- 
come obvious,  and  therefore  it  is  nearly 
always  convenient  to  classify  the  deafness 
of  gunners  and  firers  of  mines  among  occu- 
pational diseases  rather  than  among  acci- 
dents. Consequently,  for  practical  purposes 
we  may  include  the  affections  caused  by 
injurious  action  of  the  air  during  firing 
among  ear  injuries  caused  by  noise  proper. 

Outline  of  Previous  Investigations 

Classic  writers  on  occupational  diseases 
are  generally  reticent  on  the  subjectof  disor- 
ders caused  by  noise  in  industry.  Layet  (1) 
points  out  that  the  deafness  of  copper- 
smiths was  known  of  old  and  that  sheet 
iron  workers,  coppersmiths,  blacksmiths, 
and  coopers  are  nearly  always  hard  of  hear- 
ing and  become  more  so  the  longer  they  re- 
main at  their  trade  —  a  perversion  of  hear- 
ing shown  by  increased  perception  of  high 
notes  or  loss  of  perception  of  low  notes. 
Layet  observed  an  old  foreman  who  ap- 
peared to  hear  only  in  the  midst  of  the 
greatest  noise,  while  at  other  times  he  com- 
plained of  continual  buzzing  in  his  ears,  so 
that  he  was  an  example  not  only  of  the 
phenomenon  of  Willis  but  of  other  ear 
trouble.  This  phenomenon  of  Willis  (hear- 
ing better  when  a  certain  sound  is  present 
than  under  ordinary  conditions)  is  frequent 
in  noisy  inihislries.  where  another  j)hcn()m- 
enon  is  also  observed  which  must  not  be 
confounded  with  (hat  of  Willis  —  namely, 
the  power  of  certain  workers  to  converse 
together  in  a  nearly  normal  voice  when  a 


iSi 


GLIBERT  —  INFLUENCE  OF  INDUSTRIAL  NOISES                 265 

stranger  is  at  the  time  deafened  and  inca-  closed  space.  Delia  Vedova  of  Milan,  at 
pable  of  making  himself  heard  without  the  Seventh  Italian  Congress  of  Laryn- 
raising  his  voice.  In  factories  for  removal  gology  and  Rhinology,  insisted  on  good 
of  coarse  hair  from  furs  by  machinery  or  ventilation  in  enclosed  spaces  and  i)ointed 
in  works  where  hatters  fuiTiers'  proces.ses  out  among  the  causes  harmful  to  hearing, 
are  carried  on  amid  intense  noise,  I  have  dust,  irritating  gases,  high  temperature, 
often  observed  the  workers  laughing  and  dampness,  and  variations  of  almos|)lieric 
talking  together  when  I  could  not  hear  the  pressure,  and  cited  as  a  proof  of  the  iujuri- 
sound  of  their  voices.  Is  there  a  special  ous  influence  of  a  confined  space  the  fact 
adayjtation  of  the  worker's  voice  or  a  jKir-  that  among  soldiers  inflannnatory  condi- 
ticular  accommodation  of  the  organism  of  ti(ms  of  the  ear  are  less  fre(|uent  during 
the  ear,  or  both?  Be  it  as  it  may,  this  manoeuvres  than  during  life  in  l)arracks. 
phenomenon  is  not  necessarily  accompanied  As  far  back  as  1S77,  the  replacement  on 
by  a  dimimition  of  hearing  in  a  quiet  at-  railways  of  shrill  toned  whistles  by  those  of 
mosi)here.  a  dccjier  note  or  by  other  signals,  such  as 
According  to  Roosa,  workers  in  a  noisy  bells,  was  suggested.  Hedinger,  in  1882, 
atmosphere  get  a  true  nerve  lesion;  they  tested  the  hearing  of  1,100  railway  em- 
hear  less  well  and  do  not  recover  their  acu-  i)loyees  and  found  only  4S  ])er  cent,  of  hard- 
ity  of  hearing  except  by  staying  off  work  ness  of  hearing  among  engine  drivers  and 
for  some  time,  and  eventually  the  auditory  stokers  as  against  95  per  cent,  among  the 
trouble  becomes  permanent.  According  to  other  employees.  He  concludes  that  in- 
Dr.  Moure  of  Bordeaux,  the  more  the  noise  temperate  habits  are  much  more  the  cause 
produced  in  a  small,  closed  anil  resounding  of  catarrhal  affections  of  the  ear  than  is 
space,  the  more  rapid  is  the  damage  to  the  the  engine  whistle.  Guterbock  states  that 
auditory  nerve;  that  is  why  he  considers  hardness  of  hearing  among  engine  drivers 
as  the  most  ex])osed  young  persons  who  increases  in  i)roportion  to  the  length  of 
are  employed  in  coppersmiths'  workshops  service,  as  the  following  table  shows: 
to  assist  riveters  in  the  interior  of  boilers  j-^^^^  ^j  ^^^.^^  PerccUage  of  Defective  Hearers 

in  holding  rivets  in  j^lace  during  hammer-  i^gg  tlian  3 5.8 

ing.      It    is   iu»cessary   to   class   with    this  From  5  to  9 7.3 

group  young  persons  wlio  enter  the  boilers  From  10  to  U .                                    8.0 

for  the  purpose  of  removing  the  deposit  ^''°™  1^  to  li) 31.8 

/I     •]         1  \       TV  r  I  •  More  than  -20 52.1 

(boiler  cleaners).     iMy  personal  experience 

confirms  the  fact   that  these  workers  at  Dr.  G.  Boval  likewise  states  that  the 

times  leave  this   noisy   atmosphere  abso-  deafness  of  engine  drivers  and  stokers  in- 

lutely  (lazed,  deaf,  and  in  a  slate  of  vertigo  creases  with  age  and  years  of  service  from 

whicli    lasts   for   .several    minutes.      These  11.7  to  (H  per  cent,  accortling  to  age,  and 

facts   may   be   compared   with   those   ob-  from  18  to  75  per  cent,  according  to  years 

served  in  ironclads  after  a  sea  battle  and  of  service.     Barr  makes  similar  observa- 

in  this  connection  De  Merrys  reports  that  tions  on  100  persons;   after  seventeen  and 

on    the    Cesarewitsch,   twenty-four    hours  one-half  years'  service  none  heard  a  watch 

after   the   engagement,   many   men   com-  normallj',  fifty  could  not  hear  the  low  voice, 

plained  of  headache,  loss  of  memory,  and  thirty-three  jjerceived  it  with   both  ears, 

deafness.  and  eight  with  only  one  ear. 

Other  influences,  however,  than  that  of  It  is  suryjrising  that  observations  in  tex- 

a  resounding  medium  can  be  cited  to  ex-  tile  industries  are  rare.    Ropke  (2)  refers  to 

plain  auditory  lesions  of  workers  in  an  en-  the    examination    of    twenty    spinstresses. 


266 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


fourteen  of  whom  were  hard  of  hearing, 
and  of  fourteen  weavers,  none  of  whom 
heard  normally.  Dr.  E.  Coosemans,  at  the 
.  Sixth  International  Congress  of  Otology 
held  in  London  in  1899,  read  a  paper  on 
hearing  among  "beetlers,"  who,  after  ten 
or  twelve  hours  of  daily  labor,  exhibit  more 
or  less  marked  deafness,  which  diminishes 
after  a  few  hours,  and  which  becomes  nor- 
mal after  a  Sunday's  rest. 

Another  injurious  occupation  is  that  of 
telephone  workers.  Capart  (3),  reporting 
upon  the  telephone  industry,  stated  that: 
(1)  Occupational  use  of  the  telephone  is  a 
cause  of  fatigue  to  the  ear,  which  may  be  ag- 
gravated too  far  by  certain  circumstances, 
such  as  production  of  induction  currents, 
sudden  opening  and  shutting  of  the  circuit, 
etc. ;  and  (2)  fatigue  and  overwork  of  tele- 
phonists are  at  times  the  cause  of  various 
nein-oses,  neurasthenia,  hysteria,  etc.  How- 
ever, others,  as  Dr.N.R.  Blegvad  (4)  are  less 
pessimistic  and  do  not  think  that  telephone 
work  hastens,  or  makes  active,  pre-existing 
ear  affections.  Generally  the  power  of  per- 
ception of  high  sounds  is  little  altered.  Of 
354  telephone  employees  examined  with 
regard  to  the  lowest  sound  perceptible  to 
the  normal  ear  (sixteen  vibrations), seventy- 
five  could  not  perceive  it  on  one  or  both 
sides.  Blegvad  admits  that  among  certain 
individuals  employment  can  cause  earache, 
buzzing,  vertigo,  or  Meniere's  syndrome. 
Recently  Dr.  Tretrop  of  Antwerp  (5)  re- 
ported two  ear  accidents,  one  to  a  telephone 
girl,  and  the  other  to  a  merchant  speaking 
on  the  telephone,  which  he  attributed  to 
the  too  sudden  breaking  of  a  current  of 
which  the  voltage  had  lately  been  increased 
to  20  volts. 

Attention  was  first  drawn  to  the  action 
of  rejiorts  and  explosions  on  the  ear  when 
the  use  of  gunpowder  was  in!  roduced.  Am- 
broise  Pare  taught  us  that  heavy  artillery 
could  cause  ear  lesions  and  cerebral  con- 
cussion. Layet  (6)  mentions  the  investi- 
gations of  Percy  who  pointed  out  hem- 


orrhages following  a  ruptured  tympanum, 
with  persistent  severe  headache,  more  or 
less  pronounced  disturbances  of  hearing, 
and  refractory  otitis  following  on  the 
non-cicatrization  of  the  rupture.  He  also 
recalls  Barthelemy's  remarks  on  a  momen- 
tary hardness  of  hearing  with  hissings, 
buzzings,  and  "still  noises,"  (proof  of 
nerve  trouble)  met  with  among  gunners 
after  firing.  These  observations,  however, 
were  made  before  war  was  brought  to 
a  fine  art,  and  require  re-investigation  to 
prove  whether  or  not  they  ai'e  true. 

Delsaux  has  analyzed  all  the  work  on 
the  noise  of  explosions  and  firing,  and  re- 
calls the  work  of  R.  Mliller  who  examined 
fifty-one  gunners,  noting  the  extent  of  their 
hearing  before  firing  and  three  days  after. 
Six  were  excluded  because  their  ears  were 
plugged  with  wax;  of  the  remainder  ex- 
amined before  firing,  thirty-four  were  nor- 
ma:l  and  all  the  others  had  symjjtoms  of 
actual  disease  or  signs  of  old  cicatrices. 
After  firing,  fifty-two  ears  remained  in 
statu  quo  and  all  the  others  showed  tym- 
panic congestion.  There  were  seven  cases 
of  hemorrhage  of  the  tympanum  but  none 
of  rupture  of  the  membrane.  The  duration 
of  perception  of  the  timing  fork  by  bone 
conduction  was  shortened.  On  the  subject 
of  air  conduction,  the  author  is  reticent 
and  calls  for  further  investigation.  It  is 
the  experience  of  Cheatle,  in  England,  that 
naval  officers  are  more  affected  than  their 
men  and  that  the  very  high  tone  of  guns 
of  small  calibre  and  of  machine  guns  is 
more  injurious  than  that  of  big  guns.  In 
addition,  autopsies  as  well  as  experiments 
on  animals  corroborate  the  fact  that  occu- 
pational noises  are  capable  of  seriously  in- 
juring the  organs  of  hearing. 

Elementary  Knowledge 

In  reading  works  on  the  subject  of  the 
influence  of  industrial  noises,  one  is  con- 
stantly meeting  vague  expressions,  such  as 


GLIBERT  —  IXFLUENCE  OF  INDUSTRIAL  XOISES 


267 


"muffled  sounds,"  "light  sound,"  "great 
noise,"  etc.,  which  it  is  necessary  to  define 
uniformly. 

It  is  generally  admitted  that  all  sounds 
and  noises  which  the  ear  receives  can  be 
referred  to  musical  soimds.  Noise  propi'r 
is  composed  of  a  rajiid  and  irregular  suc- 
cession of  different  auditory  sensations. 
Sound,  on  the  contrary,  is  uniform,  calm, 
and  without  variations  in  its  component 
parts.  It  possesses  three  principal  (piali- 
ties  which  are  peculiar  to  it :  intensity,  re- 
sulting from  am[)litude  cf  vibration  and 
diminishing  by  distance  in  proportion  to 
the  square  of  the  distance,  from  the  fact 
of  the  diminution  of  the  amplitude  of  vi- 
bralions  transmit  ted;  height,  which  in- 
creases will)  the  number  of  \il)rati()ns;  and 
tone,  which  depends  on  the  harmonics, 
"superior  or  inferior,"  of  the  fundamental 
sound.  Certain  authorities  add  to  inten- 
sity, height,  and  tone  the  itlea  of  duration. 
To  these  intrinsic  qualities  of  sound  nuist 
be  added  an  extrinsic  (|ualily  des(ril)e(l 
thus  by  Ilelmlioltz:  "In  the  main,  in 
sounds  of  equal  strength  the  sensibility  of 
the  ear  changes  with  the  height  of  the 
sound."  Zwaardemakcr  (7)  formulates 
the  following  conclusions  as  to  this  \arial>le 
sensibility  of  the  ear  for  ilitVcrcnl  sounds: 

1.  The  maximum  sensibility  of  tlie  liuman  ear 
respoiuis  to  3,072  (loul)le  vil)rations  (g-1  of  tlie  Ger- 
man notation,  sol  (i  of  the  French  notation). 

2.  The  zone  of  very  distinct  sensibility  extends 
from  250  double  vibrations  to  6,144  double  vibra- 
tions. 

3.  Outsiile  this  zone  to  the  limits  of  the  scale, 
sensibility  diminishes  considerably. 

There  are  three  principal  theories  of  the 
way  in  which  sound  is  perceived: 

1.  Hehnholtz's  Theory.- — The  organ  of 
Corti  vibrates  in  concert.  The  elements 
of  the  internal  car  are  attuned  to  different 
heights  of  soimd;  low  sounds  are  perceived 
by  the  part  furthest  from  the  base  of  the 
cochlea,  while  sharp  sounds  are  perceived 
nearest  this  base. 


2.  Ilydrodynamic  Theory  of  Bonnier  (8). 
—  The  liquid  of  the  cochlea  moves  in  l)ulk 
and  rubs  the  sensory  epithelium.  Bonnier 
compares  the  organs  of  the  ear  not  to  res- 
onators, but  to  registers. 

:>.  Prf.s-s-iire  Theory  of  Marage.  -  The 
perception  of  sounds  is  due  to  differences 
in  the  pressure  of  the  endolymjih.  with  no 
definite  auditory  localization. 

^Musical  sounds  jiroper  are  met  at  times 
in  industry,  as  in  liannnering  deep-toned 
metals,  but  these  more  or  less  pure  sounds 
are  rarely  isolated.  ^lore  usually  noise 
proper  is  heard,  but  that  also  has  its  in- 
tensity, height,  and  tone.  It  is  compara- 
tively easy  to  determine  experimentally 
tlu^  relative  intensity  of  an  industrial  noise 
wlu-n  if  is  regular  and  more  or  less  continu- 
ous and  can  be  compared  to  anolhcr  noise, 
a  short  distance  away,  of  constant  intensitj'' 
and  sufficient  to  rise  above  it.  The  meas- 
ure of  the  displacement  required  would 
give  the  relative  intensity.  Exact  estima- 
niation  of  the  height  of  noises  is  nnich  more 
dillicult,  and  we  must,  for  the  most  ]jart, 
rely  on  a  few  observers  for  this  information. 
All  hough  a  well-trained  ear  learns  by  prac- 
tice lo  grade  the  tone  of  noises  by  comjjari- 
son  willi  a  known  height  of  tone,  it  would 
be  more  satisfactory  if  the  ear  specialist 
would  furnish  a  precise  method  of  deter- 
mining as  nearly  as  possible  the  notation 
of  different  noises.  Tone,  on  the  other 
hand,  can  be  described  with  sufficient 
precision  for  practical  purposes.  It  char- 
acterizes the  source  of  noise;  it  enables 
one  to  distinguish  various  machines  in 
action,  without  seeing  them;  and,  in  com- 
bination with  height,  it  gives  to  certain 
noises  that  disagreeable  character  which 
is  peculiar  to  them  —  e.  g.,  the  rasping 
noise  in  the  finishing  off  of  white  stones,  or 
the  grating  of  saws  or  files.  When  it  has 
this  unpleasant  character,  tone  is  important 
in  observations,  as  it  inevitably  has  an  ill 
effect  on  persons  of  nervous  temperament. 
It  is  also  necessary  to  pay  attention  to  the 


268 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


rhythm,  and  the  continuity,  regularity,  or 
irregularity  of  a  noise  essentially  uniform 
are  also  factors  to  be  dealt  with.  The  un- 
expectedness of  certain  short,  loud  noises 
bursting  forth  at  rather  long  intervals  has 
a  disagreeable  effect  on  the  nervous  system. 
Finally,  it  is  necessary  to  have  comparative 
information  on  the  subject  of  intensity  of 
vibration  communicated  to  the  ground  and 
to  the  body  of  a  worker  by  the  vibrating  of 
noisy  machines.  This  information  is  not 
difficult  to  obtain. 

NoisT  Trades 

It  would  be  wrong  to  imagine  that  all  the 
employees  in  a  brass  foundry,  in  large  iron 
works,  or  in  shipbuilding  yards  are  equally 
exposed  to  noise  in  their  work.  We  must 
have  a  reasonable  classification  which  will 
serve  to  show  that  it  is  necessary  in  each 
group  to  take  into  account  accessory  cir- 
cumstances. Take,  as  an  example,  flax 
spinning  which  must  be  carefidly  dis- 
tinguished from  weaving  of  linen,  just  as 
it  must  not  be  confounded  with  "steeping" 
and  "stripping"  or  "scutching,"  —  the 
operations  which  precede  it. 

In  a  linen  factorj^  one  meets  all  the  scale 
of  noises:  there  are  quiet  processes,  as 
winding,  or  reeling,  and  heckling;  less 
quiet  processes,  as  drying  and  packing; 
noisy  ones,  as  combing  by  machinery, 
carding;  and,  finally,  very  noisy  ones,  as 
in  the  preparing  rooms  and  spinning  rooms 
where  the  noise  is  so  great  that  orders  have 
to  be  given  by  means  of  a  shrill  whistle. 
Hence,  one  sees  the  inaccuracy  of  medical 
observation  which  is  limited  to  describing 
the  examinees  as  workers  in  the  linen  in- 
dustry. Carding,  preparation,  etc.,  irritate 
the  nasopharynx  by  dust,  and  spinning 
gives  rise  to  similar  trouble  because  of  the 
humidity  and  heat  which  may  cause 
"chills."  Combing  by  machinery  exjjoses 
the  young  worker  to  dust  and  muscular 
strain. 


In  many  factories  the  noise  is  great  in 
certain  places  and  not  in  others,  as  in  metal 
stamping,  especially  in  making  metal  boxes. 
Very  often  in  these  works  there  are  quiet 
corners,  also  the  noise  of  one  stamping 
machine  varies  from  another,  and  curiously 
enough  it  is  not  always  the  stamper  who  is 
most  exposed  to  the  noise  of  his  own  ma- 
chine. Certain  other  occupations  are  quite 
unknown  to  aurists.  How  many  of  them 
suspect  that  in  the  preparation  of  little 
rubber  objects  such  as  nipples  for  feeding 
bottles  and  toy  balloons,  there  exists  at 
times  noise  comparable  to  that  of  the 
loudest  hammering.  These  examples  are 
sufficient  to  prove  the  necessity  for  medical 
inspectors  of  factories  to  draw  up  a  list  of 
noisy  industries  which  would  serve  as  far 
as  possible  as  a  basis  of  comparison,  and  to 
point  out  all  the  other  peculiarities  which 
may  influence  health.  The  ear  specialist 
ought  to  be  in  possession  of  all  the  facts 
before  he  pronounces  on  the  etiology  of  a 
lesion,  and  he  should  take  into  account  all 
the  causes  other  than  noise  which  could 
explain  in  part  or  in  whole  the  maladj'^ 
observed. 

In  addition  to  information  in  regard  to 
noise,  the  aurist  should  know  in  detail  the 
peculiar  health  conditions  of  certain  trades. 
Lesions  of  the  middle  ear  or  nasopharynx 
are  in  themselves  a  menace  to  the  integ- 
rity of  hearing.  Noise  being  e<iual,  trades 
which  specially  expose  a  worker  to  these 
lesions  are  more  harmful  to  hearing  than 
others;  hence,  the  necessity  of  paying 
attention  to  different  accessory  risks,  such 
as  mercury,  carbon  bisulphide,  and  espe- 
cially lead,  which  is  a  poison  to  the  internal 
ear.  Irritant  vapors,  or  acid  fumes,  and 
toxic  gases,  such  as  carbon  monoxide,  in 
the  form  of  slow  chronic  poisoning  attack 
hearing  as  well  as  memory.  In  the  same 
way,  it  is  necessary  to  note  the  influence  of 
heat,  humidity,  and  dusts.  Moreover,  the 
influence  of  fatigue,  nuiscular  and  intellec- 
tual,  must  be  remembered.      Fatigue  in 


GLIBERT  —  INFLUENCE  OF  INDUSTRLIL  NOISES 


269 


itself  lessens  auditory  acuity  even  when 
not  excessive.  For  example,  examination 
of  twentj'-four  bicyclists  •  who  had  ridden 
50  kilometers  showed  that  air  perception 
was  diminished,  especially  for  sharp  sounds 
fn).  After  a  few  hours'  rest  hearing  had 
already  improved.  Finally,  it  must  be  re- 
membered that  ear  lesions  are  often  accom- 
panied by  loss  of  sense  of  space  (vertigo, 
Meniere's  syndrome),  and  in  this  connec- 
tion I  wish  to  note  the  occupational  risk 
on  ladders,  scaffolding,  and  work  in  par- 
ticularly dangerous  places. 

N.vTURK  OF  Lesions 

According  to  I/ayet,  most  authors  think 
that  noise  is  a  dclermiiiing  factor  in  caus- 
ing a  true  lesion  of  the  auditory  nerve.  At 
the  autopsy  of  an  old  co])])ersinith  afllictcd 
during  life  with  occupational  tlcafness,  Hal)- 
ermann  found  degeneration  of  the  organ 
of  Corti  and  other  nerve  elements  at  the 
base  of  the  cochlea.  Similar  lesions  were 
found  by  the  same  author  at  the  autopsies 
of  several  other  subjects  atHicled  with  deaf- 
ness which  was  considered  to  be  due  to 
occupation.  INfoure,  of  Bordeaux,  is  of  the 
opinion  that,  when  the  ()ccui)ational  dis- 
ease is  established  and,  in  spite  of  rest, 
hearing  docs  not  return,  it  is  a  question  of 
deep-seated  troul)le  —  a  labyrinthine  af- 
fection, of  which  the  diagnosis  is  certain 
and  proved  by  acoustic  tests,  before  the 
absence  of  lesions  of  other  parts,  such  as 
tympanum,  tubes,  and  ossicles,  is  objec- 
tively proved. 

Wittmaack  has  made  considerable  prog- 
ress in  the  question  of  lesions  caused  by 
noise.  He  has  demonstrated  that  aninuils, 
subjected  under  certain  conditions  to  the 
action  of  a  noise  of  varied  duration,  with 
or  without  rest,  show  profound  lesions.  On 
microscopic  examination  the  middle  ear 
appeared  intact,  as  did  also  the  vestibule, 
while  obvious  changes  were  seen  in  the  in- 
ternal ear  in  the  region  of  the  cochlea. 


Wittmaack's  work  has  been  controlled  by 
Professor  Siebenmann  and  his  pupil.  Dr. 
Yoshii,  with  varied  intensities  of  sound. 
These  authors  constantly  found  visible  and 
characteristic  anatomic  lesions  of  the  organ 
of  hearing.  These  lesions,  varying  with  the 
sound  used,  took  effect  on  the  organ  of 
Corti,  and  the  nerve  fibers  and  cell  ganglia. 
It  is  useful  also  to  recall  that,  with  a  i)ure 
sound,  always  the  same,  Wittmaack  found 
a  lesion  of  the  cochlea  peculiar  to  itself  in 
each  case. 

11.  Marx,  of  Ileidellierg.  experimenting 
on  guinea-pigs  under  conditions  similar  to 
his  predecessors,  obtained  similar  results, 
at  least  in  the  main  points.  The  degenera- 
tion of  the  organ  of  Corti,  however,  was 
found  to  be  situated  a  little  further  from 
the  base  of  the  cochlea  than  that  found  by 
Wittmaack.  Von  Eicken.  studying  the 
action  of  deep  sounds  jM'oduced  l)y  organ 
pipes,  states  that,  wlien  the  middle  ear  is 
normal,  certain  deep  sounds  cause  altera- 
tions of  the  cochlea  at  the  level  of  the 
second  turn  of  the  spiral.  Other  deep 
sounds,  on  the  other  hand,  appear  harmless. 
Delsaux  summarizes  the  conclusions  to  be 
drawn  from  the  patient,  and  extremely 
careful,  researches  of  Ilaenli.  Violent  ex- 
citation of  hearing,  or  reports,  attack  at 
first  the  terminal  organ  which  they  destroy 
in  a  certain  way  and  it  is  only  later  that 
the  neurones  atrophy.  Later  still,  there 
appear  alterations  in  the  membrane  of 
Reis.sner. 

A  good  synopsis  of  the  results  of  Witt- 
maack's, Siebenmann's  and  Yoshii's  ex- 
periments is  found  in  the  very  instructive 
work  of  E.  J.  Moure  and  P.  Cauzard  on 
functional  examination  of  the  labyrinth 
(10).  The  authors  of  this  work  are  in- 
clined to  consider  the  experimental  results 
as  jjroved  definitely,  and  allow  the  follow- 
ing assertions  of  Wittmaack:  (1)  the  in- 
tegrity of  the  vestibide  in  lesions  due  to 
noise;  (2)  the  destruction  or  alteration  of 
the  same  section  of  the  cochlea  bv  sounds 


270 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


of  the  same  instrument  (whistle).  In  a 
personal  communication  to  these  authors, 
Siebenmann  expresses  himself  thus:  "It 
follows  (from  the  experiments  of  Witt- 
maack  and  his  school)  that  a  pure  sound 
only  affects  a  single  point  of  the  cochlea  and 
that  the  lower  the  sound  is,  the  higher  the 
point  is  found  in  the  cochlear  region." 

From  the  analysis  of  twenty  principal 
clinical  works  on  the  results  of  reports  and 
explosions,  Delsaux  concludes  that  the  dis- 
orders of  hearing  or  the  lesions  of  the  ear 
arising  from  these  causes  may  be  classified 
as:  (1)  lesions  of  the  tympanum;  (2)  le- 
sions of  the  drum;  (3)  disturbance  of  the 
labyrinth;  (4)  progressive  deafness;  and  (5) 
diverse  nervous  disorders.  He  states  that 
all  experiments  tend  to  show  that,  ai)art 
from  ruptures  of  the  tympanum  and  lesions 
of  the  drum,  and,  in  rare  cases,  lesions  of 
the  ossicles,  injury  to  the  ear  by  detona- 
tions gives  rise  in  the  internal  ear  to  tem- 
porary or  progressive  or  definitive  lesions, 
situated  mostly  in  the  tymj^anic  slope  of 
the  cochlea  and  rarely  and  temporarily  in 
the  vestibular  slope  or  in  the  static  appara- 
tus of  the  internal  ear.  Finally,  it  is  well 
to  keep  in  mind  the  views  suggested  to 
Layet  by  Dr.  Moure,  namely,  that  when 
the  organs  are  intact  the  principal  indus- 
trial noises  act  on  the  labyrinth,  while  re- 
ports and  explosions  may  also  act  directly 
on  the  organs  of  the  middle  ear. 

Transmission  of  Noise  by  Air  and 
BY  Solid  Substances 

Must  one  blame  noise  transmitted  at  the 
same  time  by  air  and  by  solid  bodies? 
Must  one,  on  the  other  hand,  consider  air 
vibration  alone  as  practically  harmless  and 
blame  chiefly  vibrations  and  tremors  which 
are  communicated  to  the  bonj'  skeleton.' 
This  is  a  necessary  point  in  prophylaxis. 
It  is  a  problem,  the  solution  of  which,  if  it 
can  be  obtained,  will  revolutionize  the 
methods  of  protecting  the  worker  antl  the 


legal  measures  formulated  by  dififerent 
governments. 

The  accidental  results  of  great  explosions 
or  a  sudden  change  of  pressure  among 
workers  in  an  atmosphere  of  compressed 
air  must  be  excluded.  These  are  cases  of 
"superior  force,"  the  effects  of  which  can- 
not be  used  as  a  proof  for  or  against  the 
theory  as  to  the  cause  of  it.  Would  it  not 
be  wise  also  to  exclude  the  results  of  re- 
ports and  explosions  knowingly  caused? 
Truly,  the  deafness  of  gunners  is  an  occu- 
pational one,  but  the  conditions  producing 
it  are  not  met  with  in  industry,  except 
cjuite  exceptionally  among  those  employed 
in  shooting  galleries  or  attached  to  dejiots 
for  testing  firearms.  In  firing  a  mine,  it 
is  obviously  wise  that  workers  who  start 
the  fuse  should  be  as  far  away  as  possible, 
and  consequently  lesions  of  the  ear  among 
them  ought  to  be  much  more  often  in  the 
category  of  occupational  accidents  than  of 
occupational  diseases.  In  addition,  the 
violent  disturbances  which  occur  from  the 
deflagration  of  explosives  singularly  com- 
plicate the  principle  of  the  problem.  Hence, 
it  would  perhaps  be  wise  to  limit  the  sub- 
ject to  industrial  noises,  properly  so  called, 
which  are  far  more  frequent.  In  return,  it 
would  be  useful  to  compare  the  influence 
of  vibrations  where  the  noise  is  dominant, 
with  the  action  of  vibrations  when  shaking 
is  the  principal  cause  of  trouble. 

There  are  a  great  number  of  workers  on 
trains,  trams,  and  vehicles  of  all  kinds, 
whose  whole  bodies  are  for  many  hours  ex- 
posed to  an  energetic  vibratory  shaking, 
without  which,  however,  the  noise  to  which 
these  workers  are  exposed  would  still  be 
considered  as  excessive.  Whatever  the 
value  of  these  previous  remarks  may  be, 
let  us  examine  the  main  sources  of  infor- 
mation at  our  disposal. 

Castex,  in  1897,  speaking  of  engine 
drivers  and  stokers,  pointed  out  the  harm- 
ful influence  of  vibration:  "shaking  acts 
on  the  labvriulh  and  causes  sclerosis,  as 


GLIBERT  —  INFLUENCE  OF  INDUSTRIAL  NOISES 


^271 


seen  in  the  occupation  of  hammering." 
This  is  the  conclusion,  aptly  expressed,  to 
which  Wittniaack  came  in  his  remarkaljle 
experiments,  begun  in  1903.  on  both  ears 
of  ninety  guinea-pigs.  Six  guinea-pigs 
were  subjected  night  and  day.  without  in- 
terruption, to  the  noise  of  an  electric  bell, 
freely  susi)eiided  above  their  cage.  The 
animals  were  killed  in  succession  after  5, 
10.  '•20,  .'50,  40  and  60  davs,  and  no  lesion 

« 

was  found  in  any  ])art  of  the  auditory 
apparalus.  This  negative  result  gave  rise 
to  the  idea  that  ear  affection  cau.sed  by 
noise  must  be  due  to  something  more  tliau 
the  sim|)le  transmission  Ijy  air.  He  lliere- 
fore  modified  his  experiments  in  such  a 
way  that  the  vibrations  of  the  electric  bell 
were  comnnmicated  to  a  tin  plate  on  the 
floor  of  the  cage.  W-ry  dilfereut  results 
were  then  obtained;  rapid  emaciation  of 
the  animals  was  observed  and  two  died 
after  14  days.  Controlled  ex])eriments  led 
to  the  same  results  and  although,  as  be- 
fore, the  middle  ear  of  animals  killed  after 
various  intervals  appeared  intact,  the 
nerve  terminals  in  the  cochlea,  i-specially 
the  organ  of  Corii,  were  degenerated. 
Analogous  exjieriments,  in  which  sufficient 
rest  was  allowed  to  resemble  the  normal 
conditions  of  human  industry  as  far  as 
possible,  furnished  similar  results.  Witt- 
nuuick  tried  also  the  influence  of  other 
noises,  especially  that  of  a  whistle,  as  well 
as  air  disturbance  caused  by  firearms. 
As  a  conclusion  to  his  researches,  he  ad- 
mits the  preponderating  influence  of  vi- 
brations of  soliil  sulistances  on  lesions  of 
the  ear,  due  to  sounds,  and  he  calls  atten- 
tion to  the  fact  that  among  workers  most 
frequently  afflicted  with  occupational  deaf- 
ness one  finds  nearly  always  the  possible 
transmission  of  vibrations  by  the  bonj' 
skeleton,  especially  among  blacksmiths, 
in  whose  work  they  are  transmitted  by  the 
arm .  In  noisy  factories  the  constant  vibra- 
tion of  the  ground  is  frequently  observed. 
According  to  Peyser,  Wittmaack's  first 


statement  is  of  minor  importance;  the 
second  on  the  other  hand  is  of  capital  in- 
terest. The  elasticity  of  the  soft  parts  and 
articulations  of  the  wrist  and  of  the  arm 
appeared  to  him  to  be  a  good  non-con- 
ductor while  the  heavy  body  of  the  worker 
resting  on  vibrating  ground,  and  especially 
theb()n\-  frame,  from  feel  to  head.\\ould  be 
favorable  conductors  for  the  transmission 
of  vibratiim.  An  intenuediate  condition 
would  be  that  of  boiler  riveters,  who  sup- 
port their  mechanical  hammers  by  prop- 
ping their  elbows  against  their  chests.  In 
corroboration,  Peyser  cites  the  authority 
of  Kriedcrick  of  Kiel,  wiio  thinks  that  the 
deafness  of  naval  officers  is  at  least  jiar- 
tially  attributable  to  vibrations  of  the  ship 
during  flring.  Finally,  with  the  object  of 
studying  the  influence  of  conduction  al- 
most exclusively  by  air,  Peyser  examined 
the  builders  of  hulks  made  of  curved 
iron  sheets  which  have  to  be  riveted. 
During  construction  the  hulk  is  placed  on 
the  grouiul,  with  the  keel  in  the  air,  and 
supported  on  wooden  blocks  which  rest  on 
a  mass  of  concrete  ;}0  ceiitinu-ters  thick. 
The  worker  crawls  under  this  metallic  arch 
and  proceeds  to  rivet  by  means  of  per- 
cussion hammers  worked  by  compressed 
air.  Of  twelve  workers  engaged  for  two 
years  at  this  work,  none  had  become  hard 
of  hearing  at  the  tinu>  the  examination  was 
nuide.  Pey.ser  concludes  that  this  con- 
firms the  theory  of  Wittmaack  on  the  in- 
fluence of  vibrations.  Neither  the  number 
of  observations,  however,  nor  the  length 
of  tinu>  of  service  allow  final  conclusions 
to  be  drawn.  Peyser  concludes  with  the 
following  statements : 

1.  Coiitiiiuiil,  but  moderate  noise,  exclusively 
transmitted  l)y  air,  lias  little  or  no  action  on  the 
organ  of  hearing. 

■2.  Short,  but  intense  and  shrill  sounds,  especially 
when  repeated,  injure  the  organ  of  hearing  in  a 
temporary  or  a  permanent  way. 

:5.  Simultaneous  conduction  of  noise  by  air  and 
by  the  bony  skeleton,  and  above  all  by  the  vibration 
of  the  ground,  affects  hearing  finally  and  seriously. 


272 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Everyone  does  not  admit  the  opinions 
of  Wittmaack  and  Peyser.  Reinking  of 
Hamburg,  at  the  last  German  Congress  of 
Otology,  made  a  communication  tending 
to  show  the  importance  of  the  harm  of  air 
conduction.  Delsaux  could  not  agree  en- 
tirely with  Reinking  concerning  the  minor 
importance  pf  bone  conduction  and  rightly 
j)ut  forward  a  statement,  easy  to  prove, 
that  it  was  not  sufficient  in  normal  con- 
ditions to  stop  up  the  nose,  mouth  and 
ears  in  order  not  to  perceive  any  longer  at 
a  meter's  distance  words  uttered  in  a  high 
voice.  One  must  admit  in  this  case  that 
sound  is  transmitted  by  way  of  a  solid 
substance.  On  the  other  hand,  Delsaux 
observed  that  the  statements  of  Coose- 
mans  on  "beetlers"  in  a  linen  factory  con- 
tradict the  conclusions  of  Wittmaack  and 
Peyser.  In  fact,  Coosemans  has  not  found 
really  serious  lesions  among  workers  whom 
he  has  examined  and  who  were  subjected 
at  the  same  time  to  a  muffled  sound  and 
to  continual  vibrations  of  the  ground.  He 
concludes  that:  (1)  Every  noisy  trade  is 
not  necessarily  harmful  to  hearing.  ('2)  In 
order  that  it  may  be  harmful,  it  is  neces- 
sary (a)  that  the  worker  should  be  predis- 
posed to  affections  of  the  ear,  by  the  pres- 
ence of  lesions  in  the  nose  or  pharynx; 
(fe)  that  the  noise  should  be  intermittent; 
and  (c)  that  it  should  be  of  a  relatively 
high  tone. 

From  the  foregoing,  it  must  be  con- 
cluded that  a  certain  amount  of  doubt 
still  exists  as  to  the  extent  of  harmful- 
ness  of  transmission  of  sound  by  air.  Let 
us  hope  that  future  research  may  procure 
definite  results  on  this  point  so  important 
to  industrial  hygiene. 

Prophylaxis 

Choice  of  Worker.  —  Only  young  people 
fitted  to  undergo  the  normal  consequences 
without  damage  should  be  allowed  to  work 
in  noisy  industries.  Young  persons  with 
ear  affections  or  predisposed  to  them  by 


lesions  in  the  neighborhood  of  the  ear 
should  be  prohibited.  This  conservative 
method  must,  however,  be  used  with 
great  prudence.  Statistics  show  that  the 
number  of  persons  with  deficient  hearing 
is  considerable.  According  to  Ely,  8.5 
per  cent,  of  conscripts  were  refused  for 
this  reason  —  a  percentage  which  repre- 
sents only  the  worst  cases.  Weill  reports 
30  per  cent,  of  5^905  children,  whom  he 
examined,  as  hard  of  hearing;  Moure  re- 
ports 17  per  cent,  out  of  3,588;  Bezold 
reports  20.75  per  cent,  out  of  3,836,  with 
ear  trouble;  Lausi  shows  10.8  per  cent,  of 
deaf  scholars;  Sexton  13  per  cent.;  Gelle 
and  Von  Riechardt  22  per  cent.;  Ostman 
36  per  cent.;  Nager  40.3  per  cent.;  Ropke 
23.6  per  cent.;  Cronenberg  44.1  per  cent.; 
Hansberg  50  per  cent.;  Felix  31  per  cent.; 
Courtade  37.5  per  cent.;  MaUierbe  and 
Stackler  35  per  cent.  If  these  large  num- 
bers of  deaf  or  partially  deaf  children  were 
excluded  from  noisy  industries,  factories 
would  soon  be  empty,  for  other  groups  of 
sick  or  puny  children  woidd  also  have  to 
be  excluded,  one  for  deficiency  of  vision,  • 
another  for  poor  development,  and  another 
for  some  physical  disability.  Also  the  law 
of  work  is  universal  and  the  weak  and  in- 
firm must  work  for  their  living;  but  as  a 
defect  such  as  an  ear  lesion  may  be  an  indi- 
cation of  a  more  general  disease,  those  who 
are  excluded  from  noisy  industries  because 
they  are  partially  deaf  may  find  that  they 
are  refused  entrance  to  any  work  at  all. 
Great  discretion  must  therefore  be  used, 
and  only  those  most  liable  to  harm  should 
be  prevented  from  entering  the  most  in- 
jurious industries.  This  tolerance,  how- 
ever, recjuires  a  safeguard  in  the  form  of 
periodic  medical  sujiervision  of  young 
persons.  In  the  same  way  it  will  be  neces- 
sary to  have  a  methodical  jjcriodic  exami- 
nation of  the  ears  of  adults  working  in 
noisy  industries.  At  first  one  would 
imagine  that  an  essentially  defective  ear 
would  lie  an   indication  that  the  subject 


GLIBERT-IXFLLTEXCE  OF  INDUSTRIAL  NOISES 


should  not  work  in  a  noisy  atmosphere. 
But  if  Eicken  and  de  Hoessh  are  correct 
m  their  assertions  tliat  the  chains  of 
ossicles  conduct  sound  and  do  not  damp 
It,  as  Zimmerman  thinks,  in  certain  cir- 
cumstances a  state  of  relative  deafness, 
while  not  advantageous,  would  al  least  be 
harmless  in  certain  industries  where  there 
is  a  loud  or  rackety  noise. 

When  choosing  ^^()rkers  for  a  noisy  in- 
dustry (and  in  doubtful  cases  this  should 
be  done  by  an  ear  specialist),  the  doctor 
must  keep  in  mind  the  other  peculiarities 
ot  the  industry.    For  instance,  a  deaf  man 
IS  more  exposed  to  accidents  in  the  vicinity 
of  belts,  gearing,  etc.,  because  verv  often 
when  a  machine  is  going  wrong  an  unusual 
sound  is  emitted  which  acts  as  a  warning. 
In  the  same  way  workers  with  alterations 
in  the  auditory  apparatus  associated  with 
vertigo  and  loss  of  sense  of  space  should 
not  be  exposed  to  falls  from  heights,  such  as 
from  scaffolding,  timber  works,  or  bridges. 
In  the  medical  examination  a  fixed  unit  of 
measurement  should  be  .■n,plo^•e,l  throurr],- 
out  the  country,  so  that  absurd  and  uiiniir 
Situations  may  be  avoided;    better  still 
there  should  be  international  uniformity  to 
enable  us  to  meet  hostile  criticism  on  i)ro- 
I)hylactic  measures.     At  present,  tests  of 
hearing  lack  uniformity  and  even  precision; 
the  whispered  Aoice,  the  murmured  voice,' 
the  voice  of  conversation  and  the  tick  of  a 
watch  are  very  variable  quantities.    Still,  if 
judiciously  employed,  these  simple  methods 
seem  to  suffice  in  ordinary  examinations. 
A  definite  criterion  is,  however,  needed  for 
determining  whether  or  not  a  more  com- 
plete examination  by  an  ear  specialist  is 
desirable. 

As  a  means  of  securing  uniformity  in  ear 
examinations,  the  following  methods  of 
estimating  hearing  in  terms  of  the  distance 
at  which  a  watch  is  heard  by  the  normal 
ear  have  been  proposed: 

1.  Let  M  be  the  distance  at  which  a  watch  is 
ueard  by  a  normal  ear; 


273 

Let  d  be  the  distance  at  which  a  watcli  is  heard  by 
the  examinee; 

Let  A  be  the  auditory  acuity  of  the  examinee; 
d 


Therefore  ^-1  = 


M' 


A  '^^Z^"":  ^  ^^  ''  '  ""'"'■  "^^  ^  '^  '"  centimeters. 
■A  =0.10  meter. 

i.   Let  D  be  tlie  maxin.um  distance  at  which  the 
normal  ear  hears  the  instrument  of  measurement; 

Let  rf  be  the  maximum  distance  for  the  ear  ex- 
ammed; 

Let  A  be  the  auditory  acuity  of  the  examinee; 

Tlierefore  -4  =(^)'  since  the  intensity  of  sound 

is  in  inverse  proportion  to  the  square  of  the  distances. 

Ear  speciahsts  must  aid  us  in  drawing 
up  examinations  which  will  be  uniform  as 
to  tests,  signs  and  terms,  and  must  deter- 
mine for  us  the  best  methods  to  use,  and 
at   i)recisely   what  stage  hearing  is  suffi- 
ciently diminished  (a)  to  warrant  refusing  a 
young  j)erson  work  after  a  complete  ear 
examination;   and  {b)  to  require  an  exami- 
nation   by   an    ear   specialist    of    workers 
(young   persons   or   adults)    eniploved   in 
noisy  industries.    It  will  be  the  particular 
held  of  ear  specialists  to  do  research  on 
"the  sense  of  space"  and  "the  organ  of 
ec|iulibiiiim."    and    on    such    diseases    as 
nystagmus,  while  the  factory  doctor  can 
limit  himself  to  finding  the  degree  of  vertigo 
or  incoordination  by  the  ordinary  clinical 
means,  and  can  pass  on  to  the  specialists 
the  most  interesting  patients. 

Individual  Means  of  Protection.  —  The 
means   of   self-protection   tend   to   mufl3e 
sound,  and  plugs  of  cotton  wool  and  cover- 
ing pads,  and  especially  helmets  and  similar 
apparatus,  are  makeshifts  disliked  by  the 
workmen  on  account  of  their  weight  and 
pressure,  and  because  they  are  contrary  to 
their  habits.    Such  objects  are  often  a  liin- 
drance  to  hearing  orders  and  are  also  a 
cause  of  accidents,  as  they  diminish  the 
perception  of  unusual  sounds  or  cries  of 
appeal  from  fellow- workers  in  danger.  They 
must  therefore  be  reserved  for  special  cir- 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


274 

cumstances  where  it  is  impossible  to  do 
without  them,  and  as  these  circumstances 
are  rather  numerous,  it  is  necessary  to 
make  a  detailed  examination  of  the  pro- 
cedure to  adopt.  As  regards  the  ear  plug 
there  is  no  agreement  on  the  best  method 
of  application.  Should  it  be  slack  or  com- 
pressed into  the  ears  or  should  the  ear  be 
stopped  as  completely  as  possible  by  a 
tight  plug  impregnated  with  an  oily  sub- 
stance.' Ignorance  on  this  subject  is  due 
to  the  uncertainty  in  regard  to  the  re- 
spective roles  played  by  air  and  solid  sub- 
stances in  sound  transmission. 

It  is  certam,  however,  that  as  far  as 
fatigue  is  concerned  the  vibrations  of  the 
soil    are    an    important,    harmful    factor. 
Hence,  the  use  of  anti-vibratory  footgear 
or  mats  is  to  be  recommended  in  all  cases. 
An  individual  method,  frequently  extolled, 
is  change  of  work,  but  this  can  easily  be 
carried  too  far.     Although  excellent  in  it- 
self when  recommended  for  workers  in  a 
particularly  unliealthy  trade,  it  loses  all 
its  value  in  a  well-defined  trade.    Take,  for 
instance,  the  case  of  a  flax  spinner.     Her 
work  is  of  a  special  kind,  rec]uiring  an  ap- 
prenticeship of  from  three  to  four  years  at 
least,   and   consequently   commands   rela- 
tively high  wages.     What  would  a  spin- 
stress  do  if   she  were  put  to  winding  or 
reeling?    But  if  a  change  of  occupation  is 
often  impossible,  a  change  of  place  in  the 
same  occupation  is  often  easy,  and  with 
differences    of    intensity,    resonance    and 
height  of  noise  in  various  parts  of  the  same 
room  or  in  different  departments  or  build- 
ings of  the  same  industry,  it  is  advisable 
and  possible  l)y  a  simple  change  of  posi- 
tion to  improve  conditions  for  a  suscep- 
tible person. 

Protective  Measures  Applicable  to  Work- 
ing Conditions.  —  Extensive  and  pains- 
taking researches  should  be  made  in  order 
to  discover  the  best  means  of  lessening  in- 
dustrial noise.  The  origin,  intensity, 
height  and  rhythm  of  noise,  the  local  cir- 


cumstances which  increase  it,  the  vibra- 
tions which   accompany  it,  etc.,  must   be 
examined  in  detail.     It  is  necessary  to  re- 
duce the  intensity  as  well  as  height  and 
resonance.     Among  causes   which   aggra- 
vate are  carelessness,  lack  of  room,  wrong 
use  of  apparatus,  lack  of  upkeep  and  re- 
pairs, abuse  of  glass  partitions,  insufficient 
natural  ventilation.    But  if  it  is  true,  as  is 
sometimes  claimed,  that  the  internal  ear  is 
organized  in  such  a  way  that  each  of  its 
parts  corresponds  to  a  sound  of  definite 
height,  it  would  be  of  value  to  vary  as 
often  as  possible  the  tone  of  soimd  in  a       ^ 
factory,  and  this  is  practicable  in  many 
cases.    It  has  been  observed  that  a  sudden 
intermittent,   and   more   or  less  irregular 
noise  is  more  disagreeable  to  the  ear,  other 
conditions  being  equal,  if  produced  in  a 
quiet   atmosphere   than   m   a   noisy   one. 
Here  we  have  practically  the  action  of  the 
natural  organic  defences  still  unknown  as 
regards  the  ear.     It  is  useful  at  times  to 
compare  certain  machines  making  a  con- 
tinuous moderate  noise  with  those  making 
a  loud  noise  when  thrown  out  of  gear.  But 
before    we    can    successfully    apply    pro- 
phylaxis to  objects,  we  must  know  how 
far  air  conduction  is  harmful  to  the  ear. 
If  it  were  shown  to  be  powerless  to  create 
alone  a  serious  organic  ear  lesion,  the  prac- 
tical means  to  apply  would  be  principally 
agamst  vibrations,  and  it  would  be  neces- 
sary  to  have  special  regulations  for  the 
supporting  structure  of  machines  and  foim- 
dations  of  factories,  special  platforms  for 
the  use  of  workers,  etc. 

Conclusions 

1.  It  is  de.sirable  that  careful  observa- 
tions be  made  in  order  to  remove  the  exi.st- 
ing  uncertainty  in  regard  to  the  following 
points: 

(a)  Are  lesions  due  to  noise  so  localized 
that  high  and  deep  sounds  act  on  different 
parts  of  the  cochlea.' 


GLIBERT  —  IN  FLITEXCE  OF  INDUSTRIAL  NOISES 


275 


(b)  Is  air  conduction  in  itself  sufficient 
to  cause  in  time  lesions  of  the  internal 
ear? 

(c)  What  are  the  extreme  limits  of  de- 
ficient hearing  compatible  with  work  in  a 
noisy  factory  without  examination  by  an 
ear  specialist  ? 


2.  An  international  commission  com- 
posed of  doctors  having  access  to  all  the 
factories  of  the  country  ought  to  decide 
the  basis  of  an  inquiry  into  industrial 
sounds,  for  the  j)urpose  of  jireparing  a  de- 
tailed account  of  the  principal  noisj^  in- 
dustries. 


BIBLIOGRAPHY 


1. 


S. 


4. 


Layel:     Sixth    volume    of    the    Encyclopciiie 
d'Hygienc  de  Rocliard. 

Roplce,  F.:    Die   Berufskranklieiten  des  Olires 
und  der  Ohren  Luftwcge.    Wiesliaden,  1905. 
Capart,  A.,  Jr.:    Report  to  Belgian  Society  of 
Otorliiiiolaryngology,  Feb.,  1911. 
Blegvad,  N.  R.:    Etfets  profe.ssionels  du  tele- 
phone sur  Tappareil  auditif  et  sur  rorganisuie. 
Ann.  d'hyg.  pub.,  1907,  Series  4,  8,  375. 
Tretrop:    Trouble.s   auilitifs   il'origine    telepho- 
nique.    Presse  Otolaryngol,  beige,  1914,  13.  i~5. 


6.  Layet:  Hygiene  des  professions  et  des  indus- 
tries.   Paris,  1875. 

7.  Zwaardemaker :    Communication   to  tiie   Royal 

Academy  of  Sciences  of  Amsterdam,  Feb.  25, 
1905. 

8.  Bonnier;  L'Oreille.  Encyclopedie  des  aide- 
nu'inoire,  Leaute. 

9.  Poli:   Arch.  ital.  di  otol.,  1894. 

10.  Moure,  E.  J.,  and  Cauzard,  P. :  Examen  fonc- 
tionnel  du  iabyrinthe.  Pratique  med.,  1909,  23, 
97. 


THE  REHABILITATION  OF  E^IPLOYEES:  AN  EXPERIENCE 

^YITH  1,210  CASES* 

FREDERIC  S.  KELLOGG,  JNI.D. 
Physician,  Western  Union  Telegraph  Company,  Pittsburgh,  Pa. 


A  LTHOrGH  the  custom  of  making  a 
±\,  physical  examination  as  a  prehmin- 
ary  to  emplojTiient  has  become  very  com- 
mon in  recent  years,  there  has  growni  up 
on  the  part  of  the  employees  a  great  deal  of 
opposition  and  even  hostiUty  to  this  re- 
quirement. The  object  of  the  work  here 
described  has  been  to  extend  and  make 
practical  use  of  these  examinations  for  the 
reconstruction  of  the  employee  —  a  pro- 
cedure by  which  we  believe  that  immense 
gains,  both  economic  and  m  point  of  health, 
will  be  seciu-ed,  and  a  kindlier  feeUng  es- 
tablished. 

The  subject  of  salvage  in  general  has  be- 
come a  matter  of  vast  and  recognized  im- 
portance and  the  savings  thus  secured  are 
enormous.  We  may,  for  example,  see  this 
process  being  carried  on  daily  in  the  dis- 
posal of  city  waste:  A  broad,  endless  belt 
carries  the  waste  down  a  long  room.  Work- 
ers on  either  side  take  off  various  articles 
for  reclamation,  and  what  is  left  is  then 
swept  on  to  the  furnace.  If,  instead  of  city 
waste,  this  endless  belt  were  carrying  men 
and  women,  more  or  less  disabled,  and  if, 
instead  of  ordinarj^  workers,  there  were 
stationed  by  the  sides  physicians  and 
specialists,  would  such  wholesale  human 
salvage  be  possible.^  Or  would  it  be  better 
merely  to  make  a  selection  here  and  there 
of  the  best  ? 

The  results  sul)mitted  in  this  article  were 
secured  from  the  analysis  of  1,210  examina- 
tions made  among  the  employees  of  a  large 
department  store.  There  are  in  all  2,000 
employees  in  this  establishment,  85  per 
cent,  of  whom  are  women.  The  average 
age  is  27  years.    The  method  of  medical 

•  Received  for  publication  Oct.  10,  1921. 


service  in  use  in  this  store  has  been  fuUy 
described  in  an  earlier  paper,t  and  there- 
fore it  is  enough  for  the  present  to  say  that 
the  physical  examination  has  been  supple- 
mented by  reports  from  specialists  or  from 
laboratory  experts  whenever  such  reports 
were  needed.  The  general  physical  condi- 
tion of  these  men  and  women,  as  disclosed 

TABLE  1.  — DISTRIBUTIOX  OF  DEFECTS  IX 
OLD  AXD  NEW  EMPLOYEES  COMPARED 


Class 

h 

< 

% 

5 

% 

1 

■fl'l 

§ 

o 

a 

f-5 

■S3 

HW 

<! 

Z 

o 

H 

OQ 

^a 

New  employees  apply- 

ing for  work 

532 

23i 

14 

78 

152 

288  j  97.3 

Old  employees 

678 

27 

7 

113 

217 

341  98.9 

by  the  study  of  the  examination  records,  is 
shown  in  Table  1,  new  employees  and  old 
employees  being  gi'ouped  separately  by 
way  of  comparison.  In  Table  2  the  workers 
are  arranged  in  groups  by  decades,  in  order 
to  show  more  clearly  the  progressive  de- 
terioration suggested  by  the  figures  in 
Table  1.  From  the  schoolchildren  group  to 
the  group  of  workers  over  40  years  of  age 
there  is  a  steady  deterioration  from  75  to 
99.3  per  cent.,  the  causes  of  which,  in  the 
experience  of  this  service,  are  as  follows: 
infection  from  fellow  employees,  persistent 
bad  hygiene,  and  neglect. 

As  to  infection,  it  may  be  said  that  in  the 
examinations  analyzed  the  following  dis- 
eases have  been  found :  scarlet  fever,  diph- 
theria, measles,  whooping  cough,  impetigo 

t  F.  S.  Kellogg:  Medical  Supervision  of  Employees. 
Penn.  Med.  Jour.,  1920,  p.  667. 


276 


KELLOGG  —  REHABILITATION  OF  EMPLOITES 


'277 


contagiosa,  scabies,  pediculi,  gonorrhea, 
syphilis,  pneumonia,  erysipelas,  tubercu- 
losis and  an  immense  ninnber  of  cases  of 
diseased  tonsils,  acute  and  chronic,  and  an 
equally   large   number   of   foul   teeth    and 

TABLE  2.  —  DISTRIIUTIOX  OF  DEFECTS 
BY  DEC.VDES 


Group 

No 
DefecU 

Defective 

Per  Cent. 
Defective 

Schoolchildren              

76.0 

Under  20  years 

17 

500          96.7 

20  to  30  years 

10 

371 

97.4 

30  to  40  years   

2 

167 

98.8 

Over  40  years 

1 

142 

99.3 

septic  mouths.  Infection  is  very  real  and 
ever  present;  yet  medical  inspection  has 
been  limited  to  the  schools. 

Bad  hygiene  —  that  is,  bad  habits  which 
will  cause  disability  in  time — is  very 
common.  Out  of  425  cases  which  were  in- 
vestigated 359,  or  85  per  cent.,  were  in- 
stances of  bad  hygiene.  (Hygiene  here 
does  not  include  housing.)  Neglect  is  even 
more  connnoii,  indeed  it  is  often  the  rule, 
as  is  evideJiccd  by  the  fact  that  none  of  the 
forty-two  cases  of  tuberculosis  noted  among 
the  em])loyees  examined  was  on  treatment, 
and  also  by  the  habitual  disregard  of  treat- 
ment as  shown  by  the  figures  given  later  in 
this  paper  (see  Table  4). 

The  gravity  of  the  defects  noted  in  the 
examinations  under  discussion  can  be  seen 
by  reference  to  Table  .'?,  in  which  are  given 
the  rcfiuiremcnts  in  time  for  the  rehabilita- 
tion of  these  employees.  In  contrast  to  the 
requirements  and  needs  of  these  cases  are 
the  facts  as  to  the  actual  treatment  which 
the  patients  receive.  The  facts  are  ascer- 
tained as  follows:  On  the  completion  of  an 
examination  and  after  reports  from  special- 
ists have  been  received,  it  has  been  the 


custom  to  refer  the  patient  for  treatment  to 
a  hospital  or  to  a  speciahst.  In  order  that 
authentic  reports  of  treatment  may  be  re- 
ceived, the  patient  is  given  a  report  card 
with  a  stamped  and  atklressed  envelope. 
If  treatment  is  secured,  tlie  n-port  is  re- 
ceived and  noted  on  the  patient's  health 
record.  If  the  re])ort  card  is  not  returnetl, 
the  patient  is  called  again  to  the  office  and 
his  case  is  followed  up  until  lie  lias  received 
l)r()iH'r  treatment.  The  amount  of  follow- 
up  work  needed  is  instructive:  There  were 
llnis  given  to  patients  1,054  report  cards, 
after  a  complete  physical  examination, 
fre(|uently  supplemented  by  a  careful  ex- 
amination by  a  specialist.  The  results  were 
as  follows: 

Nuinlier  securing  treatment  williout  follow-up 

work 02 

Percentage  -securing  treatment  without  follow- 
up  work 5.9 

Number  who  had  to  be  calleil  to  office  re- 
peatedly     992 

If,  after  a  full  examination  and  with  ex- 
])ert  advice,  only  G  per  cenl.  arc  led  to  se- 
cure   treatment    from    competent    hands, 

T.\BLE  3.  —  KEQl  lUKMKNTS  IX  TIME 
FOR  TllEATMEXT 


RcquircmenU 

Number 
of  Cases 

Per  Cent. 

Xo  stopping  of  work  required.  .  .  . 

473 

39.0 

From  1  to  10  days  of  hospital  car^            573 

47.3 

From  10  days  to  1  month  at  hos- 
pital           107 

8.8 

More  than  1  month  at  hospital  or 

55 

4.6 

Incurable  and  unable  to  work  . . . 

2 

0.1 

what  percentage  would  seek  treatment 
when  left  entirely  to  their  own  initiative  — 
the  condition  of  general  practice?  Cer- 
tainly it  would  be  much  less  than  6  per 
cent.    And  of  this  small  mnnber  what  per- 


278 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


centage  would  place  themselves  in  com- 
petent hands?  Or,  being  fortimate  enough 
to  find  themselves  in  good  hands,  how 
many  would  remain  on  treatment  long 
enough  to  secure  any  permanent  benefits? 
It  is  evident  that  constructive  treatment, 
such  as  is  necessary  for  the  rehabilitation 
of  these  employees,  exists,  if  at  all,  in  only 
a  very  small  fraction  of  cases,  and  the 
progressive  deterioration  of  the  employee 
which  has  been  shown  is  evidence  of  this 
fact. 

The  most  impressive  single  fact  brought 
out  by  the  present  study  is  the  almost  uni- 
versal neglect  of  life  and  health.  And  yet 
the  only  means  used  at  present  for  the 
reclamation  of  the  disabled  employee  is  the 
treatment  which  he  secures  upon  his  own 
initiative.  The  plan  of  leaving  the  sick  or 
disabled  employee  to  his  own  resources  and 
trusting  to  his  initiative  is,  therefore,  a 
failure.  If  an^^hing  is  ever  to  be  done  for 
the  employee  we  have,  then,  as  an  alterna- 
tive, medical  supervision,  either  by  the 
company  or  by  the  state. 

Experience  avith  Medical 
Supervision 

The  experience  here  given  covers  a 
period  of  about  two  years,  and  includes  a 
very  great  variety  of  diseases  and  dis- 
abilities. Treatment  has  not  been  made 
compulsory  except  in  cases  of  tubercu- 
losis and  contagious  diseases,  including 
veneral  diseases.  Moreover,  a  case  is  con- 
sidered and  counted  as  having  been  treated 
only  when  the  patient  has  been  placed  in  a 
hospital,  or  in  other  thoroughly  competent 
hands,  and  a  report  has  been  received  on 
one  of  the  cards  already  mentioned. 

To  report  all  the  diseases  and  disabilities 
occurring  among  the  employees  of  the  de- 
partment store  under  consideration  would 
recjuire  an  unduly  long  list.  A  few  classes 
of  diseases  have,  therefore,  been  selected  in 
order  to  show  the  percentage  of  cases  secur- 


ing treatment.  (Tables  4  and  5.)  The  low 
percentage  attained  in  certain  cases,  such 
as  diseases  of  the  nose  and  throat,  is  to  be 
explained  by  the  fact  that  a  very  large 
number  of  operations  have  been  recom- 
mended. Many  of  the  cases  which  have 
not  been  treated  as  yet  will,  as  a  result  of 
further  work,  have  their  defects  corrected. 
It  is  to  be  noted,  also,  that  although  only 

T.\BLE  4.  —  CASES  TREATED  UNDER 
MEDICAL  SUPERVISION 


Disease 

Number 
of  Cases 

Number 
Treated 

Per  Cent. 
Treated 

Diseases  and  defects  of  eyes  . 

313 

117 

37.3 

Diseases  of  ears 

75 

31 

41.3 

Diseases  of  nose  and  throat  . 

691 

91 

13.1 

Bad  teeth 

717 

176 

24.5 

Diseases  of  digestive  tract.  .  . 

94 

24 

25.5 

Orthopedic  (employees  stand 
at  work) 

507 

18 

3.5 

67 

24 

35.8 

Gynecological  cases 

185 

43 

23.2 

Appendicitis   .  . 

11 

7 

63.6 

Diabetes 

i 

2 

100.0 

Diseases  of  nervous  system .  . 

6 

3 

50.0 

forty-two  cases  were  diagnosed  positively 
as  tuberculosis,  there  were  141  cases  of 
suspected  tuberculosis.  Many  of  these, 
seventy-three  in  all,  left  the  service  of  the 
company  without  allowing  a  careful  study 
of  their  ca.ses  to  be  made.  If  all  these 
cases  had  been  carefully  studied,  it  is  cer- 
tain that  there  would  have  been  manj' 
more  cases  diagnosed  as  positive  tuber- 
culosis. 

Although  the  general  average  of  cases 
treated  is  not  so  high  as  we  would  hope  to 
have  it  or  so  high  as  we  expect  to  have  it  in 


KELLOGG  —  REHABILITATION  OF  EMPLOYEES 


■JTO 


the  future,  it  is  to  be  noted  that  it  is  about 
19  per  cent,  more  than  it  would  have  been 
without  medical  supervision.  And  how- 
ever earnestly  we  may  desire  a  higher  per- 
centage  of   cases   placeti   on   constructive 

TABLE  5.  — TREATMENT  COMPULSORY 


Disease 

Numl)cr 
of  Cases 

Numtjcr 
Treated 

Per  Cenl. 
Treated 

Genito-urinary  diseases    .... 

12 

10 

83 

Syphilis  (5  cases  untreated)   . 

6 

6 

83 

Tuberculosis  (diagnosis  posi- 
tive)             

42 

30 

71 

Suspected    tuberculosis     (di- 
agnosis not  made) 

141 

Contagious  diseases 

G 

6 

100 

Pregnancy  (including  1  case  of 
toxemia  of  progimnc y) 

fi 

(! 

UHI 

Total  defects  noted 2,900         577            19.8 

treatment,  we  cannot  secure  these  best  re- 
sults without  ef bleating  the  employees. 
They  miisl  be  taught  new  and  highi-r  ideals 
of  health.  'I'he  very  existence  of  a  medical 
service,  such  as  the  one  considered  in  this 
report,  is  the  best  way  to  teach  tlie.se  ideals. 
The  constant  contact  with  the  medical  de- 
partment and  the  transformation  effected 


in  the  lives  of  many  of  the  patients  will 
teach  lessons  which  can  be  learned  in  no 
other  way.  The  relief  of  recurring  head- 
aches and  of  the  exliaustion  of  chronic  ill 
health,  the  rejuvenation  of  the  consinnp- 
tive,  the  development  of  ability  and  talent 
blighted  by  disease  —  these  benefits  will 
give  new  standards  of  health,  ami  secure 
hearty  co-operation  on  the  part  of  the 
employee. 

Conclusions 

There  is  a  [progressive  deterioration  of 
physi(|ue  in  the  group  of  employees  here 
.studied  and  i)resnmal)ly  among  working 
peo])le  in  general.  This  deterioration  is 
found  to  be  due  to  infection  from  associates, 
to  persistent  bad  hygiene,  and  to  continual 
neglect. 

The  initial  or  sporadic  examination  can- 
not suppl\-  a  healthy  body  of  employees 
nor  can  it  arrest  this  strong  tendency  to 
deterioration. 

Medical  supervision  offers  an  effective 
means  of  securing  the  rehabilitation  of 
employees,  and  salvage  of  large  groups  of 
men  and  women  is  thus  ])ra(ticable. 

The  time,  therefore,  is  surely  past  when 
employer  and  physician,  content  to  make  a 
.seleclion  here  and  there,  can  watch  with 
indiJference  the  endless  .stream  of  more  or 
less  disabled  men  and  women  sweep  by. 


TRINITROTOLUENE   POISONING  —  ITS  NATURE, 

AND   PREVENTION 

Conthmed 

CARL  VOEGTLIX,  CH.\RLES  W.  HOOPER,  and  J.  M.  JOHNSON 

From  the  Dirision  of  Pharmacology,  Hygienic  Laboratory,  U.  S.  Public  Health  Service 


DIAGNOSIS, 


Field  Investigation 

THE  jjrincipal  purpose  of  the  field  inves- 
tigation was  to  apply  the  knowledge 
gained  from  the  study  of  T.N.T.  poisoning 
in  animals  to  the  conditions  prevailing  in 
the  factories.  This  work  was  done  in  a 
large  shell-filling  plant  emjjloying  from 
7,000  to  8,000  workers,  and  was  made  pos- 
sible through  the  co-operation  of  both  the 
management  and  the  workers.  The  work- 
ers were  employed  in  tlu'ee  sliifts  of  eight 
hours  each.  The  general  sanitary  conditions 
of  this  war  settlement,  such  as  housing, 
sewage  disposal,  water  and  food  supply, 
were  excellent.  A  hospital  with  a  compe- 
tent staflf  of  physicians  and  nurses  looked 
after  the  sick  workers.  On  account  of  the 
high  wages  paid,  the  labor  turnover  was  not 
large,  a  fact  which  made  it  possible  to  ex- 
amine workers  who  had  been  exposed  to 
T.X.T.  for  a  long  time.  The  workers  of 
each  factory  unit  were  sometimes  shifted 
from  one  job  to  another,  but  on  the  whole 
a  considerable  number  were  continuously 
exposed  to  T.X.T.  The  following  brief  re- 
marks are  intended  to  familiarize  the 
reader  with  the  conditions  under  which  the 
T.X.T.  worker  is  exposed  to  the  poison. 

Manufacture  of  High  Explosive  Shells 

The  manufacture  of  high  explosive  shells 
varies  with  the  type  of  exjjlosive  used.  At 
the  beginning  of  the  war,  T.X'.T.  was  ex- 
tensively used  as  the  main  charge.  With 
the  tremendously  increased  demand  for 
these  shells,  it  became  necessary  to  supple- 
ment the  deficient  supply  of  T.N.T.  by 
using  a  mixture  of  ammoniinn  nitrate  and 
T.X'.T.,  commonly  called  amatol. 


If  T.X'^.T.  alone  is  used,  it  is  melted  in 
large  steam  kettles  at  a  temperature  of 
about  85°C.,  and  the  molten  exjjlosive  is 
then  poured  into  the  shells.  Amatol  is  pre- 
pared by  mixing  from  three  to  four  parts  of 
dry  ammoniimi  nitrate  with  T.X^.T.  at  a 
temperature  of  a])proximately  90°C.  The 
mixture,  while  still  warm,  is  pressed  into  the 
shells  by  machinery  (extruding  maclune). 
In  order  to  understand  the  process  of  filling, 
the  following  description  of  the  various 
parts  of  a  liigh  explosi^•e  shell  is  here  given.* 

The  shell  proper  is  made  of  hollow  steel 
and  fits  snugly  into  the  top  of  the  cartridge. 
The  bursting  charge  is  contained  in  the  shell 
and  consists  either  of  T.X.T.  or  amatol.  A 
circular  opening  in  the  top  of  the  shell  is 
tlu-eaded  so  as  to  allow  the  adapter  and 
booster  to  be  screwed  dowii  into  it. 

The  adapter  is  a  device  holding  a  narrow 
tube  which  in  turn  contains  a  narrower 
tube.  The  two  tubes  together  constitute 
the  booster.  The  adaj)ter  and  booster  are 
loaded  with  a  mixture  of  tetryl  (tetrani- 
troaniline)  and  T.X.T.  The  fuse  which  is 
loaded  with  a  sensitive  explosive  (mercury 
fulminate)  is  inserted  at  the  top  of  the 
shell.  The  fuse  is  not  inserted  at  the  filling 
plant,  but  is  put  in  before  the  shell  is  fired. 
The  bottom  of  medium  and  large  cahber 
shells  contains  a  mixture  of  T.N.T.,  am- 
monium nitrate  and  annnonium  chloride. 
Tills  mixture  ("smokemix")  is  used  to  pro- 
duce smoke  for  the  purpose  of  range  ob- 
servations. 

The  method  of  filling  the  shells  in  use  at 
the  plant  where  this  investigation  was  car- 
ried out  is  essentially  the  following:    The 

*  See  "Ordnance  and  Gunnerj'"  by  Tshappat,  Wiley  & 
Sons,  1917. 


S80 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


281 


empty  shells  are  first  painted  in  the  empty- 
shell  room.  After  this  they  pass  to  the 
pouring  house  containing  three  steam  ket- 
tles in  which  the  T.N.T.  is  melted.  These 
kettles  are  provided  with  a  hood  connected 
with  a  vertical  ventilating  pipe  which 
passes  through  the  top  of  the  roof.  The 
hood  has  a  window  which  permits  the  filling 
and  emptying  of  the  kettle.  The  workmen 
on  this  job  are  exposed  to  T.N.T.  fumes  and 
dust.  The  molten  T.N.T.  is  ])oured  into 
large  ash  cans,  from  which  tlie  shells  are 
filled  hy  means  of  hand  dippers.  The 
T.N.T.  in  the  shells  slowly  crystallizes. 
The  crust  which  is  formed  on  the  top  is 
broken  up  in  order  to  ])revent  cavity  for- 
mation. This  work  is  usually  attended  to 
by  women.  After  all  of  the  T.N.T.  has 
crystallized  the  shells  are  i)ut  on  trays  and 
moved  on  rails  to  the  finishing  room,  where 
the  booster  cavity  is  formed.  This  last 
process  is  done  by  ])ouring  T.N.T.  around 
a  steel  form  insi>rted  into  the  to])  of  the 
shell.  After  cooling,  the  form  is  removed 
and  the  cavity  is  l>lowu  out  with  com- 
pres.sed  air.  The  finishing  room  contains  a 
steam  kettle  of  the  same  construction  as 
those  in  the  ])ouring  room.  Finally  tlie 
booster,  couiaining  tlie  mixture  of  T.N.T. 
anil  letryl,  is  inserted  into  the  top  of  the 
shell.  The  loaded  shells  are  transferred  to 
the  stenciling  room,  where  they  are  labeled, 
weighed,  and  examined.  From  the  stencil- 
ing room  the  siiells  pass  to  the  magazine. 

The  booster  plant  is  separated  from  the 
filling  ])lant.  The  mixture  of  dry  T.N.T. 
and  tetryl  is  pressed  into  the  boo.ster  by 
means  of  hydravdic  presses.  Amatol  was 
used  as  the  main  charge  until  two  months 
before  this  work  was  begun. 

Incidence  of  T.X.T.  Poisoning 

In  the  time  at  our  disposal  it  was  impos- 
sible to  examine  all  T.N.T.  workers  in  this 
plant.  For  this  reason,  2fi7  workers  were 
selected  at  random  and  subjected  to  a 
thorough    examination,    special    attention 


being  given  to  the  presence  or  absence  of 
clinical  manifestations  of  T.N.T.  poisoning, 
such  as  cyanosis,  icterus,  and  dermatitis. 
A  specimen  of  urine  was  obtained  from  each 
worker,  and  this  was  examined  for  the 
jjresence  of  T.N.T.  derivatives  (\Yebster 
te.st),  bile  pigment  and  albumin.  The  blood 
was  tested  for  its  hemogloliin  content  by 
means  of  a  Sahli  hemogloV)inometer  stand- 
ardized against  a  standard  solution  of 
hemalin.  The  hemoglobin  figures  are 
lhereft>re  very  reliable.  The  number  and 
character  of  the  red  blood  cells  was  deter- 
mined. A  white  cell  count  and  ditl'erential 
count  were  also  made,  and  the  number  of 
micleated  red  cells  per  "^OO  white  cells 
counted.  Information  as  to  the  lengtii  of 
exi)()sure  to  T.N.T.  antl  the  type  of  woi-k 
])erfornied  by  each  worker  was  obtained. 
The  data  pertaining  to  this  work  are  com- 
piled in  the  accompanying  tables.  Before 
liroceeding  to  a  discussion  of  these  results, 
it  is  desirable  to  re\iew  l)rie(ly  the  work  of 
other  investigators  interested  in  this  sub- 
ject. 

Livingstone-Learmonth  and  Cunning- 
ham ('-28)  relate  their  exi)eriences  in  a  shell- 
filling  plant  in  Great  Britain  and  call  atten- 
tion to  the  fre((Uency  of  ])()isoniug  among 
thirty-six  women  workers  as  determined  1)\' 
clinical  .symptoms.  They  also  report  the 
blood  and  necrop.sy  findings  of  a  case  of 
toxic  jaundice.  The  blood  in  this  ca.se 
showed  4,4U0,()00  red  corpuscles,  9,[H0 
white  cells,  60  per  cent,  hemoglobin,  ab- 
sence of  methemoglobin  and  nucleated  red 
cells,  no  abnormalities  in  white  cells. 

Pant  on  (24)  examined  fifty  T.N.T.  work- 
ers, some  of  whom  had  mild  symptoms  but 
were  perfectly  fit  for  work,  with  special 
reference  to  the  blood  changes.  He  stated 
that  the  red  cells  and  hemoglobin  were  not 
adversely  affected,  with  the  exception  of  a 
slight  degree  of  poikiloc^■tosis.  A  moderate 
leukocytosis  with  a  relative  increase  in  the 
polynuclear  neutrophils  was  noted  in  many 
cases.   The  blood  serum  often  contained  an 


282 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


abnormal  amount  of  bile  pigment.  Panton 
furthermore  examined  twenty-eight  cases 
of  toxic  jaundice  and  six  cases  of  so-called 
aplastic  anemia.  In  the  foniier  gi'oup  only 
four  cases  showed  blood  changes,  these 
being  characteristic  of  aplastic  anemia. 
Panton  suggests  that  moderate  doses  of 
T.N.T.  might  lead  to  a  stimidation  of  the 
blood-forming  organs. 

Stewart  (29)  reports  fourteen  cases  of 
toxic  jaimdice,  in  some  of  which  the  blood 
re^'ealed  an  anemia  of  various  grades.  In 
nine  cases  a  neutrophil  leukopenia  with 
lymphocytosis  was  noted. 

Smith  (30)  examined  twenty-five  work- 
ers exposed  to  T.N.T.  dust.  A  few  showed 
slight  cyanosis  and  complained  of  ab- 
dominal pains,  but  were  otherwise  perfectly 
fit  for  work.  The  lowest  hemoglobin  esti- 
mation was  75,  and  the  red  cell  count  was 
never  below  4,400,000.  No  abnormality 
was  noted  in  the  character  of  the  red  cells. 
Most  of  the  cases  showed  a  moderate 
leukocytosis  and  increase  in  pol.^^nor- 
phonuclear  neutrophils.  The  platelets  ap- 
peared normal. 

Harrington  (31)  and  Gregorson  and 
Taylor  (32)  also  report  a  small  number  of 
cases  of  T.N.T.  poisoning. 

Recently  a  paper  appeared  by  ]NHnot 
(33)  in  which  the  blood  changes  found  in 
233  T.N.T.  workers  are  reported  in  great 
detail,  as  follows: 

Red  cell  abnormalities  were  found  to  be  very 
frequent.  The  most  interesting  abnormality  was  the 
frequent  finding  of  fragmented  or  fragmenting  red 
cells  which  have  a  definite  histologic  character. 
These  cells  appear  to  afford  evidence  of  a  rapid  in- 
creased destruction  of  the  red  cells.  Evidence  shows 
that  distinct  increases  of  these  cells  are  to  be  looked 
on  as  a  significant  sign  of  a  considerable  degree  of 
poisoning;  and  probably  when  they  occur  in  large 
numbers,  they  indicate  some  degree  of  toxic  jaundice. 
Among  other  red  cell  abnormalities  noted  were  the 
following:  Polychromatophilia  occurretl  in  83  per 
cent,  of  the  cases,  often  to  a  marked  degree.  Ilowell- 
JoUy  bodies,  stippling  and  blasts  were  found,  and  in- 
creased numbers  of  reticulated  retl  cells.  The  red  cell 
count  averaged  in  the  mildest  cases  4,500,000,  and  in 


the  severest  3,800,000.  It  was  found  that  there  was 
usually  a  definite  relationship  between  the  total 
amomit  of  red  cell  changes  and  the  sj'mptoms. 
Methemoglobin  or  some  form  of  changed  hemoglobin 
is  apparent  in  these  cases. 

The  white  blood  cells  do  not  furnish  as  much  in- 
formation concerning  the  workers'  condition  as  da 
the  red  cells.  Slightly  increased  white  cell  counts 
were  common.  The  observations  showed  that  an 
individual  may  become  distinctly  and  severely  poi- 
soned with  a  normal,  or  an  absolute  or  relative  in- 
creased lymphocj'te  coimt,  or  with  an  increased  or 
normal  polymorphonuclear  count.  However,  lym- 
phocytosis is  to  be  looked  on  as  an  undesirable  sign, 
but  does  not  necessarily  indicate  that  significant 
poisoning  will  occur  or  is  occurring,  exceptwhen  there 
is  a  leukopenia.  Slight  eosinophilia  (more  than  5  per 
cent.)  occurred  in  10  per  cent,  of  the  cases.  It  was 
more  common  in  cases  with  slight  symptoms  than  in 
those  with  marked. 

The  blood  iilatelets  were  usually  slightly  in- 
creased. Their  diminution  was  observed  twice  and  in 
both  cases  there  was  a  relative  ljTnphocji;osis.  Such 
a  condition  should  certainly  be  regarded  as  evidence 
of  a  severe  effect  on  the  marrow,  indicating  aplasia. 
Webster's  test  for  changed  trinitrotoluene  in  the 
urine  was  foiuid  to  be  less  valuable  than  blood  ex- 
aminatiori  to  indicate  the  worker's  condition. 

Minot  (33)  (34)  does  not  give  much  in- 
formation as  to  the  change  in  hemoglobin 
content  of  the  blood.  The  few  hemoglobin 
estimations  referred  to  were  made  by  the 
Tallquist  method,  which  is  very  unreliable. 

In  its  final  report  the  Health  of  Muni- 
tion Workers  Committee  of  the  British 
INIinistry  of  Mimitions  (35)  makes  the 
following  recommendations  concerning  the 
detection  of  the  milder  forms  of  T.N.T. 
poisoning: 

.  .  .  Care  must  be  taken  to  avoid  confusion  with 
digestive  disturbances  due  to  other  causes,  .\ccounts 
given  by  patients  may  be  unintentionally  misleading. 
The  yellow  staining  which  normally  occurs  with 
T.N.T.  caimot  be  taken  as  in  itself  a  sign  of  ])oison- 
ing.  The  following  points  are  the  more  important 
indications  of  T.N.T.  poisoning: 

(a)  Pallor  of  face  and  an  ashen  grey  colour  of  the 
lijis,  tending  to  disappear  if  the  worker  becomes  ex- 
cited, as  by  medical  examination.  Sometimes  the 
lips  and  tongue  are  purple  in  colour;  the  tongue  is 
generally  free  from  fur. 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


283 


(6)  The  character  and  situation  of  the  stomach 
pains. 

(c)  The  presence  of  constipation  and  stomach 
distention. 

The  literature,  therefore,  shows  that, 
with  the  exception  of  Minot,  all  wTiters 


however,  abnormal,  showing  anisoc^'tosis 
and  poikilocytosis.  This  relatively  high 
numher  of  red  cells  is  due  to  fragmentation 
and  jiroves  that  a  red  cell  count  alone,  in 
the  absence  of  a  hemoglobin  estimation,  is 
a  very  unreliable  diagnostic  index.  Nu- 
rely  principally  on  the  presence  of  clinical  cleafcd  red  cells  were  found  in  the  circulat- 
symptoms  for  the  diagnosis  of  T.N.T.  poi-  ing  blood  in  IS  per  cent,  of  the  anemia 
soning.  We  cannot  share  this  view,  as  our  cases.  As  regards  the  leukocytes,  4  per 
work  has  clearl.A-  shown  that  marked  blood  cent,  of  the  cases  with  anemia  showed  a 
changes  may  be  present  in  some  workers  in  Ieuko])cnia.  12  per  cent,  a  leukocytosis 
spite  of  the  fact  that  they  do  not  exliiljil      (count   above  10,000),  and  4!)  per  cent,  a 

TABLE  1.  —  CLASSIFICATION  OF  CASES  WITH  ANEMIA 
[Data  compiled  from  an  examination  of  149  male  and  88  female  T.  N.  T.  workers.) 


Number  of  Cases 

-; : . . 

Hemoglobin  in 
Per  Cent. 

Erj-throcj-te  Counts 

>.., 

■sl 

Leukocytes 

Dejfrcc  of 

I 

II 

1 

o 
"Si 

s 

Mi 

1 

1 

•s'a 

Males 

Females 

Males 

Females 

'o  2 

■3  ji' 

>-- 

a 

3 

=     '1 

Aoemiu 

< 

i 

< 

i 

i 

a 

1 
1 

S 

a 

—  .■£ 
■It' 

It 

1 

.5=   y 

od  c1 

iHf 

lUI 

SUght  

Moderate 

Severe 

so.^ 

80 
32 

1 

53.7 
21.5 
0.7 

3» 
19 

44.3 

21.6 

79 
67 
57 

97-71 

70-61 

47 

7« 
66 

91-71 
70-64 

1 
1 

4.306.000 
4,181,000 
2,936,000 

(  5.736,000  1 
1   2.928,000  1 
(  5,200,000  \ 
\  3,488,000  / 

2,936,000 

4.210.000 
4,064.000 

(  S.440.000  \ 
\  2,888,000/ 
f  4,704,000 1 
\  3,224,000  / 

38 

41 

0 

22 

• 

% 

2.S 
8.0 

23 
22 
100 

% 
46 

61 

100 

any  cyanosis,  pallor,  or  icterus.  Table  1 
reveals  the  significant  fact  that  7'-2.5  per 
cent,  of  the  workers  showed  an  anemia  of 
various  grades.  These  cases  are  grouped 
into  three  c-lasses  as  follows:  (1)  slight 
anemia,  men  with  less  than  84  per  cent, 
hemoglobin  or  a  red  cell  count  below 
4,000,000,  and  women  with  less  than  80 
per  cent,  hemoglobin  or  a  red  cell  count 
below  3,700,000;  Ci)  moderate  anemia, 
workers  with  a  hemoglobin  content  of 
from  60  to  71  per  cent.;  and  (3)  .severe 
anemia,  workers  in  whom  the  hemoglobin 
was  below  60  per  cent.  According  to 
Table  1 ,  most  of  the  anemia  cases  belong  to 
the  first  and  second  groups,  and  only  one 
case  revealed  the  presence  of  a  severe 
anemia.  The  red  cell  count  of  the  anemia 
cases  is  very  often  normal  or  even  above 
normal.    The  red  cells  of  these  cases  are. 


relative      lymphocytosis       (mononuclears 
above  40  per  cent.). 

Both  si'xes  show  approximately  the  same 
percentage  of  anemia  cases,  a  fact  which  in- 
dicates that  sex  has  no  influence  on  the 
susceptibility  to  T.N.T.  poi.soning.  'J'lie 
same  holds  true  in  regard  to  the  relation  of 
the  age  of  the  workers  to  the  susceptibility 
to  anemia,  as  the  latter  appears  in  young, 
mitldle-aged,  and  old  per.sons,  the  average 
age  of  the  workers  included  in  the  three 
grades  of  anemia  being  approximately  the 
same.  (See  Table  -2.)  In  passing,  it  should 
be  mentioned,  however,  that  the  British 
reports  refer  to  the  greater  susceptibility  of 
persons  under  18  years  of  age.  We  were 
unable  to  verify  this  observation  as  the 
factory  regulations  prohibited  the  em- 
ployment of  persons  below  18  years  of 
age. 


284 


THE  JOURNAL  OF  INDUSTRL4L  HYGIENE 


There  is  no  consistent  relation  between 
the  time  of  exposure  and  the  susceptibiHty 
to  anemia,  a  fact  which  is  probably  best  ex- 
plained by  variations  in  the  individual 
susceptibility  of  the  workers  to  T.N.T. 
poisoning.  It  will  be  recalled  that  a  very 
marked  difference  in  individual  suscepti- 
biHty was  also  observed  in  dogs,  and  there 
is  no  reason  to  doubt  that  it  may  likewise 
occur  in  man.  Moore  (7)  attributes  this 
difference  in  susceptibility  to  differences  in 
the  penueability  of  the  skin  to  T.N.T.  We 
believe  that  this  factor  may  partly  account 
for  these  differences,  but  not  entirely.  It 
cannot  be  denied  that  the  skui  of  various 


that  cyanosis  of  the  oral  mucous  membrane 
is  often  absent  in  spite  of  the  presence  of  a 
moderate  to  severe  degree  of  anemia.  Pal- 
lor of  the  skin  was  noted  in  39  per  cent,  of 
our  cases  showing  anemia. 

A  considerable  number  of  the  workers 
without  anemia  exhibited  certain  blood 
abnormalities  and  the  presence  of  cyanosis 
or  pallor.  (See  Table  3.)  This  would  indi- 
cate that  T.N.T.  was  absorbed  by  these 
workers,  but  obviously  not  in  sufficient 
quantity  to  produce  an  anemia  or  toxic 
jaundice.  In  these  cases  blood  regenera- 
tion was  able  to  overcome  any  increased 
blood  destruction  caused  by  the  poison. 


T.4BLE  2.  — RELATION  OF  .\NEMIA  TO  AGE,  TIME  OF  EXPOSURE  TO  T.  X.  T.,  AXD   CY.AXOSIS 

[Data  compiled  from  an  examination  of  149  male  and  88  female  T.  N.  T.  workers] 


Age  in  Years 

Time  of  Exposure 
in  Days 

Number  of  Cases  with  Cyanosis 
and  Anemia 

Number  of  Cases  with  Pallor 
and  Anemia 

Class 

Average 

Extremes 

Average 

Extremes 

Per  Cent, 
of  Total 
Number 
of  Cases 

Males 

Females 

Per  Cent. 

of  Total 
Number 
of  Cases 

Males 

Females 

Slight  anemia .' 

Moderate  anemia  .... 
Severe  anemia 

28 
30 
20 

18-70 

18-53 

20 

122 

102 

24 

8-545 
8-390 

24 

45 

55 

0 

46 

21 

0 

8 
7 
0 

33 

49 

0 

28 

16 

0 

11 
9 
0 

individuals  shows  a  considerable  variation 
in  penueability  to  certain  poisons.  This 
was  very  well  proved  in  the  case  of  a  num- 
ber of  war  gases.  It  is  to  be  kept  in  mind, 
however,  that  it  was  shown  in  the  previous 
section  of  this  report  that  dogs  exhibited  a 
marked  difference  in  susceptibility,  even 
when  differences  in  the  absorption  of 
T.N.T.  were  completely  excluded.  Under 
these  conditions  the  variation  in  individual 
susceptibility  is  very  likely  due  to  dif- 
ferences in  the  methods  of  dealing  with  the 
poison  on  the  part  of  the  body,  in  the 
manner  indicated  in  the  experimenlal 
section. 

Only  48  per  cent,  of  the  anemia  cases 
showed  the  presence  of  cyanosis  of  the  lips. 
This  observation  is  in  conformity  with  the 
observations  made  on  dogs  with  chronic 
T.N.T.  poisoning.   Here  it  was  also  shown 


The  urine  of  these  workers  never  con- 
tained even  traces  of  bile  pigment,  and 
icterus  was  always  absent.  In  no  case  did 
the  urine  contain  sugar,  and  in  a  few  cases 
only,  a  moderate  amount  of  albumin  was 
found.  The  urinary  Webster  test  was  made 
in  a  large  number  of  cases  and  was  nearly 
always  positive.  There  was  no  relation  be- 
tween the  intensity  of  the  test  and  the 
anemia.  The  detailed  account  is  therefore 
omitted.  The  Webster  test  has  no  diag- 
nostic value  bej'ond  showing  that  T.N.T. 
is  al).sorbe(l  antl  excreted  in  a  modified 
form.  A  few  of  the  workers  complained  of 
shortness  of  breath  and  palpitation  follow- 
ing sliglit  exertion.  Others  complained  of 
itching  of  the  skin  of  the  forearms  and 
face,  and  in  a  few  workers  a  typical  jjapillar 
dermatitis  was  observed.  The  skin  of  the 
hands  often  shows  a  yellow  staining  due  to 


VOEGTLIX  —  TRIXITROTOLT'EXE  POISONING 


285 


T.N.T.     The   hair    of   some   workers   as-  by  the  skin  of  the  workers,  it  is  impossible 

sumes  a  reddish-yellow  discoloration.  to  estimate  the  relative  importance  of  skin 

To  sum  up,  it  can  be  said  that  nearly  absorption  and  absorption  by  the  respira- 

three-fourths    of    the    workers    examined  tory   and  jjastro-intestinal  tracts.     ^loore 

showed  definite  signs  of  poisoning.    For  the  and  his  colleagues  are  inclined  to  atlril)ute 

detection  of  poisoning  the  physician  can-  all  T.N.T.  poisoning  to  skin  absorption, 

not  rely  altogether  on  symptoms,  but  lie  This  view  is  altogether  too  one-sidetl,  as 

should    also    make    a    blood    examination,  llie  estimation   of   the   air  contamination 

Much  valuable  information  can  especially  made  by  Professor  Phelps  and  ^Ir.  Cassel- 

be   gained    from   an   accurate   hemoglobin  man  of  this  laboratory  plainly  proves  that 

estimation.     A   standardized   Sahli    lieino-  under  certain  conditions  the  workers  lake 


globinomeler    is    recommended     for     this 
purpose. 

Preventive  Measuren 

In  the  manufacture  of  T.N.T.  and  in  the 
filling  of  shells  with  this  .substance,  it  is 
almost  imjjossible  to  ])re\'ent  all  contact  of 
the  workers  with  this  poison.  A  certain 
amount  of  vaj)or  is  always  formed  in  the 
heating  of  T.N.T.,  and  unle-ss  rigid  i)rc- 
cautions  are  taken  this  \a|»or  escai)cs  to 
some  extent  into  the  workrooms,  where  it  .skin  absorption  in  the  prtxluction  of 'IW.T. 
condenses    to    a    fine   dust    which    settles     poi.soning,  it  appeared  desirable  to  deter- 


in  a  considerable  amoiuit  of  the  jjoison 
with  the  inspired  air.  For  this  reason  it  is 
safer  to  take  the  necessary  precautions 
against  both  methods  of  absorption.  The 
same  ])osition  in  regard  to  this  matter  is 
taken  by  the  British  Health  of  ^Munition 
A\  orkers  ("ommittee  in  its  final  r('])ort. 

Absorption  of  T.X.T.  by  Skin 
In  \iew  of  the  imi)ortance  attached  to 


TABLE  3.  — BLOUU  ClI.VNCiES  .VNU  SVMITOMS  IN   WOltKKU.S  WITH  AND  WlTllULT  ANEMIA 


Ca«e3 

Poikiloey- 

tosw  or 

Anisocy- 

tosis 

Nuckalcd 
RedCclk 

Leukocytes 

C>*anosw 

Below 
S.OOO 

Above 
10,000 

Relative 
Lynipho- 

cylo.sLs 

Pallor 

Witli  anotiiia 

Without  aiH-niia 

171 

.■59 

% 

18 

6 

% 
4 
0 

% 
22 
15 

% 

49 
52 

% 
48 
36 

% 

39 

27 

slowly.  It  is  also  im])ossibIe  to  prevent 
completely  the  si)illing  of  either  the  molten 
or  solid  explosive,  with  the  result  that  the 
floor,  machinery,  and  tiie  outside  of  the 
shells  are  more  or  less  contaminated  with 
T.N.T.  Hence  the  workers  may  absorb 
the  poison  through  the  skin  or  the  poison 
may  enter  the  body  with  the  inspired  air. 
In  this  latter  case  part  of  the  substance 
may  be  swallowed  and  absorbed  from  the 
gastro-intestinal  tract.  On  account  of  the 
ab,sence  of  a  method  for  the  determination 
of  the  absolute  amount  of  T.N.T.  absorbed 


mine  the  skin  area  actuallj^  exposed  to  the 
poison. 

Se\eral  lumdred  workers,  both  men  and 
women,  were  examined  by  testing  the  skin 
of  the  various  parts  of  the  body  with  alco- 
holic sodium  hydroxide  (Wel)sler's  reagent) 
and  noting  the  intensity  of  the  color  so  ob- 
tained. This  varied  from  a  very  deep 
puri)le  to  a  negative  finding,  and  differed 
considerably  on  the  same  body  surfaces  in 
dififerent  individuals.  As  a  general  rule  the 
reaction  is  most  intense  on  the  palms  of  the 
hands  and  about  the  ankle  region.   Next  in 


286 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


line  comes  the  dorsal  surface  of  the  hand, 
the  wrist,  the  foot  below  the  ankle,  the 
forearm,  the  neck,  and  the  face,  in  the 
order  named.  The  reaction  is  rarely  posi- 
tive on  other  parts  of  the  body. 

The  skin  area  exposed  to  T.N.T.  in  fe- 
male workers  was  as  a  rule  not  so  extensive 
as  that  of  male  workers,  which  is  due  to  the 
facts  that  the  former  are  more  particular  in 
wearing  clean  overalls,  underwear,  and 
gloves,  and  that  they  bathe  more  fre- 
quently than  the  average  male  worker. 
This  conclusion  was  reached  from  mforma- 
tion  volunteered  by  the  workers,  and  from 
inspection  of  the  change  houses  and  living 
quarters. 

The  important  practical  point  brought 
out  by  these  tests  is  that  the  clothing  and 
overalls  protect  the  co vexed  skin  very 
efficiently  against  contact  with  the  poison. 
The  only  exception  in  this  respect  concerns 
the  ankle  region.  The  poison  gained  access 
to  this  skin  area  on  account  of  the  fact  that 
overalls  of  these  workers  did  not  cover  the 
upper  part  of  the  shoes,  and  thus  pennitted 
T.N.T.  dust  to  penetrate  the  stockings 
above  the  shoes.  In  order  to  avoid  this  the 
worker  should  be  required  to  wear  overalls 
which  cover  not  only  the  legs  but  also  the 
ankles. 

The  use  of  leather  gloves  seems  to  be 
of  little  protective  value,  as  most  of  the 
workers  remove  them  from  time  to  time, 
thus  allowing  the  inside  of  the  gloves  to 
become  covered  with  T.N.T.  Under  these 
conditions  skin  absorption  is  jirobably 
favored  instead  of  reduced,  especially  dur- 
ing the  warmer  seasons  when  exce.ssi\'e 
perspiration  might  aid  it.  The  use  of 
gloves  should  therefore  be  discouraged. 

The  British  official  reports  refer  to  the 
failure  experienced  in  the  use  of  skin 
varnishes  in  the  prevention  of  skin  absorp- 
tion. In  several  cases  varnishes  gave  very 
unsatisfactory  results.  Dr.  George  F. 
White  of  this  laboratory  has  experimented 
with  a  shellac  castor-oil  varnish  wliich  ap- 


pears fairly  satisfactory  for  this  purpose, 
but  its  trial  in  the  factory  was  impracti- 
cable. 

Further  work  was  done  in  order  to  dis- 
cover an  inexpensive,  harmless,  and  ef- 
ficient skin  wash  which  might  prove 
satisfactory  in  removing  T.N.T.  from  the 
skin  of  the  workers  before  they  left  the 
factory.  It  is  obvious  that  such  a  skin 
wash  might  considerably  reduce,  possibly 
by  two-thirds,  the  amoimt  of  T.N.T.  ab- 
sorbed by  the  skin,  as  the  woi'ker  woidd  no 
longer  absorb  the  poison  after  leaving  the 
factory.  The  regulations  in  this  plant  re- 
quired that  the  workers  should  wash  their 
hands  and  faces  very  thoroughly  with  soap 
and  water  after  stopping  work,  and  they 
were  also  advised  to  take  a  shower  bath. 
Excellent  wash  houses  were  available  for 
this  purpose,  but  the  instructions  were  only 
partially  carried  out.  It  was  furthermore 
found  that  soap  and  water  do  not  remove 
all  the  T.N.T.  from  the  skin  even  after 
thorough  and  repeated  washing.  Numer- 
ous experiments  were  then  carried  out  to 
determine  the  solubility  of  T.N.T.  in  vari- 
ous solvents.  The  most  promising  solvent 
seemed  to  be  a  10  per  cent,  sodium  sulphite 
solution.  This  wash  was  tested  out  on 
T.N.T.  workers  in  the  following  manner: 

Thirty-six  workers  volunteered  for  this 
experiment .  They  were  asked  to  wash  their 
hands  and  forearms  very  thoroughly,  first 
with  soap  and  water,  and  then  with  10  j)er 
cent,  sodium  sulphite  in  water.  The  pres- 
ence or  absence  of  T.N.T.  on  the  skin 
previous  to  and  after  the  washing  with 
soap  antl  the  sulphide  was  determined  by 
means  of  alcoholic  sodium  hydroxide  (Web- 
ster's reagent).  The  results  are  illustrated 
by  Table  4.  It  is  evident,  then,  that  wash- 
ing of  the  skin  with  soap  and  water  re- 
moves only  a  relatively  small  portion  of 
T.N.T.  Alter  washing  in  the  sodium  sul- 
phite, however,  tiie  test  for  T.N.T.  became 
negative  ui  practically  all  cases  except  where 
the  washing  had  not  been  very  thorough. 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


287 


In  order  to  gain  some  information  as  to 
the  actual  amount  of  T.N.T.  removed  by 
the  sulphite  wash,  the  following  experiment 
was  carried  out:  Four  T.N.T.  workers 
were  asked  to  wash  their  hands  and  fore- 
arms thoroughly  with  soap  and  water. 
After  this  they  washetl  a  second  time  in  a 
liter  of  10  per  cent,  sodium  sulphite,  care 
being  taken  to  prevent  spilling  of  the  solu- 
tion. The  sulphite  solution  assumed  a  dark 


made  inquiries  as  to  where  they  coidd  pro- 
cure it .  The  reason  for  the  great  interest  on 
the  part  of  the  workers  is  that  the  deep  red 
color  which  appears  on  the  skin  after  treat- 
ment with  sulphite  clearly  proves  to  the 
worker  the  presence  of  T.N.T.  on  his  skin, 
and  the  fact  that  the  color  passes  into  the 
solution  visualizes  the  removal  of  the  jioi- 
son  from  the  skin.  There  is  no  objection  to 
the  use  of  the  sidphite  solution  for  washing 


T.\BLE  4.  — RELATIVE  El'FIClEXCY  OF  SOAP  .WD  WATER  AND  SODIUM  SULPHITE 
SOLUTION  IN  REMOVING  T.  N.  T.  FROM  SKIN 


No.  ot  Worker 

Webster  Test  before 
Washing 

Webster  Test  after  Soap 
and  Water 

Webster  Test  after 
Sulphite 

Hands 

Wrist 

Forearms 

Hands 

WiUt 

Forearms 

Hands 

Wrist 

Fore- 
arms 

Remarlu 

M.  K.  471 .. . 

+  +  +  + 

+  +  + 

+ 

+  + 

+ 

+S1 

End  of  shift. 

M.  D.  (U7.  .  . 

+  +  + 

+  + 

-1- 

+  + 

+ 

+S1 

«         U            (( 

L.  I.  358 

+  4- 

-|- 

a      (1        a 

L.  E.513.... 

+  +  +  + 

+  +  + 

+  + 

+  + 

+  + 

+ 

a      u        u 

M.K.85.  ... 

+  +  +  + 

+  + 

+ 

+  + 

+ 

+S1 

a      u        u 

L.  D.  3U  ... 

+  +  +  + 

+  + 

+ 

+  + 

+ 

+ 

it      u        a 

L.K.401  ... 

+  + 

+ 

Had  been  off  T.  N.  T. 

two  weeks;  worked  on 

0 

day  of  lest. 

L. K.  192  ... 

+  +  +  + 

+  +  + 

+ 

+  +  + 

+ 

+S1 

End  of  shift. 

L.  I.  562  ... . 

+  +  +  + 

+  + 

+ 

+  +  + 

+  + 

+ 

+S1 

+S1 

u      u        u 

L.  I.  488  ...  . 

+  +  + 

+  + 

+ 

+ 

+S1 

+SI 

Did  not  w  ash  thoroughly. 

L.  I.  276  ... . 

+  +  +  + 

+  +  + 

+  + 

+  + 

+  + 

+ 

+S1 

u         u         u           u. 

L. H.  615  ... 

+  +  +  + 

+  +  + 

+  + 

+  + 

+ 

+S1 

u         a         u           u 

X 

+  +  + 

+  + 

+ 

+  + 

+ 

+ 

+S1 
+S1 

a         u         a           a 

X 

+  +  +  + 

+  +  + 

+  + 

+  + 

+ 

+ 

u         u         u           a 

L.  1.591  .... 





+  + 

+ 

+ 

U          u          u              u 

L.  I.  505 

+  +  + 

+  + 

+ 

u         u         u           u 

red  color  and  was  analyzed  for  T.N.T.  in 
the  following  manner.  The  solution  was 
acidified  with  ililute  sulphuric  acid  and  ex- 
tracted twice  with  ether.  The  ether  ex- 
tract was  washed  twice  with  distilled  water 
and  the  ether  evaporated  to  drj'uess.  The 
crystalline  residue,  after  drying  to  constant 
weight,  weighed  148  mg.  and  consisted  of 
T.N.T.  It  is,  therefore,  evident  that  at 
least  37  mg.  were- removed  from  the  hands 
of  each  worker. 

The  workers  who  used  the  sulphite  wash 
were  enthusiastic  over  the  efficiency  of  this 
chemical  for  the  removal  of  T.N.T.  and 


the  face  and  neck,  as  animal  experiments 
have  demonstrated  that  this  solution  has 
no  injurious  effect  on  either  the  skin  or  the 
eyes. 

Absorption  of  T.N.T.  by  Lungs  and  Gastro- 
intestinal Tract 

In  order  to  prevent  as  much  as  possible 
the  absorption  of  T.N.T.  by  the  lungs 
and  gastro-intestinal  tract,  the  workrooms 
should  eliminate  the  possibility  of  air  con- 
tamination with  T.N.T.  In  the  factory  in 
which  this  work  was  carried  out,  three 
operations  exposed  the  workers  to  badly 


288 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


contaminated  air.    First  of  all  the  melting 
of  T.N.T.  in  the  steam  kettles  led  to  the 
escape  of  a   considerable  amount  of  the 
vapor   into   the    workroom   as   the   kettle 
hoods  were  not  provided  with  foi'ced  draft. 
The   workmen   engaged   in   melting   were 
therefore  breathing  an*  more  or  less  satu- 
rated with  T.N.T.  vapor,  which,  according 
to    the    analyses    reported    by    Professor 
Phelps    and    JVIr.    Casselman,*    contained 
0.006  mg.  of  T.N.T.  per  liter.   The  worker 
would  therefore  breathe  at  lea.st  16  mg.  of 
T.N.T.  during  seven  and  one-half  hours. 
Another  operation  which  led  to  air  con- 
tamination was  the  sweeping  of  the  floors, 
which  was  done  three  times  during  the  day 
while  the  workers  were  at  work.   The  dust 
suspended  in  the  air  by  means  of  this  opera- 
tion is  very  light  and  settles  slowly.   As  the 
result  of  the  sweejiing,  each  worker  would 
breathe  in  approximately  9.1  mg.  of  T.N.T. 
during    a    day.     The    third    objectionable 
operation    consisted    in    blowing    out    the 
booster  cavity  with  compressed  air.    This 
was  done  very  frequently  in  the  finishing 
room,  and  the  persons  on  this  job  may  take 
in  2  or  3  mg.  of  T.N.T.  with  each  breath. 
These  serious  health  hazards  could  easily  be 
eliminated  by  the  use  of  exhaust  ventila- 
tors for  the  melting  kettles  and  an  appro- 
priate vacuum  system  for  the  cleaning  of 
the  floors  and  the  booster  cavity. 

The  figures  gi^'en  in  the  report  of  Pro- 
fessor Phelps  and  ]Mr.  Casselman  are  con- 
vincing enough  to  emphasize  the  imjjor- 
tance  of  preventing  au-  contamination.  The 
method  used  was  much  more  accurate  than 
the  one  used  by  Moore  and  his  colleagues,  a 
fact  which  explains  the  higher  values  thus 
obtained. 

As  a  further  precaution,  the  workers 
should  be  urged  to  wash  their  hands 
thoroughly  before  eating  their  meal  during 
the  working  hours.  The  protective  value  of 
respirators  has  been  tested  out  extensively 

*  Till-  report  by  Professor  I'hclps  aiul  Mr.  (iisselman 
«ill  be  publisbed  elsewhere. 


in  this  country  and  abroad,  and  has  been 
found  to  be  very  unsatisfactory. 

This  investigation,  therefore,  clearly 
proves  the  necessity  of  guarding  the  worker 
against  absorption  of  the  poison  by  the 
skin  as  well  as  by  the  lungs  and  gastro- 
mtestinal  tract. 

Diet 

In  the  first  part  of  this  paper  attention 
was  called  to  the  relation  between  diet  and 
T.N.T.  poisoning.  It  was  pointed  out  that 
dogs  on  a  meat  diet  are  more  resistant  to 
the  action  of  T.N.T.  than  dogs  fed  on 
bread  and  milk.  In  view  of  this  observation 
it  was  important  to  make  inquiries  concern- 
ing the  diet  of  the  workers. 

The  company  operates  two  mess  halls, 
one  principally  for  women,  the  other  for 
men.  In  both  of  these  a  fixed  menu  is 
seived.  There  is  also  a  "short-order" 
restaurant  where  the  workers  can  choose 
their  menu  from  a  large  variety  of  foods. 
The  portions  served  in  these  mess  halls  are 
fairly  liberal.  The  menus  vary  but  little 
from  week  to  week. 

A  relatively  small  number  of  the  workers 
live  in  family  cottages  and  procure  their 
])rovisions  from  the  company's  commissary 
store. 

It  was  evident  that  the  diet  of  the  work- 
ers was  varied  and  that  it  included  a 
considerable  amount  of  meat,  vegetables, 
cereals,  bread,  butter,  and  fruits.  The 
good  quality  of  the  diet  consumed  by  the 
workers  may  be  one  of  the  factors  which 
accounts  for  the  evident  absence  of  severe 
T.N.T.  poisoning  in  this  plant. 

Toxic  Jaundice  and  Aplastic  Anemia 

The  first  ca.ses  of  toxic  jaundic-e  at- 
tributed to  T.N.T.  were  reported  in  1915 
by  the  medical  inspectors  of  factories  to  the 
British  home  office,  which  in  turn  issued 
instructions  to  ])hysicians  to  report  all  such 
ca.ses.  According  lo  O'Donovan  CUi)  tlu-re 
occun-ed   in  England,  in   1916,   181  cases 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


289 


with  50  deaths;  in  1917,  189  cases  with  44 
deaths.  In  addition  there  were  reported 
during  this  period  14  cases  of  aplastic 
anemia,  these  cases  being  regarded  as  rep- 
resentatives of  another  extreme  form  of 
T.N.T.  poisoning.  No  statistics  are  avail- 
able as  to  the  prevalence  of  these  two  con- 
ditions in  the  United  States.  ^lartland  (5) 
and  Haythorn  (;57)  report  two  fatal  cases, 
giving  also  the  pathological  findings  at 
necropsy.  Hamilton  (SH)  (39)  reports  13 
deaths  from  T.N.T.  poisoning  in  the 
United  States,  but  fails  to  state  the  nature 
of  the  clinical  picture,  whether  toxic  jaun- 
dice or  aplastic  ancnn'ii. 

It  is  very  significant  that  tiie  occurrence 
of  toxic  jaundice  and  aplastic  anemia  in 
T.N.T.  workers  is  relatively  rare  when  it  is 
considen-d  that  (ireat  Hiitain  alone  em- 
ployed over  100, ()()(>  persons  in  the  manu- 
facture t)f  numitions.  It  is  also  to  be 
remembered  that  the  diagnosis  of  toxic 
jaundice  depends  largely  on  the  icterus, 
which  of  course  is  not  characteristic  of  this 
condition  only,  and  the  a.ssociation  of  the 
worker  with  T.N.T.  Syphilitic  icterus,  or 
true  yellow  atro])hy  of  the  liver,  may  occur 
in  T.N.T.  workers  and  may  thus  lead  to  a 
diagno.sis  of  toxic  jaundice.  The  same  holds 
true  for  aplastic  anemia,  a  disease  which 
also  occurs  in  persons  not  exposed  to 
T.N.T.  It  is  therefore  possible  that  the 
figures  given  by  O'Donovan  are  somewhat 
too  high. 

The  question  naturally  arises  as  to  why 
most  of  the  T.N.T.  workers  should  be  im- 
mune to  toxic  jaundice  and  apla.stic 
anemia.  The  following  considerations  may 
assist  in  the  solution  of  this  problem. 
From  the  results  obtained  in  the  study  of 
T.N.T.  poisoning  of  dogs,  it  is  evident  that 
T.N.T.  often  causes  the  appearance  of  a 
very  severe  anemia.  The  bone  marrow  of 
these  animals  is  hyperplastic  without  ex- 
ception, and  for  this  and  other  reasons  the 
anemia  as  ob.served  in  these  animals  cannot 
be  regarded  as  a  true  aplastic  anemia.   The 


blood  destruction  was  therefore  attributed 
to  a  primary  injury  of  the  red  cells  leading 
to  fragmentation  and  eventually  to  phag- 
ocytosis of  the  injured  red  cells  by  the 
phagocytic  cells  of  certain  organs.  The 
examination  of  the  T.N.T.  workers  has 
furthermore  revealed  the  fact  that  a  con- 
siderable number  show  a  moderate  anemia. 
IMinot  has  also  called  attention  to  the  frag- 
mentation of  the  red  cells  in  many  T.N.T. 
workers. 

We  therefore  believe  that  tlie  availal)le 
evidence  clearly  .shows  that  the  meclianism 
of  the  blood  destruction  caused  by  T.N.T. 
is  essentially  the  same  in  dogs  and  in  man. 
Previous  writers  on  this  subject  insist,  how- 
ever, that  T.N.T.  anemia  is  caused  by  the 
toxic  action  of  T.N.T.  or  some  of  its  deriva- 
tives on  the  hematopoietic  organs,  esf)e- 
cially  the  bone  marrow.  Our  data  ilo  not 
permit  us  to  exclude  this  possibility  alto- 
gether, although  they  do  show  that  T.N.T. 
anemia  is  essentially  a  phagocytic  anemia. 
The  bone  marrow  was  examined  only  in  six 
ca.ses  of  so-called  aplastic  anemia  in  T.N.T. 
workers.  The  marrow  of  the  femur  was 
described  as  gray  in  one  case,  fatty  with 
pink  spots  in  two  cases,  and  pale  pink  in 
two  cases.  Turnbull  (40)  from  the  micro- 
scopic examination  of  the  bone  marrow  in 
one  case,  claims  that  it  showed  a  relative 
excess  of  erythroblastic  activity  and  a  de- 
crease in  the  number  of  megalokaryocytes; 
numerous  plasma  cells  and  large  phag- 
ocytes containing  pyknotic  nuclei,  eryth- 
roblasts,  erythrocytes,  and  iron-containing 
pigment.  It  is  possiljle  to  conceive  that  in 
the  later  stages  of  the  anemia  the  function 
of  the  bone  marrow  may  be  seriouslj'  de- 
pressed on  account  either  of  the  oxygen  de- 
ficiency or  of  other  metabolic  abnormalities 
resulting  from  the  severe  anemia,  or  as  the 
result  of  the  direct  action  of  the  poison  on 
this  organ.  We  believe,  however,  that  these 
factors  are  of  minor  importance  in  the  pro- 
duction of  T.N.T.  anemia. 

As  to  T.N.T.  icterus,  the  experimental 


290 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


work  plainly  shows  that  this  condition  may 
often  occur  in  the  absence  of  liver  necrosis 
or  atrophy,  in  which  case  the  icterus  is 
probably  due  to  the  inability  of  the  hver 
cells  to  excrete  the  increased  amount  of  bile 
pigment  resulting  from  the  destruction  of 
erythrocytes.  Some  of  the  cases  of  toxic 
jaundice  reported  by  Panton  ('■2-1)  may  pos- 
sibly be  explained  on  this  basis.  The  blood 
of  these  patients  showed  a  normal  hemo- 
globin content  and  red  cell  count.  On 
account  of  these  findings  some  writers  ex- 
plain T.N.T.  icterus  as  being  primarily  due 
to  the  injurious  action  of  the  poison  on  the 
liver  cells,  a  view  which  is  not  necessarily 
correct  as  it  is  quite  possible  to  conceive 
that  T.N.T.  may  lead  to  a  considerable  in- 
crease in  red  cell  destruction  and  conse- 
quently bile  pigment  formation,  without 
causing  a  reduction  in  the  hemoglobin 
content  or  number  of  red  blood  cells.  The 
hemoglobin  content  and  red  cell  count  are 
not  an  absolute  index  of  the  degree  of  blood 
destruction,  as  increased  blood  regenera- 
tion may  temporarily  compensate  the  in- 
creased disintegration  of  red  cells.  Some  of 
Panton's  cases  which  he  observed  for  sev- 
eral weeks  showed  a  giadual  decrease  in 
hemoglobin  and  the  number  of  red  cells, 
this  finally  resulting  in  the  appearance  of  a 
severe  anemia.  It  is  very  likely  that  in  the 
early  stages  of  the  jaundice  the  increased 
blood  destruction  was  compensated  by 
regeneiation,  and  that  later  on,  when  this 
compensation  failed,  the  anemia  appeared. 
It  is  therefore  possible  to  attribute  the 
icterus  in  some  of  the  toxic  jaundice  cases 
to  the  increased  blood  destruction  caused 
by  T.N.T.  In  other  cases,  however,  the 
icterus  is  associated  with  a  marked  reduc- 
tion of  liver  dullness  during  life,  and  at 
necropsy  the  li\'er  shows  extensive  necrosis 
and  atrophy,  which,  according  to  Turnbull, 
Haythorn,  and  others,  cannot  be  dis- 
tinguished from  acute  yellow  atrophy.  The 
liver  was  examined  in  thirty  of  these  cases 
and  in  all  a  greater  or  less  degree  of  acute 


yellow  or  red  atrophj^  was  present.  The 
liver  cells  of  some  areas  were  completely 
destroyed.  Some  observers  also  found  a 
moderate  amount  of  cirrhotic  change.  It  is 
difficult  to  determine  whether  or  not 
T.N.T.  alone  is  responsible  for  these  liver 
changes.  We  are  rather  inclined  to  explain 
these  cases  by  assuming  that  certain  pre- 
existing pathological  conditions  affecting 
the  functional  capacity  of  the  hver,  such  as 
cirrhosis,  syphilis,  alcoholism,  etc.,  may 
predispose  some  T.N.T.  workers  to  toxic 
jaundice  in  an  abnormal  degree.  Under 
these  circumstances,  it  is  possible  to  con- 
ceive that  T.N.T.  or  its  reduction  products 
may  exert  a  more  deleterious  action  on  the 
liver  cells  than  in  persons  with  normal 
livers.  This  explanation  would  accoimt  for 
the  fact  that  in  numerous  experiments  with 
dogs  it  was  impossible  to  produce  even  the 
slightest  degree  of  liver  atrophy,  and  this 
in  spite  of  the  fact  that  these  animals  are 
highly  susceptible  to  necrosis  of  the  liver 
when  exposed  to  poisons  with  a  more  or 
less  specific  action  on  the  organ,  such  as 
chloroform,  phosphorus,  and  arsenicals. 

The  fact  that  toxic  jaundice  sometimes 
appears  in  T.N.T.  workers  several  weeks 
after  their  removal  from  all  contact  with 
T.N.T.,  agrees  with  the  observation  made 
on  dogs,  viz.,  that  T.N.T.  is  very  slowly 
eliminated  from  the  body,  and  therefore 
continues  to  exert  its  toxic  action  for  a  long 
period  of  time. 

If  the  correctness  of  these  considerations 
is  taken  for  granted,  the  prevention  of  toxic 
jaundice  and  so-called  aplastic  anemia  hi 
T.N.T.  workers  should  concern  itself  prin- 
cipally with  the  elimination  of  all  persons 
with  evidence  of  liver  disease  and  anemia 
from  contact  with  T.N.T.  Moreover,  all 
T.N.T.  workers  should  be  frequentlj'  ex- 
amined by  the  factory  physician,  special 
attention  being  given  to  the  occurrence  of  a 
slight  icteric  change  of  the  conjunctiva  or 
skin,  the  presence  of  this  symptom  being 
regarded  as  sufficient  reason  to  put  the  in- 


VOEGTLIN  —  TRINITROTOLUENE  POISONING 


291 


dividual  on  work  where  he  is  no  longer  ex- 
posed to  T.N.T.  An  accurate  hemoglobin 
estimation  should  also  be  made  on  each 
worker  every  week,  or  at  least  every  two 
weeks.  A  nurse  or  specially  trained  labora- 
tory assistant  could  easily  attend  to  this 
work.  Any  workers  with  icterus  or  severe 
anemia  should  be  admitted  to  a  hospital. 
The  treatment  should  consist  first  in  the 
removing  of  all  T.N.T.  from  the  body  sur- 
face by  means  of  a  10  per  cent,  sodium 
sulphite  solution.  The  anemic  patients 
should  receive  a  nutritious  diet  contaming 
a  fair  amount  of  fresh  meat.  The  patients 
with  jaundice  should  be  treated  with  laxa- 
tives and  should  be  fed  on  a  meat-free  diet 
containing  milk  and  fresh  vegetables. 

The  prognosis  of  cases  with  an  extreme 
anemia  is  grave.  A  considerable  number  of 
cases  with  jaundice  recover, although  the  re- 
covery proceeds  very  slowly  and  rccjuires 
six  months  or  more.  See  Crawford  (41) 
and  Bower  (42). 

Suinniurij 

The  principal  results  obtained  in  I  he 
field  investigation  are  the  following: 

The  examination  of  2;}7  T.N.T.  workers 
in  a  .shell-filling  ])lant  showed  that  72  |)cr 
cent,  of  these  workers  were  anemic.  'J'his 
anemia  exhibits  the  same  features  as  the 
anemia  observed  in  dogs  jwisoned  with 
T.N.T.,  viz.,  a  reduction  in  the  hemoglobin 
percentage,  the  presence  of  anisocytosis 
and  poikilocytosis,  polychromatophiha,  . 
fragmentation  of  retl  colls,  and  the  ai)i)ear- 
ance  of  nucleated  and  reticulated  red  cells 
in  the  circulating  blood.  The  anemia  may 
or  may  not  be  associated  with  a  leukocy- 
tosis, leukopenia,  or  relative  lymjihocy- 
tosis. 

Cyanosis,  pallor,  anil  dermatitis  were 
frequently  seen  in  these  workers,  and  indi- 
cate that  the  poison  is  absorbed.  The 
absence  of  these  symptoms,  however,  is 
not  proof  of  the  absence  of  poisoning.     A 


marked  anemia  may  exist  without  clinical 
s.^nnptoms. 

Examination  of  the  urine  nearly  always 
reveals  the  presence  of  a  derivative  of 
T.N.T.  (hydroxylamine  comijound).  The 
presence  or  absence  of  this  substance  in  t  he 
urine,  as  determined  by  the  Webster  test,  is 
of  no  prognostic  value.  The  examination 
of  the  blood,  with  particular  reference  to  its 
hemoglobin  content,  the  character  of  the 
red  cells  and  the  aj^ix-arance  of  a  slight 
icteric  discoloration  of  the  skin  or  conjunc- 
tivae, is  recommended  as  a  reliable  guide 
for  the  diagnosis  of  T.N.T.  poisoning. 

No  cases  of  toxic  jaundice  or  aj^lastic 
anemia  were  found  among  tliose  workers. 
It  is  suggested  that  the  so-called  aplastic 
anemia  observed  in  T.N.T.  workers  repre- 
sents the  final  stage  of  the  anemia  .so  com- 
monly found  in  persons  expo.sed  to  T.N.T., 
ami  that  in  the  earlier  stages  of  poisoning 
the  blood  destruction  is  essentially  due  to 
the  injury  of  the  red  cells  which  .secondarilj' 
leads  to  i)liagocytosis  of  the  injured  cells 
by  the  spleen,  liver,  and  bone  marrow.  In 
toxic  jaundice  the  hemoglobin  and  red  cell 
count  may  be  normal  or  reduced.  In  the 
first  case  blood  regeneration  probably 
compensates  for  blood  destruction.  'I'lie 
liver  lesions  found  at  necro])sy  may  be  due 
to  a  pre-existing  f\mctional  or  histological 
abnormality  of  tlie  liver  cells  which  has 
been  aggravated  l>y  I  he  'I'.N.T.  intoxi- 
cation. 

The  poison  may  be  absorbed  through  the 
skin,  the  lungs,  or  the  gastro-intestinal 
tract.  Means  of  i)revention  shoidd  be 
strictly  observed.  Skin  contact  and  air 
contamination  should  be  reduced  to  a 
minimum.  The  principal  measures  for 
skin  protection  should  consist  in  wearing 
clean  overalls  and  head  dress,  and  in  using 
sulphite  solution  for  the  removal  of  T.N.T. 
from  the  exposed  skin  surface  before  the 
worker  leaves  the  factory.  Personal  clean- 
liness in  working  and  in  the  care  of  the 
l)ody  should  be  emphasized.    Gloves  and 


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THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


respirators  are  of  no  value.  There  should 
be  efficient  ventilation  of  the  workrooms; 
the  floors,  booster  cavities,  etc.,  should  be 
cleaned  by  means  of  an  induced  draft.  The 
workers  should  be  instructed  to  eat  a 
nutritious  diet  containing  a  fair  amount  of 
meat.  They  should  be  examined  at  least 
every  week  or  two  for  the  presence  of 
clinical  symptoms  and  anemia.  Intermit- 
tent emjiloyment  on  T.N.T.  work  reduces 
the  health  hazard  somewhat,  but  does  not 
necessarily  insure  against  poisoning  be- 
cause the  system  retains  T.N.T.  for  a  con- 
siderable length  of  time.  Preliminary 
medical  examination  should  insure,  as 
nearly  as  possible,  that  no  person  is  em- 
ployed who  shows  the  shghtest  evidence  of 
liver  disease  or  anemia. 


ACKNOWLEGDMENTS 

The  authors  are  greatly  indebted  to 
Misses  K.  Dorothy  Wright,  M.Crane,  M. 
A.  Connell,  Mr.  Henry  B.  INIulholland  and 
Mr.  Lewis  D.  Hoppe  for  assistance  in  the 
blood  examination  of  the  experimental 
animals  and  T.N.T.  workers.  Dr.  Walter 
L.  Mendenhall,  of  Dartmouth  INIedical  Col- 
lege, rendered  valuable  assistance  during 
the  first  three  months  of  this  investiga- 
tion. WV  also  express  our  great  apprecia- 
tion to  Dr.  W.  G.  ISIacCallum  and  Dr. 
Henry  Christian  for  their  examination  of 
part  of  the  histological  material  obtained  in 
the  experimental  work.  The  vital  red  used 
in  the  blood  volume  determinations  was 
secured  through  the  courtesy  of  Dr.  C.  L. 
Alsberg,  Chief  of  the  Bureau  of  Chemistry. 


BIBLIOGRAPHY 

(For  bibliographical  references  numbered  less  than  28,  see  Part  I  of  this  article  iu  the  preceding 

issue  of  This  Journal.) 


28.  Livingstone-I^armonth,  A.,  and  Cunningham, 
B.M.:  Observations  on  the  Effects  of  Tri- 
nitro-toluene  on  Women  Workers.  Lancet, 
1916.  2,  261. 

29.  Stewart,  M.  J. :  Toxic  Jaundice  in  Munition 
W'orkers.    Lancet,  1917,  1,  153.. 

30.  Smith.  L.  H. :  The  Blood  of  Workers  in  Trini- 
trotoluene. Jour.  Am.  Med.  Assn.,  1918,  70, 
231. 

31.  Harrington,  T.  F.:  Tri-Nitro-Toluene  Poison- 
ing in  Massachusetts.  Boston  Med.  and  Surg. 
Jour.,  1917,  177,838. 

32.  Gregorson,  A.  W.,  and  Taylor,  F.  E.:  On 
Trinitrotoluene  Poisoning,  with  Records  of 
Five  Cases.    Glasgow  Med.  Jour.,  1918,  90,  65. 

33.  Minot,  G.  R.:  Blood  Examinations  of  Trinitro- 
toluene AVorkers.  Jour.  Am.  Med.  Assn.,  1919, 
73.  7U. 

3-t.  jNlinot,  G.  R.:  Blood  Examinations  of  Trinitro- 
toluene Workers.  JouK.  I.vou.ST.  Hyg.,  1919- 
1920,1,301. 


35.  Final  Report  of  Health  of  Munition  Workers 
Committee.     London,  1918,  p.  78. 

36.  O'Douovan,  W.  J.:  The  Epidemiology  of  Tri- 
nitro-toluene  Poisoning.  Proe.  Royal  Soc.  Med., 
1917-1918,  11,  1^9, 

37.  Haythorn,S.  R.:  The  Pathology  of  Trinitrotol- 
uene Poisoning.  Internat.  Assn.  Med.  Mu- 
seums, Bull.  No.  7,  1918,  p.  103. 

38.  Hamilton,  .V. :  Industrial  Poisons  Encountered 
in  the  Manufacture  of  Explosives.  Jour.  Am. 
Med.  Assn.,  1917,  68,  1445. 

39.  Hamilton,  A.:  Trinitrotoluene  Poisoning.  Med. 
and  Surg.,  1917,  1,  761. 

40.  Turnlnill,  H.  iVI.:  Discussion  on  Toxic  .Jaundice 
in  Munition  Workers.  Proc.  Roy.  Soc.  Aled., 
1916-1917,  10,  Part  1.  47. 

41.  Crawford.  B.  (J.  R.:  Toxic  Jaundice,  with  . Atro- 
phy of  Li\er,  followed  by  Regeneration  and 
Recovery.    Brit.  Med.  Jour.,  1918.  1,  450. 

42.  Bower,  W.:  Toxic  .Jaimdiee:  Atrophy  of  Liver: 
Regeneration  and  Recovery.  Brit.  Med.  Jour., 
1918,  1,508. 


BOOK  REMEWS 


293 


BOOK  REVIEWS 


The  Health  of  the  Industrial  Worker.  Bv  Ed- 
gar L,  Collis,  IJ.Ch.,  M.A.,  M.D.  (Oxon.).  M.R.C.P. 
(Lond.),  M.R.C.S.  (Eng.),  Mansel  Talhot  Professor 
of  Preventive  Medicine,  Welsh  National  School  of 
Medicine;  Member  of  Industrial  Fatigue  Research 
Board;  late  H.M.  Medical  Inspector  of  Factories; 
Member  of  Health  of  Munition  Workers  Committee; 
Milroy  Lecturer.  R.C.P.  (191.5);  Director  of  Welfare 
and  Health,  IMinislrv  of  Munitions;  and  Major 
Greenwoo.1,  M.R.C.P.  (I.ond.),  M.R.C.S.  (Eng.), 
Member  of  Industrial  Fatigue  liesearcli  Board; 
Eea<^ler  in  Medical  Statistics,  University  of  London; 
late  Statistician  to  Lister  Institute;  Head  of  Medical 
Rcsearcii  Brancii,  Ministry  of  Munitions;  Arris  and 
Gale  Lecturer,  R.C.S.  (1908).  Containing  a  chai)ter 
on  Rkciamatiox  of  tuk  Disahled  I)v  Arthur  J. 
Collis,  M.A.,  M.D.  (Canlab.).  M.R.C.S.  (Eng.), 
D.P.II.  (I)urh.),  Medical  Superintendent,  Ministry' 
of  PcnsiciMs  Hospital,  Leicester;  late  Temp.  Lieut.- 
Col.  R..\.M.C.  With  an  introduction  l)v  Sir  (icorgc 
Newman,  K.C.B.,  D.C.L.,  :M.I).,  F.R.C.P.  Illus- 
trated. Cloth.  I'p.  4o()  with  illustrations  and  index. 
Philadelpliia:  P.  Hlaliiston's  Son  &  Co.,  19'2L 

Sir  George  Newman  in  his  introduction  to 
this  hook  gives  the  ])oint  of  view  wliich  it  so 
forciljjy  jjrescnts:  "Wliiie  at  first  sight  acci- 
dents, poisoning,  and  a  high  occupational  death 
rate  arc  im])rcssivc,  it  caniu)t,  I  lliink,  be 
doubled  tliat  tiie  less  dranuilic  side  of  tiie  jirob- 
lem  is,  in  fact,  the  more  important  —  namely, 
the  lost  time  and  incapacity  due  to  ill-iiealth. 
For  this  is  so  widely  prex'alent  as  to  be  ahnost 
universal,  in  all  districts,  at  all  ages,  in  all 
trades,  llierc  is  tliis  vast  mass  of  wasted  life  and 
energy  due  for  the  most  part  to  preventable 
maladies  —  in  tlicir  turn  largely  attributable  to 
remediable  conditions  of  industry,  or  to  neglect 
of  hygiene." 

After  reading  this  inlroduclion  one  is  not  sur- 
prised to  find  an  absence  of  chapters  upon  in- 
dustrial toxicology  and  upon  the  minutiae  of 
industrial  medicine  and  surgery.  We  are  of- 
fered instead  a  view  of  a  new  field  in  preventive 
medicine,  a  field  which  covers  the  working  Hfe 
of  a  large  portion  of  our  po])ulalion.  Such  a 
book  places  industrial  hygiene  in  its  proper 
I)lace,  displays  its  possibilities  of  growth,  and 
removes  it  from  the  position  of  a  rather  feeble 
adjunct  to  pharmacology  and  to  the  estab- 
i       lished  practice  of  medicine  and  surgery. 


The  chapter  headings  will  give  the  best  idea 
of  the  scope  of  the  work:  I.  Industry  and 
Health  —  A  Retrospect;  II.  Review  of  In- 
dustrial Legislation;  III.  The  Utilization  of 
Statistical  Methods  in  Industrial  Preventive 
Medicine;  IV.  The  Effects  of  Industrial  Em- 
ployment upon  Health  as  Indicated  by  Vital 
Statistics;  V.  Industrial  Activity  and  Fatigue; 
VI.  Tuberculosis  and  Industry;  VII.  Cancer 
and  Industry;  VIII.  Causation  and  Preven- 
tion of  Accidents;  IX.  Industrial  Employment 
of  Women;  X.  Tlie  Feeding  of  the  Industrial 
Worker;  XI.  Food  at  the  Factory;  XII.  Tiie 
Use  of  Alcoholic  Beverages  by  the  Industrial 
Worker;  XIII.  Reasons  for  and  Methods  of 
Ventilation;  XIV.  Lighting;  XV.  Wa.shing  Ac- 
commodalion  —  Sanitary  Accommodation  — 
Drinking  Water  —  Working  Clothes  —  Cloak 
Rooms  —  Seats;  XVI.  Labour  Turnover  or 
Induslrial  Wastage;  XVII.  Supervision  of  In- 
dustrial Health;  XVIII.  Redanuition  of  the 
Disabled. 

The  treatment  of  these  subjecls  is  of  liigh 
order  and  llie  difficulty  of  handling  theiii  is 
great  because  in  the  main  they  are  at  the  be- 
ginning of  their  development.  Of  particular 
merit  are  the  chapters  upon  fatigue,  ventilation 
and  luberculosis.  The  addition  to  each  chapter 
of  well-selected  groups  of  references  is  an  addi- 
tion of  value  and  especially  useful  in  a  develop- 
ing subject. 

While  to  the  American  reader  it  may  seem 
that  tiie  treatment  should  have  extended  out- 
side Hrilish  cx|)erietices  to  a  greater  degree  than 
occiu-s,  this  does  not  seem  of  importance  to  the 
reviewer.  The  book  is  an  exposition  of  prin- 
ci]}les,  of  a  modern  jioint  of  view  upon  which 
schools  may  be  founded.  In  such  an  effort  the 
experiences  recounted  are  necessarily  inter- 
national in  their  applicability  and  significance. 

It  is  a  pleasure  to  recommend  the  work  to 
forward-looking  readers,  and  it  is  hoped  that 
those  who  have  seen  the  subject  of  industrial 
hygiene  as  the  weak  handmaid  of  medicine  and 
surgery  will  find  a  stimulating  refutation  of 
their  views  in  this  volume.  —  Cecil  K.  Drinker. 


294 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


BOOKS   RECEIVED 

Books  received  are  acknowledged  in  this  column,  and  such  acknowledgment  must  be  regarded  as  a 
sufficient  return  for  the  courtesy  of  the  sender.  Selections  will  be  made  for  review  in  the  interests  of  our 
readers  and  as  space  permits. 


Principles  of  Hygiene.  A  Practical  Manual  for 
Students,  Physicians,  and  Health-Officers.  By  D.  H. 
Bergey,  A.M.,  M.D.,  Dr.  P.H.,  Assistant  Professor 
of  Hygiene  and  Bacteriology,  L'niversity  of  Pennsyl- 
vania. Blustrated.  Cloth.  Seventh  Edition,  thor- 
oughly revised.  Pp.  556  with  illustrations,  preface, 
index,  and  appendix.  Philadelphia  and  London :  AV. 
B.  Saunders  Company,  19'21. 

Textbook  of  Surgical  Nursing.  By  Ralph  Colp, 
A.B.,  M.D.,  Instructor  in  Surgery,  Columbia  Uni- 
versity, New  York;    Lecturer  m   Surgical  Nursmg, 


Presbyterian  Hospital  Training  School  for  Nurses, 
New  York;  Adjunct  Visiting  Surgeon,  Volunteer 
Hospital,  New  York;  Chief  of  Surgical  Clinic,  Beth 
Israel  Hospital.  New  York;  Formerly  Lecturer  in 
Nursing  and  Health,  Teachers  College,  Columbia 
University,  New  York;  and  Manelva  Wylie  Keller, 
B.S.,  R.N.,  Formerly  Chief  Operating  Room  Nurse, 
St.  Luke's  Hospital,  New  York,  and  Anesthetist, 
St.  Luke's  Hospital,  New  York,  and  Mobile  Hos- 
pital No.  '2,  A.  E.  F.,  France.  Cloth.  Pp.  -153  with 
appendix,  illustrations,  and  index.  New  York: 
■  Macmillan  Company,  1921. 


THE  JOURNAL  OF 
INDUSTRIAL  HYGIENE 


PUBLISHED  MONTHLY 


Volume  hi 


FEBRUARY.  1922 


Number  10 


MODERN  VIEWS  UPON  THE  DEVELOPMENT  OF 
LUNG  FIBROSIS* 

Cecil  K.  Drinker,  M.D. 

Associate  Professor  of  Applied  Physiology,  Harvard  Medical  School 
(From   the  Laboratory   of  Applied  Physiology,   llarvartJ    Medical  School,  Boston,  Mass.) 


I.   New  Aspects  of  the  Proble 


M 


T  N  1918  Haldane  (1)  published  a  short 
-'-  and  very  suggesti\e  paper  on  the 
cause  of  serious  lung  injury  from  dust. 
He  pointed  out  that  silicious  dust  had 
been  thought  to  be  harmful  if  present 
in  the  air  in  any  considerable  amount, 
but  that  he  had  become  acquainted  with 
certain  instances  in  which  this  did  not 
seem  to  be  true,  work  in  high  percent- 
ages of  silicious  dust  being  apparently 
uninjurious.  He  then  discussed  the  fact 
that  coal  miners  who  breathe  coal  and 
shale  dust  remain  comparatively  free 
from  serious  lung  disease.  This  he  har- 
monized with  experimental  work  done 
by  Mavrogordato  (2),  who  caused  gui- 
nea-pigs to  breathe  air  laden  with 
six  different  dusts :  coal,  shale,  quartz 
from  the  Trans\-aal,  flint,  material 
from  flues,  and  pure  precipitated 
silica.  He  found  that  high  concen- 
trations of  any  of  these  dusts  re- 
sulted in  hea\'>'  deposition  in  the 
lungs,  with  marked  congestion  and 
cellular  proliferation.    His  observations 

*Rocoivp(l  for  piilpliciitidii  (X-t.  IS.   1!I21. 


did  not  continue  long  enough  to  permit 
the  widespread  development  of  fibrous 
tissue,  but  there  is  apparently  no  doubt 
that  it  would  have  occurred. 

The  significant  fact  of  the  experi- 
ments was  brought  out  by  moderate  ex- 
posures, when  it  was  found  that  "While 
coal  dust  and  shale  dust  enter  the  lung 
with  great  readiness  they  do  not  pro- 
duce, under  these  conditions,  permanent 
lesions;  and  the  lung  might  pass  for 
normal  after  a  twelvemonth.  Flue  dust 
and  crystalline  silica  are  not  eliminated 
with  such  readiness."  The  important 
suggestion  of  the  experiments  is,  then, 
that  dusts  which  do  harm  are  those 
which  for  some  reason  or  other  are  not 
eliminated.  Carbon  particles,  according 
to  Haldane  and  Mavrogordato,  cause 
rather  a  violent  reaction  when  they 
reach  the  pulmonary  alveoli,  which  re- 
sults in  their  quick  seizure  by  phago- 
c\i;es  and  their  elimination ;  while  crys- 
talline silica,  a  notably  harmful  dust, 
enters  the  lung  with  equal  readiness, 
causes  little  reaction,  remains  in  the 
lung  tissue  and  slowly  induces  fibrosis. 

It  will  be  shown  later  that  Mavrogor- 


295 


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THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


dato  makes  many  claims  as  to  the  man- 
ner in  which  dust  is  removed  from  the 
lungs,  which  are  out  of  accord  with  the 
observations  of  other  investigators.  But 
analytical  disagreements  have  nothing 
to  do  with  his  most  important  conten- 
tion, namely,  that  rate  of  dust  invasion 
is  not  more  important  than  rate  of  dust 
elimination.  When  dust  reaches  the 
lung  alveoli  there  are  three  ways  by 
which  it  may  get  out : 

L  By  the  bronchi — the  route  taken 
on  coming  in.  The  sputum  of  individ- 
uals who  have  worked  in  coal  dust  in- 
variably shows  particles,  and  a  fair  per- 
centage of  these  have  probably  been 
down  in  the  lungs  and  up  again.  They 
are  noticed  clinging  to  bits  of  mucus  or 
within  large  cells  which  are  constantly, 
but  apparently  erroneously,  thought  to 
be  desquamated  epithelial  cells  from  the 
pulmonary  alveoli.  Later  on  the  real 
origin  of  these  cells  will  be  discussed, 
but  at  this  point  it  is  enough  for  us  to 
realize  that  dust  particles  in  the  alveoli 
ma\-  be  seized  by  phagocytes  which,  by 
ameboid  mo\-ement,  find  their  way  up 
into  the  bronchi  and  then,  through  the 
activity  of  the  bronchial  cilia,  are  driven 
up  into  the  mouth.  No  doubt,  also,  the 
alveoli  may  fill  with  semi-fluid  exudate 
which  carries  particles  up  on  to  the  cilia, 
and  thence  the}'  ma\'  be  slowly  passed 
on  to  the  mouth. 

2.  The  particles  may  get  through  the 
alveolar  walls,  reach  the  lymphatics  of 
the  lunes,  and  be  slowly  moved  toward 
the  lung  roots.  Present  indications 
point  to  this  second  possibility  as  of 
most  importance. 

3.  The  particles  may  be  taken  up 
from  the  ah-eoli  by  phagocvtes  which 
wander  into  the  blood  capillaries  sur- 
rounding the  alveoli,  and  then  be  car- 
ried to  various  points  of  elimination. 
Permar  (3)  mentions  this  possibilitv  and 
feels  that  it  does  not  occur.    While  we 


must  admit  that  there  is  no  direct  proof 
of  the  removal  of  foreign  material  by 
the  blood,  there  is  a  certain  amount  of 
analogous  evidence  which  is  worth  con- 
sidering. Winternitz  and  Smith  (4) 
have  shown  that  physiological  salt  so- 
lution may  be  poured  into  the  alveoli 
of  the  dog  at  a  rate  as  high  as  3,000  c.c. 
in  30  minutes.  Undoubtedly,  removal 
of  this  fluid  is  accomplished  by  the  blood 
stream.  So  far  as  we  know  there  are 
no  direct  attempts  to  ascertain  whether 
solid  particles  may  be  removed  by  the 
same  route.  In  1916  Shipley  and  Cun- 
ningham (5)  performed  experiments 
which  are  most  suggestive  in  this  direc- 
tion. They  immersed  the  omentum  of 
the  decerebrate  cat  in  a  suspension  of 
finely  divided  carbon,  and  within  a  short 
time  were  able  to  detect  carbon  parti- 
cles free  both  in  the  capillaries  of  the 
liver  and  upon  the  phagocytic  endothe- 
lial cells  which  line  them.  These  parti- 
cles could  not  have  reached  the  liver  ex- 
cept through  the  blood  stream.  By  some 
process,  the  nature  of  which  is  not 
known,  carbon  particles  pass  into  the 
blood  capillaries  of  the  omentum  and 
drift  up  to  be  arrested  in  the  capillaries 
of  the  liver.  The  situation  within  the 
lung  alveoli  is  possibly  similar,  particles 
within  them  being  very  close  to  the 
blood  stream  and  quite  as  well  able  to 
get  into  these  capillaries,  as  in  the  case 
of  particles  which  enter  the  omental  cir- 
culation. 

If  now  we  re\iew  these  three  methods 
of  removal,  it  is  apparent  that  phagocy- 
tosis plays  an  exceedingly  important, 
indeed  an  indispensable  part  in  the  pro- 
cess. 

II.    The  Alveolar  Phagocytes 

Ma\TOgordato  describes  the  phagocy- 
tosis of  carbon  in  the  lung  of  the  guinea- 
pig  in  the  following  summary: 


DRINKER— DEVELOPiMENT  OF  LUNG   FIBROSIS 


297 


(i)  The  dust  cells,  mostly  cells  derived 
from  pulmonary  epithelium,  take  up  coal 
dust  with  great  avidity  aud  are  very  readily 
shed.  Dust  is  seen  in  tixed  cells  as  well  as 
in  free  cells,  but  the  former  are  for  the 
most  part  isolated,  aud  one  does  not  meet 
islets  of  dust-loaded  cells   to  any  extent. 

In  the  text  leading  up  to  this  sum- 
mary he  makes  such  statements  as : 
"Man}-  cells — of  large  and  small  endo- 
thelial type  and  dust  laden — were  to  be 
made  out  free  in  the  alveoli,  but  there 
was  also  much  dust  in  the  fixed  cells." 
And  later,  in  describing  experiments 
with  the  Trans\aal  silicious  dust,  he 
again  speaks  of  cells  of  "endothelial 
type."  One  cannot  decide  whether  Mav- 
rogordato  recognizes  the  possibility  of 
phagocytosis  by  actual  endothelial  cells 
or  uses  the  term  to  describe  the  appear- 
ance of  cells  of  epithelial  origin.  This 
view,  that  the  alveolar  epithelium  is  re- 
sponsible, is  in  agreement  with  that  of 
many  investigators,  but  it  is  not  con- 
firmed by  recent  obser\ations  ;  and  since 
the  origin  and  original  position  of  lung 
phagocytes  is  of  considerable  practical 
importance  it  is  necessary  to  review  the 
data  which  have  been  presented.. 

The  idea  that  the  large  flat  cells,  seen 
to  contain  dust  in  properly  exposed  ani- 
mals and  persons,  are  derived  from  the 
epithelium  is  singularly  easy  to  hold. 
By  ordinary  methods  of  staining  practi- 
calh-  all  the  cells  containing  particles, 
which  are  found  either  inside,  clinging 
to  the  alveolar  walls,  or  within  adjacent 
lung  tissue,  are  indistinguishable  from 
lining  epithelial  cells.  KnaufT  (6)  pre- 
sented this  view  many  years  ago.  Rup- 
pert  (7),  Schottelius  (8),  Wainwright 
and  Nichols  (9),  Briscoe  (10)  and  Se- 
well  (11)  agree  with  him.  Arnold  (12), 
Oliver  (13),  Beitzke  (14),  Watkins- 
Pitchford  (15),  and  Willis  (16)  believe 
that  a  \-ariety  of  cells  may  be  responsi- 
ble. Haythorn  (17)  and  Klotz  (18) 
were  the  first  to  hold  substantially  that 


the  endothelial  leukocyte  is  of  import- 
ance. Such  cells  must  be  derived  from 
the  lining  of  blood  capillaries  of  lymph- 
atics or  from  the  circulating  blood. 
They  are,  therefore,  out  of  contact  with 
dust  as  it  reaches  the  alveoli.  A  definite 
migration  through  the  lung  tissue  into 
the  alveolar  spaces  is  necessary  in  order 
to  bring  them  into  action.  Haythorn's 
identification  of  the  lung  phagocytic 
cells  as  endothelial  depended  upon  the 
facts  that  they  were  identical  in  size  and 
appearance  with  endothelial  leukocytes, 
that  they  were  phagocytic  for  blood  pig- 
ment, carbon,  and  all  kinds  of  cellular 
debris,  and  were  apparently  the  same 
type  of  cells  as  were  found  in  tubercles. 
(Gardner  (19)  studied  nearly  one  hun- 
dred dusted  guinea-pigs,  and  during  the 
stage  of  phagocyte  formation  failed  to 
find  a  single  mitotic  figure  within  alveo- 
lar epithelium.    He  says: 

.  .  .  ^loreovpr.  no  trace  of  dust  has  been 
found  irilhin  an  attached  alveolar  epithelial 
cell.  One  of  Miller's  grreat  contributions 
to  our  understandiner  of  pulmonary  anatomy 
has  been  the  distention  method  of  fixation. 
By  its  use  it  is  possible  to  determine  with 
a  considerable  dcprree  of  accuracy  the  rela- 
tion of  one  structure  or  cell  to  another.  If  a 
collapsed  or  undistendcd  lung  be  examined, 
it  seems  indisputable  that  dust  particles  are 
lyinor  witliin  attached  epithelial  cells.  If, 
however,  the  lung  be  fixed  by  the  distention 
method,  the  dust  cells,  although  they  may 
l)e  near  the  wall,  will  always  be  super- 
imposed upon  the  epithelium  or  lying  at  a 
little  distance  from  the  wall.  It  would  seem 
that  the  employment  of  this  technical  pro- 
cedure has  enabled  us  to  eliminate  one  of 
the  proposed  sources  of  the  intra-alveolar 
l)ha<-rocyte. 

Xo  definite  conclusions  on  this  disputed 
question  are  possible  at  this  time.  The  e\i- 
denee  would  seem  to  have  reduced  the  ques- 
tion of  the  orisin  of  the  alveolar  phasrocyre 
to  a  consideration  of  the  local  vascular  en- 
dothelium in  the  lung  and  to  studies  on  the 
transitional  cell  of  the  circulating  blood. 

Neither  Haythorn, Klotz. nor  Gardner, 
however,   emplciyed   staining    reactions 


298 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


which  identify  endothelial  phagocytes. 
Their  conclusions  depend  upon  analo- 
gies, or  upon  attempts  to  eliminate  the 
alveolar  epithelium  from  consideration. 
Slavjansky  (20)  practically  accom- 
plished the  identification  of  endothelial 
cells  as  the  important  agents  in  1869. 
He  gave  intratracheal  injections  of  indi- 
go followed  by  intravenous  injections  of 
cinnabar,  and  shortly  after  he  found 
phagocytic  cells,  containing  cinnabar 
particles  and  indigo,  free  in  the  alveoli. 
He  considered  that  these  cells  were 
mononuclear  elements  derived  from  the 
circulating  blood.  Tchistovitch  (21) 
used  a  somewhat  similar  technic  in 
1889.  Recently  Sewell  (11)  attempted 
the  same  sort  of  experiment  but,  for 
technical  reasons  which  need  not  be  out- 
lined, failed  in  the  proper  execution  of 
his  task. 

Foot  (22)  and  Permar  (3)— the  lat- 
ter in  a  very  beautiful  and  conclusive 
series  of  observations — have  carried 
through  the  same  type  of  experiment 
and  leave  little  doubt  as  to  the  final  con- 
clusion. The  technic  used  by  Permar 
depends  upon  the  following  facts.  It  has 
been  known  for  some  time  that  the  en- 
dothelial leukocyte  will  take  up  certain 
vital  stains.  Thus,  if  rabbits  or  guinea- 
pigs  receive  intravenous  injections  of 
trypan  blue,  isamine  blue  and  a  num- 
ber of  other  dyes,  it  is  found  that  after 
a  few  days  certain  large  cells  in  the  liver, 
spleen,  lymph  nodes,  and  bone  marrow 
are  filled  with  the  dye.  In  the  normal 
animal  practically  no  stained  cells  are 
found  in  the  lung.  The  uninjured  en- 
dothelium of  the  blood  capillaries  and 
lymphatics  does  not  take  up  the  dye. 
It  has,  howe\'er,  been  shown  that  in- 
jured or  irritated  vascular  endothelium 
very  readily  becomes  phagocytic  (23). 
If,  now,  the  animals  are  injected  intra- 
venously with  isamine  blue  and  intra- 


tracheally  with  finely  ground  carmine, 
the  injections  being  repeated  for  several 
days,  one  is  soon  able  to  find  numerous 
blue-stained  endothelial  phagocytes  in 
the  lung,  and  these  clearly  identified 
cells  may  then  be  followed  in  relation  to 
the  phagocytosis  of  the  intra-alveolar 
carmine. 

On  examining  animals  so  treated  Per- 
mar never  found  the  epithelial  cells  of 
the  alveolar  lining  either  vitally  stained 
or  carmine  containing.  He  disco\'ered 
that  the  number  of  blue-stained  cells  in 
the  lung  increased  with  intratracheal 
carmine  injections  and  sums  up  his 
work  as  follows: 

.  .  .  The  large  mononuclear  phagocyte 
of  the  lung  is  derived  by  proliferation  from 
the  vascular  endothelium,  and  in  large  pai't 
that  of  the  capillary  network  in  the  walls  of 
the  air  sacs.  This  proliferative  activity  is 
accomplislied  by  mitosis.  The  point  of 
origin  in  the  pulmonary  capillaries  is  indif- 
ferent and  determined  only  by  the  proxim- 
ity of  an  irritant  in  the  lung  tissue.  The 
proliferating  cell  is  endowed  with  an  ameboid 
motion,  and  once  free,  migrates  directly  to 
the  site  of  the  irritant,  in  the  air  sacs  and 
bronohinl  tree.  The  point  of  entrance  of  the 
wandering  cell  into  the  alveoli  is  equally  in- 
different, the  cell  passing  directly  between 
tlie  epithelial  plaques  to  gain  the  free  air 
space  where  it  at  once  proceeds  to  collect 
within  its  cytoplasm  the  foreign  substance 
wliieli  has  called  it  forth.  Ordinary  pulmon- 
ary anthracosis.  now  accepted  as  almost  a 
physiological  process,  illustrates  how  slight 
an  irritant  may  give  rise  to  a  proliferative 
endothelial   rcnction. 

If  we  return  to  Haldane's  paper  we 
find  the  following  paragraph: 

It  is  highly  probable  that  insoluble  dust 
particles  are  attractive  and  stimulating  to 
dust-collecting  cells  in  proportion  to  the  solu- 
ble substances  absorbed  in  the  dust  particles; 
and  that  the  particles  containing  little  of 
tlicse  substances  will  be  correspondingly  un- 
stimulating.  This,  at  least,  seems  to  me  the 
most  probable  explanation  of  why  some  kinds 
of  insoluble  dust  stimulate  the  cells  and 
others  do  not:    and  the  facts  so  far  known 


DRINKER— DE\'ELOP,MENT  OF  LUNG   FIBROSIS 


299 


seem  to  be  consonant  with  this  explanation, 
thougli  far  more  work  on  the  whole  subject 
is  required. 

Haldane  then  seems  to  explain  the  dif- 
ference between  the  effects  of  insoluble 
carbon  dust,  which  is  harmless,  and  the 
most  dangerous  sort  of  insoluble  sil- 
icious  dust,  by  the  suggestion  that  the 
carbon  particle,  which  has  to  a  high  de- 
gree the  power  of  adsorbing  material 
upon  its  surface,  upon  reaching  the  al- 
veolus becomes  coated  with  material 
which  renders  it  not  only  highly  irritat- 
ing so  that  many  phagocytes  at  once 
begin  to  concentrate  upon  the  scene  but 
also  highly  desirable  for  phagocytosis. 
Silica,  which  is  notably  non-adsorptive, 
owes  its  tendency  to  remain  in  the  lungs 
and  to  resist  elimination  to  the  fact  that 
absence  of  adsorbed  material  renders  it 
less  irritant  and  less  readily  pha?ocy- 
tized.  In  another  paragraph,  however, 
he  makes  the  statement  that  all  the  dif- 
ferent sorts  of  dust  used  by  Ma\ro?or- 
dato  were  apparently  taken  up  by  pha- 
gocytic cells  with  the  same  degree  of 
readiness,  and  the  difference  between 
them  lies  in  the  fact  that  cells  which 
have  ingested  carbon  are  able  to  move 
steadily  out  of  the  lung,  whereas  the  re- 
verse is  true  with  silica.  In  Mavrogor- 
dato's  words : 

1.  Coal  and  shale  are  taken  up  by  cells 
which  are  quickly  shed,  and  consequently  do 
not  set  uii  proeesse;;  wh'ch  lilock  lymphatics. 
These  cells  frequently  break  down,  and 
niasses  of  dust  are  to  be  seen  on  the  surface 
of  the  alveolar  walls. 

Fine  dust  and  crystalline  silic^T  arc  taken 
un  by  cells  which  tend  to  remain  in  situ  and 
form  plaques,  which  appear  early  and  per- 
sist. Thev  are  the  only  site  of  fibrosis  made 
out  in  this  investigation. 

Dusts  which  form  plaques  are  not  readily 
eliminated. 

Mavrogordato  apparently  believed 
that  carbon  particles  reaching  an  alveo- 
lus stimulated  the  alveolar  epithelium 


near  by  to  proliferate  and  to  ingest  them. 
Permar,  howexer,  has  shown  that  the 
particle  must  arouse  proliferation  in  the 
capillary  endothelium  with  subsequent 
detachment  of  cells  and  migration 
through  the  wall  into  the  alveolus. 
While  it  is  true  that  such  cells  have 
their  origin  \ery  close  to  the  air  space, 
the  actual  process  involved  is  somewhat 
more  formidable  than  that  concei\ed  by 
Maxrogordato,  and  gi\es  better  play  for 
differences  in  physical  characteristics  of 
foreign  particles. 

On  considering  this  entire  situation 
it  seemed  wise  to  attempt  an  analysis 
of  all  the  possibilities  raised  by  Haldane 
and  Ma\Togordato,  keeping  in  mind 
their  fundamental  contention  that  rate 
of  dust  elimination  is  as  important  as 
rate  of  inhalation,  and  subjecting  the 
different  phases  of  the  process  to  experi- 
mental procedures.  One  step  in  this 
work  has  been  accomplished.  It  was  first 
desired  to  find  out  whether  all  dusts 
really  were  taken  up  by  phagocytic  cells 
with  equal  degrees  of  readiness.  Fenn 
(24)  has  prepared  suspensions  of  car- 
bon and  quartz  and  has  shown  that  the 
polymorphonuclear  leukoc>'tes  of  the 
rat  ingest  carbon  four  times  as  readily 
as  quartz.  He  has  recently  extended 
this  observation  to  phagocytes  obtained 
by  scraping  the  surface  of  the  lung — the 
method  employed  by  Briscoe  for  obtain- 
ing similar  material — and  thus  has 
shown  that  in  the  very  first  step  of  the 
process  of  removal  of  foreign  material 
silica  lags  behind  carbon. 

III.    The  Dispos.4l  of  Foreign 
Material 

In  the  last  section  the  lung  phago- 
cytes have  been  identified,  and  the  char- 
acter of  the  discussion  has  made  it  evi- 
dent that  phagocytosis  is  an  extremely 
important  early  step  in  ridding  the  al- 


300 


THE   yoURXAL  OF  INDUSTRIAL  HYGIENE 


veoli  of  foreign  material.  In  early  ob- 
servations upon  lung  fibrosis  investiga- 
tors (25  ) advanced  the  view  that  parti- 
cles might  pass  between  the  alveolar 
epithelial  cells  or  actually  pierce  them 
to  reach  the  lung  tissue.  These  ideas 
are  apparently  entirely  discounted  to- 
da}'.  Though  there  maj^  be  differences 
of  opinion  as  to  the  cell  responsible, 
there  is  unanimity  that  particles  leaving 
the  alveoli  must  first  be  ingested  by  pha- 
gocytes. 

The  questions  which  next  arise  relate 
to  the  length  of  time  required  b}'  phago- 
cytes to  collect  a  load  of  foreign  ma- 
terial and  their  subsequent  movements. 
Haythorn  (17)  gave  soot  inhalations  to 
rabbits  for  eighty-seven  days  and  found 
pigment-bearing  cells,  "only  in  the  al- 
veoli and  interalveolar  spaces  and  there 
was  no  e\'idence  that  anj-  had  migrated 
as  far  as  the  large  lymphatics.  All  these 
points  seem  to  indicate  that  the  phago- 
cytic cells  are  not  transient  scavengers, 
but  in  a  more  leisurely  manner  gather 
their  pigment-load  and  transport  it  to 
the  tissue  spaces."  Willis  (16)  also  feels 
that  the  "absorption  [of  alveolar  phago- 
cytes] must  be  relatively  slow,  since  in 
these  normal  animals  [caged  guinea- 
pigs  in  the  laboratory  unsubjected  to 
dust  inhalations]  increments  of  dust  are 
taken  into  the  lung  only  very  slowly  and 
gradually,  yet  the  ciust  cells  are  always 
seen." 

Permar  (3),  using  powdered  carmine 
by  intratracheal  injection,  showed  that 
this  material  begins  to  be  taken  up  at 
once  by  the  few  endothelial  phagocytes 
in  the  alveoli  at  the  time  of  injection 
and  that,  while  all  the  material  intro- 
duced had  not  become  intracellular  in 
five  hours,  by  the  end  of  twenty-four 
hours  even  if  the  injections  were  large 
all  the  foreign  particles  were  intracellu- 
lar.   He  savs : 


.  .  .  These  cells  take  on  the  most  extra- 
ordinarily heav}-  loads  of  pigment,  even  when 
the  particles  are  relatively  coarse.*  As  a  re- 
sult, they  increase  enormously  in  size,  and 
the  nucleus  becomes  completely  masked  by 
the  (|uantities  of  granules  with  which  the- 
cytoplasm  is  packed. 

This  author  verifies  the  observations 
of  Haythorn  and  Willis  on  the  slowness 
with  which  cells  which  have  taken  up 
dust  leave  the  alveoli.    He  states  : 

Though  the  foreign  pigment  is  entirely 
intracellular  at  the  end  of  a  twenty-four  hour 
period,  the  endothelial  jihaaocytes  do  not 
leave  the  alveolus  at  a  rapid  rate.  On  the 
contrary,  there  is  often  very  little  difference 
in  the  picture,  even  at  the  end  of  five  or  six; 
days.  In  four  animals  killed  after  this  in- 
terval, the  alveoli  still  seem  equally  crowded 
by  the  same  groups  of  large,  heavily  loade^l 
cells.  This  is  borne  out  by  the  relatively 
slight  change  in  the  niunber  of  cells  found 
migrating  along  the  lymphatics  after  six 
days  as  compared  with  that  found  after 
twenty-four  hours.  Tn  fact,  in  some  animals 
tliere  seems  to  be  a  slowing  down  after  the 
first  acute  reaction,  and  the  migrating  cells 
are  even  fewer  in  three  to  five  days  than 
after  twenty-four  hours,  indicating  a  less- 
ened activity  after  the  acuteness  of  reaction 
is  frone.  Tlie  actual  time  period  re  |uired  to 
effect  co'nplete  clearing  of  the  alveoli  could 
rnly  be  estimated  by  experiments  covering 
loTig  periods  of  time,  possibly  even  runninsr 
into  months. 

It  should  be  pointed  out  that  the  ob- 
ser\ations  so  far  quoted,  Haythorn,  Wil- 
lis, and  Permar,  have  been  made  (1)  by 
the  use  of  carbon  dust,   (2)   upon  ani- 

*F('im  (L!-li  lia.s  shomi  that  in  vitro  i-arliiiu  par- 
ticles: 4.7  M  ill  diameter  are  ingested  a.s  readily  as 
?>-  f-  particles.  It  has  been  held  rather  (reno'-- 
.iltv.  apparently  as  a  result  of  tindin'is  in  South 
-Vfiioa  (2()j.  that  only  verj-  small  pirticlos  are  re- 
siiniisihle  for  daninge  to  the  lunir.  The  groat 
majority  of  sllioions  particles  recovered  from  the 
lung  postmurteni  were  found  to  have  a  <liameter 
less  than  1  /j-.  Particles  as  large  as  12  t^  were 
found  in  the  lung  hut  were  very  few.  The  iiuestion 
as  to  the  size  of  jiarticlcs  which  may  actually  reiiclv 
tlie  :ilve,)li  1  a.s  never  liton  iiivestigutiHl  from  a 
oareful  quantitative  point  of  view.  If  large  par- 
ticles do  rciioh  the  alveoli  there  is  no  apparent 
reason  why  they  s'unilil  not  be  picked  up  by 
phagocytes  and  cariiod  into  the  lung  tissue. 


DRIXKER— DE\'ELOPMENT  OF  LUNG   FIBROSIS 


301 


mals  acquiring  a  normal  degree  of  lung 
pigmentation  while  living  under  labora- 
tory surroundings,  and  (3)  upon  ani- 
mals recei\-ing  intratracheal  injections 
of  carmine  suspension.  The  results  are 
in  agreement  but  this  does  not  assure  us 
that  flint  dust,  organic  dusts,  etc.,  will 
bring  about  similar  states  of  aflFairs. 

Man}-  investigators  have  reported 
that  dust  falling  upon  the  ciliated  epith- 
elium of  the  bronchioles  begins  to  move 
toward  the  mouth  at  once,  and  after  a 
single  moderate  dusting  these  upper 
passages  may  become  quite  clean  before 
material  begins  to  leave  the  alveoli  eith- 
er in  cells  which  pass  through  the  wall 
or  which  mo\e  up  on  to  the  ciliated  sur- 
face and  are  then  carried  away. 

Permar  has  found,  and  others  are  in 
agreement  with  him,  that  phagocytes 
containing  dust  tend  to  accumulate  near 
the  abeolar  entrance  and  apparenth" 
move  through  the  wall  in  this  neighbor- 
hood to  enter  the  terminal  lymphatics 
of  the  lung  which  arise  about  the  al\eo- 
lar  ducts.  After  reaching  a  lymphatic 
the  dust-carrying  phagocyte,  parth- 
through  its  own  ameboitl  activity  and 
partly  through  the  lymph  flow,  moves 
toward  the  lymph  nodes  at  the  root  of 
the  lun-::.  Twenty-four  hours  ha\'e  been 
found  necessary  for  the  traverse  of  this 
distance  in  the  case  of  carmine  by  Per- 
mar, and  twent}"  hours  for  manganese 
dio.xide  b}'  workers  in  our  own  labora- 
tory. Whether  this  rate  of  tra\-el  is  re- 
duced after  foreign  material  begins  to 
accumulate,  is  not  known.  Permar  re- 
cords a  decreased  rate  of  migration  from 
the  ah-eoli  fi\e  or  six  days  after  intra- 
tracheal injection  of  carmine.  Since  the 
lymphatics  of  the  luncr  are  found  about 
the  blood  vessels  and  bronchi,  it  is  na- 
tural to  see  cells  containing  pigment, 
and  foci  of  cellular  debris  and  pigment 
at  such  points.  Willis  has  commented 
upon  the  fact  that  in  the  young  guinea- 


pig  there  is  practically  no  lymphoid  tis- 
sue in  the  lung,  but  as  life  goes  on  lym- 
phoid accumulations  begin  to  appear. 
These  masses  are  prominent  along  bron- 
chi and  blood  vessels,  and  Willis  pre- 
sents a  very  beautiful  reconstruction  of 
one  such  fusiform  collection  about  a 
small  arter}'  and  comments  upon  the 
fact  that  "Irvine  and  Watt  (27)  de- 
scribed an  irregular  periarterial  thicken- 
ing as  one  of  the  early  lesions  in  pneu- 
mokoniosis  and  remarked  that  the  thick- 
enings are  not  'nodular'  formations." 

\\  hile  dust  may  naturally  be  found 
scattered  long  the  lymph  passages  from 
their  origin  to  the  peribronchial  nodes, 
a  good  deal  is  usually  seen  in  such 
lymphoid  collections,  and  as  they  con- 
tinue to  enlarge  in  the  face  of  steady 
dusting  a  definite  mottling  of  the  lung 
is  produced  and  areas  of  lymphoid  pro- 
liferation begin  to  be  found  immediately 
outside  aheoli  at  the  \ery  beginning  of 
h-mph  channels.  Fibrosis  apparently 
takes  place  in  close  relation  to  the 
lymphatics  and  to  such  collections  of 
lymphoid  tissue,  and  it  seems  probable 
that  both  increases  in  lymphoid  collec- 
tions, through  which  l}-mph  must  flow 
to  reach  the  root  of  the  lung,  and  con- 
necti\e  tissue  encroachment  upon  lymph 
channels  must  combine  to  slow  lymph 
drainage  and  to  arrest  more  and  more 
dust-laden  phagocytes  before  they  reach 
their  final  destination  in  the  lymph 
nodes  at  the  lung  root.  It  should,  how- 
ever, be  remembered  that  while  a  cer- 
tain amount  of  data  exists  as  to  lymph 
mo\-ement  out  of  the  peritoneal  cavity 
and  out  of  the  limbs,  there  is  no  direct 
knowledge  upon  the  rate  of  lymph  flow 
in  the  lungs  and  upon  the  factors  which 
bring  it  about. 

MavTOgordato  has  contended  that  al- 
veolar phagocytes  ma}-  wander  out  of 
h'mphatics  and  through  the  walls  of 
large  bronchi.  His  data  on  this  point  are 


302 


THE   lOURNAL  OF  INDUSTRIAL  HYGIENE 


insufficient  and  are  unconfirmed  by 
other  observers.  The  reader  will  recol- 
lect that  he  distinguished  between 
carbon  and  silica  by  the  fact  that 
cells  containing  carbon  were  elimi- 
nated more  readily  than  those  con- 
taining silica.  The  cells  containing 
carbon  he  believes  to  be  quickly  shed, 
apparently  chiefl}'  by  moving  up  onto 
the  ciliated  epithelium.  Silica-con- 
taining cells,  on  the  other  hand,  do 
not  tend  to  move  but  are  apt  to  aggre- 
gate and  form  plaques  which  become 
foci  for  fibrosis.  Mavrogordato  believes 
that  the  rate  of  silica  removal  can  be  in- 
creased by  adding  carbon  to  the  air 
breathed,  thus  inducing  a  more  vigorous 
reaction  and  getting  rid  of  some  of  the 
silica  as  a  result  of  the  intense  drive  at 
the  carbon.  He  implies  that  where  air 
has  contained  silica  but  workmen  ha\'e 
experienced  no  harm  there  has  been  an 
admixture  of  carbon  or  of  some  dust 
with  similar  properties  which  has  kept 
the  silica  on  the  move.  Haldane  goes  so 
far  as  to  suggest  that  such  mixtures  be 
made  artificially  in  work  which  demands 
inhalation  of  silicious  dust. 

These  are  contentions  which  are  not 
\-erified  experimentally,  and,  as  has  been 
pointed  out,  the  ground  upon  which  they 
rest  seems  frequently  to  be  insecure. 
They  are  peculiarly  susceptible  to  ex- 
perimental attack  and  should  either  gain 
our  confidence  or  be  cast  aside  in  a  few 
years'  time. 

IV.    Some  Final  Aspects  of  the 
Problem 

Collis  (28),  in  his  classical  lectures 
upon  the  pneumokonioses,  calls  atten- 
tion to  the  innocuous  character  of  coal 
dust,  of  limestone  and  plaster  of  Paris, 


and  speaks  especially  of  crystallme  sili- 
ca as  being  the  principal  source  of  real 
lung  damage.  He  calls  attention  to  the 
fact  that  in  the  amorphous  form  this 
substance  is  not  known  to  do  harm,  and 
that  silicates  such  as  clay  (aluminum 
silicate)  are  also  harmless.  He  remarks  : 

Silica  dust,  then,  possesses  certain  quali- 
ties:— ^(1)  phj'sical,  (a)  such  smallness  as 
permits  the  particles  to  be  cai-ried  into  the 
alveoli,  and  (b)  such  hardness  and  angular- 
ity as  suggest  that  the  particles  can  act  as 
centres    of     irritation;     and     (2)     chemical, 

(a)  acidity  -svhich,  owing  to  the  presence 
of  the  element  silicon,  may  render  the  parti- 
cles capable  of  entering  into  and  modifying 
the   colloidal   structure   of   protoplasm,    and 

(b)  smell,  possibly  due  tn  a  vapour,  as  yet 
undetermined,  given  off  when  silica  is 
fractured. 

We  do  not  know  which  or  whether 
any  of  these  properties  is  responsible  for 
the  harm  done  by  silica.  To  them  Hal- 
dane has  added  another,  the  non-ad- 
sorpti\'e  power  of  silica.  We  call  atten- 
tion to  these  statements  only  in  order  to 
show  how  little  fundamental  explora- 
tion of  the  field  there  has  been.  With  the 
exception  of  Fenn's  observations,  which 
deal  with  carbon  and  silica  alone,  we 
have  no  data  on  differences  in  rate  of 
phagocytic  intake,  and  with  the  excep- 
tion of  Ma\-rogordato's  somewhat  un- 
supported contentions,  no  data  upon  dif- 
ferent rates  of  movement  of  diff^erent 
dusts  which  reach  the  aheoli.  While 
silicious  dust  is  the  most  deadly,  e\en 
carbon  dust  produces  some  lung  damage, 
and  the  whole  question  as  to  whether 
pure  organic  dusts  can  do  sienificant 
harm  may  be  regarded  as  unsettled.  For- 
tunatelv,  the  field  is  one  which  can  be 
explored  through  animal  experimenta- 
tion, and  it  is  probable  that  a  period  of 
more  exact  quantitative  investigation  is 
at  han'^. 


DRINKER— DEVELOPMENT  OF   LUNG   FIBROSIS  303 

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II.  The  Endothelial  Cell  in  Experimental  Tu- 
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Endothelium  in  Experimental  General  Mili- 
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and  Quartz.  Ihid..  ,'575. 
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Traulio  L  Quoted  by  Klotz  (18). 

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vention Committee  of  South  Africa.  Pretoria. 
1916,  p.  13.3. 

Irvine.  L.  G..  and  Watt,  A.  H. :  Miners' 
Phthisis.  Transvaal  Med.  Jour,  (now  Med. 
Jour.  S.  Africa),  1912-1913,  8,  30. 
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with  Special  Reference  to  Dust-Phthisis. 
Milroy  Lectures,  1915.  Pub.  Health,  1914- 
1915,  28,  252. 


INVESTIGATIVE    OPPORTUNITIES  IN  THE  PHYSICAL  EXAMINA- 
TION OF  LARGE  GROUPS  OF  INDIVIDUALS* 

Roger  I.  Lee,  M.D. 

Professor  of  Hygie7ie,  Harvard  Utiiversity 


''T^  HE  physical  examination  is,  or 
-*-  should  be,  the  foundation  upon 
which  am-  plan  for  supervision  of  health 
is  constructed.  It  is,  of  course,  entirely 
possible  to  accomplish  something  with- 
out physical  examination,  but  positive 
results  depend  upon  the  amount  of  real 
information  obtained  concerning  the  in- 
dividuals whose  health  is  supervised. 
The  old  comparison  of  the  examination 
of  personnel  with  the  examination  of 
property,  inanimate  machinery  and 
product  still  holds  true. 

In  many  ways  the  actual  results  of 
physical  examinations  in  industry  have 
been  disappointing.  These  examinations 
have  demanded  the  expenditure  of  time, 
energy  and  money.  Occasionally  they 
have  been  remarkably  useful  and  have 
led  to  the  detection  of  cases  of  disease 
in  early  and  perhaps  curable  stages. 
Moreover,  they  have  made  it  possible  to 
arrange  employment  better  suited  to 
the  capability  of  the  worker.  In  addi- 
tion, much  valuable  individual  advice 
has,  of  course,  been  gi\'en,  which  has  re- 
sulted in  improvement  in  the  physical 
condition  of  the  individual  workers. 
Nevertheless,  the  results  of  physical  ex- 
aminations do  not  seem  at  present  to  be 
stated  in  terms  that  enable  us  to  ap- 
praise the  personnel  as  exactly  as  the 
material  assets  of  the  industry  can  be 
appraised. 

There  are  several  reasons  for  this.  In 
the  first  place  there  are  no  generally  ac- 


*]{i'ii>ivtMl   I'di-  i)iililiciiti(iii   Dec.  l.">.  I'Jlil. 


cepted  standards  of  health.  The  Great 
War  demonstrated  how  standards  for 
acceptance  into  military  service  may 
vary.  As  has  often  been  said,  medical 
men  have  mainly  studied  disease,  and 
usually  manifest  disease,  and  are  not 
accustomed  to  studying  health.  There 
are  now  slowly  accumulating  data  for 
health  standards  but  this  collection  of 
material  is  of  very  recent  origin.  In 
general  our  instruments  of  examination 
are  tested  on  the  sick,  and  only  subse- 
quently do  we  get  the  necessary  normal 
controls  which  are  essential  to  the  estab- 
lishment of  health  standards.  A  per- 
haps familiar  illustration  is  the  occur- 
rence of  albuminuria  in  young  men. 
That  albumin  is  occasionally  present 
without  significance  in  the  urine  of 
}'oung  men  has  long  been  known,  but  it 
seemed  to  be  agreed  that  this  finding 
was  not  compatible  with  any  reasonable 
standard  of  health.  In  the  course  of 
the  examination  of  Harvard  students, 
albuminuria  is  found  in  about  5  per 
cent,  of  the  men,  the  percentage  being 
rather  higher  in  the  younger  students 
and  rather  lower  in  the  older  students. 
In  1920  we  found  albumin  in  7.3  per 
cent,  of  approximately  600  freshmen, 
with  an  average  age  of  18.  In  a  group  of 
400  upper  classmen,  with  an  average  age 
of  20,  examined  at  the  same  time,  it  was 
present  in  only  2.2  per  cent.,  and  in  a 
group  of  400  students  in  one  of  the 
graduate  schools,  it  was  present  in  less 
than  2  per  cent.  Furthermore,  on  re- 
examination this  percentage  is  fixed,  but 


304 


LEE— GROUP  PHYSICAL  EXAMINATIONS 


305 


the  individuals  vary  somewhat.  Those 
who  habitually  present  albuminuria 
during  the  day  but  not  at  night  seem 
to  belong  to  a  particular  type.  In  the 
cases  in  which  albumin  was  present  in 
the  urine,  all  of  the  requisite  examina- 
tions were,  of  course,  made  to  pro\'e  the 
presence  or  absence  of  a  nephritis.  In 
the  age  group  in  which  we  are  con- 
cerned, nephritis  is  actually  present  in 
less  than  1  per  cent,  of  the  cases  in  which 
albuminuria  is  found.  Inasmuch  as  al- 
buminuria can  be  induced  in  a  large 
percentage  of  persons  by  violent  exer- 
tion, is  it  necessary  to  assume  that  the 
albuminuria  associated  with  the  usual 
mild  exertion  of  daily  life  is  abnormal  ? 
At  Harvard  University  we  are  continu- 
ing our  studies  on  albuminuria  in  the 
hope  of  creating  some  sort  of  fairly  defi- 
nite standard  of  health  in  respect  to 
this  particular  condition. 

The  introduction  of  the  stethoscope 
has  not  been  an  unmixe  1  blessing. 
Many  physicians  have  acted  on  the  the- 
sis that  a  heart  with  a  murmur  was  a 
damaged  heart.  At  Harwird  University 
Dr.  Parmenter  has  recently  studied  car- 
diac murmurs,  and  has  found  that  ap- 
proximately 2  per  cent,  of  the  students 
have  murmurs  and  other  signs  which 
may  safely  be  accepted  as  indicating  a 
damaged  heart.  These  figures  are  essen- 
tially the  same  in  similar  series  in 
schools  and  industries,  which  exclude 
individuals  in  the  degenerative  period  of 
life.  On  the  other  hand,  in  over  70  per 
cent,  of  the  students  a  cardiac  murmur 
of  considerable  intensity,  concerning  the 
existence  of  which  there  would  be  no 
dispute  among  auditors,  can  be  demon- 
strated under  the  appropriate  conditions 
of  breathing  and  posture.  With  forced 
expiration  without  breathing  and  in  the 
recumbent  position,  a  systolic  murmur 
can  usually  be  heard  at  the  pulmonic 
area.     Such  findings  certainlv  suggest 


that  the  presence  of  a  systolic  murmur 
is  compatible  with  a  reasonable  health 
standard. 

I  might  continue  by  taking  up  each 
item  in  the  physical  examination  and 
might  point  out  the  necessity  for  the  es- 
tablishment of  a  satisfactory  standard 
in  each  item.  There  are  problems  and 
opportunities  for  in\estigation  which 
begin  with  the  first  estimations  we  usu- 
ally make,  namely,  the  height  and 
weight.  The  in\-estigative  opportuni- 
ties certainly  include  the  estimation  of 
the  blood  pressure  in  which  there  is  in- 
creasing e\-idence  that  the  normal  stand- 
ard for  a  single  observation  must  be 
given  wide  limits  which  ma}-,  however, 
be  progressively  restricted  with  increas- 
ing obser\ations. 

The  ph}-sical  examination,  however, 
should  do  very  much  more  than  estab- 
lish the  presence  or  absence  of  organic 
disease,  although  this  is,  to  be  sure,  the 
necessary  first  step  toward  the  utiliza- 
tion of  the  physical  examination  in  in- 
dustry-. The  inadequacy  of  the  usual 
type  of  physical  examination  to  answer 
the  question  as  to  whether  a  given  indi- 
vidual is  fitted  for  any  particular  task 
has  led  to  the  development  of  so-called 
physical  efficiency  tests.  The  literature 
is  full  of  physical  efficiency  tests  which 
vary  from  a  simple  strength  test  to  a 
rather  complicated  record  of  achieve- 
ments under  the  reproduced  specialized 
conditions  of  the  industry  for  which  the 
person  examined  is  a  candidate.  As  an 
illustration  of  the  latter,  we  have  the 
efficiency  test  which  was  developed  for 
aviators.  In  general,  efficiency  tests 
ha\-e  the  same  weakness  which  has 
been  commented  upon  in  the  organic  ex- 
amination, namely,  the  lack  of  accepted 
standards.  It  usually  happens  that  the 
individual  examiner  becomes  quite  ex- 
pert in  observation  and  interpretation, 
and  he  finds  the  particular  test  which  he 


30G 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


applies  extremely  valuable,  but  the  tests 
do  not  often  lend  themselves  to  general 
use,  and  when  they  are  put  into  general 
use  the  results  are  very  divergent. 

It  seemed  to  us  at  Harvard  University 
that  it  ought  to  be  possible  to  discover 
by  appropriate  examinations  some  ac- 
ceptable classification  of  the  functional 
capacity  of  the  different  physiological 
systems.  We  began  with  what  we  termed 
the  mechanical  use  of  the  body,  and  this 
we  studied  under  two  main  headings, 
namely,  how  the  individual  stands,  and 
how  he  uses  his  feet.  We  undertook  an 
arbitrary  classification  into  four  groups 
— a  classification  which  has  now  been  in 
use  since  1919,  and  which  has  given  very 
satisfactory  results.  For  example,  we 
have  classified  as  group  D,  which  is  our 
lowest  and  poorest  classification  of  bod- 
ily mechanics,  from  25  to  35  per  cent,  of 
the  students.  This  system  of  classifica- 
tion enables  us  at  once  to  visualize,  as  a 
group,  individuals  with  marked  round 
shoulders,  lordosis,  etc. 

In  1919,  our  figures  in  regard  to  bod- 
ily mechanics,  merely  on  the  basis  of 
posture,  not  on  the  basis  of  feet,  were: 
group  A  =  7.5  per  cent. ;  group  B  =  12.5 
per  cent.;  group  C=55  per  cent.;  and 
group  D  =  25  per  cent.  This  examina- 
tion was  confined  entirely  to  freshmen. 
In  1921  the  examination  of  773  fresh- 
men showed  the  following  results  :  The 
percentage  of  men  in  the  A  group  was 
1.03;  in  the  B  group,  22.5;  in  the  C 
group,  47.7;  and  in  the  D  group,  25.7. 
In  these  last  figures  the  criterion  of  bod- 
ily mechanics  was  enlarged  to  include 
the  use  of  the  feet.  In  the  graduate 
schools  282  students  were  examined,  of 
which  number  0.77  per  cent,  were  in  the 
A  group,  15.5  per  cent,  in  the  B  group, 
51.1  per  cent,  in  the  C  eroup,  and  30.2 
per  cent,  in  the  D  group.  This  su<;gests 
^•ery  much  that  the  percentage  of  people 
who  have  a  poor  mechanical  use  of  the 


body  (and  groups  C  and  D  represent 
poor  use)  is  about  the  same  in  the  older 
group  as  it  is  in  the  younger  group.  One 
sees  at  once  the  dift'erence  between  the 
results  in  this  particular  method  of  ex- 
amination and  the  findings  in  regard  to 
albuminuria,  inasmuch  as  albumin 
tends  to  disappear  with  age.  There  is  a 
certain  amount  of  e\-idence  that  poor 
mechanical  use  of  the  body  tends  to  in- 
crease in  later  life  and  is  the  presumable 
cause  of  a  certain  amount  of  backache, 
etc.,  and  the  possible  cause  of  various 
other  disturbances.  It  is,  therefore,  in- 
cumbent upon  us  to  attempt  some 
means  to  improve  this  condition.  By  the 
use  of  this  simple  classification  it  has 
been  possible  to  insist  on  the  importance 
of  recreative  exercise  in  the  students 
with  poor  mechanical  use  of  the  body, 
and  to  give  them  rather  definite  instruc- 
tions and  the  necessary  encouragement 
to  improve  their  bodily  mechanics.  It 
is  our  experience  that  associated  with 
this  impro\ement  is  usually  an  improve- 
ment in  general  physical  well-being.  It 
has  furthermore  been  of  considerable  in- 
terest to  check  up  the  association  of 
general  defects  with  this  poor  form  of 
bodily  mechanics.  For  example,  we 
ha^'e  found  that  with  \-er}'  few  excep- 
tions those  individuals  who  have  al- 
buminuria persistently  during  the  day, 
but  who  ha\e  none  immediately  after 
the  recumbent  period  at  night,  are  class- 
ified as  group  D  in  regard  to  posture. 
We  have  also  found  that  those  students 
who  deviate  from  the  average  standards 
in  pulse  rate  and  blood  pressure  read- 
ings also  tend  to  fall  in  this  particular 
group. 

In  a  similar  manner.  Dr.  Stanley 
Cobb  undertook  a  sur\'ey  of  the  students 
from  the  point  of  \iew  of  what  we  finally 
designated  as  ner\-ous  stability.  Dr. 
Cobb's  paper  in  this  issue  of  the  Joltr- 
NAL  presents  the  results  of  his  study. 


LEE— GROUP  PHYSICAL  EXAMINATIONS 


307 


His  study,  while  inconclusive,  should, 
nevertheless,  be  stimulating  to  further 
work,  because  nervous  instability  bears 
a  very  definite  relation  to  industrial  in- 
efficiency, just  as  it  does  to  academic  in- 
efficiency in  college  life.  If  it  were  possi- 
ble to  classify  men  on  the  basis  of  nerv- 
ous  stability,   it  would  be  possible  to 
make  a  much  more  intelligent  selection 
of  men  for  particular  positions,  and  fur- 
thermore it  would  give  the  foundation 
for  constructi\e  ad\-ice  toward  the  rem- 
edy of  this  condition  in  its  early  stages. 
It  is  not  always  possible  to  separate 
exactly   the   physiological    systems   be- 
cause, as  is  well  known,  these  physio- 
logical systems  are  interdependent,  and 
are  all  subject  to  nervous  control.    It  is, 
indeed,  probable  that  most  of  the  symp- 
toms referable  to  the  cardiovascular  sys- 
tem,  when  not   of  organic  origin,   are 
traceable    to    functional     disturbances 
in  the  nervous  system.  The  war  gave  us 
a  considerable  amount  of  data  concern- 
ing a  condition  known  as  "effort  syn- 
drome"— a  condition    which  we    know 
now  is  very  common  in  civil  life.    It  ap- 
parently has  no  organic  basis  and  is  to 
be  explained  on  the  basis  of  functional 
disturbance  of  the  central  nervous  sys- 
tem.  In  the  LTni\'ersity  we  are  constant- 
ly brought  face  to  face  with  this  condi- 
tion of  effort  syndrome,  usually  under 
the   guise   of   so-called   athletic   heart. 
Consequently,  the  importance  of  the  es- 
tablishment of  a  proper  standard  in  the 
examination  of  the  heart  is  here  pecu- 
liarly manifest.   Numerous  illustrations 
could  be  gi\'en  in  which  a  diagnosis  of 
heart  disease  has  been  made,  based  on 
cardiac  irregularity  and  the  presence  of 
murmurs     and    of    certain     symptoms 
related   to   the    cardiovascular    system, 
such    as    becoming    easily    winded    on 
slight  exertion.    Such  individuals  may, 
in  the  course  of  time,  appear  again  for 
examination    for    athletic    competition 


and  may  or  may  not  present  the  same 
objective  findings,  and  very  frequently 
present  none  of  the   subjective  symp- 
toms.    The  lapse  of  time  usually  has 
sufficed  to  suppress  such  a  symptom  as 
breathlessness  on  slight  exertion.    It  is 
of  considerable  interest  that  the  factors 
which  seem  to  operate  best  in  the  inter- 
val of  time  which  has  lapsed  are  those 
factors  which  tend  to  stabilize  the  nerv- 
ous system.  While  there  can  be  no  doubt 
that  graded  exercises  are  of  great  \alue, 
particularly  in   marked  cases  of  effort 
syndrome,  ne\'ertheless  very  often  an  in- 
dividual   who  was    unable  to    undergo 
athletic  competition  one  j-ear  may  eas- 
ily undergo  athletic  competition  the  fol- 
lowing  year,    although    he    may    have 
taken  very  little  in  the  way  of  actual 
physical  exercise. 

I  trust  that  I  have  made  it  clear  that 
the    physical    examinations    should    be 
much  more  than  a  purely  objective  scru- 
tiny of  the  bodily  organs.    The  obvious 
and  apparent  organic  defects  will  be  rel- 
atively few  in  any  industry.    The  value 
of  the  physical  examination  will  depend 
upon  the  wider  application  of  the  exam- 
ination to  the  actual  functional  capacity 
of  the  individual.     In  that  particular 
field  only  very  feeble  beginnings  have 
been  made  and  the  collection  of  data  is 
for  the  future.     While  it  is,  of  course, 
true  that  the  situation  in  a  university  is 
different  from  the  situation  in  an  indus- 
try, nevertheless,  there   are  many  im- 
portant features  in  common.   There  are 
two  possible  advantages  on  the  side  of 
health  supervision  in  industry,  namely, 
that  the  industrial  workers  are  a  step 
ahead  of  the  university  students  in  the 
progress  toward  their  more  or  less  fixed 
\ocation  in  life,  and  that  in  industries 
one  is  dealing  with  actual  conditions  of 
life,  whereas   in  the  university  one  is 
dealing  with  the  temporary  and  entirely 
preparatory'-  conditions  of  life.   Further- 


308 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


more,  in  industry  there  are  to  be  solved 
many  special  problems  particularly  re- 
lated to  the  development  of  fatigue  and 
the  effect  of  fatigue  upon  the  human  sys- 
tem. 

In  industry,  the  constructive  side  of 
health  supervision  must  be  based  upon 
carefully  acquired  data.  The  construc- 
tive efforts  which  result  in  better  physi- 
cal condition,  better  bodily  functioning 


of  the  individuals  concerned  will  inevit- 
ably result  in  an  increased  efficiency  in 
the  industry  itself.  But  before  there  are 
adopted  extensive  programs  for  the  sys- 
tematic improvement  of  the  physical 
conditions  of  the  workers  in  industry,  it 
is  necessary  that  further  progress  should 
be  made  on  the  solution  of  some  of  the 
problems  of  physical  examination  itself. 


BIBLIOGRAPHY 


1.  Lee,  R.  I. :  Blood  Pressure  Deteriniuations. 
L'rinary  Findings  and  Differential  Blood 
Coiuits  in  a  Group  of  002  Young-  Male  Adults. 
Boston  Med.  and   Surg.  Jour.,  1915,  7T3,  541. 

2.  Lee,  R.  I.:  Preventable  Heart  Disease.  Ibiil.. 
p.   157. 

3.  Lee,  R.  I..  Dodd,  W.  J.,  and  Young,  E.  L.,  Jr. : 
A  Stud.v  of  the  Effect  of  Rowing  on  the  Heart. 
Hid.,  p.  499. 

4.  Brown,  L.  T. :  A  Combined  Medical  and  Po^;- 
tural  Examination  of  74(>  Young  .Vdults.  Am. 
Jour.   Orthop.   Surg.,   1917,  15.  Hi. 

5.  Lee,   R.   I.,   Geer.  W.   H.,   and  Brown,   L.  T. : 


Bodily  Mechanics  in  Harvard  Freshmen.  Am. 
Phys.  Educ.  Rev.,  1920,  25,  337. 

6.  Lee.    R.    I.,    and   Brown.    L.    T. :     Corrections 
versus    Compensation    of    Physical    Defects. 
Am.  Joiir.   Med.  Sc,  1920,  160,  651. 

7.  Lee,  R.  I. :  Preventive  Medicine  and  Hy- 
giene in  Relation  to  Colleges.  Boston  Med. 
and  .Surg.  Jour.,  1920,  ISS.  750. 

S.  Parmenter,  D.  C. :  Observations  on  the  Sig- 
nificance of  Functional  Albuminuria  in 
Young  Men  at  Harvard  University.  Ibid., 
p.  077. 


A  REPORT  ON  THE  BRIEF  NEUROPSYCHIATRIC    EXAMINATION 

OF  1,141  STUDENTS* 

Stanley  Cobb,  M.D. 

AssistanL   Professor  of  Neuropathology,  Harvard  Medical  School,  and  Assistant  Neurologist, 

Massachusetts  General  Hospital 


IN  1914  physical  examination  of  stu- 
dents was  taken  up  at  Harvard  Uni- 
versity. Dr.  Roger  I.  Lee,  Professor  of 
Hygiene,  has  reported  the  method  of 
examination  and  some  of  the  results 
elsewhere  (1)  (2)  (3).  In  1916  an  or- 
thopedic examination  of  each  man  was 
also  made  under  the  supervision  of  Dr. 
Lloyd  T.  Brown  and  an  interesting 
paper  which  bears  important  relation  to 
this  report  has  been  published  (4).  Fol- 
lowing this  policy  of  taking  up  new 
fields  of  special  examination  as  the  need 
arises.  Dr.  Lee  asked  me,  in  the  autumn 
of  1920,  to  plan  a  brief  neuropsychiatric 
examination  which  might  be  added  to 
the  routine  physical  and  orthopedic  ex- 
aminations. This  seemed  necessary  to 
him  because  such  a  large  number  of  the 
students  showed  symptoms  of  that 
vague  but  incapacitating  malady  known 
as  "nervous  instability." 

Method  of  Examination 

In  order  to  avoid  the  difFuseness  like- 
ly to  occur  in  examination  for  such  an 
ill-defined  entity,  we  decided  to  investi- 
gate four  main  questions : 

1.  What  is  the  incidence  of  neurotic 
history  in  the  group.' 

2.  Can  any  physical  sign  be  taken 
as  an  indication  of  nervous  instability, 
or  as  indicating  that  the  individual  is 
potentially  unstable.' 

3.  Is  endocrinopathy  common,   and 


♦Receiwd  for  publicntion  Nov.  22.  1921. 


what  is  its  relationship  to  nervous  insta- 
bility.? 

4.  After  four  years  of  obser\ation  do 
the  men  who  showed  certain  symptoms 
at  their  first  examination  tend  to  fall 
into  significant  performance  groups.' 

The  last  question,  which  is  probably 
the  most  interesting,  cannot  be  answered 
in  this  report.  Here  we  can  only  hope 
to  discuss  the  correlation  between  phys- 
ical examination  and  past  history. 

The  routine  examination  (see  Fig- 
ure 1)  contains  many  neurological  and 
psychiatric  features,  such  as  questioning 
concerning  history  of  syphilis,  habits, 
and  sleep,  and  examination  of  pupils, 
thyroid,  heart  rate  and  rhythm,  blood 
pressure  variation  with  posture  and 
knee  jerks.  It  was  decided,  therefore,  to 
add  to  the  examination  card  a  list  of 
questions  which  might  bring  out  anj' 
history  of  previous  neurosis,  and  a  group 
of  physical  observations  (Figure  2) 
which  would  bear  directly  on  abnormal- 
ities of  the  nervous  system,  especially 
the  vegetative  nervous  system,  which  is 
known  to  be  affected  in  neurotic  and 
psychotic  conditions. 

The  examination  itself  was  carried 
out  by  a  group  of  eight  physicians  who, 
besides  being  familiar  with  the  routine 
examination,  had  discussed  with  Dr. 
Brown  and  me  what  was  desired  in  each 
special  question.  Knee  jerks,  for  ex- 
ample, had  to  be  roughly  standardized 
into  absent,  sluggish,  active,  and  exag- 
gerated, which  terms  were  designated  on 
the  examining  cards  by  the  signs  — ,  +, 


309 


310 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Figure  1 
HARVARD    rNIVERSITY 


DEPARTMENT   OF   HYGIENE 


Full  name  of  student... 
Class Age... 


F.,   born    in... 
M..  born  in... 


..Date  of  examination 

FAMILY    HISTORY 


PAST   HISTORY 

Underline  and  give  appro.ximate  age  at  which  subject  had  any  of  the  diseases  listed  in  the  square 

What   inj  uries  ?   

What  operations.' - 

Present  general  health Appetite... 

Have  done - ;  also 


..Sleep.. 


,.hrs. 


Am  doing  outside  remunerative  work hrs.  per  week 

Usual  recreation  previouslv 

ii  £  '  *'  "  *' 

now      ;• 

Dates  of  successful  vaccinations Failures 

Typhoid  vaccination  _ 

Cups  tea  average per. Cigarettes  average per 

Cups  cofTee  "        " - Pipes  "      "  - 

Swimming Cigars 


Color-vision  = 


PHYSICAL    EXAMINATION 

Color Apparent  Age Peculiarities 

Eyes:  Right Left Corrected  to  Right... 


Measles  ■ 

Pertussis 

Mumps 

Chicken-pox 

Scarlet  Fever 

Typhoid  Fever 

Diphtheria 

IVIahiria 

Smallpox 

Pneumonia 

Pleurisy 

Rheumatism 

Tonsillitis 

Influenza 

Otitis  Media 

Gonorrhea 

Syphilis 

Constipation 

Chorea 

Convulsions 


..Left... 


Wears  glasses,  constantlj',  reading,  distance,  when  obtained.     Needs  to  see  aculist. 

Hearing:  good,  fair,  poor.    Needs  aurist 

Gen.  Devi.:  excel,  av.,  poor.     A'..-  thin,  av.,  obese.     Skin: 

Skeletal  Type 


Distribution  of  fat  and  hair 

fExp.... 
Chest:  cir.  at  xiphoid  \  Neu... 

t  Ins 

Scars 

Acne :  Face ,  Chest ,  Back... 


m. 

in. 


IF  eight: lbs.     Height: Pup.:  R.  L.  re.  to  1.  and  d.     Size:  Dance. 

Teeth:  good,  av.,  poor,  neglected,  false. 

Shoulders:  norm.,  round.    Scapula:  norm.,  scaphoid.     Thyroid:  norm.,  si.  enlarged.     Vac:  R.  L.  arm, 

leg,  doubtful,  irreg.,  good. 

Chest:  norm.,  flat,  funnel,  pigeon,  flaring  at  base. 

Heart:  rate Regular,  irreg.,  intcrm..  As  Ps. 

f  Left  nipple  = _ cm. 

r,  J    1-     J  L.  bord.  card.  dul.  (,Sth  sp.)  ■=; cm. 

From   mcd.   hne^,  ^   ^^^^^   ^^^j   ^^,,    (^^,_  ^^  ^ 

[  Ap.  imp.     Seen,  felt  =.. 

Murmurs : _ 

gs  


..cm. 
-Cm. 


Lungs 


D... 


B.  P.  standing.    S mm.    D mm.  recumbent.    S... 

Blood:  Hgb.  = %  (Tallquist) 

Abdomen:  norm.    Hernia:  ing.,  fem.,  umb.,  epig.    Liv.:  edge felt.     Spleen: felt. 

R.  Kid.: felt.    L.  Kid.: felt. 

Penis:  norm.,  circum.     Testes:  R L Abnormality:  Varicocele:  R L 

Lymph  A'.;  C Ax Epitr Ing 

Knee  /.:  R L Vert.  Col.:  norm.    Lordosis: Scoliosis: - 

dors lumb .„ 

f  History  

Feet:  \  Tender  Points 
[Use 


..Shoes- 


Long  arches:  R.  high,  luw,  flat.    L,  high,  low,  fiat.    Ant.  Arches:  R.  present,  absent.     L.  present, 
absent. 

Nose:  obstruction  R.  L.  nostril Chr.  Phiryn 

Tonsils:  1,  2,  3,  4 ....Removed  totally,  partially : 

Urine:  Sp.  G.  =    Alb.  =:    Sug.  =:    Sed.  =: 


COBB— XEUROPSYCHIATRIC  EXA^IIXATIOXS 


311 


++,  +++.  Dermographia  was  tested 
for  by  sharply  stroking  the  skin  of  the 
abdomen  and  chest  with  the  pulp  of  the 
fore-finger,  the  appearance  of  a  conspic- 
uous red  line  being  considered  as  "posi- 
tive." Skeletal  types  or  unusual  devel- 
opments were  described  best  by  adjec- 
tives such  as  slightly  acromegalic,  eunu- 
choid, feminine,  etc.,  which,  taken  with 
a  description  of  the  distribution  of  the 
fat  and  hair,  and  notes  on  any  unusual 
genital  development,  were  intended  to 
give  an  index  of  the  endocrine  balance 
of  the  subject. 

I'lGUBE    2 

Nervous  symptoms 

ronvulsionn 

Chorea 

ReJ-wetting 

Night  terrors 

Sleep-walUing 

Stammering 

Development  of  size  and  weiglit  and  onset  of 
puberty  Shaving  Voire 

Any   nervous  symptoms  at  present 
Aihxptability  Mo(xl 

Muscle  tone 

Tremor 

Vasomotor,  derniatographia,  flusliing.  blushing, 
sweating,  palpitation,  sinus  arrhythmia  and  blood 
press\ire  variation 

Skeletal    (type  and   development) 

Pistribution   of  fat  and   hair 

Shape  of  external  genitalia  and  their  develop- 
ment 

The  questions  for  the  determination 
of  past  history  were  somewhat  standard- 
ized; thus,  in  asking  about  "mood  and 
adaptability"  the  examiner  would  say: 
"Are  you  a  good  mixer?  Lonely  or  so- 
ciable.'' How  do  you  get  along  with  peo- 
ple.''" and  "How  are  your  spirits?  Ever 
melancholy  or  especially  elated?"  The 
early  development  and  onset  of  pubert\- 
was  determined  roughly  by  asking 
whether  the  student  had  e\-er  had  any 
period  of  being  a  "fat  boy"  or  growing 
extraordinarily  fast,  and  asking  for  the 
date  of  the  first  "wet  dream"  or  emis- 


sion, of  the  \'oice  change,  and  the  be- 
ginning of  shaving.  At  first  I  examined 
manj-  of  the  men  myself,  and  worked 
with  each  examiner  until  it  seemed  that 
he  understood  what  was  desired.  The 
latter  part  of  the  examining  was  carried 
on  with  less  supervision. 

Results  of  Examinations 

At  the  end  of  the  examinations  the 
results  were  tabulated  in  various  ways 
and  the  tables  analyzed  for  significant 
data  as  follows: 

The  incidence  of  neurotic  history  in 
the  1,141  men  examined  was  188 — i.  e., 
'.6.4  per  cent,  gave  a  history  of  one  or 
more  of  these  troubles  : 


Per  Cent.  Per  Cent. 

No.  cfl88  of  1141 

Abnormal  mood  or  diffi- 

eiill  jiilaptatinn 14  7  1 

Nervous     symptoms     in 

past    2  1  0.17 

Convulsions    5  3  0.43 

Chorea   4  2  0.33 

Hed-wetting 22  12  2 

Nipht  terrors   26  14  2 

Sleep-walking  37  20  3 

Stammering      (34      still 

stammer)     44  23  4 

Severe    nervous    break- 
down         2  1  0.17 

Nervous     symptoms     at 

present 78  41  7 


Taking  up  the  findings  at  the  physical 
examination  in  relation  to  the  histories 
obtained,  we  see  that  (Table  1)  the  men 
with  neurotic  histories  differed  physical- 
ly from  those  with  no  such  histor}'  only 
in  more  frequently  showing  exaggerated 
knee  jerks  and  rapid  heart  beat  and 
other  vasomotor  phenomena,  such  as 
dermographia,  flushing,  excessive  sweat- 
ing and  palpitation,  but  these  symptoms 
were  found  in  the  men  with  neurotic  his- 
tories only  6  to  10  per  cent,  more  fre- 
quently. 


312 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


The  presence  of  tremor,  dilated  pu- 
pils, acne,  or  variations  in  blood  pres- 
sure with  change  of  position  did  not 
seem  to  be  significant  in  this  connec- 
tion— i.  e.,  these  symptoms  occurred 
just  as  frequently  in  the  men  with  no 
history  of  nervous  instability  as  in  those 
with  such  a  history.  Only  by  following 
up  these  individuals  with  neurotic  his- 
tories for  }'ears  can  we  determine 
whether  they  are  more  liable  to  juture 
breakdown  than  are  the  other  men. 

TABLE   1— PHYSICAL   FINDINGS  IN 
RELATION   TO   HISTORY 
OBTAINED 


o 

b 

% 

en 

s 

.3 

3 

S  ^ 

*P. 

-o 

to 

Group 

't    C 

>  £ 

3 

t- 

>v      —  *^ 

fc-    0 

o 

o 

60 

o 

"o 

Is 

% 

S 

sc  a; 

c 

^ 

3 

C3 

X  .^ 

o 

a> 

H 

e;> 

oa. 

Q 

H 

WM 

< 

2; 

% 

% 

% 

% 

% 

% 

% 

% 

All  the  men  ex- 

amined (1,141) 

25 

14 

19 

10 

7 

10 

26 

16 

No  neurotic  his- 

tory (953)    .    . 

23 

14 

18 

9 

7 

9 

27 

0 

Neurotic  history 

(188)     .    .    ,    . 

33 

14 

25 

11 

7 

16 

25 

100 

Endocrinopathy 

{ii) 

18 

9 

36 

22 

4 

9 

4 

13 

Albuminuria  (44) 

33 

11 

25 

11 

4 

14 

34 

23 

Tachycardia  indicates  the  men  whose  pulse  rate 
was  100  or  over  during  examination. 

Blood.  Pressure  Variatitm  indicates  that  the  dif- 
ference between  tlie  systolic  pressures  standing 
and  recumbent  was  more  than  15  mm.  Hg. 

Other  \  ustniiotor  Phenomena  indicates  that 
ther<>  was  excessive  Hushing.  swe;iting.  dermo- 
graphia,  attacks  of  palpitation  or  sinus  arrhythmia. 

Dilated  Pupilx  indicates  a  diameter  of  6  mm. 
or  more. 

Tremor  indicates   tremor  of  extended   fingers. 

Exatrgcrated  Knee  .Jerks  indicates  that  the  knee 
flies  out  on  a  slight  patellar  tap. 

Acne  indicates  cnnspicuous  lesions  on  face  or 
trunk. 

Xciirotie  Ilistorii  iiuiicates  past  history  or  pres- 
ent complaint  of  nervous  disorder. 

Since  vasomotor  disturbance  seemed 
in  some  ways  related  to  neurosis,  other 
special  symptoms  of  this  category  were 


analyzed  —  e.  g.,  of  285  men  having 
tachj'cardia,  20  per  cent,  had  systolic 
blood  pressure  variation  of  over  15  mm. 
Hg  on  changing  position,  and  9  per 
cent,  had  dermographia,  whereas  of  the 
whole  group  only  14  per  cent,  showed 
unusual  blood  pressure  variation,  and 
5  per  cent,  dermographia. 

Again,  of  the  161  men  having  a  blood 
pressure  variation  of  o\er  15  mm.  Hg 
as  above  mentioned,  9  per  cent,  also  had 
dermographia.  Of  forty-four  freshmen 
who  showed  albuminuria,  14  per  cent, 
showed  exaggerated  knee  jerks,  22  per 
cent,  a  neurotic  history,  36  per  cent, 
tachycardia,  and  25  per  cent,  other  vaso- 
motor phenomena.  Also,  of  twelve  un- 
classified and  Business  School  men  who 
had  albuminuria,  42  per  cent,  showed 
tachycardia. 

In  other  words,  it  is  more  common  to 
find  tachycardia,  sweating,  flushing  and 
exaggerated  knee  jerks  among  men  who 
may  be  considered  neurotic  because  of 
either  their  present  complaints  or  their 
past  histories,  than  among  more  stable 
individuals,  but  this  increase  only 
amounts  to  approximately  8  or  10  per 
cent. 

Throughout  the  examinations  a  care- 
ful watch  was  kept  for  indi\nduals  who 
might  be  considered  endocrinopathic, 
but  out  of  the  total  group  only  twenty- 
two  were  discovered.  They  were  classi- 
fied as: 

A.  Precocious  development  (6) 

B.  Delayed  development  (8) 
(".     Abnormal  development  (8) 

Of  the  men  classed  under  "Abnormal 
development"  only  two  showed  conspic- 
uous symptoms,  and  they  were  both  of 
the  typus  femininis.  There  were  two 
other  less  marked  individuals  of  this 
type,  and  two  others  that  suggested  hy- 
pothyroidism.   The  remaining  two  ap- 


COBB--NEUROPSYCHIATRIC  EXAMTNATIOXS 


513 


proached  the  acromegalic  type,  but  not 
one  of  the  whole  group  of  eight  would 
have  considered  himself  abnormal. 

This  number  is  too  small  to  analyze 
further  or  to  draw  conclusions  from,  but 
It  is  interesting  to  note  that  as  a  group 
(Table  1)  these  men  showed  less  neuro- 
tic history  and  acne,  and  more  vasomo- 


/-\\ 


'-\ 


Fiff.  3.— nijiKiani  slidwiiiK  staiidard  classes  A, 
ri.  (',  uiul  n.  acconliiiK  to  l.odilv  mocha iiics  Or 
posture. 

tor  disturbance  and  dilated  pupils  than 
the  average.  It  is  also  of  interest  that 
sinus  arrhj'thmia  was  not  found  at  all 
in     the     delayed     development     class. 

TAHLK  2.     CORRELATION-  OF  NKRVOUS  SYMI1 

C,  AND 


Minor  symptoms  that  might  be  consid- 
ered due  to  "endocrine  imbalance"  were 
taken  into  consideration. 

Perhaps  the  most  interesting  correla- 
tion obtained  was  from  a  tabulation  of 
the  nervous  symptoms  in  relation  to 
"bodily  mechanics."  Dr.  Lloyd  Brown 
(4)  has  described  how  the  posture  of 
each  man  is  examined  and  classified, 
A  men  being  normal,  B  men  those  who 
had  only  one  or  slight  variation  from 
the  normal  standard,  C  men  those  who 
had  two,  D  men  those  who  varied  from 
the  normal  to  the  extreme  in  some  or  in 
all  points  (see  Fig.  3). 

Table  2  shows  the  1,141  men  divided 
into  classes  from  A  to  D  according  to 
the  excellence  of  their  bodily  mechanics, 
and  a  glance  at  the  percentage  of  nerv- 
ous symptoms  indicates  that  men  with 
good  posture  are  distinctly  less  likely  to 
ha\e  tachycardia  and  variation  in  blood 
pressure,  although  they  just  as  frequent- 
ly showed  exaggerated  knee  jerks, 
sweating  and  flushing,  and  dermo- 
graphia.  There  also  seemed  to  be  a  rela- 
tionship between  high  blood  pressure 
and  poor  posture,  for  of  73  freshmen 
w^ith  systolic  pressure  o\er  140,  1  was  in 
posture  class  A,  9  in  B,  40  in  C,  and  23 
in  D.    Sinus  arrhythmia  also  was  more 

OMS  WITH  POSTIRE:    PERCENT.\GE.S  OF  A,  H, 
D   MEN 


C 

>> 

u 

u 

£: 

a 

n 

Group 

1 

3 

a  c 
a,  .2 

■a  a 

1^ 

'•  2 

o 

.2 

3 

-o 

% 

II 

g 

n 

a; 
o 

< 

1 

A  men  (21) 

% 
5 

% 
5 

% 

25 

% 

% 
19 

% 
10 

% 

5 

% 
10 

% 

% 

B  men  (178) 

•ii 

12 

21 

5 

7 

10 

15 

20 

6 

7 

('  men  (597) 

23 

12 

16 

10 

7.9 

11 

29 

14 

3 

5 

D  men  (345)     .... 

28.9 

17 

23 

11 

4 

9 

30 

18 

*    1 

314 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Per  Cent. 

of 

Each  Class 


Fig.  4. — Oroup  psychological  test  of  144  Busi- 
ness School  men,  made  by  Professor  Starch. 

Solid  line  indicates  men  of  good  posture  from 
posture  classes  A  and  B.  Broken  line  indicates 
men  of  poor  posture  from  posture  classes  C  and  D. 

A,  B,  C,  D,  and  E  are  the  grades  obtained  in 
the  psychological  test  given  by  Professor  Starch, 
A  being  the  highest  and  E  the  lowest. 


commonly  found  among  men  with  poor 
Dodily  mechanics ;  of  60  freshmen  with 
sinus  arrhythmia,  none  was  in  class  A, 
7  were  in  B,  27  in  C,  and  26  in  D.  Cal- 
culated in  percentages,  these  relations 
are  shown  in  Table  3,  in  which  the  per- 
centage of  men  in  each  posture  class  is 
given,  and  also  the  percentage  of  each 
class  which  showed  high  blood  pressure 
or  sinus  arrhythmia. 

Finally,  through  the  kindness  of  Pro- 
fessor Starch  of  the  Graduate  School  of 
Business  Administration,  we  were  able 
to  correlate  the  physical  and  mental  ex- 
aminations of  a  group  of  144  Business 


"Per  Cent,  of  Each  Class"  indicates  posture 
classes  A  and  B  grouped  together,  and  posture 
classes  O  and  D  grouped  together.  The  good  pos- 
ture men  are  considered  as  one  class,  and  the  poor 
posture  men  as  another  class.  The  percentage 
of  each  of  these  classes  that  obtained  grades  A, 
B,  C,  D,  or  E  in  the  test  was  charted  and  a  curve 
plotted. 

School  Students.  Only  three  men  in 
posture  class  A  took  the  psychological 
test,  and  they  all  attained  low  grades — 
one  C,  and  two  D.  Of  the  35  men  with 
B  posture  who  took  the  e.xamination, 
16  had  honor  grades  (A  and  B),  and 
only  1  failed  in  the  mental  tests. 
There  were  74  men  with  C  posture  in 
the  ps}-chological  tests,  of  whom  22  re- 
ceived A  and  B  grades  on  the  mental 
test,  and  S  failed ;  while  of  the  D  men — 
32  in  number — 7  obtained  honors  and 
1  failed.  A  rough  graph  of  these  figures 
indicates  that  men  with  good  bodily 
mechanics  stood  a  better  chance  of  pass- 


COBB>— NEUROPSYCHIATRIC  EXAMIXATIOXS 


ing  psychological  examinations  than  did 
their  less  well  set-up  fellows  (Fig.  4). 

The  general  impression  obtained  from 
examining  this  large  number  of  fresh- 
men, and  from  talking  to  them  infor- 
mally, is  that  their  problems  have  not 
yet  defined  themselves.  If  they  had  as 
yet  had  any  emotional  or  intellectual 


T.\BLK   3.— SIM'S   ARKIIYTIIMIA  AND 

BLOOD    I'RKSSl  UK   VAKIATION  OF 

585   FRESHMEN   IN    RELATION  TO 

POSTLRE 


I'os 

lire  Class 

Percentage 
of  585 

Pcrcenlago 
with  Sinus 
Arrhythmia 

Percentage 

witli  Hlood 

Pressure 

N'ariation 

A 

i 

0 

t 

R 

ic 

8 

IC 

c 

54 

9 

IS 

D 

30 

15 

IS 

problems  that  might  be  upsetting,  the}' 
were  inarticulate  about  them.  In  short, 
it  seems  too  early  for  such  examinations, 
and  more  valuable  data  could  be  ob- 
tained from  a  smaller  group  of  men  in 
a  graduate  school. 


Summary 

History  is  the  best  guide  to  nervous 
instability — family  history,  past  history 
and  present  complaints. 

In  a  short  tifteen-minute  examination 
it  is  impossible  to  get  a  history  with 
accuracy,  and  freshmen  have  few  well- 
defined  problems. 

Vasomotor  instability  was  found 
somewhat  more  frequently  in  the  men 
with  neurotic  histories. 

Tachycardia,  blood  pressure  varia- 
tion and  dermographia  were  often  found 
associated  with  each  other  and  with  ex- 
aggerated knee  jerks.  Men  with  album- 
inuria were  likely  to  show  all  these 
symptoms. 

Endocrinopathy  was  rare,  but  the 
small  number  of  cases  discovered 
showed  more  symptoms  referable  to  the 
vegetati\'e  nervous  system  and  less  neu- 
rotic history  and  acne. 

In  men  with  bad  mechanical  use  of 
the  body,  tachycardia,  sinus  arrhyth- 
mia, high  blood  pressure  and  variable 
systolic  pressure  were  more  common. 

The  men  with  good  bodily  mechanics 
passed  better  psychological  examina- 
tions than  did  those  with  poor  posture. 


BIBLIOGRAPHT 


I.oo,  K.  I.:  The  Physical  Examination  of 
Krosluiien.  Hni-vard  .Vlumni  Bull.,  1914-1915, 
n,  5J5. 

Loc,  I{.  I. :  Blood  Prpssure  Determinations, 
I'rinary  Findings  and  liiffprciitial  Blood 
Countss  in  a  Groni)  of  V02  TounK  Male  .Adults 
I'.oston  .Med.  and   Surj;-  Jour..  191.-).  173.  541. 


Lee,  n.  I.,  Geer,  W.  II.,  and  Brown,  L.  T. : 
Bodily  Meehanics  in  Harvard  Freshmen.  .\m. 
I'hys.  Educ.  Rev.,  1920,  2.5,  3.37. 
Brown.  L.  T. :  A  Combined  Medical  and  Po.s- 
tural  Examination  of  746  Younjr  Adults.  Am. 
.Tour.  Orthop.  Siwg.,  1917,  15,  774. 


STATIC  EQUILIBRIUM  AS  A  USEFUL  TEST  OF  MOTOR  CONTROL* 

\\'alter  R.  Miles,  Ph.D. 
Nutrition  Laboratory  of  the  Carnegie  I\nstitution  of  Washington,  Boston,  Mass. 


UNSTEADINESS  of  motor  control 
in  gait  and  standing  posture  is  a 
sign  of  disease  or  disordered  function 
which,  as  a  readily  observable  symptom, 
has  served  physicians  of  all  times.  Rom- 
berg was  one  of  the  first  to  recognize  and 
emphasize  its  importance  and  to  make 
specific  tests.  In  his  classical  study  of 
tabes  dorsalis  he  recorded  the  inability 
of  his  patients  to  stand  securely  with 
feet  together  and  with  eyes  closed.  In 
1851  he  wrote,  "It  is  now  ten  years 
since  I  have  pointed  out  this  pathogno- 
monic sign,  ....  since  then  I 
have  found  it  in  a  considerable  number 
of  patients,  from  far  and  near,  who  have 
applied  for  my  advice;  in  no  case  have 
I  found  it  wanting."  Romberg's  ( 1 )  un- 
qualified statements  greatly  stimulated 
the  study  of  motor  functions  in  relation 
to  disease.  This  specific  test  of  his  was 
most  simple  to  apply,  but  since  a  nor- 
mal person  always  sways  somewhat, 
even  though  he  endeavors  to  stand  mo- 
tionless, the  physician  had  to  rely  on 
his  personal  clinical  standards  in  judg- 
ing this  symptom. 

Dr.  \\'eir  Mitchell  was  among  the 
first  to  make  this  test  of  station  numeri- 
cally accurate  and  objective.  It  is  inci- 
dentally stated  in  a  paper  by  Mitchell 
and  Lewis  (2),  1886,  that  patients  were 
tested  for  their  relative  power  to  stand 
steadily  by  placing  them  in  front  of  a 
horizontal  scale  graduated  in  inches  and 
located  on  a  level  with  the  ears.  The 
observer,  about  10  feet  away,  was 
seated  in  order  to  a\oid  his  own  sway- 
ing and  observed  with  one  eye,  making 


*  RocpivfHl  fur  i>ii)>Iication  Nov.  2.  Ift21. 


separate  readings  for  lateral  and  an- 
terior-posterior positions.  They  found 
among  healthy  subjects  standing  with 
the  eyes  closed  that  the  anterior-pos- 
terior movement  is  usually  the  larger, 
being  about  1  inch,  while  the  lateral 
swaying  is  about  Yi  inch,  and  they  con- 
cluded that  any  large  increase  was  sus- 
picious. Hinsdale  (3)  (4),  working  in 
Dr.  Mitchell's  clinic  about  this  time, 
took  graphic  tracings  of  station.  One  of 
his  methods  was  that  of  "attaching  to 
the  top  of  the  man's  head  a  flat  piece  of 
cardboard,  upon  which  was  stretched 
some  smoked  paper.*  The  subject  was 
then  placed  under  an  index,  which  was 
free  to  nio\-e  up  and  down  in  a  fixed 
line,  and  which  traced  curves  on  the 
paper  as  the  subject  who  stood  beneath 
swayed  in   any  direction."!      This   ar- 

*The  iitlicr  nictliod.  the  one  which  ninsihih:'  pre- 
ferred. eoiisis:teil  ill  leiiiUng  off  from  the  head  wrfh 
two  .silk  tlire.ads.  one  in  tlie  laieral  axis  and  one  in 
the  anterior-posterior  axis;  these  tlireads  were 
carried  around  pulleys  and  made  to  move  lisht 
levers  writing  on  a  kymocraph.  Thus,  the  two 
components  of  movement  were  resistered  and  the 
extreme  range  of  movement  CDUld  be  measured. 

t  The  la-aphic  re.u'islration  of  station  as  mentioned 
in  later  literature  has  usually  been  hy  this  method, 
with  the  slight  modification  that  sometimes  the 
subject  has  had  the  writins  point  attached  to  the 
h(>:id  while  the  smi  ked  -i)aper  is  suspended.  The 
apparatus  is  referred  to  as  tlie  "-itaxiasrapli  " 
The  first  illustration  of  it  with  which  I  am  famil- 
iar is  Dana.  "Textbook  of  Xervous  Hiseases."  Now 
York.  1^,02.  ]).  .•?«.  Whipple,  in  his  discu-ssion  of 
tests  for  steadiness  of  motor  control  (see  "Manual 
of  Mental  and  I'hysical  Tests."  Part  1.  1914.  p.  156K 
{lives  the  impn-ssion  that  the  method  and  appar- 
atus were  originated  by  Crichton-Iirowne  and  used 
by  him  for  detecting  the  pivsence  of  incijiient  or 
recent  chorea.  It  is  of  minor  importanc<'  but  .lust 
as  well  to  record  that  Sir  James  Criehton-Browne 
did  not  originate  or  use  the  ataxiagraph.  To 
qtiote  from  .1  pi-rsonal  eominunication :  "I  cannot 
take  credit  for  being  tlic  inventor  of  the  ataxia- 
graph nor  can  I  tell  you  who  suggested  it.  I  used 
to  be  content  with  the  Romberg  test  and 
close  observation,  without  instrumental  aid."    Such 


316 


MILES— STATIC  EQITLIBRIU^I 


317 


rangement  came  to  be  called  the  "ataxi- 
agraph."  The  dimensions  of  a  rect- 
angle which  would  just  contain  the 
tracing  when  applied  to  it  parallel  to 
the  anterior-posterior  and  lateral  axes 
were  used  as  the  numerical  result. 

By  this  same  method  Bullard  and 
Brackett  (5)  a  little  later  measured  the 
"static  equilibrium"  of  181  "healthy 
men  who  were  undergoing  a  competitive 
physical  examination."  Subsequently, 
Hancock  (6)  used  it  as  a  means  to  study 
the  motor  ability  of  children;  Bolton 
(7)  tried  the  ataxiagraph  in  his  investi- 
gation of  the  relation  of  motor  power 
to  intelligence;  and  Wallin  (8)  used  it 
in  studying  mentally  defective  children. 

More  recently  this  graphic  measure 
of  static  equilibrium  has  found  use 
among  those  interested  in  different 
phases  of  military-  science.  MeK-ille 
(9),  in  his  contribution  to  military  hy- 
giene, found  it  useful  in  studying  the 
"attention  position,"  in  properly  ar- 
ranging the  load  of  the  soldier's  equip- 
ment pack,  and  in  recording  fatigue 
after  marching.  Gates  (10)  found  that 
unusual  steadiness  of  motor  control  in 
standing  was  one  quality  in  the  make- 
up of  a  good  marksman.  The  ph\-sical 
examinations  especially  planned  for 
aviation  candidates  have  contained 
such  static  as  well  as  dynamic  tests,  the 
belief  being,  as  noted  by  Head  (11), 
that  through  testing  the  prospective  avi- 
ator's ability  to  balance  himself  on  his 
feet,  the  examiner  might  exclude  some 
candidates  who  would  have  difficulty  in 
learning  to  fly  and  to  make  successful 
landings.      These   tests   by  examining 


boards  were  mostly  made  without  any 
use  of  graphic  registration  or  instru- 
mental aid,  and  the  protocol  for  such  an 
examination  of  a  prospecti\"e  pilot  in 
the  United  States  (12)  usually  an- 
swered the  question  of  static  control 
with  the  word  "firm."  The  young  men 
who  were  examined  for  this  branch  of 
the  service  were  practicalh'  free  from 
gross  organic  disease  and  the  Romberg 
test,  in  place  of  revealing  lesions,  served 
mostly  to  test  the  condition  of  physio- 
logical or  psychological  control  in  the 
men.  There  were  certain  workers,  how- 
ever, interested  in  the  most  eflicient  se- 
lection of  aviators  who  believed  that 
some  graphic  or  quantitati\e  record  of 
static  equilibrium  was  a  reasonable  test 
to  apply  to  such  candidates  and  might 
prove  to  some  degree  to  be  a  measure 
of  aptitude  for  flying.  Stratton  (13) 
and  Henmon  (14)  ha\e  shown,  after  ac- 
cumulating a  considerable  amount  of 
data,  that  while  excellent  control  of  sta- 
tion is  by  no  means  a  proof  or,  so  to 
sa>-,  a  pathognomonic  sign  of  an  avia- 
tor, such  scores  do  correlate  well  with 
the  later  flying  school  records  of  the  men 
tested.*  The  recent  experience  with  the 
static  equilibrium  test  carried  out  in  an 
accurate  and  objective  manner  is  there- 
fore such  as  to  recommend  its  more 
ueneral  consideration  as  one  means  of 
measuring  neuromuscular  control  in 
selecting  men  for  work,  or  in  assessing 
their  condition  after  work  or  when  sub- 
jected to  various  influences. 

Essential  Features  in  the  Measure- 
ment OF  Station 


firapliir  rpiiistriitirn  for  the  involiintiiry  movo- 
miMits  (luriiiK  standing  probably  sugfrested  itself 
independently  to  many  observers.  Ijeitenstorfer 
in  "Das  Militiiriscbe  Training  usw.",  Stuttgart. 
1S97,  ereflits  it  to  Vierordt.  I  am  indebted  to 
Prof.  F.  ri.  Pike  for  the  reference:  H,  Iminermann. 
Dentseh.  Arob.  f.  Idin.  Med..  1 80,5-1  SCO,  /.  p.  39.5. 
whioh  al.so  refers  it  to  Vierordt:  "Grundriss  der 
Physiologic  des  Mensclien,  lSr,4.  p.  408. 


A  graphic  record  of  station  theoreti- 
cally provides  three  or  more  features 
u'hich  represent  the  swaying  of  the  body 

*  Of  the  many  psycho-physieal  tests  ai>plied  to 
aviators  by  these  authors,  only  one  or  two  other 
tests  give  as  high  a  positive  correlation. 


318 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


during  the  test  period.    These  are:   (a) 
extreme  scatter  or  range  of  area  cov- 
ered; (b)  actual  length  of  the  path  tra- 
versed; and  {c)  number  of  movements 
or  oscillator}'  rate  of  movement.     The 
ideal  score  would  be  a  combination  and 
proper  weighting  of  all  of  these.    Prac- 
tically, there  appears  no  simple  way  to 
obtain  the  true  length  of  path  or  oscil- 
latory rate.     The  tracings  on  smoked 
paper,  e\-en  though  greatly  magnified  by 
projection,     cannot     be     satisfactorily 
measured  by  a  map  tracer  or  similar 
method  because  of  the  utter  confusion 
of  the  lines.*     The  authors  just  cited 
have  contented  themselves  with  meas- 
uring the  extreme  range  of  movement 
along  the  anterior-posterior    axis    and 
likewise  along  the  lateral  axis.    To  the 
use  of  this  one  feature  as  the  expression 
of  station   there   is   the  objection   that 
subjecti\-ely  the  test  is  primarily  that 
of  standing  motionless   rather  than  of 
maintaining  the  vertex  on  a  certain  cen- 
ter.   \^'ithin  the  area  where  there  is  no 
special  strain  or  marked  loss  of  equili- 
brium— and  this  area  is  relatively  quite 
large — the   subject  tries   each   moment 
to  avoid  swaying  rather  than  to  return 
to  the  starting  or  central  position.    The 
fact  is   that  the   starting   point   rarely 
forms  the  center  of  the  tracing  and  the 
subject  has  no  accurate    criterion    for 
judging  and  locating  the  central  posi- 
tion.    The  range  is  therefore  a  some- 
what incidental   feature  of  the  record. 

*  Graphic  tracings  made  by  Hinsdale's  "thread 
method"  of  recording  lend  themselves  fairly  well 
to  the  measurement  of  path  length.  Hinsdale 
seems  never  to  have  given  attention  to  this  feature 
since  he  confines  liis  discussion  to  the  extreme 
range  and  rate  of  movement.  The  general  subject 
of  tremor  has  usually  been  viewed  in  this  way. 
See  Dana,  "The  Clinical  Characters  and  Diagnos- 
tic Significance  of  Tremor,"  Med.  News,  Phila.,  1892, 
61,  673;  and  Eshner,  "A  Graphic  Study  of 
Tremor,"</o«r.  Expcr.  Med.,  1807.  2,  301.  whiili  re- 
fer to  a  considerable  amount  of  literature  on  the 
topic. 


Tj-pical  tracings  show  that  most  of  the 
swaying  movements  occur  within  an 
area  much  smaller  than  the  extreme 
range.  These  median  or  mean  excur- 
sions should  have  their  proportional 
part  with  the  larger  movements  in  form- 
ing the  total  score.  Some  mechanical 
means  of  automatically  summing  up  all 
of  the  movements  in  terms  of  their  an- 
terior-posterior and  lateral  components 
thus  appears  desirable. 

Description  of  Ataxiameter 

The  apparatus  here  described  has  been 
in  use  since  1919  and  has  proved  both 
adequate  and  practical  as  a  means  of 
recording  static  equilibrium  in  this 
quantitati\-e  way.  For  convenience  it  is 
called  an  ataxiameter  in  order  to  dis- 
tinguish it  from  the  ataxiagraph.  While 
the  ataxiameter  provides  a  graphic  rec- 
ord if  desired,  and  in  certain  respects 
this  is  still  useful,  the  unique  feature  of 
the  apparatus  is  the  possibility  at  the  end 
of  a  test  of  reading  off  directly  a  score 
in  millimeters  for  the  accumulated  or 
total  amount  of  sway  in  each  axis,  for- 
ward, backward,  left,  and  right.  The 
three  diagrams.  A,  B,  and  C,  which  com- 
prise Figure  1,  will  make  clear  the  sim- 
plicity of  the  device. 

A  square  wooden  frame  D,  61  cm.  in 
outside  dimensions  and  adjustable  ver- 
tically on  the  rigid  pipe  E  (Diagram 
B),  is  secured  at  any  desired  height  by 
two  clamps,  with  winged  nuts  F,  F. 
A  mo^'ement  added,  such  as  is  shown  in 
side  ele\-ation  in  B,  and  in  end  eleva- 
tion in  C,  is  mounted  under  each  cor- 
ner of  the  wooden  frame.  From  the 
collar  Q,  which  connects  with  the  sub- 
ject's helmet,  later  mentioned,  four  fine 
silk  threads  pass,  one  to  each  of  the 
four  mo\-ement  adders.  At  the  end  of 
each  silk  thread  there  is  a  weight  of  5 
gm.     (See    R  in    Diagram    B.)     Each 


MILES— STATIC  EOUILIBRIU^I 


319 


thread  passes  o\er  an  aluminum  pulley 
S,  in  Diagram  C,  which  is  180  mm.  in 
circumference  at  the  bottom  of  the 
groove.  The  groove  is  wide  and  ver}- 
smooth  so  that  no  fiber  of  silk  will  catch. 


..pjr3 


in  either  direction.  During  the  prelimi- 
nary adjustment  of  a  subject  to  the  ap- 
paratus all  the  movement  adders  thus 
remain  zeroized  until  the  moment  of 
actually  starting  the  test.    This  is  done 


Fig.    1. — ^Diagram    of   tlie    atnxiamcter,    an    apparatus   for    measuring   the   swaying  of   the   body 
when  a  man  trios  to  stand  iiioti(mless. 


The  small  cone  bearings  are  under  very 
slight  tension  by  the  frame  JT,  which  is 
made  of  brass  strip.  Secured  to  the 
same  shaft  with  the  pulley  S  is  a  larger 
thin  aluminum  pulley  U.  This  pulley 
is  85  mm.  in  diameter  and  the  periphery 
is  knurled.  Around  the  periphery  is 
stretched  a  rubber  band  (3-inch  by  Yz- 
inch  bands  have  been  found  satisfac- 
tory). Two  small  pawls,  X  and  X',  are 
arranged  above  U,  so  that  they  may  en- 
gage freely  with  the  rubber  band 
stretched  about  its  periphery.  Pawl  X 
is  always  in  contact  with  the  pulley  un- 
less lifted  by  the  operator  at  the  time  of 
zeroizing.  With  both  pawls  in  contact, 
as  in  the  figure,  the  wheel  will  not  turn 


b\'  unhooking  the  weight  Y,  and  drop- 
ping it  synchronously  with  starting  a 
stop-watch.  This  weight,  by  drawing  on 
a  cord,  lifts  all  four  locking  pawls  and 
thus  permits  each  adder  to  turn  freely 
in  one  direction.  The  adder  in  Diagram 
B,  for  instance,  would  obviously  accum- 
ulate all  the  anterior  movements. 
\\'hene\'er  the  body  sways  backward,  X 
holds  firmly  and  the  silk  thread  drawn 
by  its  5-gram  weight  slips  easily  in  the 
groove  of  the  pulley,  taking  up  all  slack 
and  making  ready  instantly  to  register 
any  further  movement  in  the  forward, 
direction.  Movements  as  small  as  0.5 
mm.  will  be  positiveh'  recorded. 

When  the  test  period  has  elapsed,  the 


320 


THE    JOURNAL  OF   INDUSTRIAL   HYGIENE 


weight  is  suddenly  lifted  to  its  hook  and 
instantly  all  four  adders  are  locked.  The 
subject  is  released  and  the  scales  read. 
The  graduations  on  a  scale  represent 
millimeters,  and  the  reading  is  in  refer- 
ence to  the  index  W.  To  indicate  wheth- 
er the  scale  U  of  a  movement  adder  has 
been  turned  through  one  or  more  re\-o- 
lutions  during  any  test  period,  a  cord  Z, 
with  a  small  weight  at  each  end, is  passed 
over  the  shaft.  The  cord  is  graduated 
and  the  final  separations  of  the  weights 
show  how  many,  or  if  any,  re\-olutions 
(180  mm.)  are  to  be  added  to  the  scale 
reading. 

While,  as  just  stated,  all  movements 
even  though  very  slight,  cause  a  posi- 
tive turning  of  the  adders,  it  must  be 
remembered  that  the  final  total  reading 
is  not  the  exact  length  of  the  path  of 
swaying  but  is  the  sum  of  all  anterior- 
posterior  and  lateral  components  of 
these  movements.  The  four  threads  at- 
tached to  the  subject's  head  represent 
four  axes  along  which  it  is  particularly 
arranged  to  have  movements  occur.  If 
the  swaying  were  from  and  through  the 
center  and  only  along  these  axes,  the 
score  and  length  of  path  would  closely 
agree,  indeed  would  be  identical  if  the 
four  adders  were  infinite  distances  from 
each  other.  Since  actually  opposed  ad- 
ders are  73  cm.  apart  in  this  case  so  that 
the  apparatus  will  not  be  inconveniently 
large,  a  direct  forward  sway,  for  exam- 
ple, of  20  mm.  from  the  center  will  pro- 
duce a  reading  of  20  mm.  on  the  adder 
back  of  the  head  and  also  a  turn  of  0.5 
mm.  in  each  lateral  adder,  the  sum  of 
21  mm.  havim;  thus  a  positi\'e  error  of 
5  per  cent.  A  similar  movement  of  SO 
mm.  would  show  a  plus  error  of  14  per 
cent.,  but  it  is  seldom  that  a  subject 
wanders  so  far  from  center.  He  does, 
however,  sway  in  other  axes  than  those 
which  are  directly  front,  back,  left,  and 
right,   and  roughly  traces   all   sorts   of 


plane  geometrical  figures.*  It  is  evi- 
dent that  diagonal  movements  will  pro- 
duce a  score  for  anterior-posterior  and 
lateral  components  which  may  be  40 
per  cent,  or  more  in  excess  of  the  actual 
path  length.  This  difficulty  cannot  be 
remo\ed  b}'  wide  separation  of  the  add- 
ers so  long  as  they  are  arranged  in  the 
form  of  a  square.  It  is  therefore  neces- 
sary to  assume  that  in  any  one  of  a 
group  of  two-minute  station  tests  the 
movements  in  all  axes  are  about  equally 
likely  to  occur,  and  only  on  this  basis 
are  the  sums  for  the  measured  compo- 
nents comparable  when  dealing  with  a 
series  of  tests  on  the  same  individual  or 
on  a  group  of  subjects. 

The  helmet  N,  in  Diagram  B,  is  made 
of  two  springs  which  terminate  in  leath- 
er-covered, padded  disks,  5  cm.  in  diam- 
eter. It  is  not  uncomfortable  and  is 
easily  adjusted  without  entangling  the 
subject's  hair.  On  the  rod  O,  connecting 
the  two  springs  of  the  helmet,  a  stud  P 
is  arranged  to  be  moved  and  secured  as 
required  so  as  to  be  central  in  the  frame 
D,  and  vertical,  ready  to  receive  the  col- 
lar Q.  To  this  collar  is  attached  a 
delicate  spring  with  writing  pen  V, 
as  well  as  the  silk  cords  which  actuate 
the  movement  adders.  The  smoked 
paper  record  sheet  H  is  supported  on 
two  rods  G,  G,  mounted  in  the 
wooden  frame,  and  may  be  freely 
moved  along  the  oral  axis  of  the  sub- 
ject's head.  Since  the  greater  excur- 
sions of  bod}'  swaying  are  forward 
and  backward  movements,  this  lateral 
adjustment  of  the  paper  permits  several 

*  If  all  Uie  inoT(>ments  could  lip  .Tssiimod  to  be 
linear,  then  the  lensth  of  patli  could  be  closely  ap- 
proximated as  follows:  Add  together  the  forward 
and  backward  readings  (thus  treating  opposed 
movement  adders  as  constituting  one  meter)  and 
square  their  sum,  do  the  same  for  the  two  lateral 
readings,  add  the  srpiares  and  lake  the  square  root 
of  their  sum.  Since  most  swaying  movements  ap- 
pear to  he  more  curved  than  linear  in  character, 
it  seems  better  to  use  the  ataxiameter  readings 
without  any  mathematical  trc.-itment. 


MILES— STATIC  EOUILIBRIU.M 


321 


records  to  be  taken  on  the  same  sheet. 
The  paper,  by  means  of  two  clips  K,  K, 
is  secured  to  frame  L.  This  frame,  bent 
up  from  iron  strip,  3  mm.  thick  by  18 
mm.  wide,  is  open  at  one  end  with  the 
prongs  notched  (see  M  in  Diagram  B) 
so  that  the  record  for  protection  may  be 
tilted  up  against  the  wooden  frame  dur- 
ing periods  of  adjustment.  The  two 
prongs  thus  ser\-e  as  springs  and  keep 
the  kymograph  paper  taut  while  freely 
suspended.  It  is  of  prime  importance  to 
avoid  friction  and  noise  in  recording  the 
body  sway  for,  as  is  well  known,  if  the 
subject  can  avail  himself  of  these  sec- 
ondary criteria  he  is  almost  certain  to 
do  so.  The  apparatus  here  described 
meets  these  requirements  and  without 
much  attention  remains  in  workable  ad- 
justment.* 

Factors  Inff-uencing  St.ation 

A  number  of  factors  influence  the  sta- 
bility with  which  the  erect  posture  may 
be  maintained.  Of  these  the  following 
will  be  touched  upon  rather  briefly: 
anatomy  and  physiology  of  the  "atten- 
tion position ;"  location  of  the  feet  and 
influence  of  footwear;  height  and 
weight;  sex  and  age;  respiration  and 
heart-beat  as  possible  producers  of 
swaying;  and  the  psychic  factor.  Mel- 
ville has  well  stated  some  of  the  anatom- 
ical considerations.  The  human  body  is 
symmetrically  disposed  on  either  side  of 
the  sagittal  plane,  but  asymmetrical  as 
regards  the  coronal  plane,  which  largely 
accounts  for  its  possessing  greater  lat- 
eral than  anterior-posterior  stability.  It 
is  composed  from  abo\'e  downwards  of 
several  segments  (head,  trunk,  thigh, 
leg,  and  foot)  which  are  not  rigidly  fixed 
to  each  other.  Each  segment  possesses 
a  center  of    gravity    peculiar  to    itself 

*Thp  apparatus  may  he  obtained  from  Mr.  War- 
ren B.  Collins.  584  Huntington  Ave.,  Boston,  Mass. 


which  must  be  considered  in  relation  to 
the  point  of  support  on  the  segment  just 
below  and  to  the  area  of  support  on  the 
ground.      "The  maximum   of  stability 
and  the  minimum  of  constraint  would 
be  obtained  if  the  various   centers   of 
gravity  and  the  various  points  of  bear- 
ing were  all  in  the  same  vertical   line, 
and  if  that  line  fell  immediately  in  the 
center  of  the  area  of  support"  (9) .  Cleg- 
horn  (15)  quotes  the  Weber  brothers  as 
stating  that  this  condition  is  fulfllled 
and  that  erect  posture  requires  no  mus- 
cular effort  for  maintenance.    The  facts 
seem  contrary  to  this.     The  head  is  so 
supported  that  it  tends  to  fall  forward, 
while  the  head  and  trunk  together  have 
a  center  somewhat  behind  the  main  sup- 
port at  the  hip  joint  with  the  resulting 
tendency  to  fall   backward.      For  the 
thigh  the  center  is  behind  the  coronal 
plane,  but  a  little  in  front  of  the  point  of 
bearing  at  the  knee  joint  with  the  tend- 
ency to  fall  forward;  hence  in  the  nor- 
mal comfortable  erect  posture  the  quad- 
riceps extensor  is  relaxed  and  the  pa- 
tella freely  mo\-able.     Thus  far  the  di- 
\ergencies  from  the  coronal   hip-plane 
are  1  cm.  or  less,  and  the  muscular  ac- 
tivity necessary  is  little  more  than  nor- 
mal tonus.    The  point  of  bearing  at  the 
ankle  joint  is  5  cm.  behind  the  coronal 
plane,  consequently  here  is  the  location 
of  greatest  tension  and  it  is  chiefly  the 
soleus    muscles  which    keep  the    body 
from    falling    forward.      Bullard    and 
Brackett  (5)  found  that  in  80  per  cent, 
of  all  their  tests  the  position  of  the  head 
at  the  end  of  the  trial  was  definitely  in 
front  of  the  starting  position.  In  the  use 
of  the  ataxiameter  it  is  found  that  the 
adder  for  anterior  movements  nearly  al- 
ways has  the  largest  reading.  The  soleus 
muscles  appear  to  relax  gradually  dur- 
ing the  test,  allowing  the  total  center  of 
gravity  to  shift  forward  toward  the  ball 
of  the   foot,  with   the   result   that  the 


322 


THE   JOURNAL  OF  INDUSTRIAL  HYGIENE 


strain  is  much  increased  and  fatigue  ra- 
pidly develops,  particularly  if  the  sub- 
ject continues  his  effort  to  stand  mo- 
tionless. Subjects  who  are  to  be  tested 
should  not  be  required  to  stand  for  a 
long  while  unsupported  awaiting  their 
turns. 


and  with  the  eyes  closed.  This  has,  of 
course,  been  done,  as  is  revealed  by 
Table  1  which  is  a  summary  of  certain 
of  the  earlier  data.  Hinsdale,  in  1887, 
with  twelve  normal  adults  found  closure 
of  the  eyes  to  increase  the  sway  in  the 
two  general  directions  an  average  of  54 


TABLE   1— SUMMARY  OF  EARLY  DATA   FOR  STATION  TEST 


Subject  Material 

No. 

Feet 

Eyes         '] 

Pime 

Movement 

Author 

Ant.- 

Lat. 

Post. 

1 

nin. 

mm. 

.    mm. 

Mitchell  and  Lewis  (1886)     .    . 

Normal  adults 

.' 

together 

closed 

25'- 

13- 

Hinsdale  (1887) 

Normal  adults,  young 

12 

together 

open 

£5 

20 

Normal  adults,  young 

12 

together 

e  osed 

46 

25 

Normal  adult,  young 

1 

shod 

open 

39 

6 

Normal  adult,  young 

1 

bare 

open 

73 

45 

Girls,  from  7  to  13  yrs. 

25 

together 

open 

28 

27 

Boys 

11 

together 

open 

32 

29 

Blind  inmates 

39 

together 

— 

43 

36 

Deaf-mutes,  14  to  24  yrs. 

17 

together 

open 

• 

22 

24 

Deaf-mutes,  14  to  24  yrs. 

17 

together 

closed 

.^ 

33 

30 

Adults,  locomotor  ataxia 

6 

together 

closed 

• 

75-175 

75-1501 

.\dults,  cases  of  chorea 

10 

together 

open 

60 

37 

BuUard  and  Brackett   (1888)     . 

Normal  men,  20  to  30  yrs. 

1.50 

V-form 

open 

i 

38 

20 

Normal  men,  20  to  30  )ts. 

150 

V-f  orm 

closed 

i 

35 

20 

Hinsdale  (1890) 

Normal  adults 

12 

together 

open 

1 

24 

9 

Normal  adults 

12 

together 

c  osed 

1 

29 

19 

Hancock  (189i) 

Normal  chiltlren.  boys  5  yrs. 

35 

together 

open 
closed 

1 

58 

52 

Normal  children,  boys  5  yrs. 

35 

together 

1 

67 

58 

Normal  chilflrcn,  girls  5  yrs. 

22 

together 

open 

1 

58 

50 

Normal  children,  girls  5  yrs. 

22 

together 

closed 

1 

55 

51 

Normal  children,  boys  6  yrs. 

47 

together 

open 

1 

51 

43 

. 

Normal  children,  boys  6  yrs. 

47 

together 

closed 

1 

57 

52 

Normal  children,  girls  6  yrs. 

18 

together 

open 

1 

57 

37 

Normal  c-hildren,  girls  6  yrs. 

■    18 

together 

closed 

1 

56 

43 

Normal  children,  boys  7  yrs. 

23 

together 

open 

1 

50 

42 

Normal  children,  boys  7  yrs. 

23 

together 

closed 

1 

60 

54 

Normal  children,  girls  7  yrs. 

13 

together 

open 

1 

39 

33 

Normal  children,  girls  7  yrs. 

13 

together 

closed 

1 

48 

38 

Miles  (1917)5 

.Aviation  candidates 

62 

\'-furm 

open 

1 

38 

21 

.Vviation  candidates 

02 

^'-form 

closed 

1 

37 

18 

'■  The  length  of  test  is  not  stated;  it  was  probably  1  minute. 
'  The  extreme  range  of  movement  is  represented  by  the  values  in  these  columns. 
'  Data  unpublished.        Results  taken  into  account  in  the  work  of  Stratton  (13)  and  Hennion  (14). 
were  in  excellent  physical  condition. 


The  subjects 


Of  the  three  or  more  types  of  sensory 
impressions  usually  inxohed  in  the 
maintenance  of  equilibrium  (16),  the 
influence  of  the  visual  factor  is  the  most 
accessible  to  direct  determination. 
Tests  may  be  made  with  the  eyes  open 


per  cent.  In  twenty-fi\'e  girls,  ages  7  to 
13  years,  he  states  that  the  increase  was 
about  40  per  cent.  From  thirty-nine 
blind  people  he  secured  average  scores 
which,  on  the  basis  of  results  for  nor- 
mal adults  with  eyes  open,  show  an  in- 


MILES— STATIC  EQUILIBRIUM 


323 


crease  of  about  76  per  cent.,  the  per- 
formance of  the  bhnd  thus  being  a  Uttle 
poorer  than  that  of  normal  subjects  with 
eyes  closed.  Seventeen  deaf-mutes 
showed  an  average  increase  of  37  per 
cent.,  and  he  reports  some  increase  in 
cases  of  chorea  tested.  Again,  in  1890, 
Hinsdale  found  that  a  group  of  twelve 
normal  adults  showed  increased  sway- 
ing with  eyes  closed,  amounting  to  an 
average  of  65  per  cent.  In  these  tests 
the  subjects  first  stood  with  eyes 
opened  and  then  continued  the  test  with 
eyes  closed;  whether  or  not  they  had 
previously  made  a  short  practice  trial  is 
not  recorded. 

Hancock,  1894,  measured  158  chil- 
dren, ages  5  to  7;  of  these  110  were  less 
steady  with  eyes  closed.  He  tested  with 
eyes  open  for  one  minute,  allowed  a  rest 
of  thirty  seconds,  and  then  recorded 
with  eyes  closed  for  one  minute,  and 
for  his  whole  group  an  a\erage  in- 
crease was  found  of  13  per  cent.  Con- 
trary to  the  foregoing  results,  Bullard 
and  Brackett  with  their  large  group  of 
young  men  in  the  competitive  examina- 
tion found  slightly  better  (4  per  cent.) 
stability  with  the  eyes  closed.  Miles, 
1917,  testing  aviation  candidates  also 
found  an  improvement  of  9  per  cent, 
when  the  eyes  were  closed.  In  the  test  of 
the  aviators  the  men  without  prelimi- 
nary practice  stood  at  first  with  eyes 
open  for  one  minute,  then  simultaneous- 
ly with  the  command  to  close  eyes  the 
frame*  carrying  the  smoked  paper  was 
given  a  quick  lateral  movement  so  as  to 
separate  the  two  tracings,  and  the  man 
continued  one  minute  with  lids  closed. 
The  men  had  not  been  tested  for  station 
previously.  The  first  minute  was,  to 
quite  an  extent,  a  period  of  adjustment, 
by  the  end  of  which  they  had  begun  to 
feel  easier  and  were  therefore  in  a  po- 

*  This   wns   an    earlier    .ipiiaratus   and    not   the 
atasiameter  described  in  the  present  article. 


sition  which  they  could  more  comfort- 
ably maintain.  The  unitiated,  on  be- 
ginning the  station  test,  are  apt  to  lean 
a  little  backward  and  gradually  come 
forward,  finishing  in  front  of  the  center. 
As  the  second  minute  was  really  the 
latter  half  of  the  aviator's  test,  it  would 
therefore  be  expected  to  show  less  an- 
terior-posterior range.  In  spite  of  this 
difficulty  and  the  elements  of  nervous- 
ness and  practice,  which  must  have  been 
important  also  in  the  tests  of  Bullard 
and  Brackett,  45  per  cent,  of  the  avia- 
tors were  less  steady  without  the  use  of 
vision. 

The  magnitude  of  the  visual  factor 
can  best  be  shown  by  a  group  of  meas- 
ures on  a  subject  who  has  had  much 
practice  in  taking  the  test  with  closed 
eyes  and  has  thus  come  to  feel  that  he 
need  not  rely  on  vision.  A  fragment  of 
such  data  given  without  discarding  any 
trials  is  presented  in  Table  2.  This  sub- 
ject had  performed  several  hundred  sta- 
tion tests  always  with  closed  eyes  but  no 
tests  had  been  made  for  three  months 
prior  to  those  reported  in  the  table. 
These  tests  were  two  minutes  in  length 
and  successive,  with  a  rest  (sitting)  of 
two  minutes  after  each.  The  position 
of  the  helmet  on  the  head  was  not 
changed  during  the  series.  The  feet 
were  in  V-position — i.  e.,  heels  together, 
inside  lines  of  feet  45°.  The  data  are 
gi\'en  separately  for  each  direction.  The 
three  tests  with  eyes  open  show  a  total 
average  of  273  mm.,  with  a  variation  of 
2  per  cent.,  while  the  average  score  for 
the  usual  test,  that  is,  with  eyes  closed, 
is  508  mm.,  with  a  range  of  about  10  per 
cent.  Aided  by  visual  impressions  of  his 
movements  in  relation  to  the  objects  in 
the  room,  this  practiced  subject  could 
more  quickly  stop  or  compensate  the 
swayings  and  was  thus  able  to  improve 
his  steadiness  suddenly  by  approximate- 
1)'  45  per  cent.   Data  for  the  two  condi- 


£24 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tions  show  some  minor  characteristic 
differences  other  than  in  the  amount  of 
anterior-posterior  and  lateral  sway.  In 
both  cases,  the  backward  sway  is  less 
than  the  forward.  With  eyes  shut  it  was 
89  per  cent,  of  the  forward,  with  them 
open  only  73  per  cent.    Vision  does  not 


(17).  These  impressions  from  the  laby- 
rinth are  bound  to  function  along  with 
the  great  mass  of  kinesthetic  sensations. 
Their  relative  prominence  and  import- 
ance in  the  test  are  of  interest  that  we 
may  have  a  clearer  idea  of  what  is  being 
measured  in  station.    In  the  first  place, 


TABLE  2.— INFLUENCE  OF  VISION  ON  STATION  AS  MEASURED  BY  THE  ATAXIAMETER  ON  A 

PRACTISED   SUBJECT 


Axes  of 

Movement 

1 

Eyes 
Open 

2 
Eyes 
Shut 

3 
Eyes 
Open 

i 
Eves 
Shut 

5 
Eyes 
Open 

6 

Eves 
Shut 

Av. 

Eyes 
Open 

Av. 
Eyes 
Shut 

Per  Cent. 
Increase 

Eyes 

Shut 

Front  .    .    . 

TtlTfl. 

100 

mm. 
185 

mm. 
95 

mm. 
174 

mm. 
94 

m  m . 
145 

mm. 
96 

mtn. 
16S 

75 

Left      .    .. 

17 

92 

60 

100 

53 

81 

53 

91 

72 

Back    .    .    . 

60 

158 

70 

138 

75 

154 

70 

150 

114 

Right  .    .    . 

73 

98 

-14 

99 

40 

101 

54 

99 

83 

Total    .    . 

280 

533 

275 

511 

268 

481 

273 

508 

86 

correct  the  relative  tendency  to  sway 
forward  but  increases  it,  probably  be- 
cause the  fixation  of  an  object  in  the 
room  conduces  to  movement  in  that  di- 
rection. Left  and  right  sway  are  about 
equal  in  both  cases,  respectively,  and  the 
lateral  sway  is  60  per  cent,  of  the  an- 
terior-posterior with  eyes  closed,  while 
it  is  64  per  cent,  with  e}'es  open.*  With 
\ision  playing  a  part,  any  lateral  devia- 
tion tends  to  be  instantly  corrected  rath- 
er than  that  the  subject  should  hold  mo- 
tionless in  the  new  position.  It  is  futile 
to  question  the  importance  of  vision  as 
an  aid  to  maintaining  station,  and  the 
test  for  general  use  in  measuring  nor- 
mal individuals  will  therefore  be  less 
complicated  if  made  with  eyes  closed. 

We  shall  not  be  able,  figuratively,  to 
close  the  eyes  of  the  "kineticstatic  sense" 


•  The  graphic  tracings  for  eyes  closed  have  av- 

pra!r(>  juitcrior-iuisicrior  nud  iMtcral  ranges  of  .31 
and  1.M  mm.,  while  lor  oycs  niicii.  :'.!>  and  i1  mm.  The 
tracini;s  in  tho  latter  ease  appear  to  be  made  up 
of  smiillor  movenionts  as  if  the  neck  muscles  were 
playing  an  important  r61e. 


it  is  instructi\e  to  notice  the  experience 
of  the  young  aviator*  who  is  practically 
helpless  if  he  has  to  fly  in  the  dark  or  in 
a  cloud  and  cannot  use  his  vision  by 
which  to  correct  the  position  of  his  plane 
with  the  horizon.  More  than  one  avia- 
tor in  recounting  his  experience  has 
said:  "Came  out  of  the  cloud  to  find 
the  earth  unexpectedly  rushing  up  to- 
wards me."  The  wind  pressure,  vibra- 
tion, and  cold,  and  being  strapped  into 
a  snugly  fitting  seat,  cause  the  kines- 
thetic sensations  of  the  aviator  to  be 
confused  and  blurred.   Ideally  the  laby- 


*  In  recent  years  the  worlv  of  von  Stein.  Ewald, 
II<">?>es,  and  Bflriiny  lias  lieoonif  familinr  and 
throncrh  the  impetus  of  certain  problems  arising 
from  practices  in  military  aviation  has  been  sup- 
plemented by  an  enormous  amount  of  data  on  the 
reactions  following  .stimulation  of  the  semicircular 
canal.s.  These  form  the  kinetic  labyrinth,  a  re- 
ceptor mechanism  whicli  seems  well  adapted  for 
the  detection  and  analysis  of  rotary  motions.  The 
static  labyrinth,  as  distinct  from  the  kinetic, 
through  the  pressure  of  the  otoliths  on  the  maculae 
of  the  sacctilo  and  utricle,  is  supposed  to  T)rovide 
sensory  cues  as  to  the  position  or  tilt  of  the  head 
and  to  be  acted  upon  when  linear  body  morvement 
is  accelerated  or  retarded. 


MILES— STATIC  EQUILIBRIUM 


325 


rinth  should  be  able  to  take  care  of  just 
such  conditions  but  practically  any  im- 
pressions from  it  are  not  sufficiently 
strong  to  be  a  sure  basis  for  orientation. 
Similarly  in  tabes  dorsalis  kinesthetic 
sensations  are  reduced  or  arrested.  The 
tabetic  can  stand  with  some  stability 
while  he  can  see,  but  in  the  dark  or  with 
eyes  closed  the  impressions  from  the 
labyrinth  are  too  vague  or  weak  to  suf- 
fice. 

Since  the  paper  by  James  (18),  it  has 
been  recognized  that  deaf-mutes  are  not 
subject  to  dizziness  on  being  whirled 
around.  They  do  not  show  the  charac- 
teristic reactions  following  rotation, 
douching,  or  electrical  stimulation  of 
the  canals.  It  is  therefore  reasonable  to 
suppose  in  many  cases  that  the  labyrinth 
or  the  eighth  ner\e  is  destroyed.  Yet 
these  individuals  commonly  show  satis- 
factory equilibration. t  Hinsdale  found 
that  seventeen  deaf-mutes  (see  Table  1) 
were  all  able  to  stand  well  with  eyes 
closed,  the  a\erages  of  33  and  30  mm.  for 
anterior-posterior  and  lateral  sway  com- 
paring favorably  with  results  obtained 
with  normal  subjects. 

The  recent  experiments  of  Griffith 
(19)  are  noteworthy  in  this  connection. 
He  concludes  that  the  processes  which 
constitute  the  experience  of  dizziness  or 
vertigo  are  "(1)  kinaesthesis  from  the 
eyes  and  neck  and  in  the  arms,  (2)  pres- 
sure from  the  region  of  the  abdominal 
viscera,  the  chest  and  head,  and  (3)  cer- 
tain \-ascular  processes  which  supply  an 
obscure  background  and  which  give  to 
the  whole  experience  a  characteristic 
shading."  If  ordinarily  every  tilt  and 
turn,  acceleration  and  retardation  of 
movement,  gave  a  clear-cut  sensory  im- 

t  They  sometimes  experience  difficulty  in  the 
dark  or  when  under  water,  but  normals  are  not 
entirely  free  from  such  disturbances.  Heiiig  in 
rcnch  water  in  the  dark  is  soMiewluU  !ik<>  rtyiiiL- 
in  the  dark. 


pression  from  the  labyrinth,  these  would 
constitute  a  prominent  portion  of  our 
e\eryday  sensory  experience.  We  know 
this  is  not  the  case,  but  surely  in  vertigo, 
if  at  any  time,  this  sensory  quality  ought 
to  be  sufficiently  apparent  to  be  recog- 
nized, at  least.  Griffith  was  unable,  how- 
e\-er,  to  discover  any  process  which 
could  be  called  "sensation  of  rotation" 
or  "sensation  of  movement." 

It  is  not  surprising,  then,  that  in 
maintaining  erect  posture  with  eyes 
closed,  one  is  conscious  of  only  kines- 
thetic and  tactual  impressions.  The 
labyrinth  must  be  assumed  to  be  func- 
tioning during  station  probably  by  in- 
creasing the  muscular  tonus.  It  is 
doubtful  if  the  slight  changes  in  tilt  dur- 
ing standing  are  sufficient  stimuli  to 
cause  it  to  initiate  different  compensa- 
tory movements.  If  the  average  height 
of  adults  be  taken  as  about  5  feet,  8 
inches  or  173  cm.,  then  a  sway  at  the 
\ertex  of  30  mm.  is  equal  to  just  1°  of 
body  tilt  from  the  vertical  axis.  A  con- 
tinuous movement  of  this  amount  is  un- 
usual. Thus,  there  is  provided  a  rather 
slight  opportunity  to  stimulate  a  recep- 
tor mechanism  w'hich  never  supplies 
better  than  vague,  weak  impressions, 
even  the  existence  of  which  are  in  doubt 
as  sensory  data.  We  are  therefore  war- 
ranted in  considering  station  as  pri- 
marily a  test  of  muscular  equilibrium 
against  gravity.  The  swaying  is  per- 
ceived and  controlled  in  so  far  as  this 
takes  places  through  the  lower  limbs  al- 
most entirely.  The  body's  total  center 
of  gravity  being  a  little  abo\-e  the  hori- 
zontal line  joining  the  heads  of  the 
femora  and  requiring  to  be  kept  some- 
where near  central  to  the  area  of  sup- 
port, the  main  task  is  evidently  for  the 
legs.  There  is  but  little  movement  at 
the  neck  and  hips,  as  shown  by  testing 
subjects  in  the  sitting  posture,  and  it  is 
not  difficult  to  keep  these  muscles   in 


326 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


equilibrium,  having  once  gotten  them 
into  a  comfortable  relationship.  The 
ankle  is  the  point  from  which  swaying 
takes  place  and,  as  is  known  from  the 
work  of  Goldscheider  (20),  it  is  the  least 
sensitive  of  the  large  joints  to  angular 
rotation,  its  threshold  being  from  0.75° 
to  L50°.  The  soleus  muscles  are  the 
ones  most  vigorously  contracted  to 
withstand  the  displacement  of  the  center 
ahead  of  the  support  at  the  ankle.  They 
are  bound  to  vary  in  their  contraction 
separately  and  between  themselves. 
Here,  then,  is  where  the  subject  most 
actively  exerts  control  to  maintain  a 
fine  balance  between  these  muscles  and 
all  that  may  act  as  antagonistics.  This, 
in  the  final  analj^sis,  is  the  nature  of  the 
test. 

Sensations  arising  from  changes  of 
pressure  on  different  parts  of  the  soles 
of  the  feet  and  of  strain  within  the  feet 
are  of  great  use  in  controlling  equilibri- 
um. Severe  anesthesia  of  the  soles  has 
long  been  known  to  produce  swaying  al- 
most as  marked  as  the  typical  Romberg 
symptom  itself.  Anything  which  inter- 
feres with  the  usualness  of  these  sensa- 
tions of  pressure  and  strain  will  be  re- 
flected in  decreased  steadiness.  Since  it 
is  customary  for  adults  to  wear  shoes, 
station  is  more  secure  with  the  feet  shod 
than  with  them  bare.  Hinsdale  (Table 
1)  made  such  a  test  with  one  subject, 
and  found  a  very  great  increase  in  the 
total  range  of  sway  on  removal  of  shoes. 
The  anterior-posterior  sway  was  in- 
creased .87  per  cent,  while  the  lateral 
sway  was  multiplied  more  than  seven 
times.  Typical  results  with  the  ataxi- 
ameter  may  be  reported  for  this  factor. 
A  normal  young  man  of  muscular  type, 
wholly  unpractised  in  the  test,  made  ten 
trials  with  a  total  average  of  895  mm. 
Then  the  shoes  were  removed  for  four 
trials  which  averaged  974  mm.  The 
shoes  were  replaced  and  five  trials  made, 


the  average  being  813  mm.  The  aver- 
age without  shoes  is  14  per  cent,  increase 
over  the  a\erage  figure  with  shoes.  A 
practised  male  adult  gave  an  average  of 
537  mm.  for  five  trials  with  shoes,  and 
an  average  of  667  mm.  for  five  trials 
without  shoes,  an  increase  of  24  per 
cent.  It  is  the  habituation  to  shoes 
which  aids  us  in  standing  motionless 
when  they  are  worn. 

After  practice,  swaying  in  most  cases 
would  probably  be  less  with  bare  feet 
since  the  uncramped  foot  in  contact 
with  a  flat  floor  would  be  better  situated 
for  sensing  any  shift  in  the  center  of 
gravity.  Results  obtained  with  an  art- 
ist's model  used  to  posing  with  bare  feet 
illustrate  this  point.  Two  preliminary 
trials  were  made  with  the  model  wearing 
medium  weight  low-heeled,  low-cut, 
walking  shoes,  her  usual  footwear;  these 
trials  gave  scores  of  559  and  515  mm. 
With  the  shoes  removed,  trials  three  and 
four  gave  scores  of  398  and  392  mm.,  an 
a\^erage  improvement  of  26  per  cent. 
The  shoes  were  replaced  and  a  fifth  trial 
made,  with  a  result  of  594  mm.  At  an- 
other time  with  cold  bare  feet  five  trials, 
well  separated  with  rest  periods,  gave  an 
average  of  474  mm.  With  the  model, 
the  station  test  may  be  considered  well 
practised,  owing  to  her  occupation. 
Such  facts  indicate  the  importance  of 
sensations  from  the  feet,  the  necessity 
of  using  the  same  shoes  throughout  a 
series  of  tests  on  a  subject,  and  the  de- 
sirability of  approximately  controlling 
temperature. 

Aside  from  training,  a  factor  which 
aided  the  model  in  standing  unshod  was 
the  fact  that  the  feet  thus  covered  a 
slightly  larger  area.  The  smaller  the 
base  of  support  the  more  difficult  it  be- 
comes to  keep  the  center  of  gravity  com- 
fortably centered.  The  Romberg  test  is 
made  with  the  feet  together,  causing  the 
swa\-  to  he  exaggerated.     LInder  these 


MILES— STATIC  EQUILIBRIUM 


327 


cunditions  there  are  moments  of  distinct 
loss  of  balance,  resulting  in  sudden 
large  jerks  of  the  body.  Series  of  tests 
with  the  ataxiameter  show  more  con- 
sistency between  successive  trials  if  the 
area  of  support  is  sufficiently  large  so 
that  these  great  jerks  very  seldom  occur. 
A  group  of  tests,  two  or  more  of  each 
kind,  on  a  trained  subject  taken  under 
comparable  conditions,  with  shoes,  show 
results  which  illustrate  the  influence  of 
area  of  support  on  stability  of  station.  It 
is  seen  (Table  3)  that  when  the  feet  are 

T.VBLE   3.— ST.\B1I,ITY   OF  STATION"   .\S   MODI- 
FIED  BY   AREA  OF  SUPPORT 


Position  of  Feet 


Total  Score 


mm. 

1.  Heels  and  toes  toRotlicr.  Romberg  position  .    .    .1,03!) 

2.  Parallel,  scparatiMi  by  iO  cm 4il 

3.  Heels  tofjethcr.  feet  aii>;lo  45°.  V-po.sition.    .    .    .    587 

4.  Heels  it)  em.  apart    toes  10  em.  apart  .  500 

5.  Heels '20  em.  apart,  toe.s  30  em.  apart 4il 

C.  ,  Parallel,  separateil  l>y  40  em 5i9 

7.  Left  heel  i5  em.  ahead  of  rifjlit  on  same  line,  toe- 

ing out 1.413 

8.  Left  heel  45  em.  ahead  and  20  cm.  laterally  of  right     Till 


close  together  or  far  apart  the  swaying 
is  much  increased.  The  greatest  stabil- 
ity is  found  when  the  heels  are  about  20 
cm.  apart  and  the  feet  parallel  or  toeing 
outward.  The  V^-position,  used  as  the 
standard  in  tests  reported  in  this  paper, 
is  nearer  that  of  ma.ximum  stability 
than  it  is  to  the  typical  Romberg  posi- 
tion. This  makes  for  more  consistent 
co-operation  from  all  classes  of  subjects, 
as  they  do  not  feel  themselves  placed  at 
a  disadvantage  in  the  test. 

As  the  swaying  is  principally  from  the 
ankle,  it  is  to  be  expected  that  the  taller 
and  heavier  subjects  will  show  greater 
unsteadiness  at  the  vertex.  The  testing 
of  a  large  number  of  individuals  classi- 
fied as  to  height  and  weight  would  be 
necessary  to  procure  a  correction  factor 
for  reducing  the  measures  on  several 
subjects  to  a  strictly  comparable  basis. 


A  hint  of  the  influence  of  height  and 
weight  on  recorded  stability  may  be  ob- 
tained from  the  following  set  of  trials. 
A  man   180  cm.  tall,  weighing  75  kg., 
made  several  trials  of  the  station  test 
with  an  average  score  of  499  mm.    He 
then  put  on  a  long  overcoat  with  weights 
well  distributed  in  the  pockets  and  else- 
where upon  it,  the  total  addition  to  his 
weight  being  25  kg.     The  a\'erage  for 
se\eral  tests  made  with  the  added  weight 
was  606  mm. — i.  e.,  about  20  per  cent, 
more  swaying  for  an  increase  of  one- 
third  of  the  body  weight.     Other  tests 
were  made  extending  the  height  by  the 
use  of  a  rod  placed  up  the  back  so  that 
the    connection    with    the    ataxiameter 
would  be  198  cm.  from  the  floor  in  place 
of  180  cm.    With  this  artificial  increase 
of  10  per  cent,  in  height,  the  average 
score  became  657  mm.,  which  is  approxi- 
mately 30  per  cent,  more  swaying  than 
normal.    From  these  trials  the  factor  of 
height  appears  to  exert  more  influence 
than  weight  in  the  ratio  of  about  4  to  1. 
Since  children  are  shorter  than  adults, 
the\'  should    show    less  swaying    were 
other  conditions  the  same.*     Hancock 
(Table  1)  finds  that  both  boys  and  girls, 
ages  5  to  7,  sway  absolutely  more  than 
adults.    With  eyes  open  there  is  an  in- 
crease in  control  with  each  year.    The 
girls  are  in  general   steadier  than  the 
boys.  Hinsdale  measured  girls  and  boys, 
7  to  13  years,  and  found  about  the  same 
range  of  sway  as  with  the  adults.    The 
girls  swayed  less  than  the  boys  by  about 
10  per  cent.    The  ataxiameter  thus  far 
has  not  been  used  especially  to  gather 

*  Fernald,  in  his  article  on  The  Defective  De- 
I'liiHient  ria.«s  Diffprontiating  Tests,  \m.  Jnur. 
Ii't-ini,.  1012.  6S.  'wVi.  lias  devised  n  stnndins  test 
which  he  calls  "Achievement  Capacity  Test."  The 
suliject  stands  on  one  foot  and  rests  the  other 
with  a.s  even  a  pressure  as  possible  on  a  lever 
system  wliieh  he  keeps  b.nlaneod  as  long  as  possi- 
ble. Fernald  states  that  the  age  factor  is  largely 
eliminated  since  the  stn-ength  and  development  of 
the  leg  muscles  most  closely  correspond  with  body 
weight.  ..M* 


328 


THE   JOURNAL  OF  INDUSTRIAL  HYGIENE 


data  on  sex  or  age  differences,  but  the 
following  data  which  are  at  hand  are  in- 
teresting : 


■erage 

Varia 

Score 

tion 

mm 

% 

8  Girl  Scouts,  age  16  years.  .   848  16 

11  Adult  women 731  14 

16  Adult  men   745  24 

The  men  covered  a  wider  range  in 
height  and  on  the  average  were  some- 
what taller  than  the  women,  which  is  to 
their  disadvantage  in  directly  compared 
scores.  On  the  contrary,  having  longer, 
broader  feet,  and  so  a  larger  base,  they 
have  this  advantage  of  the  women.  The 
two  factors  tend  to  counterbalance  and 
in  these  data  the  average  results  for 
adults  of  both  sexes  agree  closely. 

In  attempting  to  stand  motionless  for 
just  a  few  seconds  it  is  natural  to  sus- 
pend respiration.  Probably  inspiration 
and  expiration  slightly  shift  the  center 
of  gravity  along  the  anterior-posterior 
line.  Graphic  records  (3)  (4)  made  by 
using  threads,  connected  with  the  sub- 
ject's head,  a  method  similar  to  the 
ataxiameter  connection  but  which  pro- 
duces up  and  down  tracings  on  kymo- 
graph paper,  show  the  swaying,  particu- 
larly the  anterior-posterior,  to  be  made 
up  of  a  series  of  waves.  These  waves 
have  a  little  resemblance  to  quite  irregu- 
lar respiration  curves.  Hinsdale  con- 
cluded that  the  waves  of  swaying  do  not 
correspond  wholly  or  fractionally  with 
respiration  rate.  From  the  inspection  of 
a  number  of  such  tracings  made  with  the 
ataxiameter  it  is  certainly  clear  that 
there  are  places  in  nearly  everj'  record 
where  a  direct  correspondence  seems 
e\'ident.  But  the  same  records  show 
that  the  swaying  waves  continue  at  ap- 
proximately the  same  size  and  rate  dur- 
ing intervals  of  fifteen  to  thirty  seconds 
while  respiration  is  suspended.     While 


it  is  pro\'ed  that  these  movements  do 
not  depend  upon  the  acts  of  respiration, 
it  is  still  possible  that  these  waves  may 
result  from  slight  reflex  contractions  or 
alternating  changes  of  muscle  tonus  as- 
sociated with  respiration.  On  the  other 
hand,  any  process  of  balancing  com- 
monly results'  in  something  of  a  pendu- 
lar  movement.  From  these  tests  of 
Hinsdale  and  from  the  tests  with  the 
ataxiameter  it  is  apparent  that  subjects 
should  be  advised  to  breathe  normally 
during  the  station  test.* 

Such  factors  as  apprehension,  distrac- 
tion, and  suggestion  have  been  noted  by 
those  who  have  employed  the  station 
test  as  being  important  influences  on 
stability.  Especially  if  the  subject  is 
blindfolded  or  has  his  eyes  closed,  it 
surely  is  obvious  that  the  experimenter 
should  not  be  walking  about  him  or 
talking  with  him,  nor  should  other  indi- 
viduals be  allowed  to  move  about  in  the 
same  room  watching  or  commenting  on 
the  test  or  on  other  topics.  It  is  conve- 
nient to  control  attention  and  mental 
attitude  somewhat  by  having  the  subject 
count  silently  with  a  clock  ticking  sec- 
onds. Since  he  knows  the  test  is  going 
to  continue,  for  example,  120  seconds,  he 
is  able  to  apprehend  its  progress  and  will 
not  begin  shortly  to  feel  that  the  experi- 
menter has  forgotten  him.  If  a  test  like 
that  of  station  has  to  be  denominated  a 
"general  motor  test,"  this  is  no  warrant 
for  gi\ing  it  in  a  loose  and  general  way, 
but  should  stimulate  effort  to  achieve 
careful  control.  The  discussion  in  the 
preceding  paragraphs  of  some  of  the  in- 
fluencing factors  is  to  emphasize  that 
useful  data,  even  in  such  a  simple  test 
as  station,  cannot  be  obtained  without 
care. 


*  No  wavps  for  lieart-bont  could  be  identified 
in  the  traciiiirs.  •'Aviation  Medicine  in  the  A.  R. 
I'.."  Wasliinsrton.  T).  C.  lf)20.  p.  12.S.  specifies  tlmt 
the  breath  should  not  be  held  during  steadiiies.* 
testf,. 


MILES— STATIC  EQUILIBRIUM 


J  29 


Improvement  of  Station  with 
Training 

Hancock  reports  that  "in  30  cases 
(children)  the  tracings  were  repeated  at 
a  later  date,  without  material  difference 
in  size  and  fully  as  miscellaneous  move- 
ment." \\'ithout  referring  specifically  to 
station,  Henmon,  working  with  aviators, 
records  that  "practice  effects  are  slight 
for  daily  tests  over  a  period  of  fifteen 
days."  A  series  of  measurements  w^re 
made  in  1920  at  the  Nutrition  Labora- 
tory in  order  to  determine  the  influence 
of  training  on  the  test.  Twelve  adults, 
nine  women  and  three  men,  all  of  whom 
were  regularly  working  at  the  Labora- 
tory, were  tested  on  the  ataxiameter 
once  each  day  between  the  hours  of  8 
and  10  A.  M.  for  a  period  of  twenty-one 
successive  days,  excepting  Sundays  and 
holidays.*  The  complete  data  cannot  be 
reproduced  here.  The  average  for  the 
first  day  was  694  mm.,  slightly  better 
than  the  averages  reported  on  page  328 
of  this  paper.  The  twent}'-one  days  may 
be  di\'ic^ed  into  three  blocks  of  seven 
days  each.  The  following  general  aver- 
ages are  thus  obtained :  643,  560  and  528 
mm.  They  show  progressive  improve- 
ment in  stability,  the  second  group  of 
days  being  13  per  cent,  better  than  the 
first,  and  the  third  5.5  per  cent,  lower 
than  the  second.  The  graphic  tracings 
taken  in  connection  with  the  ataxiame- 
ter readings  were  carefully  measured  to 
find  out  if  there  was  a  similar  change  in 
the  gross  range  of  sway.  The  three 
groups  of  seven  days  each  gave  total 
averages  for  all  subjects: 

Anterior-posterior  range 

(mm.)     48.3  46.1  42.7 

Lateral  ranpre  (mm.  ~i  ...  20.0  18.3  18.9 
Rectangular     area      (sq. 

mm.)     966  844  807 

There  was  a  decrease  in  the  range  of 
forward  and  backward  movement  while 


the  lateral  range  did  not  change  much 
during  the  last  fourteen  days.  The  rect- 
angular area  within  which  the  swaying 
occurred  decreased  at  first  by  12.6  per 
cent,  and  then  by  4.4  per  cent.  These 
improvements  with  training  are  sub- 
stantially the  same  as  those  indicated  by 
comparison  of  the  ataxiameter  readings, 
but  these  latter  vary  from  each  other, 
treating  the  seven-day  groups  separate- 
ly, by  an  average  of  only  3.5  per  cent., 
while  the  gross  range  of  swa\'  shows  a 
variation  of  6.5  per  cent. — i.  e.,  nearly 
twice  as  much. 

Eight  of  the  subjects  tested  at  the  Nu- 
trition Laboratory  continued  the  tests 
for  thirty-six  days  from  the  start, 
and  after  an  interval  of  six  weeks, 
including  four  weeks'  vacation,  were 
again  tested  for  twelve  days.  It  will 
be  con\enient  to  arrange  these  re- 
sults in  six-day  groups  or  what  may 
be  termed  weekly  averages.  This  has 
been  followed  in  Table  4  where  the  daily 
a\'erages  are  all  presented  arranged 
b\'  weeks  during  which  the  test  was  con- 
tinued. The  first  \alue  at  the  top  of 
column  1,  640  mm.,  is  the  total  average 
ataxiameter  score  for  the  eight  subjects 
on  the  first  day.  The  first  result  in  col- 
umn 2,  524  mm.,  is  the  average  score  for 
the  seventh  day  and  so  on.  The  weekly 
averages  provide  the  following  series  of 
scores:  574,  506,  486,  482,  489,  506, 
\-acation,  530,  and  490  mm.  The  vari- 
ations of  a  weekly  score  from  the  daily 
scores  of  that  week  range  from  2.5  to  5.1 
per  cent,  with  no  regular  or  progressive 
change.  The  weekly  scores  indicate  con- 
sistent improvement  up  to  and  includ- 
ing the  second  week  in  July — the  fourth 
week  of  the  tests — with  a  total  decrease 

*  These  te.sts  Tvere  painstakingly  made  by  Jlr. 
E  S.  Mills.  Hi.«i  assistiiiifp  and  the  otvoneration 
.  f  those  who  served  as  siihjects  are  Kratefully  Vic- 
knowlodged.  As  usual,  tlip  tests  were  two-minute 
tests,  with  eyes  closed  and  feet  in  V-position.  in 
a  quiet  room,  the  subject  conntins  silently  during 
the  period. 


330 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


in  swaying  of  1L8  per  cent.  There  was  a  subjects   a  long  period  of  preliminary 

slight  loss  in  steadiness  during  the  fifth  practice, 
week  and  a  definite  loss  in  the  sixth 

when  the  factor  of  training  was  more  Summary 
than  offset  by  the  tedium  of  the  test,  and 

the  physical  laxness  preceding  vacation.  The  ataxiameter  as  a  means  of  care- 
After  four  weeks  of  vacation  and  tw^o  fully  measuring  station  in  man  has  been 
weeks  of  work  at  the  Laboratory,  this  used  at  the  Nutrition  Laboratory  for  in- 

TABLE  4— INFLUENCE  OF  PRACTICE  ON  STABILITY   OF  ERECT  POSTURE 


Weeks  during  Which  Tests  Were 

Continued 

Days  of 
Week 

June 

17-30 

July  1-31 

Sept. 

13-25 

1 

2 

3 

4 

5 

6 

7 

8 

mm. 

mm. 

mm. 

mm. 

mm. 

mm. 

mm. 

mm. 

1 

640 

524 

473 

489 

465 

496 

»: 

560 

525 

2 

588 

527 

449 

456 

488 

532 

?i 

559 

527 

3 

560 

545 

510 

490 

534 

518 

518 

487 

4 

543 

491 

498 

48.5 

492 

504 

£ 

511 

481 

5 

543 

484 

501 

471 

478 

49.) 

— 

520 

464 

6 

570 

467 

484 

503 

476 

492 

514 

457 

Av.  .   .   . 

574 

506 

486 

482 

489 

506 

530 

<90 

latter  interval  being  judged  sufficient 
time  for  getting  back  into  routine,  the 
tests  were  resumed.  The  score  for  the 
seventh  week,  530  mm.,  is  just  about 
half  way  between  that  for  the  first  and 
second  weeks,  showing  a  retained  im- 
provement from  training  of  7.6  per  cent, 
after  a  lapse  of  six  w'eeks.  On  the  eighth 
week  the  score  approached  quite  nearly 
to  the  previous  minimum.  While  station 
as  a  motor  test  is  found  from  these  data 
to  follow  the  law  of  improvement  with 
practice,  as  is  the  case  with  all  known 
voluntary  neuromuscular  performances, 
it  improves  rather  less  than  the  average 
of  such  tests  (21)  (22)  (23).  This  is  a 
feature  which  recommends  its  use  in 
those  circumstances  w^here  it  is  impossi- 
ble to  preface  the  testing  by  giving  the 


\estigating  the  influence  on  neuromus- 
cular control  of  such  conditions  as  those 
before  and  after  the  taking  of  food,  phys- 
ical weakness  associated  with  diabetes, 
prolonged  exposure  to  cold,  fatigue  re- 
sulting from  muscular  w'ork,  and  the 
ingestion  of  dilute  alcoholic  beverages. 
Data  could  be  given  from  such  experi- 
ments to  illustrate  the  sensitiveness  of 
the  station  test  and  the  t}-pe  of  results 
which  may  be  expected  from  its  use.  But 
such  fragmentary  data  tend  to  mislead 
the  reader  as  to  their  bearing  on  the 
problems  with  which  they  deal  and  can 
best  be  withheld  for  publication  in  their 
proper  connection.  It  has  been  the  object 
of  this  article  to  call  the  attention  of 
those  interested  in  mental  and  physical 
tests  to  the  static  equilibrium  or  station 


MILES— STATIC  EQUILIBRIUM 


331 


test  as  one  well  deserving  consideration 
for  general  use. 

L  A  general  review  is  presented,  in- 
dicating some  uses  previously  made  of 
the  station  test. 

2.  A  relatively  simple  apparatus 
called,  for  convenience,  an  ataxiameter, 
is  described.  This  automatically  accu- 
mulates all  the  anterior-posterior  and 
lateral  components  of  the  mo\'ements 
directly  in  millimeters  of  sway,  and  pro- 
vides a  convenient  method  for  making 
the  test. 

3.  The  anatomical  and  physiological 
considerations  which  influence  stabilitv 


of  station  and  the  quantitati\e  influence 
of  several  of  these  factors  ha\e  been 
shown  by  original  data.  This  constitutes 
a  description  of  how  the  test  should  be 
made. 

4.  Results  for  a  long  series  of  meas- 
urements are  presented  and  demonstrate 
that,  although  subject  to  practice,  sta- 
tion is  not  \-ery  markedly  improved  by 
training. 

5.  The  test  is  put  forward  as  a  con- 
venient and  sensiti\-e  measure  for  \-ari- 
ations  in  the  efficiency  of  the  neuro- 
muscular mechanism  of  man. 


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332 


THE  TOURNAL  OF  INDUSTRIAL  HYGIENE 


CENSUS  OF  SAFETY  AND  HEALTH  WORKERS 


AH  industrial  phj'siciaus  and  surgeons, 
industrial  nurses,  and  other  persons  engaged 
in  industrial  health  work  are  to  be  included 
in  the  census  of  safety  and  health  workers 
now  being  taken  by  the  National  Safety 
Council  in  all  parts  of  the  country.  Although 
health  work  iu  industry,  along  with  safety, 
has  made  great  strides  in  the  past  few  years, 
it  is  not  at  present  known  how  many  persons 
are  engaged  in  either  of  these  activities,  who 
they  are,  or  where  they  are  located.  This  is 
the  first  time  an  attempt  has  ever  been  made 
to  list  all  the  industrial  safety  and  health 
workers.  Public  safety  workers  will  also  be 
included  in  the  census. 

It  is  believed  that  the  results  of  the  census 
will  give  a  good  indication  of  how  extensive 
the  safety  and  health  activities  now  being 
carried  on  are.  The  census  M'ill  include  not 
only  members  and  employees  of  members  of 
the  National  Safety  Council,  but  all  persons 
engaged  in  industrial  safety  and  health  work 
whether  connected  with  the  Council  in  any 
way  or  not.  The  Council  has  almost  as  deep 
an  interest  in  industrial  health  work  as  in 
accident  prevention,  and  is  very  closely  al- 
lied with  the  American  Association  of  Indus- 
trial Physicians  and  Surgeons.  Many  health 
workers    and    companies    employing    health 


workers  are  numbered  among  the  Council's 
membership. 

Industry  in  general  and  the  nation  at  large 
will  profit  from  the  results  of  this  census. 
It  will  enable  the  Council  to  find  quickly 
speakers  on  industrial  and  public  safety  for 
any  occasion  in  any  locality ;  authors  for 
special  articles  on  accident  prevention ;  writ- 
ers of  safety  test-books ;  lecturers  on  acci- 
dent prevention  and  industrial  health  work 
for  universities  and  colleges.  The  Council  at 
present  continually  receives  requests  from 
industrial  companies,  municipalities,  civic  as- 
sociations, clubs,  schools,  colleges,  and  other 
organizations  for  help  in  finding  speakers  or 
writers  on  safety  subjects.  The  census  rec- 
ords will  greatly  increase  the  facilities  of  the 
Council  for  filling  such  requests. 

Every  reader  of  this  publication  who  is 
professionally  engaged  in  industrial  or  \n\\,- 
lic  accident  prevention  or  industrial  health 
work  —  wliether  he  is  devoting  all  or  only 
part  of  his  time  to  accident  prevention  —  i., 
urged  to  assist  in  the  taking  of  this  census 
by  sending  to  the  National  Safety  Council, 
168  North  Michigan  Avenue,  Chicago,  his 
name  and  the  other  data  requested  in  the 
Coiuicil's  census  form,  which  follows: 


Name - - 

Company  or  organization -. 

City - State 

Nature  of  company 's  business _ _ 

Is  safety  your  principal  work  ? - 

Please  check  other  activities  you  engage  in : 

Fire  protection 

Health  and  sanitation 

Workmen's  conipensjition  and  claims 

General  executive    (such  as  manager 
or  superintendent) 
How  long  have  you  been  in  your  present  position? 

Technical  or  other  special  education? 

Signed 

Title ..._ 


Engineering  (other  than  safety) 

Legal 

Insurance 

Welfare  Educational 

In.histr'al   relations 


s 


15 


THE  JOURNAL  OF 
INDUSTRIAL  HYGIENE 


PUBLISHED  MOATHLY 


COMMON  COLDS  IN  RELATION  TO  INDUSTRIAL  HYGIENE" 

Harold  G.  Tobey,  M.  D. 
Bostoti,  Mass. 


T  T  IS  generally  recognized  that  the  com- 
A    mon  "cold  in  the  head"  and  its  se- 
quelae   are  among    the    most    frequent 
causes  of  loss  of  time  from  work.    The 
common  cold  as  a  disease  is  rather  held 
in  contempt  by  the  average  indixidual 
As  far  as  his  experience  goes  it  is  a  more 
or  less  limited,  harmless    process    and 
something    to    be    endured   with    what 
equanimity  one  can  muster.     His  ex- 
perience does  not  include  the  possible 
sequelae  which  may  occur  and  which 
may  cause  serious  loss  of  time,  health 
and  even  death.  ' 

In  industrial  life  a  great  manv  of  the 
common  colds  are  rather  an  irritative 
process  set  up  by  unfavorable  surround- 
ings— ^.^.,  exposure  to  chemical  irri- 
tants, cold,  dampness  or  extreme  heat- 
necessary  to  the  particular  occupation 
at  vvhich  the  individual  is  emploved 
prolonged  exposure  to  such  conditions 
does,  to  be  sure,  render  the  individual 
susceptible  to  infection. 

Symptoms 

Properly   speaking,   the  term   "cold" 
should  be  reser^'ed  for  a  particular  dis- 


*Received  for  publication  Nov.  15,  1921. 


ease  with  definite  symptoms,— a  dis- 
ease which  Dr.  W^endell  Phillipsf  de- 
scribes as  follows: 

All  attack  of  acute  rhinitis  for  cold  in  the 
f'cadl  ,s  usually  ushered  in  l,y  sneezi  I  an  1  a 
sensation  of  nasal  stutfiness'or  obstruclion 
The  obstruction  is  a.ssociated  with  a  burning 
sensation  in  the  nose,  tenderness  over  the  fore- 
head u,,on  ,>ressure,  heat  in  and  below  the 
eyes  lachryniation,  a  general  sense  of  drvness 
of  the  mouth  and  throat,  and  often  perveVS 

Z.I^IT''  ?l  "'"  '^"^^  "f  •'''"'•ll  «"<!  taste, 
boon  after  the  onset,  the  general  svmptonis 
supervene,  such  as  languor,  fatigue,  ehillinSs 
and    pros  ration.     The   general   diturbaces 
may  l,e  slight,  but  very  commonly  thev  are 
prolonged  and  distressing  on  account  of  the 
predominance  of  one  or  more  of  these  mani- 
festations.    After  a  few  hours  the  nasal  ob- 
struction becomes  associated  with  a  iirofuse 
watery  discharge  and  the  mucosa  which  was 
at  first  hyperemic  becomes  so  much  infiltrated 
that  one  or  both  nostrils  may  become  entirely 
occluded     The  nasal  obstruction  commonly  I 
ternates  from  one  nostril  to  the  other    'The 
serous  exudate  soon  changes  to  a  mucopuru- 
lent and  therefore  thicker  discharge  as  a  result 
o±  the  increasing  admixture  with  cellular  ele- 
ments, and  meanwhile  it  diminishes  in  quan- 
tity.    Iho  discharge  often  possesses  an  irritat- 
ing quality  which  produces  excoriation  of  the 
skin  about  the  nasal  orifices  and  upper  lip 
There  may  be  a  slight  rise  of  temperature  and 
tPhillips.  W.  C:    Diseases  of  tbe  Ear.  Xose  ami 

Hor    Ph   "  '?    .'»°'l,^"'-"i'''-"-     Fifth  revise,!  ed  ' 
urn.     Ph.Ia.leli.liia,  F.  A.  Davis  Company,  1919,  p. 


333 


334 


THE   TOURNAL  OF  INDUSTRIAL  HYGIENE 


considerable  loss  of  appetite.  .  .  .  Mouth- 
breathing  is  the  rule,  especially  during  sleep, 
resulting  in  great  di-yness  of  the  pharyngeal 
and  laryngeal  mucosa  .  .  .  The  swell- 
ing of  the  mucosa  gradually  subsides,  and  the 
secretion  slowly  diminishes  and  finally  disap- 
pears; the  attack  usually  terminates  after  a 
week.     . 


Such  is  the  picture  of  the  true  cold  in 
the  head  with  which  we  are  all  familiar. 
It  is  necessary  to  have  these  symptoms 
well  in  mind  in  order  to  differentiate  be- 
tween the  true  infections  and  the  cases 
of  acute  rhinitis,  or  coryza,  from  other 
causes,  which  never  go  on  to  pus  forma- 
tion unless  infection  supervenes. 

Modes  of  Infection 

■  Two  avenues  of  infection  are  recog- 
nized: 

1.  It  is  well  known  that  potentially 
pathogenic  bacteria  may  lead  a  sapro- 
phytic existence  upon  the  pharyngeal 
mucous  membrane  of  healthy  individ- 
uals. Under  appropriate  circumstances, 
these  bacteria  become  the  active  agents 
of  infection.  Many  causes  may  be 
enumerated  for  the  lowered  resistance 
which  opens  the  door  for  active  infection 
—such  as,  for  example,  physical  ex- 
haustion from  overwork,  dissipation  or 
disease,  and  the  deterioration  of  health 
which  follows  prolonged  association 
with  insanitary  surroundings.  As  ex- 
amples of  important  insanitary  condi- 
tions predisposing  to  infection,  vitiated 
air,  o\-ercrowding,  defective  diet,  seden- 
tary habits  and  neglect  of  body  cleanli- 
ness may  be  mentioned.  Prolonged 
chilling  of  the  body  from  constant  drafts 
may  result  in  a  temporary  lowering  of 
resistance,  during  which  the  bacteria 
may  gain  a  foothold  and  acute  infection 
develop. 

2.  A  more  frequent  avenue  of  infec- 


tion is  by  direct  contagion  from  a  person 
in  an  acute  attack,  in  which  instance 
there  is  a  direct  implantation  of  patho- 
genic bacteria.  The  chance  of  infection 
will  depend  upon  the  virulence  of  the 
bacteria  and  upon  the  general  condition 
of  the  individual  as  well  as  upon  the 
local  condition  of  the  upper  respiratory 
tract.  It  is  evident  that  individuals  sub- 
ject to  the  conditions  mentioned  in  the 
previous  paragraph  are  much  less  able 
to  resist  such  contagion,  which  is 
carried  by  sneezing,  coughing,  em- 
bracing, speaking  at  close  range,  and 
possibly  by  towels,  drinking  cups  and 
other  utensils. 

Surroundings  favorable  to  contagion 
are  found  in  ill-ventilated  rooms,  halls, 
or  places  of  work,  and  in  the  close  con- 
tacts necessitated  by  crowded  trains  and 
trolley  cars.  It  has  been  found  that  in 
hot,  dry,  crowded  rooms,  such  as  ill- 
ventilated  theatres  or  meeting  halls,  the 
mucous  membranes  over  the  turbinate 
bones  and  nasal  septum  swell,  become 
turgid  with  blood  and  tissue  lymph,  and 
covered  with  thick  secretion.  In  such 
crowded  places  massive  droplet  infec- 
tion is  likely  to  occur.  On  going  out  into 
cold,  moist  air,  the  blood  vessels  con- 
strict and  the  nasal  mucous  membrane 
becomes  chilled  but  remains  swollen 
with  tissue  lymph.  This  condition  of 
the  mucous  membrane  affords  a  suitable 
condition  for  bacterial  proliferation. 
Such  an  explanation  is  in  harmony  with 
the  increase  in  incidence  of  upper  respir- 
atory diseases  during  the  cold  weather. 

Treatment 

Prophylaxis. — The  following  sugges- 
tions for  the  general  care  of  the  body 
will  be  found  helpful  in  preventing  at- 
tacks of  cold  in  the  head :  Lead  as  vigor- 
ous and  healthful  a  life  as  possible  with 
adequate  sleep,  food,  exercise  and  fresh 


TOBEY— COMMON  COLDS  AND   INDUSTRIAL   HYGIENE       335 


air.  Bathe  daily.  Keep  the  house  suffi- 
ciently warm  to  be  comfortable  but  not 
overhot  or  overdr>'.  Avoid  contagion 
from  infected  persons,  remembering  that 
respiratory  diseases  are  communicated 
chiefly  through  droplets  of  mucus 
sprayed  into  the  air  through  coughing, 
sneezing  and  speaking.  Avoid  crowd- 
ing in  hot  atmospheres. 

General  and  Local  Treatment.  — 
Treatment  may  be  divided  into  three 
stages  to  correspond  to  the  stages  of  the 
infection:  {a)  measures  directed  toward 
aborting  the  infection  in  the  prodromal 
period;  [b)  relief  from  the  profuse  dis- 
charge and  turgescence  during  the  acute 
stage;  (c)  o\ersight  of  the  last  stage  in 
order  to  hasten  the  recuperative  process 
and  to  forestall  complications. 

{a)  As  has  been  mentioned,  it  is  ex- 
tremely difficult  to  induce  persons  suf- 
fering with  an  acute  cold  to  submit  to 
the  form  of  treatment  which  mitigates 
its  severity,  lessens  its  duration  and  al- 
most surely  guarantees  immunity  from 
troublesome  and  even  serious  complica- 
tions. In  the  majority  of  cases  the  pro- 
dromal symptoms  are  not  recognized 
and  relief  is  not  sought  until  the  disease 
is  well  established.  If  these  symptoms, 
such  as  dryness  of  the  mouth  and  throat 
and  even  of  the  nose,  a  sense  of  stuffi- 
ness in  the  nose,  headache,  etc.,  are  rec- 
ognized, a  hot  bath,  a  hot  lemonade  and 
ten  grains  of  Dover's  powder  followed  by 
a  saline  cathartic  in  the  morning  will 
often  abort  or  distinctly  decrease  the  se- 
verity of  the  attack.  This  treatment  is 
more  efficacious  if  the  person  will  con- 
sent to  remain  in  bed,  or  at  least  in  the 
house,  for  two  or  three  days,  and  possi- 
bly repeat  the  above  treatment  on  the 
second  day.  It  is  important  to  remember 
that  this  treatment  is  only  to  be  insti- 
tuted upon  retiring,  as  the  object  is  to 
induce  a  profuse  perspiration. 

{b)   Opinions  differ  as  to  the  advisa- 


bility of  local  treatment  during  the  acute 
stage;  the  dangers  of  irrigations  and 
sprays  are  magnified,  and  well  so,  as  in- 
discriminate and  unskillful  douching 
and  spraying  often  lead  to  untoward  re- 
sults, spreading  the  infection  to  quite  as 
great  a  degree  as  they  remove  it. 

The  chief  indications  for  treatment 
are  the  profuse  discharge  and  the  swell- 
ing of  the  mucous  membrane.  The  wa- 
ter}' discharge  may  be  controlled  to  some 
extent  by  the  administration  of  bella- 
donna in  the  tincture,  ten  drops  every 
two  hours  until  a  sense  of  dryness  is  no- 
ticed. Belladonna  and  camphor  are  the 
principal  constituents  of  the  common 
rhinitis  tablets  which,  while  not  cura- 
tive, give  some  relief  when  properly  ad- 
ministered. Yor  the  temporary  relief  of 
the  turgescence  of  the  mucous  mem- 
brane, the  local  application  of  adrenalin 
in  the  form  of  a  light  spray,  in  the 
strength  of  1 : 5,000  will  prove  the  most 
useful.  The  resultant  shrinking  of  the 
lining  membrane  allows  a  more  thorough 
removal  of  the  excess  secretions.  If, 
after  the  tissues  have  contracted,  an  oily 
spray  containing  menthol  and  eucalyp- 
tol  is  used,  an  added  sense  of  relief  is 
produced.  Forcible  spraying  in  igno- 
rant hands  is  worse  than  no  spraying  at 
all.  The  vogue  of  aspirin  among  the 
laity  extends,  of  course,  to  the  common 
cold.  All  that  can  be  expected  of  this, 
however,  is  to  relieve  the  headache. 

{c)  In  the  last  stage  the  secretions 
have  become  thick  and  adherent  and  are 
difficult  to  expel,  the  more  so  if  irregu- 
larities of  the  septum  are  present, 
around  which  the  secretions  collect.  The 
presence  of  these  retained  secretions 
keeps  up  the  inflammation  and  infection 
which  may  gradually  extend  to  the  ac- 
cessory sinuses,  and  it  is  therefore  good 
practice  to  aid  in  their  removal.  Shrink- 
ing the  turbinates  by  use  of  the  adrena- 


336 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


lin  spray  may  be  followed  by  a  bland 
wash  which  mechanically  removes  the 
thick  mucus.  This  washing  should  be 
done  by  an  experienced  person,  in  one  of 
two  ways :  first,  under  direct  inspection 
with  a  hand  atomizer  which  throws  a 
small  non-forcible  stream ;  or,  secondly, 
by  means  of  gravity  from  a  douche  bag. 
If  the  first  method  is  chosen  the  fluid  is 
heated  to  body  temperature,  the  patient 
directed  to  hold  his  breath,  and  one  por- 
tion of  the  nasal  cavity  is  washed,  im- 
mediately after  which  the  head  is  thrown 
forward  over  a  basin  and  the  fluid  is  al- 
lowed to  drain  back.  After  all  excess  of 
fluid  has  been  removed,  the  opposite  nos- 
tril is  closed  with  the  finger,  and  the  re- 
maining fluid  with  the  washed  off  pus 
and  mucus  is  forcibly  expelled.  By  the 
gravity  method  the  same  process  is  gone 
through  with,  excepting  that  the  head  is 
thrown  forward  during  the  whole  per- 
formance. This  method  is  not,  of  course, 
carried  out  under  direct  inspection. 
Coughing,  gagging  and  swallowing  while 
excess  fluid  is  present  must  be  guarded 
against.  Such  difficulties  are  usually  oc- 
casioned by  a  fluid  of  improper  tempera- 
ture or  by  the  patient's  breathing  during 
the  operation  and  thus  allowing  the  fluid 
to  escape  into  the  oropharynx  or  e\'en 
into  the  larynx. 

It  is  axiomatic  that  no  irritating  fluids 
should  be  used  as  they  only  increase  the 
inflammation.  Any  irrigating  medium 
in  sufficient  strength  to  kill  bacteria  will 
result  in  increased  irritation  of  the  nasal 
lining.  It  must  be  emphasized  that  it  is 
only  the  mechanical  removal  of  the  irri- 
tating secretions  that  is  desired.  Non-ir- 
ritating, simple  alkaline  washes,  such  as 
liquor  alkalinus  antisepticus  (N.F.),  or 
normal  physiological  salt  solution,  may 
be  used  for  this  purpose.  (The  latter  is 
simply  one  teaspoonful  of  salt  in  a  pint 
of  water,  and  is  absolutely  non-irritant.) 


Complications 

The  nasopharynx  is  almost  invariably 
involved  in  every  case  of  cold,  and  an 
associated  acute  tonsillitis  is  common. 
The  infection  may  also  extend  to  the 
larynx  and  to  the  bronchi.  In  certain 
individuals  an  attack  of  the  common 
cold  predisposes  to  prolonged  bronchial 
inflammation.  Infection  of  the  acces- 
sory sinuses  may  occur  in  the  early 
stages,  particularly  during  a  virulent  in- 
fection. This  is  especially  true  of  the 
influenzal  infections.  Acute  involve- 
ment of  the  sinuses  is  indicated  by  severe 
pain  and  prostration.  Persons  thus  af- 
fected are  confined  to  bed  and  do  not,  as 
a  rule,  come  under  the  care  of  the  indus- 
trial clinic. 

I  wish  to  lay  particular  stress  upon  the 
colds  which  do  not  clear  up  after  ten 
days  to  two  weeks.  In  cases  of  this  kind 
we  are  probably  dealing  with  retained 
secretions — a  subject  which  I  have  al- 
ready discussed — or  with  a  sub-acute  in- 
fection of  the  accessory  sinuses.  Sub- 
acute infection  of  the  accessory  sinuses 
is  usually  indicated  by  a  continual 
discharge  from  the  nose.  The  dis- 
charge is  more  likely  to  be  unilateral, 
since  one  side  of  the  nose  is  involved 
more  frequently  than  both  sides 
together.  Contrary  to  the  usual 
idea,  pain  is  not  a  necessary  ac- 
companiment of  sub-acute  sinus  in- 
fection. Frequently  the  antrum,  or  max- 
illary sinus,  acts  as  a  reservoir  for  resid- 
ual pus  from  the  infection.  The  typical 
picture  of  such  a  condition  is  presented 
by  persons  giving  a  history  of  having  had 
a  cold  two  to  four  weeks  before,  which 
has  not  cleared  up.  There  is  a  constant 
one-sided  nasal  discharge,  and  the  head 
feels  dull  and  heavy.  The  person  cannot 
think  or  concentrate,  there  is  a  feeling 
of  lassitude,  the  voice  has  lost  its  reso- 


TOBEY— COMAIOX  COLDS  A  XD   INDUSTRIAL   HYGIENE      337 


Jiance.  Individuals  complaining  of  these 
symptoms  should  be  referred  to  a  spe- 
cialist, as  very  simple  procedures  vv^ill 
give  relief ;  neglect  frequently  means  loss 
of  efficiency  and,  later,  further  loss  of 
time  from  more  radical  procedures 
which  may  become  necessary. 

The  common  cold  may  be  compli- 
cated by  deafness  and  abscess  of  the 
middle  ear,  resulting  either  from  direct 
•extension  of  the  process  to  the  eustachian 
tubes  and  thence  to  the  middle  ear,  or 
from  the  forcing  of  infected  material 
into  the  tubes  through  careless  douch- 
ing and  spraying  of  the  nose.  Ine.xpert 
use  of  the  handkerchief  during  an  attack 
of  cold  may  result  in  infection  of  the  sin- 
uses or  the  middle  ear.  The  act  of  wip- 
ing the  nose  with  the  handkerchief  be- 
fore one  has  finished  blowing  is  almost 
a  universal  habit.  This  results  in  raising 
the  pressure  in  the  nose  and  naso- 
pharyn.x  and  in  forcing  infectious  ma- 
terial into  the  sinuses  and  eustachian 
tubes.  We  may  well  take  a  lesson  from 
the  laborer  who  closes  one  nostril  while 
clearing  the  other;  this  may  perfectly 
well  be  done  while  using  the  handker- 
chief. For  the  same  reason,  too,  forcible 
blowing  to  e.xpel  secretions  should  be 
guarded  against. 

Considerable  emphasis  has  been  laid 
upon  the  common  cold  and  its  recogni- 
tion, as  it  is  frequently  mistaken  for 
acute  rhinitis,  or  coryza,  and  vasomotor 
disturbances.  An  acute  rhinitis,  or  cor\'- 
za,  is  a  temporary  turgescence  of  the 
nasal  mucous  membrane,  often  accom- 
panied by  sneezing  and  a  profuse  watery 
discharge.  Thus  far,  it  resembles  the 
common  cold;  but  careful  questioning 
does  not  bring  out  a  prodromal  stage  of 
dryness  or  tickling  in  the  nose  or  throat ; 
there  is  no  general  lassitude,  chilliness 
nor  headache.  The  symptoms  begin  sud- 
denly, last  for  a  few  hours,  and  disap- 
pear as  suddenly  as  they  appeared.    In 


other  words,  while  the  way  is  pa\-ed  for 
infection,  such  infection  does  not  occur. 
These  attacks  result  from  various 
causes.  Attendance  at  the  theatre,  or 
other  gatherings  where  the  air  becomes 
vitiated  and  filled  with  dust,  frequently 
gives  rise  to  such  a  train  of  symptoms, 
which  ma>-  last  from  tweh-e  to  forty- 
eight  hours.  Exposure  to  irritating 
chemicals  and  dusts  in  the  industries 
may  be  the  cause.  Exposure  to  cold  and 
to  drafts  gives  rise  to  a  temporary  vaso- 
motor disturbance.  Any  drug,  such  as 
aspirin  or  rhinitis  tablets,  taken  at  this 
time,  is  promptly  proclaimed  as  cura- 
ti\e.  This  is  probably  one  reason  why 
so  man}'  and  various  drugs  have  been 
ad\ised  for  treatment.  The  essential  dif- 
ference, then,  to  be  remembered  between 
the  common  cold  and  acute  rhinitis  is 
that,  iri  cases  of  the  latter,  infection  does 
not  occur. 

With  these  conditions  in  mind,  it  be- 
comes evident  that  irritating  antiseptics 
and  gases  should  not  be  used  as  a  rou- 
tine for  these  symptoms.  Not  infre- 
quently such  procedures  set  up  a  true 
inflammatory  process  in  the  nasal  cham- 
bers upon  which  infection  is  bound  to 
occur.  The  formalin  chamber,  to  my 
mind,  is  not  good  treatment.  Formalin 
is  a  \ery  active  irritant  to  the  mucous 
membrane  and,  in  sufficient  concentra- 
tion to  be  bactericidal,  cannot  be  toler- 
ated by  the  human  body. 

Recent  studies  in  anaphylaxis  have 
shown  that  prolonged  vasomotor  dis- 
turbances, simulating  colds,  may  be 
caused  by  various  substances  which  are 
ingested  or  inhaled.  Hay-fever  is  the 
most  common  example.  Certain  indi- 
viduals are  susceptible  to  the  dust  in- 
haled from  horses,  cats,  dogs,  and  feath- 
ers, or  to  various  foods  which  are  in- 
gested. Chemists  working  in  drugs,  as 
well  as  workers  in  leather,  may  be  sus- 
ceptible.   Face  powder  is  frequently  at 


338 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


fault.  Persons  thus  affected  complain 
of  prolonged  colds  with  nasal  obstruc- 
tion, sneezing,  and  profuse  discharge. 

Summary 

1 .  Ever>'  person  complaining  of  nasal 
obstruction,  sneezing  and  discharge  is 
not  suffering  from  a  cold  in  the  head. 
Learn  to  differentiate. 

2.  A  careful  history  will  be  helpful  in 
the  diagnosis.  The  duration  of  the 
symptoms  will  indicate  to  a  certain  ex- 


tent the  character  of  the  affection.  A 
long  duration  points  to  a  complication 
or  to  some  disturbance  which  is  not  a 
cold.  Inquire  into  the  character  of  the 
person's  work,  the  conditions  under 
which  he  works,  etc. 

3.  Differentiate  the  three  stages  of  a 
cold  and  treat  the  patient  accordingly. 
Do  not  use  irritating  antiseptics  at  any 
stage. 

4.  Any  case  resisting  treatment  for 
from  two  to  four  weeks  should  be  exam- 
ined by  a  rhinologist. 


INFECTIOUS    ARTHRITIS     OF     THE    SPINE* 


J.    F.   CURRAN,   M.D.,  AND   S.  F.  FoSTER,  STATISTICIAN 

Norton  Company,  Worcester,  Mass. 


Introduction 

''T^  HE  detection  and  treatment  of  cases 
-'-  of  infectious  arthritis  localized  in 
the  spine  compel  the  interest  of  the  in- 
dustrial physician  for  two  important 
reasons:  (1)  the  insidious  character  of 
the  disease  with  attendant  difficulty  of 
diagnosis  and  treatment;  (2)  the  eco- 
nomic asppct  as  presented  in  the  direct 
cost  and  disability  to  the  victim  and  the 
indirect  cost  to  the  employer.  The 
course  of  the  ailment  is  characterized  by 
progress  without  outward  s>-mptoms  un- 
til a  stage  is  reached  when  an  act  of  over- 
exertion causes  severe  pain  and  thus  re- 
veals the  disorder.  Preventive  measures 
are  then  impossible  and  a  long  period  of 
expense  for  employee  and  employer  fol- 
lows. 

The  incidence  of  cases  of  this  disease 
is  not  large,  thereby  limiting  the  devel- 
opment of  means  by  which  it  might  be 
readily  detected  upon  entrance  examina- 
tion. Proper  placement  in  most  cases 
would  ha\e  permitted  the  employment 
of  the  patient  for  a  considerable  period 
upon  work  which  was  suitable.  Instead, 
disability  occurs  and  expense  begins.  It 
is  admitted  that,  in  the  last  analysis,  the 
function  of  the  industrial  physician  is  to 
lessen  production  costs  due  to  illness  by 
prompt  analysis  and  treatment  of  both 
major  and  minor  ills.  That  this  end 
may  be  ser\ed,  information  based  upon 
special  cases  has  been  compiled  as  to  the 
general  nature  of  the  disease,  and  as  to 
special  characteristics  brought  forward 
bv  the  cases  under  observation. 


♦Received  for  publication  Dec.  1,  1921. 


Etiology 

Infectious  arthritis  is  an  inflamma- 
tion of  a  joint  caused  by  the  presence  of 
bacteria  or  their  toxins.  Localization  in 
the  spine  is,  of  course,  subject  to  the 
same  causes  which  produce  the  disease 
elsewhere.  Lessened  local  and  general 
resistance  promote  the  activity  of  the 
bacteria  and  affect  the  progress  through 
the  various  stages  of  the  disease.  A  guide 
to  the  focus  of  infection  may  be  tonsillar 
inflammations,  past  or  present,  the  con- 
dition of  the  teeth,  or  the  symptoms  of  a 
discharging  sinus.  The  condition  of  the 
prostate,  the  seminal  vesicles,  and  the 
gallbladder  should  be  investigated. 
There  is  also  the  contributing  factor  of 
defective  assimilation  resulting  in  the 
absorption  of  toxins  from  the  large  in- 
testine. The  X-ray  is  invaluable  in  de- 
tecting the  source  of  infection. 

Pathology 

The  pathology  of  infectious  arthritis 
of  the  spine  may  be  classified  into  three 
stages,  the  progress  from  one  to  the 
other  depending  upon  the  severity  of  the 
disease  and  the  physical  resistance  of  the 
patient.  The  first  stage,  which  is  pres- 
ent in  the  milder  cases,  consists  of  a 
slight  inflammation  of  the  synovial 
membrane  within  the  joint.  In  the  more 
se\ere  cases,  erosion  of  the  interverte- 
bral disk  occurs,  and  in  the  most  seri- 
ous cases  there  is  destruction  of  the  ver- 
tebra itself.  In  determining  the  pathol- 
ogy of  the  disease,  the  X-ray  is  of  great 
importance.  By  proper  control  of  the 
development  of  the  negative,  lesions  in 


339 


340 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


the  soft  parts  may  be  discerned  and  the 
stage  of  destruction  or  erosion  of  the 
cartilages  in  the  affected  area  can  be  de- 
termined. 

Clinical  Course 

Cases  of  infectious  arthritis  of  the 
spine  are  revealed  chiefly  by  routine  ex- 
amination or  by  an  industrial  accident. 
The  onset  is  usually  acute,  and  patients 
report  that  prior  to  an  act  of  overexer- 
tion they  were  in  good  health.  Accom- 
panying the  strain  is  intense  pain  as  the 
muscles  which  have  been  serving  as  a 
support  assume  a  state  of  tonic  contrac- 
tion to  prevent  further  irritation  or  in- 
jury. Rigidity,  the  military  or  poker 
back,  quickly  develops,  and  any  move- 
ment occasions  a  considerable  amount 
of  pain.  It  is  apparent  at  once  that  the 
physician  is  confronted  by  a  serious 
problem  and  he  is  handicapped  unless 
there  has  been  physical  examination  or 
history  of  disease  or  injury  referable  to 
the  spine. 

Treatment 

The  purpose  of  treatment  is  to  eradi- 
cate the  source  of  the  disease  and  to 
apply  support  and  corrective  measures 
to  the  diseased  area.  Examination  is 
made  for  all  possible  foci  of  infection, 
and  where\'er  any  focus  is  found  reme- 
dial measures  are  administered.  A  plas- 
ter jacket  so  designed  that  the  muscular 
support  will  be  relieved  is  applied  at 
once.  When  it  becomes  ob\'ious  that 
the  disease  is  in  a  quiescent  state,  the 
patient  may  be  equipped  with  a  spring 
back  brace  and  permitted  to  return  to 
employment. 

Report  of  Cases 

The  cases  of  infectious  arthritis  of  the 
spine  to  be  presented  have  been  selected 
as  representative  of  the  characteristics 
of  the  disease.  They  illustrate  the  exten- 


sive cost  of  this  sort  of  disability  and  the 
almost  certain  resulting  incapacity  for 
ordinary  forms  of  employment.  Cases  of 
this  type  are  of  serious  concern  to  the 
industrial  physician  because  he  bears  a 
responsibility  to  his  employer  in  the  con- 
trol of  the  physical  well-being  of  the  op- 
erating force  which  should  result  in  the 
prevention  of  excessive  disability  costs. 
From  the  purely  professional  point  of 
view,  the  disease  is  of  especial  interest 
because  in  the  early  stages  when  it  is 
most  amenable  to  treatment  there  are 
few,  if  any,  symptoms.  An  accurate  di- 
agnosis is  complete  only  when  the  clini- 
cal diagnosis  is  corroborated  by  the 
X-ray.  The  \alue  of  information  relat- 
ing to  infectious  arthritis  of  the  spine 
from  the  standpoint  of  the  employer  and 
employee  is  self-evident. 

In  outline,  therefore,  the  importance 
of  the  aff"ection  to  those  involved  appears 
as  follows : 

1.  To  Employer: 

(a)  Effect  on  premium  rate 

( b )  Cost  of  treatment  and  management 
of  ease 

(c)  Production  delays  by  absence  of 
employee 

2.  To  Employee: 

(a)  Long  disability 

(b)  Great  suffering 

(c)  Loss  of  wages 

3.  To  Physician: 

(a)  Difficulty  of  diagnosis 

(b)  Difficulty  of  treatment 

(c)  Responsibilitj'  to  employer  and  em- 
ployee 

The  points  thus  shown  are  exhibited 
in  the  cases  which  follow. 

Case  1. — S.  T?.,  a  Greek  workman,  aged  35. 

History.— On  November  28,  1917.  S.  B.,  a 
Greek  of  relatively  sturdy  physique,  being  5 
feet  2  inches  tall  and  weighing  123  pounds, 
suffered  a  back  strain  while  in  the  act  of  push- 
ing an  industrial  truck.  The  extra  exertion 
required  to  move  the  truck  over  a  doorsill  oc- 
casioned the  strain.  T'pon  examination  when 
he  was  hired,  this  man  was  considered  physi- 
cally capable  of  performing  the  work  to  which 
he  was  assigned. 


CURRAN    AND     FOSTER^ARTHRITIS  OF  THE  SPINE      341 


After  receiving  treatment  he  resumed  regu- 
lar work  on  December  3,  1917,  and  continued 
until  December  17,  1917,  when  he  was  com- 
pelled to  stop  work  because  of  the  severe  pain 
in  his  back.  During  this  period,  daily  calls 
were  made  at  the  company  hospital 'where 
local  treatment  was  given. 

Complete  disability  continued  \intil  April 
3,  1918,  when  the  patient  returned  to  worli  as 
elevator  operatoi-,  a  task  which  required  little 
e.xertion.  Excessive  pains  in  the  back  caused 
him  to  stop  this  work  April  11,  1918.  lie  re- 
mained idle  until  May  8,  1918,  on  which  date 
he  was  again  placed  in  the  ])osition  of  operator 
of  an  elevator  e(iuii)pe(l  with  automatic  gates 
and  electrically  propelled.  A  minimum  of  ef- 
fort was  therefore  re(iuii-ed.  He  was  forced 
to  stop  this  work  on  July  '_',  1918,  and  up  to 
the  date  of  writing  has  not  been  employed. 

Physical  Examhmtion. — At  the  time  this 
man  was  hired  there  was  no  marked  evidence 
of  ])hysicai  weakness.  Slightly  defective  vision 
in  one  eye,  moderate  rigid  septal  deviation, 
teeth  fair  but  neglected,  first  degree  herniae, 
were  the  oidy  defects  recorded.  .Shortly  after 
the  injury  there  was  tenderness  in  the  lumbar 
region  and  motions  in  all  directions  were 
markedly  limited  and  painful.  The  patient 
stood  with  distinct  list  to  the  right  and  there 
was  an  ai-ea  of  rigidity  involving  the  tenth 
dorsal  to  tlie  fiftli  luinl)ar  vertebrae. 

A'-/7///  K.nimiiKilion. — The  n<'giitive  sliowed 
evidence  of  hypertrophic  arthritis  involving 
all  the  dorsal  and  lumbar  vertebrae. 

Treatment. — In  the  early  stages,  sympto- 
matic relief  measures  were  apjilied,  consisting 
of  baking,  nuissage  and  strai)i)ing.  Tjater  a 
plaster  jacket  was  ai)])lied  an<l  worn  by  the 
patient  for  eight  weeks.  Permanent  eipiip- 
ment  in  the  form  of  a  steel  brace  was  then 
supplied  and  the  patient  when  last  ob.served 
was  still  dependent  ujion  its  use.  The  focus 
of  infection  seemed  to  lie  in  the  teeth  to  which 
remedial  measures  wei-e  aiii)lied.  The  patient 
was  also  given  general  tonic  treatment  as  his 
suffering  occasioned  much  lo.ss  of  weight  and 
strength. 

Results. — From  the  day  of  the  accident 
until  the  present  writing  the  cost  of  this  dis- 
ability has  been  approximately  $2,200,  and  in 
all  probability  the  full  legal  amount  of  $4,000 
will  be  expended.  In  addition,  the  Associated 
Charities  have  rendered  considerable  financial 
support.  The  patient  has  suffered  eomjilete 
incapacity  for  all  ordinary  forms  of  work  and 
will  be  a  constant  hazard  to  him.self  and  to  his 
employer  in  even  the  milder  types  of  labor. 


33. 


L 


Case  2. — C.  B.,  an  Italian  workman,  aged 


History. — C.  B.,  an  Italian  with  the  average 
physical  development  of  men  of  this  race,  5 
feet  4  inches  in  height  and  weighing  140 
pounds,  wrenched  his  back  while  delivering 
coal  on  October  ,5,  1920.  His  routine  occupa- 
tion was  that  of  trucker,  at  which  he  had  been 
employed  for  two  years,  aiul  it  was  in  the 
course  of  his  regular  work,  as  he  was  emjitying 
a  100-i)ound  bag  of  coal  through  a  window  in 
a  shed,  that  he  experienced  severe  pain  in  the 
lumbar  region. 

The  patient,  although  suffering  considerable 
pain,  was  able  to  continue  w(n-k  that  day.  The 
pain  became  more  severe,  however,  and  medi- 
cal attention  was  sought.  Treatment  for  back 
disorder  was  administered  l)ut  up  to  the  pres- 
ent time  the  patient  has  been  forced  to  remain 
idle. 

Physical  Examination.  —  The  patient  ap- 
peared fairly  well  developed  and  nourished, 
and  showed  no  i)eculiarity  aside  from  the 
condition  of  his  s])ine.  There  was  a  marked 
list  to  the  left  in  his  jiosture,  together  with  evi- 
dence of  lower  dorsal  and  lumbar  left  scolio- 
sis. Motion  was  restricted  to  about  half  nor- 
mal in  all  directions,  and  there  was  no  appre- 
ciable backward  movement  below  the  tenth 
dorsal  vertebra. 

X-ray  Examination.  —  X-ray  examination 
was  conducted  by  three  different  ]>hysicians. 
in  the  views  furiiislied  by  two  of  ihest-  jjhysi- 
c'M'is.  tlicre  a])])eared  left  lumbar  scoliosis, 
while  the  negatives  from  the  third  presented 
both  scoliosis  and  infectious  arthritis  of  the 
second  lumbar  vertebra  manifested  by  consid- 
erable destruction  of  the  body. 

Treatment. — The  usual  measures  for  relief 
— namely,  strapjiing,  massage  and  baking — 
were  administered  but  the  patient  continued 
to  suffer  severe  pain.  A  plaster  cast  was  then 
applied  and  allowed  to  remain  in  place  six 
weeks.  At  the  expiration  of  this  time,  a  .spring 
brace  was  provided  for  permanent  use.  The 
focus  of  infection  could  not  be  located,  and  the 
l)atient  denied  ever  having  suffered  venereal 
disease. 

Results. — Since  the  day  of  the  accident,  no 
work  of  any  de.scriptioi^  has  been  performed 
by  the  patient.  In  all  likelihood,  this  is  a  case 
of  jiermanent  disability  and  will  entail  a  con- 
siderable sum  for  settlement.  Already  $1,200 
has  been  expended  for  comjiensation  and  med- 
ical care. 

Case  3. — F.  W.,  an  Irish  workman,  aged  19. 

History.—On  August  13,  1919,  F.  W.,  a 
strong,  well-built  man,  strained  his  back  in 
lifting  rods  of  iron  from  a  truck  to  an  ele- 
vator, an  act  which  was  in  the  course  of  his 
routine  occupation.     He  continued  to   work 


342 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


for  two  weeks,  then  he  was  forced  to  discon- 
tinue by  reason  of  the  severe  pains  in  his 
back. 

Remedial  measures  were  applied  and  the  pa- 
tient returned  to  work  in  March,  1920,  but 
was  only  able  to  contimie  for  two  weeks.  Since 
that  date  he  has  remained  incapacitated  for 
ordinary  forms  of  labor. 

Physical  Examination.  —  The  patient  pre- 
sented a  large,  over-developed  condition  in  re- 
lation to  his  age,  being  17  years  old  and  weigh- 
ing 170  pounds.  On  general  examination,  no 
peculiarities  were  observed  except  that  the 
teeth  were  irregular  and  neglected  and  hallux 
valgus  was  present  on  each  foot. 

The  patient  stood  very  erect  and  the  natural 
lumbar  curvature  was  absent.  The  legs  were 
equal  in  size  by  actual  measurement,  but  there 
was  considerable  stiffness  in  the  right  hip. 
Motion  was  restricted  in  all  directions,  there 
being  practicality  no  movement  in  the  lumbar 
region,  while  a  slight  flexion  was  possible  in 
the  dorsal  region.  Lateral  motion  to  the  left 
appeared  more  painful  than  to  the  right. 

X-ray  Examination. — Negatives  gave  evi- 
dence of  chronic  arthritis  involving  particular- 
ly the  fifth  lumbar  vertebra.  The  transverse 
process  of  the  vertebra  had  been  destroyed. 

Treatment. — The  patient  was  strapped  but 
no  relief  was  afforded.  A  plaster  cast  was 
then  applied  and  worn  by  the  patient  for  four 
months.  He  was  then  fitted  with  a  spring 
brace  which  has  become  of  daily  necessity.  No 
focus  of  infection  could  be  isolated. 

Results. — The  patient  has  remained  up  to 
the  present  time  incapacitated  for  all  foi-ms 
of  ordinary  work  and  has  been  receiving  $16 
per  week  compensation,  which  has  amounted 
to  approximately  $1,700.  It  is  expected  that 
a  lump  sum  settlement  will  be  advanced.  The 
patient,  however,  will  always  be  a  dangerous 
risk  both  to  himself  and  to  his  employer. 

Summary 

These  cases  illustrate  the  need  of  par- 
ticular care  by  industrial  physicians  in 
examining  the  backs  of  all  employees. 
Infectious  arthritis  of  the  spine  is  ex- 
ceedingly expensive  both  to  the  em- 
ployer and  to  the  employee,  and  is  a  baf- 
fling problem  to  the  industrial  phy- 
sician. 

Many  times,  trivial  accidents  involv- 
ing the  back  are  treated  as  muscular 
strains,  which  would  be  the  natural  di- 


agnosis from  superficial  examination. 
In  order  to  arrest  early  the  more  serious 
disorder  of  infectious  arthritis  it  is  good 
practice  to  X-ray  all  cases  where  there 
is  the  least  suspicion.  It  is  possible  that 
the  X-ray  may  be  negative  even  though 
the  patient  exhibits  the  unmistakable 
signs  of  local  tenderness  and  rigidity. 
Reliance  upon  the  X-ray  in  the  majority 
of  cases,  therefore,  demands  positive  evi- 
dence. 

Prompt  detection  is  of  assistance  in 
locating  an}-  foci  of  infe^ction,  as  it  per- 
mits the  application  of  corrective  meas- 
ures which  will  improve  the  patient's 
general  condition. 

From  every  angle,  the  desirability  of 
better  control  of  infectious  arthritis  of 
the  spine  is  manifest.  Upon  the  physical 
examination  at  the  time  of  hiring  work- 
men rests  the  responsibility  for  the  ex- 
clusion from  employment  of  serious 
risks  of  this  nature.  Particular  attention 
must,  therefore,  be  directed  to  the  con- 
dition of  the  joints  ;  flexion  of  the  trunk 
and  limbs  must  be  required,  and  other 
tests  must  be  applied  to  bring  out  any 
signs  of  infectious  arthritis.  When  there 
is  reason  for  suspicion,  examination 
should  be  carried  further  by  means  of 
the  X-ray. 

The  duty  of  the  industrial  physician, 
in  a  word,  requires  : 

1.  Alore  attention  to  the  condition  of 
the  joints  at  the  time  of  entrance  exam- 
ination ; 

2.  Prompt  and  exhaustive  analysis 
of  back  strain  to  detect  immediately 
cases  of  infectious  arthritis ; 

3.  Prompt  treatment  to  the  focus  of 
infection  in  an  endeavor  to  eradicate  it, 
and  adequate  treatment  to  the  diseased 
area. 

The  effects  of  this  disease  are  suffi- 
cient to  warrant  these  precautions. 


SOME  OBSERVATIONS  ON  THE  EPINEPHRIN  HYDROCHLORIDE 
TEST  (GOETSCHTEST)  IN  A  GROUP  OF  NORMAL  INDIVIDUALS* 

William  P.  Van  Wagenen 


TO  Dr.  Emil  Goetsch  we  are  indebted 
for  the  correlation  and  practical 
application  of  the  physiological  obser- 
vations of  Oswald  (1)  and  Lev>'  (2)  that 
an  increase  in  the  active  principle  of  the 
thyroid  gland  enhances  the  pressor  ac- 
tion of  epinephrin.  The  principle  of  the 
original  observations  of  this  writer  has 
been  substantiated  many  times.  From 
time  to  time,  however,  there  have  been 
reported  variations  in  the  percentage  of 
positivity  of  this  test  in  cases  of  clinical 
hyperthyroidism.  The  doubts  of  Dr. 
Martin  B.  Tinker,  of  Ithaca,  New  York, 
regarding  the  validity  of  the  obser^  ation 
that  all  cases  of  clinical  hyperthyroidism 
give  a  positive  epinephrin  hydrochloride 
test — very  severe  and  long  standing 
cases  excepted — led  me  to  undertake  to 
verify  this  observation  on  some  sixty  of 
his  cases  of  hyperthyroidism,  clinically 
so  diagnosed,  in  the  Ithaca  City  Hospi- 
tal. There  were  two  cases  which,  to  the 
best  of  my  interpretation,  gave  a  nega- 
tive result  with  this  test.  Reference  to 
six  similar  cases  of  Peabody's  will  be 
made  later.  In  the  same  series  there 
were  four  cases  concerning  which  there 
was  a  good  deal  of  doubt  as  to  the  diag- 
nosis of  hyperthyroidism.  History, 
physical  findings,  and  the  therapeutic 
test  of  rest  in  bed  were  all  negative ;  un- 
fortunately, basal  metabolism  deter- 
minations could  not  be  obtained.  The 
epinephrin  hydrochloride  test,  however, 
was  positive. 

An    experience  of    this   sort  is    not 
unique.    Woodbury  (3)  reports  eleven 

patients  who  reacted  positi\'ely  to  the 
! 

^Keceived  for  publication  Dec.  2.  1921. 

343 


epinephrin  hydrochloride  test  but  who 
had  basal  metabolisms  considered  to  be 
within  normal  limits.  They  did  not 
show  any  impro\ement  of  clinical  symp- 
toms on  rest.  The  histories  and  clinical 
symptoms,  however,  were  typical  of  hy- 
perthyroidism and  the  cases  were  diag- 
nosed as  hyperthyroidism,  in  spite  of 
normal  basal  metabolisms  and  the  result 
of  rest,  because  of  the  clinical  pictures 
and  histories,  the  histological  examina- 
tion of  the  glands  and  the  post-operative 
results.  While  the  diagnosis  in  Wood- 
bury's cases  is  doubtless  correct  because 
of  the  recent  increase  in  the  size  of  the 
goiter,  the  nervousness,  tremor,  dysp- 
nea, palpitation,  and  loss  of  strength,  I 
question  a  diagnosis  of  hyperthyroidism 
on  the  basis  of  an  increase  in  the  height 
and  size  of  active  cells,  with  infolding  of 
walls  of  the  acini  and  a  decrease  of  col- 
loid. Goetsch  (4)  states  that  in  about 
20  per  cent,  of  a  series  of  his  cases  diag- 
nosed as  hyperthyroidism  the  patholo- 
gist failed  to  associate  the  histological 
findings  with  the  clinical  course  of  the 
disease.  Likewise,  a  post-operative  con- 
dition at  a  period  of  from  six  weeks  to 
eight  months  after  operation  is  not  nec- 
essarily the  final  condition.  A  year  is 
probably  none  too  short  a  time  in  which 
to  judge  the  lasting  results  of  many 
cases  of  hyperthyroidism  that  come  to 
operation. 

Such  observations  as  these  of  Wood- 
bury's and  my  own  led  me  to  speculate 
on  what  percentage  of  normal  individu- 
als would  react  to  the  epinephrin  hydro- 
chloride test.  Normal  subjects  for 
study  with  the  Goetsch  test  were  se- 
lected from    Cornell    Universitv  Sum- 


344 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


mer  School  students  in  the  Department 
of  Physical  Education.  A  careful  his- 
tory was  obtained  from  each  student  as 
to  the  possible  existence  of  symptoms 
that  a  borderline  hyperthyroid  patient 
might  show,  fatigability,  weakness, 
tachycardia,  nervousness,  loss  of  weight, 
etc.,  and  the  records  of  physical  exam- 
inations of  these  students  were  consult- 
ed. A  more  physically  fit,  more 
symptomless  group  could  not  ha\-e  been 
desired.  So  far  as  gross  inspection 
showed,  there  were  no  cases  of  chorea, 
asthma,  epilepsy,  diabetes  or  dementia 
praecox  which  might  account  for  a  posi- 
tive epinephrin  hydrochloride  reaction 
— an  occasional  occurrence,  according 
to  Peabody  and  his  associates  (5),  in 
these  conditions.  Goetsch  (6)  adds  to 
this  list  neurocirculatory  asthenia.  The 
differentiation  of  neurocirculatory  as- 
thenia from  hyperthyroid  states  he 
makes  on  a  family  history  of  nervous 
instability  and  a  slow  gradual  onset  of 
symptoms,  usually  dating  back  before 
puberty,  which  the  patient  does  not 
know  he  possesses.  There  was  likewise 
no  history  of  symptoms  among  this 
group  that  led  me  to  suspect  such  a  con- 
dition existed.  A  basis  of  this  sort  for 
ruling  out  neurocirculatory  asthenia  is 
obviously  open  to  question. 

In  doing  the  tests,  patients  were  re- 
quired to  lie  quietly  until  the  pulse  rate, 
blood  pressure  reading  and  respirations 
were  constant  for  at  least  fifteen  min- 
utes. Parke,  Da\is  adrenalin  hydro- 
chloride was  used.  The  potency  of  the 
drug  was  determined  by  injecting  it  in- 
travenously into  a  cat  and  recording  the 
blood  pressure  changes  in  the  carotid 
artery;  also  by  using  the  sample  on 
known  hyperthyroid  patients  with  posi- 
tive results.  As  soon  as  the  patient  was 
quiet  and  accustomed  to  his  environ- 
ment, an  injection  of  0.5  c.c.  of  adrena- 
lin hydrochloride  was  given  in  the  del- 


toid region.  In  fat  individuals  care  was- 
taken  to  make  the  injection  as  super- 
ficial as  possible,  since  injection  into  the 
fat  tended  to  obscure  the  local  reaction 
or  retard  its  appearance.  Blood  pres- 
sure readings  were  taken  from  the  other 
arm  every  five  minutes  for  one  hour,  to- 
gether with  pulse  and  respiration  rates. 
Respiration  varied  so  little  that  it  is  not 
included  in  the  curves  of  other  data. 

The  question  of  interpretation  of  re- 
sults at  once  presents  itself.  Goetsch  (4) 
considers  a  positive  reaction  to  consist 
of  a  rise  in  pulse  rate  of  at  least  ten  beats 
per  minute,  and  a  rise  in  blood  pres- 
sure of  from  10-50  mm.  Hg,  together 
with  a  train  of  general  symptoms  and  a 
local  reaction  to  the  drug.  The  general 
symptoms,  as  I  found  them,  are  in  part 
objective,  and  in  part  subjective — i.e., 
tremor  of  the  platysma  group  of  mus- 
cles of  the  hands  and  lower  extremities, 
lachrj-mation,  pallor  of  the  mucous 
membranes  and  face,  a  feeling  of  weak- 
ness, tiredness,  drowsiness,  palpitation 
of  the  heart,  throbbing  of  the  aorta  and 
neck  and  head  vessels,  a  sense  of  con- 
striction of  the  chest,  white  specks  be- 
fore the  eyes  and  sometimes  blurring  of 
\ision,  and  occasionally  diuresis  and 
urgency.  When  positive,  Goetsch  (7) 
considers  such  results  to  be  practically 
diagnostic  of  hyperthyroidism.  To  quote 
from  him: 

My  epinephrhie  test  depends  upon  the  fact 
that  in  an  orpranism  in  which  there  is  an  over- 
amount  of  thyroid  secretion  present  the  sym- 
pathetic nervous  system  is  sensitized  to  the  ac- 
tion of  epine])hrinc,  and  I  have  found  after  a 
study  of  over  six  hundred  cases  of  thyroid 
disease  that  in  clinical  states  of  hyperthyroid- 
ism the  patient  reacts  positively  to  the  sub- 
cutaneous injection  of  0.5  c.c.  of  one  in  one 
thousand  adrenalin  chloride  solution,  a  dose 
to  which  a  normal  individual  does  not  react. 

From  a  practical  point  of  view, 
Goetsch  considers  the  test  of  consider- 
able value: 


AAX  WAGENEN— EPINEPHRIN  HYDROCHLORIDE  TEST    345 


A  positive  test  has  helped  me  in  determin- 
ing whether  the  case  is  truly  hyperthyroid  and 
whether  thyroidectomy  should  be  done,  or 
whether  continuance  of  medical  measures 
should  be  advised,  and  it  is  this  positive  test 
which  has  helped  me  so  much  in  the  fourth 
group,  which  I  have  termed  diffuse  adenoma- 
tosis and  which  before  had  been  so  baffling.  I 
have  advised  operation  also  in  the  adenoma 
group  in  which  the  adenomata  were  too  small 
to  be  seen  or  felt  before  operation 
and  have  had  splendid  results  from  resection 
as  has  been  shown  in  the  post-operative  study 
of  these  cases. 

Goetsch  (7)  claims  further  that  a  neg- 
ative test  excludes  hyperthyroidism  ex- 
cept in  a  few  very  severe  cases. 

Peabody,  Sturgis,  Tompkins,  and 
Wearn  (5)  make  the  pertinent  sugges- 
tion that  "a  theoretically  'positi\-e'  reac- 
tion might  indicate  hyperacti\'ity  of  the 
thyroid  gland,  of  the  adrenal  glands  or 
of  the  sympathetic  nervous  system.  It 
might,  on  the  other  hand,  depend  on  a 
lowered  threshold  of  response  of  the 
sympathetic  nervous  system.  With  the 
exception  of  hyperthyroidism  little  is 
known  of  these  conditions  in  man,  but 
they  probably  occur  and  there  would 
seem  to  be  no  reason  for  assuming  that 
a  'positive'  epinephrin  reaction  is  con- 
stantly associated  with  hyperthyroid- 
ism." Their  observations  in  instances 
of  this  will  be  referred  to  again  later. 

In  interpreting  my  own  results  I  have 
not  considered  as  positive  a  test  that  did 
not  show  a  rise  in  blood  pressure  and 
pulse  rate  of  at  least  fifteen  points,  to- 
gether with  well-marked  general  symp- 
toms. My  experience  with  the  local  re- 
action in  cases  of  known  hyperthyroid- 
ism \aries.  In  a  positive  local  reaction 
there  is  a  blanching  of  the  skin  over  the 
epinephrin  injection  in  about  five  to  fif- 
teen minutes,  which  persists  from  sixty 
to  ninety  minutes  or  longer.  The 
blanched  area  is  surrounded  by  a  nar- 
row zone  of  purple,  or  red  or  blue,  pre- 
sumably due  to  venous  dilation.    This 


outer  zone  varies  a  good  deal  in  color 
from  individual  to  individual  and  also 
in  the  same  person.  I  am  inclined  to  be- 
lieve that  a  changeability  of  color  of  this 
outer  zone  is  seen  in  the  majority  of 
cases  of  true  hyperthyroidism,  and  is 
occasionally  seen  in  normal  cases  giving 
positive  tests. 

In  the  fifty  cases  composing  this  series 
there  were  ten  positive  reactions,  or  20 
per  cent.  The  criterion  of  a  positive  test, 
as  mentioned  previously,  was  the  change 
in  blood  pressure,  pulse  rate  and  general 
symptoms,  and  the  local  reaction.  The 
average  blood  pressure  and  pulse 
changes  were  as  follows : 

a.  The  average  maximum  blood  pres- 
sure rise  for  the  ten  positive  cases  was 
16  mm.  (Fig.  1)  ;  for  the  forty  negative 
cases,  9  mm.  (Fig.  2)  ;  for  the  combined 
group,  10  mm.  (Fi^.  3). 

14S 
140 
135 

130  U 
12S 
110 
105 
100 
95 
90 
85 

80 

__     

Fig.  1. — Composite  curves  of  ten  positive  reac- 
tions to  the  epiiiepliriu  hydrochloride  test  among  a 
series  of  fifty  nonnals.  Oidinates  in  tliose  figures 
rel>rosi>nt  iiiillinieters  of  mercury  for  lilood  pres- 
sure iind  pulse  lieats  per  minute.  Abscissas  repre- 
sent miniUes. 

h.  The  average  maximum  pulse  rate 
rise  for  the  ten  positive  cases  was  25 
beats  per  minute  (Fig.  1)  ;  for  the  forty 
negative  cases,  13  beats  per  minute 
(Fig.  2)  ;  for  the  fifty  cases  (combined), 
16  beats  per  minute  (Fig.  3). 

Inspection  of  the  figures  shows  that 


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r 

^,  _ 

' 

PULSE 

RATE 

- 

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*^ 

^ 

'"* 

**le 

— 

V 

/ 

' 

/ 

t 

1 

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1     1 

1 

# 

0    ' 

\  1 

0  1 

52 

02 

5  3 

0  3 

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04 

55 

05 

5G 

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346 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


the  maximum  and  minimum  blood  pres- 
sure rises  were,  for  the  positive  cases,  38 
mm.  Hg  and  12  mm.  Hg  in  Cases  22  and 
25,  respectively.  The  pulse  rate  curves 
show  a  maximum  and  minimum  rise, 
for  positive  reactions,  of  68  beats  per 
minute  and  26  beats  per  minute  in  Cases 
18  and  32,  respectively.  In  the  forty 
negative  cases  the  minimum  rise  was 
5  mm.  Hg  in  Cases  5,  6,  24,  and  31 ;  the 
maximum  rise,  40  mm.  Hg  in  Case  3. 
The  minimum  pulse  rate  rises  were  5  in 
Case  16,  and  38  in  Case  25. 

An  instructive  fact  to  note  is  that  the 
starting  point  in  blood  pressure  readings 
and  also  in  pulse  rate  for  both  positive 
and  negative  cases  was  essentially  the 
same,  i.e.,  127  mm.  Hg  in  positive  cases  ; 
121  mm.  Hg  in  negative  cases;  81  beats 
per  minute  in  positive  cases;  80  beats 
per  minute  in  negative  cases.  It  cannot, 
therefore,  be  assumed  that  the  positive 
cases  primarily  had  tachycardia  with 
heightened  blood  pressure  as  they  might 
have  in  hyperthyroidism,  either  obscure 
or  evident  on  clinical  examination. 


of  these  curves  are  essentially  typical  of 
the  curve  seen  in  animal  experimenta- 
tion when  epinephrin  is  injected  intra- 
venously. The  difference  is  quantitative 

only. 

An  admitted  fault  in  the  procedure 
is  the  failure  to  continue  observations  on 
each  case  for  at  least  two  hours,  instead 
of  one  hour.    It  is  instructive,  however, 


0     5    10  15  20  2S  30  35  40  45  50  55  b6 


Fig.  2.— Composite  cvirves  of  forty  negative  re- 
actions to  the  epinephrin  liydroclilorifle  test. 

Inspection  of  Figures  1  and  2  shows 
that  the  first  maximum  blood  pressure 
rise  in  both  positive  and  negative  cases 
occurred  approximately  at  the  fifteen 
minute  period.  Likewise  the  secondary 
rises  occurred  together — at  the  thirty- 
five  to  forty-five  minute  periods.    Both 


5   10  15  20  25  30  35  40  45  50  55  60 


Fig.  3.— Composite  curves  of  fifty  reactions  to  the 
epinephrin  hydrochloride  test. 

to  note  that  the  curve  of  blood  pressure 
readings  is  as  nearly  back  to  normal  in 
the  positive  cases  at  the  end  of  an  hour 
as  in  the  negative  cases.  Had  the  curves 
of  the  two  groups  differed  essentially  in 
type,  one  might  not  expect  this  to  be  the 
case. 

The  pulse  rate  cur\-es  offer  more  diffi- 
culty of  interpretation.  In  general,  it 
may  be  said  that  in  the  positive  cases  the 
pulse  rate  rose  to  a  maximum,  or  nearly 
so,  in  ten  minutes,  and  was  sustained  at 
that  level,  with  slight  fluctuations,  for 
the  entire  hour,  having  fallen  but  6 
points  from  the  maximum  in  the  sixty 
minutes.  In  the  negative  cases  the  pulse 
rate  was  more  nearly  back  to  normal,  J 
i.  e.,  within  8  points  of  the  original. 
Figure  3  was  made  to  show  that  the 
whole  series  of  cases  taken  together — 
positive  cases  plus  negative  cases — gives 
a  curve  essentially  of  the  same  type  as 
those  shown  in  Figures  1  and  2,  and 
similar  to  the  curve  of  cases  of  known 
hyperthyroid  reaction. 


VAN  WAGENEN— EPIXEPHRIX  HYDROCHLORIDE  TEST    347 


If  one  cannot  combine  pulse  rate  and 
blood  pressure  findings  with  general 
symptoms,  I  believe  that  the  general 
symptoms  are  more  valuable  in  deter- 
mining a  reaction.  Tremulousness,  be- 
ginning in  the  platysma  group  of  mus- 
cles and  also  present  in  the  hands  and 
lower  extremities,  was  the  most  constant 
symptom  in  my  series,  being  present  in 
all  ten  of  the  positi\e  cases.  A  feeling 
of  general  weakness  and  tiredness  was 
next  in  order  of  constancy,  being  absent 
in  only  one  case.  Seven  patients  com- 
plained of  bladder  urgency.  There  is, 
throbbing  in  the  vessels  of  the  head, 
neck  and  aorta.  Lachrymation  was 
present  in  three  cases.  One  patient  com- 
plained of  bladder  urgency.  There  is, 
of  course,  no  means  of  quantitating  gen- 
eral symptoms,  especially  subjective 
symptoms,  except  by  their  duration.  In 
general,  the  positive  cases  gave  symp- 
toms lasting  from  thirty  minutes  to 
forty-eight  hours — one  case  each — with 
an  average  of  two  hours.  The  negative 
cases,  on  the  average,  gave  symptoms 
lasting  from  ten  to  thirty  minutes.  The 
severity  of  the  general  symptoms  in  neg- 
ative cases,  where  any  occurred,  was  al- 
ways less  than  in  the  positive  cases. 

The  local  reaction  was  a  distinct  posi- 
tive in  four  of  the  positive  cases  and  in 
four  of  the  negative  cases ;  the  blanch- 
ing of  the  overlying  skin  occurred  al- 
most at  once,  the  contraction  of  the 
erector  pili  muscles  was  prolonged  over 
one  hour  and  the  peripheral  zone  of  col- 
ors was  variable,  such  as  is  seen  many 
times  in  known  hyperthyroid  reactions. 
This  feature  of  the  test  was  the  least 
satisfactory  of  any.  With  little  subcu- 
taneous fat  and  a  coarse  skin  it  works 
very  well,  but  where  the  epinephrin  is 
injected  into  the  fat  the  results  are  more 
variable. 

From  the  foregoing  observations,  ad- 


mittedly small  in  number  but  done  with 
great  care,  I  am  forced  to  express  doubt 
regarding  the  diagnostic  value  of  a  test 
for  hyperthyroidism  in  a  "borderline 
case" — a  test  which  is  positi\-e  in  20  per 
cent,  of  a  group  of  well,  health}',  active, 
physical  education  students  free  from 
hyperthyroidism  so  far  as  history,  symp- 
toms and  observation  could  determine; 
likewise  free  from  psychoneuroses,  neu- 
rasthenia, hysteria,  and  melancholia. 

Peabody,  Sturgis,  Tompkins  and 
Wearn  (5),  working  among  soldiers  in 
camp,  likewise  present  evidence  which 
varies  with  the  statement  that  no  cases 
of  hyperthyroidism  fail  to  give  a  posi- 
tive reaction,  very  se\^ere  and  long  stand- 
ing cases  excepted.  In  a  series  of  twenty- 
one  cases  diagnosed  as  hyperthyroidism 
on  the  classic  signs,  symptoms  and  his- 
tory, together  with  the  determination  of 
the  basal  metabolism,  "six  unquestion- 
able cases,  four  in  early  stages  and  two 
in  later  stages  with  basal  metabolism 
ranging  between  21  and  35  per  cent, 
above  normal,  gave  negative  reactions." 
Two  such  cases  I  m}'self  have  observed 
and  have  already  referred  to.  Peabody 
and  his  collaborators  find  further  that 
persons  whom  they  consider  as  normal 
sometimes  react  positively  to  the  test. 
Fourteen  per  cent,  of  a  series  of  twenty- 
eight  medical  students  gave  positive  re- 
actions, and  17  per  cent,  of  a  series  of 
seventeen  cases  of  organic  heart  disease 
also  responded  positively  to  the  test. 
These  percentages  accord  fairly  well 
with  my  own.  Among  143  cases  of  "ef- 
fort syndrome"  also  studied  by  Peabody 
and  his  collaborators  48  per  cent,  re- 
acted to  the  test. 

Summary 

1.  In  determining  a  positive  reaction 
to  the  epinephrin  hydrochloride  test  the 


348 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


results  must  be  considered  as  a  whole, 
but  the  importance  of  the  findings  may 
be  grouped  in  the  following  order :  gen- 
eral objective  and  subjective  symptoms, 
pulse  rate  curve,  the  blood  pressure 
curve,  and,  lastly,  local  reaction. 

2.  The  curves  for  blood  pressure  are 
essentially  of  the  same  type  in  negative 
cases,  in  positive  cases  among  normal 
subjects,  and  in    known    hj^perthyroid 


cases,  differing  only  in  a  quantitative 
way.  The  general  symptoms,  likewise, 
differ  only  in  quantity  in  these  various 
types  of  cases. 

3.  The  20  per  cent,  of  this  series  of 
cases  which  reacted  positively  to  the  test 
make  it  seem  unlikely  that  the  test  can 
always  be  relied  upon  in  cases  where 
clinical  observation  is  unable  to  estab- 
lish a  diagnosis  of  hyperthyroidism. 


BIBLIOGRAPHY 


1.  Oswald,  A. :  Die  Beziehungen  der  Schilddriise 
zum  Bliitkreislanf  und  zu  de.ssen  Nervenap- 
parat.    Zentralbl.  f.  Phy.siol.,  1915,  30,  509. 

2.  Levy,  R.  L. :  Studies  on  the  Conditions  of  Ac- 
tivity in  Endocrine  Glands.  IV.  The  Effect  of 
Thyroid  Secretion  on  the  Pressor  Action  of 
Adrenin.    Am.  Jour.  Physiol..  1916.  ^/,  492. 

3.  Woodhury.  M.  S. :  A  Comparison  of  Methods 
for  Determining  Thyrotoxicosis.  Jour.  Am. 
Med.  Assn.,  1920,  7.',,  997. 

4.  Goetsch.  E. :  Newer  Methods  in  the  Diagnosis 
of  Thyroid  Disorders :  Pathological  and  Clini- 


cal. New  York  State  Jour.  Med.,  1918,  18,  259. 
Peabody.  F.  W..  Sturgis,  C.  C,  Tompkins,  E. 
M.,  and  Wearn,  J.  T. :  Epinephrin  Hypersensi- 
tiveness  and  its  Relation  to  Hyperthyroidism. 
Am.  Jour.  Med.  Sc,  1921.  161,  508. 
Goetsch,  E. :  Studies  on  Disorders  of  the  Thy- 
roid Gland.  Hypersensitiveness  Test  with  Es- 
pecial Reference  to  "Diffuse  Adenomatosis"  of 
the  Thyroid  Ghind.  Endocrinology,  1920.  -J.  .389. 
Goetsch,  E. :  The  Diagnosis  and  Treatment  of 
H.vperthyroidism.  New  Y'ork  Med.  Jour.,  1921, 
113,  378. 


LIGHTING  AND  VENTILATION  OF  FACTORIES,  HOURS  OF  LABOR 

AND  HEALTH* 

J.  S.  ITRDV,  U.S.O..  M.D.,  C.H.,  (Abehd.)  D.P.H..  (Cams.)  K.K.S.,  (Edix.) 
F.R.G.S.,  Methopolitax  M.O.H. 

Sydney,  Australia 


MY  experience  in  Tasmania  as  the 
first  f'liicf  Inspector  of  Factories  in 
Ilia  I  state  served  onl,\-  lo  eonfiriii  my  prt'\i- 
ous  experience  so  far  as  realizinj?  that  tlie 
average  emi)loyer  and  employee  are  hnt 
htlle  concerned  wilh  (juestions  of  health 
and  sanitation. 

I  foimd  that,  on  the  i)art  of  the  employer, 
there  was  nnich  concern  lest  the  introihic- 
tion  of  wages  hoards  and  the  jjayment  of 
wages  more  on  a  par  with  those  paid  on  the 
mainland  would  cripple  industry,  whereas, 
on  the  jjart  of  the  emi)loyee,  the  chief 
points  of  interest  were  the  securing  of 
better  wages  and  a  reduction  of  hours  of 
employment.  Time  and  again  it  was 
])oiuted  out — often,  unfortunalel\',  with 
truth —  that  attemjjts  to  improvt-  the 
conditions  imder  wliicli  men  and  women 
worki'd  in  factoi'ies  were  looked  u|)on  hy 
them  with  mistrust  or  were  actually  re- 
sented as  an  unwarranted  interference. 
One  would  find  that  ventilators  would  he 
blocked,  sanitary  conveniences  fouled,  and. 
geni'rally,  that  the  workers  were  content 
with  the  old  order,  or  disorder,  with  regard 
to  sanitation. 

The  War  has,  however,  allereil  the  out- 
look as  far  as  the  biggest  and  best  em- 
ployers are  concerned.  It  is  being  realized 
more  and  more  that  the  health  of  the 
worker  is  a  factor  of  vital  importance  in 
maintaining  energy,  without  which  out])ul 
readily  decreases.  To  maintain  health  man 
recpiires  fresh  air,  a  good  and  iilentifnl 
water   sn])ply,    sufficient   food    and   clotli- 


*  Ueai.l  before  tlie  .\iistr;ili;iii  .\ssiici:itii)ii  for  llie  Ail- 
vanccment  of  Science,  Jan.  Ki,  1"J-21.  Heceiveil  for  piilili- 
cation  April  12,  1921. 


ing,  adequate  shelter,  and,  above  all,  con- 
ditions of  cleanliness,  with  adequate  ])eriods 
for  e.xerci.se  and  recreation. 

Lighting 

In  recent  years  much  attention  has  been 
devoted  to  the  jirovision  of  proper  lighting 
in  factories.  Sunlight  is  not  only  essential 
to  the  maintenance  of  health,  but  is  the 
only  ])erfect  light.  Diffused  daylight  is, 
therefore,  always  to  be  recognized  as  the 
standard  light,  (icnerally  speaking,  how- 
ever, it  cannot  be  claimed  that  hitherto 
sufHcient  advantage  has  been  taken  to  se- 
cure I  lie  benefits  of  diffused  daylight  and, 
indeed,  the  dead  hand  of  the  ])ast  seems 
still  to  limit  window  sijace.  In  remote 
times,  before  the  discovery  of  glass,  and 
later  before  its  universal  use,  openings  for 
light  were  restricted,  while  in  still  later 
times  there  was  actually  a  window  tax, 
which  naturally  discouraged  the  pro\ision 
of  adef|nate  lighting. 

In  Australia,  as  is  true  in  most  of  the 
newer  countries,  we  have  followed  the  con- 
ventional styles  of  architecture  which  ob- 
tained in  Europe,  all  too  oblivious  as  to 
their  adaptability  or  suitability  to  the 
climate.  Any  departure  from  the  conven- 
tional or  traditional  stjdes  appears  up  to 
recent  times  to  have  been  regarded  with 
the  suspicion  of  either  being  eccentric  or 
not  complying  with  the  traditional  so- 
called  artistic  taste. 

^^'e  find  that  in  ordinary  dwellings  as 
well  as  in  factories  there  is  often  no  at- 
tempt to  adapt  W'indow  space  to  the  light- 
ing requirement  of  the  particular  room. 
One  sees  uniform  sized  windows   fixed   in 


349 


350 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


dwellings  where  exterior  obstructions  inter- 
fere with  the  natural  hghting,  just  as  in 
dwellings  where  there  are  no  obstructions. 
Moreover,  there  is  often  a  failure  to  rec- 
ognize the  fact  that  even  w^here  there 
are  no  obstructions,  the  aspect  and  conse- 
quent natural  hghting  possibilities  vary 
with  the  points  of  the  compass.  It  is  evi- 
dent that  the  fixed  rule  as  to  the  direct 
proportion  between  window  space  and 
floor  space,  such  as  l/lO  or  1/5,  should 
only  be  taken  as  a  minimum,  and  that 
such  important  factors  as  the  nature  of 
possible  exterior  obstruction,  position  of 
windows  (vertical  or  horizontal),  length 
and  width  of  room,  and  angle  of  incidence 
of  sunlight  must  be  given  due  considera- 
tion. Otherwise,  defective  lighting  will  in- 
evitably result. 

The  most  effective  natural  light  is  ob- 
tained from  a  high  window  with  splayed 
jambs,  extending  nearly  to  the  ceiling,  and 
situated  near  the  center  of  the  wall.  It  is 
impossible  to  get  too  much  natural  light, 
and  it  is  noticeable  that  this  fact  has  been 
recognized  by  the  leading  jewelry  firms  of 
Sydney,  whose  large  workrooms,  recently 
built,  have  practically  one  continuous  win- 
dow on  each  side.  The  best  lighting  effect 
in  factories,  especially  in  those  of  one 
story,  is  obtained  from  skylights,  provided 
the  roof  is  from  30  to  35  feet  high.  AVith 
roofs  less  high  the  glare  from  the  direct 
rays  of  the  sun  and  the  intense  heat  of 
summer  make  this  method  misuital)le. 

The  modern  tendency  in  cities  to  crowd 
high  buildings  on  a  limited  space  has 
necessitated  consideraljle  ingenuity  in  the 
provision  of  light  areas.  Even  where 
these  areas  are  painted  white  in  order 
that  every  advantage  may  be  taken  of 
them,  it  is  often  necessary  to  resort  to  arti- 
ficial lighting,  which  can  never  be  con- 
sidered a  comjiletely  efficient  suljstitute 
for  daylight,  and  which  is  only  justifiable 
when  daylight  fails,  or  .under  exceptional 
circumstances.      I    do    not    propose    here, 


however,  to  discuss  the  relative  merits  of 
the  various  forms  of  artificial  lighting. 
Certainly,  as  far  as  Hobart  is  concerned, 
with  her  splendid  hydro-electric  works  and 
comparatively  cheap  power,  electric  light- 
ing ought  to  hold  the  field. 

From  the  fact  that  sunlight  is  the  most 
satisfactory,  the  nearer  we  approach  in 
artificial  illumination  to  the  reproduction 
of  such  diffuse  white  light,  the  better.  We 
can,  however,  formulate  the  following  es- 
sentials in  lighting:  a  sufficiency  of  white 
light  without  excess;  ])erfect  steadiness; 
effective  diffusion;  freedom  from  violent 
contrasts;  downward  and  preferably  ob- 
lique direction.  The  source  of  light,  which 
is  usually  the  cause  of  trouble,  should  not 
be  in  a  direct  line  with  the  eye,  and  in 
the  case  of  brilliant  lights  it  is  im])ortant 
to  have  diffusion  globes  or  other  means  of 
softening  the  glare.  It  is  quite  essential, 
too,  that  the  light  be  steady;  otherwise 
the  eye  is  irritated  by  continuous  and  in- 
effective attempts  at  acconnnodation.  Di- 
rect sunlight  effects  may  be  reduced  by 
the  use  of  blinds  or,  in  factories  and  work- 
shops, particularly,  the  light  may  be  dif- 
fused by  means  of  windows  of  ground  or 
prismatic  glass. 

Sunlight  is  absolutely  essential  to  \hf 
maintenance  of  health.  ]\Iost  people  are 
familiar  with  the  anaemic  appearance,  the 
hmited  vitality  and  the  suscejitibility  to 
disease  of  those  who  habitually  live  or  work 
under  darkened  conditions.  Recently,  in 
Sydney,  I  found  an  elderly  woman  and 
a  c-hil(l  who  had  been  living  under  condi- 
tions where  they  never  got  direct  sunlight, 
and  who  con.sequently  were  blanched  and 
bleached  like  celery. 

AMien  uniform  lighting  is  desireii,  one 
foot  caiulle  can  he  obtained  from: 

1.    Electric  Lighting 

(a)  Ordinary  vacuum  lamps  0.2  to  0.3  watt 
per  siiuare  foot. 

(b)  Ga.s-fi]lcd    (half-watt)    lamps   0.1    to   0.15 
watt  per  square  foot. 


PURDY— LIGHTING  AND  VENTILATION    OF    FACTORIES    351 


2.   Gas  Liylithig 

(a)  Low  pressure  —  1  cubic  fool  per  hour  per 
100  square  feet  illuminated. 

(b)  High  pressure  —  1  cubic  foot  per  hour  per 
200  to  300  sciuare  feet,  according  to  pres- 
sure employed. 

The  above  figures  a.ssume  direct  lighting 
witli  scientifieall\-  designefl  reflertor.s  and 
appropriate  spacing.  In  general,  the  con- 
sumption will  have  to  be  increased  50  per 
cent,  for  .semi-direct,  and  TOO  per  cent,  for 
indirect  lighting,  in  order  to  obtain  the 
.same  illumination  on  the  working  plane, 
though  more  light  may  be  directed  into 
the  uj)per  part  of  the  room.  All  globes, 
shades,  and  reflectors  siiouid  l)e  cleaned  at 
regular  intervals,  \;irving  from  one  to  six 
weeks. 

In  modern  factories  (here  is  a  tendency 
to  adopt  overhead  ligiiting  from  units  in 
which  half-watt  lamps  are  used,  mounted 
direct  on  the  ceiling  or  girders.  In  order 
to  keep  the  light  out  of  the  direct  range  of 
the  vision  of  the  operators  and  to  make 
po.ssible  the  alteration  of  machines  without 
change  of  illumination,  the  walls  should 
be  lime  wa.shed  and  the  machines  i)ainted 
green  or  slate  gray.  It  is  now  possible  for 
modern  firms  actually  to  plan  an  efficient 
lighting  scheme  by  paying  attention  to 
correct  spacing  and  distril)ution.  and,  by 
specifying  the  consumption  of  electricity 
per  .square  foot,  to  forecast  with  accuracy 
the  illumination  which  will  be  i)roduced  on 
a  working  plane. 

With  indirect  lighting  the  .source  is  com- 
pletely shaded,  the  rays  being  reflected 
on  the  ceiling,  whence  they  are  diffused 
throughout  the  room.  An  excellent  effect 
is  obtained  in  the  lighting  of  the  Lord 
Mayor's  room  at  the  "Mansion  House," 
London,  which  was  one  of  the  first  places 
in  which  this  new  method  of  lighting  was 
introduced.  This  method  eliminates  glare, 
gives  soft  shadows,  and  at  the  same  time 
causes  light  to  penetrate  to  every  corner 


of  the  room.  It  requires  a  higher  degree  of 
illumination,  however,  and  is  not  suitable 
for  factories  where  pillars  or  girders  inter- 
fere with  reflection  from  the  ceiling. 

Semi-direct  lighting,  where  part  of  the 
total  lighting  is  simply  diffused  by  the 
bowl  of  the  fitting  which  is  made  of  opal 
glass  or  other  translucent  material,  is  now 
conu'ng  largely  into  vogue,  and  is  the 
method  most  commonly  used  for  lighting 
banks.  A  good  illustration  may  be  seen 
in  the  Connnonwealth  Bank  of  Sydney. 
Hut  the  effects  of  this  system  just  as  those 
of  direct  lighting  are  lo.st  by  dirty  bulbs, 
grimy  fittings,  reflectors  or  ceilings.  A 
hardly  pcrc(-[)tiblc  film  of  du.st  may  reduce 
the  effect  of  lighting  by  '•>()  per  cent.,  and 
a  several  months'  accunuilation  by  50  per 
cent . 

From  tables  which  have  been  compiled 
showing  tliat  7.5  per  cent,  of  the  accidents 
in  factories  occur  after  4  p.m.,  and  that 
there  is  an  increase  of  from  50  to  100  per 
cent,  in  the  number  of  accidents  during 
the  winter,  we  may  conclude  that  poor 
lighting  is  a  contributory  cause  of  acci- 
dents, in  addition  to  being  injurious  to  the 
lieallh  and  eyesight  of  workers.  Indeed, 
it  is  not  generally  recognized  how  much 
eyestrain  and  headache  insufficient  and 
unsuitai)le  lighting  cau.ses,  nor  how  preju- 
dicial an  effect  it  exercises  on  the  cjuantity 
and  the  quality  of  work. 

Proi)er  sui)ervision  of  work  and  mainten- 
ance of  cleanliness  and  general  .sanitary 
conditions  are  only  possible  with  efficient 
hghting.  Statutory  provisions  requiring 
adec|uate  and  suitable  lighting,  by  defining 
stanilards  for  factories  and  workshops,  are 
needed  for  the  employee  as  well  as  to  in- 
sure a  satisfactory  quantity  and  quaUty 
of  outiHit  of  work  for  the  employer.  The 
United  States,  France,  and  Belgium  are 
paying  considerable  attention  to  legisla- 
tion with  regard  to  these  questions. 

For  general  lighting,  regulations  such  as 
the  following  should  be  adopted: 


352 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Foot  Caodle  at  Horizontal 
Plane  of  Floor  Space 

1.'  Over  working  areas,  without  prejudice  to 

that  required  fo--  the  work  itself 0.'-25 

2.  In  all  parts  of  foundries,  where  any  person 

I      is  liable  orduiarily  to  pass O.-tO 

3.  In  all  parts  of  factories  and   workshops, 
\.:    where  any  person  is  liable  ordinarily  to  pass, 

''      and  not  covered  by  recommendation  (1)  .     0.10 
•t.    In  all  open  places,  one  hour  after  sunset 
and  before  sunrise  where  persons  are  em- 
ployed, and  in  any  dangerous  parts  of  the 
regular  roads  or  approaches 0-Oj 

An  important  accessory  to  any  method 
of  lighting,  if  the  maximum  ilkimination 
is  to  be  obtained  therefrom,  is  the  color 
effects  in  the  room.  It  must  be  a  bril- 
liantly lighted  room  which  can  dispense 
with  additional  light  given  off  by  suitable 
reflecting  surfaces.  Light  colored  surfaces 
are  essential  to  obtain  full  value  for  ordi- 
nary lighting,  where  circumstances  are 
such  that  external  or  internal  conditions 
interfere  with  the  direct  light  from  the 
window.  In  addition  to  white  colored  in- 
teriors, all  ol)structing  outside  surfaces 
should  also  be  white.  The  walls  of  dry 
areas  of  basements  .should  be  sloped, 
whitened,  and  kept  constantly  clean. 

We  have  found  in  Sydney  that  prismatic 
glass  in  windows,  daylight  reflectors,  and 
even  prism  jiavements  serve  a  usefid  pur- 
pose. Borrowed  light  by  means  of  tloor 
panels  glazed  with  ground,  prismatic,  or 
other  highly  reflective  glass,  are  now  fre- 
quently used  in  offices  and  factories.  Fan- 
lights for  darkened  stairways  are  also 
useful  and  should  never  be  obstructed  by 
so-called  ornamental  glazed  paper. 


Vextil.\tiox 

In  view  of  the  research  of  recent  years, 
the  whole  subject  of  ventilation  has  had 
to  be  recast.  Discomfort  with  consequent 
ill  heahh  from  lack  of  ventilation,  or 
rather  from  ab.sence  of  perflation,  is  due  to 
the  retention  of  the  surplus  heat  of  the 
body  following  an  increase  in  the  tpmpera- 


ture  and  relative  humidity  and  stagnation 
of  the  air.  The  change  which  renders  air 
unfit  for  human  beings  is  a  diminished  ca- 
pacity for  taking  up  heat,  which  is  brought 
about  by  an  increase  in  the  temperatiu-e 
and  in  the  amovmt  of  aqueous  vapor  in  the 
air.  It  is  necessary,  therefore,  to  ventilate 
rooms,  not  because  of  the  excess  of  carbon 
dioxide  that  is  to  be  found  where  persons 
are  confined  in  an  enclosed  space,  not  on 
account  of  the  lack  of  oxygen,  not  primar- 
ily because  of  any  mythical  organic  poison, 
but  first  of  all  to  eliminate  the  superfluous 
heat  from  the  bodies  of  the  occupants.  J 
This  has  l)een  definitely  proved  by  recent  " 
investigations  and  experiments  by  Leonard 
Hill,  Haldane,  Flugge  and  others. 

Paul,  in  Fliigge's  laboratory,  shut  himself 
in  a  glass  cabinet  and  breathed  the  same 
air  over  and  over  again  without  discomfort  ^ 
for  four  hours  when  the  temperature  was 
not  above  60°  F.  and  tlie  humidity  not 
above  1-2  per  cent,  of  saturation.  When 
the  temperature  was  raised  to  between 
68°  and  86°  F.  and  the  humidity  to  be- 
tween 7-2  per  cent,  and  90  per  cent.,  serious 
symptoms  appeared  in  fifteen  minutes. 
Paul  measured  the  surface  temperatvu-e  of 
his  body  and  found  that,  with  this  increase 
in  the  temperature  of  the  air,  the  tempera- 
tiue  of  his  l)ody  had  increased.  Di.scomfort 
was  relieved  when  the  hot  air  of  the  experi- 
mental chaml)er,  otherwise  imaltered.  was 
set  in  movement  with  a  fan. 

Heat,  moisture,  ami  absence  of  move- 
ment in  the  air  acting  on  the  skin  are  con- 
ditions whicii  have  to  be  prevented  in  order 
to  secure  t>fficient  ventilation.  The  air  in 
an  efficiently  ventilated  room,  therefore, 
must  have  sufficient  motion  without  cau.s- 
ing  a  chilling  drauglit,  and  re(|uires  con- 
stant change  to  prevent  stagnation  and 
over-hea.ing.  When  the  temperature  is 
too  high,  we  need  more  motion  or  a  larger 
air  supply  to  keep  the  body  cool.  \Mien 
the  temperature  is  too  low.  wi-  need  less 
motion  or  less  sui)ply  of  air  to  keep  the 


PURDY— LIGHTING  AND  VENTILATION    OF    FACTORIES    353 


body  warm.  This  is  entirely  a  surfaee  or 
skin  funetion  which  makes  the  provision  of 
ventihition  a  physical  and  not  a  chemical 
prol)leni. 

In  cerlaiii  industries  dust  is  added  to 
the  air  and  mechanically  irritates  the 
breathing  mechanism,  as  in  quartz  mining 
and  file  making.  In  other  jirocesses,  lead, 
mercury,  or  the  fumes  of  j)hosphorus  affect 
the  workers.  Dust  consisting  of  the  debris 
from  the  wear  and  tear  of  articles  in  use, 
products  of  combustion,  jiarticles  from  the 
skin  and  from  the  .streets,  all  add  to  the 
impurity  of  the  air  of  liouses  and  factories. 
Thanks  to  wiiul,  rain,  and  sun,  liowe\cr, 
the  alniosj)here  in  our  towns  is  constantly 
being  purified. 

The  air  of  a  room  or  factory,  to  be  .satis- 
factory, must  be  in  a  state  of  constant 
movement,  nuist  be  cool,  free  from  disease 
germs  and  dusi  and.  aboxc  all.  nui-'i  ])os- 
sess  a  ])ro])er  degree  of  relative  inunidity. 
When  the  temperature  of  the  wet  l)uli) 
thermometer  reaches  78°  F.,  continuous 
work  becomes  impracticable,  an<i  al  S8°  V. 
it  l)ecomes  imi)()ssil)!e.  'I'iie  comersion  of 
the  indications  of  tiie  wet  and  dry  l)uib 
thermometer  into  the  mere  ])ercentage  of 
humidity  which  might  be  comfortal)le  at 
G0°  or  70°  would  be  horribly-  oppressive  at 
S0°  or  00°,  and  fatal  at  100°.  On  the  other 
hand,  at  30°  or  40°  sucli  a  humidity  would 
make  conditions  intolerably  chilly. 

Dr.  J.  S.  Ilaldane  relied  on  the  wet  bull) 
readings  alone  and  propo.sed  70°  F;  wet 
bulb  as  the  desirable  maximum,  and  75° 
as  the  temperature  which  should  not  be 
exceeded.  Although  this  is  a  more  satis- 
factory criterion  than  the  recording  of  the 
percentage  of  saturation,  a  still  more  satis- 
factory method  is  that  introduced  by  Mr. 
John  L.  Biiice  of  Sydney.  INIr.  Bruce 
found  that  while  a  wet  bulb  temperature  of 
70°  or  7.5°  is  not  op])ressive  when  tlie  dry 
bulb  is  80°  or  90°.  yet  when  the  air  is  fully 
saturated  and  there  is  no  evaporation  — 
that  is  to  sav,  when  the  drv  ami  wet  bulb 


temperatures  are  identical  —  a  tempera- 
ture of  70°  is  very  opjjressive,  and  a  temp- 
erature of  75°  almo.st  unendurable,  most 
nuiggy  anil  oppressive. 

^Ir.  Bruce  found  that  a  wet  anil  dry 
bulb  thermometer  based  upon  a  constant 
dew  point  gave  comfortable  and  desirable 
conditions  at  all  dry  bulb  tem]>eratures  in 
N\'w  South  Wales.  So  long  as  the  dew 
point  ditl  not  rise  much  above  62°  F.  the 
conditions  were  not  unjjh-asant.  P>ven 
with  a  very  high  dry  bull)  temperature, 
bodily  vigor  was  not  im])aireil.  With  a 
dry  bulb  of  111°  anil  a  wet  bulb  of  8''2°,  but 
with  the  dew  ])oint  only  ()()°,  liard  work 
was  done  without  discomfort,  alliiough  the 
air  was  burning  hot;  whereas  with  a  dry 
bulb  of  only  77°  and  a  wet  bulb  of  75°,  but 
with  the  ilew  jioint  7:5.5°,  the  I'onditions 
were  depressing. 

'I'he  faille  of  permissii)le  Avy  and  wet 
liulb  temperatures  in  the  New  South 
Wales  Factories  Act  of  1!)0!),  as  fixed  by 
Mr.  Bruce,  was  ba.sed  ui)on  a  mininmm 
dew  i)oint  of  57°  and  a  maxinuun  of  (57°. 
This  gives  a  mean  dew  ])oint  of  ()'2°  F.,  at 
which  tem|)erature  saturated  air  is  neither 
nuiggy  nor  chilly.  ^Vhcn  tlie  dew  jx^int  is 
from  70°  to  75°,  exertion  becomes  difficult, 
but  with  the  dew  j)oint  near  ()''2°,  even  with 
high  wet  and  dry  bulb  temi)eratures,  work 
can  be  cari'ied  on  without  inconvenience. 

Mr.  lirui'c's  records  show  that  the  com- 
fortable and  invigorating  conditions  of 
temperature  in  relation  to  moisture  in  the 
air  are  indicated  by  the  dew  point  rather 
than  by  any  mere  indication  of  the  wet 
l)ull)  or  of  the  dry  bulb  alone,  liy  lines 
drawn  from  the  dry  bulb  thermouieler 
scale  to  the  wet  bulb  scale,  in  such  a  way 
that  when  the  mercury  in  the  dry  and  wet 
bulb  thermometers  is  at  the  level  of  the 
corresponding  ends  of  the  line,  a  dew  point 
of  6'-2°  is  inilicated  on  an  instriuuent  de- 
signed by  Mr.  Bruce  and  made  by  Mr. 
Esdaile,  Hunter  St.,  Sydney.  By  this  in- 
strument the  ordinarv  individual  can  re- 


354 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


cord  comfortable  conditions  of  temperature 
and  moisture,  and  can  regulate  mechan- 
ical ventilation  in  certain  industries  and 
factories  in  accordance  therewitli. 

The  Factories  Act  requires  that  in  every 
factory  in  New  South  Wales  the  means  of 
ventilation,  warming  and  cooling,  to  be 
provided  and  maintained,  shall  be  such  as 
to  keej)  the  humidity  and  temperature  of 
the  air  during  workuig  hours  wathin  the 
proportions  of  temperature  in  relation  to 
moisture  shown  in  Table  1.     The  relative 

TABLE  1.  — RELATIVE  DRY  AND  WET  BLXB 

TEMPERATLTRES  REQUIRED  BY  THE  NEW 

SOUTH  WALES  FACTORIES  ACT 


Dry  Bulb  Thermom- 
eter Showing  Air 
Temperature  in 
Degrees  Fahrenheit 

Corresponding 
Showing 
Minimum 
Fahrenheit 

Wet  Bulb  Thermometer 

Humidity  in  Air 

Maximum 
Fahrenheit 

40 

35 

37 

oO 

44 

47 

60 

53 

53 

G5 

60 

61 

70 

63 

68 

72 

64 

69 

75 

65 

70 

80 

67 

73 

85 

68 

73^ 

90 

69^ 

74 

05 

71 

75 

100 

73 

76 

105 

74 

77i 

110 

75 

78^ 

115 

76§ 

80 

1^0 

77^ 

81 

maximum  temperatures  of  the  wet  bulb 
thermometer  must  never  be  exceeded 
withm  the  factory  or  shop  except  when 
the  humidity  in  the  fresh  open  air  sur- 
rounding the  factory  or  shop  is  so  excessive 
that  it  shows  an  increase  in  those  relative 
temper  at  ui'es.  On  such  occasions  the  wet 
bulb  temperature  within  the  factory  may 
be  increased  in  the  same  proportion  as 
that  sho%\-n  by  the  open  air.  If  for  any 
special  manufacturing  process  or  storage 
purpose  any  occuijier  desires  the  air  in  his 
factory  workshoj)  to  l)e  saturated  with 
moisture  beyond  the  proportions  shown 
by  the  relative  temperatures  given  in 
Table  1,  he  must  make  written  application 


to  the  Minister  for  special  permission  to 
do  so,  specifymg  the  conditions  as  to  tem- 
perature and  moisture  which  he  desires. 

The  only  case  of  exemption  imder  the 
Factories  Act  in  New  South  Wales,  in 
which  the  relative  maximum  temperature 
of  the  wet  bulb  thermometer  is  permitted 
to  be  exceeded,  is  in  a  large  tobacco  factory. 
This  factory,  one  of  the  most  up-to-date 
m  Australia,  with  a  large  amomit  of  win- 
dow space,  requires  for  manufacturing 
purposes  an  even,  moist  temperature.  In 
hot  weather,  when  northwest  winds  pre- 
vail, windows  can  be  freely  opened,  but 
when  the  dry,  westerly  winds  are  blowing, 
the  means  of  ventilation  cannot  be  fully 
utilized,  as  the  leaf  becomes  too  dry  to 
handle  readily.  Readings  taken  by  Miss 
Harriott,  Senior  Inspector,  with  a  wet  and 
dry  bulb  thermometer,  showed  that  the 
humidity  of  the  atmosphere  in  the  "roll- 
ing" department  slightly  exceeded  that 
allowed  by  the  Factories  Act.  I  was  there- 
fore called  in  to  investigate,  and  at  my 
recommendation  a  certificate  was  given 
permitting  the  comj^any  to  vary  the  tem- 
l)erature  of  the  wet  bulb  in  the  "rolling" 
department,  so  long  as  it  did  not  exceed 
by  more  than  3°  the  temperature  indicated 
in  the  regulation.  This  company  is  prob- 
ably the  best  exponent  of  welfare  work 
among  employees,  in  New  South  Wales^ 
and  only  avails  itself  of  the  concession 
when  exceptional  weather  conditions  ren- 
der it  necessary. 

For  natural  ventilation  the  rule  is  gen- 
erally laid  down  that  openings  for  the  exit 
of  foul  air  should  average  '24  square  inches 
for  each  individual.  Where  the  openings 
for  fresh  air  are  larger  than  those  for  the 
exit  of  foul  air,  and  are  jjlaced  5  or  0  feet 
from  the  floor,  possibilities  of  draught  are 
minimized.  Hitherto,  sufficient  use  has 
not  been  madi'  of  the  natural  ventilation 
ol)tained  by  leaving  a  .sj)ace  between  the 
upper  portion  of  the  wall  and  the  roof  of 
buildings.    It  is  a  good  rule,  in  factories,  to 


PURDY— LIGHTING  AND  VENTILATION    OF    FACTORIES    355 


invest  one  person  with  the  responsibihty 
of  seeing  that  windows  are  kept  open  and 
of  prohibiting  the  closing  of  windows  ex- 
cept to  prevent  rain  or  dust  from  driving 
into  the  room.  AVith  this  proviso,  in  most 
cases  natural  ventilation  should  be  suffi- 
cient, except  on  days  with  relatively  high 
humidity,  when  it  is  necessary  to  suj)ple- 
mcnt  it  b}'  mechanical  mo\'cment  of  the 
atmosphere,  as  by  electric  fans. 

The  difficulty  of  ventilating  factories, 
largely  due  to  the  accunnilation  of  ])uckets 
of  foul  air,  especially  towartl  the  center  of 
large  rooms,  can  only  be  entirely  satisfac- 
torily rem()^'ed  by  mechani<al  means,  the 
best  of  which  apjiears  to  be  a  combination 
of  the  plenum  and  vacuum  systems.  AVhere 
there  is  special  risk  from  dust,  fumes,  or 
gases,  owing  to  thi"  nature  of  the  employ- 
men  I,  strong  exhausts  and  liocds  are  ni"c-es- 
sary  at  the  points  of  jiroduclion. 

Modern  factory  managers  who  have 
studied  the  recent  investigations  of  the 
MimitioTis  Health  Committee  nnist  realize 
llwit  the  belter  llie  vciil  ilal  ion  llic  l)etter 
tlie  health  of  (he  employees  and  tlic  liettt-r 
the  work  performed. 

Hours  of  Labor  and  Heai.tu 

A  remarkable  feature  of  the  earlier  years 
of  the  War.  when  it  was  necessary  in  Eng- 
land to  coTieentrate  on  the  organization  of 
nnmition  works,  was  that  for  a  time,  by 
mutual  agreement  of  emjjloyers  and  em- 
l)loj'ees,  the  restrictions  as  to  hours  of  woik 
were  withdrawn,  and  men,  women,  young 
l)ersons,  boys  and  girls,  all  worked  at  high 
pressure,  the  stimulus  of  national  neces- 
sity being  backed  up  by  high  remuneration. 
What  was  the  result?  It  was  found  that 
such  extensive  concentration  on  work  for 
long  hours  did  not  pay  and  that  Sunday 
labor,  that  is,  the  lack  of  one  day's  rest  in 
seven  also  did  not  pay. 

Certain  employers  who  kept  a  careful 
record  found  that  output  not  only  was  not 


increased  by  the  seven-day  working  week, 
but  that  it  actually  declined  after  the  first 
few  months.  The  six-day  working  week 
was  then  restored.  It  was  found,  how- 
ever, that  the  considerable  increase;  of 
overtime  was  telling  on  the  workers,  as 
evidenced  by  the  amoimt  of  lost  time  from 
sickness.  With  im]iroved  management  of 
the  factories,  it  was  soon  realized  that 
more  work  was  actually  done  in  an  eight- 
hour  day  than  in  a  ten-hour  day. 

The  results  of  the  investigation  by  the 
Scientific  Research  Committee  ai)])ointed 
to  revii'w  the  o])erations  of  nnmition  work- 
ers, and  the  collection  of  data  as  to  the 
occurrence  of  fatigue,  showed  that  the  out- 
put in  certain  industries  followed  the  same 
(■ur\('  as  that  of  a  muscle  stimulated  by  a 
gaKanic  current.  It  was  fomid  tliat,  just 
as  nature  observes  rhythm  and  prescribes 
periods  of  rest,  so,  in  order  to  obtain  maxi- 
mum efficiency  in  industry,  it  is  necessary 
to  observe  as  closely  as  ])ossil)le  the  pre- 
vent io7i  of  excessive  fatigue  l)eyond  the 
jioiiit  iccoveralile  by  a  reasonable  period 
of  rest.  The  old  adage  of  "all  work  and 
no  i)lay  makes  Jack  a  dull  boy"  was  again 
exemplified  in  industry.  It  was  found  that 
in  mechanical  indu.stries  the  outjjut  in- 
creased at  a  certain  ]ieriod  of  the  day  and 
then  dechned;  then  increased  again,  after 
an  interval  for  a  meal,  then  declined;  ami, 
in  some  industries,  then  increa.sed  for  the 
last  hour  in  an  eight-hour  day,  but  in  a 
ten-hour  day  steadily  declined.  Another 
interesting  ])oint  noted  was  that  where 
there  was  machinery  the  incidence  of  ac- 
cidents increased  as  the  period  of  fatigue 
was  reached. 

The  Industrial  Fatigue  Committee  of 
the  Ignited  States  Council  of  National  De- 
fence, after  an  elaborate  investigation  by 
the  Division  of  Scientific  Research  of  the 
Pubh'c  Health  Service  to  discover  in  mu- 
nitions factories  the  conditions  under  which 
a  maximum  continuous  output  might  be 
ol)tained,  discovered  that  while  it  is  often 


356 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


possible  to  increase  output  temporarily  by 
increasing  the  work  of  the  employee,  if  he 
be  overworked,  the  output  soon  falls  off. 
Such  a  method  quickly  defeats  itself  and 
is  not  profitable  in  the  long  run.  Given 
adequate  equipment  and  administration  of 
the  plant  with  a  i)roper  spirit  among  em- 
ployees, fatigue  was  found  to  be  the  gre.it- 
est  single  obstacle  to  a  maximum  output. 
Fatigue  diminishes  output  both  directly 
and  also  indirectly  by  increasing  accidents, 
sickness  and  the  proportion  of  spoiled  work. 

In  addition  to  the  mere  recording  of  a 
falling  off  of  output  per  individual  jjer 
hour,  day,  or  week  —  according  to  the 
duration  of  the  working  period  —  the  com- 
paring of  averages  per  hour  under  different 
schedules  of  work,  and  the  estimating  of 
the  fall  in  the  amount  of  electrical  or  other 
power  consumed  due  to  other  causes  than 
temporary  stoppage,  of  the  amount  of 
spoiled  work,  and  of  the  number  of  ab- 
sences from  accidents  and  sickness,  various 
tests  of  fatigue  were  supplied  by  investi- 
gators in  the  laboratory  and  applied  to  in- 
dustries. These  tests  concern  the  muscles, 
the  nervous  system,  sight,  hearing,  and 
certain  chemical  changes  within  the  body. 
Consideration  was  also  given  to  the  living 
conditions  of  the  workers  and  to  their 
habits  as  to  recreation  outside  the  factories, 
although  fatigue  due  to  outside  conditions 
is  obviously  less  easily  controlled  than  that 
caused  by  work  inside  the  factory. 

The  introduction  of  obligatory  resting 
periods  during  a  working  spell  is  well  illus- 
trated in  Australian  Shearing  Sheds  by  the 
"Smoke  ()."  You  must  have  often  read 
during  the  War  that  so  and  so  did  excep- 
tional service  for  a  continuous  period  under 
heavy  fire,  etc.,  for  forly-eight  or  seventy- 
two  hours.  Willi  regard  to  .stretcher 
bearers,  one  read  of  men  i)eing  continuously 
on  duty  for  days  during  a  heavy  engage- 
ment. My  experience  was  that  such  over- 
work did  not  pay  as  the  men  speedily 
became  fatigued.     Therefore,  when  I  was 


put  in  charge  of  the  evacuation  of  wounded 
of  the  Third  Australian  Division  for  the 
Battle  of  Megsines,  and  had  to  plan  for  the 
removal  of  the  wounded  from  four  Regi- 
mental Aid  Posts,  I  made  arrangements 
to  work  in  shifts  the  308  stretcher  bearers 
of  the  ninth,  tenth,  and  eleventh  Field 
Ambulances  who  were  at  my  disposal.  I 
insisted  on  half  the  men  resting  for  the 
first  twelve  hours  after  zero,  the  moment  of 
attack.  Consefiuently.  after  twelve  hours 
of  strenuous  work  we  had  a  fresh  group  of 
men  to  carr\'  on.  Then,  after  the  second 
twelve  hours,  those  not  casualties  in  the 
first  group  were  able  to  carry  on,  and  in 
this  way  we  managed  to  keep  up  the  work 
for  six  days  and  nights. 

It  was  also  found  during  the  War  that  a 
five  minutes"  halt  for  a  breathing  spell  at 
the  end  of  each  hour  of  marching  was  an 
advantage  for  both  man  and  beast. 

It  was  the  experience  in  American  fac- 
tories, likewise,  that  five-minute  resting 
periods  in  a  working  spell,  or,  where  this 
was  not  possible,  a  single  recess  of  ten  or 
fifteen  minutes'  duration,  increa.sed  the 
output,  especially  if  a  cup  of  cocoa  or  milk 
was  served  to  the  worker.  The  resulting 
increased  efficiency  yielded  equal,  if  not 
greater  ()uti)u1. 

Tlie  inlrodurtion  of  variety'  into  work 
also  diminishes  fatigue.  Anyone  who  has 
seen  a  girl  labelling  tins,  wra])])ing  up  .soap, 
or  i)erforming  some  other  meciianical  work, 
can  realize  that  if  she  were  trained  to  do 
.some  alternative  process  so  that  she  could 
teni])orarily  interchange  work  with  an- 
other girl,  fatigue  could  be  diminished 
without  lessening  outiml . 

Adjust iiKj  tlw  Speed.  —  When  a  single 
motor  ()|)erates  a  number  of  machines  the 
speed  may  more  easil.x-  In-  adjusted  to  the 
average  pace  if  an  exceptionally  fast  or 
slow  worker  is  transferred  to  another  job. 
in  order  that  the  same  rhythm  may  be  se- 
cure<l  tiu-oughout  the  .squad.  Fatigue  is 
least  when  the  customarv  rlivthm  is  main- 


PURDY— LIGHTING  AND  VENTILATION    OF    FACTORIES    357 


tained,  and  tlie  output  may  be  twice  as 
great  as  when  the  sjjeed  is  a  little  slower  or 
a  little  faster  than  this  customary  rhythm. 
It  was  noticeable  in  Lever  Bros,  works  at 
Balmain,  Sydney,  that  the  incentive  of 
piece  rates  in  certain  branches  kejjt  up  a 
high  rate  of  output. 

Omitting  Unneceftsary  Motion.  —  It  was 
also  noticeable  at  Lever's  works  that  tlic 
placing  of  the  packages,  which  the  workers 
had  to  handle,  at  a  convenient  height  and 
distance  from  their  liantls  j)revented  un- 
rhythmical, unnecessary  motions  or  undue 
muscidar  exertion,  and  thus  caused  the 
work  to  be  done  automatically  with  the 
lea.st  possible  waste  of  em-rgy  and  time. 

Altcnialiiuj  Dajj  and  Xinlit  H'ork.  —  The 
British  Health  of  Munition  Workers'  Com- 
mittee, after  a  careful  statistical  study  of 
output,  iound  that  wiiere  the  .same  niglil 
shift  continued  in  em])loyment  the  tt)tal 
out])ut  was  less  than  where  lliere  was  an 
alternation  of  day  and  night  work.  Tliis 
was  true  of  both  men  ami  women.  'I'lie 
alternating  periods  of  night  work  should 
not,  however,  be  less  than  one  month  in 
duration,  as  frequent  changes  of  hai)it 
miglit  l)e  deleterious  to  health. 

With  regard  to  the  workers  in  the  clean.s- 
ing  department  of  the  Sydney  City  Council 
we  find  that  it  is  atlvisable  ])eriodically  to 
change  men  on  the  night  shift  to  day  work 
and  vice  versa  as  a  means  of  keeping  dowTi 
loss  through  sickness,  especially  neuras- 
thenia, gastritis,  and  bronchitis. 

Adjusting  iTours  of  Work.  —  The  British 
Health  of  Mmiition  AVorkers'  Connnittee 
found  that  it  was  a  mistake  to  recommend 
a  uniform  day  for  all  kinds  of  work.  The 
most  profitable  duration  of  the  working 
period  for  women  and  bo\s,  even  when 
emjjloyed  on  shift  work,  was  found  to  be 
less  than  for  men.  It  is  obvious  that  a  man 
can  do  more  work  in  two  hovu's  than  in  one 
hour,  but  it  does  not  necessarily  follow  that 
he  can  do  more  work  in  tweh'c  hoiu's  than 
in  ten  hours,  or  more  in  ten  hoiu's  than  in 


eight  hours,  or  in  some  arduous  occupa- 
tions, more  in  eight  hours  than  in  six  hours, 
over  a  lengthened  period.  Whenever  the 
work  is  of  such  duration  as  to  cause  pro- 
noimced  fatigue,  it  has  been  .sho^\ni  again 
and  again  that  after  some  time  shortening 
the  working  period  actually  increases  the 
amount  of  work  done. 

A  granite-cutting  company  fountl  that 
"the  same  man  under  identically  the  same 
conditions  accomplished  more  of  exactly 
the  same  kind  of  work  when  he  was  work- 
ing nine  hours  than  he  did  when  he  was 
working  ten  hours.  And  again,  when  the 
hours  were  reduced  to  eight  hours,  this 
sanu>  man  accoTni)Hshcd  still  more  in  an 
cight-liour  di\\  than  lie  did  in  a  nine-hour 
day,  or  a  considerable  amount  more  than 
he  did  when  the  day  was  ten  hours  long." 

In  one  English  munition  factory  the 
average  weekly  hours  of  men  .sizing  fuse 
bodies  were  reduced  from  58.2  to  51.2  with 
a  total  increasi-  of  output  of  'Jl  \m-v  cent. 
Anotlier  numition  factory  one  of  the 
largest  in  I'.iigland  during  the  War,  employ- 
ing 70, (too  workers  —  gave  its  employees  a 
whole  holiday  on  Satiu'day  instead  of  a 
half  day,  owing  to  munerous  ab.sences  from 
work.  As  a  result,  the  absences  were  di- 
minisiied  by  50  per  cent.,  and  conse(|uently 
the  firm  has  continued  the  custom. 

Although  the  abolition  of  Saturday  work 
among  the  .'5, 000  employees  of  the  Sydney 
City  Council  is  only  a  recent  venture,  it  is 
an  interesting  fact  that  never  have  I  had 
so  few  men  reporting  sick  as  during  the 
last  eight  weeks.  Thus,  the  saving  in 
money  in  paying  men  during  absence  from 
sickness,  as  is  the  practice  of  the  Sydney 
City  Council,  may  in  the  end  pay  for  this 
innovati(m  which  is  so  much  appreciated 
by  both  the  indoor  and  outdoor  workers. 
The  fact  that  a  man  knows  that  he  has  two 
days'  leisure  at  the  end  of  the  wi'ck  often 
makes  him  remain  at  his  job  imtil  Friday; 
moreover,  for  the  same  reason,  men  now 
come  up  on  Fridaj'  to  sign  on  again  to  start 


358 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


work  on  the  following  Monday  instead  of 
waiting  until  9  o'clock  on  Monday  morn- 
ing foi*  medical  examination,  which  would 
generally  mean  that  they  could  not  start 
work  until  Tuesday. 

Avoiding  Overtime.  —  If  the  usual  day's 
work  stops  just  short  of  undue  fatigue, 
overtime  means  OA'erwork.  Overtime  work 
is  apt  to  result  in  an  increased  amount  of 
spoiled  work  and  in  lessened  output,  as 
well  as  in  an  increased  number  of  absences 
on  subsequent  days,  and  is,  consequently, 
unprofitable,  particularly  in  view  of  the 
increased  rate  of  wages  that  must  be  paid. 

It  has  been  very  noticeable  to  me,  espe- 
cially in  the  Electric  Lighting  Department 


of  the  Sydney  City  Council,  where,  owing 
to  certain  circiunstances,  it  has  been  neces- 
sary for  men  to  work  considerable  amounts 
of  overtime  and  in  some  cases  to  do  double 
shifts,  that  we  have  had  a  number  of  cases 
of  neurastlienia  and  gastritis,  especially  in 
the  summer  months.  In  some  cases  men 
were  absent  through  sickness,  largely  the 
result  of  over-fatigue,  treble  and  quadruple 
the  time  they  worked  overtime.  Overtime 
should  only  be  resorted  to  in  exceptional 
emergencies  and  even  then  not  for  many 
days  in  succession.  Even  in  agricultural 
work,  a  tired  worker  who  has  not  had  time 
to  recuperate  cannot  do  himself  or  his 
employer  justice. 


BOOK  REVIEWS 


359 


BOOK  REVIEWS 


Industrial  Fatigue  and  Efficiency.     By  H.  il. 

Vernon.  M.A.,  M.D.,  Investigator  for  the  Indus- 
trial Fatigue  Research  Board;  I^ate  Fellow  of 
Magdalen  College  Oxford.  Cloth.  Pp.  2CA  with 
index.    London :   George   Routledge  &  Sons,   Ltd. ; 

New  York  :  E.  P.  Dutton  &  Co.,  1921. 

This  book  constitutes  a  thorough  discussion 
■of  our  field  knowledge  of  industrial  fatigue. 
It  is  not  concerned  with  laboratory  material, 
but  has  been  compiled  with  a  thorough  ap- 
preciation of  the  significance  of  laboratory 
results. 

The  opening  chapter  gives  the  author's 
■conception  of  the  problem.  lie  accepts  fa- 
tigue as  the  necessary  result  of  work  and 
considers  that  from  the  point  of  view  of  in- 
dustrial hygiene  one  should  search  first  of 
all  for  evidence  as  to  whether  the  "fatigue 
induced  by  an  industrial  occupation  has 
an  unfavorable  influence  on  the  health  of 
the  worker."  It  is  recognized  that  effects 
on  health  may  take  weeks,  months  or  even 
years  to  appear,  and  that  consequently  the 
essential  jiroblem  of  industrial  fatigue  is 
most  difficult.  As  a  .second  and  somewhat 
less  important  endeavor,  search  should  be 
made  for  sources  of  "unnecessarj-  fatigue." 
It  is  clearly  unwLse  to  add  useless  dissipa- 
tion of  energy  to  the  routine  of  daily  labor. 
Such  a  point  of  view  lias  nothing  to  do  with 
requiring  an  honest  day's  work.  It  simply 
means  that  every  effort  should  be  made  to 
increase  productivity  through  conservation 
of   unnecessary   labor. 

The  author  regards  it  as  highly  improbable 
that  any  single  test  will  ever  give  valid  meas- 
urements of  fatigue  in  diverse  occupations 
and,  as  a  consequence,  comes  to  the  conclu- 
sion that  "the  only  satisfactory  test  at  pres- 
ent available  is  one  based  on  the  perform- 
ance of  the  operation  itself." 

In  studying  different  operations  the  work- 
ing capacity  has  been  measured  in  terms  of 
hourly,  daily  and  weekly  periods  in  many 
different  industries  and  under  varied  hours 
of  work,  rest  periods,  etc.  Chapters  con- 
cerned with  such  data  are  followed  by  others 
upon  lost  time  and  its  causation,  the  pre- 
vention of  industrial  accidents,  and  factory 
conditions.  The  introduction  to  the  final 
chapter  on  practical  conclusions  sums  up  the 


attitude  which  in  a  general  way  governs  the 
presentation  of  the  material:  "Up  to  a  cer- 
tain point  fatigue  is  a  natural  physiological 
condition,  wiiich  is  inevitably  incurred  as 
the  result  of  industrial  work,  and  it  does 
good  rather  than  harm  to  the  worker.  Be- 
yond this  point  it  becomes  pathological  and 
acts  injuriously  upon  him,  but  the  pathologi- 
cal condition  arises  so  gradually  out  of  the 
physiological,  and  the  evil  effects  produced  at 
first  may  be  so  slight,  that  it  is  often  quite 
imjiossiblo  to  put  a  finger  on  the  line  of  de- 
marcation. Often  one  can  judge  only  by 
the  cumulative  effects  of  the  over-fatigue, 
which  may  take  weeks,  months,  or  even  years, 
to  reveal  themselves  bej'ond  question,  and 
then  it  may  be  too  late  to  effect  a  remedy. 
Hence  the  emploj-er  of  labour  who  wishes 
to  avoid  all  industrial  conditions  which  in- 
jure the  health  of  his  employees,  and  the  in- 
vestigator who  wishes  to  advise  on  the  means 
of  attaining  this  end,  often  liave  to  act,  or 
suggest  action,  on  general  principles.  They 
may  not  be  able  to  adduce  specific  reasons 
wliich  can  be  substantiated  by  a  direct  ap- 
peal to  the  industry  or  occupation  under  con- 
sideration. .  .Let  the  conditions  suggested  by 
a  study  of  other  industries  be  adopted.  Some 
(if  th»m  can  be  followed  boldly  and  without 
(|uestion,  whilst  others,  about  which  less  cer- 
tainty exists,  should  be  pursued  cautiously, 
in  gradual  stages.  Let  the  effects  of  such 
changed  conditions  be  carefully  studied,  not 
for  a  few  weeks  only  but  for  many  months, 
till  definite  conclusions  can  be  drawni.  That 
is  to  say,  every  substantial  change  in  indus- 
trial conditions  ought  to  be  regarded  as  an 
experiment,  the  effects  of  which  should  be 
carefully  ascertained,  not  only  because  of 
their  immediate  interest  to  the  employer  who 
has  made  them,  but  because  they  concern 
everyone  who  is  in  any  way  connected  with 
the  industry  in  question,  and  to  a  less  ex- 
tent those  connected  with  other  industries. 
The  secret  of  progress  in  the  science  of  in- 
dustrial fatigue  is  the  adoption  of  the  experi- 
mental method,  and  the  rate  of  progress  de- 
pends very  largely  on  the  interest  and  co-op- 
eration of  employers."  This  point  of  view 
has  often  been  lacking  both  in  the  collection 
and  presentation  of  data  upon  industrial  fa- 


360 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tigue.  The  subject  is  so  closely  bound  with 
economic  and  sociological  questioiis  as  to 
cause  investigators  to  look  for  certain  things 
rather  than  to  view  the  problem  with  the  de- 
taclmient  it  requires. 

Dr.  Vernon's  book  will  serve  as  a  useful 
text  for  all  those  who  are  teaching  this  sub- 
ject   to    students    of    college    and    graduate 


grade.  Many  references  are  given,  and  in- 
dexing is  fairly  complete.  A  most  commend- 
able feature  is  found  in  the  close  proximity 
of  charts  and  tables  to  the  test  discussing- 
them.  It  is  seldom  that  one  finds  a  volume 
in  which  this  desirable  feature  of  suceessfuL 
printing  is  so  well  arranged. — C  K.  Drinker. 


BOOKS  RECEIVED 

Books  received  are  acknowledged  in  this  column,  and  such  acknowledgment  must  be  re- 
garded as  a  sufficient  return  for  the  courtesy  of  the  sender.  Selections  will  be  made  for  re- 
view in  tile  interests  of  our  readers  and  as  space  permits. 


Public  Healt^h  and  Hygiene.  In  Contributions 
by  Eminent  Authorities.  Edited  by  William  Hal- 
lock  Park,  M.D.,  Professor  of  Bacteriology  and 
Hygiene,  University  and  Bellevue  Hospital  Med- 
ical College,  and  Director  of  the  Bureau  of  Ka- 
boratories  of  tie  Department  of  Health,  New  York 
City.  Cloth.  Pp.  SSI,  with  illustrations  and  index. 
Philadelphia  and  New  York :  Lea  &  Febiger,  1920. 

Essentials  of  Laboratory  Diagnosis.  De- 
signed for  Students  and  Practitioners.  By  Francis 
Ashley    Faught,    M.D.,    formerly   Director   of   the 


Laboratory  of  the  Department  of  Clinical  Medi- 
cine and  Assistant  to  the  Professor  of  Clinical 
Medicine,  Medico-Chirurgieal  College,  etc.,  Phila- 
delphia, Pa.  Seventh  Revised  and  Enlarged  Edi- 
tion. Cloth.  Pp.  523.  with  illustrations  ami  index. 
Philadelphia :    F.   A.   Davis   Company,    1921, 

Ili.\(!W(iRM  .\Nr)  Its  SrccKssFUL  Trkatment.  By 
John  P.  Turner,  M.D.,  Medical  Inspector  of  Pub- 
lic Schools,  Philadelphia,  Pa,  CloUi.  Pp.  C2,  with 
index,  foreword,  introduction  and  illustrations. 
Philadelphia  :   F.   .\.  Davis  Company,  1921. 


NOTICES  361 

ANNOUNCEMENT   OF 

THE  AMERICAN  ASSOCIATION    OF  INDUSTRIAL   PHYSICIANS 

AND  SURGEONS 

O^iccrH  o/  the  Association 
President  2nd  Vice-President 

Dr.  C.  E.  Ford  Dr.  L.  A.  Slioiidy 

General  Chemical  Company  Bethlehem  Steel  Company 

New  York  City  Bethlehem,  Ta. 

1st  Vice-President  Sccretarri-Trcnsurcr 

r>r.  C  F.  X.   Schram  r>r.  Win.  AIfrp<l  Sawyer 

F;iirli:ink.s,  Morse  &  Company  Eastman  Kcnlak  Company 

Kcloit.  Wis.               "  343  State  St.,  Rochester,  N.  T. 

Olio  tliniisand  members  by  May,  1922 — this  is  the  goal  which  the  American  Associ- 
ation OF  Industrial  Physici^vns  and  Surgkons  has  set  for  itself  in  its  present  member- 
ship campaign. 

Can  You  as  a  physician  afford  not  to  be    interested  in  Industrial  Medicine? 

If  you  are  liolding  an  industrial  position,  however  important,  however  small,  j-ou  will 
get  more  out  of  it  and  put  more  into  it  if  you  belong  to  the  American  Association  OP 
Industrial  Physicians  and  Surgeons.    This   Association  can  serve  you — 

1.  In  the  study  and  discussion  of  problems,  national  in  scope,  peculiar  to  the  practice 
of   industrial   medicine   and   surgery. 

2.  To  develop  methods  adapted  to  the  conservation  of  health  among  workers  in  the 
industries. 

3.  To  promote  a  more  general  understanding  nf  tlie  purposes  and  results  of  the 
medical  care  of  employees. 

4.  To  unite  into  one  organization  members  of  the  medical  profession  specializing  in 
industrial  medicine  and  surgery  for  their  mutual  advancement  in  the  practice  of  their 
profession. 

ArEMP.ERSHIl'  from  now  until  the  clo.se  of  our  fi.scal  year.  May  1,  1923,  will  cost  you 
only  $(J.(X).     Yearly  dues  arc  $5.00. 

There   are   three   classes  of  membership — Active,  Associate,  and  Honorary. 

Activr  Members.  Physicians  who  are  actively  engaged  part  or  full  time  in  the  prac- 
tice of  industrial  medicine  and  surgery,  or  who  are  engaged  in  the  investigation  of 
industrial  medical  problems. 

Associate  Memhers.  Physicians  intere.sted  in  industrial  medicine.  (Entitled  to  all 
the  privileges  of  the  Association  except  voting  and  holding  office.) 

Honorari/  Members.  Persons  who  have  contributed  distinguished  service  to  the  ob- 
jects for  which  the  Association  stands. 

Membership  entitles  you  to:  (a)  Our  official  journal.  The  Nation's  Uealth.  which 
contains  full  reports  of  all  the  affairs  of  the  Association,  together  with  other  interesting 
articles  on  industrial  medicine.  (ft)  Bi-monthly  abstracts  of  current  industrial 
medical  literature,  (c)  Reports  and  digests  of  interest  to  those  engaged  in  industrial 
work. 

Remember  the  D.vte  of  the  Annual  IMeeting,  May  22,  23,  St.  Louis,  Mo. 

(The  same  week  as  the  A.M.A.  Meeting.) 


362 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


CENSUS  OF  SAFETY  AND  HEALTH  WORKERS 


All  industrial  physicians  and  surgeons, 
industrial  nurses,  and  other  persons  engaged 
in  industrial  health  work  are  to  be  included 
in  the  census  of  safety  and  health  workers 
now  being  taken  by  the  National  Safety 
Council  in  all  parts  of  the  country.  Although 
health  work  in  industry,  along  with  safetj', 
has  made  great  strides  in  the  past  few  years, 
it  is  not  at  present  known  how  many  persons 
are  engaged  in  either  of  these  activities,  who 
they  are,  or  where  they  are  located.  This  is 
the  first  time  an  attempt  has  ever  been  made 
to  list  all  the  industrial  safety  and  health 
workers.  Public  safety  workers  will  also  be 
included  in  the  census. 

It  is  believed  that  the  results  of  the  census 
will  give  a  good  indication  of  how  extensive 
the  safetj'  and  health  activities  now  being 
carried  on  are.  The  census  will  include  not 
only  members  and  employees  of  members  of 
the  National  Safety  Council,  but  all  persons 
engaged  in  industrial  safety  and  health  work 
whether  connected  with  the  Co\mcil  in  any 
way  or  not.  The  Council  has  almost  as  deep 
an  interest  in  industrial  health  work  as  in 
accident  prevention,  and  is  very  closely  al- 
lied with  the  American  Association  of  Indus- 
trial Physicians  and  Surgeons.  Many  health 
workers    and    companies    employing    health 


workers  are  numbered  among  the  Council's 
membership. 

Industry  in  general  and  the  nation  at  large 
will  profit  from  the  results  of  this  census. 
It  will  enable  the  Council  to  find  quickly 
speakers  on  industrial  and  public  safety  for 
any  occasion  in  any  locality ;  authors  for 
special  articles  on  accident  prevention ;  writ- 
ers of  safety  text-books;  lecturers  on  acci- 
dent prevention  and  industrial  health  work 
for  universities  and  colleges.  The  Council  at 
present  continually  receives  requests  from 
industrial  companies,  municipalities,  civic  as- 
sociations, clubs,  schools,  colleges,  and  other 
organizations  for  help  in  finding  speakers  or 
writers  on  safety  subjects.  The  census  rec- 
ords will  greatly  increase  the  facilities  of  the 
Council  for  filling  such  requests. 

Every  reader  of  this  publication  who  is 
professionally  engaged  in  industrial  or  pub- 
lic accident  prevention  or  industrial  health 
work  —  whether  he  is  devoting  all  or  only 
part  of  his  time  to  accident  prevention  —  is 
urged  to  assist  in  the  taking  of  this  census 
by  sending  to  the  National  Safety  Council, 
168  North  Michigan  Avenue,  Chicago,  his 
name  and  the  other  data  requested  in  the 
Council 's  census  form,  which  follows : 


Name - - — - 

Company  or  organization _ -.... 

City - - 

Nature  of  company's  business -... 

Is  safety  your  principal  work? 

Please  check  other  activities  you  engage  in: 

Fire  protection 

Health  and  sanitation 

Workmen's  compensation  and  claims 

General  execijtive    (such  as  manager 
or  superintendent) 
How  long  have  you  been  in  your  present  position? 

Teclinical  or  other  special  education? _ 

Signed- 

Title _.... 


..State- 


Engineering  (other  than  safety) 

Legal 

Insurance 

Welfare  Educational 

Industrial  relations 


THE  JOURNAL  OF 
INDUSTRIAL  HYGIENE 


PUBLISHED  MONTHLY 


Volume  111 


APRIL,   1922 


Number  12 


ADEQUATE  INDUSTRIAL  MEDICAL  SERVICE  FOR  THE  SMALL 

PLANT* 


Carey  P.  McCord,  M.D. 

AND 

Dorothy  K.  Minster 

Ciyicinnati,  Ohio 


IN  the  usual  industrial  city,  the  aggre- 
gate  of  workers  employed  in  small 
plants  exceeds  the  number  employed  in 
the  larger  plants  of  500  or  more  workers. 
In  Hamilton  County  (the  county  in 
which  Cincinnati  is  situated),  there  are, 
under  normal  industrial  conditions,  ap- 
proximately 3,000  factories,  of  which 
number  about  2,600  have  less  than  100 
employees.  Less  than  twenty  of  the 
county's  factories  employ  1,000  or  more 
persons.  Of  the  county's  industrial  pop- 
ulation less  than  5  per  cent,  receive  ade- 
quate industrial  health  super\-ision. 
This  is  due  largely  to  the  high  percent- 
age of  industries  which  are  too  small  to 
warrant  a  full-time  physician,  and  in 
which,  consequently,  medical  work  is 
usually  limited  to  the  care  of  emergen- 
cies. Such  services  are  ordinarily  ob- 
tained by  sending  the  injured  or  sick 
person  to  find  some  neighborhood  physi- 
cian or,  in  extreme  emergency,  by  call- 

•Received  for  publication  Dec.  16,  1921. 


ing  in  to  the  plant  any  available  neigh- 
borhood physician.  These  physicians 
ma>'  be  well  qualified  to  take  care  of  the 
medical  or  surgical  condition  but  very 
obviously  they  do  not  serve  the  best  in- 
terests of  the  patient  as  an  employee  or 
of  the  manufacturer,  in  that  they  are  not 
industrial  physicians,  are  not  acquaint- 
ed with  trades  processes  and  industrial 
health  hazards,  and  their  services,  how- 
ever excellent,  only  care  for  the  unneces- 
sary by-product  of  bad  plant  conditions. 
It  is  common  knowledge  to  the  indus- 
trial physician  and  the  industrial  hy- 
gienist  that  the  small  plant  proportion- 
ally harbors  a  far  greater  quantity  and 
diversity  of  health  and  safety  hazards 
than  the  large  plant.  Two  examples 
now  cited  should  be  obvious  and  con- 
vincing. The  plant  of  500  employees  is 
warranted  in  the  installation  of  a  water 
cooling  system  with  automatic  tempera- 
ture control,  with  drinking  fountains, 
suitably  placed  each  to  accommodate 


363 


364 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


about  thirty  employees.  The  plant  of 
seventy-five  employees  is,  however,  rare- 
ly justified  in  this  considerable  outlay 
and  resorts  to  the  use  of  various  types 
of  coolers — a  practice  which  increases 
the  probability  of  the  common  drinking 
cup,  harmful  low  temperature  of  water, 
etc.  In  the  large  metal  trades  plants  the 
hazard  from  cutting  fluids  may  be  re- 
duced to  a  minimum  by  sterilization  of 
the  cutting  compound  and  by  the  re- 
moval of  metallic  particles  through  cen- 
trifugalization  or  magnetization.  In  the 
small  machine  shop  the  hazard  to  the  in- 
dividual from  cutting  fluids  is  just  as 
great,  but  the  considerable  expense  en- 
tailed in  such  installation  is  usually  re- 
garded as  excessive. 

Methods  of  Extending  Medical  Ser- 
vice TO  THE  Small  Plant 

Both  the  manufacturer  and  his  em- 
ployees share  in  the  tremendous  values 
derived  from  a  factory  medical  depart- 
ment that  regularly  serves  all  employees 
in  any  sickness  or  injury,  throws  around 
them  healthy  work  conditions,  educates 
them  in  safety  measures,  and  places 
them  on  jobs  for  which  they  are  physi- 
cally and  mentalh'  suited.  Because  of 
these  immediate  returns,  the  medical  de- 
partment justifies  and  pays  for  itself 
j-ear  by  year.  This  \'ery  fact  of  self- 
maintenance  clothes  industrial  medicine 
with  extraordinary  significance  as  a 
measure  for  the  general  betterment  of 
community  health.  It  is  to  be  recog- 
nized that,  if  full  returns  are  to  be  de- 
rived from  this  constructive  type  of 
health  work,  means  must  be  found  for 
the  institution  of  the  right  kind  and  the 
right  quantity  of  health  conservation 
into  the  great  number  of  small  plants. 
The  extension  of  this  type  of  work  into 
small  plants,  however,  is  a  problem  in 
industrial  medicine  not  as  yet  solved. 


In  the  consideration  of  these  needed  ser- 
vices, three  approaches  have  been  pro- 
posed: 

First,  the  utilization  on  a  full-time 
basis  of  a  physician  not  only  for  medical 
work  but  for  such  other  activities  as  em- 
plo>'ment  management,  safety  supervi- 
sion and  personnel  work.  The  assump- 
tion of  all  these  duties  by  one  person 
usually  warrants  the  small  plant  in  se- 
curing a  high  type  of  physician.  This 
proposed  approach  is  manifestly  meri- 
torious but  is  largely  impossible  through 
the  fact  that  there  are  few  physicians 
properly  qualified  in  the  sev'eral  special- 
ties mentioned. 

Second,  in  some  localities  attempts 
have  been  made  to  solve  this  matter 
through  the  association  of  several  closely 
situated  factories,  for  the  purpose  of  es- 
tablishing a  dispensary  and  of  employ- 
ing an  industrial  physician  and  such 
other  personnel  as  may  be  required  to 
render  health  supervision  to  the  several 
factories,  participating  on  a  pro  rata 
basis.  In  actual  practice,  this  method 
has  been  successfully  applied  in  a  few 
instances.  In  other  instances,  it  has 
failed  as  the  result  of  unequal  amount 
of  co-operation  from  the  plants  partici- 
pating. 

Third,  another  approach  is  to  be 
found  in  the  association  of  a  group  of  in- 
dustrial physicians,  hygienists,  safety 
engineers,  statisticians,  etc.,  for  the  pur- 
pose of  rendering  to  small  plants  the 
right  type  of  medical  super\-ision  in 
quantities  proportional  to  their  needs. 
Such  an  organization  daily  and  regu- 
larly spends  a  certain  fixed  time  in  the 
several  plants.  For  emergencies,  ser- 
vices may  be  had  at  the  plant  by  com- 
municating with  the  emergency  physi- 
cian held  in  reserve  for  just  such  pur- 
poses. Sanitary  and  safety  investiga- 
tions are  conducted  at  such  intervals  as 
ma^'  be  deemed  desirable  from  a  know!- 


McCORD   AND   ^IIXSTER— PLANT   MEDICAL   SERVICE     365 


I 


edge  of  conditions  obtaining  in  the  sev- 
eral plants.  This  method  has  the  advan- 
tage of  supplying  at  a  low  cost  to  the 
manufacturer  the  services  of  a  group  of 
workers  qualified  in  a  variety  of  indus- 
trial health  and  personnel  problems. 

The  subsequent  portion  of  this  paper 
concerns  itself  with  the  experience  in 
one  small  plant  of  a  group  of  workers 
whose  activities  are  conducted  along  the 
lines  last  mentioned.  An  analysis  of  the 
results  of  the  industrial  medical  and  hy- 
gienic work  in  this  particular  factory 
will,  we  believe,  pro\e  the  value  of  this 
type  of  service.  The  figures  shown  and 
the  statements  made  are  necessarily 
somewhat  influenced  by  the  shifting 
of  industrial  conditions  but  our  con- 
clusions have  fully  contemplated  the 
effects  of  such  conditions  upon  our  re- 
sults. The  general  trend  of  results  points 
very  definitely  toward  the  values  of  such 
a  part-time  medical  department  both  to 
the  health  and  well-being  of  the  workers, 
and  to  the  business  interests  of  the  man- 
agement. 

N.ATURE  OF  Business  Arrangement 

The  plant  under  consideration  em- 
ployed on  an  average  115  persons,  all  of 
whom,  with  the  exception  of  a  small  por- 
tion of  the  office  force,  were  men.  This 
plant  conducted  a  combined  woodwork- 
ing and  machine  shop,  the  final  product 
being  a  variety  of  special  machinery. 
This  work  was  situated  in  one  building 
having  six  floors.  The  general  condi- 
tions of  sanitation  prior  to  the  institu- 
tion of  work  were  unsatisfactory.  No 
sanitary  or  medical  services  had  been 
provided,  except  the  usual  state  factory 
inspection  and  the  occasional  care  of 
emergencies.  Following  our  negotia- 
tions with  this  plant,  it  was  agreed  that 
a  single  room  approximately  10  by  20 
feet  was  to  be  adequately  equipped  as  a 


dispensary.  The  physicians  agreed  to 
spend  a  minimum  of  one  hour  daily  in 
the  plant  at  a  fixed  hour,  and  to  be  avail- 
able for  emergencies  during  any  hour  of 
the  work-day.  Arrangements  were  like- 
wise devised  whereby  sanitary  and  safe- 
ty imestigations  would  be  made  at  not 
less  than  monthly  intervals,  together 
with  special  investigations  as  deemed 
necessary  by  the  technical  group.  An 
intelligent  office  worker  was  designated 
for  training,  for  the  care  of  trivial  in- 
juries and  for  first-aid  purposes  until 
such  time  as  the  doctor  might  arrive. 
All  records  concerning  compensation 
awards,  etc.,  were  handled  by  the  medi- 
cal department. 

Approach  to  the  Worker 

At  the  outset  of  activities,  the  physi- 
cian assigned  to  this  plant  spent  consid- 
erable time  in  the  various  factory  de- 
partments under  the  pretext  of  studying 
trades  processes.     His    prime   purpose, 
however,  was  to  become  personally  ac- 
quainted with  the  majority  of  the  work- 
ers and  to  acquaint  them  with  the  func- 
tion and  worth  of  the  newly  created  de- 
partment.    This  procedure  also  served 
the  purpose  of  locating  several  obviously 
diseased  workers.    Later  these  workers 
were  called  to  the  dispensary,  and  there 
carefully  examined  and  treated.    Good 
results    from    these    cases,    plus    some 
knowledge  gained  from  the  doctor  on 
health  matters,  at  once  sold  the  worth 
of  such  activities  to  the  entire  plant.  At 
about  the  same  time  a  carefully  worded 
announcement  was  prepared  for  all  bul- 
letin boards  setting  forth  the  prevalence 
of  common  ailments  among  all  indus- 
trial workers,  and  the  consequences  of 
neglecting   them,    and    instructing    the 
workers   that   they  were   privileged   to 
leave  their  work  and  consult  with  the 
physician  for  genuine  ailments.    The  re- 


366 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


suits  from  these  procedures  are  shown 
in  the  next  sections  in  the  quantity  and 
nature  of  the  medical  work  carried  out 
in  the  ensuing  months. 

Experience  in  Medical  and  Surgical 
Relief 

Beginning  with  the  first  month  of  our 
service  (May,  1920),  5.2  per  cent,  of  the 
plant's  personnel  passed  through  the  dis- 
pensary on  an  average  day.  This  per- 
centage increased  until  in  July  of  the 
same  year  10  per  cent,  of  the  workers 
daily  reported  to  the  doctor  for  treat- 
ment or  consultation.  Thereafter,  the 
percentage  slowly  decreased  owing  to 
our  eradication  of  many  chronic  condi- 
tions and  to  the  lessening  of  the  number 
of  accidents,  until  in  April,  1921,  only 
3.1  per  cent,  of  the  workers  daily  passed 
through  the  dispensary.  Table  1  is  a 
statistical  analysis  with  reference  to  the 
number  of  individuals  receiving  medical 
and  surgical  relief. 


Nature  of  Physical  Conditions  Com- 
ing TO  Attention  of  Physician  in 
This  Dispensary 

The  1,816  treatments  carried  out  dur- 
ing the  year  represent  572  precise  enti- 
ties. On  an  average,  all  workers  passed 
through  the  doctor's  hands  four  times 

MiMOR  InOURlES    3\%    or    5  b  "/o 

Major  \hJosiES    '\   or  0.  fc^o 

rAE^s     17'*-  ov    SO-'Vyo 

LMess     Tfe  or    lay© 

Fig.  1. — Distribution  of  diseases  and  injuries. 

during  the  year.  The  proportion  be- 
tween the  various  types  of  cases  is  shown 
in  Figure  1.  For  the  purposes  of  our 
classification,  an  injury  is  reported  as 
"major"  if  a  loss  of  time  greater  than 
one  week  is  necessitated.  In  this  work 
no  routine  physical  examinations  were 
conducted,  which  fact  affects  the  relative 
proportion  of  the  items  in  Figure  1.  We 
believe  that  chronic  diseases,  particu- 
larly degenerative  diseases   among  old 


TABLE   1.  — MEDICAL  AND  SURGICAL  RELIEF 


Month 

No.  of 
Servii^e 
Days 

Av.  No. 

on 
Payroll 

Total 
No.  on 
PayroU 

Treat- 
ments 

Av. 
Treat- 
ments 
per  Day 

Percent, 
of  Per- 
sonnel 

No.  of 

Indi- 

\'idunls 

Served 

Av.  New 

Cases 
per  Day 

Av. 
Treat- 
ments 
per  Case 

Total 
Hours  of 
Doctor 
in  Plant 

Av. 
Hours 
per  Day 

Disability 
Time  Lost 

Indi- 
^-idiials 

Days 

May 

17 

103 

109 

6.4 

5.2 

28 

1.7 

4  0 

42  0 

2.2 

0 

0 

June 

24 

112 

207 

8.6 

7.6 

44 

1.5 

4.7 

72.2 

2.5 

5 

19 

July 

86 

113 

135 

257 

9.9 

9.7 

51 

2.0 

5.0 

51.0 

2.0 

4 

15 

Aug. 

26 

126 

144 

213 

8.2 

6.5 

47 

2  4 

3.4 

71.0 

2.7 

2 

34 

Sept. 

25 

122 

U5 

203 

8.1 

6.6 

46 

2.5 

3.2 

50.0 

2.0 

0 

8 

Oct. 

26 

128 

154 

193 

7.4 

5.8 

56 

2.1 

3.4 

41.0 

1.6 

2 

7 

Nov. 

24 

188 

155 

155 

6  4 

4.6 

42 

2  3 

2.7 

45.5 

1.8 

3 

18 

Dec. 

20 

127 

140 

120 

6.2 

4.8 

37 

2.1 

2.9 

25.0 

1.2 

4 

10 

Jan. 

25 

106 

118 

84 

3.3 

3.1 

27 

12 

2.8 

37.0 

15 

1 

IS 

Feb. 

23 

100 

118 

121 

5  2 

5.0 

36 

1.7 

2.8 

24.5 

1.0 

0 

0 

March 

23 

100 

113 

78 

3  4 

3.4 

23 

0  9 

3  4 

22.0 

1.0 

0 

0 

April 

24 

98 

100 

76 

3  1 

3  1 

19 

10 

4.0 

5.0 

0.8 

0 

0 

Total 

283 

1,3221 

1,816 

456 

486.2 

21 

122 

Ae.  per 
Month 

23.5 

115 

132 

151.3 

6  3 

5.45 

38 

1.78 

3  5 

40.5 

1.6 

(Ihr. 

35  min.) 

1.75 

10.1 

1  Totals  for  May  and  June  not  kept. 


McCORD  AND  MINSTER— PLANT  MEDICAL  SERVICE       367 


men,  greatly  exceed  the  relatively  small 
number  coming  under  our  observation. 
Although  proof  is  lacking,  there  are  rea- 
sons to  believe  that  less  than  10  per  cent, 
of  even  the  most  trivial  injuries  failed 
to  come  under  the  observation  of  the 
medical  department.  In  short,  it  is 
maintained  that  the  work  of  the  dispen- 
sary has  met  the  problems  of  medical 
and  surgical  relief  as  well  as  they  are 
customarily  met  by  a  full-time  person- 
nel in  a  large  plant. 

ACCOMPLISH.MENTS   IN  SaNIT.ATION  AND 

Hygiene 

At  the  outset  of  work,  it  was  recorded 
that  the  conditions  of  general  sanitation 
in  this  plant  were  bad.  The  plant  was 
of  the  well-known  type  having  no  drink- 
ing water  facilities  except  coolers  with 
common  drinking  cups  and  over-chilled 
water;  very  bad  lighting,  both  artificial 
and  natural ;  no  provisions  for  hot  water 
for  washing  purposes  and  no  facilities 
for  any  washing,  except  rusty  iron  sinks 
with  cold  running  water.  The  plant  was 
characterized  by  the  marked  disorderly 
arrangement  of  materials  and  of  some 
equipment.  Dirt  and  dust  and  "junk" 
had  accumulated  throughout  the  plant. 

The  new  managers  of  this  plant  were 
themselves  aware  of  bad  conditions  and 
gave  full  co-operation  in  the  betterment 
of  most  of  the  defects  in  working  condi- 
tions brought  to  their  attention  by  the 
physician.  At  the  end  of  one  year,  on 
checking  up  measures  and  mechanism 
for  the  betterment  of  working  condi- 
tions, the  following  improvements  were 
found  to  have  been  instituted  or  in- 
stalled: 

(a)  A  drinking  water  system  with  one 
outlet  for  each  group  of  about  thirty 
men  was  installed. 

(b)  \\^ashing  facilities  were  much  im- 
proved through  the  installation  of  a  hot- 


water  system  and  an  increased  amount 
of  available  washing  equipment. 

(c)  Improved  natural  lighting  was 
secured  through  the  establishment  of  the 
custom  of  routine  window  washing.  Dis- 
tinct betterment  of  artificial  lighting  was 
obtained  through  the  installation  of 
standard  lighting  equipment  practically 
throughout  the  plant. 

(d)  Improvement  in  the  order  of  the 
plant  was  effected  through  proper  stor- 
age of  much  antiquated  material  and 
machiner}-,  through  the  proper  piling  of 
materials,  and  through  the  use  of  metal 
containers  for  small  parts. 

(e)  The  general  cleanliness  of  the 
plant  was  improved  through  the  services 
of  a  hard-working  porter. 

(/)  The  ventilation  of  various  factory 
departments  was  partially  remedied 
through  the  regulation  of  open  windows, 
for  air  motion,  etc. 

(s;)  A  great  many  minor  improve- 
ments were  instituted  in  every  depart- 
ment. It  is  undesirable  that  these  be  in- 
di\idually  listed  but  some  idea  of  their 
nature  may  be  gained  from  the  citation 
of  such  examples  as  the  correction  of 
bad  posture  conditions  in  isolated  cases, 
extension  of  the  exhaust  system,  in- 
creased heating  facilities,  etc. 

Accomplishments  in  Safety  Work 

The  part-time  medical  department 
was  charged  with  full  responsibility  for 
all  safety  activities  in  the  plant.  On 
making  a  general  tour  of  inspection  and 
inquiries  at  the  inception  of  our  health 
work,  it  was  evident  that  this  plant  was 
protected  only  to  the  minimum  by  me- 
chanical guards,  that  such  as  were  pres- 
ent were  largely  due  to  the  requirements 
of  state  factory  inspection,  that  many 
guards  which  had  been  installed  were 
not  in  use,  and  that  the  spirit  of  safety 
was  not  present  either  among  workers 


368 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


and  foremen,  or  among  all  of  the  execu- 
tives. On  all  sides  many  specific  haz- 
ards were  readily  discernible. 

During  one  year  of  service  many  dis- 
tinct accomplishments  in  safety  better- 
ment were  secured. 

(a)  A  safety  committee  was  formed 
which,  however,  was  only  participated  in 
by  foremen,  sub-foremen  and  executives 
on  account  of  a  fixed  administrative 
policy. 

(b)  A  bulletin  board  service  was  es- 
tablished in  all  departments,  using  both 


such  inno\'ations  as  improved  lighting, 
improved  orderliness,  automatic  shut- 
off  of  power  for  emergencies,  etc. 

In  general,  it  is  maintained  that  the 
accomplishments  in  safety  through  this 
part-time  service  were  adequate. 

Costs   of  This   P.art-Time  Medical 
Service 

The  expenses  incident  to  the  equip- 
ping and  fitting  up  of  the  dispensary 
were  approximately  $600.    These  costs 


Fig.  2. — Absentee  rate  and  trend  of  absenteeism  during  period  from  May,  1920,  when  industrial  medi- 
cal service  was  started,  to  April.  1921,  wtien  medical  service  was  discontinued,  and  from  April,  1921,  to 
September,  1921,  when  physician  was  on  call  only. 


Standard  posters  from  commercial  ser- 
vices and  posters  prepared  by  the  medi- 
cal department  based  on  actual  plant 
conditions  or  particular  accidents. 

(c)  All  machinery  was  carefully  stud- 
ied. Numerous  guards  were  built  and 
installed,  and  various  faulty  practices 
were  corrected. 

(d)  In  special  instances,  a  study  was 
made  of  the  mental  and  physical  adapt- 
ability of  workers  to  their  particular 
jobs.  This  necessitated  the  shifting  of 
various  workers  in  the  interest  of  the 
plant  and  safety. 

{e)  An  automatic  fire-alarm  system 
was  installed. 

(/)  During  this  period  the  practice  of 
monthly  fire  drills  was  instituted. 

(g)  Numerous  general  improvements 
were  made  in  safety  conditions  through 


have  been  so  amortized  that  $100  is  the 
amount  properly  chargeable  to  this  one 
year's  experience.  The  recurring  ex- 
pense for  drugs,  bandages,  etc.,  averaged 
$5  per  month  for  a  year.  For  services  in 
medicine,  hygiene,  sanitation,  etc.,  a 
charge  of  $200  a  month  was  made. 
By  agreement  all  state  compensation 
checks,  which  ordinarily  would  have 
been  paid  out  to  a  neighborhood  phy- 
sician, were  returned  to  the  plant  physi- 
cian and  in  turn  were  given  over  to  the 
company.  This  practice  appreciably 
lowered  the  cost  of  services  to  this  plant. 
The  returns  of  such  state  checks  for  the 
se\'eral  months  are  indicated  below: 

June   $  07.25 

July    137.75 

August 91.25 

September  125.95 


xAIcCORD  AND  MINSTER- 

October    $104.75 

November   41.80 

December 79.75 

January   G3.50 

February 39.00 

March 6.50 

April   105.50 

The  actual  cost  for  services  was  thus 
$1,667.00,  which  gives  an  average  of 
$139.00  per  month  or,  on  a  basis  of  an 
average  of  115  workers,  $1.20  per  em- 
ployee per  month,  or  $14.40  per  year. 
These  supplied  figures  do  not  take  into 
consideration  the  costs  of  the  various 
sanitary  and  safety  appliances  installed 
nor  do  they  include  any  charge  against 
the  medical  department  for  loss  of  time 
of  emplo}'ees  while  off  their  jobs  in 
the  dispensary  under  treatment. 

Benefits  to  the  Plant  Owners 

In  the  foregoing  sections  of  this  paper 
we  have  set  forth  the  quantity,  the  na- 
ture, and  the  costs  of  our  activities  in 
this  small  plant.  Persons  to  whom  the 
reading  of  this  paper  will  be  a  matter  of 
interest  will  accept  without  argument 
the  benefit  of  this  type  of  work  to  the 
sick  or  injured  individual  worker  and 
to  the  workers  as  a  group.  There  re- 
mains, however,  the  necessity  of  record- 
ing the  advantages  accruing  to  the  plant 
management,  in  return  for  the  money 
paid  out  for  these  activities. 

In  this  plant  prior  to  the  inception  of 
our  work  few  compilable  records  were 
kept  of  absenteeism,  turnover,  accident 
frequency  and  of  such  other  matters  as 
later  would  enable  a  determination  by 
comparison  of  the  worth  of  human  con- 
servation. Moreover,  before  and  after 
the  commencement  of  our  work  no  pre- 
cise methods  obtained  in  the  plant  for 
measuring  the  work  output  of  individ- 
uals or  the  morale  of  the  plant's  work- 
ers.   In  the  absence  of  precise  evidence 


PLANT  MEDICAL  SERVICE       369 

m  these  last  named  respects,  no  claims 
will  be  made  to  accrued  advantages 
based  on  opinions.  Proof,  however,  is 
a\-ailable  in  other  aspects  of  work,  some 
of  which  follow. 

(a)  Absenteeism. — Records  of  absen- 
teeism were  instituted  at  the  time  of 
beginning  the  medical  department  work. 
The  experience  of  this  first  month  yield- 
ed a  daily  absentee  rate  of  6  per  cent. 
From  inquiry  into  available  records  we 
came  to  accept  this  rate  as  about  normal 
for  previous  months.  This  rate  refers  to 
absenteeism  from  all  causes,  except  va- 
cations. Immediately,  as  the  result  of 
our  acti\ities,  the  absentee  rate  fell  to 
3  per  cent.  (Fig.  2).  Accurate  records 
for  the  ensuing  eleven  months  are  as 
follows: 

Per  Cent. 

June  3.0 

•Tuly  3.8 

August   5.0 

September   2.6 

October 3.1 

November 2.4 

December I.7 

January 2.5 

February   2.2 

March 1.1 

Ai)ril   2.5 

The  average  absentee  rate  for  the 
year,  excluding  the  first  month,  was  2.7 
per  cent.  This  is  a  saving  of  3.3  per 
cent,  of  the  work  force  through  protect- 
ive measures.  It  thus  appears  that  on  a 
yearly  basis,  3.8  men  were  daily  kept  at 
work,  who  otherwise  would  have  been 
absent.  This  aggregates  a  saving  of 
1,140  days  in  the  course  of  a  year.  In 
this  plant,  because  of  the  nature  of  its 
work,  it  is  accepted  that  the  readjust- 
ments required  in  the  event  of  the  ab- 
sence of  an  employee  occasion  a  plant 
loss  equi\-alent  to  the  worker's  pay.  At 
the  low  figure  of  $3  per  day  as  the  aver- 
age wage,  $3,420  accrued  as  savings 
from  this  item  alone. 


370 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


(b)  Turnover  Rate. — Evidence  aris- 
ing from  turnover  rates  as  a  criterion 
has,  during  recent  months,  been  subject 
to  marked  fallacies  owing  to  industrial 
conditions.  In  this  city,  industrial  de- 
pression in  general,  and  particularly  in 
this  industry,  was  not  felt  until  about 
January,  192  L  For  this  reason,  our 
computations  only  embrace  our  service 
months  during  1920.  In  seeking  to  es- 
tablish a  labor  turnover  rate  prior  to 
the  commencement  of  health  supervi- 
sion, we  were  led  to  the  acceptance  of 
25  per  cent,  monthly  as  normal.  This 
unusually  high  figure  was  in  part 
brought  about  through  the  employment 
in  this  factory  of  a  considerable  num- 
ber of  old  men  and  of  young  boys, 
among  whom  the  turnover  rate  was 
known  to  be  high.  This  accepted  turn- 
over rate  is  borne  out  by  the  first  two 
months'  experience  which  again  aver- 
aged 25  per  cent.  Following  these  two 
months  the  rate  appreciably  decreased 
as  follows : 

Per  Cent. 

July    15.0 

August  10.3 

September  (high  rate  due  to  re- 
turn of  voung  boys  to  school)  .22.0 

October  .* 16.0 

November   13.0 

December 12.0 

The  average  turnover  rate  for  the  six 
months  under  consideration  was  14.7 
per  cent.  The  costs  of  labor  turnover 
are  well  known  to  both  manufacturers 
and  industrial  physicians.  The  above- 
mentioned  reduction  of  the  rate  yielded 
visible  mone}*  returns  for  the  money  in- 
vested by  the  management  in  the  medi- 
cal department. 

(c)  During  the  entire  period  of  ser- 
vice in  this  potentially  hazardous  plant, 
not  one  accident  occurred  resulting  in 
an  award  for  permanent  disability.   Al- 


though many  trivial  accidents  occurred,, 
none  was  of  such  severity  that  even  a 
single  phalanx  was  lost. 

{d)  During  this  period  of  one  year, 
only  twenty-one  persons  were  absent 
from  work  on  our  advice  because  of  in- 
jury or  sickness.  Although  322  injur- 
ies of  all  degrees  are  recorded,  only  four 
were  of  such  severity  as  to  cause  a  loss 
of  more  than  one  week's  time. 

{e)  For  every  thousand  man  days  of 
factory  work,  only  0.6  individuals  lost 
time  on  account  of  injury  or  sickness. 

(/)  The  average  loss  of  time  in  hours 
for  persons  absent  on  account  of  injury 
or  sickness  was  lifty-two  hours. 

The  significance  of  such  results  as 
these  in  a  hazardous  plant  will  be  ap- 
preciated by  industrial  executives  and 
physicians  without  an  attempt  on  our 
part  to  compute  in  dollars  and  cents  the 
worth  of  such  measures.  In  addition  to 
the  returns  cited,  many  other  benefits 
from  medical  work  of  the  kind  men- 
tioned will  be  accepted  by  all. 

Summary 

The  number  of  workers  employed  in 
small  factories  exceeds  the  number  en- 
gaged in  work  in  plants  of  500  or  more 
employees.  Proportionally,  work  con- 
ditions are  less  satisfactory  in  small  fac- 
tories than  in  larger  plants.  It  is  desir- 
able that  some  means  be  found  to  apply 
to  the  small  plant  the  same  type  of 
health  conservation  measures  that  have 
proved  so  successful  and  so  valuable  in 
larger  plants.  The  experience  of  a  group 
of  industrial  health  workers  in  a  small 
plant  averaging  115  employees  is  re- 
corded. The  results  of  such  work  have 
been  of  sufficient  benefit  to  justify  the 
assertion  that  this  procedure  may  suc- 
cessfully be  applied  to  small  plants  in 
general. 


METATARSOPHALANGEAL    FRACTURES,    WITH    A    REPORT    OF 

TWENTY-SEVEN  CASES* 

Alfred  G.  Bolduc,  M.D. 


A  LARGE  proportion  of  contusions 
and  bruises  of  the  feet  are  treated 
as  such  and  consequently  do  not  do 
well.  This  is  especially  true  of  injuries 
of  the  toes.  These  cases  are  charac- 
terized by  continuous  throbbing  pain, 
tenderness  to  pressure,  persistent  ecchy- 
mosis,  swelling,  and  in  some  cases  local- 
ized edema,  the  underlying  cause  of 
which  symptoms,  as  rexealed  b\-  the 
X-ray,  is  often  a  fractured  bone.  In- 
deed, I  ha\e  come  to  the  conclusion, 
after  several  years'  study  of  foot  in- 
juries, that  the  X-Ray  is  the  only  sure 
method  of  re\ealing  the  e.xistence  or 
non-existence  of  metatarsophalangeal 
fractures,  and  their  exact  location.  As 
a  routine  procedure,  therefore,  I  have 
a  skiagram  taken  of  all  foot  injuries 
which  warrant  the  least  suspicion  that 
a  fracture  mis^ht  exist.     (See  Figs.  1  and 

2.) 

All  of  the  cases  of  metatarsophalan- 
geal fractures  here  reported  were  due  to 
direct  violence,  and  with  one  exception 
— namely.  Case  12,  in  which  the  fracture 
was  caused  by  a  heavy  hand  truck  pass- 
ing over  the  patient's  toes — they  had  a 
history  of  some  heavy  object  falling  on 
the  foot.  (See  Table  1.)  Nearly  all  of 
the  cases  were  seen  immediately  after 
injury,  and  all  within  one  hour  after 
injury,  at  which  time  practically  the 
only  symptoms  exhibited  were  sharp, 
intense  exquisite  pain  at  the  location 
of  the  fracture,  and  ecchymosis. 

•Received  for  publication  Jan.  3,  1922. 


Bayonne,  N.  J. 

The  symptoms  in  foot  fractures,  of 
course,  \  ary.  Inability  to  bear  weight 
on  the  foot  and  localized  tenderness 
were  the  only  symptoms  in  Case  21.  Ec- 
chymosis is  quite  constant  but  not  al- 
ways present.  Crepitus  is  absent  in  the 
majority  of  metatarsophalangeal  frac- 
tures, as  is  also  mobility.  Deformity  is 
rare,  unless  swelling  is  so  classified. 


Fig.  1.. — Case  10,  showing  comminuted  fracture  of 
distal  iihnlMiix  of  left  jrrcnt  toe  and  also  of  first  toe. 

The  types  of  fracture  represented  b\' 
the  twenty-seven  cases  reported  in  this 
article  are,  in  the  order  of  their  fre- 
quency, chip  fractures,  fractures  of  the 
proximal  phalanx,  and  fractures  of  the 
metatarsal  bones. 


371 


372 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Chip  Fractures 

Comminuted  fracture,  simple  or  com- 
pound, of  the  distal  phalanx,  known  to 
the  industrial  surgeon  as  chip  fracture, 
is  the  most  common  type  of  fracture 
of  the  foot,  yet  it  recei\'es  scant  atten- 
tion in  our  textbooks  and  in  other  med- 
ical literature  as  well.  These  fractures 
present  a  very  characteristic  picture, 
even  \\-hen  seen  immediately  after  in- 
jur}'. The  most  prominent  symptoms 
are  se\ere  pain,  discoloration  caused  by 
the  extra\-asation  of  blood  into  the  tis- 
sues, and  swelling.  In  some  cases  pain 
on  palpation  is  the  only  symptom. 


Fig.  2. — Case  2G,  showing  fracture  of  distal  pha- 
lanx and  iiroxinial  plialanx  of  right  great  toe,  and 
chip  fracture  of  distal  phalanx  of  right  second  toe. 

It  is  my  experience  that  compound 
chip  fractures  heal  more  quickly  and 
are  less  painful  than  the  simple  fractures 
when  given  expectant  treatment.  On 
study  of  the  anatomy  of  the  toe,  dense 
connective  tissue  is  found  over  the  adi- 


pose tissue  and  underlying  structures, 
and  this  tends  to  form  a  capsulated  sac 
which  holds  the  extravasated  blood 
caused  by  the  fragments  of  bone  injur- 
ing the  surrounding  tissue^  This  pres- 
sure in  the  sac  causes  great  pain.  Some- 
times the  blood  escapes  to  the  nail  bed, 
and  is  then  very  easily  detected.  In 
such  cases  expectant  treatment  does  no 
good,  and  it  is  my  practice  to  incise  the 
toe,  using  a  cataract  knife  or  a  sharp- 
pointed  scalpel.  The  site  of  incision 
varies,  but  the  lateral  aspect  gives  the 
most  uniform  results.  An  incision  deep 
enough  to  free  the  extravasated  blood  is 
required.  When  free  drainage  of  the 
blood  is  established,  the  throbbing  pain 
ceases,  the  toe  uniformly  gets  well,  and 
the  period  of  disability  is  remarkably 
lessened.  The  danger  of  latent  infection 
is  practically  eliminated.  In  fact,  I 
have  never  had  a  case  of  infection  when 
prompt  surgical  intervention  was  em- 
ployed. In  some  cases  it  is  advisable 
to  puncture  or  raise  the  nail,  especially 
if  there  is  blood  beneath  it.  This  can 
be  done  with  sharp-pointed  scissors. 
Expectant  treatment  is  then  given. 

The  surgical  treatment  of  chip  frac- 
tures must  be  carried  out  under  strictly 
aseptic  conditions.  Personally,  I  swab 
the  part  with  a  5  per  cent,  solution  of 
picric  acid  in  95  per  cent,  alcohol.  Tinc- 
ture of  iodine  can  also  be  used.  Co- 
caine or  apothesine  is  used  as  a  local 
anesthetic,  and  the  operation  is  rendered 
painless.  Wet  antiseptic  dressings  are 
used  for  two  or  three  days  after  the 
operation  in  order  to  prevent  any  pos- 
sible infection  with  skin  organisms. 

As  a  result  of  my  experience,  I  have 
become  con\-inced  that  the  X-ray  offers 
the  only  sure  method  in  the  diagnosis 
of  chip  fracture,  and  that  surgical  inter- 
ference in  simple  chip  fractures  is  the 
proper  procedure. 


BOLDUC— METATARSOPHALANGEAL  FRACTURES         373 


TABLE   1.  — REPORT  OF  CASES  OF   METATARSOPHALANGEAL  FRACTLUE 


Case 
No. 


Reg. 
No. 


Date  of 
Accident 


Cause  of  Accident 


Time 
Disabled 


X-ray  Diagnosis 


End- Result 


1 
2 

S 
4 

5 

6 
7 
8 
9 
10 

11 

12 
IS 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 

24 

25 
26 


50 
355 

510 
583 
809 
866 
980 
989 
1232 
1384 

1771 

2314 
1107 
1166 
1365 
2187 
2645 
2710 
2721 

514 

1218 

915 

1166 
1166 
1159 

liO'J 


3-18-20  '  iron  bar  fell  on  foot 
I 
10-29-20     steel  plate  fell  on  toe 

1-18-20  i  casting  fell  on  foot 

12-3-19     steel  plate  fell  on  foot 

1-17-20      steel    bar    fell  on  foot 

2-3-20       steel  plate  fell  on  foot 

11-29-19      iron  bar  slipped  and  fell  on 

foot 
11-15-19      steel  plate  fell  on  foot 

8-10-20     heavy  piece  of  iron  fell  on  foot 

8-15-20      box  fell  on  toes 

1-21-21      heav>' piece  of  pipe  fell  on  foot 

11-15-19      foot   caught  under   wheel  of 

truck 
12-1-19        heavy  iron  bar  fell  on  foot 

3-23-2)      iron    plate   fell  on  toes 

3-8-21        heavy  box  fell  on  toe 

2-10-21      piece  of  iron  fell  from  crane 

I       onto  foot 
2-15-20  I  plank  fell  on  foot 

I 
1-4-21     I  heavy  plank  fell  on  foot 

10-21-21  I  heavy  iron  bar  fell  on  foot 

4-7-21  casting  fell  oa  foot 

7-18-21  heavy  piece  of  iron  fell  on  foot 

11-16-40  heavj- forging  fell  on  foot 

7-15-20  heavy  piece  of  iron  fell  on  foot 

5-15-19  I   heavy  bar  of  steel  fell  on  foot 
3-4-20     ;   heavy  box  fell  on  foot 
9-7-21      '  heavy  iron  door  fell  on  foot 


2-10-22 


1   ton  iruu  frame   fell  on  foot 
from  height  of  6  inches 


days 
17         comminuted  (chip)  fracture    of 

distal  phalanx  of  left  great  toe 
none       longitudinal   fracture   complete 

of    distal   phalanx    of   right 

great  toe 
8         longitudinal   fracture   of   distal 

phalanx  of  left  great  toe 
none        comminuted  fracture  of  distal 

phalanx  of  left  great  toe 
none       comminuted  fracture  of  distal 

phalanx  of  right  great  toe 
8  comminuted  fracture  of  distal 

phalanx  of  ri^'ht  great  toe 
26         comminuted   fracture   of   prox- 
imal phalanx  of  left  great  toe 

29  comminuted  fracture  of  distal 

phalanx  of  left  great  toe 
4  comminuted    fracture   of   prox- 

imal phalanx  of  left  great  toe 
12         conuninuled   fracture  of  distal 

phalanx  of  left  great  toe  and 

also  of  first  toe 
21  comminuted   fracture  of   distal 

phalaiLX  of  right  great  toe  and 

of  first  toe 
17         comminuted  fracture  of  distal 

phalanx  of  right  great  toe 
38         transverse  fracture  of  phalanx 

of  first  right  toe 
10         comminuted  fracture  of   distal 

phalanx  of  third  right  toe 
8  incomplete   fracture   of    distal 

phalanx  of  right  little  toe 
7         comminuted   fracture  of  distal 

phalanx  of  left  first  toe 

23  transverse  fracture  of  proximal 

phalanx  of  left  great  toe 
7         incomplete  fracture  of  proximal 
phalanx  of  left  great  toe 

7  comminuted   fracture  of  distal 

phalanx  of  right  first  toe 

30  c<implete  fracture  of  first  meta- 

tarsal bone 
37         complete  fracture  of  second  and 
third  metatarsal  bones 

8  longitudinal     fracture    of    first 

metatarsal  bone 
40  fracture    of    jjroximal    ends    of 

third  and  fourth   metatarsal 

bones 
21  fracture    of    first,    second,    and 

third  left  metatarsal  bones 

24  fracture  of  first  left  metatarsal 
bone 

30  fracture  of  distal  phalanx  and 
proximal  phalanx  of  right 
great  toe,  and  chip  fracture  of 
distal  phalanx  of  right  second 
toe 

42  fracture       of      first,       second, 

third  and  fourth  right  meta- 
tarsal bones 


no  disability 


15%  disability 
of  great  toe 
no  disability 


374 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Fractures  of  Proximal  Phalanx 

Se\-en  of  my  cases  were  fractures  of 
the  proximal  phalanx,  all  caused  by  di- 
rect violence.  Inability  to  stand  on  the 
injured  member  without  intense  pain 
was  the  only  symptom  in  Cases  17  and 
18.  The  other  cases  presented  the  usual 
fracture  symptoms,  excepting  mobility 
and  crepitus — symptoms  which  were  ex- 
hibited in  Case  13  only.  Permanent  dis- 
ability occurred  in  but  one  instance, 
namely.  Case  9.  This  patient  was  un- 
manageable and  did  not  follow  treat- 
ment. His  disability  was  a  loss  of  about 
IS  per  cent,  of  the  function  of  the  great 
toe,  caused  by  a  partial  ankylosis  of  the 
interphalangeal  joint. 

Conservative  treatment  was  gi\'en  in 
all  these  cases,  as  they  were  simply  frac- 
tures without  much  displacement.  A 
plaster  cast  covering  the  whole  foot  from 
toes  to  the  ankle  was  applied.  This 
immobilized  the  foot,  and  the  weight  of 
the  cast  prevented  the  patient  from  us- 
ing the  injured  member.  Rest  and  dis- 
use of  the  foot  is  paramount  to  good 
end-results.  The  disability  period  av- 
eraged twenty  days,  the  longest  period 
being  thirty-eight  days. 

Fractures  of  Metatarsal  Bone^ 

Six  of  my  cases  were  simple  meta- 
tarsal fractures,  all  caused  by  direct 
violence,  viz.,  some  heavy  object  falling 
on  the  foot.  Clinically  it  was  impossible 
to  make  a  diagnosis  in  three  of  these 
cases.  Inability  to  bear  weight  on  the 
foot,  and  exquisite,  localized  pain  were 
the  outstanding  symptoms  in  all  cases. 
Swelling  and  ecchymosis  accompanied 
all  cases  excepting  Case  21.  Cases  24 
and  25  were  the  only  ones  in  which 
crepitus  and  mobility  were  detected,  and 
in  which  deformity  was  in  evidence. 

A  correct  history  of  any  foot  injun.% 


with  moderate  or  severe  clinical  symp- 
toms, is  essential  for  a  correct  diagnosis. 
The  X-ray  sometimes  shows  a  fractured 
metatarsal  bone  where  it  is  least  ex- 
pected, thus  eliminating  doubtful  cases, 
and  it  should,  therefore,  be  used  as  a 
routine  in  contusions  caused  by  severe 
direct  blows. 

The  treatment  in  all  these  cases  of 
metatarsal  fracture,  excepting  Case  27, 
was  the  same.  After  good  apposition 
was  established,  a  plaster-of-Paris  cast 
was  immediately  applied,  with  a  steel 
wire  saw  underneath.     \\'hen  the  cast 


Fig.  3. — Case  27.  showing  fracture  of  first,  .soeona, 
IliirU  and  fourtli  right  inetatar.sal  bones. 


had  hardened,  it  was  cut  with  the  saw, 
and  then  bandaged,  in  order  that,  if  the 
foot  swelled  to  any  extent,  the  cast  could 
expand  accordingly,  and  no  unnecessary 
pressure  pain  result.  The  period  of 
wearine  the  cast  was  about  three  weeks, 


BOLDUC— METATARSOPHALANGEAL  FRACTURES 


375 


but  disability  as  a  rule  extended  a  week 
or  two  longer.  In  Case  27  the  fracture 
of  the  first  metatarsal  bone  could  not  be 
reduced  by  ordinary  methods  and  kept 
in  place.  (See  Fig.  3.)  I  therefore 
operated  on  the  patient's  foot,  drilling 
and  suturing  with  Kangaroo  tendon, 
and  in  this  way  procured  perfect  appo- 
sition. At  the  present  time  all  my  pa- 
tients are  working,  and  not  one  com- 
plains of  any  ill  results  from  his  injury. 

Summary 

1.  The  outstanding  symptom  in  all 
metatarsophalangeal  fractures  is  ex- 
quisite, localized  pain. 

2.  In  severe  contusions  of  the  distal 
phalanges  always  have  a  skiagram 
taken,    as    experience   has    shown    that 


fractures  are  \ery  common  and  that  they 
are  not  trivial  things. 

3.  Conservative  treatment  in  simple 
comminuted  fracture  of  the  distal  phal- 
anx is  contraindicated.  Surgical  inter- 
ference hastens  the  cure  and  prevents 
latent  infection. 

4.  All  cases  of  severe  contusions  and 
bruises  of  the  feet  should  be  treated  as 
fracture  cases  until  proven  otherwise. 

5.  Apposition  of  fragments  in  phal- 
angeal and  metatarsal  fractures  should 
be  as  nearly  normal  as  possible.  Surgical 
procedure  should  be  resorted  to  if  other 
methods  fail  in  the  desired  results. 

6.  End-results  in  metatarsophalan- 
geal fractures  are  uniformally  good  if 
proper  treatment  is  given. 

7.  In  the  diagnosis  of  metatarsopha- 
langeal fractures  the  X-ray  is  indispens- 
able. 


THE  ESTABLISHMENT  OF  A  DENTAL  CLINIC* 
L.  E.  Hastings,  M.D. 

The  ].  G.  Brill  Company,  Philadelphia 


WAR  experience  has  added  convic- 
tion to  our  conception  of  the 
utility  of  preventive  dentistry.  It  has 
become  unnecessary  to  argue  for  the 
value  of  dentistry  in  relation  to  indus- 
trial health,  and  the  only  phases  of  the 
subject  which  today  merit  discussion 
are  the  manner  of  establishment  and  the 
organization  of  the  industrial  dental 
unit. 

In  February,  1920,  the  author  sub- 
mitted for  the  consideration  of  the  man- 
agement of  The  J.  G.  Brill  Company  an 
outline  of  the  various  types  of  industrial 
dental  dispensaries,  and  at  the  same 
time  made  the  suggestions  that  the  sec- 
ond type  of  organization  described  be 
adopted,  and  that  the  dental  clinic  come 
directly  under  the  supervision  of  the 
medical  director  who  would  be  responsi- 
ble for  its  success  or  failure.  The  follow- 
ing are  the  four  kinds  of  industrial  den- 
tal dispensaries  submitted  for  considera- 
tion : 

1.  Those  wherein  only  examinations 
and  prophylaxis  are  done. 

2.  Those  wherein  examinations,  pro- 
phylaxis, and  fillings  are  done  and  a 
nominal  charge  made  to  the  employee. 

3.  Those  wherein  all  types  of  den- 
tistry are  done  for  employees  entirely  at 
the  company's  expense. 

4.  Those  wherein  work  is  done  for  the 
employees'  children.  This  is  building 
for  future  employees. 

Choice  of  any  one  of  these  groups  will 
depend  upon  local  conditions  and  upon 
the  type  of  industry  to  be  served.   In  the 


*Keceived  for  publication  Dec.  7,  1921. 


case  of  The  J.  G.  Brill  Company  the  sec- 
ond group  was  chosen,  and  the  work 
done  includes  examinations,  treatments, 
extractions,  procaine  extractions,  clean- 
ing, and  cement  and  porcelain  fillings. 
All  work  is  done  in  company's  time,  and 
all  employees  are  classed  alike,  except 
that  those  who  have  been  employed  less 
than  six  months  must  pay  regular  dental 
rates,  the  difference  being  refunded  after 
six  months'  employment. 

After  careful  consideration  the  follow- 
ing nominal  charges  were  evolved : 

Examination  free 

Treatment   25  cents 

Extractions 25 

Gas  extractions   50 

Procaine  extractions  50 

Cleaning  50 

Amalgam  fillings 50 

Porcelain  fillings   75 

The  dentist  is  paid  a  salary  by  the 
company  and  is  permitted  to  make  ap- 
pointments for  gold  work,  plate,  crown 
and  bridge  work  in  his  own  office  outside 
of  company  time  and,  of  course,  at  regu- 
lar dental  rates.  We  believe  that  such  an 
arrangement  will  always  be  successful 
if  the  dentist  is  the  right  type  of  man. 
The  employees  treated  in  the  clinic 
make  all  their  payments  through  the 
paymaster's  office.  Directly  in  front  of 
the  dentist's  chair  we  have  placed  a  sign 
reading  "Money  due  for  dental  work 
will  be  deducted  from  your  next  pay  en- 
velope." We  have  also  displayed  the 
charges  conspicuously  and  have  thereby 
avoided  controversies  most  satisfac- 
torily. 


376 


HASTINGS^INDUSTRIAL  DENTAL  CLINIC 


377 


The  dentist's  hours  will  of  course  vary 
with  the  size  of  the  industr>'.  In  this 
company,  with  an  employment  roll  of 
1,511,  we  started  with  three  mornings  a 
week  from  8  to  12  a.  m.,  but  since  the 
business  depression  have  reduced  the 
time  to  two  mornings  a  week.  This,  na- 
turally, will  be  increased  as  business  re- 
turns to  normal.  Since  the  treatments 
are  on  company's  time  we  have  found  it 
necessary  to  demand  that  all  appoint- 
ments be  made  between  8  and  8.30  a.  m. 
This  has  facilitated  the  work  very 
materially,  has  lessened  confusion,  and 
has  prevented  unnecessary  trips  to  the 
dental  office.  Emergency  work  is,  of 
course,  an  exception,  and  is  cared  for 
without  preliminary  arrangements. 

A  dental  clinic  can  be  installed  in  an 
exceedingly  expensive  manner,  yet  good 
results  can  be  secured  with  an  organiza- 
tion established  on  a  more  economical 
basis.  Our  equipment  has  consisted  of 
one  dental  chair,  one  foot  engine  and 
right  angle  hand  piece,  one  instrument 
cabinet,  assorted  instruments  and  ma- 
terial. This  equipment  has  served  our 
industry  with  a  maximum  of  efficiency 
and  a  minimum  of  cost. 


The  work  of  the  dental  clinic,  sum- 
marized from  our  records  for  the  period 
of  twenty  months  from  March,  1920,  to 
November,  1921,  is  as  follows: 

Number  of  patients 1,735 

Number  of  emergency  treatments. .  .1,621 

Number  of  cleanings 353 

Number  of  teeth  extracted 507 

Number  of  fillings 899 

Number  of  treatments 474 

The  gross  operating  cost  for  this  peri- 
od, including  the  dentist's  salary,  insur- 
ance, depreciation,  interest,  and  cost  of 
material,  was  $1,381.89.  The  receipts 
for  the  same  period  were  $1,134.75.  The 
actual  cost  to  the  company  was  thus 
$247.14,  or  a  little  over  $12.35  a  month. 

The  dental  clinic  as  we  have  estab- 
lished it  has,  therefore,  been  very  inex- 
pensi\e,  and  its  value  as  a  part  of  our 
health  service  has  been  beyond  cavil  or 
question.  The  extent  to  which  our  em- 
ployees have  taken  advantage  of  it  re- 
mo\es  all  doubt  upon  this  point,  for  un- 
less the  service  rendered  met  the  need  in 
a  substantial  manner  the  patronage  of 
the  clinic  would  have  fallen  away,  and 
this  it  has  not  done. 


REPORT  ON  AN  INVESTIGATION  TO  DETERMINE  THE  HAZARD 
TO  THE  HEALTH  OF  OPERATORS  USING  THE  SPRAYING 
MACHINE  FOR  PAINTING:    THE   RISK   OF   LEAD 

POISONING* 

N.  C.  Sharpe,  A.B.,  M.B. 

From  the  Department   of  Pharviacology  of  the  University  of  Toronto 


A  T  the  request  of  the  division  of 
■^  Industrial  Hygiene  for  Ontario 
and  the  Committee  on  Industrial  Fa- 
tigue, the  Department  of  Pharmacology 
of  the  University  of  Toronto  undertook 
an  investigation  of  the  hazard  to  the 
health  of  operators  of  paint-spraying 
machines. 

The  manufacturers  of  paint-spraying 
machines  obviously  realize  that  there 
may  be  a  risk  involved  in  their  use  as 
they  describe  in  their  advertisements 
and  show  in  their  exhibits  paint-spray- 
ing machines  with  systems  for  the  con- 
trol of  the  spray  by  means  of  cabinets, 
fans,  helmets  or  masks.  The  prohibition 
of  the  use  of  spray  machines  by  legisla- 
tion in  various  states  has  been  consid- 
ered, but  up  to  the  present  time  has 
been  defeated  in  committee  or  withheld 
for  further  consideration. 

The  dangers  involved  in  the  use  of 
paint  depend  on  the  constituents  of  the 
paint  and  the  method  of  applying  it. 
Paint  consists  of  pigment,  linseed  oil, 
turpentine,  thinners  and  driers.  Either 
pigment  or  vehicle  may  be  poisonous. 
The  pigments  used  are  mainly  lead,  zinc, 
barium,  iron  and  lithopone  (barium 
sulphate  and  zinc  sulphide).  We  have 
no  reason  to  believe  that  pigments  other 
than  lead  in  the  forms  used  give  symp- 
toms  of  poisoning.     Dr.   Hamilton   in 


♦Published  by  fiprmission  of  the  Ontario  Provin- 
cial Board  of  Iloalth.  Received  for  i)Ulilication 
Dec.  27,  1021. 


Hygiene  of  the  Painters'  Trade  (1)  says 
that  the  dangerous  pigments  are  the  dif- 
ferent salts  of  lead.  The  British  De- 
partmental Committee  on  the  Danger  in 
the  Use  of  Lead  in  the  Painting  of 
Buildings  (2)  recommends  a  law  pro- 
hibiting the  use  of  paint  material  which 
contains  more  than  5  per  cent,  of  its 
dry  weight  of  a  soluble  lead  compound. 
The  Committee  does  not  consider  other 
pigments  dangerous,  but  suggests  the 
possibility  of  danger  from  the  liquid 
vehicles. 

According  to  Legge  and  Goadby  (3, 
p.  291)  the  causes  of  lead  poisoning 
in  painting  are  arranged  in  the  follow- 
ing order  of  importance:  {a)  dust  from 
sandpapering  one  surface  of  lead  paint 
before  applying  another;  (b)  dust  from 
mixing  dry  white  lead  with  oil ;  (c)  dust 
arising  from  lead  paint  that  has  dried 
on  overalls  and  dripcloths;  (d)  contam- 
ination of  food  by  unwashed  hands  ;  (e) 
fumes  from  burning  off  old  paint.  The 
British  Departmental  Committee  above 
mentioned  emphasizes  the  fact  that  the 
center  of  danger  in  all  lead  industries 
is  in  the  dust  produced.  There  is  a 
diminution  in  the  death  rate  and  in  the 
number  of  cases  of  poisoning  following 
the  reduction  of  lead  dust  in  dangerous 
lead  processes  (4) .  The  poisonous  nature 
of  any  lead  compound  varies  with  the 
size  of  the  particles,  the  ease  of  their 
distribution  in  the  air,  and  their  solubil- 
ity in  the  normal  body  fluids. 


378 


SHARPE— LEAD  POISONING  IN  SPRAY  PAINTING 


379 


Oliver  (5)  raises  the  question  as  to 
whetlier  the  symptoms  of  so-called 
lead  poisoning  of  painters  are  always 
and  really  due  to  lead.  Goadby  (4)  is  of 
the  opinion  that  the  illness  complained 
of  by  house  painters  is  more  often  the 
result  of  turpentine  and  thinners  used 
than  of  lead. 

Lead  may  gain  entrance  to  the  body 
in  two  ways :  (a)  by  the  respiratory 
system  as  a  consequence  of  inhaling 
lead-dust-laden  air;  and  (b)  by  the  ali- 
mentary system.  Legge  states  that 
there  is  every  reason  to  believe  that  lead 
absorbed  through  the  lung  produces  the 
maximum  toxic  effect.  Lehmann,  Saito, 
and  Gfrorer  (6)  at  first  found  that  as 
high  as  35  to  42  per  cent,  of  inhaled 
white  lead  dust  reached  the  lungs,  and 
in  mouth-breathers  as  high  as  80  per 
cent.  As  a  result  of  further  experiments, 
however,  Lehmann,  Saito,  and  Majima 
(7)  later  state  that  usually  12  per  cent, 
reaches  the  lungs  and  70  per  cent,  the 
alimentary  system.  Of  the  inhaled  lead 
dust,  the  part  caught  in  the  mouth  and 
throat  would  be  mixed  with  saliva  and 
swallowed.  Food  contaminated  by  lead, 
and  lead  carried  on  pipes  and  cigarettes 
used  in  working  hours  add  to  the  quan- 
tit}^  swallowed.  The  risk  from  these 
latter  modes  of  entrance  may  be  small 
but  it  might  well  be  sufficient  to  cause 
the  breakdown  of  a  constitution  already 
undermined  by  lead  poisoning. 

The  conclusion  drawn  by  the  British 
Departmental  Committee  is  that  lead- 
laden  dust  is  by  far  the  most  serious 
evil,  and  the  first  of  the  necessary  pre- 
cautions which  it  recommends  is  "effi- 
cient measures  for  the  avoidance  or  re- 
moval of  dust  or  spray  which  is  formed 
in  the  course  of  work  and  contains  lead 
in  its  composition."  Goadby  has  em- 
phasized the  danger  of  long-continued 
inhalation  of  e\'en  very  small  quantities 
of  lead-laden  dust,  showing  that  an  ani- 


mal exposed  to  such  an  atmosphere 
during  eight  hours  each  day  for  sixteen 
months,  while  showing  no  symptoms  of 
poisoning,  has  nevertheless  undergone 
such  constitutional  deterioration  as  to 
succumb  to  a  dose  of  lead  insufficient 
in  amount  to  produce  symptoms  in  a 
normal  animal. 

In  Toronto,  there  are  thirty  or  more 
firms  using  from  one  to  three  spraying 
machines  each.  These  machines  are 
used  for  the  inside  and  outside  of  fac- 
tories and  in  painting,  varnishing  and 
shellacking  small  articles.  Several  paint- 
ers own  spray  machines,  and  use  them 
on  occasional  contracts.  During  this  in- 
\estigation,  no  painting  of  exterior  walls 
was  observed.  When  painting  walls 
and  ceilings  inside  buildings,  exhaust 
\entilators  for  the  removal  of  spray  and 
fumes  cannot  be  used.  Masks  were 
worn  by  two  operators  under  observa- 
tion, and  in  one  instance  the  machine 
was  equipped  with  an  extension  to  keep 
the  spray  nozzle  at  least  10  feet  from  the 
operator. 

For  painting  small  articles  practically 
all  machines  have  an  exhaust  system  of 
hoods  and  fans.  Only  an  occasional 
operator  on  such  machines  uses  a  mask. 
Some  wear  gloves;  others  use  vaseline 
on  the  hands  and  arms.  Most  of  the 
operators  whom  we  observed,  however, 
depended  on  the  exhaust  system  for  pro- 
tection from  the  spray.  In  all  cases  but 
one,  the  operators  said  that,  as  far  as 
tlie>-  knew,  it  was  rarely  that  a  paint 
containing  lead  was  used.  In  the  one 
exception,  a  paint  was  used  in  which 
0.3  per  cent,  of  the  pigment  was  lead. 
In  some  cases,  any  lead  paint  used  was 
applied  by  a  brush. 

As  no  lead  paint  was  used,  save  small 
amounts  in  the  case  above  mentioned, 
and  as  the  operators  had  other  duties, 
such  as  the  dilution  of  the  paint  for 
spray  purposes,  the  filling  of  containers, 


380 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


the  handling  of  the  painted  articles,  or 
painting  by  brush,  the  operators  were 
unsuitable  for  estimation  of  the  hazard 
due  to  the  lead  in  spray  painting  alone. 
Consequently,  an  experimental  test  of 
the  danger  of  lead  poisoning  in  spray 
painting  was  made. 

A  paint  was  mixed  in  accordance  with 
a  typical  formula  for  interior  work  as 
suggested  by  Dr.  Hamilton  ( 1 ) ,  in  which 
the  pigment  consisted  entirely  of 
white  lead  and  was  60  per  cent,  of  the 
whole,  the  liquid  portion  being  mainly 
of  linseed  oil  and  turpentine  in  nearly 
equal  parts.  This  mixture  was  diluted 
with  benzine  to  the  necessary  consist- 
ency for  spray  painting.  Air  pressure 
from  an  automatic  pump  was  kept  be- 
tween 35  and  55  pounds  per  square  inch, 
and  the  spray  was  directed  against  a 
vertical  surface  of  wall.  Specimens  of 
air  were  collected  by  being  drawn 
through  suction  cylinders  containing 
water  or  dilute  acid,  the  air  being  broken 
up  by  a  finely  perforated  bulb  on  the 
suction  tube.  Other  air  specimens  were 
collected  by  Duckering's  method  (8),  in 
which  the  air  is  drawn  through  a  glass 
tube  which  enters  at  a  right  angle  into 
a  collecting  bottle  of  larger  caliber,  in 
order  to  reduce  the  velocity  of  the  air 
current.  The  collecting  bottle  expands 
at  the  bottom  into  a  larger  chamber, 
of  which  the  upper  surface  makes  a  right 
angle  with  the  collecting  bottle.  '  This 
chamber  is  packed  with  cotton-wool  and 
the  end  covered  with  silk.  Air  is  sucked 
through  the  collecting  bottles  by  means 
of  a  calibrated  pump  at  the  ordinary 
rate  of  breathing.  Samples  of  air  were 
taken  at  the  \'arious  positions  likely  to 
be  occupied  by  the  nose  and  mouth  of 
a  spray  painter,  300  liters  of  air  being 
used  for  each  estimation..  To  study  the 
distribution  of  the  spray,  porcelain 
plates  varying  in  surface  area  from  12 
to  50  sq.  cm.  were  laid  horizontally  in 


different  positions  for  half-hour  periods. 
In  estimating  the  lead,  it  was  treated 
as  if  in  organic  combination,  for  it  was 
probable  that  all  lead  particles  would  be 
surrounded  by  a  layer  of  oil.  The  ma- 
terial collected  on  the  plates  was  there- 
fore treated  with  sulphuric  acid  and 
ashed  at  low  temperature  in  a  muffle  fur- 
nace. The  ash  was  then  boiled  with 
ammonium  acetate  made  alkaline  with 
ammonia  water.  This  solution  was  fil- 
tered into  a  Nessler  tube,  two  drops  of 
potassium  cyanide  solution  added  and 
then  10  c.c.  of  fresh  hydrogen  sulphide 
water.  The  turbidity  developed  by  the 
hydrogen  sulphide  water  was  matched 
with  standard  tubes  of  lead  solution, 
similarly  treated  with  ammonium  ace- 
tate, ammonia,  potassium  cyanide  and 
hydrogen  sulphide  water.  All  glassware 
and  solutions  were  tested  for  lead  before 
proceeding  with  the  colorimetric  tests. 
In  the  case  of  the  air  samples  collected 
on  cotton-wool,  the  estimations  were 
made  by  the  method  devised  by  Har- 
court  (9),  in  the  course  of  which  it  was 
necessary  to  add  to  the  standards  a  col- 
ored solution  of  cotton-wool  dissolved 
in  nitric  acid,  evaporated  to  dryness, 
and  the  residue  dissolved  in  water. 

These  experiments  were  done  in  a 
large  room  with  a  low  ceiling,  so  there 
was  a  tendency  for  the  fumes  to  roll 
back  toward  the  operator.  A^oreover, 
there  was  no  direct  draft  to  carry  away 
the  fumes.  A  mist  could  easily  be  seen 
10  feet  and  more  to  the  side;  the  opera- 
tor and  his  assistant  had  slight  choking 
sensations  which  persisted  for  some  time 
after  the  exposure;  the  boots  and  cloth- 
ing showed  a  fine  coating  of  paint ;  the 
external  nares  were  "frosted."  In  the 
case  of  a  painter  observed  when  engaged 
in  painting  the  walls  of  a  factory  base- 
ment, the  outlines  of  the  mask  which 
he  wore  over  his  nose  and  mouth  were 
well  marked  by  the  fine  coating  of  paint 


SHARPE— LEAD  POISONING  IN  SPRAY  PAINTING 


381 


on  the  rest  of  his  face.  His  arms  were 
also  coated.  There  were  no  drip  spots 
on  the  fioor,  however. 

The  collecting  apparatus  was  taken  to 
a  factory  where  small  objects  (some 
with  a  surface  area  of  from  1  to  2  square 
feet)  were  spray  painted  in  a  cabinet 
provided  with  excellent  suction.  This 
cabinet  was  on  a  stand  about  4  feet  from 
the  floor  and  had  an  open  front  about 
3  feet  square,  through  which  the  ob- 
jects to  be  sprayed  were  passed  into  the 
cabinet.  The  operator,  therefore,  could 
remain  entirely  outside  the  cabinet  while 
working  or  could  lean  forward  into  the 
cabinet  if  he  wished  to  do  so.  Air  speci- 
mens were  collected  at  the  positions  oc- 
cupied by  the  operator's  mouth  and 
nose  when  working;  plates  were  exposed 
in  different  places  in  the  cabinet  at  the 
furthest  level  forward  which  the  body  of 
the  operator  could  assume.  Plates  were 
exposed  outside  the  cabinet  also.  There 
was  no  unpleasant  sensation  when 
breathing  at  the  operator's  position, 
though  there  was  an  odor  of  paint.  No 
film  was  found  on  the  clothing,  nor  was 
the  operator's  face  coated.  The  hands 
and  arms  of  some  operators  were  coated 
owing  to  placing  the  arm  in  the  cabinet 
to  move  the  object  sprayed  or  to  turn  the 
table  on  which  it  revolved. 

From  Duckering's  analyses  of  lead 
present  in  the  air  during  certain  potter}' 
processes  and  during  sandpapering  after 
painting  (8),  Legge  has  concluded  that, 
if  the  amount  of  lead  present  in  the  air 
breathed  is  less  than  5  mg.  per  10  cubic 
meters  of  air,  cases  of  encephalopathy 
and  paralysis  will  never  occur,  and  cases 
of  colic  rarely.  A  workman  inhaling 
600  c.c.  of  air  sixteen  times  per  minute 
in  an  eight-hour  working  day  breathes 
in  4,608  liters  of  air.  If  the  inspired  air 
contains  5  mg.  per  10  cubic  meters,  this 
means  that  in  one  day  he  will  breathe  in 
about  2  mg.  of  lead — the  amount  re- 


garded b>-  Legge  as  the  lowest  daily  dose 
which,  inhaled  as  fumes  or  dust  in  the 
air,  may  in  the  course  of  years  set  up 
chronic  plumbism  (3,  pp.  176-207).  He 
considers  that  2  mg.  of  lead  per  day  may 
be  excreted  in  the  feces  of  a  lead  worker 
without  being  regarded  as  showing  that 
he  is  in  danger  of  poisoning  by  lead. 
Legge  was  aided  in  his  conclusions  by 
an  intimate  knowledge  of  the  processes 
examined  by  Duckering,  the  relative 
frequency  of  cases  of  plumbism  reported 
among  those  employed  at  these  proc- 
esses, and  the  duration  of  employment 
prior  to  attack.  In  the  case  of  sand- 
papering coach  wheels,  the  enormous 
quantity  of  1,025  mg.  per  10  cubic  me- 
ters was  found  in  the  air,  and  this 
process  of  dry  rubbing  is  placed  highest 
among  the  causes  of  lead  poisoning. 
Kaup  of  Vienna  (2,  p.  79)  found  from 
10  to  250  mg.  of  lead  per  10  cubic  me- 
ters of  air  in  a  room  in  which  dry  rub- 
bing down  was  done.  It  is  the  opinion  of 
Teleky  (10)  that  a  daily  dose  of  a  little 
more  than  1  mg.  of  lead  taken  for  sev- 
eral months  will  cause  plumbism,  and 
that  a  daily  dose  of  10  mg.  will  cause 
symptoms  of  severe  saturnine  intoxica- 
tion in  a  ver\"  short  time.  In  our  ex- 
periments, as  may  be  seen  from  Table  1, 
135  to  417  mg.  of  lead  per  10  cubic  me- 
ters of  air  were  found  when  spraying  an 
inside  wall ;  this  is  obvioush^  a  danger- 
ous amount.  In  an  eight-hour  day  at 
such  work,  a  workman  would  breathe 
in  from  60  to  180  mg.  of  lead. 

Legge  has  also  placed  the  minimum 
quantity  of  lead  required  to  produce  poi- 
soning at  about  5  mg.  per  kilogram  body 
weight.  This  amounts  to  350  mg.  for  a 
man  of  150  pounds'  weight.  Our  figures 
show  that  a  workman  employed  in 
spraying  an  inside  wall  might  in  a  few 
days  absorb  350  mg.  of  lead  over  and 
above  the  amount  which  he  can  excrete. 


382 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Consequently,  he  is  exposed  to  a  highly 
dangerous  degree. 

The  plates  exposed  for  half-hour  peri- 
ods during  the  spraying  of  an  inside  wall 
show  that  lead  was  deposited  11  feet 
to  the  right  of  the  operator  and  3  feet 
behind  him.  (See  Table  2.)  The  mist 
during  spraying  could  easily  be  seen  at 
these  distances. 

TABLE   1.  — ANALYSIS  OF  AIR  SAMPLES  IN 
SPRAYLN'G  AN  INSIDE  WALL 


Position  of  Mouth  of 
Collecting    Tube 

Mg.  of  Lead 

per  300  L. 

of    .\ir 

Mg.  of  Lead 
per    10    Cu. 
M.    of    Air 

i  ft.  from  wall  sprayed,  at  level  of 
operator's   mouth;   sample   col- 
lected     by     filtering      tbrougl' 
cotton-wool   

6.25-12.5 

208-417 

i  ft.  from  wall  sprayed,  at  level  of 
operator's  mouth;  3  ft.  to  right 
of  operator;  cotton- wool  filter.  . 

4.06 

135 

1  ft.  from  wall  sprayed,  at  level  of 
mouth;  4  ft.  to  right  of  operator; 

6.25 

208 

1  ft.  from  area  sprayed;  1  ft.  below 
level  of  mouth;   Ij  ft.  to  left  or 
right;  samples  filtered  through 

2.04-3.12 

68-104 

'  Water  or  acid  collectors  were  not  as  efficient  as  cotton- 
wool filters. 

During  a  three-day  experiment  in 
spraying  an  inside  wall,  the  operator 
was  exposed  to  the  spray  for  from  four 
to  five  hours  daily.  The  urine  of  the 
twenty-four  hours  following  showed  the 
presence  of  0.3  mg.  of  lead.  The  feces 
also  showed  the  presence  of  lead  but  less 
than  the  2  mg.  considered  by  Legge  as 
indicating  danger  of  poisoning.  The 
presence  of  lead  in  the  urine  from  a 
short  exposure  is  significant.  The  oper- 
ator did  no  dry  mixing  but  used  white 
lead  already  mixed  with  oil.  Though  he 
diluted  paint  and  handled  apparatus 
during  the  painting,  he  took  care  to  pre- 
vent his  food  and  tobacco  from  being 
contaminated.  It  is  probable,  then,  that 
all  the  lead  in  the  urine  came  from  the 


spray.  As  it  was  not  expected  that  the 
urine  and  feces  would  show  the  presence 
of  lead,  no  specimens  were  saved  other 
than  those  of  the  first  twenty-four  hours 
after  painting.  Later  specimens  of  feces 
would  probably  have  shown  increased 
amounts  of  lead. 

TABLE  2.  —  .\NALYSIS  OF  DEPOSITS  ON  ' 

PORCELAIN   PL.\TES  IN   SPR.WING   AN 

INSIDE  WALL' 


Position    with    Reference 
to   Operator 

Distance 

in     Feet 

froiji    Wall 

Sprayed 

Mg.  of  Lead 
per   Sq.    Cm. 

of   Plate 

E.xposed    for 

Halt-Hour 

Inter\'al 

At  level  of  operator's  mouth  .... 

1 

CIS 

1  ft  below                                

1 

0  81 

At  level  and  4  ft.  to  right 

2 

0.10 

1  ft.  below  and  4  ft.  to  left 

2 

0.10 

2  ft.  below  and  6  ft.  to  left 

1 

0.24 

At  level  and  10  ft.  to  right 

2 

0.066 

1  ft.  below  and  11  ft.  to  right   . .  . 

2 

0.076 

2  ft.  below  and  6  ft.  to  right   .... 

4 

0.11 

1    ft.    below    and    3    ft.    behind 

5 

0.066 

'  The  porcelain  plates  had  an  area  of  surface  exposed 
varying  from  12  to  50  sq.  cm. 

In  the  spray  painting  of  small  ob- 
jects in  a  cabinet  with  good  suction,  no 
lead  was  found  in  the  air  samples  col- 
lected outside  the  cabinet.  (Table  3.) 
Though  lead  was  present  on  the  plates 
exposed  to  the  escape  of  spray,  it  was 

TABLE  3. —  ANALYSIS  OF   AIR  S.VMPLES   IN 
SPRAYING   SMALL  OBJECTS   IN   AN 
EXHAUST  CABINET 


Position    of    Mouth    of 
Collecting   Tube 

Mg.  of  Lead 

per  300   L. 

of    Air 

Mg.  of  Lead 

per    10    Cu. 

M.  of  Air 

li    ft.    from    object    .sprayed,    at 
le%'el  of  operator's  mouth,  vary- 
ing in  position  the  full  width  of 
the    exhaust    cabinet,    but    ex- 
terior to  the  cabinet    

0.0 

0.0 

SHARPE— LEAD  POISONING  IN  SPRAY  PAINTING 


383 


found  in  very  small  amounts  in  the  cabi- 
net at  the  level  beyond  the  space  where 
the  operator's  body  goes.  The  largest 
amount  was  on  the  plate  placed  in  the 
main  line  of  beat  back  from  the  particu- 
lar object  sprayed.  No  lead  was  found 
on  the  plates  exposed  behind  the  oper- 
ator's position.     (See  Table  4.) 

Various  masks  were  tested  to  see  how 
much  protection  they  offered  from 
breathing     in     the     lead-laden     spray. 


TAHLE  4. —  ANALYSIS  OF  DKPOSITS  ON 

PORCELAIN   PLATES   IN  SPRAVI\(;    SMALL 

OBJECTS   IN   AN   EXHAUST  CABINET 


Position   of   Plate   with 
Reference    to    Operator 

Distance 

in  Feet  from 

Object 

Sprayed 

Mg.  of  Lead 
per  Sq.  Cm. 

o(  Plate 
Exposed    for 

Half-Hour 
Periods 

At  level  of  operator's  mouth,  ex- 
terior to  cabinet 

15 

0  0(1^ 

li  ft.  below  and  3  ft.  behind,  ex- 
terior to  cabinet  

At  level  and  1 J   ft.   to  left  of  ohjett 
painted,  just  within  opening  of 

(l.lll) 
0.004 

IJ  ft.  below  and   I J   ft.  to  left  of 
object  painted,  just  within  opcn- 

li 

0.003 

Ij  ft.  below  and  in  line  of   main 
beat  back  of  spray,  just  «ilhin 
opening  of  cabinet 

H 

0  018 

'  Plate  area  varied  from  \i  to  50  sq.  cui.  The  amount.s 
estiipated  for  each  sq.  cm.  are  calculated  from  the  amount 
found  ou  each  plate. 

These  tests  were  made  either  in  the 
same  room  as  those  reported  in  Table  1, 
or  in  a  room  10  by  10  by  9  feet.  In  each 
case  a  duplicate  air  sample  as  a  control 
was  taken  without  protection. 

The  ordinary  masks  provided  for  the 
painter  consist  of  cotton-wool  covered 
with  one  or  two  layers  of  gauze  and,  in 
some  cases,  having  charcoal  between  the 
layers  of  wool.  Such  a  mask  is  held  in 
place  by  an  elastic  band.  Another  type 
of  mask  has  a  rubber  facepiece  covering 
the  mouth  and  nose.     The  opening  of 


this  mask  is  covered  with  gauze  and  cot- 
ton-wool or  with  filter  paper. 

The  results  of  our  tests  reported  in 
Table  5  show  that  fine  wire  gauze  masks 
are  no  protection  whatever.  A  mask  of 
gauze  and  cotton,  as  thick  as  possible 
without  causing  uncomfortable  or 
strained    breathing,    reduced    the    lead 

TABLE  5.  —  EFFICIENCY  OF  VARIOl'S 

PROTE(  TIVE   DEVICES  TESTED   1)1  RING 

SPRAVlNd  OF   AN   I.VSIDE   WALL 


.\ir    Samples    Taken    at    Level    of 
Mouth    and    Nose   of   Operator 

Jig.  of  Lead 

per  300  L. 

of    .\ir 

.Mg.  of  Uad 
per  10  Cu. 
M.  of  Air 

A.   Number  20  wire  gauze  mask  . 
Control  —  no  ma.sk  .    . 

6.25 
6.25 

208.0 
208  0 

B.    A  miusk  of  gauze  and  cotton- 
wool of  the  maximum  thick- 
ne.s,s  allowing  easy  breathing 

0.31 
2.75 

10.42 
90  0 

C.   .\  mask  of  gauze,  cotton-wool, 
and    activated    charcoal 
manufactured      by       Bauer 
and  Black 

0.1 
3.12 

3  S3 

Control  — ■  no  mask 

104  2 

D.  .\  m.isk  of  gauze  and  cotton- 
wool of  the  maximum  thick- 
ness allowing  easy  breathing 
and     moistened     with     5% 
sodium  .sulphide  solution   .  . 
<  "ontrol  —  no  mask 

0.37 
6.98 

12.4 
282.2 

E.   As  in  D   

0.17 
0.34 

5  853 

Control  —  similar  mask  with- 
out sodium  sulphide 

11.706 

present  in  10  cubic  meters  of  air  from 
90  to  10  mg.  This  is  still,  however, 
abo\e  Legge's  danger  line  of  5  mg.  per 
10  cubic  meters. 

The  manufactured  mask  of  gauze, 
cotton-wool  and  charcoal  reduced  the 
lead  present  below  the  danger  line,  but 
in  order  to  do  this  all  the  air  must  pass 
through  the  mask.  It  was  not  found  pos- 
sible to  wear  this  mask  so  that  all  the 
air  breathed  passed  through  it  without 
discomfort  and  without  straining  in- 
spiration. No  workman  would  endure 
it.  If  worn  comfortably,  the  mask  is 
useless,  for  air  comes  in  at  the  side  of 


384 


THE  [OURNAL  OF  INDUSTRIAL  HYGIENE 


the  nostrils.  The  charcoal  is  unneces- 
sary for  the  holding  of  lead  pigment,  but 
may  be  of  use  for  volatile  bodies.  Any 
mask  will  become  useless  after  a  coating 
of  paint  is  deposited  on  it. 

Masks  of  comfortable  breathing 
thickness  moistened  with  5  per  cent, 
solution  of  sodium  sulphide  reduced  the 
amount  of  lead  present  in  the  air 
breathed  from  232  mg.  per  10  cubic  me- 
ters of  air  to  12.4  mg.  A  similar  mask, 
but  dry,  allowed  11  mg.  per  10  cubic 
meters  to  pass  through.  Both  these  re- 
sults are  still  above  the  danger  line.  So- 
dium sulphide  solution  through  which 
carbon  dioxide  was  bubbled  gave  the 
odor  of  hydrogen  sulphide,  and  the  color 
reaction  with  basic  lead  acetate  was 
soon  lost.  Sodium  sulphide  on  a  mask 
is  not  unpleasant,  though  at  first  the 
odor  of  hydrogen  sulphide  is  noticeable. 
We  found  that  there  was  an  improve- 
ment when  the  mask  was  worn  over  a 
rubber  facepiece,  allowing  an  air  space 
between  the  gauze  and  the  skin.  The 
skin  became  blackened,  however,  owing 
to  the  formation  of  lead  sulphide,  and 
was  not  very  readily  cleaned.  The  mask 
would  need  to  be  moistened  every  fifteen 
or  twenty  minutes  to  be  as  effective  as  in 
the  test  made.  Ammonium  sulphide  was 
practically  useless.  Further,  Carlson 
and  Woelfel  (11)  hsLve  shown  that  lead 
sulphide  itself  is  not  free  from  danger 
as  it  is  soluble  in  the  gastric  juice.  More- 
over, a  certain  amount  of  hydrogen  sul- 
phide would,  of  course,  be  absorbed  and 
this  is  detrimental  to  health.  Other  so- 
lutions for  moistening  masks  might  be 
made  from  soluble  sulphates  or  carbon- 
ates but  they  are  likely  to  give  only  a 
false  sense  of  security.  It  would  appear 
that  it  is  not  possible  for  a  workman  to 
get  enough  air  through  a  really  effective 
mask  of  this  type  with  any  degree  of 
comfort. 

These   experiments   show  that   when 


lead  is  a  constituent  of  the  paint  used 
in  spraying  walls  inside  a  building  there 
is  danger  of  absorption  of  lead.  Since 
much  of  the  work  is  done  in  new  build- 
ings or  in  buildings  where  the  industries 
do  not  ordinarily  require  suction  venti- 
lation, exhaust  ventilation  of  fumes  and 
spray  would  not  be  available.  Conse- 
quently, the  operator  would  have  to  de- 
pend on  currents  of  air  from  open  win- 
dows and  electric  fans  and  on  the  pro- 
tection afforded  by  masks  or  respirators. 
In  some  paint  work,  however,  a  current 
of  air  is  not  desired  on  account  of  the 
too  rapid  drying  of  the  paint.  In  ex- 
terior painting,  there  would  likely  be 
less  risk  from  lead  poisoning,  as  the 
painter  could  take  advantage  of  the  pre- 
vailing air  currents. 

There  is  no  danger  from  lead  poison- 
ing when  spraying  small  objects  proper- 
ly placed  in  an  exhaust  cabinet  provided 
with  efficient  suction.  The  more  com- 
mon faults  and  imperfections  in  this 
class  of  work,  as  pointed  out  by  Al- 
baugh  (12),  are:  (a)  good  cabinet,  but 
exhaust  absent  or  inefficient;  (^)  good  ex- 
haust, but  cabinet  too  shallow;  (c)  good 
exhaust,  but  poorly  located  in  cabinet; 
(d)  fan  too  far  from  box;  {e)  exhaust 
inlet  too  small  or  pipe  occluded  by  ac- 
cumulations of  paint,  etc.;  (/)  cabinet 
not  of  proper  shape  to  allow  uniform 
draft;  (g)  tendency  of  operator  to  spray 
at  right  angle  to  flat  surface,  so  causing 
the  spray  to  roll  back;  (h)  spraying  too 
large  objects  and  thus  getting  out  of 
range  of  the  exhaust;  (i)  spraying  pro- 
miscuously about  the  room  in  testing 
the  sprayer;  (/)  sitting  on  the  stand  in- 
side the  cabinet  in  order  to  rest  while 
spraying;  (k)  defective  vision  of  oper- 
ator; (/)  poor  illumination  of  work 
space.  Some  of  these  defects  were  ob- 
ser\'ed  during  this  investigation. 

The  painter  using  a  spray  machine 
must  obser\-e  the  precautions  necessary 


SHARPE— LEAD  POISONING  IN  SPRAY  PAINTING 


385 


for  all  types  of  painting,  if  lead  is  used 
— viz.,  adequate  washing,  wearing  of 
overalls,  protection  of  food  and  street 
clothing  from  dust  and  spray,  cleanli- 
ness of  working  clothes,  the  avoidance 
of  tobacco  and  of  the  placing  of  articles 
in  the  mouth  during  working  hours. 
The  writer,  after  using  a  spray  painting 
machine,  has  thoroughly  washed  his 
hands  and  arms  with  hot  water  and  soap 
and  a  nailbrush,  and  has  still  been  able 
to  find  a  definite  blackening  with  so- 
dium sulphide  solution.  Amounts  vary- 
ing from  2.79  mg.  to  602.64  mg.  of  lead 
monoxide  were  found  in  the  dust  re- 
moved from  clothing  by  beating,  and  in 
the  dust  in  pockets  of  overalls  (13). 

But  the  spray  painter,  more  than 
other  painters,  is  exposed  to  another  risk 
which  requires  investigation.  This  is 
the  inhalation  of  fumes  of  volatile 
prot'.ucts  used  in  the  paint,  such  as  tur- 
pentine, benzine,  benzol,  and  possibly 
linseed  oil  and  driers.  These,  as  Goad- 
by  (4)  says,  are  known  to  pro  luce  respir- 
atory effects  in  susceptible  animals.  He 
further  states  that  the  constant  inhala- 
tion of  vapors  of  volatile  fluids  is  con- 
ducive to  renal  afi"ection  and  hieh  ar- 


terial tension.  The  workman  may  be 
ignorant  of  the  presence  of  these  poisons 
and  the  dangerous  character  of  the 
work.  Not  many  painters,  however, 
would  connect  a  kidney  disturbance  with 
the  turpentine  with  which  they  -work, 
nor  would  they  recognize  chronic  bron- 
chitis as  a  hazard  of  their  trade.  More- 
over, many  of  them  accept  their  ail- 
ments as  a  necessary  evil.  Goadby's  ex- 
perience is  in  accord  with  that  of  Oliver 
(5)  who  found  that  animals  exposed  to 
the  vapor  given  off  from  freshly  painted 
surfaces  suffered  in  health  as  did  also 
animals  exposed  to  the  vapor  of  turpen- 
tine. At  the  autopsy  he  found  the  lungs 
engorged  and  the  tubular  epithelium  of 
the  kidneys  the  seat  of  cloudy  swelling. 
None  of  the  painters  interviewed  dur- 
ing this  investigation  gave  a  history  of 
symptoms  pointing  to  the  vapors  of  vol- 
atile fluids,  but  their  failure  to  do  so 
ma\'  be  explained  by  the  fact  that  they 
were  practically  all  protected  by  ex- 
haust cabinets.  A  special  investigation 
has,  however,  been  undertaken  by  this 
department  which,  it  is  hoped,  will  con- 
tribute valuable  information  on  the  ef- 
fects of  the  volatile  bodies  of  paint. 


BIBLIOGRAPHY 


1.  Hamilton.  .\. :  Hygiene  of  the  Tainters'  Trade. 
U.  S.  Rur.  I-alior  .'^tatis..  Bull.  No.  1:20.  ini.-?. 

2.  Report  of  British  Hepartinental  Coininittop  on 
the  Danger  in  the  Use  of  Tjcad  in  the  Paintina 
of  Buildings.  V.  S.  Bur.  I.alior  Statis..  Bull. 
No.  188.  lOlC. 

3.  I-eKfre,  T.  M.,  and  OoadMy,  K.  W. :  I.cad  Poi- 
soning and  Lead  Absorption.  London,  Edward 
Arnold ;  New  York,  Longmans,  Greeu  &  Com- 
pany, 1912. 

4.  Goadby.  K. :  Discussion  on  the  Importance  of 
Industrial  Medicine  to  the  Community.  Brit. 
Med.  Jour.,  1921,  2,  .".IT. 

5.  Oliver.  T. :  Industrial  Hygiene  :  Its  Rise,  Pro- 
gress, and  Opportunities.  Brit.  Med.  .lour.. 
1921,  e,  110. 

6.  Lehmann,  K.  B.,  Saito,  and  Gfrorer,  W. :  Ueber 
die  quantitative  Absorption  von  Staub  aus  der 


Luft  dnrch  den  Menschen.    .4rch.  f.  Hyg.,  1912, 
7.5,  152. 

7.  Lehmann,  K.  B.,  Saito,  Y.,  and  Majima,  H. : 
rpbor  die  quantitative  -Vbsorption  von  Fllissig- 
Vci'itstWlpfchen  als  Grundlnge  von  der  Lelire 
der  Tropfchenintoslkatlon.  Arcli.  f.  Ilyg.,  1912. 
75,  160. 

8.  Duckering,  G.  E. :  Methods  of  Determination 
of  Dust  and  Lead  in  the  .Mr  of  Workrooms. 
Ann.  Rep.  Chief  Inspect.  Factgries,  1910.  p.  201. 

9.  Harcourt,  A. :  A  Method  for  the  Approximate 
Estimation  of  Small  Quantities  of  Lead.  Tr. 
("honiical  .Society,  1910.  117,  reprinted  in  Lead 
Poisoning  and  Lead  .Vliscirption  by  T.  M.  Legge 
and  K.  W.  Goadby.  London,  Edward  Arnold; 
New  York,  Longmans,  Green  &  Company,  1912, 
p.  175. 


386 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


10.  Oliver,  T. :  Lead  Poisoning.  London,  H.  K. 
Lewis,  1914,  p.  37. 

11.  Woelfel,  A.,  and  Carlson,  A.  J. :  The  Solubility 
of  Lead  Sulphide  Ores  and  of  Lead  Sulphide 
in  Human  Gastric  Juice.  Appendix  I,  Lead 
Poisoning  in  the  Smelting  and  Refining  of  Lead, 
by  A.  Hamilton.  U.  S.  Bur.  Labor  Statis.,  Bull. 
No.  141,  1914,  p.  82. 

12.  Albaugh,  R.  P. :    The  Dangers  Connected  with 


the  Spray  Method  of  Finishing  and  Decorating. 
Division  of  Industrial  Hygiene,  Ohio  State 
Dept.  Health. 

13.  Reports  of  the  Departmental  Committees  on  the 
Use  of  Paints  Containing  Lead  in  the  Painting 
of  Buildings  and  in  the  Painting,  Enamelling 
and  Varnishing  of  Coaches  and  Carriages.  Vol. 
Ill,  Appendix  32,  p.  39.  H.  M.  Stationery  Of- 
fice, 1920. 


I 


SHERIDAN  DELEPINE 


Late  Director  of  the  Public  Health  Laboratory  and  Professor   of   Public   Health   and    Bacteriology, 
Victoria  University  of  Manchester,  and  Associate  Editor   of   the  Journal   of   Industrial    Hygiene. 


[Tlie  death  of  Dr.  Sheridan  Dolfplne  has 
removed  from  our  midst  a  pioneer  in  the  science 
of  research  into  Industrial  hygiene,  and  from  the 
staff  of  tlie  ,/ouKNAi.  one  of  its  original  associate 
editors,  the  first  wliose  death  we  have  had  re- 
gretfully to  record.  Some  appre<'iation  of  the 
man  and  of  his  worli,  coutrihutcd  liy  Dr.  T.  M. 
Legge,  who  was  well  acquainted  with  both,  Is 
here  given. — E.  L.  Collts.] 

An  appreciation  of  a  man  and  his  work 
should  take  account  of  the  circumstances  in 
which  he  found  himself  placed,  of  the  difiS- 
culties  which  he  had  to  face,  of  how  he  over- 
came them,  and  of  the  mark  which  he  has 
left  behind. 

The  phase  in  Dolepinc's  work  which  alone 
I  propose  to  touch  on  is  the  part  which  he 
played  in  trying  to  animate  public  health 
work  by  his  s.ympathy,  indomitable  indus- 
try, and,  above  all,  by  a  strictly  scientific 
spirit.  On  the  fly-leaf  of  his  first  Report  as 
Director  to  the  Advisory  Committee  of  the 
Public  Health  Laboratory  in  1902,  he  has 
inserted  this  quotation  from  J.  A.   Fronde: 

We  may  ni.aUo  our  own  oi>inions.  but  facts  were 
made  for  us ;  and  if  we  evade  or  deny  them,  it 
will  l)o  the  worse  for  us. 

This  power  of  his  to  deal  with  facts  and 
let  them  tell  their  own  story  as  brought  out 
by  laboratory  investigation,  was  his  guiding 
principle.  In  the  addresses  which  he  gave 
from  time  to  time  assuniing  t.he  standpoint 
from  which  at  the  moment  lie  regarded  the 
position  of  public  health,  he  constantly 
harped  (and  I  use  the  word  in  the  literal 
and  not  the  accepted  sense)  on  this  point: 

The  object  of  the  I>.  P.  IT.  course  is  not  to  pro- 
duce a  few  expert  scientists,  but  chiefly  to  train 
an  adequate  number  of  ollicers,  capable  of  appre- 
ciating  the    value   of   the    assistance    which    they 

*Born  Jan.  1,  1855;  died  Nov.  13,  1921.  He  was 
the  eldest  son  of  Antoine  Delfpine  of  Paris,  a  man 
of  wide  cutlook  and  culture  and  a  very  original 
thinker,  to  whose  wise  upbringing  he  o-.vid  a 
gi'eat  deal. 


may  derive  from  science  in  their  administrative 
work,  and  of  taking  an  intelligent  and  practical 
Interest  in  the  work  of  the  chemists,  bacteriol- 
ogists, veterinarians,  engineers,  statisticians,  law- 
yers, etc.,  also  engaged  in  work  closely  conneited 
with  that  of  the  medical  officer  of  health. 

While  having  this  confident  belief  in  the 
future  of  public  health  work,  p^o\^ded  the 
assistance  whicli  science  could  bring  to  the 
administrative  side  were  always  kept  prom- 
inent, he  was  never  under  the  delusion  that 
money  was  to  be  made  in  it,  but  he  felt  that 
the  opportunities  for  research  and  philo- 
sophical thought  were  more  than  an  ade- 
quate compensation. 

We  may  take  his  first  Report  as  Director 
of  the  Public  Health  Laboratory  as  a  sort  of 
midway  point  in  his  career  l)ehind  which, 
from  1882,  was  the  work  of  preparation  by 
attention  to  the  diagnosis  of  disease  by  lab- 
oratory methods,  and  afterwards — he  was  ap- 
pointed Professor  of  Pathology  at  Owen's 
College  in  1891 — the  fruition  and  practical 
application  of  his  knowledge  by  placing  the 
resources  of  his  laboratory  at  the  disposal 
of  all  medical  men  and  some  120  sanitary 
districts,  including  Manchester,  Salford,  and 
the  great  Lancashire  industrial  area. 

This  was  the  first  instance  of  the  kind  in 
which  the  scientific  side  of  a  university 
linked  itself  up  directly  with  municipal  ac- 
tivities of  a  medical  nature.  The  number  of 
specimens  examined  in  1902  was  5,16.5,  or  a 
daily  average  of  14,  whereas  in  1921  it  had 
increased  to  19,539,  or  a  daily  averafre  of 
53.5.  The  work  grew  so  vast  that  it  led  to 
the  erection  of  a  special  Public  Health  Lab- 
oratory (Delepine  himself  designed  the 
buildings)  and  the  creation  of  a  special  de- 
partment with  special  provi.sion  made  for 
teaching  the  various  branches  of  public 
health  for  the  diploma  in  that  subject.  This 
was  the  home  from  which  all  the  subsequent 


387 


38S 


T?IE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


activities  of  Delepine  and  his  busy  staiS  em- 
anated. Now  in  most  large  towns  a  munici- 
pality has  its  own  laboratory,  but  hitherto 
Manchester  and  the  great  surrounding  indus- 
trial district  have  relied  on  his  laboratory. 

Delepine  was  a  man  of  meticulous  detail 
— too  much,  I  sometimes  thought^ — and  the 
sight  of  his  immense  maps  of  the  farms  in 
the  counties  from  which  ]\Ianchester  and  Sal- 
ford  drew  their  milk  supplies,  with  dots  all 
over  them  in  different  colors  showing  the 
number  of  farms  in  which  tuberculous  milk 
was  found,  was  bewildering.  Similarly,  the 
soft  moorland  water  from  which  the  district 
derived  its  supply  was  always  kept  under  the 
closest  supervision  from  the  plumbo-solvent 
and  erosive  points  of  view.  Others,  however, 
are  more  fitted  to  deal  with  the  purely  pub- 
lic health  side  of  his  work.  I  confine  myself 
here  to  the  pioneer  work  which  he  did  in  fac- 
tory hygiene. 

His  signal  service  in  this  respect  was  the 
recognition  of  the  importance  of  factory  hy- 
giene. Manchester  University  was  the  first — 
and,  to  the  shame  of  the  other  teaching  uni- 
versities in  Great  Britain  and  Ireland,  ex- 
cept recently  Cardiff — still  is  the  only  one 
including  instruction  in  this  subject  as  an 
integral  part  of  the  course  for  the  Diploma 
of  Public  Health:  I  do  not  count  of  value 
what  the  full-time  Medical  Officer  of  Health, 
an  administrative  officer  divorced  from  the 
practice  of  medicine,  can  say  about  it.  Yet 
Delepine.  to  effect  this  change,  only  utilized 
the  powers  given  by  the  General  ^Medical 
Council  of  shortening  to  three  months  (pro- 
vided certain  special  courses  were  given) 
the  often  time-wasting  requirement  of  at- 
tendance for  six  months'  practical  work  with 
a  Medical  Officer  of  Health.  T  have  before 
me  now  correspondence  in  the  year  1910 
about  this  change,  in  which  he  insists  on  the 
differentiation  in  the  general  course  covering 
the  duties  of  all  Medical  Officers  of  Health 
and  the  special  cour-se  on  factory  hygiene, 
for  which  he  wisely  provided  a  separate  ex- 
amination of  an  honors  standard  and  a  spe- 
cial certificate.  Quite  rightly  he  never  re- 
grarded  factory  hygiene  as  anything  b\it  a 
branch  of  general  medicine  and  surgery  and, 
therefore,  a  matter  for  the  general  practi- 
tioner to  know  about  rather  than  an  admin- 
istrative officer,  but,  failing  the  possibility 
of  teaching  the  general  practitioner,  he  saw 


the    advantage    of    the    Medical    Officer    of 
Health  having,  at  any  rate,  a  smattering. 

Delepine  was  always  interested  in  indus- 
trial problems  and  placed  his  knowledge  and 
inventive  genius  in  laboratory  methods  to 
great  use  in  the  helpful  elucidation  of  such 
problems.  Thus,  in  the  great  beer  poisoning 
epidemic  from  arsenic  in  1900,  in  which  sev- 
eral thousands  were  affected,  it  was  Delepine 
who,  after  Reynolds  had  discovered  arsenic 
in  the  beer — Delepine  had  already  guessed 
it — traced  the  arsenic  to  the  glucose  used  by 
the  brewers.  For  the  Royal  Commission 
which  investigated  the  circumstances  of  the 
outbreak,  Delepine  not  only  was  the  first  to 
show  how  effective  in  helping  to  diagnose 
arsenical  poisoning  was  anatysis  of  the  hair 
for  the  metalloid,  but  also  devised  quanti- 
tative methods  of  analysis,  which  are  today 
in  constant  use.  This  hydrochloric  copper 
(Reinsch-Dclepine)  method  was  used  in  de- 
termining the  amount  of  arsenic  found  in 
the  fatal  case  of  industrial  poisoning  by 
arseniuretted  hydrogen,  published  in  the 
Journal  op  Industrdvx,  Htgiene.*  This  was 
the  only  article  which  he  contributed,  as  his 
health  was  already  failing  at  the  time  the 
JoiRNAL  was  started,  but  it  is  a  good  illus- 
tration not  only  of  his  skill  in  chemical  an- 
alysis but  also  of  his  skill  as  a  morbid  anat- 
omist and  microscopist. 

Another  inquiry  showing  his  gift  for  turn- 
ing his  scientific  knowledge  to  practical  pur- 
pose, a  gift  also  possessed  by  Haldane,  was 
his  paper  in  1911  on  "The  Pathogenic  Prop- 
erties of  the  Gases  Discharged  by  the  Ex- 
haust Pipe  of  Gas  Engines."  Even  now 
cases  of  carbon  monoxide  poisoning  are  some- 
limes  called  petrol  poisoning,  but  how  com- 
mon carbon  monoxide  poisoning  from  this 
cause  may  be  under  bad  working  conditions 
even  at  the  present  time!  When  visiting  a 
factory  for  the  assembly  of  motor  cars  in  the 
United  States,  I  was  informed  by  the  plant 
physician  that  recently  on  a  dull  morning 
he  had  treated  eighty  men  suffering  from 
.slight  effects  of  carbon  monoxide.  But  it 
was  original  research  when  Delepine.  after 
many  experiments  on  internal  combustion 
engines,  arrived  at  his  conclusions  that : 

•Dplfpine,  S. :  Report  on  Certnin  Orfrans  In 
a  Case  of  Fatal  Poisoning  by  Arseniuretted  Hy- 
(lioiren  Gas.  .ToxR.  Indust.  IIyg.,  1919-1920,  1. 
.sr)6. 


SHERIDAN  DELEPINIE 


389 


The  main  cause  of  danger  when  my  experi- 
mental gas  engine  was  overloaded  was  the  con- 
giderable  reduction  in  the  amount  of  oxygen  con- 
tained in  the  exhaust  gas;  the  proportion  of  car- 
bon dioxide  was  also  vt'ry  large.  The  danger  be- 
gan to  be  rapidly  manifest  when  the  tiuantity  of 
exhaust  gas  exceeded  50%. 

The  main  cause  of  danger  when  the  supply  of 
air  to  my  experimental  gas  engine  was  insufh- 
cient  was  the  presence  in  the  e.xliaust  gas  of  a 
large  amount  of  carbon  monoxide.  This  danger 
began  to  be  manifest  when  the  proportion  of  ex- 
haust gas  reached  1  fiai-l  of  gas  to  tii  „,■  ."lO 
parts  of  air.  The  CO  present  in  tlie  exhaust  gas 
is  partly  derived  from  the  uiiburnt  coal  gas.  and 
partly  from  the  Imperfect  combustion  of  the  gas 
that  is  utilized.  II  is  prohalile,  therefore,  that 
the  u.se  of  power  gas  is  attended  with  greater 
danger    than    the    use    of   ordinary    lighting    gas. 

Anything  blocking  slightly  the  entrance  of  the 
air  pipe   is   sufficient   to  bring  about  this  danger. 

Lastly,  the  subject  of  anthra.x  appealed  to 
him,  and  in  the  epoch-making  researches  car- 
ried out  by  the  Home  uriiee  Sub-Committee 
into  the  "Duekering"  method  of  disinfec- 
tion of  wool  (preliminary  washing  in  warm 
alkaline  solution,  passage  through  rollers, 
and  subsequent  immersion  in  warm  2iA  per 
cent,  solution  of  formaldehyde)  he  kindly 
acted  as  the  "control,"  throwing  himself 
with  zest  into  the  inquiry  and  adding  the 
weight  of  his  authority  to  the  final  demon- 
stration of  the  success  of  the  method.  Many 
years  previously  he  had  perfected  a  method 
of  current  steam  disinfection  both  rapid  and 
sure,  and  it  was  with  some  regret,  I  remem- 
ber, that'he  satisfied  himself  that  this  would 
not  do  for  wool. 

This,  in  briefest  outline,  indicates  the  wide 
range  of  his  activities.  In  his  big,  generous 
presence  one  felt  tliat  here  was  the  master 
mind.     And  yet,  perhaps,  because  his  early 


life  had  been  passed  on  the  Continent,  his 
meaning  was  not  alwaj-s  easy  to  grasp  at  first, 
and  I  have  often  smiled  at  the  recollection 
that  my  first  acquaintance  with  him  arose 
through  a  misunderstanding — by  my  think- 
ing that  lie  belittled  the  efforts  made  to  use 
Selavo's  serum  in  the  treatment  of  anthrax 
in  the  human  subject,  and  I  was  surprised 
at  the  pains  which  he  took  to  remove  the  er- 
roneous impression.  Again,  when  the  ques- 
tion of  a  medical  referee  on  industrial  dis- 
eases under  the  Workmen's  Compensation 
Act  arose  for  the  industrial  area  of  Lanea- 
.sbire,  knowing  how  bu.sy  he  was,  I  suggested 
that  one  of  the  assistants.  Dr.  A.  Sellers, 
should  be  appointed,  but  the  proposal  con- 
flicted with  his  views  of  the  status  whicli,  as 
Director  of  the  Laboratory,  he  felt  he  must 
hold,  and  so  the  difficulty  was  happily  solved 
by  appointing  both  to  the  one  position.  Pos- 
sibly this  diffieulty  in  understanding  him 
readily,  but  more  probably  his  directness,  his 
sensitiveness  and  the  absence  in  him  of  any 
trace  of  self-pushfulncss  accounted  for  the 
fact — a  source  of  surprise  and  poignant  regret 
to  his  friends — that  wide  public  recognition  of 
his  achievement  never  came  to  him.  But  as 
one  of  his  colleagues  said  years  ago  to  me, 
"Though  he  may  be  difficult  to  understand, 
few,  when  thej'  grasp  his  meaning,  do  not 
think  him  right." 

I  happened  to  hear  of  his  death  when  in 
Geneva,  a  town  which  in  his  youth  he  must 
have  known  so  well,  and  I  could  not  help 
thinking  that  few  can  have  repaid  the  teach- 
ing received  there  and  at  Lausanne  better 
than  did  Sheridan  Delepine. — T.  M.  Legge. 


390 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 
BOOK  REVIEWS 


Lead  Poisoning  in  the  1'ottert  Trades.  By 
Bernard  J.  Newman,  William  J.  McConnell,  Octa- 
vius  M.  Spencer,  and  Frank  il.  Phillips.  T'.  S. 
Public  Health  Service,  Public  Health  Bulletin  No. 
116,  May,  1921.  Pp.  220  with  index.  Washington  : 
Government  Printing  Office,  1921. 

Ill  December,  1918,  the  Brotherhood  of  Op- 
erative Potters  requested  the  Department  of 
Labor  and  Industry  of  Pennsylvania  to  in- 
vestigate potterj'  making  in  order  to  deter- 
mine the  prevalence  of  lead  poisoning  among 
dippers.  The  union  felt  that  the  discrimina- 
tion by  the  industrial  insurance  companies 
against  many  men  emploj^ed  in  the  pottery 
industry,  in  particular  against  the  dippers, 
was  unjustifiable,  and  that  a  .survey  would 
show  that  the  hazard  of  these  occupations  was 
not  nearly  so  great  as  was  supposed.  Their 
request  was  forwarded  to  the  U.  S.  Public 
Health  Service,  and  with  the  approval  of  the 
Surgeon  General  the  inquiry  was  begun.  The 
results  have  just  been  published. 

Two  eai'lier  studies  of  this  same  industry 
are  reviewed  by  the  authors,  one  made  by 
myself  for  the  Bureau  of  Labor  in  1911,  and 
one  made  by  Dr.  E.  R.  Hayhurst  in  1914. 
The  present  investigation  was  far  more  ex- 
tensive and  complete  than  either  earlier  one, 
and  the  findings  are  therefore  much  more 
authoritative.  Not  only  was  a  thorough  sur- 
vey made  of  more  than  half  the  potteries  in 
the  country  but  the  study  of  plant  condi- 
tions was  supplemented  by  estimations  of  the 
quantity  of  dust  in  the  air  of  dipping,  mixing 
and  kiln  rooms,  and  the  amount  of  soluble 
lead  in  the  dust.  The  determination  of  the 
rates  of  lead  poisoning  among  pottery  work- 
ers was  made  by  physical  examinations  of 
1,809  men  and  women  whose  work  brought 
them  in  contact  with  lead  compounds.  The 
publication  is  one  that  reflects  great  credit 
on  the  Public  Health  Service,  but  not  on  the 
pottery  manufacturers,  for  the  conditions  re- 
vealed are,  according  to  all  foreign  standards, 
very  bad  indeed,  and  it  is  discouraging  to 
one  who  reiiiombers  the  state  of  the  industry 
in  1911  to  realize  on  reading  this  report  that 
there  has  been  little  if  any  improvement  dur- 
ing the  intervening  years,  the  most  crying 
evils  have  apparentlj'  been  quite  unaffected 
by  federal  and  state  investigations  and  ad- 
monishments. 


The  authors  say  that  there  is  an  impression 
generally  held  by  manufacturers  that  it  is 
impracticable  to  install  improvements  in  the 
plants,  since  the  industry  is  bound  to  decline, 
j'et  as  a  matter  of  fact  in  a  little  over  sixty 
years  the  number  of  potteries  in  the  United 
States  has  increased  almost  a  thousand  per 
cent.,  and  the  increase  in  imported  china  has 
not  kept  pace  with  the  increase  in  population, 
pointing  to  "a  permanency  which  warrants 
serious  consideration  of  the  character  of  the 
health  hazards  and  of  means  to  minimize 
them. ' '  Another  excuse  commonly  given  for 
poor  plant  hygiene  is  that  most  of  the  pot- 
teries are  small  and  not  much  can  be  demand- 
ed in  the  way  of  control  of  hazards,  but  this 
also  the  authors  find  not  borne  out  by  the 
facts.  Of  the  ninety-two  potteries  visited 
sixty-two  emplo.yed  from  100  to  250  persons, 
and  nineteen  employed  up  to  500. 

The  United  States  Potters'  Association,  an 
organization  of  potters  manufacturing  vitre- 
ous china,  sanitary  ware  and  earthenware, 
makes  regular  working  agreements  with  the 
employees'  organization,  the  National  Broth- 
erhood of  Operative  Potters,  and  as  a  result 
of  this  arrangement  the  industry  has  been 
free  from  strikes  for  a  long  period. 

The  Public  Health  Service  inquiry  covers 
92  plants  in  Ohio,  New  Jersey,  West  Vir- 
ginia and  Pennsylvania.  The  Ohio  pottery 
field  is  muc'li  the  most  important,  and  the 
West  Virginia  field  is  closely  bound  to  it. 
Of  the  26,705  persons  employed  in  1914, 
11,096  were  in  Ohio.  These  92  plants  com- 
prised 21  manufacturing  sanitary  ware.  59 
"general  ware" — /.  e.,  table  and  toilet  ware 
— 4  yellow  ware,  4  art  ware,  and  4  tiles. 
"The  buildings  are  mostly  makeshift  struc- 
tures, ill-adapted  to  the  processes,  although 
a  few  were  found  of  modern  type.  In 
the  older  buildings  little  attention  was 
given  to  the  convenience,  comfort  or  health 
of  the  worker.  .  .  .  An  effort  toward 
improvement  was  found  in  plants  built  dur- 
ing the  last  decade,  although  these  efforts 
often  failed  because  of  lack  of  full  appreci- 
ation of  the  problems  offered  by  the  process- 
es involved."  These  processes  are  the  ones 
with  which  a  lead  hazard  is  connected,  name- 
ly, washing  or  painting  saggers  (earthen 
boxes  in  which  the  ware  is  fired)  with  lead 


BOOK  REVIEWS 


391 


glaze;  mixing  lead  glaze  (no  leadless  glaze 
was  found  in  use)  ;  dipping;  kiln  work;  and 
decorating. 

In  Great  Britain  all  potteries  using  a  glaze 
with  as  much  as  5  per  cent,  soluble  lead* 
come  under  special  rules,  as  to  the  structure 
of  the  departments  mentioned  above,  as  to 
the   provision   of   working    clothes   for   em- 
ployees,  the   provision  of  washing   facilities 
and  their  enforced  use,  of  lunch  rooms  and 
their  enforced  use,  and  of  regular  medical 
examination  of  all  men  and  women  employed 
in  the  lead  work,   with  notification  to  the 
Home  Office  of  all  eases  of  plumbism  found. 
The  rooms  in  which  these  processes  are  car- 
ried on  must  have  smooth  impervious  floors, 
flushed  at  the   end   of  the   day.     Scattering 
of  dry  or  wet  glaze  is  prohibited.     Removal 
of  excess  glaze  must  be  done  before  an  ex- 
haust, and  the  glaze  caught  in   water.     All 
boards,  racks,  and  benches,  on  which  glazed 
ware  has  stood,  must  be  wet-cleaned  at  the 
end  of  the  day.     No  dry  sweeping  or  dust- 
ing is  allowed.    At  the  lunch  hour  the  work- 
room must  be  left,  the  employee  must  divest 
hiiriself  of  working  clothes,  scrub  his  hands 
and  nails  in   warm   water,   wash   his   face, 
rinse    his   mouth,    and    go   to    a    lunchroom 
which  is  the  only  plaee  where  he  is  allowed 
to  leave  his  dinner  pail.   His  working  clothes, 
including  cap   or  sunbonnct,   are   provided, 
laundered   and   repaired   by    the    employer. 
Once  a  month  an  inspection  of  each  worker 
is  made  by  a  pliysiciau  and  if  signs  of  lead 
absorption   are    noted    the   management    is 
warned.     If  lead  poisoning  is  found,   work 
with  lead  must  be  suspended.    The  carrying 
out  of  these  provisions  has  been  admirable, 
and  the  potteries  of  the  Staffordshire  district 
are  as  free  from  lead  dust  as  it  is  possible 
to  make  them. 

A  great  contrast  is  found  in  the  plants 
visited  by  this  commission.  In  the  first  place, 
the  glazes  are  rich  in  soluble  lead.  Of  107 
samples  M'hich  were  analyzed,  73  per  cent, 
contained  from  10  to  20  per  cent,  soluble 
lead.  Eleven  had  from  20  to  50  per  cent. 
The  English  often  "frit"  the  lead,  that  is, 
add  the  lead  to  the  other  ingredients  and 
fuse  them  together,  by  which  fusion  much  of 
the  lead  changes  to  the  insoluble  disilicate. 
This  is  not  customary  in  the  United  States 
although   apparently   the   authors   found   it 

•Lead    pa.ssing    into    solution    after    two    hours' 
agitation   witli  0.25  per  cent,   hydrocliloric  acid. 


done  in  some  potteries.     The  usual  method 
is  to  add  white  lead  to  the  fritted  mass. 

In  mixing  the  glaze,  much  dust  is  formed. 
The  authors  foiuid  a  higher  dust  content  in 
the  air  in  the  mixing  rooms  than  in  any  other 
department,  but  more  soluble  lead  in  the 
dripping  rooms.  Here  the  dust  comes  from 
the  drying  of  splashed  glaze  on  floors, 
benches  and  walls  and  from  the  accumula- 
tions of  glaze  dust  on  ware  boards  and  racks. 
Handling  these  boards,  dropping  them  fre- 
quently down  on  end,  sweeping  the  floor  and 
the  passing  to  and  fro  of  kilnmen  and  ware 
gatherers,  all  keep  the  dust  stirred  and  the 
air  contaminated.  Glost-kiln  placer.s  not 
only  handle  the  glazed  ware  but  rub  off  the 
excess  from  the  feet  of  the  ware,  often 
against  their  aprons.  Here,  too,  the  benches 
and  the  floor  are  covered  with  glaze  dust. 

In  47  of  the  92  potteries,  sweeping  was 
done   during  working  hours,  and  in   25   of 
these   the   floors    were    swept    dry    or    only 
slightly  sprinkled.    In  not  one  single  plant 
was  a  separate,  modern  washroom  provided 
for  the  use  of  the  employees.     The  facilities 
for  washing  were  as  follows:  hot  water,  20; 
soap  and  towels,  4;  troughs  of  some  type, 
29:  pails  of  water.  37;  other  forms,  such  as 
tubs,  9.    "In  many  of  the  plants  the  workers 
wash    either   in   basins    removed    from    the 
racks  or  in   troughs  used  for  washing  the 
ware  and  ware   boards,"  but  as  the   glaze 
from  these   troughs  is  collected  for  further 
use,  the  workers  are  not  allowed  to  wash 
with  soap  because  the  soap  would  ruin  the 
glaze.     Yet  the  faucets  over  these  troughs 
may  be  the  only  ones  available.     "In  quite 
a  numlicr  of  plants  the  dippers  and  dippers' 
helpers  are  known  to  wash  their  faces  and 
arms   with   the   sponges   which   are   used   to 
clean  the  sides  and  edges  of  the  dipping  tubs. 
In  general,  the  washing  facilities  are  scanty 
and  inadequate,  and  because  of  this  condi- 
tion the  employees  wear  their  work  clothes 
from  the  plants  to  their  homes."     The  de- 
scription goes  on,  in  much  the  same  vein, 
with  regard  to  the  care  of  street  clothes — 
1  plant  only  possesses  a  locker  room  ;  in  C6  the 
clothes  hang, in  the  workroom — with  regard 
to  the  provision  of  drinking  water — 19  with 
pails  only,  18  with  pitchers  only — the  dis- 
covery of  individual  drinking  cups  hanging 
so  as  to  catch  lead  dust  and  of  uncovered 
pitchers  of  coffee  and  of  water  standing  on 
shelves,  often  -with  a  scum   of  dust  visible 


392 


THE   JOURNAL  OF  INDUSTRIAL  HYGIENE 


on  the  surface  of  the  liquid.  In  only  22  of 
the  plants  do  the  emploj^ees  wear  any  sort 
of  protective  clothing,  in  the  others  all 
clothing  is  worn  home  after  work.  The  em- 
ployer has  no  concern  whatever  with  this 
detail  neither  providing  clothing  nor  a  place 
in  which  to  don  it,  nor  insisting  that  the  em- 
ployee provide  it.  In  only  5  plants  were 
there  regulations  against  eating  lunch  in 
the  workrooms,  and  in  3  these  Avere  not  ob- 
served. In  80  plants  some  workers  eat  in 
these  rooms  and  in  65  the  majority  do,  that 
is,  about  969,  or  one-half  of  all  those  exam- 
ined in  the  survey. 

As  to  medical  supervision,  it  does  not  ex- 
ist, except  for  an  attempt  at  it' in  one  of  the 
92  plants.  No  examinations  of  the  workers 
are  made,  no  effort  is  made  to  diagnose  lead 
poisoning  in  its  early  stages,  there  are  no 
company  hospitals,  and  only  two  dispen- 
saries. As  no  effort  is  made  to  instruct  the 
workers  regarding  the  proper  ways  of  pre- 
venting lead  poisoning,  it  is  not  strange  that 
superstitions  pei'sist  among  the  pottery 
workers,  such  as  the  efficacy  of  tobacco 
chewing  to  carry  off  lead  dust,  and  the  bene- 
ficial effect  of  getting  drunk  and  vomiting 
the  accumulated  lead  once  a  week. 

In  view  of  the  conditions  described  above 
the  examination  of  specimens  of  dust  be- 
comes very  interesting.  They  were  collected 
from  three  departments — glaze  mixing,  dip- 
ping, kilns — and  two  from  other  localities. 
Collections  were  made  with  the  Palmer  ma- 
chine and  293  specimens  in  all  were  secured. 
Assuming  that  the  uumlier  of  Class  4  parti- 
cles per  cubic  foot  of  air  should  not  exceed 
200.000,  the  investigators  found  that  only 
25.6  per  cent,  of  the  specimens  were  as  dust- 
free  as  that,  while  26.8  per  cent,  showed 
from  200.000  to  500,000  particles  per  cubic 
foot  of  air,  and  47.8  per  cent,  would  be  re- 
garded as  excessively  dusty,  containing  over 
500,000  particles.  Thirty  per  cent,  of  these 
last  had  1,000.000  particles  or  more.  The 
highest  counts  were  found  in  the  glaze  mix- 
ing rooms  where  15  out  of  41  samples  fell  in 
the  1,000,000  column.  The  soluble  lead  in 
the  dust  was  then  estimated.  Eighty-nine 
specimens  showed  from  10  per  cent,  to  49.9 
per  cent,  soluble  lead,  and  9  more  than  50 
per  cent.  The  largest  proportion  was  found 
in  the  dipping  room  specimens,  55  out  of  90 
of  which  had  from  10  per  cent.  up. 

The  pottery  workers  are  to  a  large  extent 


American-born,  and  if  of  foreign  birth, 
chiefly  English.  Of  the  1,809  workers  se- 
lected for  examination,  1,436  were  men,  373 
women.  Only  about  8.4  per  cent,  of  all  the 
employees  in  the  potteries  are  exposed  to 
lead,  and  it  was  from  this  minority  that  all 
individuals  Avere  drawn.  The  men  were 
ehieflj'  glost-kilnmen  and  dippers ;  the  wom- 
en, dippers'  helpers  and  ware  cleaners.  Men 
are  far  more  exposed  to  lead  than  are  wom- 
en— 79  per  cent,  of  those  examined  were 
men.  The  turnover  for  men  is  high  during 
the  first  few  months  of  employment,  after 
that  rather  Ioav.  Seventy  per  cent,  of  the 
dippers  and  65  per  cent,  of  the  glost-kilnmen 
had  been  employed  more  than  ten  years. 
The  women  average  much  younger  than  the 
men  and  their  turnover  is  high. 

Great  caution  is  used  bj^  the  authors  in 
making  a  diagnosis  of  lead  poisoning,  and 
the  cases  are  grouped  under  three  heads — 
positive,  presumptive,  and  suggestive — al- 
though in  the  opinion  of  the  examiners  these 
different  diagnostic  groups  simply  represent 
different  degrees  of  plumbism,  and  the  first 
two  may,  for  all  practical  purposes,  be  con- 
sidered together.  The  discussion  of  the 
symptom-complex  which  may  be  considered 
diagnostic  is  intei-esting,  and  the  authors 
suggest  that  a  standard  terminology,  such 
as  used  by  them,  be  adopted  in  future  sur- 
vey's and  in  anah'zing  existing  records  so 
that  a  comparison  of  the  data  obtained  from 
various  sources  may  be  made.  Briefly  stated, 
their  findings  are  as  follows: 

Positive  and  presumptive  lead  poisoning 
was  found  in  13.5  per  cent,  of  all  cases,  the 
men  having  a  rate  of  14.2,  the  women  of  11. 
If  the  third  group,  containing  suggestive 
cases,  were  divided  evenly  between  the  posi- 
tive and  negative,  the  rate  would  be  22.8 
per  cent,  for  all,  with  23.1  for  men  and  21.5 
for  women.  This  last  estimate  seems  suffi- 
ciently cautious  and  conservative  in  Aaew 
of  the  description  of  these  so-called  sugges- 
tive cases.  They  are  workers  exposed  to 
lead  who  exhibit  some  combination  of  the 
following  symptoms :  constipation,  loss  of 
weiglit,  loss  of  strength,  drowsiness,  pain  in 
lumbar  region,  pain  in  joints,  headache,  in- 
somnia, confusion,  loss  of  morning  appetite, 
metallic  or  sweetish  taste. 

Agi',  or  rather,  perhaps,  length  of  expo- 
sure, has  some  influence  on  the  occurrence 
of  lead  poisoning.    The  positive  cases  among 


BOOK  REVIEWS 


393 


the  men  averaged  44.3  years  of  age,  the  nega- 
tive 37.5  years.  The  low  rate  of  plumbism 
for  women  as  compared  with  men  is  only 
apparent,  for  when  one  estimates  the  length 
of  exposure  of  the  two  sexes  and  compares 
the  rates  for  men  and  women  engaged  in 
the  same  sort  of  work,  it  becomes  apparent 
that  the  women  are  actually  more  suscep- 
tible. The  average  length  of  exposure  of 
the  positive  male  cases  is  17  years,  of  the 
female  cases  9.9  years,  while  for  the  two 
presunii)five  groups  the  figures  are  15.7  and 
6.3.  "It  should  also  be  mentioned  that  in 
most  plants  the  length  of  day  for  the  female 
worker  is  from  one-half  hour  to  one  hour 
shorter  than  tliat  of  the  male  worker.  It 
would  seem  tliat  the  female  reaches  these 
stages  of  lead  poisoning  in  about  half  the 
time  required  for  the  male  to  reach  them." 
Comparing  the  men  and  women  who  work 
side  by  side  in  the  dipping  rooms,  it  was 
found  that  58  male  ware  carriers  had  no 
positive  cases  of  plumbism.  while  62  women 
ware  carriers  had  a  rate  of  4.8  per  cent. 
The  women,  however,  had  been  exposed  a 
slightly  longer  period  of  time.  Among  71 
male  dippers'  helpers  the  rate  of  plumbism 
was  8.4  per  cent.,  and  among  149  female  dip- 
pers' helpers,  the  rate  was  14.4  per  cent. 

It  would  require  too  long  to  go  into  the 
details  of  the  studies  of  weight,  blood  pres- 
sure, pulse  rate,  dynamometer  readings,  etc., 
but  a  few  words  must  be  said  as  to  the  influ- 
ence on  the  incidence  of  plumbism,  of  such 
factors  as  high  percentage  of  lead  in  the 
glaze,  neglect  of  ordinary  hygiene,  lack  of 
washing  facilities,  use  of  the  workroom  as  a 
lunchroom,  and  the  length  of  the  working 
day.  The  rate  of  positive  plumbism  for  those 
working  seven  hours  a  day  and  less  is  7.9  : 
for  those  working  eight  hours,  9.8 ;  for  those 
working  nine  hours,  6.5 ;  and  for  those  work- 
ing ten  hours  or  more,  11.2.  Those  working 
on  a  nine-hour  schedule  are  in  occupations 
slightly  less  hazardous  than  those  employed 
for  the  other  lengths  of  da.y,  and  those  plants 
ill  which  the  nine-hour  schedule  prevails 
have  fewer  bad  conditions.  As  to  the  quan- 
tity of  lead  in  the  glaze,  the  rates  for  the 
plants  using  glaze  with  more  than  12  per 
cent,  soluble  lead  were  17.6  for  the  men  and 
14.8  for  the  women,  while  in  those  using  less 
than  12  per  cent,  soluble  lead  the  rates  were 
6.8  and  2.7.     Grouping  the  plants  according 


to  ordinarj-  factory  hj-giene,  it  was  found 
that  the  eight  worst  potteries  had  a  rate  of 
positive  and  presumptive  plumbism  of  34 
per  cent.,  while  twent\-nine  plants  with  bet- 
ter conditions  had  a  rate  of  only  6.3  per  cent. 

It  may  perhaps  be  of  interest  to  insert  at 
this  point  the  last  full  report  of  the  British 
Factory  Inspection  Department  concerning 
plumbism  in  the  potteries.  This  is  for  the 
year  1913,  the  last  year  for  which  rates  of 
poisoning  are  available.  In  this  year  there 
were  found  62  cases  of  plumbism  among 
7,085  employed,  making  a  rate  of  0.9  per 
cent.,  the  rate  for  women  being  1.0  per  cent., 
and  for  men  0.8.  The  dippers  had  the  high- 
est, 2.4  per  cent.  It  seems  probable  that  even 
this  excellent  record  has  been  improved  dur- 
ing recent  years,  for  there  were  only  21  cases 
reported  for  1919,  but  the  number  of  persons 
employed  is  not  given  and  therefore  one  can- 
not be  sure. 

In  thi>ir  summary,  the  authors  aproach 
with  extreme  caution  the  question  of  re- 
sponsibility for  the  conditions  leading  up  to 
this  excessive  rate  of  plumbism  in  American 
potteries.  Indeed,  they  may  be  almost  said 
to  lean  backward  in  their  effort  to  be  im- 
partial. Admitting  that  the  amount  of 
plumbism  seems  to  depend  upon  the  various 
amounts  of  soluble  lead  used  in  the  glazes 
and  upon  iinliygienic  conditions  found  in  the 
plants,  they  declare  themselves  unwilling  to 
say  whether  or  not  the  incidence  of  lead 
poisoning  is  to  be  charged  to  plant  condi- 
tions more  than  to  the  personal  habits  of  the 
employees.  This  is  a  little  difficult  to  un- 
derstand in  view  of  the  statement  made  on 
the  following  page  that  little  if  any  instruc- 
tion is  given  the  pottery  worker  concerning 
the  danger  he  faces  and  the  precautions  he 
should  use ;  in  fact,  it  seemed  to  the  investi- 
gators that  those  in  charge  of  the  plants 
were  "either  indifferent  or  careless  or  ig- 
norant in  regard  to  lead  hazards."  Nor  does 
it  seem  fair  to  include  "length  of  exposure" 
as  one  of  the  "personal"  factors  in  lead 
poisoning.  Even  the  reckless  habit  of  eat- 
ing with  lead  covered  hands  cannot,  in  all 
instances,  be  regarded  as  a  charge  against 
the  workman  if  the  only  water  provided  him 
for  washing  is  a  thin  suspension  of  lead 
glaze. 

All  foreign  countries  in  which  industrial 


394 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


hygiene  is  taken  seriously  have  found  that 
the  only  practical  way  of  enforcing  proper 
sanitary  control  is  to  throw  the  responsibility 
upon  the  employer.  The  question  is  not  one 
of  moral  judgment,  but  of  a  practical  work- 
ing method.  It  is  quite  as  useless  to  expect 
a  man  of  careful,  cleanly  habits  to  protect 
himself  from  lead  poisoning  in  a  pottery  as 
to  expect  the  individual  city  dweller  to  pro- 
tect his  own  family  against  polluted  water 


and  milk  and  against  communicable  disease. 
We  shall  never  get  rid  of  industrial  poison- 
ing in  the  United  States  until  we  begin  to 
deal  with  it  as  we  do  with  such  community 
diseases  as  malaria,  hookworm,  and  typhoid 
fever — that  is,  by  instruction  of  the  individ- 
ual in  the  nature  of  the  hazard  and  the 
proper  means  of  protection  against  it,  and 
by  community  control  of  sources  of  danger. 
— Alice  Hamilton. 


SUBJECT  INDEX  TO  VOLUME  III 

This  is  a  .subject  index  to  all  the  reading  matter  in  the  Joubnal  of  Industrial  Hygiene,  and  one 
should,  therefore,  look  for  the  subject  word,  with  the  following  exception :  "Book  Notices"  are  indexed 
under  Ibis  title  on  pajie  397.     The  name  of  the  author  follows  the  subject  entry  in   parentheses. 

For  nuthiii-  index,  see  page  398. 


PACK 

AcoiDENTs,  disabilities  of  back  arising  out  of 
pathological  conditions  as  reportable  acci- 
dents   (Grain  and   Slater) 197 

study  of  accident  records  in  textile  mill 
(Hewes,  Fear,  Graves,  Ijawrence,  Metz, 
and  .'^mil  h )    IS" 

Acid,  picric,  nee  Picric  acid. 

Are,  determination  of  dust  in,  by  Palmer  ap- 

panitus    (Smyth  iind   Iszard) 159 

determination     of    finer    dust    particles    In 

( Meyer ) 51 

effect  of  humidity  of.  on  m.issiveness  of 
spray  infection   (Douslas  ,Tnd  Hill) 20C 

Amesmcan  Association  of  Industrial  Physicians 

and  Surtreon.s  announcement  of 361 

Public  Health  A.ssociation  Health  Institute, 
announcement  of 21S 

Aniline  p<^)isoning  in  rubber  industry  (Davis)     57 
tumors  of  bladder,  discussion  of  etiology  of 
(Hamilton) 16 

Artiiritis,    infectious,  of  spine    (Ourran   and 

Foster) 339 

AuTOMoniLE  exhaust  gas.  physiological  effects 
of.  and  standards  of  ventilation  for  brief 
exposures  (Henderson,  Haggard,  Tengue, 
Prince,  and  Wunderlich ) 79. 137 

Back  disabilities  from  pathological  conditions 
as  reportable  accidents  (Grain  and 
Slater) 197 

Benzol,  carbon  monoxide  and  illuminating 
gas,  effect  of.  on  blood  coagulation  time 
(Forbes  and  Hompe) 213 

Blaodeb,  ani[iiio  tumors  of,  discussion  of  eti- 
ology of'  (Hamilton) 16 

Blood  coagulation  time,  effect  of  carbon  mon- 
oxide, illuminating  gas,  and  benzol  on 
(Forbes    and    Hompe) 213 

Book   Xotices,  arc  page  .'iOT. 

Carbon  inonoxido,  illinninating  gas.  and 
benzol,    effect    of.    on    blood    coagulation 

time  ( Forbes  and  HomiK>) 213 

monoxide,  physiological  effects  of  automo- 
bile exhaust  gas  and  standards  of  ventila- 
tion for  brief  exposures  (Henderson.  Hag- 
gard. Teagiie.  Prince,  and  Wunderlich)  79.  137 
monoxide  poisoning,  survey  of.  in  American 
steel  works,  metal  mines,  and  coal  mines 
(Forbes) 11 

OiiNio.  dental,  establisliment  of  (Hastings)..  376 

Goal  mine,   scr   Mine.   coal. 

Cold,  effect  of.  on  massiveness  of  spray  infec- 
tion   (Douglas  and   Hill") " 206 

Golds,     common,     in     relation     to     industrial 

hygiene    (Tol>ey) 333 

Compensation  for  disabilities  of  back  arising 
out  of  pathological  conditions  (Grain  and 
Slater) 197 

CuspinoRs.  suggestions  for,  In  industrial  plants 

(Sm.vtht 204 

DelSpine.   Sheridan,   appreciation  of   (Legge)   387 

395 


Dentai.  clinic,  establishment  of   (Hastings)..  37C 
Dust,  determination  of  finer  dust  particles  In 

air    (Meyer) 51 

in   printers'  workrooms   (Roos) 257 

modern    views    upon    development    of    lung 

fibrosis    (Drinker)     i!9.") 

practical  hygienic  etflciency  of  Palmer  ap- 
paratus for  determination  of  dust  in  air 
(Smyth   and  Iszard) 159 

Ears,  influence  of  industrial  noises   (fJlibert)   264 

Education,    physical,  sec   Physical   education. 

Efficiencv,  industrial,  relation  of  cardiac  dis- 
ease to   ( Coombs) 227 

Error,    fatigue    and.    in     mental    occupation 

(Haumberger) 149 

Fatigue     and     error     in     mental     occupation 

(Baumberger) 149 

influence     of.     on     health     and     longevity 

(  \'ernon ) 93 

prevention  of.  by  use  of  correct  work  chair 

(Emmons    and    Goldthwait) 154 

Follicuutis.   see   Skin   diseases. 

Fractures,     metatarsophalangeal,     report     of 

twenty-seven   cases    ( Bolduc » 371 

I'"^AMiNGHAif  health  demonstration  and  indus- 
trial   medicine     (Armstrong) 1S3 

Gas,  exhaust.  j>hysiological  effects  of  automo- 
bile exhaust  gas  and  standards  of  ventila-  . 
tion  for  brief  exposures  (Henderson.  Hag- 
canl,  Teague.  Prince,  and  Wunderlich)  79,137 
illuminating,  benzol,  and  carlion  monoxide, 
effect  of.  on  blood  coagulation  time 
(Forbes    and    Hompe) 213 

Headache    (Gobb   and   Parmenterl 173 

Health    and    longevity,    influence    of    fatigue 

on     ( ^'ernon ) 93 

and  safety  workers,  notice  of  census  of  ^2,  .362 
in  mercantile  establishments.    III.  Common 

sanitary  defects  in  stores    (Emmons)....     29 
Institute  of  American  Public  Health  Asso- 
ciation,   a.nnouncement    of 218 

Heart  disease  and   its  relation   to   industrial 

efficiency    (Coombs) 227 

disease,    problem    of,    in    Industrial    worker 

(White) 219 

TTouRs  of  labor  and  health,  lighting  and  ven- 
tilation   of   factories    (Purdy) 349 

HuMTDiTV  of  air.  effect  of.  in  massiveness  of 

spray    infection    (Douglas    and    Hill)....   206 
Hyperttiykoidism.     epinephrin     hydrochloride 
test  in  group  of  normal  individuals   (Van 
Wagenen )     343 

Industrial  hygiene,  common  colds  in  relation 
to     (Tobey) .333 

medical  service,  see  Medical  service,  indus- 
trial. 

medicine,  see  Medicine,  industrial. 

physician,   see  Physician,    industrial. 

poisoning,  see  under  specific  poison. 

surgery,  see  Surgery,   industrial. 


396 


TTIE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


l-Ar-.E 

Industry,  interchange  of  physical  examina- 
tions  in    (Myers) 135 

medical    supervision    in     (Brasher) 179 

pregnant  woman  in   (McCord  and  Minster)     39 
syphilis   and    (Thomson)    99 

Infection,   spray    (Douglas   and   Hill) 206 

LiEAD    poisoning,    risk    of,    in    using    spraying 

machine  for  painting   ( Sharpe) 378 

presence  of.  in  dust  in  printers'  workrooms 
(Roos) 257 

IjIgiiting  and  ventilation  of  factories,   hours 

of  labor  and  health   (Purdy) 349 

LoNOEviTY  and  health,  influence  of  fatigue  on 

(Vernon) 93 

Ltjbricant.s.   oil   folliculitis    (Page  and   Bush- 

nell) 62 

LiUNG  fibrosis,  modern  views  npon  develop- 
ment   of    (Drinker) 295 

Magnetic  field  as  industrial  hazai-d   (Drinker 

and  Thomson ) 117 

Manoanese   poisoning,    chronic,    two   cases   of 

( Davis    and    Huey) 231 

Medic.w,    service,    industrial.    f<u-    small   plant 

(McCord    and    Minster) 363 

supervision  in  industry    (Brasher) 179 

Medicine,  industrial,  and  Framingham  health 

demonstration     (Armstrong) 183 

Mental     occnpation.     fatigue     and     error    in 

(Baumberger) 149 

and    physical    examinations,    correlation    of 
(Cobb) 3f)0 

Mercantile  establishments,  health  in.  III. 
Common  sanitary  defects  found  in  stores 
(Emmons) 29 

METrAL    mine.   f>cc   Mine,    metal. 

Metatarsophalance.al  fractures,  report  of 
twenty-seven   cases    (Bolduc) 371 

MiNH,  coal,  survey  of  carbon  monoxide  poison- 
ing in  American  steel  works,  metal  mines. 

and  coal  mines   (Forbes) 11 

metal,  survey  of  carbon  monoxide  poisoning 
in  American  steel  works,  metal  mines,  and 
coal   mines    ( Forbes  I 11 

Motor   control,    static    enuilibriuni    as    test    of 

(Miles ) 310 

N.\TiON.\L  Safety  Council  census  of  safety  and 

health    workers,    notice   of .".   ,3.32.362 

Neuropsychtatric    examination    of    stndents. 

report   of    (Cobb) .309 

Noi.sB.    industrial,    influence   of    (Gilbert) 204 

Oils,    .ler    Taibricants. 

Outfit  study  of  users  and  non-users  of  to 
bacco  in  a  strenuous  physical  occupation 
(Baumberger.   Perry,   .ind   Marlin) 1 

Painting,  hazard  of  lead  i)oisoning  from  use 

of  spraying  machine   in    (Sharpe) ,37S 

Palmer  apparatus,  practical  hygienic  effi- 
ciency   of.    for    determinin;;    dust    in    air 

(Smyth   and    Tszard) 159 

Pitv.siCAi.  and  mental  examinations,  correla- 
tion   of    ( ( "ol.b  t 309 

education     friin\     standjKiint     of    industrial 

physiciiin    ( Elliott  I     168 

examinations,    interclinnge    of.    in    industry 
(Myers) ".   l.SB 


PAGE 

Physical  examinations  of  large  groups  of 
individuals.      investigative      opportunities 

in     (Lee) 301 

occupation,  strenuous,  output  study  of  users 
and  non-users  of  tobacco  in  (Baumberger, 
Perry,    and    Martin) 1 

Physician,  industrial,  and  physical  educa- 
tion   (Elliott ) 168 

industrial,  qualifications  essential  to  suc- 
cess  of    (McConnell) 130 

Physiological     effects      of      magnetic      field 

(Drinker   and   Thomson) 1 17 

IICRic   acid  in   industrial   sui-gery    (Bolduc)  .  .   202 

Po.STURE.  a   correct  work  chair   (Emmons  and 

Goldthwait) 154 

Printers'    workrooms,    dust    in     (Roos) 257 

Rehabilitation  of  employees,  experience  with 

1.210    cases     ( Kellogg) 276 

Ri-iiUER  industry,  aniline  poisoning  in   (Davis)     57 

-Safety   and   healtli   worliers.   notice  of  cen-sus 

of 3.32.  3r>2 

Sanitation,  common  sanitary  defects  in  stores 

( Emmons ) 29 

Seating,  a   correct  work   chair    (Emmons  and 

Goldthwait) 154 

Silica,  presence  of,  in  du.st  in  printers'  work- 
rooms    (Roos) 257 

Skin  diseases,  oil  folliculitis  (Page  and  Bush- 

nell) 02 

Smokers,   kcc   Tobacco, 

Spine,    infectious    arthritis    of    (Curran    and 

Foster) 3.39 

Spraying    machine,    liazard   of  lead  .poisoning 

from   use  of.   in   painting    (Shnrpe) .378 

.Station,   static   e(|uili1>riuni    as   test   of  motor 

control    (Miles) 316 

Steel  works,  surve.v  of  carbon  monoxide 
poisoning  in  American  steel  works,  metal 

mines,   and   coal    mines    (Forbes) 11 

works,  two  ca.ses  of  chronic  manganese 
poiscming    in     (Davis    and    Hue,v) 231 

Si-kgery,  industrial,  iiicri(>  acid  in   (Bolduc)  .  .   2(r2 

Syphilis   and    industry    (Thomson) 99 

Textile  mill,  study  of  accident  records  in 
(Ilewes.  Fear.  Graves,  LawTence,  Metz. 
and    Smith)     1«7 

Tobacco,  output  study  of  users  and  non-users 
of  tobacco  in  a  strenuous  pliysical  mvnpa- 
tion    (Baumberger.   Perry,   and   Martin)..        1 

Trtnitrotoliene     as     an     industrial     jioison 

(Hamilton)     102 

poisoning,  nature,  diagnosis  and  prevention 
of    (Voegtiln.    TTooper,    and    .Tolinson)   2.39.280 

TiRERctLOsis,  Franiingliain  healtli  demonstra- 
tion and  industrial  medicine   (.\rnistrong)    183 

Ventilation   and   ligliting   of   factories,   hours 

of  labor   .-ind    health    (Purdy) 349 

effect  of.  on   innssiveness  of  spra.v  infection 

(DouL'las    and    TTill) ' 206 

standards  of.  for  brief  exposures  to  automo- 
bile exhaust  gas  (Flenderson.  TTaggard, 
Teague.    Prince,    and   Wundcrlicli)  .  .  .  .   79,1.37 

Women,  precnant  woman  in  indn^tr.v  (SlcCord 

and    Minster) 3!) 

Worker,  industrial,  problem  of  heart  disease 

In     (White)     219 


SUBJECT    INDEX 


397 


BOOK  NOTICES 


Aiiiar.  J.:  Tlie  Iluiiiaii  Muinr  or  the  Scientific 
Foundations    of    Labor    and    Industry 

Balier.  C.W.  :  <ioveriimeut  Control  and  Opera- 
tion of  Industry  in  (ireat  Britain  and  the 
United    States   during    the   World    War.... 

Bergey,   I>.H.:    Principles  of  Hygiene 

B]al<e.  FM..  «<■(■  <)pi<-.  E.L. 

Bunihani.  A.C. :  Tlie  roniinunity  Healtli 
I'rohlem     

("arl)on  monoxide  i)oisoning.  comprehensive 
treatise   on    (Lewin) 

Clark.  .J.B. :  The  Control  of  Sex   Infections.. 

CoIIis.  10. Ia,  and  <;reenwooii.  M. :  The  Health 
of    the    Industrial    Worker 

Colp,  U.,  and  Keller,  M.W. :  Textbook  of  Sur- 
gical    Nursing 

Community    health    i)rot>l('m     (  Burnliam  I  .  .  .  . 

Crowell.   .T.F. :   Government   War  Contracts... 

Disease,    communicable,    hygiene   of    ( Munsou 

Disea.se.  e.i>id('mic  ri'.s])iratory  ( Opie.  Blake. 
Small,    and    Rivers  I 

Dreyer,  G.,  and  Hanson.  G.F. :  The  .\ssessnient 
of  I'hysical  Fitness  by  Correlation  of  \'ital 
Capacity  and  Certain  Measurements  of  the 
Body    

Kducation.  civic,  industrial  organization  and 
social  medicine  in  Kngland  and  T'nited 
States    (Sand)    

Rfficioncy.  human,  and  levels  of  intelligence 
(G(Kldard)     

EfHci<'iuy.   industrial    fatigue  and    (Vernon).. 

Fatigue,    industrial,    and    efficiency    (Vernon) 

Faugbt.  F..\. :  Ks-^entials  of  Laboratory  Diag- 
nosis      

GcMldard.  H.IL:  Human  Efficienc.v  and  Levels 
of    Intelligence 

Greenwood.   M..  nrr  CoUis,  E.L. 

Hanson,    G.F.,    iter   Dreyer.    G. 

He.ilth.   commuuity.   |)r(iblem  of   (Burnbami.. 

Henlth  of  lndustri;il  worker  (Collis  and 
Greenwood  i      

Health,  .iiublic.  and  h.vgiene   (Park) 

Ile.Mllb.    public,    and    insurance    (Xewsholnie) 

Henley's  Twentieth  Century  F<u-mulas.  Tle- 
cijM's  and    rroces--e<    (  Hiscox) 

Hiscox.  G.D. :  Henley's  Twentieth  Century 
Fornuilas.   Recipes   and   Processes 

Human  motor  or  scientific  foundations  of 
labor   .'ind    industry    (.\niar) 

Hygiene  and    imblic   health    (Park) 

Hygiene   of  communicabb'  diseases    (  Munson ) 

Hygiene.    lU'inciples    of    (Bergey) 

Industrial  oriranization.  social  medicine,  and 
civic  education  in  England  and  T'nited 
States    (Sand)     

Industry.  governmiMit  control  and  oi^eration 
of.  in  Great  Britain  .md  T'nited  States  dur- 
ing world   war    (Baker) 

Insurance,   public  health   and    (Xewsholme)  . . 


196 
294 


147 

76 
196 

293 

28)4 

147 

196 

)   37 

196 


217 

38 

147 
359 
359 

360 

147 

147 


293 
360 

76 

196 
196 


2.14 
.160 
1.'}7 
294 


.^S 


196 
76 


Intelligence,  levels  of.  and  human  efficiency 
((i<xldard  i      147 

Keller.   .M.W.,   .„  t    dip,   R. 

Laborat.iry   diagnosis,   essentials  of    (Fauglit)   360 

I/ead  poisoning  in  pottery  trades  (Newman, 
.McConnell,  Si>eucer,  and  Phillips  I 390 

Lewin,  L. :  1  tie  Kohlenoxydvergif tung.  Eln 
Handbuch  fiir  Mediziuer.  Techniker  und 
liifallrichter     76 

Loosmore.  W.C. :  Nerves  and  the  Man 196 

.McConnell,   W..T.,  mc   Newman.   B..L 

Medicine,  .social,  industrial  organization  and 
civic  education  in  England  and  I'liited 
States    ( Sand ) 33 

Munson,  F.M. :  Hygiene  of  Comnumicable  Dis- 
sea.ses.  A  Handbook  for  Sanitarians.  Med- 
ical Officers  of  the  Army  and  Navy  and  Gen- 
eral   Practitioners 37 

Nervous  breakdown,  psychological  and  con- 
structive  study   of    (Loosmore) 196 

.Newman.  P.. I.,  M(<'onnell,  W..L.  Spencer.  O. 
.M..  and  l'hilU|)s.  F.M  :'  Lead  Poisoning  in 
the    Pottery    Trades S90 

Newsholme.  .\. :  Public  Health  and  Insurance: 
/\jnerican  Addresses 76 

Nursing,  surgical,  textbook  of  ( Colp  and 
Keller ) 294 

Opie,  E.L.,  Blake.  F.G..  Small.  .I.e..  and  Rivers. 
T.M. ;    Epidemic    Respiratory    Disease 196 

Park.   W.H.:    Public   Health   and   Hygiene 360 

Phillips.   V.M..  /tre   Newman,   B..T. 

Physical  fitness,  assessment  of,  by  correlation 
of  vital  capacity  and  <'ertJiin  measurements 
of  body    (Dreyer  and   Hanson) 217 

Pliysiolotry.  industrial,  scientific  foundations 
of   labor  and   industry    (.\mar) 254 

Pottery  tr.ides.  lead  poisonin:;  in  (Newman, 
McConnell.  S|M'ncer.  an<l  Pliillips) .390 

Ringworm,    treatment    of    (Turner) 360 

liivers.  T.M..  sec  Opie.   E.L. 

Sjuul.  R. :  Organisation  Industrielle.  Medecine 
Sociale  et  Educ'ition  CivJiue  en  Angleterre 
et    aux    Etats-T'nis 38 

Sex  infections,  control  of  (Clark) 196 

Skin,   occufiational   affections   of    (White)....   217 

Small,  .I.e..  srr  Opie.  E.L. 

.Spencer.  O  M..  sit  Newman.  B..I. 

Turner.  .T.P. :  Ringworm  and  its  Successful 
Treatment ' 3()0 

A'ernon.  11. M.:  Industrial  Fatigue  and  Efli- 
ci(>ncy .359 

War.  government  control  and  operation  of  in- 
dustry in  Great  Britain  and  T'nited  States 
during  world  war   (Baker) 196 

War,   government   war   contracts    (Crowell)..    196 

White,  R.P. :  Occupational  Affections  of  the 
Skin 217 

Worker,  iudustinal,  health  of  (Collis  and 
Greenwood) 293 


AUTHOR  INDEX  TO  VOLUME  III 


PAGE 

Armstrong,  D.B. :  The  Framingham  Health 
Demonstration  and  Industrial  Medicine 183 

Baumberger,  J.P. :  Fatigue  and  Error  in  a 
Mental    Occupation •  •   149 

Baumberger,  J.P.,  Perry,  E.E.,  and  Martin, 
E.G. :  An  Output  Study  of  Users  and  Non- 
Users  of  Tobacco  in  a  Strenuous  Physical 
Occupation 1 

Bolduc,  A.G. :  Metatarsophalangeal  Frac- 
tures, with  a  Report  of  Twenty-Seven  Cases  371 

Bolduc,  A.G. :  Picric  Acid  in  Industrial  Sur- 
gery   202 

Brasher.  C.W.J. :  Medical  Supervision  in 
Industry 179 

Bushnell,    L.D.,   see   Page,    C.G. 

Cobb,  S.:  A  Report  on  the  Brief  Neuropsy- 
cliiatric   Examination   of   1.141    Students...   309 

Cobb,  S.,  and  Parmenter,  D.C. :  Headache 173 

Coombs.  C.F. :  Cardiac  Disease  and  its  Rela- 
tion to  Industrial  Efficiency 227 

Grain.  R.P...  and  Slater,  B..T. :  When  Are  Dis- 
abilities of  the  Back  Arising  Out  of  Path- 
ological   Conditions   Reportable  Accidents?.   197 

Cun-an,  J.F.,  and  Foster,  S.F. :  Infectious 
Arthritis   of   the    Spine 339 

Davis,  G.G.,  and  Hue.v,  W.B. :  Chronic  Man- 
ganese Poisoning :   Two   Cases 231 

Davis.  P.A. :  Aniline  Poisoning  in  the  Rubber 
Industry 57 

Douglas.  S.R.,  and  Hill,  L. :    Spray  Infection.   206 

Drinker,  C.K. :  Modern  Views  upon  the  De- 
velopment   of    Lung    Fibrosis 295 

Drinker,  C.K..  and  Thomson,  R.M. :  Does  the 
Magnetic  Field  Constitute  an  Industrial 
Hazard? 117 

Elliott,  R.W. :  Physical  Education  from  the 
Standpoint  of  the   Industrial  Physici.iii. .  . .   168 

Emmons.  A.B.,  2d:  Health  in  Merciintilo  Es- 
tablishments. III.  Common  Sanitary  De- 
fects   in    Stores 29 

Emmons,  A.B.,  2d.  and  Goldthwait,  .T.E. :  A 
Work    Chair 154 

Fear,  R.,  see  Hewes,  A. 

Forbes,  U.S.:  A  Survey  of  Carbon  Monoxide 
Poisoning  in  American  Steel  Works,  Metal 
Mines,    and    Coal    Mines 11 

Forbes,  H.S ,  and  Hompe,  L. :  Carbon  Mon- 
oxide. Illuminating  Gas.  and  Benzol:  Their 
Effect  on  Blood  Coagulation  Time 213 

Foster,  S.F.,  see  Curran,  J.F. 

Gilbert.   D..T. :    Influence  of   Industrial   Noises  204 
Goldthwait,  .I.E.,  see  Emmons,  A.B.,  2d. 
Graves,  B.,  .ice  Hewies,  A. 

Hagganl,  H.W..  scr  Henderson.  Y. 

Hamilton.  A. :  A  Discussion  of  the  Etiology 
of  So-Called  Aniline  Tumors  of  the  Bladder     10 

Hamilton,  A. :  Trinitrotoluene  as  an  In- 
dustrial   Poison 102 

Hastinirs,  Iv.E. :  The  Establishment  of  a  Den- 
tal  CUnic    376 

398 


llender.son,  Y.,  Haggard.  H.W.,  Teague,  M.C., 
Prince,  A.L.,  and  Wuuderlich,  R.M. :  Physi- 
ological Effects  of  Automobile  Exliaust  Gas 
and  Standards  of  Ventilation  for  Brief  Ex- 
posure's       79,  137 

Hewes,  A.,  Fear,  R.,  Graves,  E.,  Lawrence,  M., 
Metz,  F.,  and  Smitli,  H.F. :  Study  of  Acci- 
dent Records  in  a  Textile  Mill 187 

imi,    L.,   see  Douglas,   S.R. 

Hompe,  li.,  see  Forbes,   H.S. 

Hooper,  C.W.,  see  Voegtlin,  C, 

Huey,  W.B.,  see  Davis,  G.G. 

Iszard,  M.,  see  Smytli,  H.F. 

Johnson,  J.M..  sec  Voegtlin,  C. 

Kellogg:.  F.S. :  The  Rehabilitation  of  Em- 
ployees: An  Experience  with  1,210  Cases..   276 

Lawrence,  M.,  see  Hewes,  A. 

Lee,  R.I. :  Investigative  Opportunities  in  the 
Physical  Examination  of  Large  Groups  of 
Individuals 304 

Legge.  T.M. :  Appreciation  of  Sheridan  Del- 
epino    387 

Martin.    E.G.,    sec    Baumberger,    .T.P. 

MeConnell.  W.J. :  The  Industrial  Pliysician 
and  the  Qualifications  Essential  to  his  Sue- 
cess  130 

McCord.  C.P.,  and  Minster,  D.K. :  Adequate 
Industrial  Medical  Service  for  the  Small 
Plant 363 

McCord.  C.P..  and  Minster,  D.K. :  The  Preg- 
nant   Woman    in    Industry 39 

Metz,  F.,  see  Hewes,  A. 

Meyer,  A.L. :  .\  Method  for  Determining  the 
Finer   Dust   Particles  in  Air 51 

Miles.  W.R. :  Static  Equilibrium  as  a  Useful 
Test   of  Motor   Control 316 

Minster,  D.K.,  sec  McCord.  C.P.     (2). 

Myers,  H. :  An  Interchange  of  Physical  Es- 
aminatiims  ill   Industry 135 

Page.  C.G.,  and  Bushnell,  L.D. :  Oil  Folli- 
culitis      62 

Parmenter.   D.C,  see  Cobb,   S. 

Perry.   E.E..    see  Baumberger,   J.P. 

Prince.    A.L.,   scr   Henderson.    Y. 

Purdy.  J.S. :  Lighting  and  Ventilation  of  Fac- 
tories, Hours  of   Labor  and  Health 349 

Roos,  C.  B. :    Dust  in   Printers'  Workrooms..  257 

Sliarpe.  N.C. :  Report  on  an  Investigation  to 
Determine  the  Iljizard  to  tlie  Healtli  of  Op- 
erators Using  tlio  Spraying  Macliine  for 
Painting.     The  Risk  of  Lead  Poisoning 37S 

Slater.    B.J..    sec    Grain,    R.B. 

Smith,    H.F.,    sec    Hewes,    A. 

Smyth.  H.F. :  Suggestions  for  Cuspidors  In 
Industrial    Plants 204 

Smytli.  H.F..  and  Iszard,  M. :  The  Practical 
Hygienic  EtTicioncy  of  the  Palmer  Appara- 
tus  for  Determining  Dust  in   Air 159 


AUTHOR    INDEX 


399 


Teague,    M.C.,    see   Henderson,    Y. 

Thomson,  A.N. :    Syphilis  and   Industry 99 

Thomson,  R.M.,  .lee  Drinker,  C.K. 
Tobey,   H.G. :    Common  Colds  in  Relation  to 
Industrial    Hygiene 333 

Van  Wagenen.  W.P. :  Some  Observations  on 
the  Epiiiephrin  Hydrochloride  Test  (Goetsch 
Test)   in  a  Group  of  Normal  Individuals...   543 


l-AOE 

Vernon.  H.M. :  The  Influence  of  Fatigue  on 
Healtli    and    Longevity 93 

Voegtlin,  C,  Hooper,  C.W.,  and  Johnson,  J.M. : 
Trinitrotoluene  Poisoning — Its  Nature, 
Diagnosis,    and    Prevention 239,280 

White.  P.D. :    The  Problem  of  Heart  Disease 

in  the  Industrial  Worker 219 

Wunderlich,    R.M.,    see    Henderson,    Y. 


ABSTRACT  OF  THE 
LITERATURE 


OF 


INDUSTRIAL  HYGIENE 

SUPPLEMENTARY  TO 

THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


EDITORS 

DAVID  L.  EDSALL,  M.D.,  S.D.,  United  States 
EDGAR  L.  COLLIS,  M.D.,  M.R.C.S.,  Great  Britain 


VOLUME  III 

MAY,  1921— APRIL,  1922 


PUBLISHED  BY 

HARVARD  MEDICAL  SCHOOL 

240  Longwood  Avenue,  Boston,  Mass. 


EDITORS 

United  States  Great  Britain 

David  L.  Edsall,  M.D.,  S.D.  E.  L.  Collis,  M.D.,  M.R.C.S. 


HONORARY  CONSULTING  EDITOR 
Thomas  M.  Legge,  M.D.,  D.P.H. 

ASSOCIATE  EDITORS 

United  States 
W.  Irving  Clark,  Jr.,  M.D. 


Alice  Hamilton,  A.M.,  M.D. 
Emery  R.  H.ayhurst, 

A.M.,  Ph.D.,  M.D. 
Yandell  Henderson,  Ph.D. 
William  H.  Howell, 

Ph.D.,  M.D.,  Sc.D.,  LL.D. 
Frederic   S.  Lee, 

A.M.,  Ph.D.,  LL.D. 
H.AJiRY  E.  Mock,  M.D. 
J.  W.  Schereschevvsky,  M.D. 
C.-E.  A.  WiNSLOw, 

M.S.,  A.M.,  Dr.P.H. 


Great  Britain 
W.  F.  Dearden, 

M.R.C.S.,  D.P.H. 
Sir  Kenneth  Go.adby, 

K.B.E.,  M.R.C.S.,  D.P.H. 
Leonard  Hill, 

M.B.,  F.R.S. 
T.  Lister  Llewellyn, 

B.S.,  M.D.,  M.I.M.E. 
Sir  Thomas  Oliver,  M.D. 
R.  Prosser  White, 

M.D.,  M.R.C.S. 
H.  Al  Vernon,  A.M.,  M.D. 
D.  A.  Coles,  M.D. 


South  Africa 
W.  Watkins-Pitchford,  M.D.,  F.R.C.S. 


Canada 
J.  J.  R.  Macleod,  M.B. 


Australia 
H.  W.  Arm  IT, 

M.R.C.S.,  L.R.C.P. 
MANAGING   EDITORS 
Cecil  K.  Drinker,  M.D.  M.ario.v  C.  Shorley,  A.B. 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


-MAY,  1921 


Number  1 


CONTENTS 


PAOB 

General 1 

Systemic  Occupational  Diseases:  Occurrence,  Treat- 
ment and  Prevention 4 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc 0 

Dust  Hazards  and  Their  Effects !) 

Occupational  Infectious  Diseases:  Occurrence,  Treat- 
ment and  Prevention 10 

Occupational  Affections  of  the  Skin  and  Special  Senses.  1 1 


PAOB 

Occurrence  and  Prevention  of  Industrial  Accidents  . .     \i 

Industrial  Surgery 15 

Industrial  Physiology: Nutrition,  Metabolism, Fatigue, 
etc 15 

Women  and  Children  in  Industry 17 

Industrial  Sanitation :  Factory  Construction,  Illumina- 
tion, Ventilation,  Heating,  Water  Supply,  Sewage 
Disposal 20 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Industrial  Plants 22 


GENERAL 


Industrial  Diseases.  T.  M.  Legge.  Great 
Britain  Ann.  Rep.  Chief  Inspect.  Factories  and 
Work.shops  for  the  Year  1919,  58-68.  —  Pe- 
riodic examinations  have  been  instituted  for 
briquette  makers  with  special  reference  to 
regular  medical  examinations  for  early  detec- 
tion and  prevention  of  cancer. 

Welfare  Orders.  —  In  fruit  preser\'ing,  oil 
cake  mills,  gut  scraping,  etc.,  questions  of  first- 
aid  equipments  for  special  needs  of  each  in- 
dustry have  been  referred  to  the  medical 
inspector  of  factories.  Dr.  Bridge  has  inquired 
into  skin  effects  of  orange  peelers  and  gut 
scrapers,  also  of  workers  in  manufacture  of 
clinical  thermometers,  and  has  dealt  with  the 
difficulties  encountered  by  first  aid  and  ambu- 
lance orders.  He  has  inspected  effects  of  tem- 
porary blindness  from  electric  welding,  the 
effect  on  women  of  the  "Oliver"  Forges,  dust  in 
silk  manufacture  and  poisoning  from  industries 
using  arseniuretted  hydrogen.  The  branch  in- 
vestigating the  employment  of  women  and 
children  in  unhealthy  occupations,  lead,  an- 
thrax infection,   and  carbonic  gas  poisoning, 


concluded  that  pregnant  women  should  be  de- 
barred as  maternity  is  affected  by  lead.  Where 
lead  fumes  and  dust  are  excluded,  women  may 
be  enii>loyed.  "Carrotting"  fur  with  mercury 
solution  is  under  consideration.  Wool  should  be 
disinfected  for  spores  of  anthrax  at  the  port  of 
entry,  and  universal  factory  inspection  is  rec- 
ommended. Hereafter,  to  notifiable  diseases 
will  be  added  epitheliomatous  ulceration  from 
tar,  pitch,  bitumen,  mineral  oil  or  compounds 
or  residues,  and  chrome  ulcer.  Useful  informa- 
tion appears  as  follows. 

Epitheliomatous  Ulceration.  —  Raw  surfaces 
properly  treated  heal  quickly,  except  in  hand- 
lers of  tar,  pitch  or  paraffin,  in  persons  past  the 
third  decade  of  life  and  especially  in  those  who 
have  worked  in  these  substances  for  ten  years  or 
longer.  Such  ulcers  spread  broadly  and  deeply 
and  demand  notification  as  skin  cancer.  They 
occur  frequently  on  the  scrotum. 

Chrome  Ulceration.  —  Chrome  produces  ec- 
zema or  circumscribed  idcers,  "chrome  holes," 
and  both  these  conditions  are  reportable. 

Lead  Poisoning.  —  This   increased   in    1919 


2 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


owing  to  the  return  from  army  to  ordinary 
trades.  Lead  poisoning  is  now  greatest,  not 
from  manufacture  of  white  lead,  pottery  or 
coach  painting,  where  it  is  prevalent  enough, 
but  from  electric  accumulators,  especially  in 
"pasting."  This  process  should  be  done  en- 
tirely by  pasting  machines,  at  present  employed 
only  in  the  larger  works,  for  hand  pasting  is 
very  dangerous.  Exhaust  ^'entilation  is  re- 
quired in  lead  burning  and  wire  brushing  de- 
partments. Examination  of  25,000  reports 
leads  the  author  to  the  conclusion  that  exhaust 
ventilation  is  the  only  protection  from  dust 
and  fumes.  Many  fatalities  are  arteriosclerotic, 
general,  or  specially  localized  in  brain,  kidneys, 
etc.,  residting  from  poisoning  many  years 
earlier. 

The  Internationa]  Labor  Conference  recom- 
mends that,  due  to  dangers  to  maternity  and 
child  development,  women  and  young  people 
below  IS  years  be  excluded  from:  (1)  furnace 
work  in  reduction  of  zinc  and  lead  ores;  (2)  any 
handling  of  ashes  containing  lead  and  in  de- 
silverizing of  lead;  (3)  melting  lead  or  zinc  ores 
on  a  large  scale;  (4)  manufacture  of  solder  or 
alloj's  of  over  10  per  cent,  lead  content;  (5) 
manufacture  of  litharge,  massicot,  red,  white 
or  orange  lead,  sulphate,  chromate  or  silicate 
(frit)  of  lead.  It  is  also  recommended  that 
women  and  persons  below  18  years  be  permitted 
to  work  in  lead  on  the  condition  that  provision 
is  made  for:  (1)  local  exhaust  ventilation;  (2) 
clean  tools  and  workrooms;  (3)  notification  to 
government  authorities  of  all  cases  of  plumbism 
with  compensation;  (4)  periodic  examinations; 
(5)  suitable  cloakroom,  washing  and  messroom 
accommodation,  and  special  protective  cloth- 
ing; (6)  no  food  or  drink  to  be  taken  into  the 
workrooms. 

PhospJwrus  and  Arsenic  Poisoning. — The 
former  is  rare;  the  latter  more  frequent.  An 
additional  safeguard  is  a  valve  feed  for  ice  such 
as  the  one  used  in  one  reduction  plant,  where 
cases  of  poisoning  were  reduced  to  nil.  Large 
arsenic  output  from  the  urine  of  men  without 
symptoms  was  found  in  many  patients  using 
arsenic  containing  vessels. 

Mercnry  Poisoning.  —  Three  cases  occurred 
in  the  manufacture  of  philosophical  instru- 
ments, two  in  the  manufacture  of  fulminate  of 
mercury,  and  two  in  a  certain  smelting  process. 

Toxic  Jaundice.  —  AH  three  cases  occurred 
from  T.N.T.,  and  all  proved  fatal.  One  case  is 
reported  of  atrophy  of  the  liver  eight  months 
subsequent  to  cessation  of  work;  another  had 


headache,  dyspnea,  weakness  and  vomiting, 
with  dermatitis  of  hands,  and  cyanosis;  a  third 
necropsy  revealed  fat  necrosis  of  liver  and  pur- 
pura of  the  trunk  and  extremities. 

Fumes  and  Gases.  —  Study  here  brings  out 
the  need  of  rescue  appliances  always  ready  for 
use  by  the  worker;  the  dangers  of  working  alone; 
and  lastly,  the  great  risks  taken  by  rescuers. 
Carbonic  oxide  gas  is  the  greatest  hazard,  but 
blast  furnace  gas,  power  and  suction  gas  (as  in 
charging  the  producer  plant),  coal  gas,  and 
coke  fumes  also  take  their  toll. 

Anthrax. — A  table  is  inserted  including  all 
the  ca.ses  of  anthrax  during  1919. 

Dermatitis.  —  Cases  were  investigated  among 
men  engaged  in  wire  drawing  by  hand;  in- 
flamed palms  and  circular  ulcers,  knowai  as 
"soap  holes,"  were  found.  The  wire  is  lime 
coated  to  prevent  rusting  and  this,  with  con- 
stant friction,  induces  inflammations  which  can 
easily  become  infected.  Dermatitis  from  zinc 
cliloride  used  as  flux  was  investigated.  Care- 
lessness of  operatives  was  responsible  for  a  great 
number  of  cases.  Dermatitis  occurred  in  the 
use  of  coal  tar  dyes,  formic  acid  and  essential 
oU,  in  the  preparation  of  toilet  soaps.  — 
F.  Fremont-Smith. 

Industrial  Hygiene  as  a  Factor  in  Pro- 
duction. Bernard  J.  Neioman.  Ann.  Am. 
Acad.  Pol.  Sc,  Sept.,  1920.  —  Attention  is 
called  in  this  article  to  the  experience  of  ord- 
nance and  similar  plants  in  maintaining  and 
increasing  production  by  improving  working 
conditions.  In  many  plants,  which  at  first 
looked  upon  industrial  hygiene  askance,  ex- 
perience demonstrated  that  this  sort  of  work 
was  not  only  desirable,  but  essential  after  it  had 
once  been  inidertaken.  Several  cases  are  cited 
showing  how  the  elimination  of  industrial 
health  hazards  tended  to  reduce  turnover  and 
absenteeism  due  to  sickness  and  other  causes. 

Health,  comfort,  and  contentment  are  very 
active  factors  in  production.  In  order  to  pro- 
duce to  his  maximum  capacity  the  worker  must 
be  physically  fit.  Where  initiative  is  inv^olved 
the  element  of  mental  alertness  is  especially  im- 
portant, and  this  to  a  considerable  extent  de- 
pends upon  the  physical  condition  of  the  worker. 

Besides  mere  physical  capacity  other  factors 
definitely  related  to  hygiene  are  involved  in 
production.  (1)  Fatigue  improperly  regulated 
leads  to  the  accumulation  of  waste  products 
which  act  as  toxins.  At  the  same  time  the 
accident  rate  tends  to  increase.    (2)  OrderUness 


ABSTRACTS 


in  a  j)lant  has  a  definite  relation  to  uncleanli- 
ness  and  slovenly  workmanship.  (.'5)  Unpleas- 
ant odors,  distracting  sounds,  and  extremes  of 
tem])erature  all  tend  to  decrease  the  worker's 
effectiveness,  often  without  developing  any 
marked  j)liysical  incapacity.  Not  only  do  the.se 
factors  influence  production  within  a  plant,  but 
they  also  attract  a  jworer  class  of  workmen  and 
lead  to  a  higher  [lorcentage  of  labor  turnover. 

The  dcvclf)j)nicnf  of  a  satisfactory  |)olicy  for 
carrying  on  industrial  hygiene  in  a  j)lant  de- 
mands a  high  degree  of  technical  knowledge. 
As  far  as  jjossiblc  new  plants  should  be  built 
with  a  careful  view  to  their  hygienic  (|uali(ica- 
tions  just  as  they  arc  built  with  a  view  to  their 
production  qualifications.  Such  aids  as  job 
analysis  should  be  called  to  the  assistance  of  the 
suj)ervisor  of  hygiene  within  the  plant.  lie 
sliould  be  interested  not  only  in  the  elimination 
of  hazards  but  also  in  the  pro|)er  placing  of 
workers  so  that  their  physical  capacities  will  be 
accurately  correlated  with  job   requirements. 

—  C.  H.Vaull. 

Pkeventive   Medicine   and   Hygiene   in 

Rel.vtion  to  Colleges.  R.  I.  Lee.  Ab- 
stracted as  follows  from  Boston  Med.  and 
Surg.  Jour.,  Dec.  30,  19-20,  1«:5,  No.  "27,  in  Jour. 
Am.  Med.  A.s.sn.,  Jan.  '2'2,  UHl.  70,  No.  4,  '2(i9. 

—  "Lee  believes  that  while  our  standard 
methods  of  |)rcvenlive  meilicine  with  which  we 
are  all  familiar  can  be  perfected  considcrablx-, 
nevertheless,  not  much  more  is  to  be  exjjected 
of  them.  Already,  in  consequence  of  competent 
medical  advice,  there  is  only  an  occasioiuil 
inevitai)le  death  from  such  conditions  as  aj)- 
pendicitis,  nuistoid,  etc.  At  the  ])resent  time 
local  sanitary  inspection  and  public  health 
measures  largely  guarantee  the  i)urity  of  water 
and  milk  and  tend  to  eliminate  typhoid  fever. 
It  is  for  these  reasons  that  Lee  suggests  strongly 
that  more  emi)hasis  shoulil  be  laid  on  instruc- 
tion in  hygiene  and  the  systematic  endeavor  to 
attempt  to  establish  Iti  the  po[)ulation  of  all 
connnunilies  adecjuate  health  habits."  —  M.  C. 
Shorley. 

Occupation  and  Public  Health.  .1.  Gutt- 
stein.  Abstracted  as  follows  from  \'olkswohl- 
fahrt,  1930,  No.  7,  p.  VM  by  C.  Guenther  in 
Hyg.  Rundschau,  Aug.  15,  19-20,  30,  No.  16, 
505  506.  —  "The  author  emphasizes  the  im- 
portance of  occupational  advice  —  a  new 
branch  of  industrial  science  in  process  of  de- 
velopment,  concerned   with    the    securing    of 


proper  methods  of  determining  qualifications 
for  occupations,  in  which  quickness  of  mind  and 
special  activity  of  the  sense  organs  are  con- 
cerned. With  the  suitable  selection  of  occupa- 
tion and  the  exclusion  of  the  unfit  from  certain 
lines  of  work,  nmch  disaster,  both  |)hysical  and 
mental,  can  be  prevented.  Naturally,  the  ques- 
tion of  suitability  of  work  plays  a  large  role 
with  men  whose  health  is  permanently  im- 
I)aired  from  some  illness  or  defect.  Further, 
those  cases  deserve  special  attention,  in  which 
the  man  suffering  with  a  disease  of  long  dura- 
tion is  a  public  menace  (active  tuberculosis, 
.syphilis).  The  dangers  to  health  inherent  in 
occupations  occur  in  a  large  variety  of  pursuits: 
dust  formation,  changes  of  air  pressure,  tem- 
perature, humidity,  and  loud  noises  may  be 
harmful;  here  also  belong  the  danger  to  the 
eyes  of  workers  from  fire  and  light,  the  mani- 
fold injuries  by  chemicals,  such  as  i)hosphorus, 
lead,  mercury,  arsenic,  chlorine,  etc.,  and 
further  injuries  due  to  animate  causes  of  disea.se 
(the  s|)Ieiiic  fever  of  tanners).  It  is  often  diffi- 
cult to  judge  the  cases  in  which  a  real  or  al- 
leged industrial  disease  undergoes  a  more  rajiid 
or  a  less  favorable  course  due  to  an  accident." 
—  E.  L.  Sevringhaus. 

DlSE.VSES  .VNU  STIG.^L\TA  OK  HuOO.M  M.VKERS. 

p.  Piccinini.  H  Lavoro.  Sept.  30,  ig-iO,  11,  No. 
5.  l.r)  14'2;  Oct.  31,  \i)i().  No.  6.  166-169.— 
The  author  concludes  as  follows: 

1.  Broom  makers  frequently  develop  der- 
matitis cau.sed  by  mechanical  irritation  which 
sometimes  becomes  eczematous  and,  in  many 
cases,  presents  the  character  of  occupational 
lesions. 

2.  The  distribution  of  callosities  depends  on 
the  peculiarities  of  the  employment. 

3.  Kxcept  for  a  very  conunon  conjunctival 
catarrh  there  is  no  special  affection  of  the  eyes. 

4.  Acute  inflammation  of  the  upper  respira- 
tory passages  is  fairly  frequent,  and  chronic 
bronchial  catarrh  is  not  rare,  but  there  is  no 
evidence  of  industrial  tuberculosis.  There  is, 
however,  a  mild  transitory  febrile  affection 
which  is  industrial  in  origin. 

5.  The  morbidity  of  broom  makers  is  in- 
fluenced by  their  work  and  surroundings,  but  is 
serious  only  in  exceptional  cases.  —  Alice 
Hamilton. 

Department  Store  Hygiene.  A.  B.  Em- 
mons, 2(L  Survey,  Dec.  '25,  19'-2(),  45,  No.  13, 
463. —On    December    1,    1919,  the    Harvard 


4 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Mercantile  Health  Work  was  started  under  the 
supervision  of  the  Harvard  Industrial  Hygiene 
Division.  The  field  of  this  work  includes:  (1) 
the  environment  of  the  worker;  (2)  fitting  the 
worker  to  suitable  tasks;  and  (3)  medical  care 
and  health  education  for  the  worker.  It  is  only 
a  matter  of  time  when  the  same  attention  wUl 
be  gi'V'en  to  the  health  of  store  employees  as  is 
now  bestowed  upon  the  health  of  industrial 
workers.  This  movement  is  founded  upon  the 
frank  basis  of  increased  production  and  good 
business  policy.  —  L.  A.  Shaw. 


Adult  Working-Class  Education  in 
Great  Britain  and  the  United  States.  C.  P. 
Sweenei/.  U.  S.  Bur.  Labor  Statis.,  Bull.  No. 
271,  Aug.,  IdiO,  pp.  101.  —  A  plea  for  the  more 
liberal  and  intellectual  education  of  the  adult 
workman.  Hitherto  continuation  and  night 
schools  have  been  mainly  vocational.  The 
workday  must  be  made  uniformly  bj'  law  an 
eight-hour  one,  and  in  some  especially  hard 
trades,  of  even  shorter  duration.  Give  the 
workman  a  little  leisure  in  which  to  think  and 
study.  —  M.  Dent. 


SYSTEMIC  OCCUPATIONAL  DISEASES:    OCCURRENCE,  TREATIMENT 

AND  PREVENTION 


INIENTAL 

The  Mental  Hygiene  of  Industry.  Mary 
C.  Jarrett:  Ment.  Hyg.,  Oct.,  1920,  4,  No.  4, 
867-884.  —  Miss  Jarrett's  report  of  the  work 
undertaken  under  the  Engineering  Foundation 
of  New  York  on  the  mental  hygiene  of  industry 
is,  on  the  whole,  encouraging.  Employers  and, 
in  .some  cases,  labor  organizations  are  beginning 
to  realize  that  the  problem  of  individual  adjust- 
ment in  our  highly  specialized  modern  industrial 
life  is  one  to  be  dealt  with  and  that  it  is  a  prob- 
lem with  which  they  are  incompetent  to  deal 
without  the  aid  of  trained  experts. 

The  workers  in  a  particular  plant  are  divided 
into  three  definite  classes:  (1)  a  very  small 
group  of  employees,  with  actual  mental  dis- 
ease; (2)  nearly  half  the  workers,  with  some 
mental  or  nervous  peculiarity  to  be  adjusted; 
(3)  the  largest  group,  possibly  more  than  half, 
whose  general  efBciencj'  can  be  materially  de- 
veloped and  stimulated.  Employers  will  readUy 
acknowledge  the  application  of  mental  hygiene 
to  the  first  group  and  they  are  beginning  grad- 
ually to  see  it  for  the  second  group.  If  it  can  be 
demonstrated  that  it  is  ajjplicable  to  the  third 
group,  the  results  may  be  very  far-reaching. 

^liss  Jarrett  has  do!ie  work  in  the  Psycho- 
palhic  Hospital  and  she  also  cites  cases  from  her 
personal  investigations  in  twenty-five  centers 
of  industrial  work  in  thirteen  cities,  in  which 
often  the  best  workmen  would  gradually  or 
suddenly  "fall  off"  in  the  f|ualify  of  their  work, 
or  would  become  undeijcndable  and  take  a  day 
off  whenever  the  spirit  moved  them.  In  every 
case  she  found  either  a  family  difficulty  or  some 
mentally  unhygienic  working  condition  which 
could  be  straightened  out  by  personal  direction 
and  tact. 


"Gradvuilly  all  points  of  view  from  which  in- 
dustry is  studied  —  economics,  medicine,  en- 
gineering, labor,  capital  —  are  coming  to  a 
focus  upon  the  basic  fact  that  production  rests 
upon  mind.  Mental  power  is  the  greatest  force 
in  the  world,  and  it  is  still  to  be  studied  from 
the  standpoint  of  industrial  production."  — • 
Stanley  Cobb. 

RESPIRATORY  SYSTEM 

Observations  and  Investigations  on  the 

ANAPH-iXACTIC       BrONCHL\L       AsTHMA       FROM 

Para-Phenylenediaiiine  Dyes.  Curt  Gerdon. 
Zentralbl.  f.  Gewerbehyg.,  Sept.,  1920,  8,  No.  9, 
183.  —  The  author  comments  on  the  great  in- 
cidence of  bronchial  asthma  among  workers  in 
furs  and  pelts  since  the  introduction  of  para- 
phenylenediamine  as  a  dye,  and  on  the  scarcity 
of  literature  on  this  subject.  The  first  case  ob- 
served by  Curschmann  was  interpreted  not  iis 
an  acute  or  even  chronic  intoxication  but  as  a 
case  of  anaphylaxis.  The  author,  in  investigat- 
ing the  condition  from  this  standpoint,  enters 
upon  a  review  of  Erdmaiui's  discovery  that 
para-])henyl('nediamiue  upon  weak  oxidation  is 
convertctl  into  quinone-diimine,  which  in  turn 
undergoes  in  aqueous  solution  trimolecular  poly- 
merization.   (Continued.)  —  H.  V.  Williams. 

Observations  and  In\'-estigations  on  the 
.\napiivlactic  Bronchial  Asthma  from 
P.VR a-Phenylenediamine  Dyes.  Curt  Gcrdoit. 
Zentralbl.  f.  Gewerbehyg.,  Oct.,  1920,  8,  No.  10, 
188-194.  — Para-i)henylenedianiine  is  sold  un- 
der the  trade  name  of  ursol  D,  DD,  and  P. 
During  one  stage  of  the  process  there  arises  a 
vapor  of  the  dyestuff  and  it  is  to  this  that  the 


ABSTRACTS 


majority  of  patients  attribute  their  asthmatic 
attacks. 

The  author  re\'iews  the  experiments  of  Erd- 
mann  and  Vahlen,  in  which  they  found,  as 
evidences  of  intoxication  due  to  ursol,  inflam- 
mation of  the  mucous  membrane  of  the  respira- 
tory tract  with  fatal  termination.  Moreover 
the  quinone-diimine,  the  hydrochloride  of 
which  was  u.sed  because  of  its  stability,  had  a 
caustic  action.  Subcutaneous  injections  in  dogs 
resulted  in  abscess  formation;  intravenously 
there  was  no  effect.  In  forty  cases,  von  Crie- 
gern  regarded  the  effects  of  i)henylenediamine 
preparations  as  the  expression  of  a  superficial 
lesion  and  grouped  his  cases  in  three  classes. 

The  author  then  adds  his  own  views,  based 
on  seven  cases  and  the  exiierience  of  his  assist- 
ant. Abstracts  of  tlie  cases  are  given.  Xo 
tolerance  to  this  dye  takes  place,  and  anyone 
once  sick  is  sensitized  to  it.  All  of  Gerdon's 
cases  were  of  workers  wiio  had  spent  from  one- 
quarter  to  ten  years  in  contact  witli  ursol  l)efore 
showing  tlie  first  attack.  If  after  the  first  attack 
the  patient  came  in  any  way  in  contact  with  the 
dye,  an  attack  occurred  one-half  to  twenty-four 
hours  after  inhalation  of  the  vai)or.  The  at- 
tacks sulisided  after  remo\al  of  the  ursol,  and 
with  furs  dyed  with  other  dyes  than  ursol  no 
symptoms  were  noted.  To  these,  in  his  sum- 
mary of  symptoms,  tlie  author  adds  tlie  fact 
that  ])cciiliar  odor  and  taste  sensations  were 
apparent  to  those  ad'ccted  by  breathing  ursol, 
which  normally  is  tasteless  and  odorless. 

In  order  to  determine  whether  para-jilienyl- 
enediamine  and  its  derivatives  can  cause  ana- 
phylaxis, Gerdon  began  a  .series  of  animal 
experiments.  He  employed  for  intravenous  in- 
jection a  standard  .solution  of  quinone-diimine 
which  rejircsented  an  iiiterincdiate  product  of 
the  dye  reaction;  a  sokitioii  of  the  end-product 
was  administered  subcutaneously;  and  serum 
from  afl^licted  patients  was  used  for  intra- 
peritoneal injection.  After  standardizing  by 
preliminary  tests  in  which  he  found  no  appear- 
ances of  intoxication  as  described  by  Erdmanii 
and  Vahlen,  three  sets  of  experiments  in  passive 
anaphvlaxis  were  undertaken.  {Continued.) 
—  H.  V.  AVilliaiiis. 

Observations  .vxd  Ixvestig.\tioxs  ox  the 
Anaphylactic  Bronchial  Asthma  from 
Para-Phenylenediamine  D.yes.  Curl  Gerdon. 
Zentralbl.  f.  Gewerbehyg.,  Nov.,  19'-20,  8,  No. 
11,  SOl-SOS.  {Conclusion.)  —  In  animals  made 
passively   anaphylactic  by  intraperitoneal  in- 


jection of  Serum  \',  there  is  some  shock  imme- 
diately following  this  injection.  If  these  animals 
are  then  given  intravenous  injections  of  the 
standard  solution  of  quinone-diimine  the  aiia- 
pliylactic  shock  occurs.  This  is  found  to  be 
milder  after  an  interval  of  only  one  or  two  days 
than  after  an  interim  of  three  days;  in  the  latter 
case  only  is  the  shock  fatal  (after  twenty-two 
hours).  The  symptom  picture  is  made  up  of  a 
.sharp  drop  in  temperature  of  the  guinea-pig, 
apathy,  bristling  hair,  trembling,  chewing 
movements,  free  passage  of  stools  and  urine, 
and  in  the  worst  cases  a  rubliing  of  the  fur  and 
labored  inspiratory  movements.  The  autoi)sy 
showed  anasarca,  subpleural  ecchymoses,  lungs 
emphysematous  and  the  bronchioles  constricted. 

Similarly  sensitized  animals  were  injected 
subcutaneously  after  one  and  two  days  with  a 
suspension  of  the  dye  itself  (end  product). 
Mud  symptoms  of  anaphylactic  shock  were 
obtained.  Therefore,  anaphylactic  reaction  fol- 
lowing sub(utaiiet)us  inoculation  is  not  im- 
I)robable. 

Again,  animals  .sensitized  as  abo\e  were  al- 
lowed to  l)reatlie  for  six  minutes  the  dye  which 
had  been  precijjitated  on  fur.  In  animals  which 
had  an  interval  of  two  and  three  days  there 
were  mild  symptoms,  shown  by  the  control  to 
be  due  to  respiratory  irritation,  followed  after 
one-half  hour  or  more  by  symjitoms  of  a  mild 
shock,  with  recovery  in  four  hours.  .Vftcr  four 
or  five  days,  however,  these  animals  died  fol- 
lowing two  hours  of  severe  shock  with  dyspnea 
and  clonic  convulsions.  .\n  animal  which 
breathed  the  dye  after  an  interval  of  six  days 
had  a  very  severe  shock  l)egiiining  one-half 
hour  later,  but  recovered  completely  in  seven 
hours  and  did  not  die.  The  delay  in  the  onset 
of  shock  symptoms  is  thought  to  be  due  to  the 
in.soIiibility  of  the  dye  in  the  secretions  of  the 
respiratory  tract,  with  delayed  absorption.  No 
ex])laiiation  is  made  of  the  apparent  recovery 
and  later  death  in  typical  anai)hylactic  sjiock. 
The  animal  which  recovered  is  thought  to  liave 
had  less  residual  protection  from  the  shock  of 
the  sensitizing  serum  and  hencp  to  have  had  a 
more  severe  initial  shock,  recovery  from  which 
was  followed  by  protection  long  enough  to  last 
over  the  period  where  the  other  animals  re- 
ceived their  fatal  shocks. 

Active  anaphylaxis  was  produced  in  sixteen 
to  eighteen  days  by  intravenous  injection  with 
the  standard  solution  of  quinone-diimine,  but  it 
was  not  produced  by  subcutaneous  inoculation 
with  the  suspension  of  the  dye  proper. 


6 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Of  the  seventeen  guinea-pigs  used,  several 
showed  an  eosinophilia  following  the  second 
injections  (the  anaphylaxis  provoking  doses), 
most  marked  on  the  fourth  day  afterward,  the 
maximum  being  13  per  cent.  No  control  animal 
was  so  affected.  Both  controls,  which  had  only 
the  second  dose  without  being  sensitized,  and 
the  other  animals  showed  increases  of  mast- 
cells  up  to  5  per  cent,  by  the  tenth  day, 
appearance  of  irritation  forms  of  white  blood 
corpuscles  and  polychromatophilia. 

Four  of  the  seventeen  guinea-pigs  showed 
respiratorjf  symptoms,  but  human  anaphy- 
lactic manifestations  are  somewhat  different. 
Men  may  show  disturbed  contraction  of  smooth 
nmscle  (diarrhea,  disturbed  micturition  and 
reduced  blood  pressure)  and  vasomotor  dis- 
turbances such  as  urticaria,  gland  and  joint 
swellings  and  edema,  besides  the  recognized 
spasm  of  the  bronchial  muscle  and  the  swelling 


of  bronchial  mucosa  in  asthma.  In  the  seven 
cases  observed,  three  showed  salivation,  seven 
catarrhal  colds,  three  edema,  two  diarrhea, 
and  two  exophthalmos. 

It  may  be  that  the  inspiration  of  the  para- 
phenylenediamine  or  its  derivatives,  which  are 
known  to  be  toxic,  by  workers  in  hides  and  furs, 
may  make  the  respiratory  tract  a  less  resistant 
place  for  the  localization  of  the  anaphylactic 
phenomena.  There  is  a  high  mortality  in  these 
occupations  where  the  dye  is  inspired. 

It  is  concluded  that  the  asthma  of  furriers  is 
anaphylactic,  not  toxic.  Dr.  H.  Curschmann, 
acting  on  this  hypothesis,  got  at  least  a  transi- 
tory improvement  in  Case  1  by  administering 
calcium.  He  advises  the  prophylactic  use  of 
calcium  for  such  workers,  since  calcium  reduces 
the  irritability  of  the  whole  nervous  system  and 
tends  to  relax  vascular  endothelium.  —  E.  L. 
Sevringhaus. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS:    GASES, 
CHEMICALS,  ETC. 


A  Contribution  to  the  Study  of  the 
Toxicology  of  Tellurium.  II  Lavoro,  Nov. 
30,  lO'JO,  11,  No.  7,  204-205.  —  Before  the 
medical  society  of  Modena  at  the  sitting  of 
June  18,  1920,  Luzzati  and  Levi  Angela  pre- 
sented results  of  researches  into  the  toxicology 
of  telluriinn.  They  show  that  sodium  telluride 
is  one  of  the  most  powerful  of  hemolytic  poi- 
sons. The  microscopic  lesions  in  the  organs 
following  poisoning  by  tellurium  compounds 
are  secondarj^  to  the  intense  anemia  and  the 
hemoglobinuria,  but  the  organic  lesions  are  not 
profound.  They  were  not  able  to  demonstrate 
urobilin  or  urobUiuogen  in  the  urine,  showing 
that  the  liver  functions  well.  Histologic  ex- 
amination bears  this  out,  for  there  are  few 
le.sions  in  this  organ.  They  also  call  attention 
to  the  absence  of  icterus.  —  Alice  Hamilton. 

The  Early  Recognition  of  Industrl^l 
Le.\d  Poisoning  with  the  Aid  of  Blood 
Ex.\MiN.VTioN.  N.  Welwart.  Abstracted  as 
follows  from  Dcutsch.  med.  Wchnschr.,  1920, 
p.  939  by  Globig  in  Hyg.  Rundschau,  Aug.  1, 
1920,  30,  No.  1.5,  476. —  "The  statement  of 
Schnitter  that  '  basophilic  stipi)iing  '  of  the  red 
blood  cells  is  almost  always  the  first  sign  of 
chronic  lead  jioisoning  leads  the  author  to  re- 
port that  in  a  stool  submitted  to  him  to  be 
tested  for  blood  he  was  unable  to  demonstrate 


either  blood,  iron  or  bismuth,  but  that  he  found 
lead  in  large  amounts,  and  antimony  in  small 
amounts.  He  determined  subserjuently  that 
this  lead  came  from  the  dust  of  an  ammunition 
chest  at  the  repair  of  which  the  patient  —  a 
cabinet  maker  —  was  employed,  and  that  this 
cabinet  maker  showed  no  signs  of  lead  poison- 
ing. 

"The  author  considers  it  possible  that  in  the 
case  of  industrial  lead  poisonings  also  lead  may 
be  demonstrable  in  the  stools,  probably  earlier 
than  by  tlie  above-mentioned  change  in  the 
blood."  —  E.  L.  Sevringhaus. 

The  Nature  of  Industrial  Lead  Poison- 
ing IN  THE  Light  of  Medical  Investigation. 
Korner.  .\bstracted  as  follows  from  Zentralbl. 
f.  Gewerbehyg.,  Sept.,  1919,  7,  No.  9,  161,  in 
Hyg.  Rundschau,  July  1,  1920,  30,  No.  13,  409. 
—  "A  resume  of  the  symptoms  and  the  on.set  of 
lead  poisoning;  contains  nothing  new."  —  E.  L. 
Sevringiiaus. 

Rare  M\nife.stations  of  Lead  Poisoning. 
Rinnldo  Cas.sanello.  II  Lavoro,  Oct.  31,  1920, 
11,  Xo.  0,  161  -165.  —  Duodenal  ulcer  is  a  rare 
effect  of  chronic  lead  poisoning,  three  cases  of 
which  have  been  seen  by  the  author  within 
little  more  than  a  year's  time.  In  all  three 
cases  the  diagnosis  of  ulcer  of  the  duodenum 


ABSTRACTS 


with  stenosis  was  confirmed  by  surgical  opera- 
tion. Two  of  the  men  were  painters,  exposed  to 
lead  for  eleven  years  and  for  three  years,  re- 
spectively; the  third  had  been  a  compositor 
more  than  ten  years.  The  symptoms  of  chronic 
lead  poisoning  had  come  on  unusually  quickly 
followed  by  cachexia,  and  iiad  then  yielded  to 
symptoms  characteristic  of  duofleiial  ulcer  with 
cicatricial  stenosis.  —  Alice  Hamilton. 

Lead  Poisoning  ix  the  Glas.s  Industry. 
L  Lavoro,  Oct.  81,  19-20,  11,  Xo.  6,  17-2.  —  La 
Sicurezza  e  I'lgieiie  nell'  Industria,  Xo.  4,  1020, 
contains  the  rejwrt  of  cases  of  lead  poisoning 
discovered  in  a  factory  producing  lead  glass 
for  incandescent  lamjjs.  Sucli  glass  contains 
potassium  hydrate,  soda,  and  red  lead.  For  tlie 
most  part,  the  cases  develojjed  in  the  mixing 
room  where  the  compounds  are  handled  dry. 
Eighty  such  cases  have  recently  been  dis- 
covered in  similar  establishments  in  Vienna, 
but  these  were  among  glass  blowers.  Exam- 
ination of  the  air  showed  a  notable  quantity  of 
lead,  and  lead  in  vai)or  form  issued  from  the 
ovens,  but  the  latter  could  not  be  regarded  as 
the  exciting  cause  since  the  blowers'  heljiors 
working  near  the  ovens  did  not  suH'or,  while  the 
blowers  who  did  suffer  were  much  farther  off. 
The  glowing  mass  of  glajs  worked  up  by  the 
glass  blowers  was  foimd  to  gi\e  oil"  vajxirs  rich 
in  lead,  and  this  undoubtedly  reached  the  lungs 
when  the  blower  inspired  air  through  his  |)ipe. 
Proof  of  this  was  fiu-nished  by  analysis  of  the 
air  in  a  pipe  which  contained  0.1  gm.  of  lead.  — 
Alice  Hamilton. 

EXPEHIEN'CES  WITH  IXDISTRIAL  Hv(iIEXE 
IN  THE  liA\AHL\X  MlNITIOXS  IxnrsTKV.  F. 
Koehrh.  .Abstracted  as  follows  from  Oell'entl. 
Gsndhts])flg.,  l!)lf),  p.  •2,57  by  Holtzmann  in  Hyg. 
Rundschau,  .luly  1,  1<)'20.  30,  Xo.  13,  409-410. 
—  "The  author  describes  the  health  hazards  to 
which  the  Bavarian  workers  engaged  in  tilling 
shells  and  the  allied  operations  were  exposed. 
The  most  ])oisonous  shell  contents  were  those 
containing  <linitrobenzol.  This  was  observed 
especially  in  a  factory  where  there  were  handled 
consecutively  different  nitro  compounds,  biui- 
trotoluol  and  trinitrotoluol,  binitronaphthalene 
and  trinitronaphthalene  and  dinitrobenzol,  and 
only  the  latter  caused  poisoning.  The  filling  of 
the  projectiles  was  accomplished  by  pouring  in 
by  hand  through  a  funnel  and  then  tamping 
down  firmly.  There  occurred  thus  an  intimate 
contact  with  the  material  as  well  as  a  formation 


of  dust.  In  general,  women  are  employed  in  less 
dangerous  work,  and  are  less  often  taken  ill, 
although  their  predisposition  is  greater.  The 
possibility  of  being  affected  is  increased  by  un- 
familiarity  with  the  work,  by  high  tempera- 
tures, by  the  use  of  alcohol,  and  by  personal 
predisposition.  According  to  tiie  author  the 
use  of  lemonade  favors  the  formation  of  met- 
henioglobin  by  raising  the  alkalinity  of  the 
blood. 

"  Trinitrotoluol,  trinitronajihthalene  and 
picric  acid  appear  to  be  rclati\ely  harmless. 
Factory  laborers  in  general  are  sick  two  and 
one-half  times  as  often  as  farm  laborers  of  the 
same  region. 

"  In  the  preparation  of  smoke  producers  for 
controlling  the  bursting  of  ])rojectilcs,  a  mixture 
of  red  phosphorus  with  i)araffin  and  metallic 
arsenic  was  employed.  From  this  there  oc- 
curred irritation  of  the  skin  and  mucous  mem- 
branes, (ieni-ral  ])oisoning  with  arsenic  was 
only  ob.scrved  from  accidental  ignition  of  the 
mass,  when  an  arsenic  acid  compound  was 
formed.  Red  jjhosphorus  appeared  non-toxic." 
—  E.  L.  Sevringhaus. 

Hladdeu  Tumor.s  IX  Workers  ix  Che.mic.vl 
IxDU.STRiES.  Schwerin.  Zentralbl.  f.  Gewer- 
behyg..  .\])ril.  19'20.  8,  Xo.  4,  64(58.— The 
author  discusses  117  cases  of  so-called  aniline 
tumors  of  the  bladder  in  the  literature.  These 
tumors  have  been  attributed  to  the  action  of 
aniline,  benzidine,  nai>htliylamines,  and  other 
amido  comjjounds,  but  it  is  impossible  to  know 
certainly  which  compoiuid  is  responsible  with- 
out much  further  study  of  the  e.xact  substances 
to  which  the  men  are  expo.sed  and  without 
.systematic  examination  of  the  urine  and  u.se  of 
the  cystoscope.  The  history  of  these  cases 
shows  that  there  is  at  first  cystitis,  sometimes 
ulceration,  then  papillomatous  growths  or 
poly])i,  then  carcinomatous  degeneration.  The 
length  of  exposure  is  frt)m  six  to  nineteen  years, 
and  cases  may  develop  some  years  after  ex- 
posure has  ceased.  Of  ninety-five  patients, 
forty-nine  were  opera tcfl  on,  thirty-one  of  them 
died,  eighteen  recovered.  Prevention  consists 
in  doing  away  with  the  poisonous  substances  or 
shortening  the  period  of  exposure.  —  Alice 
Hamilton. 

The  Detection  of  Aromatic  Amido  Com- 
pounds IN  the  Urine  and  the  Change  Thet 
Undergo  in  the  Body.  A.  Kuckenbecker. 
Zentralbl.  f.  Gewerbehyg.,  April,  1920,  8,  Xo.  4, 


8 


THE  JOITRNAL  OF  INDUSTRIAL  HYGIENE 


68-71 .  —  As  the  quantity  of  amido  compounds 
eliminated  in  the  urine  is  too  small  to  allow 
of  their  isolation,  Kuchenbecker  attempts  to 
demonstrate  their  presence  by  forming  azo 
colors  from  them.  He  succeeds  in  obtaining 
rose-red  azo  colors  and  advises  the  use  of  cotton 
threads  which  take  up  no  color  from  the  urine, 
even  on  boiling,  but  which  take  up  minute 
quantities  of  the  azo  dye.  This  test  succeeds 
for  the  detection  of  aniline  and  ortho-toluidine, 
but  not  for  para-toluidine,  benzidine,  tolidin,  or 
the  naphthylamines.  This  shows  that  Leuen- 
berger's  statement  that  bladder  tumors  are 
caused  by  the  presence  of  a  hj'droxyl-aromatic 
amido  compound  in  the  urine  (para-amido- 
phenol,  which  can  be  diazotized  by  Kuchen- 
becker's  procedure)  is  not  true  of  all  cases,  for 
these  tumors  are  found  in  men  working  with  the 
substances  given  above,  which  do  not  undergo 
hydrolysis  in  the  body.  —  Alice  Hamilton. 

Occupational  Poisoning  with  Phosgen. 
Irene  Gerher.  Abstracted  as  follows  from  Rev. 
Med.  de  la  Suisse  Romande,  June,  1920,  40, 
No.  6,  356,  in  Jour.  Am.  Med.  Assn.,  Aug.  28, 
1920,  75,  No.  9,  640.  —  "Gerber's  patient  was 
a  manufacturing  chemist;  with  two  men  he  was 
experimenting  with  phosgen,  passing  it  through 
alcohol.  Each  felt  some  irritation  after  several 
hours'  work  but  the  two  men  soon  threw  off  the 
conjunctivitis  and  cough.  The  other  after  four 
hours  of  slight  symptoms  showed  signs  of  pul- 
monary asphyxia  progressing  to  a  fatal  ter- 
mination the  twenty-fourth  hour."  —  M.  C. 
Shorley. 

The  Action  and  Intoxication  of  Inspired 
Hydrocyanic  Acid.  F.  Flury  and  W.  Heubner. 
Abstracted  as  follows  from  Biochem.  Ztschr., 

1919,  95,  Nos.  3  and  4,  249-256,  by  Wesenberg 
in  Hyg.  Rundschau,  June  15,  1920,  30,  No.  12, 
379-380. —  '''The  treatment  of  hydrocyanic 
acid  poisoning  with  sodium  thiosulphate  given 
by   Teichmann   and   Nagel    (see   the   Ztschr., 

1920,  p.  315)  is  considered  by  the  authors  to 
be  of  little  promise  as  indicated  by  their  own 
animal  experiments,  since  it  comes  too  late. 
On  practical  grounds  they  take  a  very  skep- 
tical attitude  also  toward  the  prophylactic 
method  —  the  injection  before  work  of  thio- 
sulphate into  those  persons  engaged  in  produc- 
ing the  hydrocyanic  acid  gas.  (Compare  also 
the  work  of  H.  Fiihner  on  Hydrocyanic  Acid 
Poisoning  and  ?te  Treatment,  Deutsch.  med. 
Wchnschr.,  1919,  p.  847.)  "— -E.  L.  Sevringhaus. 


Pulmonary  Tuberculosis  as  a  Result 
of  Inspiring  Tetranitroxieth.\ne  Vapors.' 
Curschmann.  Abstracted  as  follows  from  Zen- 
tralbl.  f.  Gewerbehyg.,  Oct.,  1919,  7,  No.  10, 
173-175,  in  Hyg.  Rundschau,  JiJy  1,  1920,  30, 
No.  13,  408.  —  "A  worker  breathed  some 
fumes  of  tetranitromethane  at  work,  as  a  result 
of  which  irritative  conditions  were  called  forth 
in  his  respiratory  tract.  Pulmonary  tuber- 
culosis which  appeared  was  referred  to  the 
accident.  The  possibility  of  the  origin  of 
tuberculosis  in  this  way  is  admitted  by  the 
author;  it  must  be  assumed  that  there  is  not 
only  an  irritation  but  an  ulceration  of  the 
mucosa  wherein  the  tubercle  bacilli  may  lodge 
and  develop.  If  the  subject  had  been  com- 
pletely well  and  if  the  breathing  of  the  fumes 
at  one  time  had  caused  the  anatomic  changes 
in  the  mucosa,  the  tuberculous  infection  could 
still  be  looked  upon  as  a  sequel  to  an  accident, 
not  only  as  the  end  result  of  an  industrial  dis- 
ease. In  the  above  case  the  initial  attack  was  so 
slight  that  damage  to  the  cells  of  the  lungs  may 
be  excluded.  Between  the  disaster  mentioned, 
in  June,  1919,  and  the  established  lung  changes 
in  March,  1917,  there  had  been  no  complaints 
sufficient  to  cau.se  a  physician  to  be  called. 
Therefore,  the  author  declines  to  assert  any 
connection  between  tuberculosis  and  the  acci- 
dent in  this  case."  —  E.  L.  Se\Tinghaus. 

Histologic  Changes  in  the  Lungs  roL- 
lowing  Inhalation  of  Bromine.  II  Lavoro, 
Oct.  31,  1920,  11,  No.  6,  178. —R.  Pellegrini 
reported  to  the  Medical  Society  of  Rome  the 
results  of  animal  experiments  with  bromine  gas. 
When  death  occurred  immediately,  an  intense 
pulmonary  edema  was  found  and  severe  lesions 
in  the  bronchi;  if  death  occurred  after  several 
days,  a  bronchopneimionia  was  discovered. 
The  author  believes  that  the  injury  to  the 
alveoli  is  caused  more  by  prolonged  contact 
with  edematous  fluid  rich  in  halogen  com- 
pounds than  by  the  bromine  gas  because  this 
fluid  serves  as  an  excretion  i)ath  for  the  bromine 
absorbed  by  other  organs.  Both  in  acute 
asphjTvia  and  in  the  slower  form  there  is  frag- 
mentation of  the  elastic  fibers  of  the  lung  which 
is  either  mechanical  or  secondary  to  broncho- 
pneumonia. —  Alice  Hamilton. 

Early  Appe.a.rance  of  Secondary  Pneu- 
monia after  Severe  Injuries  by  Blunt 
Force  and  after  Poisoning  with  Illltm- 
inating  Gas.     G.   Strassmann.     \'rtljschr.   f. 


ABSTRACTS 


gerichtl.  Med.,  Jan.,  1920,  Third  Series,  59, 
No.  1,  82-99.  —  Pneumonia  may  occur  after 
severe  trauma  to  the  tliorax  and  especially  to 
the  head  with  resulting  unconsciousness.  Al- 
though a.spiration  pneumonia  occurs  rather 
promptly  and  hypostatic  pneumonia  only  after 
some  intervening  time,  it  is  often  difficult  to 
determine  which  type  is  seen.  No  distinction 
is  necessary  for  medico-legal  inirposcs.  Also, 
following  poisoning  where  unconsciousness  is 
caused,  as  in  illuminating  gas  cases,  there  may 
occur  either  an  aspiration  of  vomitus  with 
immediate  death  or  bronchopneumonia  or  a 
hypostatic  pneumonia. 

This  i)aper  concerns  the  study  of  forty  cases 
where  death  followed  severe  injuries  of  various 
types,  and  of  twelve  cases  where  death  followed 
carbon  monoxide  poisoning.  The  object  was  to 
determine  how  .soon  the  first  signs  of  pulmon- 
ary inflammation  ajjpear,  and  whether  a 
definite  time  can  be  set  for  the  first  appearance 
of  a  secondary  pneumonia.  Some  of  these  cases 
had  been  recorded  at  autojKsy  as  showing  ])ul- 
monary  inflammation.  Sections  of  the  lungs 
were  stained  with  hemato.xj'lin-eosin  and  van 
Gieson  stains.  Nineteen  ])atienls  had  injuries 
to  the  head,  including  basal  fractures,  intra- 
cranial hemorrhages,  and  injuries  to  the  brain. 
Except  in  two  instances  all  of  the  forty  patients 
were  so  severely  injured  that  unconsciousness 
or  stupefaction  was  produced.  (This  is  aj)- 
parently  the  criterion  for  the  selection  of  the 
cases  from  mortuary  material.) 

In  the  four  patients  from  the  traumatic 
group,  who  died  practically  inunediately,  there 
were  fat  emboli  and  .some  edema  in  three.  In 
the  fourteen  patients  who  died  within  less  than 
a  day  there  was  marked  edema,  hypostatic 
hyperemia,  beginning  atelectasis  and  separa- 


tion of  alveolar  epithelium.  This  may  have 
been  "agonal  pulmonary  edema."  Definite 
pneumonia  was  not  demonstrable.  There  was 
evidence  of  hemoptysis  in  one  out  of  three 
patients  with  cranial  injuries,  and  in  two  out  of 
six  with  thoracic  injuries.  No  aspirated  gastric 
contents  were  identified  in  any  eases. 

In  the  four  cases  where  death  occurred  after 
one  day  there  were  more  definite  signs  of 
inflannnation.  In  four  ]iatients  dying  after 
two  days,  early  pulmonary  inflammation  was 
definite,  with  round  cells  predominating,  red 
and  white  blood  cells  about  equal  in  number, 
and  fibrinous  exudate  seen  at  times.  In  the 
fourteen  remaining  patients  dying  after  inter- 
vals of  from  three  days  to  five  weeks,  some 
showed  more  fully  developed  pneumonia,  yet 
.some  .showed  only  the  very  earliest  changes,  or 
develo]X'<l  a.spiration  or  hypostatic  pneumonia 
only  after  some  interval  of  time. 

In  nine  of  the  cases  of  poisoning  by  carbon 
monoxide  the  subjects  were  found  dead  in 
rooms  filled  with  the  gas.  These  cases  all 
showed  pulmonary  edema  with  a  few  red  and 
white  blood  cells  in  the  exudate.  Three  of  the 
eases  also  showed  alveolar  cells  containing 
brown  pigment  in  the  exudate,  interi)reted  as 
due  to  destruction  of  red  cells  in  the  earlier 
part  of  the  exudate.  The  cellular  part  of  tlve 
exudate  was  more  marked  in  one  patient  dying 
after  thirty-six  hours.  In  a  case  where  death 
occurrctl  after  five  days  there  was  pulmonary 
edema  in  the  posterior  parts  and  some  focal 
pneumonic  spots.  A  patient  who  died  after 
three  weeks  showed  a  well  marked  but  early 
pneumonia.  The  pulmonary  edema  in  the 
cases  with  rapid  death  is  interpreted  as  be- 
ginning pneumonia.  —  E.  L.  Sevringhaus. 


DUST  HAZARDS  AND  THEIR  EFFECTS 


The  H.\RMFrLNEss  of  Dust  in  the  Work- 
shop. H.  F.  Smyth.  Safety,  Aug.-Sept.,  1920, 
8,  Nos.  8,  9,  121-131.  —The  relation  of  indus- 
trial dusts  to  diseases  of  the  respiratory  .system 
has  been  studied  quite  extensively  during  the 
last  few  years.  Dr.  Smyth  gives  .some  of  the 
results  of  statistical  and  medical  studies  of  this 
subject  carried  out  in  the  United  States  and 
abroad.  His  classification  of  dusts  according 
to  their  effects  rather  than  their  origin  or 
nature  is  espeeiallj'  interesting.  According  to 
this  method  of  analysis  dusts  may  be  grouped  as : 


1.  Cutting  —  sharp,  spieulate,  or  angular; 
mineral  or  metallic  dusts  as  iron,  steel,  stone, 
sand,  glass,  pearl,  etc. 

2.  Irritant  —  animal  or  vegetable  dusts  as 
wood,  ivory,  textiles,  wool,  hair,  hemp,  etc. 

3.  Toxic  —  (a)  inorganic  metallic  poisons  as 
lead,  arsenic,  mercury,  etc.;  ih)  organic  as 
picric  acid,  T.N.T.,  etc.,  or  volatile  organic  sub- 
stances adherent  to  other  dusts  as  aniUne  or  the 
iron  oxide  from  an  aniline  reducer,  etc. 

4.  Soluble  —  saline  dusts  which  may  be  irri- 
tant or  poisonous. 


10 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


5.  Obstructive — dusts  such  as  carbon,  rouge 
flow,  etc.,  whicli  act  purely  mechanically  by 
their  bulk. 

6.  Infectious  —  animal  or  mixed  dusts  con- 
taining disease  germs  as  anthrax  from  hides  or 
tubercle  bacilli  from  dirty  rags,  etc.,  or  any 
dust  into  which  tuberculous  persons  have 
expectorated. 

The  defensive  organization  of  the  human 
respiratory  tract  against  dust  and  the  ways  in 
which  dust  harms  the  lungs  together  with  pre- 
cautions for  dusty  occupations  are  also  dis- 
cussed. —  G.  M.  Fair. 

Health  Hazards  of  Pottery  Workers. 
Z.  La  Forge.  Pub.  Health  Nurse,  Jan.,  1920, 12, 
No.  1,  26-31.  —  In  1912  an  investigation  of  the 
pottery  industry  in  the  United  States  was 
begun  by  the  United  States  Department  of 
Labor.  East  Liverpool,  Ohio,  is  the  center  of 
this  industry  in  the  United  States,  and  the 
official  records  of  deaths  occurring  there  since 
1915  are  the  chief  sources  of  information  for  the 
present  study.  For  further  investigation,  per- 
sonal visits  were  made  to  one  of  the  large  plants 
and  to  the  workers'  homes. 

The  processes  of  the  manufacture  of  pottery 
producing  the  greatest  health  risks  are  the 
dusty  processes  of  mLxing  and  drying,  and  the 
use  of  lead  glaze.  In  the  manipulation  of  the 
clay  for  any  purpose,  there  is  some  waste  or 
excess  which,  on  drying,  becomes  dust.  Clay 
dust  is  as  fine  as  powder,  but  in  reality  each 
fine  grain  of  the  powdered  clay  has  a  sharp 
cutting  edge.  In  another  process,  that  of 
"dipping,"  by  which  the  glaze  is  added,  the 
workers  are  constantly  exposed  to  poisoning  by 
lead,  which  is  one  of  the  chief  ingredients  of  the 
glaze. 

Sanitation  of  the  pottery  plants,  especially 
in  regard  to  the  reduction  and  removal  of  dust, 


is  highly  important.  The  reports  of  the  U.  S. 
Department  of  Labor  show  that  85  per  cent,  of 
potteries  are  far  from  being  in  a  sanitary  con- 
dition and  that,  besides  the  dangers  mentioned, 
exposure  to  weather  and  insufficient  lighting 
are  common.  In  addition  to  the  need  of  im- 
provement, both  in  the  matter  of  genera)  sani- 
tary conditions  and  in  respect  to  the  special 
hazards,  the  housing  problem  among  workers 
peculiarly  exposed  by  nature  of  their  employ- 
ment to  respiratory  diseases  is  important.  In 
1913,  the  mortality  from  tuberculosis  and 
other  respiratory  diseases  was  37.7  per  cent,  of 
deaths  from  all  causes  among  pottery  workers, 
as  compared  with  18.2  per  cent,  among  workers 
engaged  in  other  gainful  occupations,  as  calcu- 
lated from  official  reports  of  deaths  in  the  city 
of  East  Liverpool.  —  G.  E.  Partridge. 

The  Action  of  Dust  Inspired  in  Mines. 
Juiu/hans.  (From  a  communication  from  J.  S. 
Haldane.)  Abstracted  as  follows  from  Zen- 
tralbl.  f.  Gewerbehyg.,  Oct.-Nov.,  1919,  7, 
Nos.  10  and  11,  181  and  200,  in  Hyg.  Rund- 
schau, July  1,  1920,  30,  No.  13,  408-409.  — 
"The  author  reports  on  observations  on  pul- 
monary lesions  in  coal  miners.  Coal  and  clay 
dust  particles  appeared  relatively  harmless 
and  were  easily  eliminated  as  compared  with 
quartz.  The  latter  again,  as  also  all  other  hard 
minerals,  is  comparatively  harmless  when  in- 
haled mixed  with  clay.  The  author  attributes 
to  coal  and  clay  dust  the  property  of  absorbing 
other  substances,  as  it  were,  to  enter  into  solid 
solution  with  tiiem.  Where  the  respiration  of 
dangerous  dust  of  minerals  cannot  be  reduced, 
there  is  reconunended  a  mixture  with  harmless 
dust.  Coal  dust  with  60  per  cent,  clay  seejns 
especially  suitable  since  the  mixture  cannot 
explode.  The  author  does  not  say  how  this  is  to 
be  done  in  practice."  —  E.  L.  Se\Tinghaus. 


OCCUPATIONAL  INFECTIOUS  DISEASES:   OCCURRENCE, 
TREATMENT  AND  PREVENTION 


Anthrax  in  Animal  (Horse)  Hair:  The 
Modern  Industrial  and  Public  He.u.th 
Menace.  S.  Dana  Hubbard.  Jour.  Am.  Med. 
Assn.,  Dec.  18,  1920,  75,  No.  25,  1687.  —  Dur- 
ing the  last  seventeen  months  twenty-four 
cases  of  human  anthrax,  with  eleven  fatalities, 
have  been  reported  to  the  division  of  industrial 
hygiene  of  the  New  York  City  Department  of 


Health.  These  cases  have  occurred  amongst 
individuals  engaged  in  the  handling  of  hair  and 
it  has  proved  difficult  to  educate  both  em- 
ployers and  employees  as  to  the  dangers  of  in- 
dustry in  which  unsterilized  animal  hair  is  used. 
Shaving  brushes  made  of  horsehair  and  a 
mixture  containing  horsehair  have  cau.sed 
eighteen   of  the   tliirty-four   cases,    with   nine 


ABSTRACTS 


11 


fatalities,  and  numerous  samples  of  horsehair 
and  shaving  brushes  made  of  horsehair  have 
been  examined,  80  per  cent,  of  which  have 
shown  anthrax  spores.  Ordinary  methods  of 
bleaching,  etc.,  will  not  kill  these  spores  and  as 
yet  it  is  not  known  positi\ely  whether  such  dis- 
infectants as  mercuric  chloride  1 : 2,.500  with 
1  per  cent,  formic  acid,  or  a  forty-eight  hours' 
exposure  to  2  per  cent,  hydrochloric  acid  with 
10  i)er  cent,  sodium  chloride  will  certainly 
destroy  spores. 

The  measures  to  be  used  in  the  prevention  of 
anthrax  are  cleanliness,  use  of  gloves,  masks, 
etc.,  on  tlie  part  of  workmen,  immediate  care  of 


skin  lesions  however  small,  and  sterilization  of 
hair  and  hides.  —  C.  K.  Drinker. 

Keeping  Workehs  Well.  Factory,  Dec.  15, 
19-20,  2.5,  No.  1-2,  1908.  —That  tuberculosis  is 
an  occupational  disease,  is  well  attested  by  ex- 
jierts  throughout  the  world.  A  proper  ])rogram 
for  preventing  this  serious  disease  is  herewith 
outlined  under  five  headings:  (1)  education  of 
workers  and  employers;  (-i)  a  higher  standard 
of  living;  (3)  improvement  of  the  connuunity 
environment;  (4)  correction  of  faulty  personal 
habits;  and  (.'5)  provision  for  institutions  to 
care  for  the  tuberculous.  — L.  A.  Shaw. 


OCCUPATIONAL  AFFFXTIOXS  OF  THE  SKIN  AND  SPECIAL  SENSES 


Skix  Lesioxs  fko.m  Coal  Tak  axd  Xapii- 

T1L\    DERnATIVES    AND    THEIR    PlIOTODTi-N.VMIC 

A.SPECTS.  F.  Koclsch.  Abstracted  as  follows 
from  Zeiitralbl.  f.  Gewerbehyg.,  Se|)t.,  1919,  7, 
No.  9,  157,  in  Ilyg.  Rundschau,  July  1,  1920. 
30,  No.  13,  406-407.  —  "  From  the  use  of  the 
substitute  oils  during  the  war  there  occurred 
principally  skin  lesions,  at  times  so  severe  as  to 
cause  serious  reductions  in  production.  Women 
were  especially  endangered.  Combinations 
were  frequent  with  the  formation  of  comedones, 
callosities,  acneform  growths,  and  j)igmenta- 
tions.  It  is  diaractcristic  of  the  coal  tar  oils 
that  parts  of  the  body  exposed  to  the  air  are 
most  severely  affected  and  that  direct  light 
from  the  sun  or  snow  makes  the  malady  lui- 
endurable.  The  author  also  .saw  .severe  inflam- 
mation from  the  medicinally  used  wartime 
vaseline. 

"The  coal  tar  derivatives  act  in  three  ways: 
stopping  and  irritation  of  the  sebaceous  glands, 
irritation  of  the  skin  to  overgrowth,  and  to 
black  coloration,  melanosis.  This  the  author 
refers  to  a  photodynaniic  action  of  the  coal  tar 
derivatives  on  the  luunan  skin  with  the  expo- 
sure to  light.  This  action  is  esi)ecially  notice- 
able with  the  German  coal  tar  pitch  but  is 
lacking  with  the  American  product.  Also  coal 
tar  preparations  manufactured  during  the  war, 
such  as  '  Karboneol,'  exiiibit  the  action.  The 
occasionally  noticed  dark  brown  pigmentation 
of  the  skin  in  chlor-acne  is  related  to  this,  and 
possibly  also  the  so-called  carbol-ochronosus, 
the  grayish  black  i)igmentation  of  other  organs. 

"  Prophylactically  there  are  to  be  considered 
the  greatest  cleanliness  as  well  as  the  wearing 
of  suitable  working  clothes.   It  is  recommended 


that  this  most  unpleasant  irritation  by  pitch  be 
met  by  assigning  this  work  to  night  shifts,  or 
at  least  by  reduction  of  sunlight.  Greasing  the 
hands  gives  relief.  Esi)ccially  susceptible 
workers  should  be  removed  from  the  work. 
Treatment  nuist  be  combined  with  cessation 
from  the  work.  The  dermatoses  are  stubborn, 
and  recurrences  frequent." — E.  L.  Sevringhaus. 

Tar-Melanosis  IX  THE  Makixg  of  Dry- 
Batteries.  Alfred  Arn.ileiii.  ^liinchen.  nicd. 
Wchnschr.,  July  30,  1920,  67,  No.  31,  902.— 
Some  women  in  an  electric  flashlight  factory, 
while  spreading  thin  layers  of  tar  between  the 
elements  of  the  batteries,  raised  light  i)rown 
clouds  of  tar  vapor.  After  a  few  weeks  all  their 
exposed  skin  took  on  a  decj)  brown  color.  It 
was  most  intense  on  the  forehead,  and  faded  off 
rapidly  on  the  neck  and  elbows.  The  places  of 
normal  pigmentation,  such  as  the  nii)])les  and 
axillae,  were  not  affected.  There  were  no  other 
signs  or  symptoms,  aside  from  the  cosmetic 
effects,  except  a  moderate  eosinophilia. 

Arnstein  thinks  that  the  cause  for  this  con- 
dition is  to  be  found  in  some  impurity  in  the  tar, 
such  as  acridine,  which  sensitizes  the  skin  to 
light  rays  and  induces  a  protective  pigmenta- 
tion. He  thinks  that  general  malnutrition  may 
be  a  contributory  cause.  As  prophylaxis  he 
suggests  purification  of  the  tar  and  better  ven- 
tilation of  the  factory.  —  H.  G.  Noyes. 

Impairmext  of  Health  from  Calciim 
Cyan.a_mide  Fertilizers.  Schlier.  Abstracted 
as  follows  from  Oeffentl.  Gsndhtspflg.,  1919, 
p.    201    by  Holtzmann    in    Hyg.  Rundschau, 


12 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


July  1,  1920,  30,  No.  13,  410. —"The  author 
describes  a  case  of  periostitis  of  tlie  hand  in  a 
farmer,  caused  by  calcium  cyanamide,  similar 
to  the  periostitis  in  men  who  turn  mother  of 
pearl."  —  E.  L.  Sevringhaus. 

Dermatosis  Dystrophic-Atrophic  of  the 
Lower  Limbs  from  Chilling.  II  Lavoro, 
Oct.  31,  19^20,  11,  No.  6,  175.  —At  a  meeting 
of  the  Medical  Society  in  Milan,  Pasini  de- 
scribed a  case  of  this  form  of  dermatosis  in  a 
man  of  50  years  of  age  who,  since  he  was  15 
years  old,  had  followed  the  occupation  of  salt- 
ing fish  and  had  been  obliged  to  spend  several 
hours  of  the  day  with  his  feet  in  icy  water.  At 
first  there  was  a  transient  ischemia  of  the  lower 
extremities,  then  permanent  congestion  with 
swollen,  cyanotic  skin,  varicose  veins,  and 
ulcers,  and  finally  a  dystrophic-atrophy  of  the 


extremities  with  perforating  ulceration  of  the 
soles  of  the  feet.  There  were  no  clianges  in  the 
nervous  system  which  would  account  for  these 
lesions,  sensibility  was  almost  completely  pre- 
served. The  author  attributes  the  lesions  to  the 
prolonged  action  of  cold  augmented  by  stand- 
ing. The  radiograph  showed  no  alteration  of 
the  bones.  —  Alice  Hamilton. 

Injury  of  the  Cornea  by  Aniline.  Bach- 
stez.  Abstracted  as  follows  from  Wiener  Ophth. 
Ges.,  Feb.  10,  1919;  Zentr.  Augenheilk.,  1919, 
Vol.  43,  p.  92;  Zentr.  Biochem.  Biophys.,  Vol. 
21,  p.  346,  by  H.  S.  Paine  in  Chem.  Abstr., 
Nov.  20,  1920,  14,  No.  22,  3465.  —  "PhNHj 
caused  sharply  defined  band-like  turbidity  and 
clouding  of  the  epithelium  and  superficial 
corneal  layers  in  the  region  of  the  palpebral 
fissure  in  the  case  of  a  cotton-dyer." 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Seventh  Annual  Meeting  of  the  In- 
ternational Association  of  Industrial 
Accident  Boards  and  Commissions.  Carl 
Hookstadt.  U.  S.  Bur.  Labor  Statis.,  Month. 
Labor  Rev.,  Nov.,  1920,  11,  No.  5,  10-19.  — 
A  resume  of  the  above  meeting,  which  included 
the  following  topics:  accident  prevention;  eye 
injuries;  systems  of  rating  permanent  and  par- 
tial disability;  industrial  rehabilitation;  sys- 
tems of  compensation  insurance;  medical 
problems;  miscellaneous  subjects;  and  business 
section.  —  R.  B.  Crain. 

Industrial  Accident  Record  of  1919. 
Frederick  L.  Hoffman.  Safety  Engin.,  Nov., 
1920,  40,  No.  5,  208. —The  average  rate  of 
fatal  accidents  in  1919  was  1.08  per  1,000;  in 
1918,  1.31  per  1,000;  in  1915-1919,  1.27  per 
1,000.  The  non-fatal  injury  rate  was  106.5  per 
1,000  in  1919;  115.37  per"  1,000  in  1918;  and 
129.65  per  1,000  in  1915-1919.  —  M.  Dent. 

Accident  Report  of  1920.  Bull.  N.  Y. 
State  Indust.  Com.,  Sept.,  1920,  5,  No.  12, 
221. — The  Bureau  of  Compensation  of  the 
State  Industrial  Commission  reports  that  in  the 
year  ended  June  30,  1920,  there  were  345,672 
industrial  accidents  reported  to  the  New  York 
State  Industrial  Commission.  Of  these,  there 
were  filed  with  the  Commission  52,251  claims 
for  compensation,  indicating  that  many  per- 
sons were  disabled  beyond  two  weeks,  as  com- 


pensation is  not  paid  the  first  two  weeks.  There 
were  12,832  direct  settlements  of  compensa- 
tion claims  between  employers  and  employees. 
There  were  1,275  fatal  accidents  resulting  in 
death  claims.  Of  the  total  number  of  accidents 
232,303  were  reported  in  the  New  York  City 
district  and  29,957  of  the  compensable  acci- 
dents were  there.  —  K.  R.  Drinker. 

Eastman  Kodak  Company  Cuts  Accident 
Severity  and  Frequency  R.\tes.  Nat.  Safety 
News,  Aug.  30,  1920,  2,  No.  9,  7.  —  A  reduction 
of  47  per  cent,  in  accident  severity  rate  and  of 
30  per  cent,  in  the  accident  frequency  rate  for 
the  first  six  months  of  1920,  as  compared  with 
the  corresponding  period  of  1919,  is  reported  by 
the  Eastman  Kodak  Company. 

A  reduction  of  approximately  50  per  cent,  in 
the  number  of  lost-time  accidents  and  a  saving 
of  388  days  in  lost  time  due  to  accidents  also  are 
noted  in  the  I'cport  covering  accidents  at  the 
Camera  Works  of  this  company,  from  January 
2  to  June  1,  1920.  A  table  is  given.  —  M.  Dent. 

What  the  Ohio  State  Industrial  Com- 
mission Has  Done  to  Promote  Safety  Edu- 
cation. F.  G.  Lange.  Nat.  Safety  News,  Nov. 
8,  1920,  2,  No.  19,  5.  —  The  problem  of  safety 
education  includes  not  only  about  1,000  deaths 
annually  reported  to  the  Ohio  Industrial  Com- 
mission but  6,500  accidental  deaths  not  re- 
ported, as  outside  industry.  Training  for  safety 


ABSTRACTS 


13 


from  childhood  is  thought  possible  but  it  is  a 
difficult  task  with  adults  who  require  constant 
repetition  to  instill  new  mental  habits;  hence 
Lange  proposed  before  the  Industrial  Cotnmis- 
sion  a  school  safety  propaganda.  A  letter  was 
sent  to  every  city,  county  and  district  superin- 
tendent in  the  state.  The  co-operation  of  all 
newspapers,  presidents  of  local  F'edcrations  of 
Women's  Clubs,  and  the  state  president  of  the 
Ohio  Federation  of  Women  was  .secured.  The 
letter  sent  to  all  .school  principals  advi.sed  as 
follows : 

1.  That  safety  education  shall  henceforth  be 
a  part  of  the  curriculum. 

2.  That  the  plan  to  effect  this  shall  be  as  fol- 
lows: (fl)  A  Central  School  Safety  Council  shall 
be  organized,  charged  with  the  development  of 
school  safety;  (b)  Each  school  shall  have  one 
teacher  representative  on  the  council,  who  shall 
receive  full  professional  credit  for  work  done 
along  this  line;  (c)  There  .shall  be  a  council 
president,  vice-president,  and  .secretary,  elected 
by  the  representatives;  (d)  Such  committees  as 
are  deemed  necessary  shall  be  created.  There 
may  be  a  committee  on  methods  of  teaching 
safety,  a  statistical  connnittee,  etc.;  (c)  The 
council  shall  meet  every  week  (two  or  four 
weeks)  at  .  .  .  place,  to  discuss  any  accidents 
which  may  have  occurred  since  last  meeting;  to 
fornuilate  ways  and  means  of  preventing  future 
accidents;  to  discuss  present  methods  of  teach- 
ing safety  and  possible  improvements. 

;J.  That  the  person  chosen  as  representative 
shall  have  charge  of  the  .safety  program  in  the 
school  which  he  reiire.sents,  anil  shall  (a)  inspect 
the  conditions  in  and  surrounding  the  .school 
and  the  district  traversed  by  the  children  on 
their  way  to  school,  in  order  to  discover  dan- 
gerous conditions  and  .secure  their  correction; 
(b)  organize  a  school  safety  council,  each  class 
electing  one  or  more  pupil  representatives 
thereto.  The  school  safety  council  .shall  be 
charged  with  the  safety  of  the  pupils;  (c)  re- 
ceive from  the  class  representatives  reports  on 
accidents  occurring  to  the  pupils.  These  re- 
ports shall  be  investigated  when  necessary.  All 
reports  shall  be  tabulated  and  then  transmitted 
to  the  Central  Safety  Council.  —  F.  Fremont- 
Smith. 

Safety  Org.4.nization.  A.  P.  Costigane. 
Safety,  Aug.-Sept.,  1920,  8,  No.  8-9,  131r-144. 
—  This  paper  discusses  the  organization  of  in- 
dustrial plants  for  the  purpose  of  preventing 
accidents  and  gives  details  of  results  obtained 


by  the  Ontario  Pulp  and  Paper  Makers'  Safety 
Association.  The  plan  of  the  Association  to 
prepare  a  set  of  text-books  on  the  subject  of 
"Safety"  is  of  especial  interest.  —  G.  M.  Fair. 

Defective  Illumixatiox,  a  Cause  of  Ix- 
DUSTRi.u.  Accidents.  R.  E.  Simpson.  Safety 
Engin.,  Nov.,  1920,  40,  No.  5,  204-207.  — 
About  15  per  cent,  of  industrial  accidents  are 
caused  by  defecti\-c  ligliting.  These  accidents 
cost  industry  $300,000,000  every  year,  a  sum 
more  than  the  cost  of  the  lighting.  Ninety  per 
cent,  of  employees  have  defects  in  vision,  and 
in  the  majority  of  cases  these  could  be  remedied 
by  glasses.  Poor  eyesight  causes  ill  health,  care- 
lessness, dullness,  and  listlessne.ss  generally. 

The  author  stresses  the  need  for  reflectors, 
sufficient  light,  and  lighting  in  stairwaj's,  pas- 
sages, and  storerooms,  where  danger  points 
cannot  be  seen.  —  M.  Dent. 

Radium  in  the  Safety  Movement.  Safety 
Engin.,  Nov.,  1920,  40,  No.  5.  210.  —Radium 
may  be  used  as:  (1)  a  therapeutic  agent,  treat- 
ing thousands  of  cases  of  cancer  yearly;  (2)  in 
industry.  Many  accidents  in  factories  and 
mines  can  be  eliminated  by  the  u.se  of  luminous 
radium  material  on  high  pressure  gauges,  elec- 
tric switches,  fire  alarms  and  e.xtingui.shers, 
telephones,  bells,  etc.,  all  of  which  should  be 
lighted  night  and  day.  Dark  bolts,  channels  in 
mines,  etc.,  touched  with  radium  will  glow 
dependably  without  danger  of  explosion  or 
burning  when  other  lights  fail,  fuses  blow  out 
and  wires  break  down.  —  M.  Dent. 

Reduction  of  Accidents  through  Visual 
Acuity.  //.  F.  J.  Porter.  Safety  Engin.,  Nov., 
1920,  40,  No.  5,  195-200. —  Visual  acuity  is 
the  i)ossession  of  efficient  vision.  Very  few 
I)Cople  have  perfect  eyes.  Employers  should 
realize  their  responsibility  and  insist  on  eye 
correction  and  proper  illumination. 

1.  Bright  lights  paralyze  the  muscles  of  the 
eye;  they  should  be  shielded  and  glare  pre- 
vented. 

2.  Flickering  lights  tire  the  muscles  of  the 
eye  and  cause  headaches. 

3.  General  illumination  .should  be  made  as 
even  as  possible,  without  shadows.  Work 
planes  should  have  from  10  to  15  foot-candles 
illumination. 

Fifteen  thousand  deaths  per  year  are  caused 
from  falls;  most  falls  are  cau.sed  by  poor  vision 
and  faulty  illumination.  —  M.  Dent. 


14 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Goggles  Save  Eyes  Every  Day.  Safety 
Engin.,  Sept.,  19^20,  40,  No.  3,  103.  —  A  de- 
scription of  an  accident  to  a  workman  from  an 
explosion  of  aluminum  spilled  onto  the  floor, 
and  how  his  goggles  saved  his  eyes,  though  his 
face  was  badly  burned.  —  M.  Dent. 

Tanks  and  Pipe  Lines  as  Causes  of  Acci- 
dents. Homer  A.Hoffman.  Chem.  and  Metall. 
Engin.,  Nov.  21,  1920,  23,  No.  21,  1023-1025. 
—  A  study  of  hazards  involved  in  the  use  of 
storage  tanks  and  pipe  line  distributing  sys- 
tems in  chemical  plants  together  with  instruc- 
tions for  the  safe  construction,  cleaning  and 
repairing  of  underground  and  overhead  tanks 
and  pipe  lines.  —  G.  M.  Fair. 

The  Progress  of  Safety  Work  in  the 
Shipbuilding  Industry.  T.  A.Walsh.  Safety, 
Oct.,  1920,  8,  No.  10,  159-166.  —  This  address 
given  before  the  Ninth  Annual  Congress  gives 
a  description  of  the  advances  made  in  removing 
or  reducing  the  prominent  causes  of  injury  in 
the  shipbuilding  industry.  —  G.  M.  Fair. 

Safeglt.\rding  Woodworking  Machinery'. 
F.  G.  Lovett.  Safety  Engin.,  Oct.,  1920,  40, 
No.  4,  177-178.  — ^Woodworking  tools  are  per- 
haps the  most  hazardous  of  all  classes  of  ma- 
chines, and  of  these  the  saw  is  the  cause  of  most 
accidents.  The  need  is  stressed  of  providing 
adequate  safeguards  —  the  practical  sort  which 
the  employee  will  not  throw  into  the  scrap  pile; 
of  improving  lighting  systems;  and  of  improv- 
ing the  general  condition  of  most  of  our  mills, 
especially  planing  mills,  which,  the  author  as- 
serts, are  as  they  were  forty  years  ago.  —  M. 
Dent. 

Rules  and  Regulations  for  Safeguard- 
ing W^oodworking  ]\L\chinery'.  Mass.  Dept. 
Labor  and  Industries, ""Indust.  Bull.  No.  16, 
1920,  pp.  10. — This  bulletin  contains  specific 
rules  of  the  Safety  Department,  and  recom- 
mendations of  the  Commission  for  safeguarding 
woodworking  machinery.  —  M.  Dent. 

A  Practical  Guard  for  Contact  Points 
OF  Sheave-Wheels  and  Cables.  T.  W.  Os- 
good. Safety  Engin.,  Nov.,  1920,  40,  No.  5, 
209-210.  —  An  unreasonable  number  of  acci- 
dents to  fingers,  hands,  and  arms  arc  due  to 
catching  these  members  between  cables  and 
sheave-wheels  at  points  where  the  former  run 
into  the  latter.    A  diagrammatic  picture  and 


detailed  description  of  a  guard  are  given.  — 
M.  Dent. 

Makes  Toggle  Presses  Safe.  Safety  Engin., 
Oct.,  1920,  40,  No.  4,  179-180.  — "A  Cleveland 
rubber  company  is  using  magnetic  clutches, 
operated  by  limit  switches  of  the  rotating  cam 
type,  with  their  toggle  presses  to  eliminate  any 
possibility  of  the  operators  being  caught  be- 
tween the  platen  and  upper  head  of  the  press 
when  reaching  in  to  remove  the  finished  prod- 
uct or  to  insert  the  molding  material."  — 
M.  Dent. 

Can  the  Producers  of  and  Contractors 
FOR  ]\L\CHiNES  Be  M\de  Legally  Respon- 
sible IN  General  for  the  Provision  of 
Safety  Appliances?  Hir.^ing.  Abstracted  as 
follows  from  Zentralbl.  f.  Gewerbehyg.,  Oct., 
1919,  7,  No.  10,  175,  in  Hyg.  Rundschau,  July 
1,  1920,  30,  No.  13,  409.  —  "The  question  is 
discussed  by  a  worker.  Heretofore  the  regula- 
tions have  failed  because  of  the  difficulty  in 
deciding  in  the  case  of  each  machine  which  is 
the  best  conceivable  safety  device  and  there- 
fore the  one  to  be  required.  The  author  re- 
commends a  commission  of  workers  and  ex- 
perts which  after  practical  experience  should 
proi)ose  to  the  central  office  for  accident  pre- 
^•ention  the  best  safety  device  for  each  ma- 
chine. This  office  must  be  in  closest  relation 
with  the  governmental  industrial  inspection 
officials,  who  should  in  the  future  be  alone  re- 
sponsible for  the  preparation  of  directions  for 
accident  prevention  and  for  super\'ising  their 
carrying  out."  —  E.  L.  Sevringhaus. 

A  Fatal  Accident  in  a  Low  Voltage  In- 
stallation. C.  Herjdrich.  Zentralbl.  f.  Gewer- 
behyg., Dec.,  1920,  8,  No.  12,  239-240. —A 
workman  in  a  peat  field  struck  an  electric 
cable  with  his  neck,  grasjjcd  it  with  his  hand 
and  stood  motionless  until  the  current  was 
turned  off.  He  fell  dead  and  could  not  be 
resuscitated.  The  cable  carried  a  220  volt 
supply  to  a  motor  in  the  field.  The  accident 
was  due  to  a  faulty  type  of  cable  and  faulty 
installation.  The  cable  contained  too  inflexible 
a  stranded  copper  wire,  which  iiy  l)cudii)g  was 
broken  and  then  pushed  through  the  insulation 
to  come  into  contact  with  the  metal  armor  of 
the  cable.  The  metal  armor  was  not  grounded, 
nor  was  the  cable  weather  proof.  The  danger  of 
220  volt  installations  is  not  generally  appre- 
ciated. —  E.  L.  Sevringhaus. 


ABSTRACTS 


15 


Safety  Disconnecting  Hangers  as  a 
Safeguard.  A.  J.  Tliompnon.  Safety  Engin., 
Nov.,  IQ^O,  40,  No.  5,  SO^-^O^.  —  The  cleaning 
and  repairing  of  electric  lamps  is  necessary  for 
safety  and  production,  but  travelling  cranes 
and  ladders  are  extremely  unsafe  for  such  pur- 
poses.   Cleansing  and  repairing  are  facilitated 


l)y  having  lamps  on  safety  disconnecting 
hangers.  No  climbing  is  necessary.  The  lamp 
comes  down  without  any  dangling  loops  of  wire, 
and  the  lowering  automatically  disconnects  it 
from  the  electric  current,  makes  it  safe  to 
handle,  and  eliminates  climbing  hazards.  — 
M.  Dent. 


INDUSTRIAL  SURGERY 


Industrial  Surgery  as  a  Specialty.  Wil- 
liam O'Neill  Sherman.  Mod.  Med.,  Jan.,  1!)-21, 
3,  No.  1,  29-.'30.  —  This  .specialty  is  <lemarided 
by  the  growing  sen.se  of  responsibility  of  pro- 
gressive and  humane  employers  as  well  as  by 
the  enactment  of  emi)loyer's  liability  legisla- 
tion. 

Originally  the  plan  for  securing  medical  at- 
tention was  contract  practice  which  often  re- 
sulted in  the  directing  doctor  getting  the  lion's 
share  of  the  collections.  In  isolated  comnumi- 
ties  where  this  still  obtains  and  where  it  is 
necessary  to  collect  a  fixed  sum  from  the  em- 
ployees, an  attempt  should  be  made  along  the 
lines  of  a  grouji  system,  somewhat  comparable 
to  the  Mavo  Clinic. 


Industrial  surgery  has  been  greatly  modified 
by  the  exiwrience  gained  in  war  surgery.  There 
are  many  more  resources  at  our  disposal  for 
the  saving  of  lives  and  limbs  today  than  there 
were  six  years  ago.  These  resources  should  be 
adopted  without  further  delay.  Infection 
should  be  a  thing  of  the  ])ast.  All  methods  to 
shorten  disability  and  all  methods  to  lessen 
permanent  disability  should  be  studied  and 
practiced,  both  by  individuals  and  in  the  medi- 
cal schools  of  the  country.  .V  post-graduate 
course  in  some  large  industrial  center  is  to  be 
hoped  for.  ^Nlorc  conferences  with  state  de- 
l)artments  of  industry,  etc.,  are  needed,  since 
those  already  held  have  proved  of  constructive 
value.  —  Elinor  D.  Gregg. 


INDUSTRIAL  PHYSIOLOGY:  NUTRITION,  -METABOLISM.  FATIGUE,  ETC. 


Tests  for  Physical  Fitness.  C.  B.  Ileald 
and  B.  Thomson.  Abstracted  as  follows  from 
the  Lancet,  Oct.  0,  1!)'20.  2,  No.  1.5,  7.'5()-741  in 
Physiol.  Abstr.,  Dec.  19-20,  .5,  No.  !).  400.— 
"Two  methods  specially  were  .selected  —  viz., 
Dreyer's  of  vital  capacity,  and  Flack's  breath- 
holding  tests.  The  authors  believe  them  ca- 
pable of  great  extension,  and  ho])e  to  obtain 
from  them  u.seful  '  efficiency  factors.'  So  far  as 
one  can  gather  from  the  paper  the  methods  are 
almost  incapable  of  '  formulative  expression.' 
(Whether  this  mathematical  deficiency  is  a 
genuine  evil  it  is  difficult  to  judge,  for  the  i)aper 
is  written  in  highly  technical  mathematical 
language.  The  authors  would  be  doing  bio- 
logical and  medical  renders  a  .service  if  they 
could  explain  their  meaning  in  plain  English.)" 
—  McKeen  Cattell. 

Biochemical  Studies  on  I\L\rine  Organ- 
isms. II.  The  Occurre.vce  of  Zinc.  M. 
Budansky.  Jour.  Biol.  ChenL,  Nov.,  1920,  44, 
No.  2,  399-407.  —  A  brief  review  of  the  litera- 
ture on  the  physiological  occurrence  of  zinc  is 


given.  Delerminators  of  the  zinc  content  of 
the  tissues  of  twenty  species  of  marine  animals 
were  made  by  Hirckiier's  turbidinietric  method. 
(See  Birckner:  Jour.  IJiol.  Chem..  1919,  Vol.  38, 
191.)  Zinc  was  found  and  quantitated  in  every 
species  studied  and  the  author  concludes  that 
it  is  a  normal  constituent  of  the  ti.ssues.  —  A.  S. 
Minot. 

ACETONURIA  of  F.\TIGUE  DURING  ALIMENTA- 
TION. Azzi  Azzo.  Abstracted  as  follows  from 
Riforma  Medica,  1919,  in  D  Lavoro,  Nov.  30, 
19-20,  11,  No.  7,  -20-2. — Azzo  confirms  the 
assertion  made  by  Preti  in  1910  that  muscular 
labor  causes  acetonuria.  The  author  carried 
out  his  tests  on  an  adult  healthy  man  who  was 
on  a  constant  mixed  diet.  He  gave  particular 
attention  to  the  elimination  of  ketones  and 
observed  that  during  fatigue  the  phenomenon 
of  acetonuria  appeared  and  remained  above 
normal  as  long  as  the  subject  took  no  food,  nor 
did  it  subside  quickly  on  cessation  of  e.xercise. 
Acetonuria  reappeared  if,  after  taking  food,  the 
subject  underwent  exercise  more  fatiguing  than 


16 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


usual,  but  in  this  case  it  did  not  persist  and  it 
disappeared  quickly  with  repose.  It  is  diffi- 
cult to  say  if  the  phenomenon  depends  on  an 
increase  of  organic  combustion  and  therefore 
the  passage  into  the  circulation  of  a  larger 
quantity  than  normal  of  the  ordinary  products 
of  metabolism,  or  if  it  depends  on  a  transient 
alteration  of  metabolism  through  an  excessive, 
abnormal  destruction  of  the  reserve  fats  and 
hydrocarbons.  The  presence  in  the  blood  of 
large  quantities  of  acetone  bodies,  however, 
constitutes  a  state  of  intoxication  which  has  an 
effect  on  the  nervous  system  especially,  and  it 
cannot  be  denied  that,  together  with  other 
poisons  formed  during  work,  it  is  one  of  the 
causes  of  the  sensation  of  exliaustion.  —  Alice 
Hamilton.  ' 

Effect  of  Shorter  Hours  of  Work  on 
Output  and  Health.  From  Foreign  Letters, 
Jour.  Am.  Med.  Assn.,  Nov.  27,  loio,  75,  No. 
22,  1509.  —  "The  annual  report  of  the  chief 
inspector  of  factories  and  workshops  for  1919 
shows  that  the  shortening  of  hours,  perhaps 
more  than  any  other  recent  improvement  in 
industrial  conditions,  has  had  a  beneficial  effect 
on  operatives.  Better  time-keeping  has  been 
the  result  of  discontinuing  work  before  break- 
fast. There  is  also  less  absence  for  sickness  and 
other  reasons.  In  one  large  factory  the  average 
daily  number  of  absentees  numbered  forty 
some  years  ago;  now.  with  a  forty-four  hour 
week,  the  average  number  has  dropped  to  ten. 
Less  fatigue  and  overstrain  are  fomid.in  fac- 
tories, and  although  more  men  are  employed  in 
the  engineering  and  allied  trades,  the  accident 
list  has  not  increased.  Increased  leisure  has 
been  used  by  many  workers  for  educational 
advantage.  The  reports  of  various  inspectors 
disclose  wide  differences  as  to  the  effect  of 
shorter  hours  on  production.  When  the  produc- 
tion depends  almost  entirely  on  the  speed  of 
machinery,  as  in  cotton  and  woolen  spinning, 
the  output  is  reduced  in  a  proportion  nearly 
corresponding  to  the  reduction  of  hours.  In 
other  machine  operations  which  call  for  con- 
stant alertness,  such  as  weaving,  output  has  not 
suffered  to  this  extent,  and  in  exceptional  cases 
has  been  scarcely  affected.  In  a  third  cla.ss  of 
processes,  in  which  output  is  largely  or  entirely 
dependent  on  the  exertion  of  the  worker,  there 
is  frequently  no  loss  in  production.  Indeed,  in 
one  wholesale  tailoring  establishment  an  in- 
crease of  -10  per  cent,  was  reported;  but  this  was 
partly  due  to  reorganization.    In  a  boot  factory 


in  which  the  hours  were  reduced  from  fifty-two 
to  forty-eight  a  week  there  was  a  considerable 
increase  in  output.  Unfortunately,  a  few  of  the 
reports  indicate  an  exceedingly  unfavorable 
result  in  some  work  where  the  shortening  of 
hours  has  been  followed  by  a  reduction  in  the 
hourly  rate  of  production;  and  for  this,  no 
adequate  explanation,  as  a  rule,  is  given." — - 
C.  K.  Drinker. 

One  Day  of  Rest  in  Seven  for  District 
OF  CoLirMBiA  Workers.  Editorial.  Am.  Labor 
Legis.  Rev.,  Dec,  1920,  10,  No.  4,  256-257.  — 
A  bill  for  one  day  of  rest  in  seven,  w^hich  con- 
forms with  a  standard  bill  prepared  by  the 
American  Association  for  Labor  Legislation 
and  recognizes  that  while  we  can  and  must  have 
continuous  industries  we  cannot  and  must  not 
try  to  have  continuous  men  and  women,  has 
been  introduced  for  passage  at  the  session  of 
Congress  beginning  in  December.  The  stand- 
ard bill  covers  the  following  points : 

1.  Scope  of  Act.  —  Every  employer  in  a  fac- 
tory or  mercantile  establishment  shall  allow 
every  emjiloyee  except  those  specified  under 
(2)  at  least  twenty-four  consecutive  hours  of 
rest  in  every  seven  consecutive  days.  No  em- 
ployer shall  operate  a  factory  or  mercantile 
establishment  on  Sunday  except  as  provided 
under  (3). 

2.  Exceptions.  —  Janitors;  watchmen;  em- 
ployees whose  duties  include  not  more  than 
three  hours'  work  on  Sunday  at  specified  tasks; 
superintendents  or  foremen  in  charge;  em- 
ployees in  the  production  of  certain  foods, 
where  not  more  than  seven  persons  are  era- 
ployed. 

3.  Schedule  for  Sttndojj  Workers.  —  A  list  of 
employees  who  are  to  work  on  Sundays, 
designating  the  day  of  rest  for  each,  is  to  be 
posted  conspicuously  and  a  copy  filed  with  (the 
Commissioner  of  Labor) . 

4.  Time  Book. — A  book  showing  names  of 
employees  and  their  hours  nnist  be  always  open 
to  inspection  by  the  connnissioner  of  labor. 

5.  Pcnaltji.  —  A  fine  of  $5.00  will  be  collected 
for  each  otfense.  —  Elizahetii  C.  Putnam. 

Three  Shifts  in  Steel.  A.  Adele  Shaw. 
Survey,  Dec.  11,  1920,  45,  No.  11,  387-388.  — 
At  a  joint  meeting  of  the  Taylor  Society,  the 
^Management  and  Metropolitan  Sections  of  the 
American  Society  of  Mechanical  Engineers, 
and  the  New  York  Section  of  the  American 
Institute  of  Electrical  Engineers,  convoked  to 


ABSTRACTS 


17 


discuss  the  Long  Day  in  the  Steel  Industry,  the 
assembly  agreed  that  whether  or  not  they  ap- 
proved the  three-shift  system,  the  time  had 
come  for  a  change  and  the  real  question  was 
how  it  should  be  brought  about.  While  some 
agree  that  the  change  should  be  to  au  eight- 
hour  day,  others  felt  that,  except  as  a  matter  of 
convenient  division  of  hours  in  a  process  that 
must  be  continuous,  a  ten-hour  day  could  be 
managed.  Mr.  Drury,  formerly  of  tlic  Eco- 
nomic Department  of  Ohio  Slate  University 
and  recently  with  the  Industrial  Relations 
Division  of  the  United  States  Sliij)i)ing  I5(iard, 
sunnnarized  his  findings  in  a  detailed  study  of 
five  three-shift  plants,  as  follows: 

1.  Effect  on  Matnigcr.i.  —  "Practically  all  of 
them  are  glad  they  made  the  change." 

Manufacturers  kejjt  saying  that  they  "re- 
garded the  three-shift  better  from  a  business 
standpoint."  * 

"Probably  the  real  reason  why  nearly  all  the 
three-shift  manufacturers  with  wliom  I  si)oke 
were  in  favor  of  conliiniing  was  because  of  tliosc 
not  easily  measured  efliciencies  that  s])ring  out 
of  the  spirit  of  the  men." 

Reported  a  marked  improvement  in  ab- 
senteeism. 

2.  Effect  on  Worlcem.  —  "After  the  men 
have  once  got  used  to  the  three-shift  system, 
you  could  not  pull  it  jxway  from  them  with 
tongs." 


3.  Increase  in  Men  Needed.  —  Thirty-five 
per  cent,  increase  conser\'ative.  From  50  per 
cent,  in  some  mills  to  11  per  cent,  in  American 
Rolling  Mills. 

4.  Increase  in  Wage  Rates.  —  Twenty-five 
per  cent,  maximum  that  would  be  required, 
even  under  conditions  of  shortage  of  labor. 

"It  has  been  shown  that  the  men  see  the 
reasonableness  of  jiaying  for  their  greater 
leisure  by  .some  reduction  in  total  earnings." 

5.  Increa.te  in  Output.  —  Average  10  per 
cent. 

The  cost  of  making  the  change,  Mr.  Drury 
further  pointeil  out,  is  entirely  incommensurate 
with  its  importance.  "If  there  were  no  in- 
creased efficiency  at  all;  if  the  plant  increa.sed 
its  force  of  shift  men  full  50  per  cent.;  if  the  out- 
I)ut  were  no  greater  than  under  two  shifts,  and 
tiie  hourly  wage  rates  raised  'ii  per  cent.,  the 
totjd  additional  cost  for  the  steel  ingot  would 
not  be  more  than  46  per  cent.,  while  it  sells  for 
about  that  numy  dollars."  According  to  a 
statement  i)y  W.  II.  Baldwin,  former  Secretary 
of  tiie  t)hio  Steel  Comi)any,  not  only  did  the 
government  investigations  of  ten  years  ago 
show  that  the  profits  from  steel  were  so  great 
tiiat  tlu'  industry  could  have  then  stood  the 
three  siiifts.  l)ut  nothing  could  "contribute  so 
much  to  i)etter  fecliilg  between  employer  and 
employee  and  keep  out  outside  influences."  — 
Eliziibetii  C.  Putnam. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


The  New  Position  of  Womk.v  in  .Vmkhk  an 
Industry.  U.  S.  Dept.  Labor,  Women's  liur.. 
Bull.  No.  12,  1920,  pp.  158.— A  report  is  here 
given  of  the  intlustrial  oi)portunities  which  tlie 
war  brought  to  women,  and  of  the  present 
status  of  women  in  labor.  The  work  of  men 
and  women  in  the  same  tyjjes  of  work  is  com- 
pared, industry  by  industry.  —  M.  Dent. 

Telephone  Industry  Ina'estigation.  Bull. 
N.  Y.  State  Indust.  Com.,  March.  1920,  5,  No. 
6,  113;  April,  1920,  5,  No.  7,  137;  May.  1920.  5, 
No.  8,  157;  .June.  1920.  5,  No.  9,  174.  179; 
July,  1920,  5,  No.  10,  189-1!)0,  197.  —  This  is  a 
report  of  a  recent  investigation  of  the  telephone 
industry  by  the  Bureau  of  Women  in  Industry. 
Health  is  required  for  the  necessary  concen- 
tration of  mind  and  alertness  of  hand  of  the 
operator.  The  company  recognizes  this  and 
arranges  for  adequate  light,  heat,  ventilation 


and  comfort,  especially  in  the  larger  cities. 
Ventilation  is  the  chief  physical  difficulty  of  the 
operating  room.  In  the  larger  cities  forced 
drafts  arc  installed,  but  in  smaller  ones  win- 
dows and  fans  are  relied  upon.  The  rooms  are 
in  hourly  use  the  year  round,  hence  the  diffi- 
culty of  thorough  airing  daily.  Adjustable 
chairs  reduce  fatigue  to  the  minimum.  In  most 
o])erating  exchanges,  washing  facilities  and 
toilets  are  am])le  and  clean,  as  are  also  the 
lockers.  Rest  rooms  are  adequate  for  the  relief 
periods,  a  victrola  and  piano  being  provided 
and  an  attempt  made  at  having  very  attractive 
rooms.  One  em])loyee  devotes  her  entire  time 
to  planning  and  inspecting  the  rest  rooms  in  the 
Manhattan  and  Bronx  Division.  A  reasonable 
amount  of  current  literature  and  periodicals  is 
provided.  The  New  York  Telephone  Com- 
pany has  gone  further  than  the  majority  of 
large  employers  of  women  in  paying  particular 


18 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


attention    to    the    physical    conditions    under 
which  its  emploj^ees  work. 

Lunch  Room  Serrice.  —  For  a  number  of 
years  the  company  has  furnished  free  tea, 
coffee,  sugar,  and  condensed  milk  to  the  girls; 
now  cafeterias  are  being  installed  with  food  at 
or  below  cost  and  continued  free  tea,  coffee,  etc. 
Of  thirty  buildings  containing  exchanges, 
twenty-six  have  regidar  cafeteria  service. 
Outside  Manhattan  and  the  Bronx,  however, 
cafeteria  service  is  as  yet  not  largely  de^'eloped. 

The  cost  of  training  an  operator  is  from  $68 
to  $100.  For  e\'ery  three  operators  entering  the 
service,  one  drops  out  in  training,  and  a  second, 
before  the  end  of  the  first  year.  The  third  stays 
longer.  According  to  the  company's  statistics, 
only  after  two  years'  service  is  an  operator 
competent  to  carry  efficiently  the  theoretic 
load  of  230  calls  per  hour.  In  Manhattan 
24§  per  cent,  had  been  with  the  company, 
after  training,  six  months  or  less;  13.7  per  cent., 
from  six  months  to  one  year;  13.4  per  cent., 
over  one  year  and  through  two  years.  The 
problem  of  the  telej)hone  company  is  in  re- 
taining operators  beyond  the  two  year  period, 
when  their  maximum  efficiency  is  being  reached. 

Medical  Department. — There  is  need  of 
special  study  of  fatigue  in  the  whole  telephone 
system.  The  New  York  Bell  Telephone  Com- 
pany employs  twenty-seven  physicians  three 
hours  daily,  and  fifteen  graduate  nurses  full 
time.  The  New  York  medical  dejjartment  is 
fully  equipped  for  blood  tests.  X-ray,  and  other 
lal)oratory  work.  A  medical  examination, 
given  by  women  doctors,  is  requisite  to  enter- 
ing the  service.  In  1919,  from  9,429  applicants, 
8.fi  per  cent,  were  rejected  for  physical  dis- 
ability; 20  per  cent,  of  these  rejections  were  for 
lung  conditions,  10  per  cent,  for  nervous  dis- 
orders, and  18  per  cent,  because  of  under- 
development. There  is  no  doubt  but  that  the 
number  of  losses  from  the  operating  force  could 
be  considerably  reduced  if  the  telephone  com- 
pany undertook  a  more  thorough  medical 
sujjervision  of  the  operators,  and  ap]>Iied  the 
results  to  making  the  operator  fit  iier  job. 
The  whole  trend  of  telephonic  invention  has 
been  to  intensify  the  strain  by  heightening  the 
speed,  with  little  attention  to  the  effect  upon 
the  operator  or  her  children.  The  problem 
from  this  point  of  view  is  medical,  and  by  study, 
a  valuable  contribution  could  be  made  to  this 
subject. 

Basic  time  is  forty-eight  hours  a  week  for  the 
day  time  and  forty-two  hours  for  evenings  and 


split  work,  but  actual  working  hours  dift'er  on 
account  of  the  shifts.  Sometimes  it  is  necessary 
to  work  overtime  and  sometimes  undertime. 
Twenty-five  per  cent,  of  the  operators  in  New 
York  State  work  over  time  with  increased  pay, 
which  is  poor  policy  from  the  physical  stand- 
point. In  the  week  ending  December  13,  1919, 
2.3  per  cent,  of  the  New  York  force  worked 
seven  days;  91  per  cent,  more  than  six  days. 
The  company  is  making  every  effort  to  reduce 
overtime  work,  which  results  in  absence  and 
undue  nervous  strain.  Absence,  often  unavoid- 
able, may  also  be  due  to  fatigue,  over-long 
hours,  or  insufficient  wage  incentive.  Statistics 
of  a  sample  day  with  normal  weather  and  no 
epidemic  show  that  8.79  per  cent,  of  the  total 
force  in  New  York  State  was  absent.  Broken 
time,  which  means  time  less  than  one  day  and 
more  than  one  hour  of  expected  duty,  as  well  as 
absenteeism  reduces  the  efficiency  of  the  service 
to  the  public. 

Including  overtime  wages  in  JNIanhattan  Di- 
vision, where  538  operators  received  $18  to  $19 
per  week,  the  regular  minimum  wage  being 
$15,  336  operators  received  under  $12,  2,485 
between  $18  and  $21,  and  1,976  between  $21 
and  •1*25.  Wages  were  increased  in  1919,  but 
the  Bureau  of  Women  in  Industry  believes  that 
the  inaxinuun  rate  could  be  advantageously 
increased  and  promotions  made  more  rapidly, 
to  increase  the  permanency  of  the  organized 
force.  The  Bureau  reconunends  (1)  an  amend- 
ment to  the  labor  law  subjecting  exchanges  to 
the  same  supervision  of  the  industrial  Commis- 
sion as  the  factory  and  mercantile  establish- 
ments, and  (2)  consideration  by  the  Public 
Health  Service  Commission  of  such  parts  of  the 
above  report  as  bear  upon  inadequacy  of  tele- 
phone service.  —  F.  Fremont-Smith. 

The  PsYcnoLOGic.\L  Appro.\ch  to  the 
Chilo  L.\nou  Problem.  R.  G.  Fuller.  Am. 
Child,  Aug.,  1920,  2,  No.  2,  119-127. —The 
data  of  modern  psychology  are  increasingly 
valuable  for  the  miderstanding  and  interpreta- 
tion of  tiie  child  labor  evil,  and  in  the  actual 
procedure  of  child  labor  reform  psychology  will 
be  of  great  practical  value.  The  evil  of  child 
labor  is  not  to  be  measured  wholly  in  terms  of 
what  child  labor  does  to  some  children;  it  must 
be  estimated  also  with  reference  to  what  society 
ought  to  do  for  all  children.  There  are  several 
important  distinctions,  made  possible  iiy  mod- 
ern psychology,  which  must  be  regarded:  such 
as  that  between  cliild  labor,  which  is  a  social 


ABSTRACTS 


19 


evil,  and  child  work,  which  is  a  biological  good; 
or,  again,  the  distinction  between  the  needs  of 
the  child  as  regards  his  preparation  for  adult 
life  and  his  requirements  as  a  child.  The  cen- 
tral and  dominant  interest  should  be  in  the 
child  as  a  child.  He  is  the  proper  point  of 
departure  in  child  labor  reform.  We  nnist  ask 
first  what  constitutes  a  normal  childhood. 
Psychologj^  would  an.swer  that  activity  in 
which  old  racial  e.vpcriencc  is  re-enacted  in 
childhood  is  developmental  and  hygienic.  It 
coincides  with  a  normal  motor  life,  which  is 
more  than  physical  activity,  being  also  psy- 
chical. Activity  in  childhood,  i)sychology 
shows  also,  l)ecomcs  increasingly  constructive. 
Both  educational  activities  and  work  nnist 
conform  to  these  normal  laws  and  qualities  of 
childhood.  In  considering  what  is  normal  in 
work  for  the  child,  we  nnist  take  motivation 
into  consideration:  such  as  filial  <lc\'otion,  the 
self-as.sertivc  in.stinct  in  its  various  forms  of 
expression,  the  desire  for  independence,  the 
desire  for  money  for  the  sake  of  ])ossessing  it  or 
for  its  u.se  in  .self-display  or  in  indulgence  and 
amu.scment,  the  desire  to  iniitate  friends,  the 
spirit  of  adventure,  etc. 

.\l)plicd  psychology  must  give  iitlciitiuu  to 
the  causes  and  consequences  of  clijiiigc  of  em- 
ployment; it  mustconsider  tlie]jroblems  of  men- 
tal hygiene  connected  with  child  work  —  such 
problems  as  that  created  by  work  <lone  with 
defective  p.sychic  im]>ulsion.  which  |)roduccs 
friction  and  thus  fatigue.  The  ell'ects  of  such 
work  would  be  studied  in  their  contrasts  to  the 
physical,  mental,  and  moral  benefits  of  a  nor- 
mal play  life.  Children  ])ossess  work  impulses 
as  well  as  play  impulses,  but  both  are  rei)re.s.seil 
by  child  labor.  Any  occupation  that  causes 
over-use  of  the  acces.sory  small  muscles  or  con- 
tiiuially  restricts  the  u.se  of  the  large  funda- 
mental nuisclcs;  any  occupation  that  ])rechi(lcs 
the  development  of  the  finer  ncuro-nni.scular 
co-ordinations,  such  as  nuich  of  ordinary  farm 
work;  any  occupation  that  tends  toward  the 
formation  of  bad  motor  habits;  any  .sedentary 
occupation;  any  occujiation  that  stands  in  the 
way  of  a  wholesome  oI)jective  life;  any  occupa- 
tion that  interferes  with  a  full  childhood  is  far 
from  being  a  gainful  occupation.  —  G.  E. 
Partridge. 

The  Juvenile  Court  and  Child  L.\bor. 
Mabel  B.  Ellis.  Am.  Child,  Aug.,  19^20,  2,  No. 
2,  128-138. — The  juvenile  court  occupies  a 
good  vantage  ground  from  which  to  view  the 


operation  of  child  labor  laws  and  to  aid  in  their 
enforcement;  it  is  not  strange,  therefore,  that 
in  at  least  six  sUites  probation  officers  are 
specifically  mentioned  among  those  charged 
with  the  enforcement  of  the  child  labor  law, 
and  that  in  at  least  twenty-five  states  peace 
officers  and  truant  officers,  who  often  are  the 
only  probation  officers  for  small  courts,  are  so 
named.  No  juvenile  court,  which  rightly  inter- 
prets its  function  of  .searching  out  and  .seeking 
to  remove  the  cau.ses  of  juvenile  maladjust- 
ment, will  fail  to  note  the  frequency  with  which 
premature  or  unsuitable  employment  enters  as 
a  factor.  The  officer  of  the  juvenile  court  must 
take  a  broader  view  than  the  mere  legal  one. 
He  nnist  study  the  mental  and  physical  con- 
dition of  the  child.  Knowledge  concerning  the 
employment  of  the  child  is  highly  inqjortant, 
and  the  effects  of  the  occupation  upon  the 
child  during  the  period  of  prol)ation  —  the 
president  of  the  National  Probation  Associa- 
tion has  urged  that  this  period  be  usually  not 
less  (hail  a  year  —  must  be  watched  clo.sely. 

.\iiotlicr  problem  in  which  the  juvenile  court 
is  concerned  is  that  of  work  in  institutions. 
The  question  of  child  labor  in  institutions  must 
be  faced  .scjiiarely.  It  is  difficult  to  draw  the 
line  bclween  work  which  is  educational  and 
work  which  is  mere  drudgery,  but  we  shall  have 
no  training  schools  in  a  real  sense,  until  house- 
hold managers  and  farm  foremen  in  these  in- 
stitutions have  professional  training  for  their 
work  and  a.ssume  a  professional  attitude  to- 
ward it.  —  G.  E.  Partridge. 

IIkaltii  and  the  Wohkixg  Child.  //.  H. 
Milrlull.  Pub.  Health  \urse.  Jan.,  1920,  12, 
No.  1,  .'51-33. — The  health  of  the  working 
child  stands  between  two  great  public  health 
specialties  —  school  hygiene  and  industrial 
liygicne.  The  working  child  represents  jirob- 
ably  one-fifth  of  our  j)opulation  between  the 
ages  of  14  and  15  years,  and  is  particularly  in 
need  of  health  supervision.  Thus  far  only  six- 
teen of  the  states  re(|iiire  a  certificate  of  physical 
fitness  from  a  i)hysician  before  a  child  is  al- 
lowed to  engage  in  wage-earning  pursuits.  In 
a  few  cities,  the  child  is  required  to  return  for 
examination  whenever  he  changes  his  employ- 
ment. Examining  physicians  are,  however, 
often  lenient,  and  the  restrictions  do  not  reach 
a  large  number  of  children  with  the  milder 
physical  defects.  If  we  recognize  that  our  only 
excuse  for  auif  child  lal)or  is  real  economic 
hardship,  it  should  be  clear  that  it  is  not  econ- 


20 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


omy  to  allow  a  child  with  physical  defects  to 
risk  his  health  in  occupations  involving  severe 
strain,  excessive  fatigue  or  exposure  to  poi- 
sonous substances  or  dust.  The  medical  ex- 
ammation  that  rejects  3  or  even  10  per  cent, 
of  the  applicants  and  then  gives  them  no  fur- 
ther attention  is  not  sufficiently  protecting  the 
health  of  children. 

There  is  serious  need  for  some  further  super- 
vision of  the  health  of  working  children.  It  is 
not  sufficient  merely  to  examine  the  child.  If 
he  has  any  pjiysical  defects,  even  in  a  mild 
degree,  they  may  prove  enough  to  break  down 
his  physical  resistance.  Periodic  physical 
examinations  are  essential,  and  with  the  de- 
velopment of  the  continuation  school  there 
should  be  given  to  the  working  child  such 
health  supervision  that  when  he  reaches  ma- 
turity he  may  enter  the  industrial  world  with 
a  body  at  least  free  from  disease  or  physical 
weakness.  —  G.  E.  Partridge. 

What  Is  Health  Protection  for  Working 
Children?  H.  H.  Mitchell.  Am.  Child,  Aug., 
1920,  2,  No.  2,  145-150.  —The  value  of  phys- 
ical fitness  certificates  of  children  applying  for 
permits  to  work  has  probably  been  very  much 
overestimated.  The  value  of  physical  exam- 
inations under  the  present  methods  of  admin- 
istration is,  in  fact,  very  limited,  and  it  is 
certain  that  a  much  smaller  number  are  re- 
fused work  permits,  or  are  held  until  corrections 
are  obtained,  than  appear  to  be  the  total  num- 
ber of  defective  children  among  those  ex- 
amined. Cities  in  which  20  to  30  per  cent,  of 
the  children  are  refused  on  first  examination 
and  5  per  cent,  finally  refused  are  probably 
considerably  above  the  average  in  the  physical 


standards  required  for  a  certificate.  What  is 
needed  is  a  more  flexible  system,  discretionary 
power  in  the  administration  of  the  laws,  a 
scientific  point  of  view,  and  means  of  following 
up  and  treating  cases  individually.  Each  certif- 
icate might  be  issued  for  a  particular  occupa- 
tion. The  physician  should  not  be  placed  in  the 
impossible  position  of  having,  as  his  only  means 
of  protecting  a  child's  health,  the  refusal  of  a 
permit.  In  the  larger  cities  there  should  be  full- 
time  medical  executives  giving  especial  study 
to  the  health  problems  of  the  working  chUd, 
and  in  the  smaller  cities  the  needs  may  be  met 
by  grouping  several  welfare  activities  so  that 
trained  social  workers  will  be  employed  who 
will  direct  the  issuance  of  work  permits  and 
follow  the  advice  of  part-time  medical  ex- 
aminers in  protecting  the  health  of  each 
individual  child.  —  G.  E.  Partridge. 


Examination  of  Children  for  Industries. 
Medical  Notes.  Boston  Med.  and  Surg.  Jour., 
Oct.  21,  1920,  183,  No.  17,  500.  —The  Massa- 
chusetts Department  of  Labor  and  Industries 
calls  attention  to  the  provision  of  the  school 
attendance  law  in  regard  to  the  issuance  of 
working  certificates  to  children  between  the 
ages  of  14  and  16.  The  child  must  be  examined 
by  a  physician  and  found  physically  able  to 
perform  the  work  which  he  intends  to  do.  The 
object  of  the  law  is  defeated  unless  the  exam- 
ination of  the  child  is  definitely  related  to  the 
work  upon  which  he  desires  to  enter.  It  has 
been  revealed  that  certificates  have  been  is- 
sued after  a  superficial  examination  or  even 
when  no  examination  has  been  made.  —  Bar- 
nett  Cohen. 


INDUSTRIAL  SANITATION:  FACTORY  CONSTRUCTION,  ILLUMINATION. 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEWAGE  DISPOSAL 


Industrial  Sanitation.  W.  N.  Fitch. 
Safety  Engiu.,  Oct.,  1920,  40,  No.  4,  163-168. 
—  Workmen  are  affected  in  their  health,  habits, 
personal  appearance  and  efficiency  by  the  en- 
vironment under  which  they  work.  This  paper 
discusses  the  following  important  items  of  good 
industrial  sanitation,  applicable  not  only  to 
new,  but  to  old  constructions: 

1.  General  Cleanliness.  —  No  type  of  sanita- 
tion is  more  neglected.  There  should  be  suffi- 
cient light,  and  pure  air  —  clear  of  dust  or 
poisonous    vapors.     The    broom    and    brush 


should  be  relegated   to  the  dump  heap,  and 
vacuum  cleaners  installed. 

2.  Drinking  Water.  —  Water  for  drinking 
purposes  should  be  clear,  pure,  and  of  an  agree- 
able temperature.  Mctliods  of  purifying  and 
cooling  arc  discussed,  and  for  furllier  informa- 
tion readers  are  referred  to  United  States  Pub- 
lic Health  Bulletin,  May  11,  1917,  Volume  32. 

3.  Cuspidors.  —  A  fairly  sanitary  cuspidor  is 
described. 

4.  Toilets.  —  Toilets  are  very  much  neg- 
lected in  some  industries.   They  should  always 


ABSTRACTS 


21 


be  inside  the  factory.  Eleven  practical  points  of 
good  sanitary  toilets  are  given. 

5.  Necessities  and  Comforts.  —  Under  this 
head  lockers,  baths,  and  lunchrooms  are  dis- 
cu.ssed.  —  M.  Dent. 

Elements  of  Good  Industri.4l  Lighting. 
S.  E.  Doane.  Safety  Engiii.,  Nov.,  1920,  40, 
No.  5,  201-202.  —  Putting  aside  such  elements 
of  .good  lighting  as  lack  of  glare,  uniformity  of 
light  distribution,  etc.,  the  author  stresses 
.speed  of  vision.  "Laboratory  tests  have  been 
designed  and  study  is  progressing  to  put  values 
in  fractions  of  a  second  to  the  speed  of  vision 
under  various  conditions  of  quantity  and  qual- 
ity of  light;  in  amount  of  contrast  between 
background,  etc."  When  the  light  is  dim  we 
make  a  longer  exposure  on  the  photographic 
plate.  It  is  the  same  with  the  camera  as  with 
the  human  eye.  "There  is  amjjle  evidence  to 
show  that  the  brain  receives  no  notice  whatso- 
ever that  the  j)icture  is  being  recorded  on  the 
retina  of  the  eye  until  the  time  such  exposure 
reaches  some  definite  value  which  is  a  function 
of  the  light  intensity.  Tiie  time  that  the  eye 
takes  under  jiractically  all  conditions  of  arti- 
ficial lighting  is  measurable  in  considerable 
fractions  of  a  second."  Hence,  the  poorer  the 
lighting  the  slower  the  workman.  —  M.  Dent. 

Indu.strml  Lighting  in  Relation  to 
He.vlth  .\nd  Safety.  L.  Gaster.  Jour.  State 
Med.,  Sci)t.,  1920,  28,  No.  9,  274-282.— 
When  the  outbreak  of  the  war  occurred,  there 
was  a  movement  aJreaxly  begun  in  several  of 
the  most  imi)ortant  countries  to  obtain  a  fidler 
knowledge  of  lighting  in  factories.  The  work 
was  interrupted  in  some  of  the  countries,  but  in 
England  a  report  was  jM-iiited  in  1915,  based  on 
a  series  of  over  4000  measurements  of  illumina- 
tion in  K!;?  workrooms  in  factories  throughout 
the  country.  The  rejjort  recommended  statu- 
tory i)rovisions  demanding  certain  conditions 
to  be  fulfilled  in  industrial  lighting,  but  this 
reconunendation  was  not  carried  out  because  of 
conditions  brought  on  1)>-  tlie  war.  Progress  has 
been  made  also  in  the  introduction  of  simple 
apparatus  for  measuring  illumination,  there 
now  being  a  variety  of  tji^es  available. 

Six  states  in  the  United  States  now  possess 
codes  of  industrial  lighting,  following  lines 
adopted  in  the  Briti.sh  Departmental  Commit- 
tee's report,  but  coutaming  more  detailetl 
prescrijitions,  specifying  generalh-  the  amount 
of  illummation  in  foot-candles  for  rough,  fine 
and  very  fine  work. 


A  survey  of  industrial  lighting  has  recently 
been  published  by  R.  P.  Eiustman  in  the  Trans- 
actions of  the  American  Illuminating  Engineer- 
ing Society,  summarizing  the  results  of  visits  to 
44C  mstitutions  in  fifteen  states.  About  80  per 
cent,  of  the  men  interviewed  agreed  that  better 
lighting  leads  to  an  increase  in  production. 
Many  thought  it  brought  about  a  decrease  in 
spoilage;  that  it  was  useful  in  preventing  acci- 
dents; that  it  led  to  imi)rovcmcnt  in  discipline; 
that  it  led  to  better  hygienic  conditions. 

Statistics  in  regard  to  accident  rate  presented 
in  the  report  of  the  British  Home  Office  De- 
I)artment  Committee  on  Flighting  in  Factories 
and  \\'orkshops  show  the  relative  frequency  of 
accidents  in  night  and  day  work.  It  was  found 
that  almost  invariably  the  accident  rate  was 
higher  in  night  work,  the  average  increase 
being  29  i)er  cent,  for  all  forms  of  accident,  iind 
71  i)er  cent.  In  the  case  of  persons  falling.  The 
Commonwealth  Edison  Company  of  Chicago 
recently  made  an  investigation  of  the  ligiiting 
conditions  in  ninety-three  factories.  It  was 
arranged  to  light  these  factories  for  several 
months,  first  with  the  ordinary  ilhimmations 
and  then  with  higher  ilhunination,  an  account 
of  ()uti>ul  being  kei)t.  In  one  ca.se  the  improved 
illumination  resulted  in  an  increased  output 
varying  from  8  per  cent,  to  27  per  cent,  in 
different  deiiartments,  and  it  was  concluded 
tliat,  on  the  average,  an  increased  cost  of  light- 
ing amounting  to  not  more  than  5  per  cent,  of 
the  i)a>Toll  would  lead  to  an  increased  produc- 
tion of  15  per  cent. 

The  A\Titer  emphasizes  the  xahxe  of  interna- 
tional agreement  on  regulations  hi  regard  to 
factory  lighting.  —  G.  E.  Partridge. 

Selling  Better  Lighting  as  an  Aid  to 
Safety,  Conservation  of  Vision  and  In- 
cheased  Production.  John  A.  Hoeveler. 
Safety,  Nov.-Dec,  1920,  8,  No.  11-12,  193- 
200.  —  This  paper,  in  the  form  of  a  dialogue 
l)ctwcen  an  inspector  of  the  Industrial  Com- 
mission of  Wisconsin  and  the  owner  of  a  factory 
where  the  artificial  lighting  was  far  below  code 
standard,  brings  out  the  .salient  reasons  why 
better  lighting  is  of  advantage  to  industrial 
plants.  The  reasons  themselves  are  too  well 
known  to  be  repeated.  —  G.  M.  Fair. 

What  One  Plant  Has  Le,\kned  about 
Lighting.  James  J.  McLaughlin.  Factory, 
Nov.  1,  1920,  25,  No.  9,  1413-1415.  —  Among 
the  factors  of  good  lighting  are  reduction  of  ac- 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


cidents,  increased  accuracy  in  workmanship, 
reduction  of  spoiled  material,  and  a  general  in- 
crease in  production.  The  worker  experiences 
less  eye-strain  and  is  freed  from  tlie  fatigue 
which  accompanies  it.  Good  lighting  also 
makes  for  better  super\-ision  and  generally 
higher  standards  in  a  department.  Of  91,000 
accidents  recorded  by  an  insurance  company 
within  a  year  23.8  per  cent,  were  attributed  to 
improper  or  inadequate  lighting.  In  many  in- 
stances the  impairment  of  \-ision  due  to  i)oor 
lighting  does  not  become  evident  for  a  con- 
siderable time.  Wliile  this  obviously  reacts 
unsatisfactorily  in  the  case  of  the  workman, 
it  is  just  as  definite  a  calamity  to  the  state  in 
that  it  shortens  the  productive  career  of  the 
individual. 

The  greater  part  of  this  article  is  devoted  to  a 
discussion  of  the  relative  merits  of  local  and 


general  lighting  systems.  Some  of  the  undesir- 
able features  of  local  lighting  are  direction  of 
light  to  the  eye  rather  than  to  the  work  where 
reflectors  are  not  used,  irregular  distribution  of 
light  in  a  room,  making  dark  corners,  rapid 
deterioration  of  reflectors  where  they  can  be 
handled  by  workmen,  and  eye-strain  due  to 
wide  variability  in  light  intensity. 

Several  illustrations  are  given  to  call  atten- 
tion to  these  difficulties.  In  a  few  jobs  it  is 
impossible  to  use  general  lighting  effectively. 
This  is  true  where  it  is  necessary  to  illuminate 
the  inside  of  material  in  process  of  manufacture, 
such  as  cylinder  boring.  Here  a  portable  light 
on  a  standard  can  be  used  eff'ecti^•ely.  In  con- 
clusion the  writer  calls  attention  to  a  table 
which  he  gives  based  on  state  lighting  codes  and 
showing  intensities  for  various  occupations  and 
industries.  —  C.  H.  PauU. 


INDUSTRIAL  MEDICAL  SERVICE:   MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


Industry  Needs  an  Adequate  Medical 
Service.  Hugh  S.  Cumming.  Nat.  Safety 
News,  Sept.  6,  19^20,  2,  No.  10,  7.  —  The  author 
gives  in  very  concise  form  the  chief  reasons  for 
the  establishment  of  an  adequate  medical  serv- 
ice in  industrial  plants,  as  follows;  the  reduc- 
tion of  the  labor  turnover,  the  ])lacement  of 
men  where  best  suited,  the  control  of  fatigue, 
the  uncovering  of  unhygienic  conditions  in  the 
plant,  a  promotion  of  the  feeling  of  security 
among  the  employees,  the  study  of  accident 
prevention,  the  early  treatment  of  trauma, 
medical  care  during  working  hours,  discover- 
ing and  checking  epidemics,  and  removing  the 
causes  of  occupational  diseases. 

Economy  of  man  power  demands  industrial 
medical  service  to  help  Ln  the  rcmo\-al  of  causes 
of  accident,  excessive  labor  turnover  and  ocpu- 
pational  diseases.  —  Elinor  D.  Gregg. 

Physical  Examination  for  E.mplovees. 
C.  M.  Douthilt.  Finance  and  Industry,  Oct.  2, 
1920,  23,  29.  —  Many  of  the  larger  industries 
have  installed  a  more  or  less  (■f)mplete  medical 
service  and  have  found  it  economically  profit- 
able. If  the  experiment  is  a  failure  it  is  due 
usually  to  the  selection  of  a  poor  physician. 
The  greatest  weakness  of  industrial  health  .serv- 


ice at  present  is  its  tendency  to  care  only  for 
the  sick  and  injured,  without  due  attention  to 
the  prevention  of  sickness.  The  majority  of 
cases  of  sickness  found  are  due  to  colds,  con- 
stipation, indigestion,  etc.  These  slight  but 
troublesome  ills  cause  about  nine-tenths  of 
lost  time  due  to  .sickness.  Compulsory  exam- 
ination will  not  be  objected  to  by  employees 
when  they  realize  it,  is  for  their  good.  — L.  A. 
Shaw. 

Pl.\nt  Dispensary  Saves  Employes'  Time. 
DeWitt  BnmghUm.  Hosp.  Management,  June, 
1920,  9,  No.  G,  58,  60.  —  The  medical  organiza- 
tion of  the  Brown-Lipe-Chapin  Company,  a 
gear  factory  employing  .slightly  under  3000 
workmen,  consists  of  a  phj-sician,  a  nurse,  and 
two  first-aid  attendants.  This  organization  is 
able  to  benefit  the  company  in  the  following 
manner:  (1)  It  assigns  ap])licants  to  work  for 
which  they  are  pliysically  best  adapted.  (2)  It 
prevents  employment  of  applicants  who  are 
costly  for  the  company  to  carry.  (3)  It  reduces 
the  mmiber  of  men  out  of  work  by  timely  treat- 
ment of  cases  of  injury.  (4)  It  reduces  the  time 
lost  by  accidents  by  providing  light  work  for 
the  injured  until  coniplete  recovery  has  been 
effected.  —  L.  A.  Sluiw. 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


Jl'XE,  IQ^l 


NUMBEH    i 


CONTENTS 


Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc a 

Occupational  Affections  of  the  Skin  and  Special  Senses.     25 

Occurrence  and  Prevention  of  Industrial  Accidents  . .     id 

Women  and  Children  in  Industry 27 

Industrial  Sanitation:  Faclory  Conslruclion,  Illumina- 
tion, Ventilation,  Heating,  Water  Supply,  Sewage 
Disposal 28 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Industrial  Plants 29 


Industrial  Nursing 31 

Industrial  Personal  and  Community  Hygiene:  Hous- 
ing, etc 32 

Industrial  Investigations  and  Surveys 33 

Industrial    Management    in    Its    Health    Relations: 

Special  Tests  in  the  Selection  of  Employees 35 

Industrial  Health  Legislation:  Court  Decisions:  Work- 
men's Compensation  and  Insurance 37 

Rehabilitation  of  Disabled  Employees 41 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS:  GASES,  CHEMICALS.  ETC. 


A  Rare  Diseask.  Bull.  N.  Y.  State  Indust. 
Com.,  Nov.,  1920,  6,  No.  2,  22. —Two  men 
employed  in  the  coating  room  of  the  Dupont 
Fahrikoid  Company  work.s  in  West  Newhurgh 
died  of  a  com ])ara lively  rare  di.sease  known  as 
"purpura  hemorrhagica,"  which  so  decreases 
the  volume  of  white  corpuscles  in  the  blood  as 
to  destroy  the  power  of  coagulation,  so  that  the 
patient  bleeds  from  the  mucous  membrane. 
It  was  asserted  that  in  the  Newburgh  oases  the 
disease  was  caused  by  the  poisonous  fumes  of 
benzol,  and  that  the  company  had  not  taken 
proper  precautions  to  dissipate  these  fumes  by 
the  placing  of  fans  and  ventilators  — ■  an  asser- 
tion which  the  company  denies.  It  was  re- 
ported that  other  men  in  the  coating  room  had 
had  nose  bleeding,  but,  on  the  other  hand,  it  is 
maintained  that  some  men  now  on  the  payroll 
of  the  company  have  worked  regularly  in  the 
coating  room  for  fifteen  years  without  suffering 
any  bad  effects  from  their  work.  —  G.  E. 
Partridge. 


The  Hygienic  Conditions  in  the  Sulphcr 
Industry  of  Catania.  G.  Sangiorgi.  Ab- 
stracted as  follows  from  Rivista  di  Ingegneria 
Sanitaria  e  di  Edilizia  moderna,  1919,  No.  5,  21, 
22,  in  II  Lavoro,  Oct.  SI,  1920,  11,  No.  6,  186- 
188.  —  The  author  describes  conditions  in  the 
sulphur  works  of  Catania  where  the  occupa- 
tional diseases  are  similar  to  those  found  in  the 
sul|)hiir  mines,  but  the  dangers  are  greater  in 
the  mines  because  of  the  presence  of  carbon 
dioxide  and  hydrogen  sulphide,  the  great 
humidity,  high  temperature,  and  poor  ventila- 
tion. The  only  poisonous  elements  in  the  sul- 
phur factories  are  sulpluir  dioxide  and  sulphur 
dust.  According  to  Lehmann,  sulphur  dioxide 
is  irritating  when  present  in  0.006  to  0.01  per 
cent,  and  may  cause  serious  disturbance  in  the 
proportion  of  0.03  per  cent.  The  powdered 
sulphur  has,  in  addition  to  an  irritating  action 
on  the  eyes  and  nasal  and  bronchial  mucosa,  a 
slower  but  more  serious  effect  on  the  lungs 
which  shows  itself  in  a  chronic  indurative  proc- 


23 


24 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ess,  as  a  consequence  of  which  part  of  the  lung 
is  devoid  of  function.  Puhnonary  tuberculosis 
should  be  considered  as  an  occupational  dis- 
ease of  these  workmen.  The  age  at  which  boys 
may  enter  this  industry,  now  15  years,  should 
be  raised.  —  Alice  Hamilton. 

EXPEEIENCE    WITH     COMBINED    P0ISON.S    IN 

Industry.  Midler.  Abstracted  as  follows  from 
Zentralbl.  f.  Gewerbehyg.,  1019,  7,  pp.  57,  73, 
97,  113,  138,  in  Hyg.  Rundschau,  Feb.  1,  19£0, 
30,  No.  3,  85-86.  —  "Tables  show  that  in  some ' 
industries  a  variety  of  poisonous  substances  are 
used  and  many  possibilities  exist  of  simul- 
taneous or  consecutive  action  of  poisons.  Mix- 
tures of  dangerous  substances  may  form  new 
poisons;  the  susceptibility  of  the  body  to  one 
poison  can  be  altered  by  contact  with  another. 
Combined  poisoning  is  apt  to  occur  in  jiaint  or 
cement  works  and  especially  in  furrier's  work. 
Since  the  furrier's  macerating  liquor  contains 
mercury,  mercuric  chloride,  nitric  acid,  and 
arsenic,  an  interaction  of  the  results  is  not 
surprising.  Technicians  for  scientific  institu- 
tions are  not  infrequently  made  iU  by  their 
contact  with  many  poisons.  The  author  men- 
tions as  an  example  an  anatomical  technician 
who  injected  blood  vessels  with  a  mass  con- 
taining carbon  bisulphide,  red  lead,  mercuric 
chloride,  and  carbolic  acid. 

"Change  of  work,  impure  products,  and 
changes  of  procedure  especially  favor  the  ap- 
pearance of  combined  poisoning.  The  author 
cites  examples  of  all  three  possibilities.  Sol- 
vents for  varnish,  colors  or  celluloid  are  almost 
always  mixtures.  Striking  attacks  of  illness  in  a 
factory,  beginning  witii  inflammation  of  the 
eyes  and  clouding  of  the  cornea,  were  explained 
by  the  composition  of  a  leather  varnish,  which 
contained  acetone,  methyl  alcohol,  formalde- 
hyde, nitrobenzene,  aniline,  and  extraordinarily 
much  chlorine  (chloracetone  is  a  very  poisonous 
substance) .  During  the  war  substitute  products 
contained  many  poisonous  substances.  Shoe- 
creams  contained  large  amounts  of  nitroben- 
zene. The  comparatively  harmless  toluenes  are 
often  mixed  with  tetranitromethane.  The 
carbon  used  in  the  electrochemical  industry 
contains  phosphorus  and  suli)hur,  hence  the 
acetylene  produced  is  contaminated  with  hy- 
drogen sulphide  and  pho.sphine,  thus  giving 
occasion  to  j)oisoning. 

"Carbon  monoxide  i)lays  a  large  role  in  com- 
bined poisoning.  Bad  (|uality  of  the  coal  and 
coke    mixtures    increases    this   danger.     As    a 


result  of  the  combination  of  different  intoxica- 
tions the  syndromes  are  often  atypical.  In  the 
combustion  of  celluloid  there  appear  vapors  of 
carbon  monoxide,  nitrogen,  the  two  forms  of 
nitrogen  tetroxide  (NO2  and  N2O4),  and  hydro- 
cyanic acid,  which  at  times,  with  the  bad  con- 
ditions of  buildings,  lead  to  intoxication.  In  the 
pharmaceutical  industry  unforeseen  poisonings 
often  occurred  since  a  change  in  the  product 
had  to  be  made. 

"Animal  experiments  have  shown  that  the 
respiration  of  toxic  gases  makes  animals  less 
resistant  to  infections.  Men  show  the  same  re- 
action. Also  poisons  more  readily  affect  the 
organism  chronically  weakened  by  age,  over- 
tiring,  anemia  and  other  illnesses.  Alcoholism 
makes  the  body  most  sensitive  to  poisoning  by 
many  substances,  as  for  instance  cyanamide, 
zinc,  aniline,  and  mercury.  Just  like  the  bodies 
damaged  by  alcoholism  and  other  habitual 
poisons,  the  organism  weakened  by  lead  indus- 
tries is  subject  to  the  possibilities  of  other 
poisonings.  The  author  cites  several  examples. 
He  emphasizes  the  necessity  for  the  physician, 
when  taking  a  history  from  a  sick  person,  to 
inquire  in  detail  into  the  industrial  environ- 
ment, not  contenting  himself  with  the  state- 
ments made  by  the  worker  or  the  manager  of 
the  industry.  Pursuits  that  have  been  con- 
sidered safe  for  years  may  become  dangerous 
through  the  impurity  of  materials  or  slight 
changes  in  the  processes.  After  having  estab- 
lished the  occurrence  of  one  poison,  one  must 
guard  oneself  against  overlooking  the  action  of 
a  second  and  perhaps  more  powerful  poison, 
which  fre(|uently  hajjpens  in  cases  of  carbon 
monoxide  jwisoning.  Insufficient  study  of  a 
case  may  prejudice  a  worker  in  his  claims  for 
legal  insurance."  —  E.  L.  Sevringhaus. 


Medic.\l  Discuetion  in  Industrial  Poi- 
sonings. Curxchmann.  Abstracted  as  follows 
from  Zentrall)].  f.  Gewerbehyg.,  1919,  7,  |)p. 
131,  145,  171,  191,  in  Hyg.  Rundschau.  July  1, 
19'20,  .30,  No.  13,  407-408.  —  "A  molder  in  a 
brass  foundry  felt  ill  on  the  evening  of  the  day 
after  an  alcoholic  excess,  was  mildly  stupefied, 
and  had  to  be  taken  home,  where  he  died  the 
following  day.  Carbon  monoxide  was  found  in 
his  blood.  The  technical  construction  of  the 
foundry  was  free  from  objection.  Poisonings 
had  not  been  observed  on  the  day  of  the  acci- 
dent or  before  by  the  management  of  tlie  works. 
The  clinical  course  gave  no  indication  of  the 


ABSTRACTS 


25 


symptoms  of  the  well-known  carbon  monoxide 
poisoning.  The  author  believes,  therefore,  that 
in  spite  of  the  carbon  monoxide  demonstrated 
in  the  blood,  the  poisoning  with  carbon  mon- 
oxide may  be  ruled  out,  and  considers  it  more 
probable  that  the  death  is  to  be  referred  to  the 
harm  from  the  alcohol  plus  the  methyl  alcohol 
which  was  so  frequently  admixed  during  the 
war.  Animal  exi)erimcnts  as  well  as  the  findings 
in  one  patient  known  to  have  taken  methyl 
alcohol  demonstrate  that  after  poi.soning  with 
methyl  alcohol  carbon  monoxide  may  be  found 
in  the  blood. 

"A  soldier-workman,  employed  for  weeks  in 
a  trinitrotoluol  factory,  was  engaged  in  emjjty- 
ing  a  container  which  held  trinitrotoluol  and 
benzene.  He  suddenly  fell  and  was  dead  al- 
though help  was  immediately  at  hand.  I'nsl- 
mortem  sections  showed  nornud  findings  in  the 
internal  organs,  the  heart  was  flaccid  and  with- 
out pathological  changes.  In  the  upper  arm 
was   a    large    hemorrhage,    the    brain    showed 


many  punctate  hemorrhages,  and  an  aromatic 
odor  was  connected  with  the  respiratory  pas- 
sages. It  is  known  that  benzene  vapors  can 
have  fatal  results  in  a  very  short  time  and  that 
in  such  cases  death  comes  with  no  jjreceding 
symptoms,  and  above  all  that  the  aft'ected  per- 
son cannot  make  an  attempt  to  get  out  of  the 
dangerous  atmosphere.  The  blood  change  from 
ai)S()ri)tion  of  benzene  acts  upon  the  \-agus 
center  so  that  cardiac  action  stops.  Death  is  a 
kind  of  shock  action.  If  the  heart  is  not  com- 
|)lctcly  resistant  or  is  subject  to  special  demands 
as  during  the  stage  of  digestion  an  exciting 
c-iu.se  is  furnished.  The  postmortem  findings 
are  not  characteristic:  bright  color  of  the  blood, 
congestion  of  the  brain,  extravasations,  and  the 
bcnzciic-like  odor  of  the  rcsjiiratory  organs  are 
mcidioncd.  The  .soldier-workman,  wln>  was  the 
victim  of  the  poi.soning,  was  of  reduced  resist- 
ance and  was  at  the  time  in  the  stage  of  diges- 
tion. Death  was  cau.sed  by  ins])iration  of 
benzene  fumes."  —  E.  L.  Sevringhaus. 


OCCUPATIONAL  AFFECTIONS  OF  THE  SKIN  AND  SPECIAL  SENSES 


Par.\ffinom.\  .\nd  Wax  C.vncer.  li.  /•'. 
Daiis.  Jour.  Am.  Med.  A.ssn..  Dec.  18,  V.)H). 
75,  No.  "a."},  1709  1711.  —  "A  woman,  aged  .'5(1, 
referred  by  Dr.  Oliver  Ormsby  in  June,  11)18, 
had  become  annoyed  in  .luiie,  t!tl(!,  by  a  couple 
of  small  moles  of  ai)proximalely  synmictrical 
location  on  each  cheek.  These  had  been  re- 
moved by  electrolysis,  leaving  small,  dei)re.s.sed 
scars.  Paraflin  had  then  been  injected  by  a  .so- 
called  beauty  specialist  to  till  out  the  depres- 
sions; the  innnediate  results  were  so  pleasing 
that  several  small  wrinkles  on  each  cheek  hafi 
also  been  filled  out  at  sub.ser|uent  sittings.  In 
about  a  year  the  site  of  the  injections  bet'amc 
slightly  swollen,  indurated,  and  assumed  a 
dusky  red  color.  The  induration  and  discolora- 
tion gradually  s[)read  to  involve  the  greater 
part  of  each  cheek  lying  between  the  angle  of 
the  moulli  anteriorly,  the  zygonui  above,  the 
anterior  border  of  the  masseter  muscle  pos- 
teriorly, and  the  mandibular  margin  below.  It 
became  im[)ossible  to  open  the  mouth  more 
than  one-half  inch.  The  induration  tran.s- 
formed  the  smooth  convexity  of  the  cheeks 
which  had  immediately  followed  the  paraffin 
injections  into  pronounced  concavities.  At 
frequent  intervals  the  lesions  became  the  seat 
of  mild  sui)purati\'e  processes  a.s.sociated  with 
the  extrusion  of  minute  particles  resembling 


paraflin;  these  would  leave  small  ulcers  which 
would  crust  over,  heal,  and  again  break  dow  n, 
so  that  there  was  an  almost  constant  discharge 
from  areas  involved.  .  .   ." 

"There  were  three  rea.sons  for  operating:  to 
(1)  reduce  disfigurement;  {i)  incrca.se  the 
mobility  of  the  mandible,  and  (3)  forestall 
e|)ithelionia.  The  treatment  ado|)ted  was  com- 
plete excision  of  involved  tissue  and  substitu- 
tion of  a  flap  of  skin  and  fat  removed  from  the 
arm,  one  side  at  a  time.  This  involved  four 
different  ojjerations.  At  the  first  operation,  the 
lesion  on  the  right  cheek  was  exci.sed,  the  dis- 
section being  carried  to  the  mucous  meinbrane 
at  one  point;  the  right  arm  was  brought  up 
over  the  head  and  a  i)edicled  flap  from  the  arm 
stitched  into  the  cheek  defect.  The  position  of 
the  arm  was  maintained  by  a  plaster  cast  for 
two  weeks  when,  under  gas-o.\ygen  anesthesia, 
the  cast  was  removed,  the  pedicle  of  the  flap 
cut,  and  the  arm  brought  down  to  the  side.  The 
stump  of  the  transplant  on  the  cheek  was  then 
sutured  in  position.  Ten  days  later  the  pro- 
cedure was  repeated  on  the  opposite  side.  Heal- 
ing in  each  instance  w-as  uneventful.  The  result 
when  the  patient  was  last  .seen,  that  is,  eight 
months  after  operation,  was  a  decided  success 
from  the  standj)oint  of  each  of  the  three  objec- 
tives of  treatment.   .   .  ." 


26 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"We  may  say  that  paraffinoma  is  a  chronic 
granuloma  produced  by  prolonged,  continuous 
exposure  of  Susceptible  tissues  to  the  irritation 
of  paraffin.  Disfigurement,  deformity,  and 
interference  with  function,  if  the  lesion  is  in  a 
region  requiring  motility,  are  the  chief  types  of 
disability    resulting;    cancerous    degeneration, 


"wax  cancer,"  is  an  occasional  intruder.  Com- 
plete extirpation  of  the  involved  tissue  is  the 
treatment  of  choice.  Paraffinoma  probably  is 
not  the  expression  of  a  specific  growth-incit- 
ing property  of  paraffin,  but  is  rather  the  result 
of  the  long  continued  action  of  a  low  grade 
chemical  irritant."  —  C.  K.  Drinker. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Use  of  Stenches  as  a  Warning  in  Mines. 
S.  H.  Katz,  V.  C.  Allison,  and  W.  L.  Egy.  U.  S. 
Bur.  Mines,  Tech.  Paper  No.  244,  1920,  pp.  31. 
—  The  summary  of  the  paper  is  as  follows : 

"1.  The  placing  of  stenches  in  the  com- 
pressed-air lines  of  a  mine,  to  warn  miners  of 
danger,  offers  certain  advantages  over  the  use  of 
electric  bells  or  other  means  of  warning.  Among 
these  advantages  are  convenience  of  installa- 
tion, reliability  of  action,  and  positive  effect 
upon  the  miners,  the  natural  instinct  being  to 
flee  from  the  ill-smelling  air  to  pure  air."  The 
necessary  properties  of  stenches  are  non- 
toxicity,  moderate  vapor  pressure,  odor  (which 
should  be  disagreeable),  and  availability. 

"2.  An  apparatus  or  'odormeter'  for  meas- 
uring intensity  of  odors  was  devised  for  the 
laboratory  examination  of  various  stenches. 

"3.  Of  24  chemicals  examined,  butyl  mer- 
captan,  ethyl  mercaptan,  amyl  acetate,  butyric 
acid,  and  valeric  acid  were  found  most  promis- 
ing for  mine  warnings. 

"4.  Tests  performed  in  mines  .showed  that  a 
quick  and  positive  warning  could  be  given  with 
these  materials. 

"5.  A  simple  apparatus,  or  injector,  has 
been  devised  for  introducing  the  liquid  chemi- 
cals into  compressed-air  lines  of  mines. 

"6.  Instructions  for  the  use  of  the  chemicals 
and  the  injector  have  been  given. 

"  7.  It  is  important  that  good  ventilation  be 
established  to  clear  mines  of  the  stench  after  a 
warning."  —  M.  Dent. 

Prevention  of  Gas  Explosions  in  Bitu- 
minous Coal  Mines.  R.  A.  Walter.  Safety 
Engin.,  Oct.,  1920,  40,  No.  4,  173-177. —  Gas 
explosions  in  bituminous  coal  mines  can  be  pre- 
vented by  providing  such  ventilating  current 
under  jiroper  control  as  will  dilute  to  a  liarmless 
mixture  and  carry  away  all  exjjlosive  gases,  and 
by  preventing  all  contact  between  dangerously 
ga.s-ladeii  mine  air  and  flames  or  sparks  suffi- 
ciently hot  and  sustained  to  cause  ignition. 


Ventilation.  —  There  must  be  delivered  at 
the  working  face  150  cubic  feet  of  air  per 
minute  for  every  man,  and  500  cubic  feet  for 
every  mule,  with  such  further  volume  as  may 
be  necessary  to  dilute  to  |  of  1  per  cent,  the  gas 
content  in  individual  splits,  and  to  f  of  1  per 
cent,  the  gas  content  in  the  entire  return  from 
the  mine.  Too  much  importance  cannot  be 
placed  on  proper  proportioning  of  air  courses 
and  the  construction  of  overcasts,  stoppings, 
regulators,  brattices  and  doors.  Splits  should 
be  taken  off  with  relation  to  gas  transpired, 
number  of  men  worked,  air  velocity  and  loca- 
tion of  old  workings.  Rules  are  given  for  the 
construction  of  regulators  and  brattices,  auto- 
matic doors,  and  splits,  and  for  the  provision  of 
skilled  fire  bosses. 

Precautionary  Measures. — These  concern 
explosives,  shot  firing  systems,  tamping,  open 
lamps,  machinery,  fires,  electric  locomotives, 
switches,  fuses,  etc. 

The  author  concludes  with  the  statement 
that  enormous  unnecessary  waste  in  money  and 
life  occurs  every  year  owing  to  poor  ventilating 
.systems  and  poorly  thought-out  safety  meas- 
ures. —  M.  Dent. 

Accident  Prevention  in  the  Mines  of 
Butte,  Montana.  Daniel  Harrington.  U.  S. 
Bur.  Mines,  Tech.  Paper  No.  229,  1920,  pp.  57. 
—  This  careful  report  is  based  on  data  ob- 
tained in  1916,  1917,  and  1918  by  personal  ob- 
servation and  study.  Much  lime  was  spent 
undergromid  and  more  than  twenty  of  the 
larger  mines  were  thoroughly  examined. 

Safety  organization  is  described.  Causes  of 
accidents  are  analyzed.  One  serious  difficulty 
in  dev('l()i)ing  .safety  work  is  the  ra|)id  turnover 
of  labor  at  Huttc.  This  has  amounted  to  .50 
per  cent,  or  more  per  month.  Measures  to  pre- 
vent this  are  suggested.  —  H.  S.  Forbes. 

Accidents  in  Mines  and  on  Railroads  in 
the  United  Kingdom  in  1919.     U.  S.  Bur. 


ABSTRACTS 


<il 


Labor  Statis.,  Month.  Labor  Rev.,  Dec,  IQSO, 
11,  No.  6,  133-134. —A  summary  from  tlie 
report  of  the  chief  in.sj)ector  of  mines  for  Great 
Britain  .shows  a  total  of  1'23,4.54  accidents  in 
quarries  and  mines  in  Great  Britain  and  Ire- 
land (including  for  quarries  the  Isle  of  Man) 
during  tlie  year  1919.  Of  tiie.se  accidents, 
1,2'29  were  fatal.  The  figures  are  given  sepa- 
rately for  coal  mines,  metalliferous  mines  and 
quarries,  and  accidents  are  classified  in  main 
groups.  The  falling  of  ground  was  responsible 
for  42,518  non-fatal  and  .589  fatal  accidents  in 
the  coal  mines  in  that  year,  and  there  were 
about  11,000  surface  accidents  connected  with 


these  mines.  Shaft  accidents  and  explosions 
make  relatively  a  very  small  number,  and  about 
half  of  the  accidents  in  the  coal  mines  are 
grouped  as  miscellaneous  underground  acci- 
dents. Accidents  in  the  metalliferous  mines 
show  a  .somewhat  different  distribution,  but 
these  altogether  make  but  about  3  |)er  cent,  of 
all  the  accidents.  Fatality  rates  for  1918  and 
1919  are  given  for  each  type  of  accident  for  the 
three  groups  .separately,  and  the.se  figures  are 
computed  on  the  basis  of  1,191,31.3  employees 
in  tiie  coal  mines,  ^UfiOl  in  the  metalliferous 
mines,  and  57,076  in  the  quarries.  —  G.  E. 
Partridge. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


WoKK  Accidents  amoxg  Women.  Nellc 
Swartz.  Bull.  N.  Y.  State  Indust.  (\}m..  Dec, 
1920,  (),  No.  3,  56-57.  —  In  this  j)a])er  which 
was  read  before  the  Fifth  Industrial  Congress 
at  Syracuse,  Dec.  7,  1920,  the  author  states 
that  of  the  known  accidents  in  industry,  about 
95  j)er  cent,  are  accidents  to  men,  although 
men  comprise  only  about  70  per  cent,  of  tiie 
total  working  po])ulation.  ^'cry  little  being 
known  about  work  accidents  among  women 
as  distinguished  from  accidents  among  men. 
Miss  Swartz  undertook  to  study  1,000  com- 
pensated accident  cases  among  women  occur- 
ring during  the  i)eriod  from  June  1,  1917  to 
June  1,  1918.  Six  industries  or  industrial 
groups  were  chosen:  metal,  textile,  clothing, 
paper  products,  printing,  and  a  mi.xed  grouj) 
which  included  12  per  cent,  of  the  cases;  of  all 
the  cases  it  was  found  that  about  one-half  fell 
to  the  metal  and  textile  trades. 

Various  factors  in  the  causation  of  accidents 
were  found.  Inability  to  speak  English  is  one. 
Of  the  accidents  studied,  18  per  cent,  occurred 
to  women  who  had  been  with  their  em[)loyers 
less  than  a  mouth,  and  about  6.3  per  cent,  to 
women  who  had  been  with  their  employers  less 
than  a  year.  Almost  half  of  the  women  were 
less  than  20  years  of  age.  Twenty-eight  per 
cent,  of  the  accidents  happened  to  married 
women,  although  married  women  constituted 
only  10  per  cent,  of  the  total  number  of  the 
women,  and  it  is  suggested  that  the  combina- 
tion of  shop  work  with  domestic  work,  with  its 
inevitable  fatigue,  is  a  factor  in  this  result. 
Almost  90  per  cent,  of  the  injured  women  were 
receiving  less  than  $15  per  week,  and  more  than 
50  per  cent,  were  receiving  less  than  $10. 


The  greatest  mnnber  of  accidents  are  cau.sed 
by  machinery  and  are  |)articularly  numerous  in 
the  metal  industry  where  presses  are  especially 
hazardous.  The  sewing  machine  causes  nuiny 
accidents  in  the  clothing  trades.  In  the  paper 
trade  the  most  dangerous  machine  is  the  corner 
stayer.  Stumbling  and  falling  accitlents  made 
the  largest  class  with  the  exception  of  machine 
accidents,  comprising  about  17  per  cent,  of  the 
whole.  Poor  lighting  and  bafl  construction  of 
staircases  are  in  part  responsible,  but  the  fac- 
tor of  fatigue  must  al.so  be  considered.  Less 
than  2  per  cent,  of  all  the  accidents  can  be 
traced  directly  to  clothing. 

.Vs  to  accident  |)revention,  it  may  be  said, 
first,  that  we  have  [lassed  the  point  when 
women  should  be  prohibited  from  working  on 
certain  kinds  of  machinery  because  these  ma- 
ciiines  are  dangerous;  instead,  the  machines 
should  l)e  made  safer.  In  the  next  place,  it  may 
be  urged  that  women  ought  to  be  taken  more 
into  consideration  in  the  safety  movement. 
Safety  experts  maintain  that  not  more  than  25 
or  33  per  cent,  of  accidents  can  be  prevented 
by  safety  devices,  indicating  that  training  is 
needed  quite  as  much  by  women  as  by  men. 
Since  fatigue  is  probably  a  more  important 
factor  in  causing  accidents  among  women  than 
among  men,  fatigue  should  be  better  under- 
stood and  controlled  with  reference  to  accident 
I)revention  among  women.  Rest  jjeriods,  re- 
tluction  of  hours  of  work,  change  of  processes 
during  the  day  must  be  provided  for.  —  G.  E. 
Partridge. 

Tenement  Homework  in  New  York  City. 
Manj  G.  Schonberg.   Am.  Child,  Nov.,  1920,  2. 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


No.  3,  257-261.  —The  homes  of  500  famihes  in 
which  home  work  was  being  done  were  visited 
for  the  purposes  of  the  study.  The  families 
were  distributed  in  different  parts  of  the  city, 
and  the  work  engaged  in  was  varied.  Most  of 
the  home  workers  are  mothers,  and,  as  a 
consequence,  they  not  only  become  nervously 
and  mentally  exhausted,  but  also  neglect  their 
house-work  and  their  children.  As  to  the  em- 
ployment of  children,  it  is  impossible  to  obtain 
accurate  figures,  but  there  are  many  signs  of 
overworked  children,  and  of  children  who  suf- 
fer indirectly  from  home  work.  "The  story  of 
the  child  in  tlie  tenement  is  one  long  tale  of 
neglect,  undernourishment  and  overwork,  and 
.  .  .  every  argument  directed  against  child 
labor  in  the  factory  applies  even  more  strongly 
to  child  labor  in  the  home,  because  of  the 
peculiarly  adverse  conditions  under  which  these 
children  work."  The  ordinary  licensing  and 
inspection  are  wholly  inadequate  to  meet  the 
requirements,  and  there  is  needed  a  long  cam- 
paign of  education  and  publicity  that  such 
legislation  may  be  enacted  as  will  abolish 
altogether  this  iniquitous  and  now  unnecessary 
phase  of  industry.  —  G.  E.  Partridge. 


Maternity  and  Labor.  V.  Fraschetti.  Ab- 
stracted as  follows  from  Bollettino  dell'  Ufficio 
Municipale  del  Lavoro  di  Roma  in  II  Lavoro, 
Dec.  31,  1920,  11,  No.  8,  247-250. —The 
following  table  is  based  on  13,865  births  which 
occurred  in  the  six  years,  1912  to  1918  inclusive, 
in  three  maternity  hospitals  in  Rome.  The 
figures  represent  average  weight  in  grams  of  the 
children  at  birth. 

Employment  of  Mother  Weight  of  Offspring 

Sick  nurses 3,317 

Hotel  chambermaids 3,285 

Fruit  venders 3,204 

Cooks 3,224 

Laundresses 3,224 

Peasant  women 3,218 

Performers  in  theatres  and  cat6s  chant- 
ants 3,192 

Domestic  servants 3,168 

Janitresses 3,166 

Tailors 3,134 

Pressers 3,091 

Tenement  house  workers 3,079 

Metal  polishers 3,033 

Printers 2,929 

Machinists  (making  projectiles) 2,880 

Employees  on  tramways 2,204 

—  A.  Hamilton. 


INDUSTRIAL  SANITATION:   FACTORY  CONSTRUCTION,  ILLUMINATION, 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEWAGE  DISPOSAL 


Effective  Printing-Planx  Illumination. 
A.  D.  Bell.  Electrical  World,  Dec.  11,  1920,  76, 
No.  24,  1153-1155.  —  In  discussing  the  meth- 
ods of  laying  out  an  effective  lighting  system  for 
printing  establishments  the  writer  pays  particu- 
lar attention  to  abundance  of  light,  avoidance 
of  glare  and  shadows,  simplicity  and  uniformity 
of  design.  —  G.  M.  Fair. 

Deterioration  of  the  Air  in  Closed 
Rooms  on  Naval  Vessels  with  Especl\l 
Reference  to  Battle  Conditions.  Bathe. 
Abstracted  as  follows  from  the  original  —  a  75- 
page  illustrated  booklet  from  the  press  of 
Gustav  Fischer,  Jena,  1920,  No.  2  of  the 
marine  medical  experiences  of  the  war,  pub- 
lished by  the  medical  division  of  the  admiralty 
—  by  Martini  in  Hyg.  Rundschau,  June  1, 
1920,  30,  No.  11,  342.  —  "During  the  war  the 
author  arranged  a  series  of  experiments  in  cer- 
tain closed  rooms  on  battleships  which  were 
designed  to  have  artificial  ventilation  in  order 
to  make  possible  the  continued  occupancy  by 
men.    By  simultaneous  attention  to  the  chem- 


ical and  the  physical  conditions  with  reference 
to  the  habital)ility  of  the  experimental  rooms  it 
was  found  that  the  fotmer  factors  lay  far  be- 
hind the  latter  in  their  harmful  effect.  It  is  not 
the  carbon  dioxide  but  the  humidity,  together 
with  the  high  temperatures,  which  renders  life 
so  soon  impossible  in  these  rooms  which  are  so 
important  for  the  ship  if,  for  examj>le,  during  a 
battle  the  ventilation  apparatus  must  be  pro- 
tected from  the  poisonous  gases  incidental  to 
the  explosion  of  shells.  Unfortunately  the 
ventilation  method  must  suffice  (although  the 
arrangement  coidd  be  improved  in  its  effective- 
ness) as  long  as  a  better  means  for  the  removal 
of  moisture  is  not  found."  —  E.  L.  SevTinghaus. 

Determination  of  Atmospheric  Impuri- 
ties. Osborn  Monnett.  Chem.  and  Metall. 
Engin.,  Dec.  8,  1920,  23,  No.  23,  1117-1121; 
Dec.  15,  1920,  No.  24,  1173-1176.  —  This  is  a 
study  of  the  character  and  amounts  of  atmos- 
pheric impurities  in  the  air  of  Salt  Lake  City. 
It  includes  (1)  the  estimation  of  .solids  and 
gases  present  including  sulphur  dioxide   and 


ABSTRACTS 


29 


smelter  gas  and  (2)  a  soot  fall  study  in  which 
material  settling  at  different  locations  was 
measured  and  analyzed  at  monthly  intervals  of 
time. 

The  author  summarizes  his  results  as  fol- 
lows : 

1 .  The  concentration  of  solids  in  the  atmos- 
phere varied  from  less  than  0.1  nig.  to  2.5  nig. 
per  cubic  meter.  The  higiicst  amount  occurred 
during  the  heating  .sea.son  and  in  the  business 
district.  In  this  heating  .sea.son  tiie  solids  orig- 
inated practically  entirely  from  fuel. 

2.  The  total  soot  fall  during  tiie  heating 
season  averaged  about  2.30  Ions  per  .scjuare  mile 
per  annum.  Ninety-five  tons  or  about  -10  per 
cent,  of  this  material  was  combustible  matter. 

3.  Sulphur  dioxide  determinations  siiowed 
an  average  concentration  of  ().].'>  |)arts  per 
milUon  during  December  and  January,  and 
0.10  parts  per  million  during  March.  The 
presence  of  the  gas  was  due  to  coml>ustion  of 
coal  in  the  city.  It  was  a  negligil)lc  factor  in 
the  smoke  nuisance. 

4.  The  smoke  concentration  and  .soot  fall 
was  as  high  as  that  observe<l  in  cities  consum- 
ing five  to  ten  times  as  nuich  coal  yearly. 

Some  of  the  nietliods  u.sed  in  determining 
these  factors  should  be  of  interest  to  industrial 
hygienists.  —  G.  M.  Fair. 

PuRK  Drinking  W.vter  kor  Indi-strial 
Pi^vNTS.  Arthur  M.  Buswell.  Nat.  Safety 
News,  Sept.  6,  1920,  2,  No.  10,  12;  Nov.  1, 
1920,  No.  18,  13.  —  Damage  suits  have  been 


paid  by  a  corporation  in  the  west  for  damages 
resulting  in  sickness  and  death  from  typhoid 
fever  contracted  from  impure  drinking  water. 
The  ruling  of  the  Wisconsin  Supreme  Court 
that  contaminated  drinking  water  was  an  acci- 
dent for  wliich  the  employer  is  financially  liable 
would  be  upheld  under  most  workmen's  com- 
pensation acts. 

Tyjjhoid  fever  is  our  most  prevalent  water- 
borne  disease.  The  yearly  cost  of  typhoid 
fever  is  $1.50,000,000.'  So*  much  difficulty  is 
found  in  obtaining  pure  drinking  water  from 
city  sujjplies  that  it  behooves  employers  to  look 
carefully  to  the  purity  of  their  water  supply. 

The  methods  of  water  purification  are  given 
in  outline: 

For  clarification: 

1.  Filters  of  porous  material.  Impractical 
for  large  amounts  of  wjjter. 

2.  Sand  filters. 

(a)  Slow  gravity  type  without  chemical 
coagulant.    Requires  too  much  space. 

(/))  Mechanical  pressure  type  with  chem- 
ical coagulant.  Practical  but  incom- 
])lete  without  sub.sequent  sterilization. 
For  sterilization: 

1.  Chlorination.  Cheap,  and  effective  if 
chloramine  is  u.sed,  but  requires  about  thirty 
minutes  before  the  action  is  complete.  There  is 
fretpiently  a  disagreeable  taste  and  odor. 

2.  I'ltra  violet  ray.  The  ultra  violet  ray  is 
eifective  immediately  and  once  adjusted  does 
not  vary  in  effectiveness,  as  no  human  equation 
is  involved.  —  Elinor  D.  Gregg. 


INDUSTRIAL  MEDICAL  SERVICE:   MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


The  Medical  Department  of  the  Fulton 
B.\G  AND  Cotton  Mills.  D.  T.  Hci/.ser.  Mod. 
Med.,  Oct.,  1920,  2,  No.  10,  (i73-(i74.  —  This 
is  an  article  describing  an  industrial  medical 
department  which  conducts  unusually  exten- 
sive and  varied  work.  This  de|)artinent  under- 
takes to  care  for  families  of  employees  as  well  as 
for  the  workers  themselves.  A  small  hospital  is 
maintained  with  resident  physician  and  nur.se. 
Two  nurses  of  the  staff  devote  most  of  their 
time  to  visiting  the  homes  of  employees,  doing 
actual  bedside  nursing  and  giving  instruction  in 
hygiene.  The  physician  also  visits  employees 
or  their  families  in  the  home.  As  a  part  of  the 
hospital  service  a  dental  clinic  is  maintained  as 
well  as  the  usual  first-aid  rooms. 


Among  the  special  activities  of  the  medical 
.service  are:  nutrition  clas.ses  for  children;  naso- 
pharyngeal clinics  conducted  by  visiting  .spe- 
cialists; a  baby  hygiene  clinic;  a  day  nursery; 
prenatal  instruction  in  connection  with  the 
maternity  work  of  the  hospital;  and  a  clinic  for 
venereal  treatment.  —  H.  W.  Stevens. 

The  Medical  Unit  of  a  Factory.  R. 
Rapp.  Month.  Bull.  N.  Y.  City  Dept.  Health, 
Aug.,  1920,  10,  No.  8,  187-189. —A  medical 
unit  is  needed  in  every  factory  because  of  major 
and  minor  injuries  which,  despite  automatic 
safeguards  and  safety  bulletins,  are  certain  to 
occur  in  operating  high  velocity  machinery. 
Saving  of  time  through  prompt  and  effective 


30 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


attention  in  cases  of  illness,  examination 
of  physical  and  mental  condition,  which  leads 
to  the  redistribution  of  workers,  etc.,  are  func- 
tions and  results  of  the  medical  work.  The 
proper  personnel  consists  of  an  industrial  phy- 
sician, an  industrial  nurse  or  nurses,  first  aid,  a 
clerk,  a  superintendent  or  manager  ex  officio, 
and  a  visiting  dentist.  The  work  of  the  indus- 
trial physician  should  be  done  with  attention  to 
the  value  of  routine  and  system.  The  nurse 
must  be  equally  efficient  and  orderly,  and,  in 
addition  to  her  purely  professional  work  as 
assistant,  she  should  confer  with  foremen,  take 
an  initiative  in  discovering  needs,  and  clear  up 
misunderstandings  between  doctor  and  pa- 
tients. The  first-aid  man  should  be  able  to 
apply  artificial  respiration,  control  hem- 
orrhages, and  do  antiseptic  dressing.  Others 
who  are  factors  in  the  medical  work  must  also 
take  their  functions  seriously,  and  be  reliable 
and  discreet.  Equipment  must  be  adequate, 
and  all  the  details  of  the  work  attended  to  in  a 
business-like  manner.  —  G.  E.  Partridge. 

Medical  Service  of  the  Gillette  Com- 
pany. Hosp.  Management,  Oct.,  1920,  10, 
No.  4,  64.  —  The  plant  hospital  of  this  com- 
pany has  a  very  low  daily  average  of  cases,  due 
'  to  precautions  taken  against  accidents  and  to 
the  attention  given  to  health  conservation, 
such  as  drmking  fountains,  scientific  ventila- 
tion, etc.  —  L.  A.  Shaw. 

Comprehensive  Service  for  Employees. 
Charles  H.  Lemon.  Hosp.  Management.  Oct., 
1920,  10,  No.  4,  66. —The  Milwaukee  Elec- 
tric Railway  and  Light  Company  and  its  Em- 
ployee's Mutual  Benefit  Association  furnish  to 
the  employee,  his  wife,  and  his  dependents 
under  18  years  of  age,  everything  that  they 
need  in  the  way  of  medical  service.  The  doc- 
tors forming  the  personnel  are  experts  in  the 
lines  for  which  they  are  chosen.  The  service 
rendered  is  comprehensive,  acute  as  well  as 
chronic  ailments  being  treated.  The  service 
thus  given  is  preventive  as  well  as  curative. 
Statistics  of  the  company  show  a  reduction 
from  the  former  average  disability  of  nine  days 
per  man  per  year  to  a  little  over  four  days  per 
man  per  year.  Through  siich  a  system  the 
man  is  kept  contented  with  his  work,  his  family 
life  is  greatly  improved,  and  his  average  medi- 
cal expenses  are  much  reduced.  —  L.  A.  Shaw. 

132,913  Sick  and  Injury  Cases  in  a  Year. 
J.  L.  Bower.   Hosp.  Management,  July,  1920, 


10,  No.  1,  56-58. —The  Pennsylvania  Rail- 
road Company  lays  great  stress  on  first-aid 
work  which,  by  direction  of  the  management, 
has  been  placed  under  the  jurisdiction  of  its 
relief  department.  First-aid  packets  are  widely 
distributed,  and  at  industrial  centers,  such  as 
shops,  fully  equipped  first-aid  rooms  have  been 
established  with  a  properly  trained  man  in 
constant  attendance  and  with  a  daily  visit  by 
the  medical  examiner.  First-aid  corps,  in- 
structed by  the  medical  corps,  have  been 
established  at  all  points  where  first-aid  cabinets 
have  been  placed.  Sanitary  inspection  of 
camps,  dormitories  and  other  places  is  a  part  of 
the  routine  duty. 

The  recent  establishment  of  an  eye  depart- 
ment equipped  to  treat  diseases  of  the  eye  and 
especially  to  correct  refractive  errors  has 
proved  a  valuable  addition  to  the  company's 
medical  service.  In  the  near  future,  the  com- 
pany contemplates  placing  similarly  equipped 
eye  establishments  at  several  of  the  large 
terminals  for  the  greater  use  and  convenience 
of  all  needing  such  help.  —  L.  A.  Shaw. 

High  Stand.vrds  in  Health  C.uie  at  Hotel 
Mc.\lpin.  Samuel  H.  MacFarlane.  Mod. 
Med.,  Oct.,  1920,  2,  No.  10,  667.  —  Recent  ex- 
pansion of  medical  service  has  developed 
hospital  service  for  hotels.  "The  Hotel  Mc- 
Alpin  has  a  completely  equipped  hospital, 
modern  in  every  respect"  in  charge  of  a  phy- 
sician and  a  well-trained  nurse.  The  service  of 
the  hospital  is  available  to  guests  as  well  as  to 
employees. 

Daily  clinics  are  held  from  9  to  10.30  morn- 
ings and  from  5  to  6  evenings;  and  emergency 
treatment  is  given  immediately  when  required. 
Physical  examinations  are  made  of  all  em- 
ployees, especial  attention  being  given  to  those 
working  with  food  or  in  the  laundries. 

X  social  worker  who  is  a  graduate  nur.se 
visits  all  workers  absent  becau.se  of  illness. 

\  sanitarian  and  food  chemist  works  in  con- 
junction with  the  hospital  service.  Her  work 
com])riscs  inspection  and  testing  of  all  foods 
u.sed.  Manicuring  of  all  cooks,  waiters  and 
food  handlers  is  also  a  part  of  her  daily  pro- 
gram. Several  other  hotels  are  served  by  the 
same  food  chemist. 

The  writer  quotes  an  extract  from  a  report  of 
an  inspection  of  the  McAlpin  made  by  the 
N.  Y.  City  Department  of  Health:  "We  found 
measures  taken  for  the  sanitary  handling  and 
preparation  of  food  and  personal  care  of  em- 


ABSTRACTS 


31 


ployees  that  we  did  not  believe  to  exist  in  any 
institution  in  the  country."  —  H.  W.  Stevens. 

How  Can  Medical  Service  Be  Impro\'ed? 
F.  H.  Thompson.  Proc.  6th  Ann.  Meeting 
Internat.  Assn.  Indu.st.  Accident  Boards  and 
Commissions,  U.  S.  Bur.  Labor  Statis.,  Bull. 
No.  273,  Aug.,  1020,  2!)o-2!)9.  —  Pay  a  better 
fee  for  skilled  .service  and  thus  secure  the  best 
possible  service.  Give  the  industrial  boards 
broader  jKjwer  to  regulate  services  and  to  make 
certain  rules  to  enforce  them.  Induce  a  clearer 
understanding  between  the  medical  i)rofession 
and  the  industrial  board.  Encourage  recon- 
struction of  injured  workmen  and  through  in- 
vestigation, etc.,  place  the  man  in  (■omj)etent 
hands  as  early  as  possible.  Eliminate  the  per- 
nicious contract  .system  for  medical  service  in 
industrial  work.  —  Barnctt  Cohen. 


How  THE  Factory  Dentist  Earns  his 
Salary.  E.  F.  Boicers.  Factory,  July  15, 
1920,  25,  No.  2,  219. —  The  establishment  of 
dental  infirmaries  in  connection  with  industrial 
enterprises  is  being  looked  upon  today  as  an 
economic  necessity.  Not  only  is  there  an  im- 
mense saving  in  dental  fees  to  the  eni])loyce, 
but  tiierc  is  an  enormous  saving  in  time  which 
operates  to  the  advantage  of  the  employer,  for 
bad  teeth  mean  lowered  vitality  and  often 
illness.  —  L.  A.  Shaw. 

Indisthial  Dental  Dispensaries.  San- 
Jord  DcTIart.  Am.  Machinist,  Dec.  9,  1920,  53, 
No.  24,  1085-1086.— A  description  of  the  den- 
tal dispensary  of  the  R.  K.  LeBlond  Machine 
Tool  Com])any,  together  with  reconunenda- 
tions  ba.sed  upon  the  experiences  obtained  in 
its  oi)eration.  —  G.  M.  Fair. 


INDUSTRIAL  NURSING 


Relation  of  Industrial  Nirse  to  Em- 
plov.ment  Manager.  FAizabeth  lios.s.  Piil). 
Health  Nurse,  Nov..  1920,  12,  No.  11,  948- 
950.  —  This  is  a  discussion  of  a  previous  ])ai)er, 
in  which  a  writer  advocateil  making  the  posi- 
tion of  industrial  nurse  a  stepping  stone  to  the 
position  of  employment  manager.  The  present 
writer  thinks  that  it  is  important  to  keep  the 
industrial  mirse  within  the  bounds  of  her  own 
])rofession.  A  possible  line  of  advancement 
would  be  in  establishing  better  relations  be- 
tween the  industrial  nurse  and  the  emjjloy- 
ment  manager.  In  most  industries  a  real  health 
conservation  dci)artment  does  not  exist.  Nurses 
complain  that  they  are  obliged  to  u.se  indirect 
methods  to  gain  recognition  of  their  work,  and 
that  the  nurse's  position  is  generally  very  in- 
definitely defined  and  very  variable.  She  may 
be  merely  a  liosi)ital  worker,  lier  activities  con- 
fined to  her  assigned  room;  or  she  may  be  re- 
garded in  the  light  of  a  truant  officer,  spending 
her  time  in  hivestigating  absenteeism;  or  she 
may  be  called  uj)on  to  run  a  restaurant,  a 
library,  or  a  company  boarding  house,  or  to 
take  charge  of  a  general  social  program — all  of 
these  valuable  services  which  the  imrse  is  able 
to  ])erform,  in  so  far  as  they  do  not  demand 
methods  incompatible  with  professional  ethics. 

At  the  present  time  there  are  many  nurses 
engaged  in  industrial  nursing,  who  lack  knowl- 
edge of  social  and  industrial  conditions  and 
have  low  ideals  in  regard  to  their  work.    After 


all,  however,  it  is  the  management  that  is  to 
blame.  Industry  needs  our  best  women,  and 
this  need  should  be  recognized  fully;  these 
women  should  be  well  trained,  and  should  be 
given  opportunity  and  freedom  to  do  their  work 
in  the  mosteflScient  manner. — G.  E.  Partridge. 

Why  Nurses  Fail  in  Industrial  Work. 
O.  F.  Scott.  Pub.  Health  Nurse,  3Iarch,  1920, 
12,  No.  3,  223  -228.  —  The  troubles  of  the 
medical  department  in  industrial  work  arise 
very  frequently  from  lack  of  co-operation 
cither  in  the  employment  department  or  in  the 
service  department.  The  industrial  physician 
and  the  industrial  nurse  are  jjcrhaps  not  in 
accord,  or  there  may  be  a  lack  of  understanding 
between  the  managers  of  the  employment  or 
the  service  department  and  the  industrial 
nurse  or  physician.  The  only  remedy  is  to 
secure  the  necessary  co-operation;  and  for  this 
there  is  required  patient  and  tactful  effort  on 
the  part  of  the  industrial  nurse.  Failure  con- 
fronts the  nurse  in  two  directions:  She  may 
fail  to  make  headway  in  removing  opi)osition, 
and  con.sequently  fall  back  into  an  ineffectual 
way  of  working;  or  she  may  inspire  dislike  and 
in  that  way  lose  her  hold  upon  the  situation. 
What  is  needed  is  personality. 

The  nurse  in  the  industrial  plant  at  the 
present  time  must  often  do  without  adequate 
equipment  and  work  in  poor  quarters,  since  it 
is  the  tendency  to  disregard  the  needs  of  the 


32 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


medical  department  in  the  industrial  service. 
The  nurse  must  bend  her  efforts  toward  ob- 
taining for  her  work  proper  sanitary  space, 
efficient  standardized  equipment,  and  au- 
thority for  supervision  in  her  own  department. 
—  G.  E.  Partridge. 

Suggestions  for  the  Industrial  Nurse. 
Christine  R.  Kefauver.  Am.  Jour.  Nursing, 
Nov..  1920,  21,  No.  2,  77-80. —Among  the 
functions  of  the  industrial  nurse  as  indicated  by 
this  article  are  (1)  setting  a  proper  example  to 
other  women  employed  in  the  plant  by  the 


wearing  of  the  simple  form  of  dress  which  is 
characteristic  of  the  nurse's  uniform;  (2)  the 
rendering  of  first  aid;  (3)  investigations  of 
conditions  which  lead  to  absenteeism  and  labor 
turnover;  (4)  supervision  of  home  conditions 
where  needed;  (5)  inspection  of  sanitary  con- 
ditions within  the  plant;  (6)  education  of 
workers  in  health,  sex  hygiene,  etc.,  through 
talks;  (7)  proper  understanding  of  industrial 
processes  so  as  to  be  able  to  recommend  the 
improvement  of  working  conditions  both  from 
the  health  and  the  safety  standpoint.  —  C.  H. 
Paul]. 


INDUSTRIAL  PERSONAL  AND  COMMUNITY  HYGIENE:  HOUSING,  ETC. 


How  Shoavers  Improve  Morale.  Factory, 
Dec.  15,  1920,  25,  No.  12,  1910.  —  The  installa- 
tion of  shower  baths  for  employees  has  been 
found  profitable  by  many  successful  concerns 
which  are  making  progress  in  maintaining  the 
health  of  their  employees.  —  I/.  A.  Shaw. 

How  Eleven  ]V£\nufacturers  Combined 
FOR  Better  Housing.  Con  De  Free.  Factory, 
Oct.  15,  1920,  24,  No.  8,  1226-1227. —The 
WTiter  outlines  a  housing  development  plan  in 
which  the  industries  in  the  community  fur- 
nished capital  for  a  home  building  association. 
This  association  carries  on  its  activities  with 
no  OA'crhead  expense.  Instead  of  building  its 
houses  in  one  locality  it  is  scattering  them  in 
the  community,  thereby  eliminating  the  neces- 
sity for  great  variety  in  structure.  At  the  out- 
set nine  plans  were  drawn,  thus  permitting  a 
sufficient  variety  so  that  where  several  houses 
were  located  near  together  the  danger  of 
monotony  was  eliminated.  The  houses  are  of 
two  types,  a  one-story  bungalow  selling  for 
from  $4000  to  $4500,  and  a  two-story  house 
selling  for  from  $5000  to  $5500,  the  variation 
in  cost  depending  largely  upon  the  purchasing 
price  of  the  land.  —  C.  H.  Paul). 

Model  Building  Regulations  of  the 
State  Comiiissioner  of  Housing  of  April 
25,  1919.  Tittler.  Zentralbl.  f.  Gewerbehyg., 
Oct.,  1920,  8,  No.  10,  197-200.  —In  the  model 
building  code  of  April  25,  1919  of  the  state 
commission  for  housing  in  Prussia  are  many 
points  of  interest  to  workers. 

Provisions  for  building  permits  have  under- 
gone extension,  and  now  include  not  only  aU 
new  buildings  and  existing  buildings  subject  to 


remodelling,  but  also  restoration  of  gas  fur- 
naces, electric  installations  and  motors.  All 
quarters  which  are  used  for  industrial  purposes, 
before  undergoing  remodelling,  the  fitting  up  of 
rooms  for  human  habitation,  and  the  specifica- 
tions for  warehouses,  fall  within  the  scope  of  the 
extended  regulations.  The  term  "fireproof" 
has  also  been  accurately  defined  by  the  new 
code.  For  factory  buildings,  special  regula- 
tions are  made  for  fireproofing  of  walls,  fire 
engine  service,  exits  and  air,  gas  and  sewage 
disposal.  Distances  between  factory  buildings 
must  be  at  least  5  meters  and  if  occupied  by 
workers  must  be  separated  by  a  distance  half 
the  height  of  the  buUdings.  Special  localities 
for  factory  buildings  are  designated.  Dispen- 
sations and  some  exceptions  will  be  permitted. 
For  the  protection  of  workers  regulations  are 
made  relative  to  per  capita  space  allotments  in 
all  buildings  designated  "for  the  continuous 
presence  of  human  beings."  In  this  category 
are  included  shops,  business  offices,  workers' 
rest  rooms,  bureaus  and  stores.  Such  places 
must  be  protected  against  dampness  and  imto- 
ward  weather  conditions.  Lighting  regulations 
are  not  particularly  specified.  A  minimum  of 
2j  meters  is  set  for  houses  of  two  to  three 
stories;  those  with  two  stories  or  less,  2^  meters. 
Top  floor  rooms  need  be  only  2.2  meters  high. 
The  author,  however,  believes  that  the  regula- 
tions ought  to  demand  a  minimum  of  3  meters 
in  all  cases.    {Continued.)  —  H.  V.  Williams. 

Model  Building  Regulations  of  the 
State  Commissioner  op  Housing  of  April 
25,  1919.  Tittler.  Zentralbl.  f.  Gewerbehyg., 
Nov.,  1920,  8,  No.  11,  208-212.  (Conclusion.) 
—  The  following  conditions  are  prescribed  for 


ABSTRACTS 


33 


rooms  designated  "for  the  continuous  presence 
of  human  beings."  Floors  are  to  be  at  least 
0.4  meters  above  the  level  of  ground  water. 
No  such  rooms  may  be  in  the  cellar  of  a  small 
house.  A  cellar  is  the  floor  below  the  first  full 
story,  which  latter  must  not  be  over  0.4  meters 
below  the  surface  of  the  ground.  It  is  forbidtlen 
to  erect  l)uildings  for  continued  occupancy  on 
the  ground  floor  except  in  certain  ca.scs,  where 
the  lighting  is  specified  as  not  from  the  north 
and  at  not  less  than  4.5  degrees.  There  is  no 
provision  that  working  rooms  be  not  over  9.5 
meters  below  the  surface. 

Floors  nuist  be  of  wood  or  other  washable  ma- 
terial. Halls  must  be  sufficiently  well  lighted 
and  ventilated.  Rooms  may  be  used  for  stor- 
age or  work  witli  dwelling  rooms  above,  only 
if  there  is  a  fireproof  and  vapor  proof  floor  be- 
tween and  a  separate  and  fireproof  stairway. 
Steam  aj)paratus  and  internal  combustion 
engines  must  have  special  vents. 

Water  sui)])ly  is  guarded.  Springs  nnist  be  at 
least  10  meters  from  certain  listed  .sources  of 
pollution;  ,'5  meters  is  permitted  in  soils  that  are 
imj)ervious.  In  large  buildings  water  nuisl  be 
piped.  Every  working  place  must  have  a 
privy  i)ro\'ifled.  Protection  nuist  be  afforded 
against  falling  glass  unless  wire  glass  is  used. 
Provisions  are  made  for  protection  of  workers 
on  building  construction. 

Firewalls  are  required  to  separate  rooms  with 
any  fire  risks  and  must  be  at  intervals  of  not 
over  40  meters  in  extensive  buildings.  Wooden 
raftered  roofs  nnist  be  plastered.  Stairways 
must  not  be  over  '25  meters  from  the  center  of  a 
room.  Distances  between  woodwork  and  smoke 
pipes  and  firejjlaces  are  prescribed.  \\\  build- 
ings must  border  on  an  oi)en  street.  The  dis- 
tance between  buildings  is  set  at 'S  to  5  meters 
at  least,  according  to  illumination  and  fire 
hazard. 

Provision  is  made  for  establishing  districts 
where  onlj*  industrial  buililings  may  be  erected. 
Machinery  causing  noi.se  or  vibration  must  not 
be  fastened  to  walls  which  will  conduct  the  dis- 
turbance to  dwelling  rooms.  Chimneys  must 
be  high  enough  to  carry  off  smoke,  soot  and 


dust.  Spark  catchers  are  required  in  certain 
cases.  Sewage  connections  are  required  for 
factories.  Liquids  dangerous  to  health  must  be 
properly  disposed  of. 

It  is  considered  highly  desirable  that  in  fram- 
ing sudi  a  code  there  should  be  more  co-opera- 
tion between  the  building  regulation  officials 
and  the  industrial  inspection  officers.  —  E.  L. 
Sevringliaus. 

Providing  Homes  for  the  Workers.  J.  S. 
Smith.  Abstracted  as  follows  from  INIanufac- 
turers'  News,  18,  No.  8,  in  Business  Digest 
Service,  Oct.  Month.  Cumulation,  Executive 
Management  and  Accounting  Section,  Oct.  27, 
1<)'2(»,  -2V,,  No.  17.  —  "Through  the  activities  of 
the  (ieneral  Motors  Corj)oration  at  Flint  and 
Pontiac,  ^lichigan,  a  company  known  as  the 
^Modern  Housing  Corjjortion  has  been  formed 
for  building  workers'  homes  on  a  large  .scale  and 
at  low  cost. 

"Each  employee  who  buys  a  home  which 
costs  from  ^.SoOO  to  $8500  from  this  corporation 
has  paid  for  him.  by  the  Cicneral  Motors  Cor- 
poration, SfSOO  to  be  used  as  part  of  his  first 
payment.  This  money  is  a  gift,  but  in  return 
the  employee  agrees  to  allow  the  company  to 
purchase  the  house  of  him  and  return  the  money 
(not  including  the  $800)  he  has  ])aid  for  prin- 
cipal, interest,  taxes,  assessments,  and  insur- 
ance. He  will  be  charged  a  sum  equal  to  rent  at 
the  rate  of  10  per  cent.  i)er  annum  on  the  selling 
price  mentioned  in  the  contract,  in  case  he 
resigns,  is  discharged,  or  dies  within  five  years 
from  the  date  of  purchase.  The  purchaser  of  a 
home  from  the  Modern  Housing  Corporation 
is  required  to  make  a  cash  payment  of  at  least 
5  per  cent,  of  the  purcha.se  price.  After  that  he 
is  required  to  devote  at  least  25  per  cent,  of 
his  earnings  each  year  to  payments  of  principal, 
interest,  taxes,  and  fire  insurance  until  the 
building  is  entirely  paid  for.  After  deducting 
the  estimated  cost  of  insurance  and  taxes  the 
balance  of  the  25  per  cent,  is  divided  into 
twelve  equal  parts  which  represent  the  monthly 
instalments.  The  average  buyer  will  i)ay  for 
his  house  in  ten  years."  —  M.  C.  Shorley. 


INDUSTRIAL  INVESTIGATIONS  AND  SURVEYS 


Preliminary  Notes  on  the  Boot  and 
Shoe  Industry.  J.  Loveday  and  S.  H.  Munro. 
Industrial  Fatigue  Research  Board,  Report 
No.  10.  Boot  and  Shoe  Series  No.  1,  His 
Majesty's  Stationery  Office,  London,  1920,  pp. 


32.  —  This  report  is  divided  into  four  sections: 
the  first,  an  historical  sketch  of  the  boot  and 
shoe  industrj'  in  England;  the  second,  a  descrip- 
tion of  the  processes  of  boot  and  shoe  making; 
the  third,  an  account  of  an  investigation  of  daily 


34 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


output  of  several  factories;  and  the  final  section, 
a  report  of  an  experiment  on  rest  pauses. 

The  analysis  of  records  of  daily  output,  which 
in  many  industries  has  yielded  information  of 
great  value,  has  proved  somewhat  disappoint- 
ing when  applied  to  the  boot  and  shoe  industry. 
Boot  and  shoe  factories  are  usually  com- 
paratively small;  none  of  the  operations,  except 
one  or  two  minor  processes,  are  strictly  auto- 
matic; the  industry  is  essentially  a  "following- 
on"  manufacture,  the  worker's  output  being 
determined  in  part  by  what  is  done  in  preced- 
ing processes.  Records  were  obtained  from  five 
factories,  all  of  which  showed  a  low  output  on 
Saturday  as  compared  with  other  days  of  the 
week.  Some  manufacturers,  recognizing  this 
fact,  have  abandoned  Saturday  work  alto- 
gether, and  it  is  their  experience  that  Friday's 
output  does  not  fall  off  to  the  same  extent  as 
does  Saturday's  output  under  the  old  plan.  It 
is  shown  that  where  two  or  more  records  are 
available  for  the  same  operation,  the  more 
highly  skilled  workman  has  a  more  regular 
graph  and  shows  less  inclination  to  fall  off  in 
his  work  toward  the  end  of  the  week.  This 
occurs  so  frequently  that  a  very  irregular 
graph  or  serious  falling  off  beginning  early  in 
the  week  will  be  found,  in  the  great  majority  of 
cases,  to  coincide  with  a  low  output. 

The  experiment  on  rest  pauses  consisted  of  a 
study  of  the  comparative  output  and  general 
results  from  working  some  double  presses  with 
teams  of  three  girls,  each  operative  working  for 
forty  minutes  in  each  hour  and  resting  twenty 
minutes,  replacing  the  old  method  of  employing 
two  girls  continuously  through  the  day.  The 
result  was  that  the  total  increase  of  output  on 
six  jjresses  amounted  to  more  than  44  per  cent. 
—  a  result  obtained  with  a  reduction  of  the 
working  hours  of  the  individual  operative  by 
one-third,  and  without  the  addition  of  new 
machines.  The  effect  upon  the  workers  was 
good.  At  first  they  were  opposed  to  the  new 
system,  but  exjicrience  reconciled  them  to  it, 
and  none  wished  to  return  to  the  old  system. 
All  that  were  interviewed  declared  that  their 
health  had  improved,  and  that  they  no  longer 
felt  tired  out  when  the  day's  work  was  over. 
The  benefit  of  the  new  system  was  felt  espe- 
cially by  the  weaker  and  the  less  highly  skilled 
girls.  —  G.  E.  Partridge. 

Sickness  Frfquenct  ^uiong  Industrial 
Employees:  Disease  Prevalence  among 
Wage-Earners  during  the  First  Half  of 


the  Year  1920.  U.  S.  Pub.  Health  Ser.,  Pub. 
Health  Rep.,  Dec.  3,  1920,  35,  No.  49,  2897- 
2907.  —  The  work  here  reported  is  being  done 
by  the  Statistical  Office  of  the  Public  Health 
Service  with  the  aid  of  a  committee  of  the 
American  Public  Health  Association,  and  in- 
cludes the  collection,  tabulation,  and  publica- 
tion of  information  concerning  the  prevalence 
of  disease  among  the  wage-earning  population. 

The  cases  included  in  the  present  study  are 
those  which  caused  disability  for  one  week  or 
longer,  and  the  data  are  obtained  from  sick- 
benefit  associations.  The  tables  show  that  the 
recurrence  of  the  influenza  epidemic  in  the 
early  months  of  the  year  has  determined  the 
type  of  the  seasonal  variation  for  the  whole 
group  of  diseases,  and  that  the  apex  of  the 
curve  falls  in  February.  Segregating  all  dis- 
eases except  grippe  and  influenza,  there  appears 
to  be  a  steady  decline  in  the  frequency  rate 
from  the  beginning  of  the  year  through  June 
when  the  reports  terminate,  except  for  a  slight 
rise  during  May.  The  main  causes  of  disability 
are  foimd  in  the  general,  respiratory  and  diges- 
tive diseases.  The  respiratory  diseases  show  a 
very  large  seasonal  fluctuation,  and  are  ^'ery 
prevalent  as  compared  with  other  diseases  in 
the  first  month  of-  summer.  The  digestive  dis- 
eases were  the  second  largest  group,  the  general 
diseases,  in  every  month  except  April,  being 
slightly  less  prevalent.  Next  to  influenza  and 
grippe,  the  most  prevalent  diseases  were 
bronchitis,  pneumonia,  and  diseases  of  the 
pharynx,  principally  tonsillitis.  Rheumatism 
occurred  more  frequently  in  June  than  in  the 
winter  months,  and  its  incidence  rate  was  fairly 
high  in  that  month  for  aO  the  large  groups  con- 
tributing to  the  materials  for  the  study.  In 
some  other  respects,  however,  wide  variations 
were  foand  in  the  reports  from  ditt'erent  groups. 
The  frequency  rate  for  two  associations  for 
February,  for  example,  stand  in  the  ratio  to  one 
another  of  one  to  .seven,  and  in  April  another 
association  shows  six  times  as  much  sickness  as 
the  lower  in  the  two  just  mentioned.  These 
marked  differences  are  regarded  as  strong 
reasons  for  a  careful  study  not  only  of  the 
causes  of  illness  in  the  different  plants,  but  of 
the  conditions  which  give  rise  to  them. 

Co-oj)eration  is  invited  in  the  coUccliou  of 
sickness  statistics.  "While  the  number  of  re- 
porting associations  has  been  considerably 
augmented  of  late,  it  is  hoped  that  more  estab- 
lishments will  re])ort  the  disabilities  occurring 
among  their  employees."  — G.  E.  Partridge. 


ABSTRACTS 


35 


The  Typographical  Industry  in  Rome. 
A.  Ranelletti.  Abstracted  as  follows  from 
BoUettino  Ufficiale  Municipale,  1919,  in  II 
Lavoro,  Dec.  31,  1920,  11,  No.  8,  247. —A. 
Ranelletti  made  an  investigation  of  this,  the 
most  important  industry  in  Rome.  He  found 
conditions  good  in  about  half  the  shops,  me- 
diocre in  a  third,  bad  in  a  fifth.  Three-quarters 
of  the  employees  are  men,  5  per  cent,  of  them 
boys  from  10  to  15  years  of  age.  The  sickness 
rate  is  29  per  cent.,  with  many  cases  of  pul- 
monary tuberculosis.  The  death  rate  is  high, 
especially  from  diseases  of  the  respiratory 
system  and  tuberculosis,  and  the  causes  are  to 
be  found  in  the  early  age  at  which  work  is 
begun,  the  fact  tiiat  the  trade  attracts  weak- 
lings, and  the  overcrowded,  ill-ventilated  print- 
ing shops  with  the  danger  of  lead  poisoning. 
There  is  a  high  mortality  among  the  children  of 
printers,  especially  if  the  mother  is  employed 
in  printing.  —  Alice  Hamilton. 

Conditions  Affecting  Health  in  the 
Millinery  Industry.  S.  D.  Tlubbard  and 
Christine  R.  Kcfaiiver.  Month.  Bull.  N.  Y. 
City  Dept.  Health.  Ajml,  1920,  10,  No.  4, 
81-97.  —  Investigations  made  by  the  Division 
of  Industrial  Hygiene  of  the  Department  of 
Health  revealed  almost  incredible  conditions 
in]|the  millinery  industry.  This  industry  is 
carried  on  to  a  great  extent  in  small  shops, 
many  of  them  located  in  converted  tenements 
unsuited  to  the  ])urpose.  The  industry  in- 
cludes so  many  ditlVreiit  jirocesses,  often  carried 
on  in  different  establishments,  that  it  is  best 
to  treat  it  according  to  its  subdivisions,  such 
as   artificial    flowers,    velvets,   frame    making, 


feathers  (treating,  finishing,  dyeing),  dyeing, 
assembling,  and  selling. 

In  the  making  of  artificial  flowers,  the  con- 
ditions are  very  bad.  Gas  is  used  extensively  in 
the  processes,  and  is  both  a  fire  hazard  and  a 
menace  to  the  health.  Wood  alcohol,  often 
disguised  by  artificial  coloring,  arsenic,  and 
white  lead  are  employed.  Irregularity  of  hours 
of  employment  is  another  evil,  and  hours  are 
extended  by  home  work,  ostensibly  taken  for 
other  members  of  the  family,  but  i)resumably 
often  done  by  the  shop-worker,  and  not  infre- 
quently by  very  young  children. 

In  \'elvet  working,  there  is  danger  from 
moving  machinery,  from  the  presence  of  more 
or  less  continuous  moisture  and  from  the  use 
of  acids  and  alkalies  in  watery  .solutions  under 
conditions  especially  favorable  for  producing 
irritation  of  the  skin.  Ventilation  is  insuffi- 
cient, since  proper  ventilation  interferes  with 
the  processes.  Myositis  often  results  from  the 
work,  and  those  who  continue  in  it  for  long 
periods  frequently  show  deposits  similar  to 
those  observed  in  rheumatoid  arthritis. 

The  treating  of  feathers  anil  the  making  of 
feather  ornaments  arc  difficult  to  make  .sani- 
tary under  any  conditions,  but,  added  to  their 
natural  dirty  and  insanitary  hazards,  they  are 
very  commonly  carried  on  in  (juarters  imfit  for 
any  manufacturing  purposes,  where  fire  risks 
are  great,  lighting  poor,  and  washing  facilities 
negligible.  In  some  of  the  proces.ses  there  is 
danger  from  chemicals.  And  yet,  despite  these 
very  bad  coinlitions,  workers  were  found  quite 
indifferent  to  them. 

A  bibliography  of  twenty  titles  is  appended 
to  the  article.  —  G.  E.  Partridge. 


INDUSTRIAL  MANAGEMENT  IN  ITS  HEALTH  RELATIONS: 
SPECIAL  TESTS  IN  THE  SELECTION  OF  EMPLOYEES 


Report  on  Psychiatry.  Henry  R.  Stedmaii 
and  Donald  J.  MacPherson.  Boston  Med.  and 
Surg.  Jour.,  Nov.  11,  1920,  IS,*?.  No.  20,  579- 
584.  —  Psychiatry  as  an  aid  to  industrial  effi- 
ciency is  reviewed.  A  reasonable  application 
of  psychiatry  to  industry  would  seem  to  be  the 
following:  (1)  physical  examination  of  all  appli- 
cants for  work;  (2)  mental  examination  by  a 
period  of  training  and  observation,  or  by  men- 
tal tests;  (3)  keeping  in  personal  touch  with 
employees'  individual  problems  by  means  of 
good  foremen,  a  system  of  watching  individual 
efficiency,  or  a  sympathetic  staff;    (4)  training 


the  industrial  physician  to  appreciate  human 
nature  in  the  light  of  dynamic  psychology.  — 
Barnett  Cohen. 

The  Present  Attitude  of  Employees  to 
IxDUSTRi.^L  Psychology.  Susie  S.  Brierley. 
Abstracted  as  follows  from  Brit.  Jour.  Psy- 
chology, March,  1920,  10,  pp.  210-227,  "in 
Mental  Hygiene,  Oct.,  1920,  4,  No.  4,  970- 
973. —  It  is  difficult  to  get  the  "feel"  of  an 
original  article  from  an  abstract,  although  in 
this  particular  case  the  reviewer  is  generous 
with    quotations.     Miss    Brierley's    viewpoint 


36 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


seems  to  be  broad  and  sympathetic  and  she 
does  not  neglect  details.  She  gives  five  reasons 
for  antagonism  on  the  part  of  the  workers  to 
industrial  hygiene:  (1)  suspicion  of  the  mo- 
tives behind  the  movement;  (2)  jealousy  for 
the  solidarity  of  the  workers;  (3)  fear  of  in- 
creased monotony;  (4)  dread  of  loss  of  crafts- 
manship; (5)  emphasis  on  the  value  of  human 
personality.  It  would  seem  that  she  omits  the 
usual  reaction  of  the  layman  to  psychiatry  — ■ 
the  fear  of  exposing  his  failings  to  a  critical 
analysis  and  the  dread  of  the  stigma  of  being 
found  to  have  mental  trouble.  She  does  not 
confine  her  observation  to  the  worker  and  his 
job,  init  detaches  him  from  his  environment  and 
analyzes  his  psychology  as  a  citizen  and  a 
human  being.  As  the  British  labor  unions  are 
more  powerful  and  more  ably  led  than  those  in 
this  country,  the  study  of  the  workers'  mass 
psychology  should  be  of  particular  interest.  — 
Stanley  Cobb. 

Vocational  Selection  for  Specialized 
Tasks:  A  Study  of  Selective  Tests  for 
Hollerith-Machine  Oper.\tives.  Jour.  Ap- 
plied Psychology,  June-Sept.,  1920,  4,  Nos.  2 
and  3,  186-206.  —  A  poor  selective  process  will 
result  in  the  choice  of  many  candidates  who 
will  ne\-er  make  good  workers,  and  from  this  it 
follows  that  money  is  spent  unnecessarily  in 
the  trial  and  error  process,  that  more  workers 
are  employed  than  would  be  necessary  with 
proper  selection,  and  that  the  general  tone  of 
the  working  force  is  lowered,  offering  fruitful 
soil  for  dissatisfaction  and  unrest.  At  the  pres- 
ent time,  there  are  two  evils  —  the  hit-or-miss 
selective  plan,  and  the  patent,  or  made-over- 
night "scientific"  method,  which  includes  the 
offers  of  charlatans  who  have  become  very 
numerous  in  the  field  of  personnel  work. 

As  a  sample  of  the  scientific  method  applied 
to  the  evaluation  of  tests,  the  writer  offers  a 
comparative  study  of  the  results  of  Civil  Serv- 
ice examinations  of  candidates  for  Hollerith- 
machine  operatives,  and  the  results  of  nine 
psycln)logical  tests  selected  from  the  Wood- 
worth- Wells  series.  Correlations  of  actual 
ability  in  the  work,  as  measured  by  speed  and 
accuracy,  with  the  score  in  the  j)sychological 
tests  and  with  the  marks  obtained  in  the 
Civil  Service  examinations,  were  computed, 
and  it  was  found  that  the  correlation  of  the 
tests  vnih  ability  was  50  per  cent,  greater  than 
the  correlation  of  the  commission's  marks  with 
ability.  —  G.  E.  Partridge. 


A  New  Application  of  Psychology  to  In- 
dustry. H.  C.  Link.  Jour.  Applied  Psychology, 
Junf^Sept.,  1920,  4,  Nos.  2  and  3,  244-249. 
—  This  is  a  study  of  a  typical  industrial  prob- 
lem. The  foreman  of  a  group  of  eighty  bullet 
inspectors  said  that  the  rate  of  pay  for  the 
work,  done  as  piece-work,  was  too  low;  the 
time-study  man  said  that  the  rate  was  a  just 
one.  Investigation  of  the  group  by  means  of 
the  Woodworth-Wells  cancellation  test  and 
group  checking  test,  which  had  shown  high 
correlations  in  previous  examinations  of  in- 
spectors, showed  that  the  bullet  inspectors 
were  poorer  than  any  other  group  of  inspectors 
in  the  processes  tested,  and  that  the  trouble 
was,  therefore,  probably  due  to  the  compara- 
tive inferiority  of  the  group  rather  than  to  the 
rate  of  payment.  With  this  determined,  inci- 
dental causes  of  discouragement  were  looked 
for.  It  was  found  that  dissatisfaction  and  de- 
pre.ssion  were  caused  by  certain  regulations  in 
regard  to  returning  for  re-inspection  work  in 
which  mistakes  were  found.  It  was  discovered 
that  the  units  subject  to  return  and  re-inspec- 
tion were  unnecessarily  large,  and  that  the 
custom  of  returning  all  imperfect  work  to  the 
inspector  at  the  close  of  the  day  caused  dis- 
content and  depression,  leaving  the  inspector 
with  work  which  must  be  done  the  following 
day  without  pay.  These  sources  of  trouble 
■nere  easily  corrected.  Although  such  problems, 
the  writer  maintains,  are  not  j)sychological 
problems  in  the  strictest  sense,  they  are  broadly 
psychological,  and  they  constitute  an  impor- 
tant part  of  industrial  psychologj'.  —  G.  E. 
Partridge. 

The  Place  Industrial  Medicine  Has  in  a 
Labor  Policy.  Oifo  Geier.  Factory,  Xov.  1, 
1920,  25,  No.  9,  1416-1417.  —  The  writer  calls 
attention  to  the  fact  that  many  managers  lack 
a  carefuUj-  defined  labor  policy  although  they 
are  unwilling  to  accept  any  such  policy  as  out- 
lined by  others. 

In  developing  a  labor  policy  it  is  necessary  to 
have  .some  one  who  can  maintain  an  intimate 
contact  with  the  workers.  No  one  is  in  a  better 
po-sition  to  accomplish  this  than  the  plant 
physician.  His  acti\itics  should  include  a 
much  liroader  fieltl  than  those  of  |)ure  medicine. 
Much  of  his  work  should  be  educational.  He 
should  have  a  broad  understanding  of  the 
problems  of  industrial  relations,  employment 
procedure,  and  the  safety  and  sanitary  reciuire- 
ments  of  the  plant  in  which  he  is  employed. 


ABSTRACTS 


37 


The  management  should  not  be  satisfied  with 
the  doctor  who  can  be  hired  at  a  nominal 
salary.  It  should  place  itself  in  a  position  to 
pay  adequately  and  to  demand  a  highly  intelli- 
gent type  of  medical  service.  —  C.  H.  Paiill. 

Building  a  Better  Force  of  Workers. 
Eugene  S.  Beiige.  Factory,  Oct.  15,  10^20,  '■24. 
No.  8,  h237~U'ii).  —  This  article  is  an  attcnij)! 
to  show  how  trade  tests  may  be  developed  for 
use  in  employment  departments.  There  are 
four  general  tyjies  of  trade  tests  in  use  at  the 
present  time.  These  are  (1)  the  written  test: 
(2)  the  performance  test  which  involves  the 
doing  of  some  definite  task;  (3)  the  picture  test 
in  which  the  individual  is  asked  to  sn|)[)ly 
something  missing  in  an  illustration;  and   (H 


the  oral  test  in  which  the  individual  is  asked 
certain  questions  regarding  the  occupation  in- 
^"olved.  In  the  development  of  any  trade  test 
there  are  four  steps:  gathering  of  trade  infor- 
mation; proper  stating  of  questions;  stanilard- 
ization  by  trial  upon  individuals  of  known 
ability;  and  final  revision. 

Material  for  trade  tests  can  be  best  obtained 
from  men  actually  at  work  in  the  trade.  Where 
pictures  are  required  illustrations  from  tech- 
nical or  similar  journals  are  often  heljiful. 

In  the  standardization  of  tests  tho.se  adojjted 
for  (iuiil  use  should  be  proved  to  api)ly  to  the 
l)articular  class  of  workmen  for  whom  they  are 
intended.  The  WTiter  gives  a  chart  for  express- 
ing visually  the  values  of  various  tests  as  ap- 
plied to  ty])es  of  workers.  —  C.  II.  I'auil. 


INDUSTRIAL  HEALTH  LEGISLATION:    COURT  DECISIONS: 
WORKMEN'S  COMPENSATION  AND  INSURANCE 


CorRTS      AND      THE      .\((O.MI'LISlIME\T       OK 

Workers'  Safety.  ScIiHHikj.  Zenlralbl.  f. 
Gewerbehyg.,  Dec,  1920,  8,  No.  12,  225-228.  — 
There  is  a  certain  amount  of  comi)laint  at  the 
failure  to  inipo.se  suitable  ])cnalties  for  \ii)la- 
tions  of  the  rules  fr)r  industrial  safety.  The 
lack  of  co-operation  of  the  industrial  inspectors 
and  the  prosecuting  ;ittorneys  is  believer!  to  be 
partly  rcs[)(>iisiblc.  The  |)ropcr  observance  of 
the  existing  laws  and  rules  of  practice  by  these 
officials  would  help.  Some  suggested  new  rules 
of  procedure  for  prosecution  of  ca.ses  and  the 
carrying  out  of  .sentences  are  given.  —  E.  L. 
Sevringhaus. 

Objectives  and  Results  in  Legislation 
for  the  Protection  of  Workers.  A'op/.vc/*. 
Abstracted  as  follows  from  Deut.sch.  med. 
AVchnschr.,  1919,  \o\.  45,  347-349  by  Globig  in 
Hyg.  Rundschau,  May  1,  1920,  30.  No.  9,  283- 
284. —  "Of  the  demands  of  the  Erfurt  pro- 
gram for  the  year  1S9I  the  author  mentions  as 
obtained  the  eight-hour  nornuil  working  day, 
the  unbroken  rest  period  of  thirty-six  hours  in 
each  week,  and  the  forbidding  of  the  payment 
in  goods  rather  than  money,  the  truck  .system. 
The  age  limit  for  industrial  child  labor  remains 
still  at  13,  not  at  14  as  demanded.  The  forbiil- 
ding  of  night  work  extends  at  present  only  to 
women  and  children  and  to  bakeries.  Of  the 
further  demand  for  a  supervision  of  all  indus- 
trial pursuits,  up  to  the  present  time  the  mer- 
cantile and  commercial  pursuits  are  excluded. 


In  the  di.scussion  of  the  demand  of  the  Erfurt 
program  for  a  thorough  industrial  hygiene  the 
author  describes  the  present  expansion  of  the 
industrial  medical  ser\icc  and  its  future.  For 
the  training  of  industrial  physicians  he  desires 
more  contact  with  practical  life,  continuation 
courses,  etc."  —  E.  L.  Sevringhaus. 

Re(;ulatioxs  of  Jan.  27,  1920  of  the  Im- 
perial Minister  of  Labor  for  the  Estab- 
lishment AND  Management  of  Works  for 
the  Prei'au.\tion  of  Lead  Colors  and  Other 
Lead  Compocxds.  Abstracted  as  follows  from 
Reichs-Gesetzbl.,  j).  109,  by  (/.  in  Hyg.  Rund- 
.schau,  March  15,  1920,  30,  No.  (!,  187-188.  — 
"According  to  No.  11  of  the  Regulations  the 
employer  must  forewarn  em[)l()yc<'s  who  will 
come  into  contact  with  lead-containing  sub- 
stances as  to  the  deleterious  effects  of  lead  on 
health  and  the  conduct  required  while  in  con- 
tact with  such  materials.  He  must  give  them 
the  notice  published  by  the  imperial  minister  of 
labor. 

"The  above-mentioned  Lead  Notice,  printed 
in  the  I'eroff.  d.  Reichs-Ges.-A.,  1920,  No.  7,  p. 
127,  is  as  follows: 

Every  one  is  liable  to  the  danger  of  lead 
poisoning  who  in  the  course  of  his  work  comes 
into  contact  with  lead  or  lead  compounds 
(except  lead  sulphide) ,  or  other  lead-containing 
substances.  This  danger  is  the  greater  .since 
this  poison  (excepting  sugar  of  lead)  does  not 
reveal   its  presence   to   the  worker  by   either 


38 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


smell  or  taste,  thereby  warning  him  before  it  is 
taken  into  the  body.  Lead  poisoning  usually 
occurs  in  this  wise:  Lead  which  has  remained 
chnging  to  the  hands,  clothing  or  beard  gets 
into  the  mouth  in  small  amounts  during  eating, 
drinking,  or  the  smoking,  snuffing  or  chewing 
of  tobacco,  or  the  dust  is  breathed  during  work. 
The  lead  accumulates  slowly  in  the  body  and 
brings  on  the  poisoning  sooner  or  later,  accord- 
ing to  the  amount  of  the  poison  absorbed  and 
to  the  resistance  of  the  worker.  If  a  blue-gray 
border  (lead-line)  appears  on  the  gums  near 
the  edge  of  the  teeth,  this  is  an  indication  that 
an  appreciable  amount  of  lead  has  already  been 
taken  into  the  body  and  that  an  attack  of  lead 
poisoning  threatens  to  occur.  The  existence  of 
a  lead-line  should  cause  the  worker  to  be  more 
careful  than  before  to  see  that  he  takes  in  no 
more  lead;  he  still  has  it  in  his  power  to  escape 
an  attack.  Otherwise  there  will  occur  often 
very  soon,  at  times  however  only  after  weeks  or 
months,  the  real  lead  poisoning  which  is  truly 
painful,  lingering,  and  under  certain  circum- 
stances dangerous  to  life. 

"  'Prevention  of  Lead  Sickness.  — Lead  poi- 
soning can  be  avoided  with  certainty  by  care 
and  cleanliness.  Especially  are  the  following 
points  to  be  observed:  (1)  As  far  as  possible 
during  work  the  hands  and  working  clothes  are 
to  be  guarded  against  soiling  with  lead,  lead 
compounds  or  lead-containing  substances.  The 
nails  should  be  kept  closely  cut.  During  work 
smoking,  snuffing,  or  chewing  tobacco  is  to  be 
omitted.  Cigars,  tobacco,  pipes  and  other 
smoking  articles  shall  not  be  carried  into  the 
working  rooms.  (2)  Workers  may  not  eat, 
drink,  or  leave  the  place  of  work  luitil  they  have 
first  taken  off  their  working  clothes  and  thor- 
oughly washed  their  hands  with  soap  and 
brushes.  The  face  and  especially  the  beard 
deserve  a  careful  cleansing  if  they  have  become 
soiled  during  the  work.  (3)  In  all  lead  work  the 
above  mentioned  work  clothes  are  to  be  worn. 
To  avoid  the  breathing  in  of  lead-containing 
dust,  in  all  work  where  dust  is  formed,  if  the 
dust  is  not  completely  and  immediately  carried 
off  by  suction,  respirators,  damp  sponges  or 
muslin  bands,  which  cover  nose  and  mouth,  are 
to  be  worn.  (4)  The  widely  accepted  belief  that 
the  regular  use  of  certain  drugs  (potassium 
iodide,  sulphur  pills,  Glauber's  salt  and  other 
cathartics)  or  the  drinking  of  milk  is  sufficient 
protection  against  lead  poisoning  is  not  justi- 
fied. On  the  other  hand  a  certain  value  is  to  be 
attributed  to  a  strong  and  well  nourished  con- 


dition and  therefore  also  to  the  drinking  of 
milk.  The  use  of  alcoholic  drinks,  especially 
of  brandy,  increases  the  danger  of  an  attack  of 
lead  poisoning  and  is  therefore  to  be  shunned. 
(5)  Exercise  in  the  open  au%  gymnasium,  baths, 
etc.,  make  the  body  more  resistant  and  should 
therefore  be  made  use  of  as  much  as  possible. 
If  a  worker  who  comes  into  contact  with  lead, 
lead  compounds,  or  lead-containing  substances 
is  taken  sick,  in  the  interest  of  himself  and  his 
family  he  should  at  once  consult  a  physician 
and  tell  him  immediately  that  he  comes  in 
contact  with  lead  in  his  work.' 

"In  No.  17  of  the  '  Regulations  '  it  is  pro- 
vided that  the  investigation  and  supervision  of 
the  condition  of  health  of  lead  workers  is  to  be 
assigned  to  a  physician  approved  and  em- 
powered for  the  purpose  by  the  higher  gov- 
ernment board.  This  authorization  is  to  be 
conferred  only  after  the  physician  has  taken 
oath  to  follow  a  certain  course  of  service  as  pre- 
scribed by  the  imperial  minister  of  labor.  This 
course  of  service  is  described  in  the  same  place 
referred  to  above,  p.  127.  It  contains  in  an 
appendix  a  guide  to  special  methods  of  study 
for  the  confirmation  of  a  case  of  lead  poisoning : 
(1)  hemoglobin  determination;  (2)  search  in 
the  blood  for  stippled  erythrocytes;  (3)  blood 
pressure  determination;  (4)  search  in  the  urine 
for  hematoporphyrin." — E.  L.  Sevringhaus. 

French  Court  Decisions  Reg.uiding  In- 
capacities FROM  Industrial  Accidents.  Ab- 
stracted as  follows  from  Jour.  Societe  de 
Statistique  de  Paris,  June,  1920,  in  Month. 
Labor  Rev.,  Sept.,  1920,  11,  No.  3,  162.— 
"The  French  industrial  accident  law  of  April  9, 
1898,  provides  that  a  totally  and  permanently 
injured  person  shall  receive  compensation 
equal  to  two-thirds  of  such  person's  yearly 
earnings,  but  the  law  does  not  indicate  what 
constitutes  a  total  permanent  injury  nor  does  it 
establish  any  basis  for  computing  the  industrial 
incapacity  resulting  from  various  lesions. 

"During  the  twenty  years  the  law  has  been  in 
operation  the  decisions  of  the  courts,  though  not 
invariably  settling  these  important  questions, 
serve  as  a  criterion. 

"The  burden  of  the  proof  is  on  the  injured 
person;  the  judges  must  estimate  the  effect  of 
the  injury  on  normal  industrial  capacity.  Com- 
pensation is  invariably  based  on  the  earnings  of 
the  injured  at  the  time  of  the  accident.  The 
probabilities  of  future  increase  in  earnings  and 
aggravated  injuries,  due  to  the  act  of  the  in- 


ABSTRACTS 


39 


jured,  have  not  been  considered.  Total  in- 
capacity is  understood  as  rendering  the  injured 
person  incapable  not  only  of  performing  his 
usual  work  but  also  any  other  remunerative 
labor.  .  .  .  Permanent  infirmity  resulting 
from  slow  and  prolonged  development  due  to 
normal  and  continued  labor  not  compensable." 
The  determination  of  the  amount  of  compensa- 
tion depends  uimhi  the  effect  of  the  injury  on 
the  injured  person's  industrial  capacity.  — 
M.  Dent. 

A  Plea  for  More  Adequate  Comi'exsa- 
TioN  Rates.  E.  Stewart.  U.  S.  Bur.  Labor 
Statis.,  Month.  Labor  Rev.,  Dec,  10-20,  11, 
No.  6,  1-8.  —  It  is  probably  generally  admitted 
that  comj)ensation,  even  under  the  conditions 
jirevailing  at  the  time  when  the  laws  were 
j)assed,  has  never  been  adequate.  But  now 
conditions  are  much  worse.  Even  in  the  most 
liberal  states  the  workman  receives  a  much 
smaller  percentage  of  his  wages  as  compensa- 
tion, and  the  total  cost  of  compen.sation  for  the 
emi)loyer  is  a  very  nmch  smaller  percentage  of 
the  i)ayroll  than  in  1910.  The  trouble  is  caused 
by  the  waiting  time  and  by  the  provision  for 
maximum  compensation. 

The  writer's  main  point  is  that  "if  it  is  agreed 
that  the  statutory  percentage  is  a  fair  division 
of  the  burden  as  between  the  employer  and 
the  employee,  then  the  question  of  the  justice 
of  removing  the  c()iui)lications  caused  by  the 
weekly  mininuini  is  one  that  it  would  seem 
might  be  fair  to  consider."  To  show  how  the 
present  regulations  work,  tables  are  presented 
indicating,  for  the  states  providing  compensa- 
tion, the  relation  of  tlie  statutory  weekly  com- 
pensation to  the  standard  wages  received  by 
specified  occui)ations;  the  actual  percentages  of 
wages  received  as  comj)ensation,  for  19^20,  by 
specified  occupations;  the  actual  i)ercentages  of 
wages  received  as  compensation  by  structural 
iron  workers  for  specified  -years;  and  other 
useful  computations  bearing  on  the  case. 

The  following  statements  are  typical:  Con- 
necticut, which  apparently  in  1920  paid  a  man 
earning  $40  per  week  35  per  cent,  of  his  wages- if 
injured,  owing  to  her  seventeen  day  waiting 
period  did  in  fact  pay  him  but  31.7  per  cent.; 
and  in  the  case  of  Delaware,  where  a  fourteen 
day  waiting  period  obtains,  instead  of  an  ap- 
parent 37.5  per  cent,  we  find  an  actual  29.7  per 
cent.  —  G.  E.  Partridge. 

Systems  of  Medical  Service.  John  W. 
Mowell.    Mod.  Med.,  Dec.,   1920,  2,  No.   12, 


802. —  The  present  Medical  Aid  Act  of  the 
state  of  Washington  was  passed  in  1917  as  an 
amendment  to  the  Workmen's  Compensation 
Act,  found  to  be  absolutely  necessary  for  the 
provision  of  efficient  treatment  for  injured 
workmen.  The  separate  board  which  ad- 
ministers the  amendment  has  provided  two 
systems:  (1)  the  "Contract  System,"  whereby 
"an  employer  maj-,  with  the  consent  of  51  per 
cent,  of  his  employees,  enter  into  a  contract 
with  a  physician  or  hospital  for  the  care  of  his 
injured  workmen,  this  contract  to  be  approved 
by  the  Medical  Aid  Board  and  the  contractor 
to  receive  90  per  cent,  of  the  money  contrib- 
uted from  such  employer  and  his  employees 
for  medical  aid  as  payment  for  this  .service;" 
and  (2)  the  "State's  Plan"  whereby  "all  em- 
I)loyers  who  see  fit  not  to  contract  pay  all  of 
the  medical  aid  money  into  the  medical  aid 
fund,  out  of  which  all  surgical,  hosj)ital  and 
other  bills  for  injured  workmen  are  paid,"  and 
the  emj)loyee  is  given  free  choice  of  physician 
and  hosi)ital  in  the  first  instance.  The  Medical 
Aid  Act  |)rovides  that  a  physician  and  surgeon 
shall  i)c  cliairnuui  of  the  board,  and  delegates 
to  him,  with  the  approval  of  the  board,  the 
administration  of  rules  and  regulations,  thus 
enabling  the  board  to  consider  efficiency  of 
treatment  (mly;  for  instance,  while  the  man 
has  the  choice  of  his  physician  in  the  first  in- 
stance, the  board  can,  if  it  thinks  best,  move  a 
patient  who  is  seriously  injured  to  another 
locality  where  he  can  receive  the  best  possible 
treatment  for  his  particular  injury.  This 
jjrovision  allows  the  board  to  take  up  recon- 
structive or  post-operative  work  and  is  the 
greatest  feature  of  the  Medical  Aid  Act  in 
Washington  at  present. — -Eli/abeth  C.  Putnam. 

Medical  Service  under  the  Massa- 
chusetts Workmen's  Compensation  Act. 
Francis  D.  Donoghue.  Mod.  Med.,  Dec,  1920, 
2,  No.  12,  803-805. —  "From  a  modest  be- 
giiming,  the  medical  work  of  the  IVLissachusetts 
Industrial  Accident  Board  has  greatly  de- 
veloped until  its  importance  is  now  second  to 
no  other  provision  of  the  law,  not  excei)ting 
even  compensation  provisions.  From  a  little 
section  dealing  with  the  furnishing  of  medical 
and  hospital  services  during  the  first  two  weeks 
after  the  injury  only,  the  law  has  been  amended 
until  it  now  takes  in  every  case  of  serious  and 
unusual  injury,  provides  for  reasonable  medical 
and  hospital  treatment  and  medicines  for  the 
full  period  of  hospital  care,  under  the  wise  and 


40 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


broad  interpretation  given  the  '  unusual  case  ' 
provision  of  the  law  by  the  Board,  and  lately 
has  been  amended  so  that  the  Board  may, 
whenever  in  its  opinion  such  appurtenances  are 
beneficial,  order  the  insurer  to  furnish  and  pay 
for  artificial  appliances  and  thus  get  the  em- 
ployee back  into  industry  within  the  shortest 
possible  period  of  time."  The  medical  features 
of  the  law  have  been  given  a  place  among  the 
most  important  sections  of  the  statute,  and 
have  been  amended  to  provide  that  hospital 
records,  duly  certified,  and  the  written  report 
of  the  "impartial  physician"  shall  be  admitted 
as  e^^dence  before  the  Board. 

The  work  of  the  INIedical  Department,  estab- 
lished in  1914,  embraces  the  systematization 
of  the  vast  amount  of  medical  information  re- 
quired imder  the  Workmen's  Compensation 
Act;  advice  with  reference  to  all  medical  prob- 
lems; the  outlining  of  the  fundamental  medical 
facts  required  to  decide  whether  disputed  cases 
are  covered  by  law;  and  "the  preparation  of 
such  cases  impartiaUy  for  hearing,  in  order 
that  provisions  of  the  Act  may  be  made  effec- 
tive speedUy  and  with  the  least  possible  cost 
and  annoyance  to  the  parties  at  interest."  It 
further  includes  the  selection  and  supervision 
of  the  "impartial  examining  physicians."  They 
are  chosen,  if  possible,  from  a  locality  near  the 
employees'  home,  but  in  some  cases  it  becomes 
necessary  for  patients  to  report  for  examina- 
tion to  Boston  or  some  other  large  center. 
"In  all  cases  the  aim  in  selecting  physicians  is 
to  provide  the  man  whose  training  and  ex- 
perience fit  him  to  examine  and  report  expertly, 
according  to  the  special  features  involved  in  the 
case,  not  only  as  to  the  past  disability  but  as  to 
future  treatment.  AYhen  the  impartial  report  is 
received  at  the  medical  ad\'isor's  office,  the  case 
is  first  read  by  him  to  make  sure  the  report 
covers  the  necessary  points.  Copies  are  then 
sent  to  the  employees,  insurance  companies, 
and  perhaps  to  other  persons  directly  inter- 
ested, so  that  c\'eryone  has  a  medical  opinion 
which  under  the  law  has  the  weight  of  being 
entirely  separated  from  any  direct  interest  in 
behalf  either  of  the  employee  or  of  the  insur- 
ance comi)any.  The  impartial  physician  has 
eliminated  the  professional  witness  who  ap- 
peared in  court  for  or  against  the  claimant.  It 
was  found  that  in  Massachusetts  malingering 
was  almost  imknown  and  that  what  was  needed 
from  the  sjjecialist  was  his  aid  in  restoring 
function  rather  than  in  determining  whether  or 
not  the  disability  existed.    "The  great  success 


of  the  Accident  Board  has  come  from  the  util- 
ization of  the  best  medical  brains  in  the  com- 
monwealth." The  medical  advisor's  office  gives 
informal  opinions  in  insured  fatal  cases;  in 
cases  where  additional  compensation  for  per- 
manent disabilities  is  in  question;  and  in 
instances  of  disputed  bills.  Many  questions 
are  thus  settled  informally,  although  neither 
side  is  thereby  prevented  from  having  a  formal 
hearing  and  decision. 

One  of  the  difficulties  that  the  Industrial 
Accident  Board  faces,  and  one  which  wiU 
eventuall}^  be  eliminated  by  a  more  careful 
checking  up  of  jjractitioners  and  hospitals  by 
the  Massachusetts  Board  of  Registration  in 
Medicine  or  some  other  state  board,  is  the 
decision  in  cases  where  the  employee  has 
chosen  his  own  doctor  or  hospital  and  has 
chosen  unwisely.  But  under  present  conditions, 
"outside  of  a  law  providing  specifically  for 
complete  medical  and  hospital  care  for  the  full 
period  of  incapacity,  the  Massachusetts  law,  as 
mterpreted  by  the  members  of  the  Industrial 
Accident  Board,  could  not  be  improved  upon." 
—  Elizabeth  C.  Putnam. 

Workmen's  Compensation,  with  Especial 
Reference  to  Loss  of  Vision.  Frank  All  port. 
Jour.  Am.  Med.  Assn.,  Jan.  17,  1920,  74,  No. 
3,  16G-168.  — The  writer  calls  attention  to  the 
possibility  of  considerable  injustice  being  done 
to  employers  in  awarding  compensation  in 
cases  of  eye  injury.  Lack  of  properly  estab- 
lished standards  for  measuring  impairment  of 
vision  leads  not  infrequently  to  damages  being 
allowed  beyond  the  extent  of  the  injury.  Ex- 
cept in  the  case  of  monocular  traumatic 
cataracts,  compensation  shoidd  be  based  upon 
visual  results  obtained  with  glasses  rather  than 
uj)on  results  obtained  without  glasses. 

It  is  pointed  out  that  laws  are  unjust  both  to 
the  worker  and  to  the  employer  where  they 
make  the  cmjiloyer  responsible  for  the  loss  of 
both  eyes  when  one  had  been  lost  at  a  time 
previous  to  employment.  Such  laws  put  an 
undue  burden  upon  the  emploj'er  and  at  the 
same  time  make  the  i>rocuring  of  work  more 
difficult  for  individuals  possessing  a  visual 
handicap. 

In  constructing  a  table  for  monocular  visual 
losses  which  might  well  sen'e  as  a  common 
standard,  the  writer  points  out  that  three 
points  must  be  con.sidered: 

1.  "What  constitutes  industrial  blindness  in 
one  eye.'' 


ABSTRACTS 


41 


2.  "What  is  the  maximum  legal  compensa- 
tion for  such  blindness? 

3.  "What  are  fair  and  diminishing  percent- 
ages of  visual  losses  from  maximum  to  mini- 
mum?" 

Taking  the  standard  of  the  Chicago  Ophthal- 
mological  Society  as  being  fair,  the  wTiter 
concludes  that  vision  worse  than  20  '^OO  con- 
stitutes industrial  blindness.  The  answer  to 
the  second  question  is  at  present  determined 
by  state  laws.  In  Illinois  the  maxinmui  for 
monocular  blindness  is  $1200. 

The  answer  to  the  third  question  is  worked 
out  in  a  table  given  on  page  1()8.  Varying  per- 
centages of  visual  efficiency  are  given  from 
20/'20  to  20/200,  the  range  of  percentages  being 
100  to  10  per  cent.  —  C.  H.  Paull. 

Your  Li.\bility  for  Concurrent  Com- 
pensation. Chesla  C.  Sherlock.  Am.  Bla- 
chinist,  Nov.  25, 1920.  53,  No.  22,  998-1000.  — 
This  article  exi)lains  the  amount  of  compen.sa- 
tiou  allowable  for  various  degrees  of  injury 
resulting  from  the  same  accident.  Court 
decisions  of  several  states  are  given  as  ex- 
amples. —  G.  M.  Fair. 

Corrections  versus  Compens.vtion  of 
Physical  Defects.  /?.  I.  Lee  and  L.  T.  Brown. 
Abstracted  as  follows  from  Am.  Jour.  Med.  Sc, 
Nov.,  1920,  no,  Xo.  5,  051  in  Jour.  Am.  Med. 
Assn.,  Jan.  22,  1921,  7(i.  No.  4,  2GS.  —  "Lee 
and  Brown  are  not  prepared  to  support  the 
theory  that  many  ailments  of  the  nervous 
system  or  of  the  gaslro-iutesliual  system  are 
related  to  bad  uicchanica!  use  of  the  body.  How- 
ever, they  state  that  there  is  a  fre(iuent  associa- 
tion of  such  symptoms  with  the  mechanical  use 
of  the  body.  Their  investigations  have  shown 
that  albuminuria  of  young  men  which  is  not  a 
true  nephritis  is  associated  almost  exclusively 
with  very  bad  mechanical  use  of  the  body. 
They  believe  that  a  sufficient  case  can  be  made 


out  of  correction  as  against  compensation  on 
the  basis  of  actual  ailments  of  the  back  and 
feet,  generally  conceded  to  be  due  to  faultj'  use 
of  the  body  even  without  the  addition  of  pos- 
sible symptoms  connected  with  other  organs. 
Physical  training  can  only  accomplish  what  it  is 
expected  to  accomplish  when  it  is  based  on 
satisfactory  fundamental  principles  and  when 
bodily  mechanics  is  regarded  in  a  similar  faslii(ui 
as  are  the  disturbances  of  any  other  system  of 
the  body."  —  M.  C.  Shorley. 

British  Nation.\l  Health  Insurance  Act 
OF  May  20,  1920.  H.  J.  Harris.  U.  S.  Bur. 
Labor  Statis.,  Month.  Labor  Rev.,  Sept.,  1920, 
11,  No.  3,  1-11.  —  In  this  article  the  author 
points  out  a  number  of  important  changes 
made  by  this  act  "in  the  health  insurance 
system  described  in  the  Monthly  Labor  Review 
for  January,  1920.  Pages  45-59."  — R.  B. 
Crain. 

Ohlioatory  Sickness  Insurance.  Borne. 
Revue  d'Hygiene,  April,  1920,  42,  No.  4,  252- 
284.  —  There  are  presented  in  detail  the  legal 
provisions  in  Switzerland.  England,  Belgium, 
Genuany,  Austria,  and  France  for  includ- 
ing certain  specific  occupational  diseases  with 
industrial  accidents  for  which  compensation  to 
affected  workmen  must  be  paid.  The  author 
endeavors  to  make  clear  that  it  is  impossible 
to  provide  adequately  by  such  means  for  com- 
pensation due  affected  workmen  through  dis- 
ability which  may  unquestionably  develop 
because  of  conditions  of  employment,  because 
in  many  instances  the  disability  cannot  be 
demonstrated  with  necessary  exactness  to  be 
due  to  conditions  of  employment.  He  believes 
that  only  with  compulsory  health  insurance 
can  these  doubtful  cases  receive  the  proper 
compensation,  and  presents  briefly  a  proposed 
law  already  brought  before  the  Chamber.  — 
Wade  Wright. 


REHABILITATION  OF  DISABLED  EMPLOYEES 


Vocational  Rehabilitation  of  Persons 
Disabled  in  Industry  or  Otherwise.  Voc. 
Summary,  Aug.,  1920,  S,  No.  4,  49-51.— An 
act  passed  by  Congress  and  approved  by  the 
President  on  June  2,  1920  provides  for  the 
promotion  of  vocational  rehabilitation  of  per- 
sons disabled  in  industry  or  otherwise,  and  their 
return  to  civil  employment.    It  is  very  difficult 


to  obtain  even  an  approximate  estimate  of  the 
number  of  such  cases  occurring  annually  in  the 
United  States,  but  the  number  is  probably  not 
less  than  100,000,  and  200,000  may  not  be  too 
high  an  estimate.  The  annual  yield  does  not, 
of  course,  indicate  the  total  number  of  cases 
accumulated  already,  and  perhaps  600,000  arc 
now  living  who  are  more  or  less  handicapped 


42 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


because  of  industrial  accidents;  to  this  must 
be  added  the  great  number  of  injured  persons 
not  properly  classified  as  belonging  to  the  in- 
dustrially injured. 

As  a  contribution  to  the  support  of  the  pro- 
gram of  rehabilitation,  Congress  has  appro- 
priated $750,000  for  the  year  1920-1921,  and 
$100,000  a  year  for  the  three  following  years. 
To  benefit  under  the  act  the  several  states  must 
match  this  expenditure,  and  acceptance  of  the 
federal  act  by  any  state  makes  the  state  re- 
sponsible for  the  maintenance  and  supervision 
of  such  rehabilitation  courses  as  may  be  pro- 
vided out  of  the  joint  federal  and  state  fund. 
The  states  will  be  obliged  to  maintain  organiza- 
tions capaljle  of  performing  such  services  as 
keeping  a  list  of  persons  eligible  to  rehabilita- 
tion aid,  imparting  accurate  information  to 
prospective  beneficiaries,  determining  eligi- 
bility for  rehabilitation  and  training,  system- 
atic personal  advisement  of  these  prospective 
beneficiaries,  and,  in  the  case  of  tho.se  who 
accept  training,  continuous  advisement  and 
supervision  during  the  whole  period  of  training 
and  placement.  Co-ordination  can  advanta- 
geously be  arranged  with  state  boards  for 
vocational  education  and  other  state  agencies, 
and  this  is  especially  true  of  the  agency  in  every 
state  which  has  charge  of  the  administration 
of  the  workmen's  compensation  act.  The  first 
and  greatest  need  is  publicity;  this  will  be  the 
best  basis  for  the  individual  case  work  that  is  to 
come.  —  G.  E.  Partridge. 


commission,  provide  for  coiu-ses  of  vocational 
rehabilitation  and  appoint  the  state  treasurer 
as  custodian  of  funds.  Each  state  board  for 
vocational  rehabilitation  must  submit  its  plans 
to  the  federal  board  for  approval,  open  its 
courses  to  disabled  federal  employees  and  re- 
port annually."  Five  states  (New  York, 
Georgia,  New  Jersey,  Nevada  and  North 
Carolina)  have  already  accepted  the  provisions 
of  this  act.  In  addition  nine  states  (California, 
Ilhnois,  Massachusetts,  Minnesota,  Nevada, 
New  York,  Pennsylvania,  Rhode  Island,  and 
Virginia)  ha\'e  taken  advanced  steps  for  re- 
habilitation of  industrial  crijjples,  although  they 
have  not  specifically  accepted  the  federal  law. 
Through  a  special  provision  allowing  the 
governor  of  the  state  to  accept  the  plan  tem- 
porarily in  case  his  legislature  did  not  meet 
before  Dec.  31,  19'-20,  it  is  now  in  force  in 
twenty  states  (Alabama,  Arizona,  Arkansas 
Delaware,  Indiana,  Idaho,  Iowa,  Michigan, 
Minnesota,  INIississippi,  Nebraska,  New  Mexico, 
North  Dakota,  Ohio,  Oregon,  South  Carolina, 
Tennessee,  Texas,  and  West  ^'irginia). 

"The  present  urgent  need  is  the  passage  of  a 
bill  by  every  state  to  make  possible  at  once  full 
co-operation  with  the  national  government." 
The  complete  text  of  a  tentative  draft  of  such  a 
bill,  prepared  by  the  American  Association  for 
Labor  Legislation  and  the  Federal  Board  for 
Vocational  Education,  is  given  in  this  article 
as  an  aid  to  prompt  legi-slative  action.  —  Eliza- 
beth C.  Putnam. 


Bill  Proposed  for  Co-operation  bt  all 
States  tinder  the  New  Federal  Law  for 
THE  Rehabilitation  of  Industrial  Cripples. 
Frederick  MacKenzie.  Am.  Labor  Legis.  Rev., 
Dec,  1920,  10,  No.  4,  246-249.  —  On  June  2. 
1920,  "an  act  to  provide  for  the  promotion  of 
vocational  rehabilitation  of  persons  disabled  in 
industry  or  otherwise  and  their  return  to  civil 
employment"  was  passed  by  Congress.  The 
act  authorizes  the  federal  board  to  allot  certain 
sums  to  the  states,  "in  proportion  to  popula- 
tion, on  condition  that  each  state  appropriate 
an  equal  amount  for  vocational  rehabilitation." 
To  qualify  for  this  allotment  and  "bring  to 
com{)lete  success  this  enlightened  development 
of  workmen's  compensation  .  .  .  each  state 
must  accept  this  act,  empower  its  state  board 
for  vocational  education  to  co-operate  with  the 
federal  board,  arrange  for  co-operation  between 
its  state  board  and  its  workmen's  compensation 


Rehabilitation  of  the  Tuberculous  in 
District  12.  L.  W.  Bartlett.  Voc.  Summary, 
Nov.,  1920,  3,  No.  7,  101  102.  —  An  account  of 
the  vocational  training  of  tuberculous  patients 
through  the  Federal  Board  in  District  12.  A 
training  in  vocational  and  general  subjects  is 
given  while  still  in  the  hospital.  The  factors 
involved  in  this  training  are:  (1)  the  .selection 
of  a  training  center;  and  (2)  close  and  constant 
su])ervision.  The  most  difficult  problem  in  re- 
liabilitating  the  tuberculous  is  the  actual  em- 
ployment, which  must  always  be  accorajjanied 
by  the  strain  of  comi)etition.  Finally  the 
author  points  out  tliat  vocational  training  in 
the  convalescent  sbige  occnjjies  the  mind  and 
speeds  recovery;  that  proper  training  converts 
the  trainee  into  a  self-sustaining  citizen;  and 
that  the  welfare  of  the  tuberculous  is  of  na- 
tional concern,  demanding  hospital  care,  voca- 
tional training  and  employment.  —  L.  A.  Shaw. 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


JILY,  1921 


Number  3 


CONTENTS 


General 4:! 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc 45 

Dust  Hazards  and  Their  Effects 50 

Occupational  Infectious  Diseases:  Occurrence,  Treat- 
ment and  Prevention ai 

Occupational  Affections  of  the  Skin  and  Special  Senses.  53 

Occurrence  and  Prevention  of  Industrial  Acciilents  . .  51 

Industrial  Surgery 57 


Industrial  Physiology :  Nutrition,  Metabolism, Fatigue, 
etc 58 

Heat,  Cold  and  Humidity , . . .     58 

Women  and  Children  in  Industry 59 

Industrial  Sanitation:  Factory  Construction,  Illumina- 
tion, Ventilation,  Heating,  Water  Supply,  Sewage 
Disposal (il 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Industrial  Plants C2 


GENERAL 


./~  Relation  ok  Industuiai,  Micdicine  to 
PiBMc  Hkaltit.  R.  T.  Legijv.  Am.  .lour.  Pub. 
Health,  -Jan.,  liHl,  11,  No  i^  (i-i  (U.— The 
degenerative  diseases  are  the  cause  of  much  un- 
necessary iUncss  and  early  demise,  and,  in  so  far 
as  many  of  those  conditions  arc  llic  result  of 
labor,  witli  its  industrial  fatigue  and  strain,  and 
tlie  environmental  surronndinj^s  of  the  worker, 
it  behooves  the  public  health  official  to  interest 
himself  in  industrial  hysiienc.  The  modern  in- 
dustrial physiiian  nnist  be  not  oidy  an  epide- 
miologist but  a  hygienist.  While  the  work  of 
large  jilants  may  be  cared  for  by  their  own  in- 
dustrial physicians  yet  there  are  many  smaller 
plants,  labor  camps,  and  mines  without  jiroper 
health  supervision,  making  a  "no  man's  land" 
which  should  be  cared  for  by  bureaus  of  indus- 
trial hygiene  in  federal,  state  and  municipal 
boards  of  health  in  charge  of  specially  trained 
experts.  The  public  health  profession  has  not 
adequately  met  its  responsibilities  unless  this  is 
generally  recognized  and  provided  for.  —  H.  F. 
Smyth. 


The  Future  of  Industri.\l  Medicine  as  a 
Lahou  Policy.  OHo  P.  Geier.  Mod.  Med., 
Dec,  1!)'2(),  i.  No.  l^,  794-796.  —  Looming 
large  in  the  universal  unrest  and  disorder  which 
arc  shaking  all  nations  as  never  before,  is  an  in- 
diistrial  strife  of  proportions  beyond  imagina- 
tion. Not  only  is  the  iiulnstrial  outi)ut  fatally 
low  at  the  very  moment  when  mass  production 
is  most  needed,  but  the  disorganized  character 
of  industrial  life  pulsating  throughout  the  coni- 
numity  makes  for  an  unhapjjy,  restricted  exist- 
ence and  for  bad  citizenship. 

In  no  phase  of  the  world's  disorder  is  it  more 
true  than  in  industry  that  peace  and  progress 
will  not  come  from  the  old-time  ])olicies  and 
diplomacies,  but  from  individual  right  thinking 
and  doing.  The  old  labor  policy,  which  too 
often  consisted  only  in  a  blind  prejudice  against 
organized  labor  and  was  more  i)roperly  a  lack  of 
labor  policy,  is  helpless  in  meeting  the  present 
conditions.  A  new  policy  —  a  thoughtful  con- 
clusion based  on  all  the  basic  principles  of  social 
and  economic  justice  that  enter  into  wage  con- 


43 


44 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ditions,  necessarily  tempered  by  the  varying 
attitudes  of  the  employer  and  employees  — 
must  be  formed.  Recognizing  that  while  much 
may  be  learned  through  broad  reading  and 
from  the  ]>ractical  results  of  other  researchers 
after  similar  truths,  the  greatest  wisdom  will  be 
gained  through  genuine,  human  relations  be- 
tween management  and  workmen,  many  leaders 
in  industry  are  establishing  i)ersonal  service,  or 
"human  relations"  departments.  Here  is  the 
great  opportunity  for  the  industrial  physician. 
All  better  understanding  is  most  successfully 
based  u])on  the  better  physical  and  mental 
health  of  individual  workers;  and,  furthermore, 
the  relation  between  physician  and  patient  is 
that  most  desired  in  personal  service  depart- 
ments —  simple,  direct  and  natural,  with  no 
suggestion  of  paternalism.  Thousands  of  con- 
tacts are  made  each  year  through  the  medical 
department;  and  the  physician  who  has  the 
support  of  the  management,  a  knowledge  of  the 
safety  and  sanitary  recjuirements  of  the  plant, 
and  a  broad  imderstanding  of  the  problems  of 
industrial  relations,  has  it  in  his  power  to  make 
a  marked  contribution  toward  the  solution  of 
industrial  difficulties  and  thus  of  the  world-wide 
disorganization  of  today.  —  Elizabeth  C  Put- 
nam. 

Types  of  Physicians  Contracting  with 
Industry.  Otto  P.  Geier.  Ed.  Mod.  Med., 
Dec,  1920,  2,  No.  12,  7!).S.  —  In  the  di.scussion 
of  a  recent  committee  rejiort  concerning  in- 
dustrial medicine  as  a  .specialty  made  to  the 
Cincinnati  Academy  of  ^ledicine,  the  defini- 
tion, scope  and  results  of  industrial  medicine 
were  brought  up  as  preliminary  to  a  considera- 
tion of  the  types  of  industrial  medical  i)racti- 
tioners.  Industrial  medicine  embraces  not  only 
the  care  of  injureil  and  sick  employees  as  the 
need  may  arise,  but  the  securing  of  clean  work- 
ing conditions,  of  state  compensation  and  sick- 
ness insurance,  the  mechanical  safeguarding  of 
machinery,  ])hysical  examination  at  the  time  of 
employment  and  later,  and  the  education  of  the 
worker  in  .safe  mechanical  processes,  in  hygiene, 
in  the  avoidance  of  fpiacks  and  the  wide  use  of 
the  |)hysician  and  dentist  for  himself  and  his 
family.  The  true  industrial-  i)hysician,  there- 
fore, is  not  one  who,  in  the  course  of  private 
practice,  cares  for  the  victims  of  industrial  ac- 
cident; is  not  one  who  gives  a  certain  time  to 
work  witiiin  the  plant  while  keejjing  his  chief 
interests  outside;  is  not  even  one  who  agrees  to 
give  .some  supervision  to  the  sanitation  of  sev- 


eral factories  and  to  give  medical  or  surgical 
attention  when  asked.  He  is,  rather,  one  who 
gives  up  private  practice  to  enter  industry  for 
the  purpose  of  using  his  knowledge  of  medicine, 
surgery,  hygiene,  safety,  economics  and  psy- 
chology to  serve  the  worker  and  the  manage- 
ment. He  will  bring  all  his  specialized  science 
to  bear  ujion  imhealthy  irorhing  and  living  con- 
ditions, and  unhealthy  attitudes  of  mind  to- 
ward the  job  and  society,  and  will  thereby 
increase  individual  and  community  health, 
wealtii,  and  happiness.  —  Elizabeth  C.  Putnam. 

Welfare  in  Factories  and  Workshops. 
A.  M.  Anderson.  Great  Britain  Ann.  Rep. 
Chief  Inspect.  Factories  and  Workshops  for  the 
Year  1919,  73-82.  —Rules  were  made  in  1919 
for  examining  fruit  preserving  works,  oil  cake 
mills,  laundries,  gut  scraping,  manufacture  of 
hollow  ware,  galvanizing,  and  herring  pickling 
works.  Inspectors  report  good  i)rogress  in  .se- 
curing legally  or  voluntarily  improved  condi- 
tions. 

\'oluntary  messrooms,  canteens,  lavatories, 
cloakrooms,  and  lunchrooms  were  found  in 
many  factories  in  Sheffield;  such,  over  the  king- 
dom, "get  the  pick  of  the  labour  in  the  neigh- 
bourhood." In  practically  all  new  factories 
most  of  these  things  are  provided  for,  but  in 
older  factories  where  room  is  scarcely  available 
progress  must  be  slow  unless  compulsion  is 
brought  to  bear.  Slowness  in  these  things  is 
greater  in  cotton  than  in  woolen  manufactures. 
In  the  Lancashire  and  Yorkshire  districts  and 
in  the  metal  industries  in  the  Midlands,  "there 
is,  with  one  or  two  exceptions,  jjractically  no 
welfare  work."  In  glass  works,  bichromate,  fruit 
preserving,  and  oil  cake  works,  ret|uirements  are 
well  in  progress. 

Drinking  Water.  —  Here  the  order  of  1917  is 
giving  the  results  anticipated. 

Canteen  and  Me.s.sroom.  —  Advance  is  tardy 
in  this  branch  of  welfare  work  !)ul  there  are 
many  exceptions.  Canteen  service  is  best  in 
engineering,  wire  making,  iron  founding,  gas 
works,  india  rubber  works  and  woolen  mills. 
Messroom  .service  is  best  in  pa])er  making,  box 
and  stationery,  drugs  and  ink  making,  brewing 
and  beer  bottling,  job  dyeing  and  rag  sorting, 
and  excellent  devolo|)ment  a]ipears  in  clothing 
factories  in  the  Northwest  Division  and  North 
London.  "Since  the  institution  of  this  canteen, 
fainting  attacks  wiiich  tisod  to  vary  from  two  to 
ten  a  day  have  fallen  to  about  one  a  week."  A 
separate  canteen  is  maintained  for  men.    Con- 


ABSTRACTS 


45 


ditions  are  as  yet  less  favorable  in  many  work- 
shops in  London  and  in  city  factories.  In 
Ireland  progressive  firms  are  arranging  mess- 
rooms  and  the  spirit  is  encouraging. 

Protective  Clothiiuj,  Conreniences.  —  Regula- 
tions require  protective  clothing  when  material 
such  as  potassium  bichromate  is  handled,  or 
when  the  work  itself  is  hot  or  dirty. 

In  Scotland  the  requirements  of  the  welfare 
order  in  regard  to  women  are  I)eing  carrieil  out, 
especially  in  glass  works.  In  fruit  preserving 
and  laundries  advance  is  variable  but  progres- 
sive. 

Seats.  —  Seats  are  su|)iilicd  by  various  pros- 
perous industries  and  arc  found  to  conserve  tiic 
powers  of  the  employees.  In  the  Northeast 
Division  nearly  everyone  in  a  cotton  spinning 
mill  had  a  comfortable  seat  and  the  women 
could  watch  tlicir  machines  better  when  seated. 
In  Yorkshire  and  Lancashire  a  nuijority  of  mills 
had  no  seats. 

Volunteer  Welfare  in  Shale  Oil  Works.  — 
Rules  have  been  observed  in  Scottisii  siiale 
works  during  the  ])ast  year  protecting  workmen 
from  spent  shale  tlust  and  fumes;  for  shelters, 
protective  clothing  and  spray  baths;  periodical 
medical  examination,  first  aid  and  ambulance, 
and  special  treatment  of  skin  allVctinns,  with 
gratifying  results.  Masks  are  provided  when 
the  atmosphere  is  poisonous. 

Welfare  in  the  Fish  Curimj  Indn.strii.  — The 
.special  hardshii)  of  this  work  engaged  the  atten- 
tion of  welfare  workers  for  many  years  before 
the  war.  This  seasonal  trade  is  carried  on 
by  women  in  October  and  Xo\ember  on  the 
beaches  in  siicds  with  tlu'cc  sides  ()|)cn  to  the 
weather.    Housing  was  inadequate  and  many 


workers,  after  hours  of  standing  at  the  farlanes, 
had  long  distances  to  go  for  lodgings  and  food. 
Many  suffered  from  salt  sores,  due  to  salt  en- 
tering the  cuts  made  by  knives  in  gutting  fish. 
The  inspectors  all  reported  need  for  mess  and 
rest  rooms,  first-aid  stations,  cloak  and  wash- 
rooms. The  worst  conditions  were  at  Yarmouth 
and  at  Lowestoft.  —  F.  Fremont-Smith. 


TiiK  L<)N(!  Day:  Does  It  Pay?  Ed.  Am. 
Labor  Legis.  Rev.,  Dec,  19-20,  10,  No.  4,  '26-1- 
lli.  —  The  consideratiorus  of  leisure  for  citizen- 
ship, for  recreation,  and  for  home  life  and 
jirotection  against  strain  should  be  the  funda- 
mentals for  determining  hours  of  labor.  Long 
hours,  though  popularly  supposed  to  ho  elim- 
inated, are  still  very  real  in  the  steel  industry. 

Tiie  three  conventional  objections  urged 
against  the  shorter  shift  are:  (1)  The  company 
cannot  afford  it.  As  a  matter  of  fact,  it  has 
been  proved  invariably  true  that,  when  the 
transfer  has  been  made  thoughtfully  and  scien- 
tifically, it  not  only  does  not  cost  more,  but  it 
actually  pays,  (i)  The  men  do  not  want  it. 
This  is  true  if  it  means  cut  wages,  but  expe- 
rience ])roves  that  wages  are  not  decrease<l  b>it 
often  increasetl  because  of  the  increased  effi- 
ciency of  the  worker.  (3)  It  will  open  wider  the 
door  to  foreign  competition.  The  contrary  is 
true  because  the  efficiency  of  the  highly  jjaid, 
scientifically  trained  .Vmerican  workman  is  so 
much  greater  that  "fear  of  foreign  competition 
has  been  reduced  or  even  cut  out  entirely  in  this 
country  in  factories  under  a  careful  reorganiza- 
tion, a  feature  of  which  was  the  shorter  shift." 
—  Elizabeth  (".  Putnam. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS:    GASES, 
CHEMICALS,  ETC. 


Electrocardiographic  Studies  in  Acute 
PoisoN'iNcis.  E.  Schott.  Arch.  f.  exper.  Path.  u. 
Pharmakol..  Sept.  '24.  1!)'20,  87,  No.  .5,  •21.— 
The  author  gives  the  graphic  records  and  pro- 
tocols of  a  number  of  experiments  upon  frogs, 
guinea-pigs,  and  rabbits,  given  large  doses  of 
various  poisons,  sodium  salicylate,  benzf)l, 
tetrachlormethane,  ethyl  chloride,  chloroform, 
ether  and  alcohol.  These  substances,  which  are 
of  course  encountered  in  many  technical  proc- 
esses, each  produce  a  more  or  less  characteristic 
alteration  in  the  form  of  the  electrocardiogram. 


which  Schott  believes  might  be  of  diagnostic 
value  clinically. — T.  J.  Putnam. 

Toxic  Effects  of  Carbon  Monoxid.  W.  H. 
Wilmer.  Am.  Jour.  Ophth.,  Feb.,  1921,  4, 
No.  2,  7:3-90.  —  The  hulk  of  this  article  is  de- 
voted to  a  description  of  the  experiences  of  a 
family  in  a  "haunted  house."  The  odor  of  gas 
was  often  noticed  and  on  investigation  a  leaky 
furnace  was  found.  The  symptoms,  chiefly 
auditory  and  visual  hallucinations,  were  attrib- 
uted to  carbon  monoxide  intoxication.   A  case 


46 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


of  optic  neuritis,  found  in  a  member  of  this 
family  four  years  after  leaving  the  house,  was 
considered  liy  the  wTiter  to  be  due  to  carbon 
monoxide  poisoning.  — H.  S.  Forbes. 

Asphyxiation  ix  Garages.  N.  Y.  Dept. 
Labor,  Special  Bull.  No.  101,  Dec,  19'20,  pp. 
23.  —  This  report  is  based  chiefly  on  an  inspec- 
tion of  1,308  garages  and  auto-repair  shops  in 
New  York  State.  One  hundred  and  thirteen 
cases  of  asphyxiation  (degree  not  stated)  were 
found  within  two  years.  All  but  twelve  of  these 
occurred  outside  of  New  York  City,  indicating 
the  greater  danger  in  smaller  garages  where 
men  may  be  working  singly. 

The  concentration  of  carbon  monoxide,  the 
chief  poisonous  constituent  of  exhaust  gas,  is 
given  as  0.05  per  cent,  to  cause  headache,  and 
0.2  per  cent,  to  be  very  dangerous.  These 
figures  are  quoted  from  Haldane.  In  consider- 
ing the  question  of  chronic  exhaust  gas  poisoning 
no  mention  is  made  of  benzol  being  a  possible 
important  factor.  Better  garage  ventilation  is 
urged.  Only  thirty-six  garages  of  the  1 ,308  had 
the  better  type  of  ventilation  by  tube  from  the 
exhaust  pipe  heading  directly  out  of  doors.  — 
H.  S.  Forbes. 

The  Spinal  Fluid  in  Carbon  Monoxide 
Poisoning.  Legry  and  Lermoyez.  Abstracted 
as  follows  from  Presse  med.,  Nov.  13,  1920,  28, 
p.  816,  in  II  Lavoro,  Dec.  31,  1920,  11,  No.  8, 
238.  —  Lumbar  puncture  made  under  certain 
conditions  affords  a  valuable  aid  in  the  diag- 
nosis of  carbon  monoxide  poisoning.  The  fluid 
comes  out  under  increased  pressure,  is  clear, 
^^ath  a  slight  sediment  of  red  blood  cells  and  of 
leukocytes,  two-thirds  of  which  are  jwlynu- 
clears  and  one-third  mononuclears.  This  cyto- 
logic meningeal  reaction  is  to  be  attributed  to  a 
congestive  and  hemorrhagic  process  in  the 
cortex.  —  Alice  Hamilton. 

Extensive  Intr.wital  Clotting  in  Illu- 
minating-Gas Poisoning.  K.  Ilediiigcr.  Vrtl- 
jschr.  f.  gerichtl.  Med.,  April,  1920,  ,59,  .series  3, 
No.  2, 177-181.  —  In  cleaning  a  plugged  pipe  at 
a  gas  plant,  a  45-year  old  workman  was  forced 
to  breathe  an  unusual  aniouut  of  illuminating 
gas,  so  that  in  the  afternoon  he  complained  of  a 
queer  taste  in  his  mouth  and  had  no  a{)petite. 
At  3  o'doc-k  the  next  morning  he  awoke  and 
complained  of  nausea,  and  fell  flat  on  the  floor 
when  he  got  out  of  bed.  He  managed  to  get 
back  to  bed  again,  however.    About  three  hours 


later  he  had  a  free  movement  of  the  bowels  and 
felt  better,  but  soon  after  he  suddenly  fell  dead. 

The  autopsy  was  held  at  4  p.m.,  with  the  fol- 
lowing results: 

Macroscopic  Findings.  —  Well-marked  death 
rigor;  skin  a  striking  bright  red;  no  edema;  ex- 
treme ^'aricosity  of  both  long  saphenous  veins, 
especially  above  the  knees;  heart  large  and 
flabby  (weight,  370  gm.).  In  the  right  heart  a 
large  dark  red  clot  with  a  dull  surface,  which 
was  continued  into  the  chief  branch  of  the 
pulmonary  artery.  The  same  kind  of  clot  was 
found  in  the  small  lung  arteries,  the  inferior 
vena  cava,  and  both  interior  and  exterior  com- 
mon iliacs.  The  femoral  veins  and  the  varicose 
saphenous  veins  were  full  of  bright  red  blood; 
the  lungs  were  very  hyperemic,  and  scattered 
throughout  them  were  dark  red  wedge-shaped 
throm])i,  measuring  1  to  3  cm.  The  pleura  was 
smooth  and  shining  over  these  spots.  The  brain 
and  other  organs  showed  simple  hyperemia. 
Carbon  monoxide  was  present  in  the  blood. 

Microscopic  Findings.  —  In  the  region  of  the 
lung  infarcts  there  was  extensive  invasion  of  the 
meshwork  with  crenated  red  blood  corpuscles. 
The  alveolar  septa  and  epithelium  still  showed 
good  nuclear  staining.  The  vessels  nearby  were 
packed  full  of  red  blood  corpuscles,  with  some 
fibrin  and  white  blood  corpuscles.  The  large 
thrombi  in  the  lung  arteries  and  in  the  inferior 
vena  cava  consisted  almost  entirely  of  many  red 
blood  corpuscles  with  a  little  fibrin,  .sugge-sting  a 
postmortem  clot.  The  long  saphenous  vein 
showed  thickening  of  the  intima  in  spots,  with  a 
rather  sharj)  interruption  of  the  elastic  intima, 
but  without  infiltration.  The  other  organs 
showed  simple  hyperemia. 

It  is  well  known  that  small  thrombi  can  be 
formed  in  carbon  monoxide  poisoning,  al- 
though in  acute  illuminating  gas  poi.soning  the 
bright  red  blood  is  usually  fluid  for  a  long  time. 
In  this  case  the  author  thinks  that  the  extensive 
clotting  can  be  accounted  for  by  the  predispos- 
ing condition  which  was  present  in  the  varicose 
veins.  The  small  amount  of  thrombosis  present 
was  tremendously  accelerated  by  the  carbon 
monoxide,  so  that  large  enough  emboli  were 
sent  off  to  cause  death.  — H.  G.  Noyes. 

Acute  Poisoning  from  Nitrous  Fu.mes. 
F.  Jacoulct.  .\bstracted  as  follows  from  Paris 
med..  Nov.  20,  1920,  10.  No.  47,  369.  in  Jour. 
.\m.  Med.  .Vssii.,  .Ian.  8,  1921,  76,  No.  2,  144.  — 
"The  ])lumber  had  been  repairing  a  ventilator 
opening  into  the  '  lead  rooms  '  of  a  chemical 


ABSTRACTS 


47 


fertilizer  factory,  and  was  exposed  to  the  nitrous 
fumes  for  several  minutes.  He  felt  a  general 
malaise  during  the  afternoon,  and  at  night  de- 
veloped a  distressing  spasmodic  cough.  By  the 
next  morning  the  dyspnea  was  extreme,  all 
the  symptoms  suggesting  suffocating  ca|)illary 
bronchitis.  Wet  cups  were  applied  and  spartein 
and  camphorated  oil  injected  without  relief. 
Venesection  improved  conditions  a  little  hut  the 
condition  grew  progressively  wor.se,  with  suh- 
coma,  jjrogressive  asjjhyxia  and  asystoly,  the 
condition  desperate  by  the  thirty-sixth  hour. 
Then  subcutaneous  injection  of  oxygen  through 
a  serum  needle  induced  slight  progressive  im- 
provement. In  forty-eight  hours  more  than  80 
liters  of  oxygen  were  thus  injected,  forming  an 
emphysema  over  the  entire  body  to  the  base  of 
the  chest,  and  the  man  rapidly  recovered.  In 
Pic  and  Durand's  case  the  man  was  in  complete 
coma  but  recovered  after  sut)cutaneous  injec- 
tion of  180  liters  of  oxygen  the  first  day,  to  a 
total  of  '■2'W  liters  in  forty-eight  hours.  The 
diffusion  and  absorption  of  the  oxygen  are  ])ro- 
moted  by  light  massage;  the  absorption  ])ro- 
ceeds  the  more  rapidly  the  more  avid  the  tissues 
for  oxygen.  Jacoulct  knows  of  only  four  at- 
tempts to  inject  oxygen  by  the  vein,  and  urges 
that  for  the  i)resent  it  is  better  to  keej)  to  the 
subcutaneous  route.  Tiiis  has  proved  its  harni- 
lessness,  and  these  ca.ses  demonstrate  its 
efficacy."  —  M.  C.  Shorley. 

Perfor.vtions  ok  thk  X.\.sal  Skptim  Di  k 
TO  Inhal.\tion  of  Arsenous  Oxid.  L.  G.  Dun- 
lap.  Jour.  Am.  :\Ied.  Assn.,  Pel).  "20,  W2\.  70, 
No.  9,  508.  —  The  author  concludes  with  the 
following  sunnnary : 

"1.  Arsenous  oxid  is  a  valuable  by-product 
of  the  Rocky  Mountain  copper  ore  smelling, 
and  many  workers  come  into  contact  with  tons 
of  the  pure  product. 

"2.  Arsenous  oxid  causes  a  characteristic 
septal  perforation  and  associated  pathologic 
condition  of  the  skin,  throat  and  eyes. 

"3.  Treatment  consists  of:  (a)  resection  of 
cartilage,  ])roducing  nnico.sa  to  mucosa  approxi- 
mation, or,  in  smaller  perforations,  (6)  plastic 
operation  or  (c)  a  mechanical  obturator  to  re- 
lieve the  objectionable  crusting."  —  C.  K. 
Drinker. 

Question  of  the  Resistance  of  Various 
AxiAiALS  to  Arsenic.  M.  Willberg.  Ab- 
stracted as  follows  from  Sitzb.  Naturf.  Ges. 
Univ.  Dorpat.,  1919,  22,  42-88;  Zentr.  Biochem. 


Biophys.,  21,  288,  by  H.  S.  Paine  in  Chem. 
Abstr.,  Dec.  10,  1920,  U,  No.  23,  3724-3725.  — 
"  Large  doses  of  AS2O3,  when  administered  per  os 
to  dogs,  caused  vomiting  with  con.sequent  elim- 
ination of  the  greater  (lart  of  the  })oison.  Dogs 
showed  efpial  resistance  to  subcutaneous  and 
internal  administration  of  KAsOj;  do.ses  ex- 
ceeding 0.007  gm.  per  kilogram  of  body  weight 
caused  death.  Extensive  necrosis  of  the  sub- 
cutaneous tissue  and  skin  around  the  site  of 
injection  was  invariably  oiiserved  when  Ks.V.sOj 
was  subcutaneously  injected.  The  skin  of  the 
dog  showed  pronounced  sensitiveness  to  As  as 
compared  with  the  skin  of  other  experimental 
animals;  the  skin  of  cats  showed  similar  sensi- 
tiveness. The  limiting  dose  of  KAsO^  for  rab- 
bits was  0.009-0.01  gm.;  0.010  gm.  of  As.Oj 
cau.sed  death.  In  general,  when  administered  in 
double  amoimt,  As.O.i  killed  them  only  about 
half  as  rapidly  as  K3ASO3.  AsjOj  is  cai)al)le  of 
causing  miscarriage.  Hares  showed  less  resist- 
ance than  rabbits  to  subcutaneous  injection  of 
K.3.\s().|.  Of  all  mammals  stuilied,  mice  .showed 
tiie  greatest  relative  resistance  to  subcutaneous 
injection  of  KsAsOi.  Guinea  pigs  easily  with- 
stood repeated  subcutaneous  injection  of 
KASO3  in  doses  of  0.003  0.00!)  gm.  per  kilo- 
gram; a  single  dose  of  I). 01  0.012  gm.  caused 
death.  Hens  showed  varying  behavior,  but  all 
succumljed  with  gastroenteritis  when  0.00- 
O.l.)  gm.  of  AS2O3  was  administered  per  o.s;  mel- 
anosis of  the  comb  always  occurred.  Pigeons 
tolerated  1.780  gm.  of  AsjOa  i)er  kilogram  of 
body  weight,  inasmuch  as  the  poison  was  elim- 
inated by  vomiting;  they  were  .sensitive  to  sub- 
cutaneous injection  of  KAsOs.  In  the  case  of 
snakes,  administration  of  0.019  gm.  ])cr  kilo- 
gram caused  death. 

Is  THE  Industrial  Disease  of  Briquette 
Makers  Chronic  Arsenical  Poi.soning? 
Uurkhanli.  Zentralbl.  f.  Gewerbehyg.,  Dec, 
1920,  8,  No.  12,  220.  — This  is  a  criticism  and 
refutation  of  the  article  by  Bayet  and  Slosse 
which  was  abstracted  in  this  Jourxal.  1919, 
Vol.  I,  p.  00.  The  Belgian  authors  maintain 
that  the  skin  lesions  of  briquette  workers  are 
caused  by  the  presence  of  arsenic  in  the  coal 
used  for  briquette  manufacture,  and  back  up 
their  assertion  by  presenting  analy.ses  of  coal, 
coal  dust,  hair,  blood,  and  urine  of  workmen, 
all  positive  for  arsenic.  They  also  insist  that  all 
workmen  engaged  in  industries  which  work  uj) 
anthracite  coal  or  its  bv-])roducts  are  expo.sed 
to  arsenical  poisoning,  for  they  claim  to  have 


48 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


found  it  in  the  dust  in  illuminating  gas  plants, 
in  the  tar  and  purification  residue  of  the  same 
plants,  and  finally  in  the  hair  and  blood  of  the 
workmen. 

Burkhardt  believes  that  publications  of  this 
kind  are  likely  to  cause  widespread  alarm,  and 
should  be  subjected  to  close  scrutiny.  It  is  im- 
possible to  tell  how  significant  is  the  discovery 
of  arsenic  in  briquette  and  gas  factories  and  in 
the  hair  and  blood  of  workmen,  because  no 
statement  is  made  as  to  the  quantity  of  arsenic 
found.  The  method  of  reporting  positive  find- 
ings in  percentages  is  misleading  when  we  see 
that  arsenic  was  found  in  the  hair  of  60  per 
cent,  of  the  workmen,  and  then  discover  that 
that  means  three  out  of  five.  The  description 
af  the  skin  lesions  in  these  cases  corresponds 
with  the  typical  industrial  disease  of  briquette 
workers  as  it  has  been  known  for  many  years, 
but  is  not  characteristic  of  arsenical  poisoning. 
The  skin  lesions  of  arsenic  smelters  are  not 
nearly  so  widespread  as  those  of  briquette 
workers,  and  are  characterized  by  pustules  and 
ulcers,  not  by  warts  and  keratomata  with  a 
tendency  to  carcinomatous  degeneration.  The 
author  quotes  K.  B.  Lehmann  to  the  effect 
that  contact  with  chemicals  containing  small 
quantities  of  arsenic  is  not  particularly  dan- 
gerous, as  is  seen  among  Dutch  and  Belgian 
workmen  handling  zinc  white  with  0.4  per 
cent,  arsenic  for  many  years  without  trouble. 
Koel.sch  of  Bavaria  has,  during  ten  years"  time, 
seen  very  few  industrial  diseases  caused  by 
arsenic  and  its  solid  compounds.  This  is  in 
great  contrast  to  the  enormous  incidence  of  so- 
called  arsenical  poisoning  found  by  Bayct  and 
Slosse  which  afi'ccted  the  majority  of  the  work- 
men and  caused  epithelioma  in  no  less  than  30 
per  cent.  Their  theory  as  to  the  causation  is 
untenable,  and  the  real  agent  is  to  be  sought  in 
some  organic  compound,  probably  similar  to 
the  compounds  which  cau.se  bladder  tumors  in 
aniline  workers.  —  A.  Hamilton. 

Industri.vl  Trinitrotoluene  Poisoning. 
C  Rubino.  Abstracted  as  follow-s  from  La  Ri- 
forma  Medica,  Dec.  4,  1920,  36,  No.  49,  ll^l, 
in  II  Lavoro,  Dec.  31,  19-20,  11,  No.  8,  234-238. 
—  The  ex|)erience  during  the  war  in  Italian 
munition  plants  with  regard  to  T.X.T.  poison- 
ing was  far  more  favorable  than  that  of  Great 
Britain  and  the  United  States.  The  author 
made  a  thorough  examination  of  ninety-nine 
persons  wiio  had  worked  with  T.X.T.  from  four 
days   to   thirty-four   months.     There   was   no 


alcoholism  among  these  people,  which  explains 
perhaps  why  there  was  no  serious  poisoning. 
There  was  no  dermatitis  and  but  one  case  of 
icterus.  This  was  in  a  man  40  years  of  age  who 
had  been  employed  for  three  months.  He  died 
in  coma  after  sixteen  days  but  no  autopsy  was 
made. 

The  greater  frequency  of  toxic  jaundice  in 
British  and  American  T.N.T.  workers  is  prob- 
ably to  be  explained  by  the  favoring  action  of 
a  second  poison,  alcohol.  The  most  frequent 
symptom  in  the  Italian  workmen  was  loss  of 
weight,  present  in  37  per  cent.  Loss  of  appetite 
was  present  in  18  per  cent.,  headache  in  9  per 
cent.,  but  the  symptoms  so  often  observed  in 
the  other  countries  —  nausea,  vomiting,  dizzi- 
ness —  were  absent.  Anemia  was  present  in  9 
per  cent.  Almost  all  the  workmen  passed 
through  a  period  of  slight  disturbances  followed 
by  a  period  of  adaptation,  after  which  toxic 
symptoms  sometimes  appeared,  but  there  were 
no  .serious  cases  of  T.N.T.  intoxication.  Those 
engaged  in  nitrating  toluol  were  exposed  to  irri- 
tating fumes  of  nitrogen  oxides  and  to  poisoning 
by  mononitrotoluol.  The  AVebster  reaction  was 
found  to  be  of  great  value,  especially  as  a  warn- 
ing of  an  impending  attack.  —  Alice  Hamilton. 

Zinc  Chlorid  Poisoning.  Report  of  Out- 
BRE.\K  .\jioNG  Workers  in  a  Wood  Preserv- 
ing Industry.  Carei/  McCord  and  ('.  H.  Kilker. 
Jour.  Am.  Med.  Assn.,  Feb.  12,  1921,  76,  No.  7, 
442-443.  —  Tars,  creosotes  and  zinc  chloride 
are  used  in  the  preserwttion  of  wood.  The 
authors  describe  skin  conditions  in  seventeen 
patients.     Tiie  lesions  found  were  as   follows: 

"(«)  Tar  Dermatitis.  —  Dermatitis  venenata, 
attributable  in  part  to  preparations  used  by 
employees  in  '  cleaning  up,'  such  as  benzene, 
light  and  heavy  oils  from  coal  tar  distillation, 
and  in  jiart  attributable  to  coal  tar  distillation 
products  in  the  tar  employed,  was  ob.served 
in  only  two  cases. 

"(i)  Tar  Acne.  —  This  condition  was  noted 
in  varying  degrees  among  all  the  employees  ex- 
amined. It  is  a  common  disease  among  all  tar 
workers  and  is  due  to  the  accumulation  of  tar 
in  hair  follicles,  esijecially  those  of  the  fore- 
arms. 

"  (r)  Tar  Cancer. — In  two  cases,  lesions 
were  exhibited  suggestive  of  tar  workers'  or 
'  chimney  swee[>  '  cancer,  which  has  been  care- 
fully descril)ed  by  Schamberg.  One  of  these 
lesions  was  situated  on  the  scrotum,  and  the 
other  on  the  forearm.   The  quick  disappearance 


ABSTRACTS 


49 


of  these  lesions  under  treatment  makes  one 
hestitate  before  making  a  diagnosis  of  tar 
cancer. 

"(d)  Zinc  Chlorid  Burna.  —  In  addition  to 
the  foregoing  conditions,  all  patients  presented 
nniltiple  lesions  of  the  fingers,  hands,  forearms 
and  rarely  of  the  legs  and  thighs.  All  patients 
gave  a  history  of  slight  injury,  such  as  abrasion, 
splinters,  burns  or  crevices  from  chapping.  The 
typical  lesion  was  a  small  oijcning  in  the  skin 
usually  corresponding  to  the  size  and  shai)e  of 
the  antecedent  injury.  The  surrounding  skin 
appeared  normal,  but  on  careful  examination  it 
was  found  to  be  readily  removable.  When  the 
initial  break  in  the  skin  was  api)roximatcly 
4  mm.  in  diameter,  the  subsequent  impaired 
skin  area  was  about  Vi  mm.  in  diameter.  This 
I)roi)ortion  obtained  roughly  for  all  sizes  of 
lesions.  On  removal  of  the  im])aircd  skin,  the 
underlying  tissues  were  found  to  be  white  and 
bloodless.  In  the  center  there  was  a  cylinder  of 
e.scharotic  tissue,  the  de|)lh  of  which  depended 
on  the  duration  of  the  lesion.  There  was  no 
evidence  of  infection,  and  little  or  no  swelling 
was  noted.  .\t  times,  some  of  the.se  lesions  were 
exquisitely  painful,  anil  others  were  wholly  and 
continuously  |)ainless." 

Treatment  of  the  zinc  chloride  ".sores"  con- 
sisted in  removal  of  the  .scar  tissues  and  filling 
in  the  wound  with  sodium  bicarbonate  alone  or 
with  jM'trolatum.  I'revcntion  through  the  u.se 
of  "linoleated"  canvas  gauntlets  |)ro\cd  cn- 
tirelv  satisfactorv.  —  ('.  K.  Drinker. 


rare  individuals  who  are  peculiarly  susceptible. 
—  A.  S.  Minot. 

The  Blood  ix  Poisoxixg  by  C.\rbox  Oxv- 
CHLORiDE  (Phosgexe).    Achard.  Lebanc.  and 
Binei.    Abstracted  as  follows  from  Archives  de 
medecine  experimentale  et   d'anatomie   path- 
ologique,  March,  19'20.  in  II  Lavoro,  Nov.  30, 
l!>-2(),  11,  Xo.  7,  ^204.  —The  authors  produced 
intoxication  in  dogs  by  kee])ing  the  animals  for 
an  hour  in  a  chamber  with  a  capacity  of  1  cubic 
meter,  in  \Vhich  was  evaporated  1  to  '•2  c.c.  of 
a  io  per  cent,  solution  of  carbon  oxychloride. 
.V  similar  dose  for  ten  to  fifteen  minutes  was 
enough  for  rabbits.    During  the  stage  of  acute 
edema  of  the  lungs  the  authors  found  a  pro- 
nounced ])olycvthcmia,  an   increase  of  hemo- 
globin and  of  the  rcs|)iratory  capacity  of  the 
blood,  which  they  regard  as  a  reaction  of  the 
organism  against  a.sphyxia.    At  the  .same  time 
there  is  a  leukocytosis  —  polynudear  —  which 
is  also  evident  the  day  after  breathing  the  gas. 
The  week  following  the  experiment  they  ha\e 
often  found  increased  coagulation  of  the  l)lood 
and  slight  diminution  of  the  albuniins  of  the 
serum,    .\fter  the  disappearance  of  the  acute 
sym[)toms  there  is  a  [jrogressive  dimiiuition  in 
the  red  cells,   in  the  hemoglobin,  ami   in   the 
respiratory  capacity  —  in  other  words,  a  pro- 
gressive anemia   which   .seems   to  be  of  toxic 
nature.    The  return  to  normal  state  is  slow  in 
pro|)ortion   as   the  poisoning  was   intense.  — 
.Vlice  Hamilton. 


Absokptiox    .\xd    Elimination    of   M.vx- 

GANESE    In(;K.STED    -\S   O.XIDES    .\ND    SiLK'.VTES. 

C.  K.  Bfimaii  and  .i.  N.  Minot.  Jour.  Biol. 
Chem.,  Dec,  19-20.  45.  No.  1,  13;?-14:5.  —  Ores 
containing  manganese  as  oxides  and  silicates 
are  shown  to  be  soluble  in  the  gastric  juice. 
Manganese  is  aV>sorbed  into  the  blood  stream 
from  which  it  is  quickly  removed  and  elim- 
inated by  the  liver  in  tjie  bile  and  l)v  the  intes- 
tine. The  increase  in  manganese  content  of  the 
bloofl  after  ore  ingestion  in  no  case  readies 
more  than  twice  the  nornud  value  and  in  .some 
individuals  no  increase  is  noted.  The  authors 
suggest  that  this  difference  may  be  correlated 
with  difference  in  suscei)tibility  to  nuingane.se 
poisoning.  Prolonged  feetling  of  large  amounts 
of  manganese  to  dogs  caused  no  significant 
changes  in  manganese  content  of  blood  and 
ti.ssue  and  produced  no  i)atliological  .symijtoms. 
The  conclusion  is  drawn  that  manganese  ores 
are  very  non-toxic  and  induce  poisoning  only  in 


StiDIES     of     ("lIHO^IC      IXTOXIC.VTIOXS     OX 
.\LHIN0       R.VTS.         III.     .\CETIC'       .VXD       FoR.MIC 

Acids.  T.  Sollmann.  .\bstracted  as  follows  from 
Jour.  Pharmacol,  and  Exper.  Therap.,  Jan., 
19-21,  l(i.  No.  6.  4(W  in  Jour.  .\m.  Med.  Assn., 
Pel).  19,  ]iH\,  7(i,  Xo.  8.  .547. —  "The  imme- 
diate occasion  for  investigating  these  acids  was 
the  question  of  the  safety  of  the  use  of  formic 
acid  for  the  preservation  of  foods.  However, 
the  investigation  was  j)lanned  with  a  view  to 
I)ossible  wider  a])i)lications.  Sollmann  found 
that  acetic  and  formic  acids  behave  approxi- 
mately quantitatively  alike,  when  added  to  the 
drinking  water  of  rats  in  concentration  up  to 
{).')  per  cent,  and  daily  doses  up  to  0.3G  c.c.  of 
absolute  acid  ])cr  kilogram  of  body  weight,  for 
from  two  to  four  months;  this  being  the  .sole 
source  of  fluid  for  the  animals.  Concentrations 
of  from  0.01  to  0.2.5  per  cent.,  corresponding  to 
daily  dosage  of  0.-2  c.c.  of  acid  per  kilogram  of 
body  weight,  produced  no  efi'ect  on  growth. 


50 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


appetite,  or  consumption  of  fluid.  They  are, 
therefore,  quite  harmless.  The  diuresis  de- 
scribed in  the  hterature  for  formates  and  ace- 
tates, SoUmann  believes,  must  be  due  to  the 
sodium,  potassium  or  lithium,  and  not  to  the 
formic  radical.  With  concentrations  of  0.5  per 
cent,  and  daily  dosage  of  0.36  c.c.  of  absolute 
acid   per   kilogram   of   rat,    the   appetite   and 


growth  but  not  the  fluid  consumption  are  ma- 
terially, immediately  and  progressively  dimin- 
ished with  both  acids.  This  is  evidently  due  to 
their  acidity;  but  the  experiments  do  not  throw 
any  light  as  to  whether  this  is  due  to  local  action 
on  digestion,  or  whether  to  some  more  pro- 
found disturbance  of  the  acid-base  equilib- 
rium." —  C.  K.  Drinker. 


DUST  HAZARDS  AND  THEIR  EFFECTS 


■  Industrl\l  Dust.  A.  S.  Leiich.  Pub. 
Health  Jour.,  Aug.,  19-20,  11,  No.  8,  341-347; 
Sept.,  19-20,  No.  9,  396-404.— The  object  of 
this  paper  which  was  read  at  the  Annua!  fleet- 
ing of  the  Ontario  Safety  League  in  19-20  by 
A.  S.  Leitcli  of  Sheldons,  Ltd.,  makers  of  en- 
gines, blowers,  fan  and  exhaust  systems,  is  to 
call  attention  to:  (1)  the  various  harmful  gases, 
fumes,  vapors  and  dusts  produced  by  industrial 
processes;  (2)  the  physiological  effect  which 
these  dusts  have  on  the  human  organism;  (3) 
present  day  methods  by  which  they  can  he 
eliminated  and  healthy  conditions  maintained 
in  the  workrooms. 

Under  headings  1  and  2  a  useful  account  is 
given  of  the  hazards  of  various  industries  and 
their  effects,  but  the  important  part  of  the 
paper  is  section  3  in  which  descriptions  in  con- 
siderable detail  and  with  good  illustrations  are 
given  of  the  following: 

Hoods  for  grinding,  polishing  and  buffing 
letters. 

Hoods  for  use  with  woodworking  machines. 

A  system  for  exhausting  the  dust  from  the 
scutching  machines,  tow  dusters  and  brakes  in 
a  flax  mill. 

A  ventilating  system  for  a  linotype  room. 

A  supply  system  for  delivering  into  the  room. 

A  volume  of  air  slightly  in  exces.s  of  that 
"carried"  oft'  by  the  exhaust  fan. 

An  exhaust  system  for  use  in  connection  with 
granite  polLshing,  stone  grinding,  chopping,  etc. 

Hoods  for  use  in  connection  with  the  spray 
brush  method  of  painting. 

The  final  paragraph  of  this  article  is  of  espe- 
cial interest  as  an  appeal  from  industry  for  the 
co-operation  of  science  and  is  (pioted  in  full: 

"Li  conclusion  it  is  to  be  regretted  tiiat  so 
little  attention  has  been  paid  to  this  problem  by 
our  universities  and  professional  experimen- 
talists. For  generations  our  leading  technical 
institutions  have  been  experimenting  on  cen- 
trifugal i)umps,  steam  turbines,  steam  bailers. 


heating  plants  and  other  various  lines  of  useful 
and  economical  apparatus  for  industrial  and 
domestic  use  and  are  still  doing  it,  yet  it  is  safe 
to  say  that  none  of  them  plays  a  more  impor- 
tant part  in  the  development  of  our  industries, 
the  safety  of  human  life  and  the  economical 
production  of  manufactured  goods  than  does 
the  application  of  fans  and  blowers  to  the  re- 
moval of  fumes,  vapours,  gases  and  dusts,  all  of 
which  have  been  discussed  under  the  heading  of 
'  Industrial  Dust  '■  in  this  paper."  —  R.  M. 
Hutton. 

Recent  Experiments  in  the  Control  of 
Air  Dustiness.  0.  M.  Spencer.  U.  S.  Pub. 
Health  Ser.,  Pub.  Health  Rep.,  Dec.  3,  19-20, 
35,  No.  49,  -2907--2916.  —  This  is  a  discussion  of 
some  of  the  results  obtained  in  recent  studies 
made  by  the  United  States  Public  Health 
officers  to  determine  the  condition  of  the  air  in 
certain  occupations  which  have  a  tendency  to 
excite  or  accelerate  the  development  of  tuber- 
culosis. "It  is  not  generally  known  that  there 
are  certain  principal  occupations  creating  air 
conditions  that  tend  to  produce  characteristic 
fibroid  changes  in  the  lungs,  commonly  desig- 
nated as  pneumonoconiosis,  which  changes 
predispose  the  worker  to  infection  from  the 
tubercle  bacilli."  The  list  of  these  occupations 
includes  those  of  cutlery  makers,  filers,  grind- 
ers, abrasive  workers,  polishers,  buffers,  manu- 
facturers of  jewelry,  brass  workers,  finishers, 
sand  blasters,  saw  filers,  toolmakers,  glass 
blowers,  gla.ss  workers,  cotton  workers  (because 
of  mineral  substances  used  in  sizing),  marble 
and  stone  quarry  men,  molders,  potters,  miners 
of  copper,  gold,  silver,  graphite,  iron,  lead, 
zinc,  mic:i,  ])hos|)hate,  spar,  and  ((uicksilver. 

There  arc  standard  methods  for  air  purifica- 
tion in  general  use  in  industrial  plants.  These 
methods  take  the  form  of  hoods,  exhausts,  and 
fume  lines  usually  beginning  at  or  near  the 
work  plane  and  following  engineering  specifica- 


ABSTRACTS 


51 


tions,  exhausting  at  a  place  sufficiently  remote 
and  protected  to  control  the  hazards  arisinj^ 
from  the  occupation.  In  some  occupations, 
where  such  fume  lines  seem  to  be  unsatisfac- 
tory, wet  processes  have  been  introduced,  the 
wet  process  antedating  the  exhaust  as  a  means 
of  controlling  dusty  operations.  Some  ob.serva- 
tions  made  by  officers  of  the  Public  Health 
Service  aroused  doubt  as  to  the  adequacy  of 
these  so-called  protective  devices,  and  led  to  a 
detailed  research.  Tlie.se  investigations  confirm 
the  doubts  and  show  that  in  many  cases,  be- 
cau.se  of  mistakes  in  i)laiming  and  installing  and 
because  of  imperfect  methods  of  determining 
the  efficiency  of  the  devices,  operatives  have 
been  exposed  to  almost  as  great  a  hazard  as 
though  no  ])rotective  devices  had  been  installed. 
'J'lic  greatest  need  is  a  method  for  checking  the 
efficiency  of  the  apparatus,  and  this  check  can 
best  be  made,  not  by  anemometer  or  I  -tube 
readings,  but  by  air  samples  taken  at  liie  plane 
of  work  and  dust  counts  made  fnmi  these 
samples. 

It  has  been  the  almost  universal  belief  that, 
in  contntlling  air  dustiness,  wet  grinding  is  safer 
and  has  a  smaller  dust  hazard  than  ilry  grinding 
under  an  exhaust  system.  In  many  instances, 
this  has  been  shown  to  bo  false  l)y  studies  con- 
ducted by  Winslow  and  (ireenburg  in  an  ax- 
grlnding  factory.  Dust  counts  of  samples  were 
collected  by  the  Palmer  water-spray  machine  in 
the  wet  and  dry  grinding  .shops,  and  it  was 
shown  that  the  wet  grinding  was  ha/ardons  and 
gave  a  false  sense  of  .security,  and  that  the  ex- 
haust system  in  the  dry-grinding  plant  was 
adequate.  Other  investigations  have  given 
similar  results.  Both  jirocesses  have  dangers 
and  disadvantages.  Dust  in  wet  grinding  is 
often  caused  by  the  workman  who  regulates  the 
flow  of  liquid  to  suit  himself,  in  order  to  increase 
the  si)eed  of  his  work  or  to  jirotect  him.self  from 
the  s])ray.  With  dry  grinding,  care  and  atten- 
tion nuist  be  given  to  the  size  and  location  of 
the  hoods,  the  angle  of  taper  of  the  ducts,  the 
angle  at  which  the  branch  pipes  enter  the  main 
pipe,  the  use  and  size  of  the  bends  and  elbows, 
the  i)lugging  and  stoppage  of  the  screens  in  the 
hoods,  and  most  important  of  all,  the  suction 
maintained  at  the  terminal  hoods.  The  only 
entirely  reliable  means  of  measuring  the  effec- 
tiveness of  the  method  is  the  actual  dust  count 
at  the  plane  of  the  work.  Circumstances  and 
the  character  of  the  work  to  be  done  should 
determine  the  nature  of  the  safety  device  to  be 
installed.    It  mav  be  concluded  that  the  "dust 


content  of  a  polishing  shop  can  be  kept  gen- 
erally under  ,'500,000  small  one-fourth  standard 
unit  dust  particles  per  cubic  foot  and  sliould  not 
average  over  200,000."  —  G.  E.  Partridge. 

hirsG  Infl.\mm.ition  among  the  Workers 
WITH  Thomas  Slag  Dust.  Karl  Opitz.  Zen- 
tralbl.  f.  Gewerbehyg.,  Dec.  19^20,  8,  No.  li, 
ii'.i—lio.  —  No  study  of  the  dangers  to  workers 
in  the  Thomas  slag  industries  has  been  made 
since  the  voluntary  and  governmental  regula- 
tions which  greatly  decreased  the  hazards.  The 
ty])ical  sickness  of  these  men  is  a  non-si)ecific 
inflanunation  of  the  lungs.  The  sharp  dust  and 
the  resulting  injury  to  the  lung  fabric  makes 
access  of  a  morbific  agent  ea.sy.  Hofore  the  regu- 
lations the  mortality  among  these  workers  was 
as  high  as  '■28  per  cent,  of  those  employed  in  one 
factory.  After  1911  the  figure  dropped  to  1.^2 
])er  cent,  annually,  which  is  twenty  times  that 
in  other  industries.  In  tlic  sixty  (-lerman  i)lants 
with  about  2,500  workers  there  occur  about 
tliirty-five  deaths  annually.  Since  the  industry 
is  rather  scattered  no  one  physician  sees  many 
cases. 

The  laws  forbid  the  employment  in  this  in- 
dustry of  females  and  of  men  suffering  with 
catarrhal  troubles  of  the  respiratory  tract,  on 
the  supposition  that  such  i)ersons  are  more 
susce])tible  to  infiammation.  The  results  have 
borne  out  this  theory.  During  the  war  women 
were  allowed  in  the  Thomas  i)hosphate  meal 
works,  catarrhal  subjects  being  excluded. 
Statistics  are  availai)lc  from  one  plant,  a  part  of 
a  large  plant  where  '20  per  cent,  of  the  emjiloyees 
were  women.  In  the  Thomas  work  where  regu- 
lar monthly  medical  examinations  were  made, 
in  two  years  transient  catarrhal  colds  occiirred 
in  5.9  per  cent,  of  the  men  and  5.7  i)er  cent,  of 
the  women.  Excluding  the  ei)idemic  of  in- 
fluenza, serious  respiratory  di.seases  caused 
absence  from  work  in  ;Ui.8  ]>er  cent,  of  the 
women  and  '27.9  i)er  cent,  of  the  men.  During 
the  influenza  epidemic,  July  to  December,  1918, 
the  incidence  of  the  disease  in  the  whole  plant 
was  .'51. 1  per  cent",  among  the  men,  66.4  per  cent, 
among  the  women.  In  the  Thomas  plant,  73.3 
per  cent,  of  the  men  and  93.0  per  cent,  of  the 
women  suffered  from  the  disease,  although  the 
women  had  all  been  selected  as  having  less 
sensitive  mucous  membranes. 

Pnemnococci  are  especially  common  or- 
ganisms in  the  lung  cases  among  the  slag  work- 
ers. The  incidence  of  disease  may  be  cut  down 
bv  decreasing  the  numbers  or  the  virulence  of 


5^2 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


the  pathogenic  organisms  on  normal  nuicosae. 
Optochin  and  its  derivatives  might  be  used 
prophylactically  at  least  in  those  who  have  re- 
peated  catarriial   troubles   referable   to   pneu- 


mococfi.  In  any  case  of  nimierous  colds  among 
the  population  at  large  or  among  the  endan- 
gered workmen  prophylactic  treatment  with 
optochin  should  be  used.  —  E.  L.  Sevringhaus. 


OCCUPATIONAL  INFECTIOUS  DISEASES:  OCCURRENCE, 
TREATIVIENT  AND  PREVENTION 


A  Case  of  Human  Glanders.  F.  H.  Jacob, 
11.  M.  Turnhull,  J.  A.  Arkwright,  and  G.  M. 
Dobrashian.  Brit.  Jour.  Dermat.  and  Syph., 
Feb.,  \m\,  p.  39. —This  is  a  carefully  in- 
vestigatetl  record  of  a  somewhat  atypical  case. 
Unfortunately,  the  source  of  infection  remains 
unknown.  Lesions  in  the  skin,  the  soft  palate, 
a  gland  from  the  groin,  the  lungs  and  spleen  all 
showed  Gram-negative  bacilli,  which  the  report 
states  were  obviously  the  Bacilli  mallei.  Apart 
from  the  preponderating  number  of  these  or- 
ganisms, the  histological  findings  were  so 
definite  in  character  that  the  writers  do  not 
hestitate  to  affirm  that  these  alone  indicate  the 
causal  organism. 

The  patient  was  a  farmer  aged  31  years.  He 
attributes  his  complaint  to  milking  a  cow  whose 
udder  was  affected  with  a  series  of  small  lumps 
discharging  water  and  matter.  A  previous  milker 
of  the  same  cow  is  said  to  have  suffered  from  the 
same  complaint,  but  he  finally  became  quite 
well.  In  August,  1!)17  the  subject  of  this  article 
noticed  a  lumj)  on  his  wrist  which  grew  to  the 
size  of  half  a  crown.  In  three  weeks  it  com- 
pletely disappeared.  From  this  time  until  his 
death  a  series  of  these  lesions,  beginning  as 
small  papules  and  in  twenty-four  hours  attain- 
ing the  size  of  shillings  and  affecting  any  part  of 
his  body,  continuously  appeared  and  died 
away.  They  were  purplish  red  in  color  and  felt 
as  hard  as  a  Hunterian  chancre,  when  grasped 
between  the  fingers.  None  ever  ulcerated  ex- 
cept a  few  at  the  beginning  of  the  disease.  In 
February,  1918  the  patient's  throat  gave  him 
great  trouble  and  his  left  tonsil  and  soft  palate 
broke  into  decj)  holes.  His  tem])erature  ranged 
between  100^  and  1()'2°,  but  his  general  condition 
remained  fairly  good.  During  the  following 
September  the  sores  in  his  mouth  ulcerated 
through  tiie  cheek  and  the  destruction  of  tis- 
sues spread  rai)idly  like  "cancrum  oris."  His 
general  health  rapidly  became  wor.se  and  he 
died  on  September  26,  1918.  No  evidence  could 
be  eliciteil  of  anything  resembling  glanders 
among  his  own,  or  his  neighbors"  horses,  to 
account  for  tiiis  infection. 


.\  colored  plate  and  photographs  illustrate 
the  article.  — R.  Prosser  White. 

Tuberculosis  .\mong  Polishers  and 
Grinders  ix  an  Ax  Factory.  W.  Herbert 
Drurij.  U.  S.  Pub.  Health  Ser.,  Pub.  Health 
Rep.,  Feb.  4,  1921,  36,  No.  5,  159-178.  —  The 
author  gives  the  following  summary  and  con- 
clusions : 

"1.  This  statistical  study  of  an  industrial 
establishment  developed  the  fact  that  a  certain 
group  of  w-orkers,  viz.,  '  polishers  and  grinders,' 
are  subject  to  a  very  high  death  rate  from  pul- 
monary tuberculosis.  .  .  .  The  excess  death 
rate  among  the  '  poli.shers  and  grinders  '  indi- 
cates that  seventy-eight  men  have  died  .during 
the  past  two  decades  as  a  result  of  industrial 
tuberculosis  in  these  particular  grinding  shops. 

"2.  The  maximum  niunber  of  deaths  from 
tuberculosis  among  '  polishers  and  grinders  ' 
occurs  at  the  age  of  45  years,  instead  of  at  25 
years  as  among  the  other  operatives  in  the  mill. 
This  ])eculiar  age  incidence  and  the  enormous 
excess  death  rate  for  the  '  polishers  and  grind- 
ers '  are  closely  associated  with  the  environ- 
mental conditiims  of  the  industry,  although  the 
])robleni  is  complicated  by  the  fact  that  the 
grinders  also  represent  a  foreign  group  of  low- 
social  status  and  intemperate  habits. 

"3.  In  view  of  the  facts  brought  out  by 
Winslow  and  Greenburg  in  regard  to  the  dust 
content  of  the  air  of  various  workrooms  in  the 
jjlant,  it  seems  clear  that  the'  dust  produced  in 
wet  grinding  is  largely  responsible  for  the 
enormous  incidence  of  tuberctilosis  found  in 
connectiim  with  this  industrial  establishment. 
The  practical  conclusion  to  be  drawn  from  this 
investigation  is  that  wet  grinding,  instead  of 
being  a  dustless  and  innocuous  process,  as  has 
conunonly  been  sujjposcd,  may.  under  certain 
conditions,  be  a  dusty  and  exceedingly  dan- 
gerous one,  particularly  when  grinding  wheels 
of  natural  sandstone  are  used.  When  such  is  the 
case,  every  ctt'ort  should  be  made  to  substitute 
a  dry-grinding  process  properly  protected  by 
the  installation  of  exhausts,"  —  M.  C.  Shorley. 


ABSTRACTS 


53 


OCCUPATIONAL  AFFECTION'S  OF  THE  SKIN  AND  SPECIAL  SENSES 


Metol  Dermatitis  ("Photogkaphers'  Ec- 
zema"). From  Queries  and  Notes,  Jour.  Am. 
Med.  Assn.,  Feb.  10.  l'>21.  76.  No.  8.  540.— 
"  To  the  Editor:  —  The  other  day  a  photog- 
rajjlier  consulted  me  for  cutaneous  lesions 
around  the  inner  canthi  of  both  eyes,  and  hirge 
areas  on  the  anterior  surface  of  tiie  left  knee 
and  groin.  Tiie  lesions  did  not  have  the  apijcar- 
ancc  of  ])soriasis  hut  ratlier  that  of  '  weeping  ' 
eczema.  The  family  hi.story  was  negative  for 
psoriasis  or  other  similar  skin  lesions.  Further 
history  elicited  thai  llie  lesions  first  ai)i)eared 
atjout  l!)l'-2;  and  at  this  lime  the  i)ationt  began 
using,  in  developing,  a  German  preparation 
called  Metol  (Hoff),  handled  solely  by  G.  Gcn- 
nert,  "24-20  East  Thirteenlli  Street,  New  York, 
whicii  chemical  is  now  widely  used  in  ])hotog- 
raphy.  Furthermore,  the  ])atient  has  a  friend 
who  cannot  come  into  the  room  wlicrc  this 
product  is  u.sed  without  having,  as  a  result, 
intense  itching  and  a  fine  jiajjular  eruption  on 
variable  |)laces  of  the  body. 

"The  indexes  of  The  Journal,  for  several 
years  l)ack,  give  no  information  on  this  subject. 
Can  you  give  me  any  source  of  information  on 
this  subject? 

"Answer. — ^Yorkers  in  photograj)hic  es- 
tablishments, especially  tho,se  engaged  in  the 
de\cloi)iiig  jjrocess.  are  exposed  to  a  number  of 
industrial  poisons,  such  as  bromin,  chromiuni, 
'metol'  (a  trade  name  for  mono-methyl  para- 
amido  metacresol  sulphate),  cyanogen,  plat- 
inum, vanadium,  anilin  and  mercurial  com- 
pounds. Kobcr  and  Hanson  (Diseases  of 
Occupation  and  N'ocalional  Hygiene,  Phila- 
delphia, lOIO,  ]).  (516)  state  that  '  in  an  ex- 
amination of  forty  studios  in  Chicago  by  Dr. 
Karasck,  |)latinum  pa])er  was  found  to  be  the 
cause  of  eight  cases  of  iioisoning.  characterized 
by  "])ronounced  irritation  of  the  throat  and 
nasal  passages,  causing  violent  sneezing  and 
eougliing;  broncliial  irritation,  causing  such 
res])iratory  ditticulties  as  to  ]irecludo  the  use  of 
the  ])ai)er  entirely  for  .some  individuals,  and 
irritation  on  contact  with  the  skin,  causing 
cracking,  bleeding  and  ])ain."  Metol  poisoning, 
characterized  by  an  erythematous  rash  of  the 
hands  and  arms,  occasionally  involving  other 
parts  of  the  body  and  giving  rise  to  ulcers,  was 
found  in  thirty-one  cases  in  this  same  study. 
The  de^•eloJ)ing  jjrocess  frequently  gives  rise  to 
inflammatory    conditions    of    the    hands    (ec- 


zema), ulcers  and  pigmentation  unless  pro- 
tected by  rubber  gloves.' 

"The  so-called  '  i)hotogra])hers"  eczema,'  the 
most  common  disease  of  this  occujjation,  is  due 
to  '  metol.'  In  an  answer  to  a  cpiery  in  this  de- 
partment several  years  ago  (Metol  Dermatitis, 
The  Journal,  Feb.  15,  1915,  p.  610)  concern- 
ing the  method  of  treatment  for  this  condition, 
it  was  stated  that: 

"There  have  been  various  recommendations 
for  ])rophylaxis  and  treatment.  Coating  the 
hands  \\\{\\  ])etrolatum  before  beginning  de- 
vel(>|)nient  is  a  useful  ])recaution.  L.  A.  Free- 
man [British  Journal  of  Photographi/,  June  5, 
1914)  recommends  that  2  drops  of  pure  phenol 
(carbolic  acid)  be  added  to  a  quart  of  cold 
water.  Innner.se  the  hands  in  it  after  the  use  of 
metol,  and  warm  gently  over  a  gas  flame  until 
the  heat  is  no  longer  tolerable.  Then  wash 
thoroughly  with  carbolic  soap  and  dry  well. 

"  Before  the  skin  is  broken.  \.  T.  Beers  {Sew 
)'orL-  M.  ./..  Sept.  10.  1!)08:  ahstr..  The  Jour- 
nal, Sept.  "26, 1908,  p.  1107)  recommends  .sooth- 
ing ai)plications,  such  as  lead  lotion.  After  the 
skin  is  broken,  care  must  l)e  taken  to  ])roteet 
the  parts  tiioroughly  and  to  use  the  blandest 
of  applications.  Zinc  stearate  with  1  or  "2  ])er 
cent,  of  phenol  or  salicylic  acid  makes  a  useful 
dusting  |)owder.  In  the  later  stages,  more 
stinuilating  applications  may  be  u.sed,  such  as 
small  aniiiiinls  of  oil  of  cade  or  of  resorcin  or 
ichthyol. 

"This  ointment  has  been  advised:  ichthyol, 
resorcinol,  glycerin,  of  each.  1  ou'nce;  zinc  oxid. 
',  ounce;  white  ])etrolatum.  (>  ounces  (lirlt.  J. 
'rhotog.,'Sov.  7,  1913,  p.  860)."— C.  K.  Drinker. 

Affections  of  the  Retina  and  Optic 
Nerve  Caused  by  Arsenical  Poisoninc. 
//.  A'.  (Ic  [lactis.  Abstracted  as  follows  from 
Arch.  Ophth..  1919,  99,  p.  16;  Zentr.  Biochem. 
Biophys.,  "21,  p.  .'545  by  H.  S.  Paine  in  Chem. 
Abstr.",  Nov.  "20.  19"26.  14,  No.  2"2,  :54(i5.  — 
"As  was  detected  in  the  urine  of  55  out  of  58 
patients  with  inflammatory  modifications  of 
the  retina  and  optic  nerve.  H.  describes  the 
clinical  aspect  of  arsenical  neuroretinitis.  The 
occurrence  of  arsenicuria  was  established  by 
use  of  sensitive  methods  and  careful  technic. 
Normal  urine  is  free  from  As.  The  urine  con- 
tained an  average  of  only  13.7  mg.  AS2O3  per 
1.  in  arsenical  neuroretinitis." 


54 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Industrl\l  Myopia  and  Selection  of 
A  Tr.\de.  R.  Schneider.  Miinchen.  med. 
Wchnschr.,  July  .'?0,  UHO,  67,  No.  31.  Sdi.  — 
The  material  for  this  study  was  obtained  from 
the  record  of  the  refraction  of  5,600  troops  who 
were  sent  to  an  eye-station  behind  the  western 
front  during  the  period  from  August,  1917  to 
March,  1918.  No  cycloplegic  was  used,  and  the 
cases  of  simple  and  mixed  astigmatism  were 
not  considered.  The  men  were  classified  into  six 
groui)s,  according  to  their  civilian  occupation, 
as  follows:  farmers  antl  farmhands;  unskilled 
workmen  and  day-laborers,  factory  hands,  rail- 
road men,  and  chauffeurs;  workmen  with 
coarse  hand-work,  such  as  gardeners,  masons, 
carpenters,  smiths  and  bakers;  workmen  with 
fine  hand-work,  as  typesetters,  printers,  photog- 
raphers, draftsmen,  painters,  musicians,  sculp- 
tors, watchmakers,  and  opticians;  merchants, 
booksellers,  students,  officials  without  higher 
education;  and  men  with  higher  education,  and 
labor  officials.      It  was  found  that: 

1.  There  were  many  more  myopes  in  the 
higher  groups. 

i.  In  spite  of  the  myopia,  the  visual  acuity 
was  much  better  in  those  who  did  near  work. 

3.  The  lower  (-0.25  to  -3)  and  middle 
(  —  3.50  to   —8)  grades  of  myopia  were  more 


common  in  the  higher  groups,  but  the  higher 
grade  (above  —8)  was  five  or  six  times  more 
common  in  the  two  lower  groups  than  in  the 
sixth. 

4.  Those  in  the  higher  groups  who  had  the 
higher  grades  of  myopia  had  a  better  visual 
acuity  than  those  in  the  lower  groups  with  the 
same  grade  of  myopia. 

Professor  Schneider  thinks  that  these  find- 
ings can  be  explained  for  the  most  part  by  selec- 
tion and  elimination.  For  instance,  merchants 
and  students  find  that  a  moderate  degree  of 
myopia  is  ad^•antageous  when  presbyopia 
comes  on.  As  Weismann,  the  great  student  of 
heredity,  says,  "the  nearsighted  linxes,  falcons, 
and  gazelles  were  destroyed  by  natural  selec- 
tion, as  was  the  myopic  Indian;  but  the  near- 
sighted European  of  the  upper  classes  finds 
business  iind  bread."  In  some  trades  the  myope 
is  eliminated  by  law  {e.  g.,  postal  service,  rail- 
ways, sea)  or  by  prejudice  against  glasses 
(waiters).  Some  reasons  why  myopes  of  high 
grade  are  found  in  the  lower  groups  are:  their 
low  visual  acuity,  the  teaching  that  they 
should  get  work  that  does  not  require  close 
application,  and  the  avoidance  of  marriage  by 
those  in  the  upper  groups  who  have  extreme 
myopia.  —  H.  G.  Noyes. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


A  Standard  Schedule  as  an  Aid  to  Uni- 
formity IN  Accident  Reporting.  Leonard 
W.  Hatch.  Am.  Labor  Legis.  Rev.,  Dec,  19'20, 
10,  No.  4,  aS'J-^SS.  —  AVith  a  view  to  establish- 
ing a  simple  and  convenient  uniform  lilank  for 
the  legal  reporting  of  industrial  accidents,  the 
American  Association  for  Labor  Legislation 
has  drawn  ni>  a  standardized  form,  given  in 
full  in  this  article,  which  it  urges  all  states  to 
adopt.  —  Elizabeth  C.  Putnam. 

Nucleus  for  Accident  Prevention  Li- 
brary. Safety  Engin.,  Dec,  1920,  40,  No.  6, 
268.  —  This  list  was  compiled  by  Miss  Keller, 
librarian  of  the  Independence  Bureau,  Phila- 
delphia, with  the  advice  and  approval  of  the 
accident  engineers  of  the  Bureau.  —  M.  Dent. 

Occurrence  and  Prevention  op  Indus- 
trial .\ccidents.  J.  Ale.rander.  Abstracted 
as  follows  from  Baltimore  (ias  and  Electric 
News,  in  Per.sonnel,  Jan.,  1921,  3,  No.  1,  8.  — 


The  author  draws  attention  to  the  following 
factors  in  accident  prevention : 

1.  Provision  for  proper  lighting  and  ventila- 
tion in  industrial  plants.    • 

2.  Adoption  of  safeguards  on  all  machines, 
etc.,  that  are  likely  to  cause  accident. 

3.  The  avoidance  of  loose  clothing  of  any 
kind  that  may  become  entangled  in  a  belt  or 
gear. 

4.  Goggles  should  be  provided  and  worn 
whenever  there  is  danger  of  foreign  material 
flying  in  the  eyes. 

5.  Tools  of  every  description  should  be  prop- 
erly racked  in  a  convenient  location  and  the 
floor  kepi  clear  of  all  material  that  might  result 
in  a  fall. 

6.  Habitual  carelessness  of  employees  should 
be  strongly  supi)ressed  even  though  it  entails 
the  transfer  of  tiie  oft'ender  to  .some  other  de- 
partment where  the  work  is  of  the  fool-proof 
variety. 

7.  Repeated  medical  e.xaminations  should  be 
required  of  all  employees  engaged  in  hazardous 


ABSTRACTS 


oo 


occupations  in  order  to  determine  their  physical 
fitness  for  that  particidar  class  of  labor. 

8,  Prompt  and  skilled  surgical  attention 
should  be  obtained  immediately  after  injury. 

Avoidance  of  overfatigue,  a  careful  atten- 
tion to  all  minor  cases  of  sickness  with  a  close 
observance  of  the  ordinary  rules  of  personal 
hygiene  will  further  our  effort  to  assist  the 
employee  in  accident  prevention  at  his  par- 
ticular plant  or  station.  —  M.  Dent. 

Saving  Men  .\nd  Money.  L.  lie.itiick:  Xat. 
Safety  News,  Dec.  6,  1920,  2.  No.  23,  3-7;  Il- 
ls.—  The  safety  and  medical  work  of  the 
Bethlehem  Steel  Com])any  is  liere  <iescril)ed. 
The  corporation  operates  fotir  i>lants  employ- 
ing altogether  about  31, ()()()  men,  and  the 
building  uj)  of  the  medical  and  safety  work  has 
been  given  serious  attention.  In  the  aggregate, 
the  results  which  have  been  obtained,  measured 
in  terms  of  saving  of  life  and  time,  appear  very 
decisively  to  justify  the  effort  and  ex])ense. 
The  figures  for  tlic  first  ten  montlis  of  V.HO, 
comjjared  with  those  for  the  preceding  year, 
show  for  all  the  plants  a  reduction  of  ').'>  per 
cent,  in  fatal  accidents;  of  7t)  per  cent,  in  acci- 
dents resulting  in  the  loss  of  eyes;  of  ,)0  per 
cent,  in  accidents  resulting  in  loss  of  legs  or 
feet.  During  the  year  191!),  the  accident  sever- 
ity rate,  measured  in  days  lost  per  hundred  men 
per  month  was  1.5.3,  while  for  !!)','()  the  rate  was 
reduced  to  1.3. 7,3  —  an  ecjuixaleiit  of  tiic  full 
time  of  twenty  men  for  the  whole  period  of  ten 
months. 

In  1910,  when  .safety  work  was  in  its  in- 
fancy, at  least  .50  per  cent,  of  the  injuries  in  in- 
dustry became  se|)lic  womids,  while  the  |)resent 
record  of  the  Bethlehem  Steel  Company  shows 
that  during  1920  not  a  single  ea.se  of  infec- 
tion ajjpeared  in  many  thousands  of  cases 
treated  in  the  coniiiany  lios])ital.  iJefore  1913 
nothing  that  could  be  called  organized  accident 
prevention  was  done  at  Bethlehem,  but  since 
then  the  medical  work  and  safety  work  ha\e 
been  greatly  extended  and  thoroughly  or- 
ganized. Each  of  the  plants  has  its  safety  super- 
intendent, assisted  Iby  an  office  staff  and  two 
outside  .safety  inspectors,  who  also  act  as  first- 
aid  instructors.  In  addition  to  the.se  there  is  an 
army  of  unpaid,  i)ermanent  safety  committee- 
men; there  are  more  than  4,000  men  in  the 
Bethlehem  steel  plants  who  have  received 
thorough  training  in  first-aid  work.  For  several 
years  there  has  been  in  ojjeration  in  the  Beth- 
lehem plant  a  guard-making  shop  employing 


about  fifty  men,  who  are  constantly  bn.sy  re- 
pairing, making,  and  installing  safeguards,  and 
who  equip  an  average  of  4,000  machines  a  year. 
Recently  the  safety  department  of  the  Beth- 
lehem Comijany  became  dis.satisfied  with  its 
work.  Upon  investigation  it  was  found  that 
the  organization  was  cumbersome,  that  the 
departmental  committees,  because  they  were 
com|)oscd  entirely  of  workmen,  were  not  re- 
cei\ing  proi)er  attention  from  the  foremen,  and 
that  the  safety  department  was  hampered 
because  there  were  still  thousands  of  work- 
men iti  the  plant  w'ho  understood  little  or  no 
Knglish.  The  (ic])ar(inent  was,  therefore,  sub- 
divided, superintendents  of  the  various  steel 
plants  were  asked  to  become  responsible  for 
safety  work  in  their  departments,  and  classes 
were  established  to  teacii  the  Knglish  language 
and  arithmetic.  The  result  of  the  reorganiza- 
tion appears  in  the  form  of  a  steady  reduction  in 
lost  time.  —  G.  E.  Partridge. 

Five  Months  witiioit  .\n  Accident: 
Recoki)  of  Sheepskin  Wokkehs.  Nat.  Safety 
News,  Jan.  17,  1921,  3,  No.  3,  7.  —  Nine  of  the 
seventeen  subdivisions  of  the  A.  C.  Lawrence 
Leather  Company  of  Peabody,  Mass.,  are  re- 
ported as  having  an  absolutely  clean  accident 
record  for  tiie  first  five  months  of  1920.  Two 
divisionii  made  the  same  perfect  record  during 
the  entire  year  1919,  making  .seventeen  months, 
therefore,  during  which  no  person  lost  a  day 
because  of  injury  received  during  work. 

The  time-lost  records  for  all  divisions  of  the 
sheepskin  d<'[)artment  of  tiiis  coni])any  average 
lower  than  one  man's  time  ])er  thousand  men 
lost  ])er  day  for  each  month.  Each  member  of 
the  .safety  committee  of  this  plant  is  selected 
from  a  section  doing  a  certain  class  of  work,  is 
given  the  title  of  safety  director  of  his  unit,  and 
is  resjjonsiblc  for  tlie  .safety  work  iu  that  unit. 
—  G.  E.  Partridge. 

The  Question  of  Incre.\sed  Protection 
ACAi.vsT  Accidents  for  Indvstkial  Workers 
Who  Were  Injired  in  the  War.  H.  F. 
Ziegler.  Zentralbl.  f.  Gewerbehyg.,  Dec.,  1920, 
8,  No.  12,  232-23(i.  —  It  is  more  necessary  than 
ever  to  take  safety  measures  in  the  training  and 
employment  of  men  who  were  injured  during 
the  war.  Suggestions  are  given  from  the  de- 
vices and  practices  at  the  Siemens-Schukkert 
works  near  Berlin.  The  inspectors  and  the 
labor  unions  have  pronounced  these  methods 
completely  satisfactory.    Many  blind  men  are 


56 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


employed  here  at  machine  work.  All  rotary 
and  moving  i>arts  are  enclosed.  Electric  unit 
drive  is  valuable.  Automatic  conveyors  aid 
in  the  system.  Adequate  illumination  and 
clear  floor  space  are  essentials.  Care  must  be 
taken  that  these  men  are  not  exposed  to  the 
danger  of  coal  tar  products  or  to  the  skin  lesions 
of  inferior  oils.  To  guard  against  injuries  to 
fingers  and  hands,  punches  are  so  made  that 
both  hands  are  needed  to  operate  the  machine. 
'  Sharp  edges  of  tools  and  products  are  guarded. 
Openings  for  material  to  fit  into  machines  leave 
no  room  for  a  hand  beside  the  metal.  Rivet 
machines  have  wire  cages  which  automatically 
push  the  hands  out  of  the  way  of  the  moving 
parts.  The  measures  are  so  effective  that  in 
three  years  with  114  reported  accidents  only 
three  came  from  this  plant,  all  of  which  were 
slight.  No  blind  men  were  involved  in  acci- 
dents. —  E.  L.  Sevringhaus. 

Getting  Rid  of  Ladder  Accidents.  W. 
Dean  Keefer.  Nat.  Safety  News,  Jan.  3,  1921, 
3.  No.  1,  4-5.  — It  is  estimated  that  in  1919 
about  1.000  persons  were  killed  by  falls  from 
ladders.  Many  more  each  year  are  permanently 
disabled  by  such  accidents.  To  prevent  them, 
certain  rules  about  the  construction  of  ladders 
should  be  adliered  to.  For  stationary  ladders: 
(1)  a  clearance  of  not  less  than  CJ  inches  should 
be  provided  back  of  the  ladder  rungs,  to  allow 
firm  hold  upon  the  rung;  ('•2)  a  continuous  clear- 
ance, in  front,  of  at  least  30  inches,  and  at  least 
15  inches  on  each  side  of  the  center  line  of  each 
ladder  should  be  allowed,  so  that  a  cram])ed 
position  will  not  be  necessary  in  climbing  the 
ladder;  (3)  wherever  possible,  long  stationary 
ladders  should  be  built  in  zigzag  sections  with 
safety  platforms  about  every  20  feet;  (4)  the 
side  rails  of  the  ladder  should  be  extended  at 
least  45  inches  above  the  landing;  (5)  station- 
ary ladders  more  than  30  feet  in  length  sliould 
be  provided  with  a  well-ba.sket  or  cage  guard. 

Portable  ladders  which  are  always  made  of 
wood,  should  never  exceed  30  feet  in  leng^i. 
The  licst  materials  should  be  used  and  great 
care  taken  to  .see  that  the  ladders  are  in  good 
condition  and  free  from  splinters.  The  method 
of  fastening  the  rungs  to  the  side  rails  is  an 
im|)()rtant  ])()int.  They  should  always  be  in- 
serted in  holes  and  never  nailed  or  screwed  to 
the  outside.  Tiiere  are  many  types  of  ladder 
feet  and  safety  shoes,  none  suitable  for  use  on 
all  kinds  of  floors.  For  rough  or  wooden  floors, 
the  bases  should  have  case-hardened  steel  spurs 


or  disks,  or  lead-footed  bottoms.  On  concrete 
and  rough  iron  floors,  shoes  of  lead  or  other 
abrasive  substance  are  good.  For  wet  and  rela- 
tively smooth  floors  recessed  rubber  bases  have 
given  the  best  satisfaction.  On  some  floors, 
nothing  in  the  way  of  shoes  is  safe,  and  the 
only  method  is  to  tie  the  ladder  or  have  it  held 
at  the  foot.  Whenever  possible,  ladders  with  a 
goose-neck  or  hook  at  the  top  should  be  used. 
Step-ladders  are  subject  to  hard  usage,  and 
great  care  is  necessary  in  providing  proper 
strength  and  rigidity.  They  should  never  be 
more  than  20  feet  in  length,  and  it  is  essential 
that  each  step  be  reinforced  and  secured  to  the 
side  rails  by  other  means  in  addition  to  nails. 
Another  important  point  is  the  provision  of  the 
metal  automatic  locking  device  or  spreader  to 
hold  the  front  and  back  rails  apart.  To  have 
the  proper  pitch,  the  spreader  should  be  so 
arranged  that  when  the  ladder  is  open,  the 
spread  at  the  bottom  between  the  front  and 
back  rails  will  be  greater  than  the  spread  at  the 
top  by  an  amount  not  less  than  \\  inches  for 
each  foot  of  ladder  length.  All  ladders  should 
be  kept  clean;  iron  and  steel  ladders  should  be 
coated  with  a  preservative  paint  or  composi- 
tion, but  wooden  ladders  .should  never  be 
painted,  since  paint  is  likely  to  cover  imper- 
fections. Each  ladder  should  be  numbered  and 
subjected  periodically  to  inspection.  —  G.  E. 
Partridge. 

Safety  in  the  Construction  Industry. 
F.  A.  Daridson.  Safety,  Nov.-Dec,  1920,  8, 
No.  11-12,  181-192. —The  author  believes 
that  tiie  modern  safety  idea  can  be  applied  to 
the  construction  industry  as  it  has  been  in 
other  lines.  This  industry  cannot  afford  to 
postpone  the  taking  of  vigorous  action  to  re- 
duce accidents  if  only  as  a  business  proposition. 
The  necessary  practical  steps  to  accomplish 
this  action  are  outlined  as  follows: 

1.  Tiie  insistence  by  executives  that  acci- 
dents be  eliminated. 

2.  The  arranging  for  complete  co-i)])eration 
between  the  various  divisions  of  each  individual 
comi)any  and  also  betweeh  different  construc- 
tion comi)anies. 

3.  The  compiling  of  standard  accident 
recortis. 

4.  The  utilization  of  every  practical  means 
to  educate  the  field  forces  in  safety. 

5.  The  taking  of  every  precaution  to  have  all 
of  the  mechanical  features  of  construction  work 
thoroughly  safe.  —  G.  M.  Fair. 


ABSTRACTS 


57 


Hand  Tools.  National  Safety  Council, 
Safe  Practices  No.  39,  pp.  16;  Machine  Shop 
Machinery.  Safe  Practices  No.  40,  pp.  16; 
Suggestion  Systems.  Safe  Practices  No.  41, 
pp.  1.5.  —  A  representation  of  accident  hazards 
with  hand  tools  and  machine  shop  machinery, 
and  suggestions  as  to  the  best  practices  for 
their  elimination.  —  M.  Dent. 

Inspections  for  Hazards  in  Llthbering 
and  Logging.  CO.  Hern.  Safety  Engin.,  Dec, 
lOSO,  40,  No.  6,  2.58^26-2.  —  A  description  of 
the  sawing,  lumbering,  logging,  and  veneering 
operations,  and  the  various  dangers  to  which 
men  are  subjected  while  engaged  in  them.  The 
author  concludes  with  the  truism  that  safety 
education  is  the  best  possible  way  of  eliminat- 
ing accidents.  —  M.  Dent. 

The  Hazards  of  the  Logging  Industry  — 
Mechanical  vs.  Human.  W.  Graham  Cole. 
Safety  Engin.,  Dec.  lO'JO,  40,  No.  6,  ^.^S-'J.)?. 
—  Althougii  it  is  generally  agree<l  that  from  7.5 
to  80  per  cent,  nt'  all  industrial  accidents  are 
preventable,  in  the  logging  industry  no  attemi)t 
has  been  made  until  very  recently  to  ap|)ly 
safety  inetliods.  This  industry  is  carried  on  iiy 
backwoodsmen,  ])rone  to  do  as  tiieir  fathers 
and  grandfathers  before  them  have  always 
done.  They  are  trained  to  the  knowledge  that 
theirs  is  a  dangerous  living,  and  it  has  not  oc- 
curred to  them  to  try  safer  methods. 


A  table  is  given  showing  the  causes  of  acci- 
dents in  the  logging  industry,  the  most  notable 
of  which  have  been  extracted  and  listed  here: 
(1)  fall  of  trees  —  the  most  frequent  and  severe 
type  of  accident.  Accidents  from  the  "kick- 
back" of  falling  trees  are  preventable  by  the  use 
of  the  V-Bed  method  in  sawing;  (2)  hand  tool 
accidents;  (3)  railroad  operations;  (4)  various 
causes,  such  as  handling  exijlosives,  animals, 
machinery,  cables,  chains,  blocks,  etc. 

The  men  being  rough  and  careless,  the  most 
needed  step  is  to  educate  them  in  precaution- 
ary methods.  —  M.  Dent. 

EngineeuiNg  Problems  in  Di'st  Explo- 
sion Prevention.  David  J.  Price.  Chem.  and 
Metall.  Engin.,  Jan.  5,  1921,  24,  No.  1,  29-32. 
—  .\fter  di.scussing  the  types  of  industrial 
plants  in  which  dust  explosions  may  occur,  tiie 
writer  takes  up  the  causes  of  explosions  by 
c<)m])aring  this  type  of  explosion  with  a  gas 
explosion  to  which  it  is  similar  in  all  its  salient 
characteristics,  except  that  the  [jarticles  in  a 
dust  cloud  are  larger  than  the  minute  molecules 
in  a  gas  niLxture.  To  produce  either  type  of 
explosion  it  is  necessary  that  a  proper  mixture 
of  gas,  or  dust,  and  air  and  a  source  of  ignition 
be  |)resent.  The  writer  has  studied  the  ignition 
temperatures  of  gases  and  dusts,  the  propaga- 
tion and  velocity  of  the  flames,  the  pressures 
developed  by  the  explosion  and  the  relation  of 
iuiniidity  to  explosion  frccjuency.  —  G.  M. 
Fair. 


INDUSTRIAL  SURGERY 


A  Case  of  Industrial  Inji'ry  in  a  Cooper. 
W.  Smiial.  Zentralbl.  f.  Gewerbehyg.,  Dec, 
1920,  8,  No.  12,  228-231.  — Details' are  given 
of  a  36-year  old  cooper  who  had  sutt'ered  three 
different  times  in  twenty-two  years  of  such 
work  from  a  painful  c;illous  tumor  on  the  hy- 
pothenar  eminence  of  the  left  hand.  There  was 
a  slowly  developing  loss  of  nmscle  sense  in  the 
left  hand  and  forearm  causing  him  to  droj)  his 
tools.  The  condition  was  cured  by  removing 
the  callous  skin  and  also  beneath  this  layer  a 
purulent  cyst  with  a  callous  covering.  The  first 
two  treatments  were  by  incisions,  the  latter,  by 
the  author,  was  a  softening  of  the  tissue  with 
baths  and  salicylic  plasters,  followed  by  pain- 
less removal  of  the  masses.  There  was  evi- 
dence of  involvement  of  the  palmar  fascia. 

The  continued  trauma  to  the  hand  from  the 


use  of  a  hannner  with  a  metal  ferrule  on  the 
handle  cau.sed  the  callous  to  develop  and  also 
gave  rise  to  a  raucous  cyst.  This  tissue  is  very 
friable,  and  during  work  in  cold  water  in  winter 
infection  easily  enters  through  cracks.  Infec- 
tion reaches  the  cyst  and  causes  painful  inflam- 
mation. An  inspection  of  the  hands  of  a  large 
number  of  coopers  showed  such  left  hand  cal- 
lous places,  and  there  were  many  histories  of 
winter  inflammations  in  the  region. — E.  L. 
Sevringhaus. 

A  Pecltliar  Injury  Dub  to  Black  Italian 
Thread.  OHo  Sach.s.  Wien.  klin.  Wchnschr., 
July  19,  1920,  33,  No.  34,  752-754.  —  A  case  is 
described  in  which  a  seamstress  abraded  her 
little  finger  with  black  thread  made  in  Italy. 
Ti-ssue  necrosis  occurred  and  the  wound  spread, 


58 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


refusing  to  heal  under  local  treatment.  Second- 
ary infection  followed.  Excision  of  the  focus 
permitted  early  healing.  Chemical  examination 
and  animal  experiments  demonstrated  clearly 
that  the  cause  of  the  necrosis  was  primarily  due 


to  the  aniline  dye  known  as  "ice-black,"  a 
lipoid-sohible  azo  dye  similar  in  structure  to 
amido-azotoluol.  Austrian  black  thread  is 
dyed  with  aniline  black,  which  is  harmless.  — 
Barnett  Cohen. 


INDUSTRIAL  PHYSIOLOGY:  NUTRITION,  METABOLISM, 

FATIGUE,  ETC. 


Practical  Methods  of  Reducing  Fatigue. 
Frank  B.  Gilbreth  and  L.  M.  Gilbreth.  Mod. 
Med.,  Jan.,  1921,  3,  No.  1,  22.  —  In  this  article 
the  fact  is  set  forth  that  as  much  data  as  any 
individual  may  collect  on  the  elimination  of 
fatigue  will  be  of  great  value  to  those  who  are 
devoting  themselves  to  the  scientific  study  of 
this  important  industrial  question.  To  have 
more  data  is  of  greater  importance  than  to  dis- 
pute as  to  the  relative  efficiency  of  present 
methods  and  devices.  To  obtain  these  data 
let  each  man  analyze  his  process  of  work  in 
terms  of  motion  and  the  resulting  fatigue, 
with  the  aim  of  devising  the  one  best  way 
to  do  the  work.  This  will  add  greatly  to  the 
amount  of  attention  devoted  .to  these  special 
problems. 

All  material  should  be  carefully  checked  and 
re^'ised  by  a  trained  laboratory  worker  in  order 
to  attain  the  greatest  economy  of  effort  and  the 
most  profitable  and  permanent  results.  To  test 
the  value  of  rest  periods  is  a  matter  for  experts 
and  careful  trial  and  study. 


A  method  of  study  for  reducing  fatigue  is 
suggested  which  includes  the  worker,  the  sur- 
rounding conditions  and  tools,  and  motion 
study.  Motion  study  is  analyzed  according  to 
types  of  motion  and  also  to  cycles  of  motion. 
The  types  of  motion  are  (1)  those  which  re- 
quire the  worker's  best  effort  and  ability;  (2) 
those  which  are  performed  with  the  ease  and 
pleasure  of  habit;  (3)  those  which  soon  are  re- 
duced to  dull  monotony.  The  work  should  con- 
tain the  right  balance  of  these  tliree  types.  The 
cycles  of  motion  are  the  various  combinations 
of  the  sixteen  elements  of  search,  find,  select, 
grasp,  position,  assemble,  use,  disassemble,  in- 
spect, transport,  load,  pre-position  for  next 
operation,  release  load,  transport  empty,  un- 
avoidable delay,  and  rest  for  overcoming 
fatigue. 

The  cost  of  studying  fatigue  reduction  could 
be  lessened  by  the  application  of  each  to  his  own 
task  but  in  any  case  the  cost  is  quite  justified  by 
the  results  in  increased  efficiency.  —  Elinor  D. 
Gregg. 


HEAT,  COLD  AND  HUMIDITY 


A  Preliminary  Study  of  the  Physi- 
ological Effects  of  High  Temperatlties 
and  High  HniiDiTiEs  in  Metal  Mines.  R. 
R.  Saijers  and  D.  Harrington.  U.  S.  Pub. 
Health  Ser.,  Pub.  Health  Rep.,  Jan.  28,  1921, 
36,  No.  4.  116  129.  —  "I.  In  still  air  in  metal 
mines,  with  a  wet  bidb  temperature  over  90°  F. 
and  under  100°  F.,  and  with  a  relative  humidity 
of  89  per  cent,  or  higher,  the  following  signs  and 
symptoms  were  found,  even  when  little  or  no 
exercise  was  taken: 

"1.  Hlood  pressure,  systolic  and  diastolic, 
fell  rapidly. 

"2.  IJody  temperature  rose;  in  one  case  it 
reached  102°  F.,  and  this  after  less  than  two 
hours  having  been  sjient  in  the  hot,  luunid 
air  described. 


"3.    Pulse  rate  increased  and  seemed  more 
sensitive  to  exercise  than  normally. 

"4.    Persjiiration  was  very  j)rofiise. 

"5.    Dizziness  was  a  common  symptom,  and 
sometimes  was  marked. 

"6.    Physical  weakness  or  exhaustion  was 
marked  in  some  cases  and  present  in  all. 

"  7.    Inat)ility  to  think  quickly  or  accurately 
was  a  very  connuon  symptom. 

"  8.    Nausea  was  occasionally  found. 

"9.    Headache  was  also  occasionally  found. 

"  10.   Loss  of  weight  was  especially  marked 

in  men  who  had  been  employed  under  above 

conditions  over  a  period  of  years,  but  occurred 

even  after  exposure  only  a  few  days. 

"H.    In  still  air,  with  wet  l)ulb  tem])eratures 
of  from  85°  F.  to  86°  F.  and  a  relative  humidity 


ABSTRACTS 


59 


of  96  per  cent.,  there  were  no  marked  changes 
in  the  blood  pressure  or  b()d\'  temperature,  nor 
were  the  symptoms  dizziness,  physical  weak- 
ness, and  inability  to  think  or  act  quickly, 
mentioned  in  I,  found  as  long  as  the  subjects 
remained  at  rest  or  took  only  light  exercise. 
When  moderate  exercise  was  taken  —  climbing 
up  and  down  an  eight-foot  ladder  fifteen  times 
in  five  minutes  —  the  blood  jiressure  and  body 
temi)erature  ro.se  .somewhat. 

"III.  Blood-pressure  readings  taken  after 
the  subject  had  reached  the  cool  air  of  the  sur- 
face were  found  to  vary  considerably  with  men 
unaccustomed  to  high  tem])eratures.  I'nder 
conditions  which  resulted  in  a  rise  of  body 
temperature  to  100°  F.,  or  more,  the  systolic 
pressure  fell,  but  where  the  conditions  were 


such  as  not  to  cause  the  body  temperature  to 
rise  above  100°  F.,  there  was  a  rise  in  the 
systolic  pressure  when  the  subjects  reached  the 
surface.  In  one  man,  long  accustomed  to  hot, 
humid  air,  a  fall  of  systolic  pressure  was  also 
found.  In  three  others,  not  accustomed  to  the 
conditions  mentioned,  there  was  a  rise  of 
systolic  pressure. 

"IV.  It  was  found  that  the  body  tempera- 
tures readied  normal  in  from  one  to  two  hours 
after  the  subjects  had  reached  the  cool  air  of 
the  surface  after  having  been  subjected  to  con- 
ditions that  caused  a  rise  above  100°  F. 

"V.  It  was  noted  that  a  shower  bath,  begin- 
ning with  tei)id  water  and  ending  witli  a  dash 
of  cold  water,  had  but  little  immediate  eft'ect 
upon  the  body  temperature."  —  M.  Dent. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


The  New  Place  of  Women  in  Indistkv. 
IV.  Women  of  the  Intekn.\tion.\l  II.\h- 
VESTER  Company.  Ida  M.  Tarbell.  Indust. 
Management,  Jan.  1,  19'21,  61,  No.  1,  51-57.  — 
In  the  International  Harvester  Comj)any 
women  are  now  regarded  as  permanent  ojjera- 
tors  on  a  variety  of  light  machine  sho])  opera- 
tions which  five  years  ago  were  thought  to  be 
beyond  their  capacity.  The  women's  work  is 
not  men's  work,  nor  is  it  the  work  of  trained 
mechanics,  l)ut  rather  such  work  as  was 
formerly  done  by  young  men  of  18  or  'iO  years 
of  age.  On  such  work  women  are  regarded  as 
far  superior  to  boys  because  they  show  more 
interest  in  their  work,  are  (juicker,  and  take 
better  care  of  their  efi\iii)mcnt.  The  range  of 
o])erations  which  the  International  Harvester 
Company  thinks  that  women  have  mastered 
includes  all  kinds  of  oi)erations  on  lathes,  drill 
and  ])iUK'h  i)resscs,  niiliing  and  screw  machines, 
grinders  and  polishers,  and  gear  bobbers. 
Women  are  regarded  as  especially  good  in  the 
work  of  inspecting.  They  are  more  tradable 
than  men  although,  despite  danger,  most 
women  will  not  adhere  strictly  to  rules  in  re- 
gard to  uniform.  —  G.  E.  Partridge. 


Night-Working  Mothers  in  Textile 
Mills,  Passaic,  New  Jersey.  Agties  de  Lima. 
Published  by  the  National  Consumer's  League 
and  the  Consumer's  League  of  New  Jersey, 
Dec,  19'20,  pp.  18.  —  This  pamphlet  is  not 
primarily  a  statistical  study.    It  is  an  expose  of 


human  relations  in  industry  as  conducted  in 
the  textile  mills  of  Xew  Jersey.  The  restrictive 
legislation  in  regard  to  night  work  of  women  in 
the  state  of  New  Jersey  has  been  repealed. 
Hence  conditions  obtain  in  that  state  (even  in 
govermnent  owned  i)ro])erty)  tliat  are  the  more 
lamentable  in  that  the  same  industry  exists 
with  no  night  work  of  women  in  the  nearby 
states  of  New  York,  ]Mas.sachu.setts,  Connecti- 
cut and  Delaware. 

The  investigation  was  carried  out  from  door 
to  door,  aiming  to  secure  a  general  i)icture  of 
home  life  rather  than  mere  lists  and  tabulations. 
The  opinion  of  the  community  was  ascertained 
as  to  the  value  of  night  work.  It  was  con- 
demned but  dio.sen  by  the  operatives  as  better 
than  leaving  the  children  alone  all  day  or  trying 
to  live  on  the  wage  paid  to  the  men. 

The  picture  of  Passaic  is  that  of  a  town  of 
many  large  textile  mills,  in  which  the  labor  is 
Hungarian,  Polish,  and  RussiaiL  The  United 
States  Bureau  of  Education  finds  an  unusually 
high  rate  of  illiteracy.  All  attempts  to  remedy 
this  have  failed,  due  to  the  suspicion  and  dis- 
trust caused  by  the  employer's  policy  of  espio- 
nage and  black-listing  for  union  activity. 

The  salient  facts  brought  out  are:  that  it  is 
the  younger  married  women  with  three  or  four 
children  who  are  to  be  found  in  the  night  .shift; 
that  the  children  are  neglected;  that  the  moth- 
ers are  perforce  up  most  of  the  day  averaging 
about  five  hours  of  interrupted  sleep;  that  there 
is  no  regulation  even  as  to  pregnant  women 
being  on  the  night  force;  that  night  work  for 


60' 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


women  is  fostered  by  the  low  wage  scale  for 
men,  coupled  with  a  comparati\'ely  high  wage 
level  for  women  (and  more  for  night  work), 
which  tempts  them  into  industry.  Even  when 
running  only  three  days  a  week,  the  night  shift 
is  maintained. 

It  is  evident  to  the  Consumer's  League  that 
the  managers  of  this  industry  in  New  Jersey 
must  be  forced  by  legislation  to  do  what  all 
enlightened  manufacturers  do  for  their  own 
benefit.  We  can  scarcely  afford  to  let  the 
ignorant  manager  drag  down  our  industries  by 
abusing  the  vitality  of  our  workers.  —  Elinor 
D.  Gregg. 

The  Child  Labor  Problem.  Harold  H. 
Mitchell.  Pub.  Health  Nurse.  Jan.,  19^21,  13, 
No.  1,  27-29.  — The  author  makes  a  plea  for 
careful  examination  and  periodic  re-examina- 
tion of  children  in  order  to  secure  early  diagno- 
sis, and  to  give  advice  through  clinics  for  pre- 
ventive hygiene.  The  public  health  nurse  will 
be  the  agent  by  whom  this  service  is  understood 
and  made  effective. 

The  present  state  of  protection  offered  to  the 
adolescent  working  child  is  quite  unorganized 
as  the  laws  in  different  states  vary.  More 
evidence  is  needed  on  plwsical  tests  for  various 
industries  and  standards  of  physical  fitness 
should  be  established.  The  United  States 
Children's  Bureau  has  made  a  tentative  report 
on  standards  of  moral  develoj^ment  and  phys- 
ical health.  The  great  weakness  of  the  present 
laws  Hes  in  their  non-enforcement.  Yet  there 
should  be  no  difficulty  in  establishing  medical 
examination  in  the  continuation  schools.  The 
re-examination  might  very  well  take  jjlace 
there  also  or  when  a  change  of  work  is  lieing 
made. 

Public  health  nursing  services  must  be  de- 
pended upon  for  co-operation  in  securing  hy- 
gienic conditions  in  tlie  home.  There  are  many 
loose  ends  to  he  picked  up  in  order  to  prevent 
these  children  from  becoming  incompetents, 
dependents  and  discouraged  failures.  Research 
work  in  this  line  is  needed  to  iiresent  the  i)roh- 
lem  as  it  is  today  clearly  and  adequately.  — 
Elinor  D.  (iregg. 

One  Thois.^nd  Industri.vl  Accidents  Suf- 
fered BY  ]\Iass.\chusetts  CHILDREN".  LiicUe 
Emeu.  -Am.  Child,  Nov.,  1920,  2,  No.  3,  222- 
232.  —  Records  of  cases  reported  to  the  Mas- 
sachusetts Industrial  Accident  Board  were 
studied  by  the  students  in  the  School  of  Social 


Work  of  Simmons  College.  The  reports  in- 
dicate that  males  of  all  the  ages  included  are 
more  subject  to  industrial  accidents  than 
females,  and  that  more  than  half  of  the  acci- 
dents were  due  to  the  wage-earning  employ- 
ments of  the  children.  The  need  is  emphasized 
of  safety  committees  whose  activities  may  be 
stimulated  by  encouraging  competition  in  the 
promotion  of  low  accident  rates  and  by  offering 
rewards  for  suggestions  which  will  increase 
safety.  There  is  also  need  of  thorough  instruc- 
tion concerning  the  dangers  peculiar  to  local 
industrial  establishments  —  instruction  which 
might  well  be  given  in  continuation  and  other 
vocational  classes.  —  G.  E.  Partridge; 

Conserving  Children  in  the  Industries 
OF  Massachusetts.  Mass.  Dept.  Labor  and 
Industries,  Indust.  Bull.  No.  15,  Boston,  1920, 
pp.  21. — The  establishment  of  continuation 
schools  in  Massachusetts  affords  opportunity 
for  imparting  to  working  children  valualjle 
knowledge  in  regard  to  the  hazards  incidental 
to  modern  industry.  At  the  present  time  acci- 
dents are  very  numerous,  and  notwithstanding 
the  plain  requirements  of  the  statutes  many 
serious  violations  take  place.  But  with  forty- 
four  continuation  schools  now  established  in 
^Massachusetts,  attended  by  about  30,000 
children,  it  seems  hardly  possible  to  believe 
that  these  violations  of  the  statutes  could  exist 
without  the  knowledge  of  the  teacher  of  the 
continuation  school.  Co-operation  between  the 
continuation  school  teachers  and  the  Depart- 
ment of  Labor  and  Industries  would  operate 
to  the  advantage  of  the  child.  Co-ordination 
of  the  activities  of  the  Division  of  Industrial 
Safety,  the  inspection  force  of  which  frecjuently 
visits  all  the  industrial  centers  in  the  state, 
with  the  work  of  the  teacher  in  the  continua- 
tion school  would  be  a  most  effective  means  of 
instructing  children  in  regard  to  industrial 
hazards,  and  of  teaching  them  the  fundamental 
principles  of  safety. 

During  the  year  ending  June  30,  1919,  as  the 
re|)ort  of  the  In<lustrial  Accident  Board  shows, 
l,(j91  children  between  14  and  16  years  of  age 
sustained  tabulatable  injuries  —  i.e.,  injuries 
arising  out  of  employment  and  causing  in- 
capacity for  longer  than  the  remainder  of  the 
shift  or  the  day  —  ten  ending  fatally  and 
sixty-two  resulting  in  permanent  partial  dis- 
ability of  the  child.  Tables  are  given  showing 
the  causes  of  these  injuries,  j)recisely  the  proc- 
ess during  which   the  accident  occurred,  and 


ABSTRACTS 


61 


the  nature  of  the  injury  received.  From  these 
tables  certain  practical  coiichisions  may  be 
drawn,  such  as,  for  example,  that  nearly  all  the 
serious  accidents  sustained  l)y  children  be- 
tween the  ages  of  14  and  16  years  are  prevent- 


able. In  almost  every  industry  a  traditional 
habit  is  responsible  for  numerous  injuries,  such 
as,  in  textile  establishments,  the  practice  of 
picking  cotton  waste  from  moving  machinery. 
—  G.  E.  Partridge. 


INDUSTRIAL  SANITATION:  FACTORY  CONSTRUCTION,  ILLUMINATION, 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEWAGE  DISPOSAL 


"He.\lth  First"  Campaign:  Outune  for 
Industries.  G.  J.  Soderherg.  Personnel, 
Jan.,  19-21,  3,  No.  1,  1,  5.  —  First,  there  should 
be  a  comprehensive  survey  of  the  ground  and  of 
the  buildings,  which  would  include  inspection 
of  land  drainage,  care  of  rubbish,  construction 
and  care  of  walks,  condition  of  roofs,  general 
floor  conditions,  floor  cleaning  and  dust  elim- 
ination, plumbing,  drinking  water,  ventilation, 
disposal  of  dusts,  fumes,  gases,  and  noises, 
lamj)  shading,  .seats  and  <'lotliing  for  workers. 

There  should  be  systematic  cleaning  of 
floors  by  any  method  that  eliminates  dust, 
preferal)ly  after  working  hours.  Painted  floor 
lines  are  recoinmendcd  as  means  of  insuring 
maximum  speed  in  movement  of  ])roduction 
and  of  workers.  Water-closets,  wash  l)asins, 
slop  sinks  and  drinking  fountains  .should  be  of 
vitreous  china,  or  good  grade  of  white  baked 
enamel  over  iron.  Common  cu|)s,  common 
towels  and  the  like  should  be  entirely  aiiolisiied. 
Toilet  rooms  should  be  painted  with  enamel  or 
other  liard  surface.  Setting  \ip  exercises  for  a 
five-mimite  jjcriod  during  the  forenoon  and 
again  in  the  afternoon  are  goo<l  for  .seilentary 
workers.  Adjustable  chairs  for  w(unen  workers 
at  machines  will  pay  well.  Hare  lam])s  should 
be  shaded,  dinnned  or  ollierwisc  protected  to 
eliminate  glare,  and  should  be  i)roi)er!y  placed. 
Goggles  or  masks  should  be  provided  for  work- 
ers where  there  is  excessive  dust,  or  hazard 
from  chips,  etc.  Physical  examination  of  em- 
ployees as  a  condition  of  accc])ting  work  might 
be  required,  especially  for  workers  on  heavy 
tasks.  Attention  to  clothing  is  important. 
Finally,  the  industry  should  keep  in  do.se 
touch  with  industrial  health  bureaus  and  other 
helpful  organizations.  —  G.  E.  Partridge. 

Hygienic  Precautions  to  be  Observed  in 
THE  Manufacture  and  Indistrial  Use  of 
Carbon  Disulfide.  Julea  Blain.  Abstracted 
as  follows  from  Industrie  Chimique,  19'20,  7, 
.SI  1-313,    by    S.    D.    Kirkpatrick    in    Chem. 


Abstr.,  Jan.  20,  1921,  15,  No.  2,  281.  —  "Work- 
ers liandling  CS>  under  unsatisfactory  hygienic 
conditions  are  subject  to  serious  intoxication 
resulting  in  neurotic  disorder  and  greatly  lessen- 
ing their  cai)acity  for  work.  Certain  types  of 
workers  are  more  susceptible  than  others; 
es|)eciall.\-  is  this  true  with  alcoholics  and  others 
of  weakened  vitality.  Medical  examination  of 
all  employees  at  regular  periods  and  the  im- 
mediate examination  of  those  complaining 
of  symptoms  such  as  eye  fatigue  are  recom- 
mended. Among  the  industrial  uses  for  CS..  are 
extracting  grease  and  oil  from  hones  (,to  be  used 
for  bone  black),  from  seeds  and  oilcakes;  de- 
greasing  wool;  ])urifying  i)araffin;  extracting 
jxTfumes;  dissolving  S  from  its  minerals; 
maimfacturing  of  litiuid  Are.  certain  types  of 
varnisii  and  rubberized  clotli.  and  in  the  vul- 
canization of  rui)ber  by  the  cold  (Parke)  proc- 
ess. In  all  of  these  industries  the  factories 
should  have  high  ceilings  and  adetiuale  ventila- 
tion; periodic  medical  examination  is  recom- 
mended wherever  possil)le.  (ireat  Britain  has 
stringeid  laws  regulating  factories  making 
rubberized  cloth.  A  diagram  is  .shown  of  a 
filter  for  removing  sulfur-carbon  compounds 
from  the  air  by  means  of  crude  petroleum  and 
CaCls."  — M.  ('.  Shorley. 

SuGGf:sTiONS  ON  Heating  and  Ventilating 
Paper  Machine  Rooms.  Edward  A.  Ryan. 
Abstracted  as  follows  from  Jour.  Engin.  Inst,  of 
Canada,  Jan.,  1921,  in  Nat.  Safety  News,  Feb. 
7,  1921,  3,  Xo.  6,  12.  —  "The  chief  advantages 
of  a  properly  designed  and  operated  ventilating 
•system,  according  to  Mr.  Ryan,  are  increased 
production  due  to  fewer  shutdowns,  greater 
safety  for  the  workmen  because  of  better  illu- 
mination when  the  excess  vapor  is  carried 
away,  a  more  even  product  resulting  from  uni- 
form humidity  and  tem])erature,  and  a  longer 
life  for  machine  felts  due  to  decreased  moisture 
content  of  the  air  in  the  machine  room."  — 
M.  C.  Shorley. 


62 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


INDUSTRIAL  MEDICAL  SERVICE:   MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


FUND.\MENTAL  REQUIREMENTS  FOR  SUCCESS- 
FUL Medical  Work  in  Industry.  W.  A. 
Sauryer.  INIod.  Med.,  Jan.,  1921,  3,  No.  1,  23- 
26.  —  The  first  essential  for  industrial  medical 
practice  is  a  sympathetic  co-operation  from  the 
heads  of  the  organization.  The  second  is  ade- 
quate personnel  —  adecjuate  in  quantity  and 
character.  Third,  is  the  equipment  adapted  to 
the  needs  of  the  department?  Fourth,  a  pro- 
gram in  which  ideals  plus  daily  practice  will 
result  in  consistant  growth.  The  point  of  de- 
parture to  secure  this  fourth  requisite  is  a 
complete  and  painstaking  physical  examina- 
tion. The  rea.sons  given  for  this  examination 
are  as  follows : 

1.  For  the  purpose  of  placement  or  exclu- 
sion. The  interest  and  co-operation  must  be 
secured  at  this  point. 

2.  Periodic  re-examination  for  possible  haz- 
ards and  advice  as  to  corrections.  This  should 
be  for  rank  and  file,  executive  and  all,  and  care- 
ful records  kept  and  studied. 

3.  It  contributes  to  reduction  of  absentee- 
ism. 

4.  It  contributes  to  longevity  of  service. 

5.  It  dovetails  with  outside  public  health 
work. 

6.  It  leads  into  all  other  medical  work  in 
industry. 

7.  The  future  of  medicine  lies  in  .prevention 
of  disease.  This  must  be  taught  to  the  lay 
mind.  Physical  examination  should  protect 
from  ill-advised  treatment  and  from  neglect  of 
important  conditions.  —  Elinor  D.  Gregg. 

Economy  of  Proper  Medical  Treatment. 
Paul  B.  Magnuson.  Mod.  Med.,  Dec,  1920, 
2,  No.  12,  799-802.  —  In  a  paper  written  in  the 
light  of  exj)erience  as  chief  surgeon  of  several 
large  corporations  and  as  medical  director  of 
the  Industrial  Commission  of  Illinois,  Dr. 
Magnuson  cm])hasizes  the  fact  that  from  every 
point  of  view  the  first  consideration  in  indus- 
trial accidents  is  the  selection  of  a  thoroughly 
good  surgeon.  When  '"the  new  tlieory  that 
industry  as  a  whole  should  stand  the  loss  in- 
cident to  accident  to  emjiloyces  "  was  enacted  in 
law,  some  of  the  more  far-sighted  corporations 
began  to  furnish  surgical  atletition  to  men  in- 
jured in  their  i)lants.  I'lifortiiiiately,  however, 
the    doctor    was    considered    primarily    as    an 


adjunct  to  the  claim  department  and  his  train- 
ing, competency  and  ability  to  handle  men, 
were  of  little  importance.  The  employment  of 
a  physician  on  this  basis  is  an  uneconomical 
start  from  the  social  point  of  view,  because  the 
physician  comes  into  closer  contact  with  the 
employees  than  almost  any  other  department 
head  and  thus  has  it  in  his  hands  to  make  or 
mar  good  relations  between  management  and 
ero}jloyees.  For  example,  one  surgeon  "  took 
charge  of  a  large  industry  which  was  perfectly 
controlled  in  its  organization  by  the  union,  and 
within  a  year  of  the  time  he  took  charge  he  had 
also  been  elected  official  examiner  for  that 
union.  This  same  man  saved  that  company, 
the  first  year  of  his  employment,  $20,000  in  the 
claim  department,  in  spite  of  the  fact  that  the 
mmiber  of  accidents  increased  10  per  cent,  over 
the  previous  year;  and  as  against  thirty-one 
lawsuits  filed  the  year  before  he  took  charge, 
there  was  one  lawsuit  filed  the  first  year  of  his 
employment.  ...  It  would  be  hard  to  con- 
vince this  company  at  this  time  that  a  man 
with  small  training  is  an  economical  man  to 
employ." 

The  employment  of  a  second-rate  physician 
is  also  —  and  more  obviously  —  uneconomical 
from  a  professional  point  of  view.  In  his  hands 
the  diagnosis  of  an  apparently  simple  case  is 
made  in  a  haphazard  way,  with  sometimes 
serious  and  very  expensive  results.  A  man  in 
construction  work,  for  instance,  who  falls  from 
a  height  and  strikes  the  ground  on  his  feet,  has 
probably  received  a  fracture  of  the  os  calcis  of 
one  or  both  feet.  If,  as  in  most  cases  coming 
before  tlic  Illinois  Industrial  Commission,  the 
fracture  goes  unrecognized  and  the  man  is 
treated  for  a  sprained  ankle  only,  a  very  serious 
condition  develops,  "the  man  has  a  foot  which 
grows  ])rogressively  worse  with  use  and  finally, 
in  a  large  number  of  cases,  lo.ses  from  .50  to  90 
per  cent,  of  the  use  of  his  foot,  which  totally 
incapacitates  him  for  any  occupation  that  in- 
volves climbiTig,  or  walking  on  scaffolding  or 
uneven  groiuid.  If  these  ca.ses  are  taken  in  time 
and  properly  treated,  the  major  part  of  this 
disability  can  l)e  averted,  and  the  surgeon  who 
prevents  one  of  these  disabilities  .saves  a  con- 
siderable ])orti<)n  of  his  yearly  salary  on  one 
case  alone,  altiiough  it  may  be  much  better 
than   the  ordinary  salary  paid  industrial  siir- 


ABSTRACTS 


63 


geons."  Other  similar  and  coininoii  instances 
are  cases  of  back  injury  which  are  diagnosed 
and  treated  as  simple  strains  and  which  con- 
sequently drag  on  from  month  to  month;  in- 
flammed  bursae  of  the  shoulder,  frtnii  which 
entirely  unnecessary  adhesions  and  weakness 
result  if  the  arm  is  immobilized  in  the  wrong 
position,  and  the  process  of  getting  back  to  the 
normal  is  long  and  painful;  a  broken  limb 
which  is  allowed  to  remain  too  long  in  fixation 
dressings  and  is  consequently  a  very  painful 
thing  to  move.  In  cases  such  as  this  latter, 
another  element  enters  in  the  mental  attitude 
of  the  patient  toward  the  management.  If 
nothing  is  done  for  the  broken  member,  al- 
though it  is  so  useless  and  painful;  after  the 
bone  has  healed,  there  is  little  wonder  that 
neurosis  develops;  the  habit  of  pain  becomes 
firmly  fixed  in  the  i)atient"s  mind,  espec-ially  if 
he  feels  he  is  being  neglected  by  those  whom  he 
also  feels  are  responsible  for  his  injury.  If  the 
surgeon  knows  enough  to  remove  the  cast  as 
soon  as  possible  for  gentle  massage  each  day, 
the  patient  "not  only  receives  results  on  the  in- 
jury but  he  feels  that  there  is  something  Vicing 
done  to  hurry  his  recovery.  His  mental  atti- 
tude remains  that  of  a  man  who  is  friendly." 

The  wise  employer  will  ap|)reciate  these  social 
and  professional  factors  and  will  select  the  best 
doctor  he  can  get  with  the  most  complete  train- 
ing; he  will  feel  that  this  is  the  i)est  investment, 
because  such  a  man  will  ins])ire  confidence  in 
the  employees,  smooth  the  way  for  amicable 
adjustment  of  claims,  make  a  small  jx'rcentage 
of  disability  where  there  may  have  been  a  large 
l)ercentage,  jirevcnt  disabilities  where  they  are 
l)reven  table,  and  save  his  salary  every  three 
months  for  any  large  employer  of  labor,  to  say 
nothing  of  sparing  the  human  race  the  trouble 
which  is  brought  aliout  by  disabilities.  Such 
service  is  adequate  and,  in  the  long  run, 
economical.  —  Elizabetli  C.  Putnam. 

Why  Physical  Exa.min.vtion?  ./.  P.  AuMin. 
Personnel,  Feb.,  19'21.  3,  No.  '•2,  5.  —  The  ad- 
vantages of  physical  examination  and  conse- 
quent treatment  of  diseases  and  injuries  are 
found  to  be;  (\)  minimizing  loss  of  time  and 
accidents;  (2)  minimizing  absenteeism,  tardi- 
ness, and  the  inefficiency  due  to  illness;  (3) 
improving  general  health;  (4)  giving  employees 
tasks  equal  to  their  physical  powers;  and  (5) 
improving  each  individual.  —  M.  Dent. 

Keeping  Workers  Well.  Factory,  Nov.  1, 
19^20,    25,    No.    9,    1520-1524.  —  Among    the 


items  under  this  heading  is  one  entitled  "Ex- 
amining New  Employees."  The  National 
Malleable  Castings  Company  follows  a  verj- 
definite  i)rocedure  in  its  medical  examinations. 
Besides  heart  and  lung  tests  the  worker  is  ex- 
amined for  spinal  and  abdominal  defects.  The 
extremities  are  carefully  inspected  also.  The 
full  procedure  is  gi\en  in  this  article  under 
sixteen  headings.  —  C.  H.  Paull. 


Phvskal  Examinations  ok  Indi  strial 
WoRKKRS.  F.  L.  Rector.  Jour.  Am.  Med. 
Assn.,  Dec.  18,  1920.  75,  No.  25,  17,39. —A 
statement  obtained  through  the  use  of  a  ques- 
tionnaire sent  to  100  industrial  establishments. 

"The  results  of  the  board's  investigation  of 
I)hysical  examination  of  industrial  workers  may 
be  thus  smnmarized: 

"1.  Thirty-four  rejjlies  were  received,  in- 
cluding fifteen  industries  and  410,10()  em- 
])loyees.  of  whom  327,183  were  men  and  82,923 
were  women. 

"2.  Physical  examinations  among  the  in- 
dustrial establishments  reporting  were  first 
introduced  in  l!l(l(t,  but  in  the  majority  of  cases 
they  ha\c  been  in  operation  only  since  1914. 

"■'{.  Where  ])hysical  examinations  have  been 
given  a  fair  trial,  they  have  proved  their  value 
and  have  been  continued  and,  with  one  excep- 
tion, tiie  original  scojie  of  the  examinations  has 
been  maintained  or  extended. 

"  4.  The  average  time  consumed  -in  making 
regular  physical  examinations  at  establish- 
ments reporting  was  eight  minutes  per  person 
examined. 

"5.  An  earnest  effort  was  being  made  in  the 
majority  of  ])lants  re|)orting  to  place  defec- 
tives, rather  than  eliminate  them  from  industry. 

"fi.  The  average  percentage  of  rejected  ap- 
phcants  for  employment  was  only  4.6,  and,  by 
eliminating  certain  special  cases,  was  only  2.8. 

"  7.  There  was  no  uniformity  of  time  for  re- 
examination of  employees. 

"8.  Objections  to  physical  examinations  on 
the  part  of  prospective  or  actual  workers  were 
negligible. 

"This  investigation  shows  that  substantial 
progress  has  been  made  in  the  application  of 
medicine  to  industry.  The  position  of  the  phy- 
sician in  industry  has  been  made  secure,  and  he 
should  now  bend  his  efforts  to  the  solution  of 
industrial  problems  closely  related  to  the 
medical  work.  By  his  training  and  experience 
he  is  qualified  to  advise  with  the  management 


64 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


as  to  the  placing  of  employees  to  the  best  ad- 
vantage of  themselves  and  the  industry  with 
which  they  are  connected.  He  is  also  in  a  posi- 
tion to  suggest  necessary  impro\'ements  in  the 
fields  of  lighting,  ventilation  and  general  sani- 
tation, as  well  as  of  personal  hygiene,  in  order 
that  employees  may  be  kept  in  good  physical 
condition. 

"A  classification  of  the  results  of  physical 
examinations  is  necessary  in  order  that  workers 
may  be  properly  placed.  The  physical  capaci- 
ties and  limitations  of  an  A-1  worker  and  of  a 
substandard  worker  sliould  be  fairly  well  de- 
fined. For  example,  only  workers  without 
physical  defects  should  be  placed  in  the  A-1 
class.  This  will  be  a  relatively  small  group  as 
compared  with  the  vast  majority  of  workers, 
who  suffer  from  some  slight  physical  or  func- 
tional disability,  but  who  are  well  able  to  carry 
on  practically  any  work  to  which  they  may  be 
assigned. 

"A  classification  of  findings  of  physical  ex- 
aminations which  tends  to  place  the  worker  in 
his  proper  group  has  been  adopted  and  promul- 
gated b}'  the  Conference  Board  of  Physicians  in 
Industry,  after  a  careful  analysis  of  a  very 
large  number  of  j)hysical  examination  records. 
That  such  a  classification  is  needed  has  been 
demonstrated  by  the  analysis  of  the  reports 
summarized  above.  Tliis  classification  is  as 
follows : 

"Class  1:  Persons  physically  fit  for  any  em- 
ployment. 

"Class  2:  Persons  physically  fit  for  any  em- 
ployment but  below  jjar  in  physical  develop- 
ment or  other  condition. 

"Class  3:  Persons  physically  fit  only  for  cer- 
tain employment  when  specifically  apjiroved 
for  it  l)y  examining  physician. 

"Class  4:  Persons  physically  unfit  for  any 
employment. 

"Knowing  the  requirements  of  the  work 
which  the  ap|)licant  for  employment  is  to  do 
and  having  a  record  of  his  jjhysical  condition, 
the  task  of  the  industrial  physician  then  be- 
comes one  of  physically  adapting  the  employee 
to  his  work,  with  the  a.ssurance  that  if  this  is 
done  i)roperly  there  will  lie  greater  content- 
ment, lessened  labor  turnover,  and  greater 
production."  —  C.  K.  Drinker. 


IxDusTRiAL  Clinics  in  Gexeral  Hospitals. 
W.  Wright.  Mod.  Hosp.,  Dec,  1920,  15,  No.  6, 
506-508.  —  The  new  industrial  medicine  tends 
to  introduce  new  needs  and  broader  concep- 
tions into  the  medical  .sciences,  especially  in 
respect  to  diagnosis.  Technical  diagnosis  must 
be  supplemented  by  social  diagnoses  concerning 
influences  in  the  patient's  life  which  were,  per- 
haps, as  j)otent  factors  as  an  infection  in  causing 
the  disease.  It  is  not  enough  to  find  tuber- 
culosis or  lead  poisoning:  we  should  speak  of 
tuberculosis  plus  malnutrition;  or  lead  poison- 
ing plus  an  ignorance  of  industrial  hazards  as 
causes  of  diseases. 

It  is  the  recognition  of  the  importance  of 
work  as  a  factor  in  the  ill  health  of  an  individual 
that  has  ])roduced  the  branch  of  medicine  now 
called  industrial  hygiene.  General  hospitals 
must  adapt  themselves  to  these  new  and  larger 
requirements.  There  shoidd  be  clinics  or  de- 
partments to  which  ca.ses  possibly  related  to 
industrial  activity  or  to  environment  may  be 
referred.  The  clinic  can  best  be  established  in 
connection  with  tlie  hospital  dispensary,  but 
this  clinic  should  have  the  pri^■ilege  of  selecting 
its  own  material,  becau.se  of  the  inability  at  the 
present  time  of  most  clinicians  to  recognize 
either  sjjccific  industrial  maladies  or  the  com- 
mon effects  of  industrial  health  hazards.  The 
specialized  industrial  clinic  can  serve  not  only 
in  making  accurate  diagnosis  and  offering  effi- 
cient treatment,  but  also  in  observing  the  con- 
ditions of  life  and  of  employment  which  aft'ect 
working  -people.  Though  specific  industrial 
di.seases  are  relatively  few,  the  deleterious 
effects  of  many  kinds  of  work  are  important 
and  prevalent  factors  in  disease,  and  it  falls  in 
part  to  the  industrial  clinic  of  the  hospital  to 
investigate  these  factors  and  to  meet  the  con- 
ditions that  they  jire.sent.  In  inchistrial  com- 
munities hospitals  should  provide  resources  for 
the  treatment  of  industrial  cases  by  the  best 
methods,  including  industrial  eye  injuries  and 
treatment  of  serious  burns  and  fractures,  as 
well  as  facilities  for  the  restoration  to  function 
of  im|)aired  niemliers.  The  cost  of  such  hospital 
care  should  be  borne  in  full  by  industrial  com- 
missions or  designated  insurance  carriers,  or 
should  he  shared  by  the  employers  of  injured 
workers.  —  (i.  E.  Partridge. 


ABSTRACT  OF  THE  LITERATURE 

OF 

INDUSTRIAL  HYGIENE 


Volume  III 


AUGUST.   1921 


Number  i 


CONTENTS 


General 65 

Systemic  Occupational  Diseases:  Occurrence,  Treat- 
ment and  Prevention 08 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc 69 

Occupational  Affections  of  the  Skin  and  Special  Senses.     71 

Occurrence  and  Prevention  of  Industrial  Accidents  . .     7i 

Industrial  Surgery 75 

Industrial  Physiology :  Nutrition,  Metabolism, Fatigue, 
etc , 70 

Hazards  of  Compressed  Air,  Diminished  Pressure, 
Generation  and  Use  of  Electricity,  and  Electrical 
Welding 78 


Women  and  Children  in  Industry 79 

Industrial  Sanitation:  Factory  Construction,  Illumina- 
tion, Ventilation,  Heating,  Water  Supply,  Sewage 
Disposal 8() 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Industrial  Plants 83 

Industrial  Personal  and  Community  Hygiene:  Hous- 
ing, etc 8-i 

Industrial  Investigations  and  Surveys 84 

Industrial  Health  Legislation:  Court  Decisions:  Work- 
men's Compensation  and  Insurance 84 

Rehabilitation  of  Disabled  Employees 89 

Industrial  Mortality  and  Morbiditv  Statistics 90 


GENERAL 


Health  Service  Estabmsiies  Footing. 
C.  D.  Selby.  Hosp.  Maiiageinciit.  Jan.,  19'^1, 
11,  No.  1,  58.  —  A  review  of  lO^O  show.s  us  the 
footing  of  industrial  surgery  and  industrial 
medicine.  The  present  status  of  the  industrial 
physician  has  largely  lieen  brougiit  about  by 
compensation  laws  for  injuries  and  industrial 
diseases.  Although  in  the  present  business  de- 
pression the  industrial  physician  must  stand 
aside  for  a  wiiile,  there  can  be  no  doubt  that 
employers  will  soon  recognize  the  importance  of 
industrial  medicine.  —  Elinor  D.  Gregg. 

The  Application  op  Statistics  to  the 
Study  of  Emploitment  .\nd  Sickness.  Thiele. 
Zcntralbl.  f.  Gewcrbehyg.,  Feb.,  19^21,  9,  No.  2," 
35-38.  —  The  author  discusses  the  necessity,  in 
the  statistical  study  of  industrial  medical  prob- 
lems, for  a  practical  and  exact  classification  in 


order  to  make  it  clear  which  workmen  are 
exposed  to  particular  industrial  hazartls  and 
whicli  ones  are  otherwise  connected  wilii  the 
industry  in  question.  —  E.  L.  Sevringiiaus. 

Fishermen's  Diseases.  //.  2fiiir  Evans. 
Notes  and  Comments,  Lancet,  March  5,  1921, 
1,  No.  10,  517-518.  —  The  accidents  described 
were  those  due  chiefly  to  the  dogfish,  the  sting 
ray  and  the  greater  and  lesser  weever.  Dr. 
Evans  said  the  most  conuuon  injury  was 
caused  by  the  poisonous  spine  of  the  weevers, 
which  possess  a  perfect  double-grooved  explor- 
mg  needle  on  either  gill  cover.  At  the  root  of 
tlie  spine  is  a  definite  poison  gland.  When 
alarmed,  the  fish  erects  its  gill  cover,  bends  it- 
self round,  driving  the  poisoned  spine  into  any 
adjacent  body,  which  at  once  receives  some 
grumous  drops  of  a  highly  poisonous  nature. 


65 


66 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


There  are  smaller  poison  organs  on  each  spine 
of  the  dorsal  fin. 

The  burning  pain  that  follows  a  sting  is  so 
severe  that  men  will  attempt  to  throw  them- 
selves overboard,  or  will  hairtmer  the  affected 
part  with  a  thole  pin  against  the  bulwarks. 
The  pain  lasts  several  hours  and  is  accompanied 
by  immediate  swelling  of  the  affected  part. 
The  limb  may  be  partially  paralyzed  for  .a 
time.  In  a  few  hours  the  swelling  subsides,  or 
it  may  go  on  to  phlegmonous  inflammation 
with  local  gangrene  around  the  site  of  the 
injury. 

Dr.  Evans  finds  that  weever  venom  contains 
a  neurotoxm,  a  hemolysin,  and  a  leukotoxin. 
The  hemolytic  constituent  differs,  however, 
from  most  snake  venoms,  in  that  it  acts  di- 
rectly on  washed  red  corpuscles  —  that  is  to 
say,  without  the  presence  of  serum.  This  state- 
ment, he  affirms,  conflicts  with  certain  French 
workers,  but  he  considers  it  is  because  they 
used  filtered  glycerine  extracts,  while  his  experi- 
ments were  made  with  fresh  poison.  This  fish 
venom  markedly  diminishes  the  phagocytic 
action  of  the  leukocytes  and  thus  secondary 
septic  inflammation  frequently  follows  a  sting. 

Regarding  treatment,  ammonia  is  popularly 
presumed  to  counteract  the  poison.  In  the 
islands  of  ^lauritius  and  Reunion  where  a 
similar  stinging  fish,  the  synancia,  frcciuently 
injures  the  feet  of  fishermen,  the  natives  em- 
j)loy  the  leaves  and  seeds  of  a  species  of  datura, 
and  find  they  give  relief.  According  to  Bottard, 
the  seeds  of  abrus  precatorius,  or  jequirity, 
have  the  virtue  of  a  specific.  Applications  of 
heated  vinegar  or  the  liver  of  the  fish  itself  to 
the  injured  part  are  other  remedies  in  use. 
Fish  venom,  just  as  snake  venom,  is  destroyed 
by  potassium  permanganate,  chloride  of  lime, 
and  chloride  of  gold.  Dr.  Evans  suggests  that 
a  "Lauder  Brunton  snake-bite  lancet"  be  car- 
ried by  all  drifters  and  smacks  so  that  a  really 
efficient  remedy  may  be  at  hand. 

During  the  summer  voyages  the  drift  fisher- 
men get  their  nets  full  of  jelly-fish  and  the  sting 
causes  nuich  burning  pain  followed  next  day  by 
intense  itching.  The  toxin  contained  in  the 
tentacles  is  thalassine.  After  the  summer  fish- 
ing, while  piending  the  nets,  the  men  sometimes 
suffer  so  greatly  from  lachrymation  and  sneez- 
ing that  this  work  has  to  be  sto{)ped.  The 
author  suggests  that  this  trouble  is  cau.sed  by 
the  toxin  which  clings  to  the  strands  and 
which,  when  dry,  is  liberated  with  the  dust 
from  the  nets. 


Boils,  sometimes  spreading  to  form  large 
suppurating  areas,  are  common  on  the  fore- 
arms of  fishermen  during  the  autumn  and 
winter.  The  rubbing  by  the  edges  of  the 
"oilies,"  the  sea  water  and  dirt  of  the  sea- 
farers' calling  are  no  doubt  responsible.  —  R. 
Prosser  White. 

JOPLIX    ZlXC:      IXDCSTRLU.    CONDITIONS    IN 

THE  World's  Greatest  Zinc  Center.  C.  M. 
Mills.  Survey,  Feb.  5,  \M\,  45,  No.  19,  657- 
666.  —  The  Joplin  district  occupies  corners  of 
Oklahoma,  Missouri,  and  Kansas,  comprises 
1,000  square  miles,  and  is  the  home  of  1^2,000 
miners.  The  territory  is  peculiarly  barren  and 
hideous  in  its  outlook  because  of  the  ravages 
caused  by  mining.  This  seems  to  be  a  psy- 
chological factor  in  the  life  of  both  miner  and 
operator.  Peculiar  features  of  the  district  are 
that  94  per  cent,  of  the  miners  (in  the  leading 
towns)  are  American  born  of  American  parents, 
and  that  they  are  entirely  unorganized. 

The  natural  conditions  of  mining  in  the  Jop- 
lin district  are  favorable  but,  from  the  stand- 
point of  safety,  the  equii)ment  and  mode  of 
operation  are  poor.  The  statutes  of  Oklahoma 
require  that  the  operator  shall  provide  every 
gear  carriage  used  for  the  hoisting  or  lowering 
of  persons  with  a  sufficient  overhead  covering, 
and  that  at  all  shafts  safety  gates  shall  be 
placed.  In  visiting  many  mines,  however,  the 
author  ne\'er  saw  an  overhead  covering  on  a 
can,  nor  any  evidence  of  hoisting  safety  devices. 

Comparison  of  mining  accidents  occurring  in 
the  Missouri  jjart  of  the  Joplin  district  with 
those  of  the  Eastern  Missouri  district  for  the 
years  1914  to  1918  shows  '•24.8  fatal  accidents 
per  year  in  the  Joplin  district  and  8  in  the 
Eastern  district  per  1,000  three  hundred-day 
workers;  and,  respectively,  14.3  and  7.4  non- 
fatal accidents.  Fall  of  rocks  is  the  greatest 
cause  of  accidents,  and  it  can  be  said  that  these 
accidents  are  largely  due  to  the  carelessness  of 
the  miner  and  the  operator.  The  system  which 
allows  miners,  roofers,  and  drill  men  to  work 
above  sho\'elers,  contributes  to  unnecessary 
accidents.  The  chief  cause  of  accidents  in  mills 
is  unguarded  machinery.  In  no  mills  visited 
were  there  proper  safety  devices,  and  in  some 
cases  the  conditions  were  very  bad.  The  author 
recommends  a  safety  program  which  would  cor- 
rect these  conditions  and  which  would  include 
education  through  safety  councils  and  commit- 
tees, prohibition  of  "squib  shots,"  and  elimina- 
tion   of    the    hazards    mentioned    by    obvious 


ABSTRACTS 


67 


remedies,  such  as  the  installation  of  well-known 
safety  devices.  The  piece-rate  system  is  also  to 
be  condemned  as  tending  to  exhaust  the  human 
factor  in  the  industry,  leading  to  the  jiermanent 
injury  of  the  workers  and  the  ultimate  disad- 
vantage of  the  operator. 

Jophn  ore  is  brittle  and  produces  a  great 
quantity  of  dust.  Silicosis  or  miners'  consump- 
tion is,  therefore,  very  prevalent  in  the  district. 
After  an  investigation  in  191.5  state  laws  were 
passed  in  Missouri  requiring  the  use  of  water 
lines  for  sj)rinkling,  wash  and  change  houses, 
and  the  closing  of  unsafe  and  imsanitary  mines. 
The  watercore  drill  has  come  into  general  u.se 
in  the  district  and  lias  brought  about  nuicli  ini- 
[)rovenient  in  the  conditions.  The  silicosis 
problem  still  remains,  however,  and  not  very 
much  progress  has  been  made  with  it. 

Individualism  and  freedom  have  protluced 
irres])onsibilily  in  regard  to  .sanitation  and 
housing.  The  operators  in  the  Joplin  district 
have,  with  rare  exceptions,  done  nothing  for  the 
welfare  of  their  employees.  The  whole  industry 
"stands  in  a  i)re-Victorian  period  of  social 
development."  The  short-lived  character  of  the 
average  productive  area,  and  the  fact  that  the 
ojjerators  in  this  district  are  small  capitalists 
and  not  large  corporations,  explain  in  part  the 
conditions.  The  result  is  that  the  houses  are 
poor,  little  is  done  to  improve  them,  and  less 
than  half  of  them  have  adequate  sanitary  con- 
ditions. To  a  considerable  extent  the  barrel 
system  of  water  sup])ly  pre\ails  —  a  fertile 
source  of  contagion,  though  the  water  is  good. 

The  operators  are  responsible  for  the.se  con- 
ditions and  change  must  come  through  them. 
Production  is  carrieil  on  with  little  reference  to 
ilutside  conditions  of  the  market,  and  the  whole 
organization  is  to  some  extent  unnatural.  The 
economic  development  is,  therefore,  in  the 
direc'tion  of  centralization  of  ojjerating  interests 
and  labor  organization.  There  shoT;ld  i)e  co- 
operation with  the  United  States  Public  Health 
Service,  enforcement  of  mining  laws,  a  safety 
campaign,  modification  of  the  piece  system, 
passage  of  health  insurance  laws  covering  sili- 
cosis, adoption  of  modern  sanitary  methods, 
adequate  hospitals,  co-operative  housing  asso- 
ciations, and  counnunity  recreational  centers. 
—  G.  E.  Partridge. 

Employment:  Horns  of  Work.  W.  Wil- 
liam.i.  Ann.  Rep.  Chief  Inspect.  Factories  and 
Workshops  for  the  Year  1919.  London,  19'-20, 
pp.  88-94.  —  From  an  industrial  point  of  view 


a  remarkable  effect  of  the  war  has  been  the  re- 
duction in  the  hours  of  work,  "which  now  rarely 
exceed  an  aggregate  of  forty-eight  a  week." 
The  reduction  has  been  made  without  legisla- 
tion; it  has  occurred  in  almost  all  industries, 
and  for  the  most  jiart  withoiit  serious  friction 
between  workers  and  emjjloyers  As  regards 
the  division  of  time,  there  is  wide  variation, 
e\en  in  the  .same  district,  but  there  are  four 
I)revailing  systems:  (1)  the  five-day  week;  (2) 
the  single-break  day  (with  only  one  long  pause 
for  meals);  (3)  the  double-break  day;  (4)  the 
shift  system.  The  .selection  of  the  system  has  in 
many  eases  been  left  to  the  majority  of  the 
workers. 

The  reports  indicate  that  the  shortening  of 
the  hours  has  had  a  beneficial  effect  on  the 
workers,  "perliaps  more  so  than  any  other 
recent  imi>rovenicnt  in  industrial  conditions." 
One  result  has  been  better  " tinie-kee])ing": 
reports  are  received  that  there  is  not  only  less 
sickness,  but  also  less  ab.sence  for  general  rea- 
.sons,  such  as  attending  to  home  affairs.  There 
is  a  ditt'ereiice  of  exj)erience  as  to  the  effect 
upon  production.  When  the  production  de- 
pends almost  entirely  upon  the  speed  of  ma- 
chinery the  output  is  said  to  be  reduced  nearly, 
or  (|uite,  in  ])roportion  to  the  hours.  In  cases 
where  the  production  dei)cnds  mainly  or  en- 
tirely upon  the  exertion  of  the  workers,  there  is 
often  said  to  be  no  decrease  in  production,  and 
sometiiiies  an  increase  is  even  found.  On  the 
other  hand,  there  are  instances  in  which  the 
shortening  of  hours  has  in  .some  way  reduced 
the  hourly  rate  of  production.  Changes  in  the 
method  of  work  and  in  organization  make  a 
fair  comparison  of  the  output  before  and  after 
the  reduction  difficult  to  some  extent. 

Even  with  the  shorter  hours,  there  still  re- 
mains the  difficulty  of  arranging  sufficiently 
short  jK-riods  of  work  to  avoid  diminished 
hourly  output  because  of  fatigue.  Many  firms 
have  adopted  the  i)lan  of  having  a  short  l)rcak 
in  the  work  in  the  forenoon  and  another  in  the 
afternoon;  and  in  general  it  has  been  found  that 
these  breaks  result  in  increased  i)roduction.  In 
some  districts  there  has  been  a  lengthening  of 
the  mid-day  interval,  and  there  are  various 
other  provisions,  such  as  special  hours  for 
married  women  and  especially  for  mothers  with 
babies.  —  G.  E.  Partridge. 

A     IVL^NUF.^CTXJHER     ON     THE     ShORT     Day. 

Henry  H.  Collins,  Jr.  Survey,  Dec.  4,  1940,  45, 
No.   10,  362. —  Mr.  Collins  states  that   inas- 


68 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


much  as  wages  are  fundamentally  dependent 
upon  unit  production  which  also  determines  the 
cost  of  the  manufactured  article,  the  problem 
of  the  shorter  working  day  is  whether  produc- 
tion per  individual  can  be  sufficiently  main- 
tained to  make  it  possible  to  pay  a  living  wage 
and  sell  the  product  at  a  reasonable  price. 
England's  experience  cannot  be  used  as  the  sole 
criterion  for  this  country,  nor  can  all  industries 
be  expected  to  react  alike.  The  fact  remains, 
howe\-er,  that  it  is  one  of  the  problems  of  good 
management  to  ascertain  the  amount  of  fatigue 
which  can  readily  be  borne  by  the  workers  in 
each  industry.  We  have  the  exi^edient  of  two  or 
three  shifts  for  plants  working  continuously. 

In  Mr.  Collins'  experience,  a  3  per  cent,  re- 
duction in  production  was  more  than  compen- 
sated for  by  the  spirit  of  contentment  which  it 
brought  aljout  among  the  workers.  Rest 
periods  of  from  ten  to  fifteen  minutes  in  the 
mid-morning  and  mid-afternoon,  and  an  after- 


noon limch  of  crackers  and  milk  contributed 
noticeably  toward  the  diminution  of  accidents. 
—  Elinor  D.  Gregg. 

The    L.\bohatort    for    Industrial    Psy- 

CHOTECHNICS    AT    THE    TECHNICAL     TrAINING- 

ScHOOL  IN  Charlottenbl'rg.  W.  Woede. 
Deutsch.  med.  Wchnschr.,  Dec.  2,  1920,  46, 
No.  49,  1370.  —  A  psychotechnical  laboratory 
has  been  established  in  connection  with  the  in- 
dustrial training-school  at  Charlottenburg, 
where  an  attempt  will  be  made  to  study  the 
individual  peculiarities  of  each  pupil  with  re- 
gard to  the  type  of  occupation  for  which  he  will 
be  most  fitted,  and  also  to  study  the  psycholog- 
ical requirements  of  various  industrial  tasks, 
with  a  view  to  lightening  them  whenever  pos- 
sible. The  co-operation  of  several  factories,  the 
railroads,  and  the  post-office  has  also  been 
secured  for  the  study  of  industrial  tasks  outside 
of  the  school.  —  T.  J.  Putnam. 


SYSTE]\nC  OCCUPATIONAL  DISEASES:  OCCURRENCE,  TREATMENT 

AND  PREVENTION 


CIRCULATORY  SYSTEM 
The  Ambulatory  Patient  with  Cardiac 

DlSE.\SE,  WITH  SpECL\L  REFERENCE  TO  DIGI- 
TALIS Therapy.  Emil  J.  Pellini.  Jour.  Am. 
Med.  Assn.,  March  19,  1921,  76,  No.  12,  774- 
777.  —  The  author  gives  his  experiences  with 
250  cases  followed  in  the  cardiac  clinic  of  the 
Bellevue  Hospital,  in  New  York.  He  is  partic- 
ularly interested  in  the  use  of  digitalis  with 
ambulatory  patients  who  are  not  under  the 
perfect  control  characteristic  of  hosjjital  cases. 
Patients  are  carefully  examined  with  a  view 
to  estimating  the  condition  of  the  cardiac 
muscle.  If  a  patient  is  not  perfectly  compen- 
sated, he  is  given  digitalis  until  a  dosage  is 
found  which  can  be  taken  indefinitely  without 
fear  of  overdigitalization.  In  doing  this  it 
shoidd  be  remembered  that  there  is  more  dan- 
ger in  too  little  digitalis  than  in  too  much.  The 
final  readjustment  of  the  patient  to  his  work 
takes  ])lace  after  he  has  been  functionally  classi- 
fied and  jjlaced  u])on  a  definite  regime  of  digi- 
talis, and  this  readjustment  is  a  matter  for 
careful  study  in  each  patient.  —  C.  K.  Drinker. 

The  Equivalent  of  Ordinary  Exertion. 
Ma)/  G.  Wilson.  Jour.  Am.  Med.  Assn.,  Ajiril 
30,  1921,  76,  No.  18,  1213-1214.  —  Patients 
with  cardiac  di-sease  have  been  placed  in  the 


following  classes  by  the  Association  of  Cardiac 
Clinics  in  1917: 

"Class  1.  —  Patients  with  organic  heart  dis- 
ease who  have  never  had  symptoms  of  cardiac 
insufficiency  under  ordinary  conditions  of 
activity. 

"Class  2.  — Patients  with  organic  heart  dis- 
ease who  have  had  such  symptoms  previously, 
but  who  do  not  have  them  at  present  under 
ordinary  conditions  of  activity. 

"Class  3.  — Patients  with  organic  heart  dis- 
ease who  at  the  time  of  observation  have  symp- 
toms of  cardiac  insufficiency  following  ordinary 
exertion. 

"Class  4.  —  Patients  with  possible  heart  dis- 
ease. Patients  who  have  abnormal  i^hysical 
signs  in  the  heart,  but  in  whom  the  general  pic- 
ture or  the  character  of  the  physical  sign  leads 
us  to  lielieve  that  it  does  not  originate  from 
cardiac  disease. 

"Class  5.  —  Patients  with  potential  heart 
disease.  Patients  who  do  not  have  any  sugges- 
tion of  cardiac  disease,  but  who  are  suffering 
from  any  infectious  condition  which  may  be 
accompanied  by  such  disease;  or  who  have  suf- 
fered from  such  diseases:  e.  g.,  rheumatic  fever, 
tonsillitis,  chorea,  syphilis." 

This  classification  depends  throughout  on 
what  sort  and  amount  of  activity  is  considered 


ABSTRACTS 


69 


to  be  ordinary  exertion.  A  table  of  test  exer- 
cises —  work  with  dumb  bells  and  climbing 
stairs  —  is  giv^en  which  is  considered  to.  repre- 
sent ordinary  activity  in  children.  Since  the 
data  furnished  apply  to  individuals  between  6 
and  15  years,  they  are  only  of  suggesti\-e  indus- 
trial significance  and  are  not  reviewed  in  detail. 
—  C.  K,  Drinker. 

Electrocardiogr.\phy  and  its  Sign'ifi- 
CANCE  IN  Insurance  Medicine.  77.  Sachs. 
Zentralbl.  f.  Gewerbehyg..  Jan.,  1921,  9,  No.  1, 
8-11. — An  elementary  di.scussion  of  cardiac 
rhythm  and  conduction,  the  use  of  the  string 
galvanometer,  the  use  of  tlic  electrocardiogram 
in  diagnosis,  followed  by  the  statement  that  the 
method  should  help  in  insurance  work  to  decide 
doubtful  cases  and  to  demonstrate  the  harm- 
less character  of  certain  cases  of  arhythmia.  — 
E.  L.  Sevringhaus. 

NEIROMUSCIXAR  SYSTEM 

New  Of cti'ational  Pain;  Case  of  Cho- 
rea.   J.  J.  Morcn.    Abstracted  as  follows  from 


Kentucky  Med.  Jour.,  Feb.,  1921,  19,  No.  2, 
43,  in  Jour.  Am.  Med.  Assn.,  March  19,  1921, 
76,  No.  12,  820.  —  "Moren  relates  the  case  of  a 
man,  aged  48.  a  railroad  mechanic  who  during 
January,  1920,  began  to  complain  of  pain  in  his 
right  elbow;  in  May  the  left  elbow  became  in- 
volved. He  has  had  all  kinds  of  treatment  with- 
out relief.  He  suffers  a  great  deal  of  ])ain  after 
he  cjuits  work.  There  is  practically  no  pain  on 
extension.  The  pain  sometimes  radiates  up  and 
down  the  arm.  No  particular  portion  is  affected 
more  than  another.  Contraction  of  the  muscles 
by  the  electric  current  j^roduces  the  same  pain 
as  on  \-(>luntary  flexion  of  the  elbow.  Physical 
examination  was  negative.  On  making  in- 
quiries as  to  occupation  it  was  found  that  he 
was  handling  a  (•()mi)ressed  air  motor  drilling 
holes  in  various  pieces  of  machinery.  His  posi- 
tion in  the  use  of  this  motor  was  one  of  flexion 
of  the  arm,  lifting  the  weight  and  at  the  same 
time  holding  it  in  i)osition,  and 'was  accom- 
panied by  more  or  less  vibration.  Rest  gave 
relief."  —  C.  K.  Drinker. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS:  GASES,  CHElNnCALS,  ETC. 


Medical  Decisions  on  Cases  of  Indus- 
trial Poisoning.  F.  Cursrhnnnin.  Zentralbl. 
f.  Gewerbehyg.,  Feb.,  1921.  9,  No.  2,  .SS  44.  — 
Two  cases  are  di.scussed  and  declared  to  be  in- 
stances of  septic  thrombus  in  the  brain  and  of 
local  arteriosclerosis  in  the  foot  rather  than  of 
poisoning  with  acetylene  or  with  tiie  li(|uid  and 
fumes  from  the  "Clark"  apparatus  as  was  al- 
leged by  the  victims.  In  neither  case  had  the 
physician  in  charge  doubted  that  his  patient 
was  suffering  from  industrial  ])oison.  —  E.  L. 
Sevringhaus. 

Foundry  Fever.  E.  Rosi.  Abstracted  as 
follows  from  Arb.  Reichsgcsundh.,  1920,  Vol. 
52,  pp.  1-4,  by  H.  V.  Atkinson,  in  ("hem.  Abstr., 
April  10,  1921,  15,  No.  7,  10;57. —  "■  Experi- 
ments on  animals  and  men  indicate  that  Zn 
vapors  in  foundry  gas  are  the  cause  of  foundry 
fever.  Zn  was  foimd  in  the  urine  and  feces  of 
workers.  Foundry  fever  may  be  prevented  by 
better  ventilation." 

Chronic  Carbon  Monoxid  Poisoning  — 
Its  Immediate  and  Subsequent  Manifesta- 
tions. Georgine  Liiden.  Mod.  i\led.,  Feb., 
1921,  3,  No.  2,  102-106. —This  article  deals 
with  the  personal  experiences  of  the  author  and 


of  her  friend.  For  several  months  they  suffered 
a  wide  variety  of  symj^toms.  Qualitative  tests 
for  carbon-monoxide  hemoglobin  were  found 
positive.  The  number  of  tests  is  not  stated. 
The  symptoms  were  attributed  by  the  author 
to  ])oisoning  by  furnace  gas.  The  belief  is  ex- 
pressed that  chronic  carbon  monoxide  poisoning 
is  very  frcipicnt  and  .serious;  that  the  endocrine 
glands  are  involved,  and  that  a  "hypersensiti- 
zation"  occurs.  No  convincing  proof  of  these 
assertions  is  brought  forward,  however.  — H.  S. 
Forbes. 

Chronic  Carbon  Monoxid  Poisoning  — 

Its  biMEDIATE  and  SlTBSEQUENT  MANIFESTA- 
TIONS. Georgine  Luden.  Mod.  Med.,  March, 
1921,  3,  No.  3,  167-170.  —  This  article  de- 
scribes in  detail  a  great  variety  of  symptoms 
attributed  to  inhalation  of  carbon  monoxide  in 
furnace  gas.  The  observations  are  based 
chiefly  upon  subjective  symi)toms  noted  by  the 
author  and  a  friend  living  in  the  same  house, 
and  upon  certain  objective  signs. 

Mention  is  made  of  one  qualitative  test  for 
carbon  monoxide  hemoglobin  which  was  posi- 
tive in  three  inmates  of  the  house.  No  gas 
analyses  of  the  air  in  the  house  are  given.  The 
assertion   is   made   that   the   gas   clings   tena- 


70 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ciously  to  clothing,  etc.;  the  evidence  brought 
forward  in  support  of  this  is  based  upon  symp- 
toms noted  by  tlie  author  in  herself  and  in  her 
friends.  The  belief  is  expressed  that  a  relation 
exists  between  chronic  carbon  monoxide  poison- 
ing and  disorders  of  the  endocrine  glands,  and 
the  chief  basis  for  this  opinion  seems  to  be 
analogA^  of  symptoms.  In  conclusion,  the  au- 
thor finds  a  "relation  between  slight  chronic 
carbon  monoxide  poisoning  and  many  hy- 
gienic, social  and  domestic  problems."  — H.  S. 
Forbes. 

Industrial  Poisoning  with  Hydrocyanic 
Acid  Gas  in  Gold  and  Silver  Plating. 
HoUztnann.  Zentralbl.  f.  Gewerbehyg.,  Feb., 
1921,  9,  No.  2,  44-45.  — A  resume  of  the  tech- 
nical processes  in  the  gold  and  silver  plating 
industries  explains  the  ways  in  which  a  slow 
but  continuous  evolution  of  hydrocyanic  acid 
fumes  may  occur.  A'entilation  is  sufRcient  to 
remove  all  danger.  Only  part  of  those  exposed 
suffer  any  symptoms.  Acute  manifestations  are 
conjunctival  irritation,  sweet  taste,  and  head- 
ache. Some  suffer  from  eczema.  Many  phy- 
sicians refer  a  chlorosis  among  the  women  to  a 
chronic  poisoning  by  this  gas.  —  E.  L.  Sevring- 
haus. 

Poisoning  from  Wearing  Dyed  Shoes.  F. 
Neuhojf.  Abstracted  as  follows  from  Mo.  State 
Med.  Assn.  Jour.,  Feb.,  1921,  18,  No.  2,  53,  in 
Jour.  Am.  Med.  Assn.,  March  19,  1921,  76,  No. 
12,  820.  —  "Five,  and  again  three,  hours  before 
becoming  ill  NeuhofF's  patient  had  dyed  his 
shoes  while  wearing  them.  The  dye  was  found 
to  contain  a  large  amount  of  nitrobenzol,  an  in- 
termediate product  formed  in  the  manufacture 
of  anilin  from  benzene.  Taken  internally, 
seven  drops  have  caused  death.  It  is  also  poi- 
sonous when  inhaled  or  applied  to  the  skin.  It 
is  used  in  the  manufacture  of  explosives  and 
anilin  derivatives.  AVorkmen  who  inhale  too 
much  of  it,  or  spill  it  on  themselves,  are  poi- 
soned by  it,  death  even  at  times  resulting.  The 
symptoms  of  poisoning  come  on  several  hours 
after  the  application  of  the  poison  to  the  skin 
and  are  favored  by  perspiration.  They  are 
cyanosis,  anxiety,  vomiting,  formication,  ring- 
ing in  the  ears,  disturbed  co-ordination,  low 
blood  pressure.  The  blood  becomes  a  l)rownish 
color.  In  fatal  cases  there  may  be  jaundice, 
convulsions,  and  coma  preceding  death.  The 
treatment  recommended  is  blood  letting,  arti- 
ficial resjjiration,  inhalation  of  oxj'gen,  and 
stimulants,  but  no  alcohol."  —  C.  K.  Drinker. 


Cancer  of  the  Bl.\dder  among  Workers 
IN  Aniline  Factories.  Internat.  Labour 
Office,  Studies  and  Reports,  Series  F,  No.  1, 
Feb.  23,  1921,  pp.  26.  —  "Although  it  is  not 
possible  at  present  to  formulate  definite  con- 
clusions, inasmuch  as  the  problem  still  presents 
too  mam*  lacunae  and  obscure  points,  it  may, 
nevertheless,  be  said  that: 

"(1)  There  is  a  close  connection  between 
the  manipulation  of  certain  amino-compound 
products  and  the  existence  of  tumours  of  the 
bladder. 

"  (2)  The  number  of  cases  of  tumour  of  the 
bladder  proved  to  have  occurred  among  work- 
ers in  contact  with  amino-compounds  is  cer- 
tainly small.  It  nuist  be  concluded  from  this 
that  the  individual  factor  plays  a  great  part  in 
the  pathology  of  the  disease,  seeing  that  the 
patients  constitute  a  small  minority. 

"  (3)  Action  of  long  duration  is  necessary  to 
produce  tumours  of  the  bladder.  There  is  no 
relation,  however,  between  their  occurrence  and 
the  duration  of  employment. 

"  (4)  It  is  not  possible  to  determine  the  sub- 
stance capable  of  engendering  tumours.  At 
present  one  can  go  no  further  than  to  incrim- 
inate the  amino-compounds,  and  particularly 
benzidine  and  beta-naphthylamine. 

"(5)  The,  same  substance  may  produce 
either  simple  cystitis,  or  benignant  or  malignant 
tumours. 

"  (6)  Hygienic  precautions,  strictly  applied, 
will  assure  at  the  end  of  a  few  years  the  diminu- 
tion and  even  the  disappearance  of  the  disease. 

"  (7)  It  is,  therefore,  absolutely  necessary 
that  in  factories  in  which  workers  are  exposed 
to  the  dangerous  action  of  aromatic  bases,  the 
most  rigorous  application  of  hygienic  precau- 
tions should  be  required. 

"  (8)  ^Meanwhile,  it  is  desirable  that  the  in- 
dustries concerned  should  continue  to  carry 
on  researches  with  a  view  to  ascertaining  the 
dangerous  substance,  and  that  the  statistical 
particulars  in  every  case  should  be  very  precise 
and  .should  follow  tlie  ])roiiosed  questionnaire." 
—  M.  C.  Shorley. 

Intoxication'  with  Fluori.ne  Comi'ounds. 
Kockel  and  Zimmermann.  Abstracted  as  fol- 
lows from  Miinchcn.  med.  Wchn.schr.,  1920, 
Vol.  67,  J)]).  777-779.  by  S.  Amberg,  in  Chcm. 
Abstr.,  March  10,  1921.  15,  No.  5,  705.  —  "Two 
cases  of  fatal  F  poi.soning  are  reported,  one  due 
to  a  rat  poison,  '  Orwin,'  containing  NaF,  the 
second  a  case  of  murder.    The  course  of  the  in- 


ABSTRACTS 


71 


toxication  does  not  show  anything  pathogno- 
monic for  F.  To  demonstrate  the  F,  the  organs 
were  boiled  with  water,  the  filtrate  evaporated, 
the  residue  treated  with  H2SO4,  heated  and  the 
vapors  were  tested  in  the  usual  way  for  their 
power  to  etch  glass.  The  stomach  and  its  con- 
tents as  well  as  the  small  intestines  gave  a  posi- 
tive test.  Liver,  kidneys,  spleen  and  blood  did 
not." 

The  Early  Diaoxosis  of  Lead  Poisoxixg. 
J.  Schoenfeld.  Zentralbl.  f.  Gewerbehyg.,  Jan., 
1921,  9,  No.  1,  3-7.  — Symptoms  have  not  al- 
ways l)een  sufficient  for  an  early  diagnosis  of 
lead  poisoning.  The  stijjpling  of  the  red  blood 
cells  is  the  best  guide  to  diagnosis  and  to  the 
progress  of  recover^-.   The  author  has  seen  from 


30  to  15,000  stippled  cells  per  million.  He  con- 
siders 100  per  million  as  a  positive  diagnosis. 
The  stippled  cells  disappear  when  the  severe 
symptoms,  such  as  nephritis  or  paralysis,  occur. 
Stippled  cells  gradually  disappear  under  treat- 
ment in  the  course  of  weeks  to  months,  the 
hemoglobin  increasing  simultaneously. 

Women  appear  more  susceptible  to  lead  than 
men.  Since  1913  the  number  of  ca.ses  of  lead 
poisoning  and  the  loss  of  laboring  time  have 
markedly  decreased,  as  prophesied  by  tiie  au- 
thor at  that  time.  He  believes  this  is  due  fun- 
damentally to  early  diagnosis  being  made  by 
l)lood  examination.  A  further  reduction  in  in- 
cidence is  to  i)c  looked  for  from  the  dcvelup- 
ment  of  a  sense  of  individual  responsibility  in 
the  workers.  —  E.  L.  Sevringhaus. 


OCCUPATIONAL  AFFECTIONS  OF  TIIE  SKIN  AND  SPECIAL  SENSES 


OccuPATioxAL  Deuxiatitis  IX  Dentists: 
SuscEiTiBiLiTv  TO  I'rocaix.  C.  Ghij  Lane. 
Arch.  Dcrmat.  and  Syi)h.,  March,  19'21,  3,  \o. 
3,  !235-'241.  —  Dr.  Lane  re])()rts  three  ca.se  his- 
tories of  dermatitis  caused  by  the  use  of  pro- 
cain,  a  cocain  substitute  employed  extensively 
by  the  dental  profession  and  which  has  several 
technical  advantages  over  cocain.  The  .symp- 
toms shown  were  redness,  swelling,  severe  itch- 
ing and  fissures,  with  scaliness.  The  skin  tests 
showed  uniform  reactions.  The  evidence  olfered 
is  debatable  ground  i)ut  indicates  an  indi\idual 
susceptibility  rather  than  sensitization  by  con- 
stant handling.  There  are  recorded  three  cases 
of  death  after  the  use  of  procain.  It  is  unusual 
but  ])o.ssible  for  poison  to  enter  through  the 
normal  integument.  The  eases  reported  all 
cleared  witli  protection  by  rubber  gloves  but 
relapsed  when  that  care  was  discontinued.  — 
Elinor  D.  Gregg. 

Derm.\titis  Due  to  Carpoglvphis  Pas- 
sularum.  W.  J.  0' Donovan.  Abstracted  as 
follows  from  Brit.  Jour.  Dermat.  and  Syph., 
ig^O,  Vol.  'ii,  p.  '■297,  by  Senear,  in  Arch. 
Dermat.  and  Syph.,  March,  1921,  3,  No.  3,  299. 
—  "O'Donovan  reports  the  case  of  a  man  who, 
while  shoveling  dried  figs,  developed  over  the 
forearms,  backs  of  the  hands  and  on  the  face  an 
eruption  of  discrete,  closely  set,  apparently  fol- 
licular papules,  pale  pink  in  color  with  red 
scabbed  tops.    The  lesions  were  suggestive  of 


scabies,  but  were  too  small,  and  there  was  no 
evidence  of  burrowing. 

"  Examination  of  the  figs  showed  them  to  be 
covered  with  a  fitie,  light  brown  powder,  which 
microscopic  examination  disclosed  was  made  up 
of  live  and  dead  mites  and  numerous  frag- 
mented particles  of  acari  and  tlicir  liniijs.  The 
parasite  was  identified  as  ('(irpo(ihiphu.i  pa.s- 
.sularnm.  The  author  states  that  Ra.sch  had 
])reviou.sly  described  two  cases  of  dermatitis  due 
to  the  Carijoglyphus  occurring  among  workers 
who  had  l)een  handling  dried  plums."  —  M. 
Dent. 

^'Isl'AL  Fatigue.  E.  Jackson.  Abstracted  as 
follows  from  .Vm.  Jour.  Ophth.,  Feb.,  1921,  4, 
No.  2,  119,  in  Jour.  Am.  Med.  Assn.,  March  19, 
1921,  76,  No.  12,  817.  — "Some  analysis  of  dif- 
ferent forms  of  visual  fatigue,  and  attempt  to 
localize  the  essential  change  that  gives  rise  to 
fatigue,  and  a  recognition  of  the  extremely  im- 
l)ortant  part  that  efi'orts  of  co-ordination  play 
in  protiucing  fatigue,  Jackson  believes  ought  to 
be  u.scful  in  giving  a  better  conception  of  a  con- 
dition that  passes  easily  from  physiologic  to 
])athologic  significance.  It  should,  he  says,  be 
borne  in  mind  that  normal  visual  fatigue  rarely 
rises  into  consciousness.  Only  when  the  organ- 
ism in  response  to  long  continued  or  repeated 
excessive  fatigue  has  developed  a  method  of 
translating  this  into  discomfort  or  pain  does  it 
develop  into  symptoms."  —  C.  K.  Drinker. 


72 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Inadequacy  of  Ixdustbial  Accident  Sta- 
tistics Published  in  State  Reports.  Mar- 
garet Gadshij.  U.  S.  Bur.  Labor  Statis.,  Month. 
Labor  Rev.,  March,  V>1\,  \-Z,  No.  3,  167-176. 
—  The  author  very  strikingly  ilUistrates  her 
subject  and  contention  by  a  series  of  state  re- 
ports for  the  years  1917,  1918,  and  1919.  — R. 
B.  Grain. 

The  Obscitre  bit  Most  Prolific  Hazard. 
E.  W.  Mou-ery.  Safety  Engin.,  April,  19'21,  41, 
No.  4,  183-184.  —  Two  charts  picture  the 
causes  of  accidents.  In  the  first  of  these,  23.5 
per  cent,  of  the  accidents  from  seventeen  dif- 
ferent causes  were  due  to  falls.  The  second 
shows  the  high  percentage  of  falls  which  occur 
oii  the  level  ground  —  23.4  per  cent,  of  all  falls 
from  ten  different  causes.  Slipping  hazards 
should  be  sought  out  and  eradicated;  various 
anti-slip  treads  help.  —  M.  Dent. 

Who  is  to  Bl.\]me  for  Accidents?  Nat. 
Safety  News,  Feb.  28,  1921,  3,  No.  9,  3,  10.  — 
A  study  of  the  accidents  that  have  occurred  in 
the  plants  of  the  Nicetown  Works  of  the  ^Nlid- 
vale  Steel  and  Ordnance  Company  during  a 
period  of  ten  years  led  to  the  conclusion  that 
the  responsibility  is  divided  as  follows:  acci- 
dents in  which  the  injured  individual  is  respon- 
sible constitute  about  00  i)er  cent,  of  the  cases; 
accidents  which  are  "nobody's  fault"  (  most  of 
them  trivial)  make  about  30  per  cent.;  those  for 
which  a  fellow  workman  is  to  blame  make  a 
little  less  than  10  per  cent.,  and  accidents  for 
which  the  company  is  responsible  constitute 
less  than  one-half  of  1  per  cent. 

Accidents  that  are  nobody's  fault  include 
those  which  arise  out  of  the  occupational  haz- 
ards more  or  less  incidental  to  the  employment 
and  they  are  usually  non-preventable.  Acci- 
dents for  which  the  company  is  responsible  are 
such  as  those  occurring  where  sufficient  light 
or  the  proper  tool  has  not  been  provided,  or 
the  proper  safety  device  installed.  The  content 
of  the  remaining  classes  is  varied  —  workmen 
are  responsible  when  they  ojjerate  a  machine 
without  jiermission,  neglect  to  wear  goggles, 
violate  various  rules,  .select  improper  methods 
of  work,  etc.  Carelessness  in  handling  mate- 
rials, scuffling,  etc.,  are  examples  of  the  causes  of 
accidents  to  others.  —  G.  E.  Partridge. 

Unhted  St.\tes  Steel  Corporation  An.\- 
LYZEs  Causes  of  200,000  Accidents.  Nat. 
Safety  News,  Feb.  7,  1921,  3,  No.  6,  3-4.  —  A 


recent  bulletin  of  the  Bureau  of  Safety,  Sanita- 
tion and  AYelfare  of  the  United  States  Steel 
Corporation  contains  a  chart  analysis  of  220,- 
707  accidents  that  have  occurred  in  the  plants 
of  the  corporation.  Hand  labor  is  reported  as 
responsible  for  44.47  per  cent,  of  all  the  acci- 
dents, and  machinery  for  4.94  per  cent.  The 
remaining  50  per  cent,  are  somewhat  ob- 
.scurely  classified  as  follows:  mines,  14.76  per 
cent.;  falls,  8.09  per  cent.;  burns,  7.13  per  cent.; 
eyes,  5.10  per  cent.;  railroads,  4.26  per  cent.; 
all  others,  11.30  per  cent.  The  conditions  under 
which  nearly  half  of  the  accidents  occur  are 
almost  entirely  within  the  control  of  the  work- 
men and  the  accidents  are  due  largely  to  their 
carelessness  or  thoughtlessness.  In  addition  to 
these  hand  labor  accidents,  there  are  hundreds 
of  accidents  in  which  the  fault  of  the  employees 
was  a  contributing  cau.se;  in  carefully  analyzing 
the  causes  of  any  100  accidents,  it  will  be  found 
that  at  least  90  per  cent,  of  them  might  have 
been  prevented,  if  a  little  more  care  had  been 
taken.  The  guarding  of  machinery  is  necessary, 
but  it  is  not  such  an  imiiortant  part  of  the  work 
of  prevention  as  is  sometimes  supposed. 

The  report  also  contains  figures  in  regard  to 
the  amount  of  money  exjjended  by  the  com- 
j)any  in  safety  work,  the  number  of  men  trained 
in  first  aid,  and  the  number  of  articles  and  de- 
vices provided  for  the  comfort  and  welfare  of 
its  employees.  —  G.  E.  Partridge. 

Quarry  Accidents  in  the  United  States 
during  the  Calendar  Year  1919.  IT'.  W. 
Adams.  U.  S.  Bur.  Mines,  Tech.  Paper  275, 
1921,  pp.  66.  — A  series  of  tables  based  on  re- 
ports received  from  operators  of  quarries,  and 
which,  therefore,  present  all  stages  of  the  in- 
dustry, and  are  representative  of  the  entire 
industry.  —  M.  Dent. 

Coal  Mining  Accidents  in  the  State  of 
Washington.  Safety  Engin.,  Feb..  1921,  41, 
No.  2,  62-64.  —  This  paper  contains  a  sum- 
mary of  educational  provisions  in  effect  Jan- 
uarj'  1,  1920,  the  decrease  in  frequency,  and 
increa.se  in  severity,  of  accidents;  and  a  com- 
parison of  coal  mine  fatalities  in  the  ]jrinci])al 
coal  producing  countries  for  a  period  from  1901 
to  1911. —M.  Dent. 

Rules  for  Prevention  of  Gas  Explo- 
sions in  Anthracite  Mines.  J.  J.  Walsh. 
Safety  Engin.,  Feb.,  1921,  41,  No.  2,  69-72.  — 
The  casualties  as  a  result  of  gas  explosions  in 


ABSTRACTS 


73 


the  anthracite  mines  of  Pennsylvania  during 
the  past  forty-seven  years  were  one  every  work- 
ing day,  the  ratio  being  one  fatal  to  three  non- 
fatal. Rules  are  given  for  the  installation  and 
driving  of  ventilating  fans,  building  of  stop- 
pings, analysis  of  air,  the  avoidance  of  the  use 
of  main  doors  as  far  as  possible,  as  well  as  rules 
requiring  that  special  care  be  taken  of  sections 
where  1^5  cubic  feet  or  more  of  methane  is 
generated.  —  M.  Dent. 

The  Statu.s  of  L.\bor  Union'  Accident 
Preventiox.  F.  Rothc.  Zcnlralbl.  f.  Gewer- 
bchyg.,  Feb.,  \iH\,  9,  Xo.  -2,  4(J-48.  —  In  this 
categorical  reply  to  an  article  which  appeared 
under  the  same  title  in  Zentnilhhitt  for  Sejit., 
IdH),  the  empiiasis  is  placed  on  the  need  for 
specialists  in  accident  prevention  and  on  the  fact 
that  the  real  aim  of  the  work  is  the  reduction  of 
dangers  rather  tlian  the  multij)lication  of 
safety  devices.  —  E.  L.  Sevringhaus. 

Closing  Devices  for  C.vrboys.  Safety 
Engin.,  Ajml,  1921,  41,  No.  4,  188.  — Frequent 
fires  and  accidents  occur  due  to  the  leakage 
from,  or  breakage  of,  carboys  used  in  trans- 
porting aciils  and  other  dangerous  materials, 
which  were  until  recently  generally  closed  by  a 
loosely  fitting  earthenware  sto|)|)cr  held  in 
place  by  clay,  plaster  of  Paris,  or  l)urla]). 

Work  is  being  carried  on  by  the  IJurcau  of 
E.\pit)sives  for  the  venting  of  acid  carboys  in 
order  to  prevent  internal  pressure,  and  for  the 
development  of  jiorous  stoppers  which  will  ]ier- 
mit  the  escape  of  vapors  i)roduced  in  transit  and 
thus  prevent  accumulation  of  pressure.  —  M. 
Dent. 

Wooden  Machine  Guards.  F.  S.  Benedict. 
Safety  Engin.,  Ai)ril,  19-21,  41,  Xo.  4,  176.  — 
The  first  ert'orts  directed  toward  safeguarding 
are  almost  invariably  made  with  wooden 
guards,  cheapness  being  the  appeal  most  readil.\- 
listened  to.  There  are  thousands  of  wooden 
overhead  belt  guards  which  would  be  utterly 
useless  in  ca.se  the  belt  broke.  These  wooden 
guards  accumulate  dust  and  disea.se  germs; 
become  saturated  with  oil,  and  thus  de\elop 
into  a  fire  menace;  act  as  flues  if  fire  should 
start  below;  and  sj)linter  easily,  thus  causing 
small  injuries  which  may  become  infected.  — 
M.  Dent. 

Dispensarv  on  Con.structiox  Jobs.  Her- 
bert L.  Daris  and  Thomas  H.  George.  Hosp. 
Management,  Jan.,  19-21,  11,  Xo.  1,  60.  —The 


Thompson  Starrett  Company  of  X'ew  York  be- 
lieves in  the  well-worn  cry  of  "Safety  First." 
Somebody  has  been  able  to  jiut  life  into  the 
phrase  and  a  spin  into  the  company's  safety 
program.  Co-operation  exists.  Accidents  are 
cared  for  —  even  the  trivial  ones.  There  arc  no 
crijjplcs  and  very  little  lost  time.  Most  amaz- 
ing is  the  record  of  infections  —  only  fourteen 
out  of  8-20  accidents  and  none  serious.  Safety 
bulletins  on  the  early  treatment  of  scratches 
and  puncture  wounds  are  posted  conspicuously. 
—  Elinor  D.  Gregg. 

What  Penn.sylvania  is  Doinc;  for  Safety 
AXD  Safety  Code.s.  C.  B.  Connrllcy.  Hull. 
Penn.  State  Dept.  Labor  and  Industry,  19-20,  7, 
Xo.  7,  pp.  -20.  — The  safety  ])rogram  of  Penn- 
sylvania is  based  upon:  (1)  the  enforcement  of 
at  least  twenty-five  specific  acts  of  legislature, 
among  them  the  acts  creating  the  Department 
of  Labor  and  Industry  and  the  Workmen's 
Compensation  and  Rehabilitation  Acts;  (-2)  the 
placing  of  the  responsibility  for  compliance 
with  tlie  requirements  of  thirty  safety  stand- 
ards upon  employers  as  well  as  employees; 
(3)  serving  the  employees,  the  state  officials 
and  manufacturers  with  a  means  of  knowing 
and  a])])roving  ai)i)liaiiccs  which  arc  safe  —  tiie 
ai)proved  devices  numlwring  1(!0  and  classified 
as:  (n)  boiler  appliances,  (b)  elevator  a])])liances, 
[c)  mechanical  appliances,  (rf)  electrical  ap- 
pliances, (e)  motion  picture  appliances,  (/)  fire 
prevention  and  protection  a])pliances,  and  (r/) 
miscellaneous  safeguards  and  appliances  such 
as  anti-.slip  treads,  no-slip  ladder  shoes,  ladders, 
etc."  (4)  educational  cami)aigns  such  as  the 
Safety  Congress  and  connnuiiity-wide  safety 
programs,  motion  j)icture  enterlainments,  vo- 
cational clinics  and  the  publication  of  bulletins, 
posters  and  pamphlets;  (5)  co-operation  with 
the  Department  of  Public  Education  in  the 
instruction  of  "Safety  First"  in  the  public 
schools. 

The  history  of  the  safety  movement  in  the 
state  is  sketched  for  four  periods:  the  pion- 
eer period,  the  compensation  period,  the  war 
jjcriod,  and  the  re-adjustment  or  reconstruc- 
tion period. 

Part  II  of  the  report  discusses  the  making  of 
a  safety  standard — a  standard  requiring  the  co- 
operation of  the  worker,  the  employer,  the 
engineer  or  technical  expert,  the  manufacturer, 
the  state,  the  insurance  carrier,  and  the  public. 

In  addition  to  the  revision  of  all  its  codes  the 
Pennsylvania  Department  is  formulating  new 


74 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


codes  for  head  and  eye  protection,  sanitation, 
laundries,  housing,  and  refrigeration.  —  G.  E. 
Partridge.  ^ 

Saving  Men  and  Money  at  the  duPont 
Pl.\nts.  L.  Resnick.  Nat.  Safety  News,  Feb. 
21,  1921,  3,  No.  8,  3-8,  14.  —  The  most  modern 
school  of  safety  men  has  taken  the  position 
that  every  accident  is  a  symptom  of  ineffi- 
ciency. The  nature  of  the  business  of  the  du- 
Pont Company  in  its  early  days  made  it  quick 
to  recognize  this  principle.  But  the  greatest 
accomplishment  of  this  company  has  been 
achieved  since  1917,  when  the  executives  in 
charge  of  production  "came  to  a  clearer  realiza- 
tion that  all  production  men  must  be  directly 
charged  with  responsibility  for  safety  and 
health  work."  The  result  has  been  the  reduc- 
tion of  the  "fatal  frequency  rate  per  1,000- 
3,000  hour  men"  from  3.20  in  1916  to  1.49  in 
1920,  and  one  department  especially  is  to  be 
noticed  for  having  passed  the  year  1920  with- 
out a  lost-time  accident,  although  it  is  de- 
voted to  experimental  work  involving  a  great 
number  of  hazards. 

The  occupational  disease  problem  of  the 
duPont  Dye  Works,  on  account  of  the  opera- 
tions and  the  materials  handled,  is  as  important 
as  that  of  accident  prevention.  An  initial  ex- 
amination is  made,  and  re-e.\amination  is  re- 
quired of  many  men  each  month  in  order  to 
detect  the  first  traces  of  occupational  disease. 
As  a  result,  there  has  not  been  a  death  from 
occupational  disease  since  the  dye  works  began 
operations  three  years  ago.  In  one  building, 
where  trouble  had  occurred  on  account '  of 
poisoning  from  aromatic  nitro-compouuds,  the 
wooden  platforms  and  the  wooden  boxes,  which 
had  become  saturated  and  were  giving  off 
fumes,  were  replaced  by  steel  gratings  and 
galvanized  iron,  and  a  special  fume  exhaust 
was  installed  for  each  container,  the  contents  of 
which  were  imder  process  of  liquefaction  by 
steam.  Extreme  care  was  given  to  personal 
cleanliness  and  to  the  cleanliness  of  the  build- 
ing, and  as  a  result  there  was  a  marked  reduc- 
tion in  the  cases  of  poisoning  and  an  increase  in 
production.  Other  improvements  in  processes 
were  made,  such  as  replacing  a  filtrose-bed  for 
pelleting  material  with  a  pelleting  machine. 

The  methods  employed  to  stimulate  interest 
in  safety  work  take  into  consideration  char- 
acteristics of  group  consciousness.  Depart- 
ments are  put  into  competition  with  one 
another,    and    sometimes    groups    within    de- 


partments. Records  are  kept  of  "days  without 
accidents,"  and  the  results  are  displayed  on 
bulletin  boards  about  the  plants.  Appeal  to  the 
sporting  blood  of  the  workers  has  proved  a  very 
effective  way  of  reducing  the  accident  rate. 

The  Safety  Section  of  the  duPont  plant  is 
divided  into  three  branches:  construction  and 
design;  manufacturing;  and  accidents  and  in- 
juries. To  the  first  division  there  falls  the 
standardizing  of  safeguards  and  the  checking  of 
designs  for  new  structures,  etc.  The  manu- 
facturing division  superintends  all  the  safety 
work  of  the  manufacturing  operations,  and 
visits,  inspects  and  standardizes  educational 
activities.  The  third  branch  keeps  records,  pre- 
pares statistics,  and  attends  to  matters  per- 
taining to  compensation  and  the  like. 

Engineering  revision,  rather  than  after- 
thought machine-guarding,  is  a  fundamental 
principle  of  the  safety  work  of  the  company; 
and  on  the  lines  adopted  good  results  have  been 
obtained  in  reducing  accidents  and  diseases. 
"Even  the  explosion  hazard  yields  ...  to 
treatment  by  engineering  revision,  safety  edu- 
cation, and  proper  supervision."  —  G.  E. 
Partridge. 

How  TO  Induce  Workmen  to  Come  to  the 
Shop  Hospital.  C.  F.  .Y.  Schram.  Nat.  Safety 
News,  Feb.  14,  1921,  3,  No.  6,  7,  10.  —  Since 
accidents  cannot  be  wholly  prevented,  it  is  im- 
portant that  there  be  provision  for  caring  for 
injuries,  and  it  is  essential  that  all  accidents, 
even  very  minor  ones,  be  reported  for  treat- 
ment. The  plan  adopted  at  the  Fairbanks, 
Morse  and  Company  plant  at  Beloit,  Wiscon- 
sin, includes  monthly  statements  to  depart- 
ments of  the  records  of  all  departments  in 
respect  to  delayed  reports.  Lists  of  lost-time 
accidents  are  also  sent  out.  In  case  a  lost-time 
accident  is  one  in  which  there  was  a  delayed 
report,  special  attention  is  called  to  this  fact. 
Another  valuable  aid  to  efficient  service  of  the 
medical  department  is  the  proper  attitude  to- 
ward injured  men  —  such  considerate  treat- 
ment as  will  cause  men  to  go  jironiptly  for 
treatment.  The  "department  monthly  expense 
exhibit,"  in  the  form  of  a  bulletin,  helps  to  make 
department  heads  interested  and  careful.  A 
good  annual  rei)ort  regarding  the  safety  and 
the  hospital  <lcj)artments  is  valuable.  Finally, 
every  plant  employing  over  500  men  (and  .some 
employing  less)  should  have  a  trained  nurse  and 
a  hospital  department  —  not  simply  a  first-aid 
station. 


ABSTRACTS 


75 


"No  statement  regarding  the  early  reporting 
of  injuries  would  be  complete  if  it  did  not  take 
into  account  the  educational  work  done  by  the 
National  Safety  Council  through  its  bulletins. 
It  keeps  the  hospital  department,  the  safety 


department,  the  superintendent,  the  foreman 
and  the  workman  continually  reminded  that 
accidents  are  generally  unnecessary,  but  that, 
when  they  do  happen,  proper  care  is  essential." 
—  G.  E.  Partridge. 


INDUSTRIAL  SURGERY 


Ambul.\nce  .\n'd  Fir.st  All).  ./.  ('.  Bridge. 
.Vnn.  Rep.  Chief  Insjject.  Factories  and  Work- 
shops for  the  Year  1919,  London,  lO-iO.  pp.  83- 
87.  —  This  report  is  mainly  of  local  interest, 
since  it  consists  |)rincipally  of  tal)les  siiowing 
the  extent  to  wliicii  the  factory  regulations, 
etc.,  in  regard  to  first-aid  and  ambulance  room 
service  have  been  complied  with  in  the  United 
Kingdom.  There  are  a  few  points  of  general 
interest.  In  respect  to  first-aid  boxes,  the  most 
noticeable  irregularity  is  in  the  lack  of  steri- 
lized dressings.  AVhen  the  boxes  are  installed 
they  are  i)roperly  e(|uipped,  but  when  dressings 
are  re|)laced,  unsterili/cd  dressings  are  apt  to 
be  obtained,  and  it  is  al.so  reported  that  the 
sterilized  dressings  that  are  on  the  market  are 
clumsy,  and  that  there  are  not  enough  shapes 
and  sizes  to  suit  all  cases.  There  is  some  ol)- 
jection  made  to  the  habil  of  dealers  of  sup])ly- 
ing  in  the  boxes  articles  not  required  (lint, 
bandages,  iglodine,  iodine  solution,  etc.).  The 
objection  is  made  on  the  ground  that  in  this 
way  beginners  do  not  become  fixed  in  the  habit 
of  using  the  sterilized  dressings,  although  it  is 
admitted  that  the  iodine  .solution  and  the  band- 
ages may  be  allowable.  Another  comjjlaint  is 
that,  des])ite  printed  instructions  to  tiie  con- 
trary, there  is  still  a  good  deal  of  washing  of 
wounds.  One  inspector  thinks  that  it  would  be 
better  if  the  directions  omitted  the  negative 
caution,  "do  not  wash,"  and  merely  explained 
how  to  clean  wounds  with  iodine. 

Progress  is  reported  in  the  provision  of  am- 
bulance rooms,  and  there  is  some  discussion  of 
the  effect  of  the  installation  of  the  ambulance 
room  ui)on  the  first-aid  treatment  in  the  shoj), 
emphasizing  especially  the  value  of  the  iuune- 
diate  use  of  the  sterilized  dressings.  It  is  sug- 
gested that  the  better  keeping  of  records  of 
accidents  is  having  a  good  effect  in  focusing 
attention  on  the  causes,  and  that,  as  regards 
first-aid  training,  the  necessity  is  for  more  edu- 
cation in  the  use  of  the  sterilized  dressing;  and 
it  is  urged  that  this  treatment  should  be 
taught  universally  in  first-aid  classes.  —  G.  E. 
Partridge. 


Injuries  of  the  Feet.  ['.  V.  Portmann  and 
F.  C.  Warnshuis.  Jour.  Am.  Med.  Assn.,  Ai)ril 
30,  1921,  76,  No.  18,  h2U~l'216.  —  A  general 
review  of  the  subject  summarized  by  the  au- 
thors as  follows: 

"One  might  continue  at  iiMigtii  to  cite  nu- 
merous case  histories  illustrative  of  the  extent 
and  character  of  foot  injuries  that  we  have 
l)een  accustomed  to  classify  as  minor  but  which 
have  ])roduced  great  disability  with  some  de- 
gree of  permanence.  It  is  our  ])ur])()se  here,  not  . 
to  de\elop  an  exhaustive  treatise  but  to  stimu- 
late a  better  plan  of  treatment  of  foot  injuries 
based  on  a  better  conce])tion  of  ])hysiologic 
functioning  and  reaction.  Wc  therefore  draw 
attention  to  certain  facts: 

"  1 .  The  structure  of  the  foot  is  complex,  and 
there  is  a  difference  in  the  reaction  of  the 
tissues. 

"i.  Injury  to  an  integral  part  lias  a  large 
incapacitating  influence  on  the  whole  member 
and  the  individual. 

"3.  The  integral  part  affected  must  lie  ac- 
curately determined,  and  roeiilgenograms  made 
a  routine  procedure  in  examination. 

''4.  The  site  of  injury  should  not  be  treated 
exclusively.  The  whole  part  and  its  anatomic 
and  iiliysiologic  relationship  should  be  con- 
sidered. 

"5.  Rest  in  elevation  should  be  instituted 
at  the  beginning  of  treatment. 

"6.  Improjier  hot  bathing  is  more  jjroduc- 
tive  of  harm  than  of  benefit. 

"7.  We  are  always  dealing  with  infected 
areas. 

"8.  Incisions  should  be  made  at  sites  of  elec- 
tion, never  on  plantar  surfaces,  and  all  wounds 
must  be  carefully  debrided  and  coapted. 

"9.  Anatomically  correct  adjustment  of 
footwear  merits  greater  attention  and  fre- 
quently accomplishes  the  complete  eradication 
of  the  final  results  of  traumatism." —C.  K. 
Drinker. 

Diagnosis  and  Treatment  of  Disabili- 
ties OF  THE  Back.  James  Warren  Sever.   Mod. 


76 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Med.,  Feb.,  1931,  3,  No.  2,  98-102.  —Besides 
the  traumatic  injuries  to  the  back  which  are  a 
result  of  industrial  accidents,  there  are  three 
common  types  of  disability  —  namely,  those 
due  to  the  poor  posture  or  static  backache, 
which  is  produced  by  sitting  or  standing,  in- 
equality in  the  length  of  the  legs,  sacro-iliac 
strain,  and  spondylolisthesis  or  a  slipping  for- 
ward of  the  body  of  the  fifth  lumbar  vertebra; 
those  due  to  pelvic  disease  or  abnormality  in 
women,  and  which  are  invariably  confined  to 
the  sacral  or  very  low  lumbar  regions  and  com- 
prise chiefly  lacerations,  retroversions,  pro- 
lapse, etc.;  and  those  resulting  from  diseases 
such  as  arthritis,  tuberculosis,  osteomyelitis, 
etc.,  of  the  vertebrae. 

Back  injuries  due  to  industrial  accidents  re- 
sult from:  (1)  strain  from  lifting,  when  the  back 
seems  to  "snap"  suddenly — in  these  cases  it  is 
difficult  to  differentiate  between  muscular  and 
ligamentous  tears,  but  the  author  believes  that 
ligamentous  tears  are  of  longer  duration,  and 
that  the  soreness  and  tenderness  are  deeper 
seated;   (2)  crush  fractures  —  a  very    general 


type  of  injury,  in  which  the  lesions  are  most 
commonly  located  at  or  about  the  dorsolumbar 
junction;  (3)  compressed  fractures,  which  are 
most  frequently  caused  by  falls  on  the  buttocks, 
shoulder  or  back,  or  from  landing  on  the  feet 
from  a  great  height;  (4)  contusions,  which 
usually  follow  a  blow  or  a  fall,  and  in  which  the 
resultant  injury  is  generally  to  the  soft  part, 
although  deeper  bony  structures  may  be  in- 
jured; (5)  fractures  of  the  vertebral  bodies. 
These  are  especially  interesting  because  the 
patient  only  complains  of  a  stiff  or  lame  back, 
and  some  tenderness  over  the  site  of  the  injury. 
Very  few  have  s.ymptoms  due  to  nerve  pressure, 
probably  owing  to  the  fact  that  the  spinal  cord 
ends  at  about  the  level  of  the  first  lumbar 
vertebra,  the  point  of  greatest  frequency  of 
fracture.  The  treatment  should  be  early  and 
adequate  fixation  of  the  spine  in  a  plaster 
jacket  and,  subsequently,  by  a  brace.  An 
X-ray  is  always  essential.  Common  complica- 
tions are  sciatica,  hypertrophic  arthritis,  gen- 
erally quiescent  and  pre-existent  to  the  injury. 
—  Elinor  D.  Gregg. 


INDUSTRIAL  PHYSIOLOGY:  NUTRITION,  IVIETABOLISM. 

FATIGUE,  ETC. 


Quantitative  Distribution  of  Particu- 
late Material  (Manganese  Dioxide)  Ad- 
ministered Intravenously  to  the  Cat. 
Cecil  K.  Drinker  and  Louis  A.  Shaw.  Jour. 
Exper.  Med.,  Jan.  1,  1921,  33,  No.  1,  77-98.  — 
As  the  result  of  a  most  instructive  series  of  ex- 
periments the  authors  draw  the  following  con- 
clusions : 

"1.  Manganese  dioxide  suspended  in  an 
acacia-sodium  chloride  solution  provides  a  non- 
toxic injection  which  in  the  present  experi- 
ments has  contained  no  particles  larger  than  1  jj. 
and  which,  when  deposited  in  the  body,  can  be 
determined  (|uantitatively  and  seen  micro- 
scopically. 

"2.  Intravenous  injections  have  been  made 
under  precautions  which  jirccludc  removal 
from  the  blood  or  deposition  in  organs  through 
simple  cajiillary  blockage. 

"3.  In  nine  experiments  out  of  thirteen  the 
circulating  blood  containctl  no  manganese  after 
18  minutes.  In  the  four  remaining  instances 
there  was  a  slight  elimmation  which  was  in- 
complete at  the  end  of  1  hour.  Within  certain 
limits  the  rate  of  removal  from  the  circulating 


blood  and  the  sites  of  deposition  in  the  animal 
are  not  influenced  by  the  concentration  of  the 
suspension,  the  blood  pressure,  or  antecedent 
introduction  of  acacia  or  histamine. 

"4.  In  the  cat  amounts  of  manganese 
dioxide  varying  between  9.8  and  3.9  mg.  of 
manganese  and  containing  from  .50,000,000,000 
to  10,000,000,000  particles,  if  injected  intra- 
venously, permit  recovery  at  the  end  of  1  hour 
of  90  per  cent,  of  the  material  in  the  lungs, 
liver,  and  spleen  in  the  following  proportions: 
lungs  47  per  cent.;  liver  38.3  per  cent.;  spleen 
4.3  per  cent. 

"5.  These  experiments,  coupled  with  correl- 
ative results  by  other  investigators,  make  it 
clear  that  in  certain  organs  —  the  lungs,  liver, 
and  si)lccn  of  the  cat  —  the  vascular  endothe- 
lium possesses  phagocytic  power  rendering  the 
capillaries  permeable  to  particulate  material  as 
well  as  to  gases,  liquids,  and  dissolved  sub- 
stances." —  H.  F.  Smyth. 

Shop  Standards  .\nd  Fatiolt:.  Bernard  J. 
Newman.  Mod.  Med.,  Feb.,  1921,  3,  No.  2,  93- 
97.  —  Sufficient  progress  has  been  made  in  dis- 


ABSTRACTS 


77 


covering  the  cause  of  industrial  over-fatigue  to 
warrant  the  introduction  of  plant  programs  for 
its  control.  The  economic  losses  from  fatigue 
are  estimated  at  ii)  cents  per  worker  per  day  per 
year.  On  this  basis,  with  the  normal  working 
year  of  three  hundred  days,  the  monetary  loss 
to  the  nation  amounts  to  $'2,400,000,000  —  a 
very  appalling  figure. 

Fatigue  is  caused  by  the  nuiscle  waste  pro- 
duced by  metabolism;  its  usual  manifestations 
are  loss  of  ap])etite,  anemia,  digestive  derange- 
ments, respiratory  and  cardiac  afl'ections, 
fatigue  neuroses  and  neurasthenia,  and  weak- 
ened power  of  resistance  to  bacteria.  Industrial 
fatigue  is  caused  directly  by  continuous  lifting, 
long  standing,  crampeil  positions,  the  contin- 
uous use  of  the  same  set  of  nuisclcs,  sitting  in 
faulty  postures,  excessive  noise,  high  tempera- 
ture and  humidity,  extremes  of  heat  and  cold, 
and  light  intensity;  tlie  indirect  causes  may  be 
said  to  be  dust-producing  work,  inadequate  and 
insanitary  drinking  facilities,  no  rest  rooms,  un- 
sympathetic management,  unattractive  work- 
rooms, congestion  of  workrooms,  no  industrial 
hygiene  nor  (irovisions  for  medical  and  surgical 
relief. 

The  tests  for  industrial  fatigue  are  divided 
into  the  four  following  groups:  (1)  laboratory 
tests  touching  j>liysiological,  chemical,  and 
bacteriological  reactions  to  labor  causing  over- 
fatigue; ("2)  factory  tests  in  regard  to  produc- 
tion —  spoiled  work  and  accidents  are  also 
important  indices  of  fatigue;  (8)  physical  tests 
upon  emjjloyees  to  determine  their  capacity  for 
arduous  labor;  and  (4)  a  miscellaneous  group 
including  a'l  tests  of  other  character. 

The  fundamentals  of  a  plant  j)rogram  for  re- 
ducing fatigue  are:  (1)  physical  examination  of 
applicants  and  periodic  re-examination;  (2) 
physical  examination  of  the  jobs  to  find  out 
their  reciuirements,  mentally  and  nniscularly; 
(3)  physical  examination  of  the  plant  to  dis- 
cover the  working  conditions  which  may  injure 
the  health  of  the  worker,  increase  fatigue  and 
reduce  output.  —  Elinor  D.  Gregg. 

The  Influence  of  Dilution  on  the  Toxic 
Action  OF  Alcoholic  Liquids.  H.  M.  J'enion. 
Brit.  Jour.  Inebriety,  Oct.,  lO^O.  18,  No.  2,  39- 
76.  —  The  author's  summary  is  as  follows:  "A 
series  of  fifty-seven  experiments  nas  made  in 
which  alcoholic  liquids  containing  15  to  90  c.c. 
of  alcohol  were  taken  three  and  a  half  hours 
after  food,  or  on  an  empty  stomach.  A  mem- 
orized passage  was  typed  at  twenty  minute  in- 


tervals before  and  after  the  alcohol,  and  it  was 
found  that  the  typing  mistakes  were  invariably 
increased,  and  the  typing  time  almost  invari- 
ably. For  each  extra  mistake  the  typing  time 
was  increased,  on  an  average,  by  about  two 
seconds  above  its  pre-alcohol  value  of  ninety- 
eight  seconds,  and  the  alcohol  acted  syn- 
chronously on  time  and  on  mistakes;  but  in 
order  to  reduce  the  results  to  terms  of  a  single 
variable,  the  mistakes  made  were  corrected 
throughout  to  a  constant  typing  speed. 

'■  It  was  found  that  when  taken  in  the  form  of 
whisky  of  -20  per  cent,  alcoholic  strength  (by 
volume),  18.3  c.c.  of  alcohol  caused  an  increa.se 
of  O.S  in  the  number  of  corrected  mistakes, 
30  c.c.  alcohol  one  of  .'5.4,  45  c.c.  one  of  8.0,  and 
60  c.c.  one  of  17.0,  or  the  effect  increased  at  a 
more  and  more  rapid  rate  the  greater  the  quan- 
tity of  alcohol  taken.  With  5  per  cent,  whisky 
the  efi'ects  ])roduced  were  considerably  smaller, 
and  75  c.c.  alcohol  taken  in  this  form  had  the 
same  effect  as  57  c.c.  alcohol  in  the  form  of  20 
l)er  cent,  whisky.  Beer  of  5  per  cent,  alco- 
holic strength  i)roduced  20  per  cent,  more  mis- 
takes than  wiiisky  of  the  same  strength,  but  4 
|)er  cent,  beer  was  much  less  toxic,  and  90  c.c. 
alcohol  in  this  form  produced  only  as  much 
effect  as  68  c.c.  alcohol  in  the  form  of  5  per 
cent.  i>eer. 

"The  toxic  effect  of  3  per  cent,  beer  and  3 
per  cent,  cider  was  much  slighter  than  could 
iiave  been  anticipated,  and  90  c.c.  alcohol  in  the 
form  of  3  per  cent,  beer  produced  only  as  nnich 
effect  as  54  c.c.  in  the  form  of  4  per  cent,  beer,  as 
46  c.c.  in  the  form  of  5  per  cent,  beer,  and  as 
42  c.c.  in  the  form  of  20  per  cent,  whisky.  The 
90  c.c.  of  alcohol  mentioned  is  contained  in  5j 
pints  of  the  beer,  and  it  was  calculated  that  in 
my  own  case  10  pints  would  be  needed  in  order 
to  induce  a  condition  of  intoxication,  and  that 
it  would  take  over  four  hours  to  drink  it.  In 
that  I  am  more  susceptible  to  alcohol  than  the 
average  man,  it  may  be  said  that,  pradicalhj 
speaking,  beer  containing  3  per  cent,  by  volume  of 
alcohol,  or  5.25  per  cent,  of  proof  spirit,  ?*■  a  non- 
in tox ica tin g  liq itid . 

"It  appears  that  the  alcohol  in  5  per  cent, 
whisky  and  5  per  cent,  beer  is  absorbed  rather 
faster  than  that  in  20  per  cent,  whisky,  though 
the  simultaneous  absorption  of  a  greater  vol- 
ume of  water  reduces  the  toxic  effect  produced. 
Concentrated  alcoholic  liquids  exert  such  a 
paralytic  effect  on  absorption  that  the  effects 
produced  by  45  c.c.  alcohol  were  practically  the 
same,   whether  this  was  taken  as  whisky  of 


78 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


48.5  per  cent.,  20  per  cent.,  or  10  per  cent,  con- 
centration. Again,  it  makes  very  little  differ- 
ence whether  the  whisky  is  drunk  in  a  minute  or 
spread  over  half  an  hour. 

"Beer  differs  from  whisky  in  that  it  has  a  rel- 
atively greater  effect  on  the  typing  time  and 
a  relatively  less  effect  on  the  typing  mistakes. 
Claret  has  nearly  the  same  effect  as  whisky  of 
equal  alcoholic  strength."  —  C.  K.  Drinker. 


The  Application  of  Certain  Physical 
Efficiency  Tests.  Verner  T.  Scott.  Jour.  Am. 
Med.  Assn.,  March  12,  1921,  7(5,  No.  11,  70.5- 
707.  —  Schneider,  in  May,  1920,  gave  an  ac- 
count of  a  method  for  physical  efficiency  rating 
used  in  the  air  service.  The  plan  utilized  varia- 
tions in  pulse  rate  and  blood  pressure  under 
simple  conditions  and  resulted  in  a  point  score 
for  each  individual  examined,  18  being  the 
highest  rating  attainable.  Crampton  in  1915 
proposed  a  somewhat  similar  Init  less  compli- 
cated test. 

Scott  has  compared  both  systems  and  finds 
Crampton's  less  adequate,  since  it  does  not 
cover  all  the  necessary  physiological  elements. 
To  gain  the  details  of  both  methods  of  testing, 
the  reader  must  consult  the  original  papers  by 
Schneider  and  Crampton,  to  which  references 
are  given  in  Scott's  article. 

On  the  basis  of  410  cases  to  which  Schneider's 
test  was  applied  Scott  gives  the  following  sum- 
mary : 

"Schneider's  test  does  not  sup])lant,  but 
should  be  used  in  conjunction  with,  a  thorough 
physical  examination.  For  use  with  aviators 
and  athletes,  this  is  the  best  test  so  far  offered 
for  measuring  physical  efficiency  and  fatigue. 


"The  practitioner  of  preventive  medicine, 
and  physical  directors  of  schools  and  colleges, 
will  find  this  test  a  valuable  aid  in  determining 
the  amount  of  exercise  necessary  for  physical 
fitness  in  each  individual  case.  There  may  be 
overtraining  and  undertraining  of  an  individ- 
ual. Although  we  find  that  a  score  of  7  or  less 
is  an  indication  of  improper  functioning  of  the 
neurocirculatory  apparatus,  we  believe  that  a 
man  who  can  only  make  a  score  of  9  should  be 
given  a  thorough  ])hysical  examination  to  de- 
termine whether  his  condition  is  due  to  disease 
or  to  insufficient  exercise. 

"The  conditions  that  we  find  that  lower  the 
index  are  aviation  fatigue,  loss  of  sleep,  lack  of 
physical  exercise,  alcoholic  and  sexual  excesses, 
and  acute  infections. 

"We  have  encountered  two  conditions  in 
which  this  test  or  any  other  test  based  on  pulse 
rate  will  not  reveal  the  true  condition  of  the 
man.  Bradycardia  on  account  of  the  low  pulse 
rate  gives  a  better  rating  than  the  condition 
warrants,  and  those  who  are  disturbed  psy- 
chically by  a  physical  examination  will  get  a 
lower  rating  than  they  deserve  on  account  of 
high  pulse  rate.  But  the  latter  condition  can  be 
allayed  by  a  tactful  luirse  or  physician. 

"The  index  gives  the  true  condition  at  the 
time  of  the  test.  When  it  comes  to  qualifying  or 
disqualifying  an  aviator  for  flying,  or  to  deter- 
mining the  amount  of  exercise  needed  by  an 
athlete,  it  is  best  to  determine  the  index  on 
three  successive  days.  If  the  man  has  not  lost 
sleep  or  dissipated,  his  index  will  not  vnry 
more  than  1  point.  The  reason  for  not  relying 
on  one  index  is  that  one  may  be  getting  his 
average  physical  condition  plus  loss  of  sleep  or 
dissipation."  —  C.  K.  Drinker. 


HAZARDS  OF  COMPRESSED  AIR,  DIMINISHED  PRESSURE,  GENERATION 
AND  USE  OF  ELECTRICITY,  AND  ELECTRICAL  WELDING 


The  Ruling  of  June  28,  1920  for  the  Pro- 
tection OF  Workers  in  Compressed  Air. 
Leijmann.  Zentralbl.  f.  Gewerbehyg.,  Feb., 
1921,  9,  No.  2,  30-.S5.  —  An  explanation  of 
caisson  disease  and  of  the  extent  of  work  done 
under  increased  air  pressure  is  followed  by  an 
abstract  of  the  ruling.  Besides  technical  de- 
tails of  construction  which  are  prescribed  for 
safety,  the  rates  of  compression  and  decom- 
pression are  fixed  and  the  maximum  hours  of 


work  per  day  for  the  different  pressures  are 
stated.  Medical  examination  of  workers  and 
supervision  of  the  whole  undertaking  are  re- 
quired. First-aid  information  for  the  employees 
must  be  provided.  For  aU  work  done  at  or 
over  2  kilograms  per  square  centimeter,  there 
must  be  a  chamber  in  which  persons  suffering 
from  caisson  di.sease  may  be  subjected  to  the 
same  high  pressure  and  then  to  gradually 
lowered  pressures.  —  E.  L.  Sevringhaus. 


ABSTRACTS 


79 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


A  Physiological  Basis  for  the  Shorter 
Working  Day  for  Women.  George  W.  Web- 
ster. U.  S.  Dept.  Labor,  Women's  Bureau, 
J3ull.  No.  14,  Feb.,  1921,  pp.  20.  —  Dr.  Web- 
ster points  out  the  wastefulness  of  the  "trial 
and  error"  method  in  discovering  "the  mini- 
mum number  of  hours  in  which  the  laborer  may 
produce  the  maximum  output,  day  after  day, 
week  after  week,  year  after  year,  and  remain 
well,  at  least  as  far  as  injury  from  overwork  is 
concerned."  Scientific  inotiiods  of  determining 
the  right  number  of  working  hours  in  each  in- 
dustry are  urged.  Fatigue  is  discussed  as  the 
one  element  in  the  living  machine  different  from 
the  non-living  machine. 

Fatigue  is  a  protective  device,  and  neglect  of 
it  may  lead  to  physiological  bankruptcy.  This 
means  economic  waste  and  a  waste  of  life  as 
well.  Fatigu<'  is  jjroducod  by  labor,  speed, 
monotony,  noise,  machine  rhythm,  and  shop 
conditions  of  ventilation,  temperature,  hu- 
midity, etc.  The  psychological  causes  of  fatigue 
are  found  in  the  "balking"  of  some  of  the 
fimdanicntal  instincts.  In  the  development  of 
manhood  some  expression  for  such  instinc-ts  as 
self-preservation,  self-exjjression,  workmanshij), 
self-sacrifice,  home  making,  loyalty,  and  wor- 
.'.hi])  nuist  be  found.  It  is  the  development  of 
manhood  to  which  an  industrial  and  social 
system  must  be  directed.  We  nnist  not  foster 
the  "balked"  disjjosition. 

The  measure  of  industrial  fatigue  is  to  be 
found  in  output  and  spoiled  work,  in  accidents, 
and  in  illness  and  occupational  disease.  The 
general  con.sequence  of  fatigue  is  physical  debil- 
ity which  brings  about  lax  moral  fil)re,  which  in 
turn  leads  to  intemperance  and  inefficiency. 

The  legality  of  the  limitation  of  working 
hours  of  adult  women  has  been  tested  and 
reported  upon  favorably  as  a  protective  health 
measure  for  the  well-being  of  the  ])rosi)cctive 
mothers  of  the  future  race.  The  agreement  of 
many  leaders  of  opinion  is  for  the  eight-hour 
day  for  women.  —  Elinor  D.  Gregg. 

Physical  Standards  for  Working  Chil- 
dren, a  Preliminary  Report  of  the  Commit- 
tee Appointed  by  the  Children's  Blt^eau 
to  Formul.\te  Standards  of  Normal  De- 
velopment AND  Soi'ND  Health  for  the  Use 
of  Physicians  in  Examining  Children  En- 
tering Emploitment  and  Children  at  Work. 
Children's  Bureau  Publication  No.  79,  1921.  — 


The  child  who  goes  to  work  between  1-t  and  18 
years  of  age  is  in  need  of  special  protection  if  he 
is  to  arrive  at  maturity  with  good  health  and 
a  vigorous  and  well-developed  body.  During 
these  years  he  is  passing  through  the  most  crit- 
ical jjcriod  of  his  physical  development,  when 
his  botly  must  meet  the  unusual  demands  of 
rapid  growth  and  physiological  readjustment. 
If  at  the  .same  time  he  is  subjected  to  the  mental 
and  physical  strain  of  gainful  em])loymcnt,  the 
burden  upon  his  immature  |)hysique  is  a  double 
one,  and  special  precautions  are  necessary  if 
normal  growth  and  development  are  not  to  be 
endangered. 

The  mandatory  requirement  of  a  physical 
examination  for  every  child  securing  an  em- 
ployment certificate  is  now  found  in  the  laws  of 
eighteen  states,  but  adequate  enforcement  of 
this  |)rovision  of  the  cliihl  labor  laws  de|)cnds 
upon  definite  standards  of  ]>hysical  fitness  and 
upon  thoroughness  and  uniformity  in  making 
examinations.  As  the  result  of  a  resolution 
passed  at  the  Children's  Bureau  Conferences 
on  Standards  of  Child  Welfare  in  191!),  a  com- 
mittee of  physicians  was  ajjpointed  by  the 
Children's  Bureau  to  formulate  definite  stand- 
ards of  normal  devel()|)niont  and  jjhysical 
(itness  for  the  use  of  |)liysi(ians  in  examining 
children  a|)plying  for  emi)loyment  certificates. 
The  memljership  of  the  committee  is  as  follows: 
Dr.  Cieorge  P.  Barth,  Director  of  Hygiene,  City 
Heaitii  De])artment,  Milwaukee,  Wisconsin, 
Chairman;  Dr.  Emma  M.  Ajjpel,  Employment 
Certificate  Department,  Chicago  Board  of 
Education;  Dr.  S.  Josephine  Baker,  Chief, 
Bureau  of  Child  Hygiene,  Department  of 
Health,  New  York  City;  Dr.  Taliaferro  Clark, 
representing  the  U.  S.  Public  Health  Service; 
Dr.  C.  Ward  Cramp  ton.  Dean,  Normal  School 
of  Physical  Education,  Battle  Creek,  Michigan; 
Dr.  b.  L.  Edsall,  Dean,  Harvard  Medical 
School,  Boston;  Dr.  George  W.  Goler,  Health 
Officer,  Rochester,  New  York;  Dr.  Harry  Lin- 
enthal.  Industrial  Clinic,  Massachusetts  Gen- 
eral Hospital;  Dr.  H.  H.  Mitchell,  representing 
the  National  Child  Labor  Committee;  Dr. 
Anna  E.  Rude,  Director,  Hygiene  Division, 
U.  S.  Children's  Bureau;  Dr.  Thomas  D.  Wood, 
Chairman  on  Health  Problems  and  Education, 
Columbia  University;  Miss  E.  N.  Matthews, 
Director,  Industrial  Division,  U.  S.  Children's 
Bureau,  Secretary. 

The  preliminary  report  of    this   committee 


80 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


contains  certain  minimum  standards  of  physi- 
cal fitness  for  children  entering  and  working  in 
industry,  which  include  standards  of  normal  de- 
velopment and  standards  of  sound  health  and 
physical  fitness  for  employment.  Under  the 
latter  the  following  defects  for  which  children 
should  be  refused  certificates  are  named:  (1) 
cardiac  disease,  with  broken  compensation; 
(i)  pulmonary  tuberculosis  or  other  evidence  of 
serious  pulmonary  disease;  (3)  active  glandular 
tuberculosis;  (-4)  active  tuberculous  or  syphilitic 
disease  of  joints  or  bones;  (5)  total  blindness 
(unless  no  further  educational  facilities  can  be 
provided  for  such  children);  (C)  total  deafness 
(unless  no  further  educational  facilities  can  be 
provided  for  such  children);  (7)  trachoma;  (8) 
chorea;  (9)  syphilides;  (10)  hyj)erthyroidism; 
(11)  acute  or  subacute  nephritis;  and  (l^) 
hookworm. 

A  list  of  remediable  defects  for  which  chil- 
dren should  be  refused  certificates  pending 
correction  is  given  as  follows:  (1)  defective 
vision  suliject  to  correction  by  glasses;  (i)  con- 
tagious eye  and  skin  disease;  (3)  defective  teeth 
—  extraction  or  prophylactic  care  needed;  (-i) 
malnutrition  requiring  supervision  or  medical  at- 
tention and  not  under  treatment;  (o)  untreated 
inguinal  or  femoral  hernia;  (6)  diseased  tonsils; 
(7)  defective  nasal  breathing  requiring  correc- 
tion and  not  under  treatment;  (8)  discharging 
ears  not  under  treatment;  (9)  orthojiedic  de- 
fects not  under  treatment;  (lOj  intestinal 
parasites  (other  than  hookworm)  not  under 
treatment. 

Provisional  certificates  for  a  period  of  not 
more  than  three  months  may  be  issued,  accord- 
ing to  the  report,  on  recommendation  of  the 
metlical  examiner  under  the  following  condi- 
tions: (1)  where  treatment  has  been  started  but 
not  completed  in  such  cases  as  (a)  defective 
teeth,  (b)  malnutrition,  (c)  orthopedic  defects, 


(d)  defective  nasal  breathing,  (e)  discharging 
ears,  (f)  intestinal  parasites  (other  than  hook- 
worm); ('2)  partial  blindness;  (3)  partial  deaf- 
ness; (4)  other  defects  (not  specified  above) 
which  in  the  opinion  of  the  medical  examiner 
require  supervision. 

Li  addition  to  specific  minimum  standards 
for  entrance  into  industry,  the  report  makes  a 
number  of  general  recommendations.  Among 
the  most  significant  of  these  are  the  following: 
The  minimum  age  for  entrance  into  industry 
should  be  set  at  16  years,  since  pubescence  is  a 
time  of  special  strain  for  the  child;  no  child  be- 
tween 16  and  18  years  of  age  should  be  permit- 
ted to  go  to  work  untU  he  has  had  a  complete 
physical  examination  and  has  been  declared  to 
be  of  normal  development,  in  sound  health  and 
physically  fit  for  the  work  at  which  he  is  to  be 
employed;  children  at  work  should  be  re-exam- 
ined when  changing  occupations  and  should 
have  at  least  one  yearly  physical  examination 
up  to  the  age  of  18;  methods  of  examination 
should  be  imiform  and  centralized  under  state 
control;  physical  examinations  of  schoolchil- 
dren should  be  made  for  the  purpose  of  dis- 
co^■ering  and  correcting  physical  defects  before 
the  child  reaches  working  age;  special  study 
should  be  made  by  local  administrative  and 
medical  officers  of  occupations  in  which  children 
are  employed  and  their  effect  upon  health.  The 
need  of  autlioritative  scientific  investigation  of 
the  effect  of  different  kinds  of  work  upon  the 
health  and  physique  of  the  adolescent  child  is 
emphasized,  and  a  suggestive  list  is  given  of 
subjects  with  reference  to  which  special  re- 
search is  needed. 

A  record  form  for  the  use  of  physicians  in  ex- 
amining children  and  instructions  for  filling  in 
the  form  are  included.  An  appendix  gives  the 
laws  ri'hiting  to  physical  requirements  for  em- 
ployment, in  effect  on  January  1,  1921. 


INDUSTRIAL  SANITATION:   FACTORY  CONSTRUCTION   ILLUMINATION, 
VENTILATION,  HEATING.  WATER  SUPPLY,  SEWAGE  DISPOSAL 


Saxitatiox.  C.  F.  Wrifiht  and  Mica  SUtcock. 
Ann.  Rej).  Chief  Inspect.  Factories  and  Work- 
shops for  the  Year  1919.  London,  19-20.  jip. 
47-57.  —  This  report  on  sanitation  includes 
items  in  respect  to  cleanlmess  and  hygienic 
conditions,  washing  conveniences,  sanitary-  con- 
veniences, temperature,  fiueless  gas  stoves, 
lighting,  and  dust  removal. 

There  is  a  general   inij)rovement   in   clean- 


liness and  liygienic  conditions,  ])artly  due  to 
getting  l)ack  to  pre-war  conditions,  and  partly 
to  the  continuation  of  experiments  and  im- 
provements begun  during  the  war.  The  intro- 
duction of  vacuum  cleaners  in  some  places  is 
observed,  and  imjirovement  in  whitewashing 
and  cleaning;  and  attention  to  cleanliness  on 
the  part  of  the  workmen  is  noticeable.  Tene- 
ment   factories,   particularly   those   let   out    in 


ABSTRACTS 


81 


small  single  rooms  as  in  the  Sheffield  cutlery 
trade,  are  generally  found  to  be  in  poor  con- 
dition as  regards  sanitation.  The  reports  from 
nearly  all  divisions  have  some  reference  to 
floors,  and  show  that  even  where  walls  and 
ceilings  of  workplaces  are  clean,  the  floors 
frequently  receive  inadequate  attention.  It  is 
recommended  that  more  consideration  he  given 
to  the  effects  of  Vjrighter  decoration  in  factories. 

Progress  in  providing  washing  conveniences  is 
slow.  Some  employers  complain  that  these 
conveniences  are  seldom  used,  but  in  such  cases 
incpiiry  usually  shows  that  hot  water,  son])  and 
towels  have  not  been  provided,  and  that  there  is 
a  lack  of  supervision,  the  importance  of  which 
needs  to  be  emphasized. 

In  the  matter  of  sanitary  conveniences,  re- 
ports show  very  great  variation  of  standard 
throughout  the  country;  in  some  factories  there 
are  modern  conveniences  equal  to  those  pro- 
vided in  first-class  liuildings,  while  in  others  the 
most  i)rimitive  and  insanitary  arrangements 
are  still  found.  The  conditions  are  found  at 
their  worst  in  some  of  the  cotton  towns  and  also 
in  tenement  cutlery  factories. 

The  (|uestion  of  heating,  especially  in  large 
factories  such  as  engineering  sho|)s,  is  receiving 
much  attention,  and  considerable  advancement 
is  being  made  in  the  installation  of  the  "unit 
system."  In  this  .system,  the  unit  consists  of  a 
fan  whic-h  forces  the  air  under  pressure  down- 
wards over  steam-heated  i)ipes  and  .so  distrib- 
utes the  heated  air  at  floor  level,  where  the 
effect  is  most  felt  by  the  workers.  Textile  fac- 
tories have  special  jtroblems:  wool  sorting  sho|)s 
are  apt  to  be  too  cold,  while  in  wool  combing 
and  carbonizing  works  high  temperatures  are 
likely  to  be  found.  The  conditions  in  wool 
combing  have  been  changed  by  imjjroved  ven- 
tilatit)n,  as  have  also  the  conditions  in  carbon- 
izing shops.  High  tenii)eratures  have  also  been 
reduced  by  the  use  of  electric  light  instead  of 
gas,  by  increasing  the  air  inlets,  and  by  the 
extraction  of  hot  air  near  the  ])oint  of  origin. 
The  douche  system  of  air  cooling,  by  which 
cold  air  is  blown  by  fans  into  the  space  where 
the  men  are  at  work,  is  another  develoj)ment. 
This  has  lieen  adopted  in  many  glass  works,  in 
the  tin])latc  works  and  elsewhere. 

The  flueless  gas  sto\e  came  into  more  fre- 
quent use  in  England  during  the  war,  although 
there  is  much  to  be  said  against  it.  As  a  sub- 
stitute, a  new  electric  steam  radiator  is  men- 
tioned, in  whicji  water  is  vaporized  by  electric 
current.    For  lighting,  diffused  ceiling  lighting 


is  coming  more  and  more  into  \-ogue,  the  arc 
lamp  is  disappearing,  and  the  "half -watt" 
lamp  is  taking  its  place.  "This  lamp  is  de- 
scriljed  as  the  last  word  in  efficiency,  as  it  gives 
a  brilliant  light  for  small  energy  consum])tion." 
Objectionable  glare  can  be  overcome  by  proper 
shading. 

"Very  satisfactory  reports  have  l>een  re- 
ceived as  to  tiie  solution  of  tiic  proljlem  of  dust 
removal  in  the  preparing  departments  of  hemp, 
jute,  and  flax  mills."  In  the  future,  the  ma- 
chine makers  can  adapt  their  machines  and 
arrange  them  in  the  mills  to  co-operate  with 
the  ventilating  j)lant.  An  improved  .system  of 
"stack  mixing"  is  mentioned  (page  55).  The 
dust  conditions  in  the  cotton  card  rooms  are 
discussed  at  some  length.  In  the  potteries  the 
conditions  are  not  entirely  satisfactory,  and 
.some  of  the  attempted  solutions  have  not  been 
at  all  successful.  Recommendations  are  made 
in  regard  In  tliediisl  problem  in  dolomite  grind- 
ing. 

The  re|)ort  closes  with  some  evidence  of  the 
failure  of  the  regulations  to  record  humidity  in 
cotton  cloth  works.  The  workers  still  refuse  to 
make  joint  rea<lings  of  hygrometers  with  the 
employer's  representative.  The  need  of  a  .self- 
registering  hygrometer  is  emphasized.  —  G.  E. 
Partridge. 

S.vMTATiox  i\  Hakkhiks.  //.  E.  Barnard. 
.Vni.  Jour.  Pub.  Health.  .May,  lO'il,  11,  No.  5, 
439-451.  —  This  is  a  brief  review  of  the  salient 
points  in  modern  state  laws  regulating  the 
bread  baking  industry,  and  lays  particular 
stress  on  re(|uirements  for  ])hysical  examina- 
tions before  em[)loyment,  on  general  sanitary 
regulations  of  bakeries,  and  on  the  prohibitit)n 
of  the  resale  of  stale  loaves.  The  use  of  the 
bread  box  outside  of  retail  stores  is  condemned 
in  spite  of  regulatory  restrictions. 

Tiie  modern  bakery  has  deserted  the  cellar 
and  back  street  and  does  its  work  in  modern 
buildings,  even  in  the  broad  light  with  the  con- 
simier  for  a  spectator.  Industry  is  frequently  in 
opposition  to  legislation,  but  here  the  bakers 
have  demanded  laws  for  bettered  conditions  of 
construction,  maintenance  and  health  for  em- 
ployees. —  H.  F.  Smyth. 

Industrial  Painting.  Safety  Engin.,  Feb., 
1921,  41,  No.  2,  G5-66.  —  According  to  the 
Electrical  Testing  Laboratories  of  New  York  a 
surface  of  pure  white  glos.sy  paint  increases 
lighting  19  to  36  per  cent.    It  is,  therefore,  an 


82 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


industrial  economy  to  have  factory  workrooms 
and  machinery  painted  in  Hght  colors,  both 
from  the  standpoint  of  the  amount  of  illumina- 
tion required  and  the  physical  strain  put  upon 
the  workmen  producing  in  ill-lighted  rooms.  — 
M.  Dent. 

Where  Light  is  Wasted.  Factory,  Dec.  1, 
1920,  -25,  No.  11,  1808. —A  company  that 
manufactures  paint  has  recently  made  a  series 
of  tests  to  discover  which  colors  are  the  best 
reflecting  mediums.  Where  indirect  lighting  is 
used,  a  well-painted  white  ceiling  will  give  20 
or  30  per  cent,  more  illumination  intensity  than 
an  ordinary  white,  buff,  or  similar  colored  ceil- 
ing. The  table  below  gives  the  percentage  of  the 
incident  illumination  that  is  reflected  by  walls 
of  different  colors: 

Per  Cent. 

AMaite  enamel 80 

\Miite 79 

Cream,  flat  tone 71 

Pearl  gray 63 

Buff,  flat  tone 59 

Pink,  enamel 57 

Satin,  green 50 

French,  gray,  enamel 39 

Pale  azure,  flat  tone 3G 

Blue,  enamel 31 

Green,  enamel 29 

Red,  enamel 27 

Brown,  flat  tone 22 

Forest  green,  flat  tone 21 

Wine,  enamel 12 

Gas  green,  enamel 10 

—  :M.  C.  Shorley. 

How  17  Everyday  Lighting  Problems 
Have  Been  Solved.  S.  G.  Hibben.  Factory, 
Dec.  1,  1920,  25,  No.  11,  17;57-1~40.  —  "No 
lighting  engineer  can  foresee  all  the  peculiar 
lighting  requirements  of  any  industrial  plant." 
Perhaps  the  industrial  .manager  will  find  among 
the  examples  mentioned  in  this  paper  an  appli- 
cation which  will  fit  his  conditions,  or  will  be 
able  to  profit  from  a  survey  of  what  others  have 
done  under  similar  circumstances.  —  M.  Dent. 

Recent  Advances  in  Mine  Illi-mination. 
Heinrich  Midler.  Zentralbl.  f.  Gewerbehyg., 
Jan.,  1921,  9,  No.  1,  11-15.  —This  is  a  survey 
of  the  types  of  miners'  lamps.  Stationary 
electric  installations  are  also  described,  and 
considerable  attention  is  paid  to  the  mechanical 
devices  by  which  explosions  of  mine  gas  are  pre- 
vented in  case  the  glass  globe  is  broken  or 
opened  while  the  lamp  is  lighted.    Neon-filled 


bulbs    are    briefly    coumieuted    on.  —  E.    L. 
Sevringhaus. 

IVL^KiNG  the  Factory  a  Better  Place  to 
Work.  Factory,  Jan.  1,  1921,  26,  No.  1,  29.  — 
The  Faulkner  and  Colony  INIanufacturing 
Company  has  solved  the  problem  of  excessive 
humidity  in  the  ventilation  of  dye  houses  and 
bleacheries  by  placing  pipes  to  carry  warm  air 
directly  over  the  tubes  and  machines  from 
which  steam  and  vapor  are  originating,  and  to 
form  the  mo\ing  film  of  warm  air  along  sur- 
faces where  condensation  is  likely  to  occur  and 
cause  disagreeable  dripping.  —  ]\I.  Dent. 

Ventil.\tion  in  Metal  Mixes.  Daniel 
Harrinijiou.  U.  S.  Bur.  Mines,  Tech.  Paper 
251,  1921,  pp.  44. —This  bulletin  deals  pri- 
marily -with  the  atmosphere  in  which  miners 
work  in  metal  mines,  its  contamination  from 
various  sources,  the  effect  of  different  contam- 
inations, the  methods  of  ventilation  used  and 
the  need  of  improved  ventilation,  and  recom- 
mendations for  improvement,  but  it  also 
touches  u])on  the  three  other  subjects  which  the 
Bureau  of  Mines  is  investigating,  namely, 

"  1.  The  effect  of  various  kinds  of  mine  dust 
in  relation  to  miners'  pulmonary  diseases  and 
the  preventive  measures  suggested. 

"2.  Humidity  of  the  atmosphere  in  metal 
mines,  the  effect  of  high  humidity  on  the 
health  and  the  working  efficiency  of  miners, 
and  how  conditions  can  be  improved. 

"3.  The  high  temperature  found  in  deej) 
mines  and  in  some  comparatively  shallow 
mines,  its  effect  on  the  health  and  morale  of 
workers,  and  how  the  temperature  may  be 
lowered  to  projjer  limits  or  its  ill  effects  over- 
come." —  M.  Dent. 

Industrial  Wastes  in  Relation  to  Water 
Supplies.  IT'.  DonaUson.  Am.  Jour.  Pub. 
Health.  March,  1921,  11,  No.  3,  19;J-198. — 
The  effect  of  industrial  waste  on  public  water 
supplies  is  generally  manifested  either  as  dis- 
agreeable odors  and  tastes,  foreign  substances 
making  the  water  unsiglitly  and  unsuitable  for 
use  or  else  interfering  with  proper  functioning 
of  purification  works,  or  as  chemical  substances 
in  .solution  causing  damage  to  water  works 
structures  or  rendering  water  less  fit  for  domes- 
tic or  industrial  use,  whether  or  not  detrimental 
to  health. 

On  account  of  the  multitude  of  waste  sub- 
stances derived  from  industrv,  the  varietv  of 


ABSTRACTS 


83 


effects  on  water  supplies  are  numerous.  This 
article  considers  in  some  detail  the  effects  of 
coal  mine  wastes  containing  acids  in  solution  or 
coal  dust  in  suspension;  aromatic  coal  distilla- 
tion wastes  from  gas  houses,  containing  phenols, 
cresols,  etc.,  the  odors  and  tastes  from  which 
are  accentuated  by  chlorination;  wood  distilla- 
tion wastes;  oily  and  salt  wastes  from  oil  well 
operations;  and  wa.stes  from  oil  refineries,  tan- 
neries, paper  mills  and  other  industries. 


The  principal  responsibility  for  preventing 
stream  pollution  by  industrial  wastes  should  be 
placed  on  the  plants  themselves^  But  mimi- 
cipalities  should  not  depend  upon  out-of-date 
purification  plants  stereotyped  in  design  and 
planned  primarily  for  removing  sewage  effects, 
turbidity,  and  color.  State  health  officers 
should  have  regulating  powers  under  stand- 
ardized laws  conforming  to  federal  practices.  — 
H.  F.  Smvth. 


INDUSTRIAL  :\IEDICAL  SERMCE:   MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


Medical  Welfare  Work  in  Small  Fac- 
tories. A.  C.  Burnlutiii.  Mod.  Med.,  Feb., 
1921,  3,  No.  2,  90-9^2. —  Dr.  IJurnham  com- 
bines several  studies  to  show  that  the  indus- 
trial plants  employing  less  than  500  workers 
give  very  little  medical  or  surgical  care  l)ey()nd 
that  required  l)y  the  prcvaiMng  compensation 
laws.  Among  employers  of  small  forces  of  lal)or 
the  consensus  of  o|)inion  is  that  welfare  work 
has  no  effect  on  labor  turnover  or  production. 
Among  the  large  concerns  the  opjjosite  opinion 
is  held.  The  prevailing  equipment  among  tiie 
small  factories  is  not  generally  adequate,  while 
that  in  most  large  concerns  otters  every  facility 
to  the  hospital  jicrsonnel.  In  the  large  establish- 
ments the  number  of  workers  to  each  unit  of 
the  medical  i)ersonnel  varies  between  700  to 
1,000. 

A  co-oi)erative  scheme  would  be  the  best  way 
to  secure  for  the  smaller  concerns  the  results 
which  are  being  obtained  by  the  large  plants. 
Several  different  plans  have  been  tried,  some  of 
which,  with  further  development,  would  be 
adequate.  In  .some  cities  the  employers  are  or- 
ganized to  furnish  information  in  regard  to  such 
matters  as  traffic,  casualty  insurance  and  em- 
ployment; this  might  be  extended  to  medical 
care.  The  plan  of  a  mniiber  of  doctors  com- 
bining in  a  commercial  way  to  establish  a 
dressing  station  in  the  vicinity  of  a  group  of 
factories  has  proved  more  or  less  satisfactory 
according  to  the  character  of  the  doctors,  but 
the  commercial  element  is  apt  to  defeat  its  own 
purpose.  The  health  stations  that  have  been 
started  by  the  State  Boards  of  Health  might 
readily  be  extended  to  cover  accidents  and 
general  medical  care  though  at  present  they  are 
confined  largely  to  the  study  of  industrial  dis- 
ease and  industrial  hygiene.    Perhaps  the  most 


sure  of  success  is  a  co-operative  service  in 
charge  of  a  voluntary  organization,  such  as  the 
Red  Cross.  This  is  more  apt  to  command 
the  loyalty  of  the  people  and  administrative 
changes  are  more  easily  made.  There  is,  how- 
ever, need  of  more  accurate  information  as  to 
the  expense  of  such  ventures.  Certainly  a  co- 
o]KTative  (lisi)ensary  where  there  were  no 
ho.spital  facilities  would  prove  of  great  value  to 
the  industries  and  to  the  whole  connnunity.  — 
Elinor  D.  Gregg. 

BiDA  Co.  Medical  Service.  FI.  M.  Tupper. 
IIosp.  Management,  Dec,  1920,  10,  No.  C, 
62.  —  This  is  chiefly  an  account  of  the  physical 
examinations  given  by  the  Biida  ('omi)aiiy 
medical  dejjartment  and  of  the  various  causes 
for  rejection  of  applications.  —  M.  Dent. 

Factory  Eye  Room  Saves  Workers'  Sight 
AXD  In'creases  Output.  Sanford  Dellart.  In- 
dust.  Management,  Jan.  1,  1921,  61,  No.  1,  23- 
24.  —  It  is  estimated  that  there  are  15,000 
persons  in  the  TTnited  States  at  the  present 
time  who  are  blind  as  a  result  of  industrial  acci- 
dents. Statistics  show  that  200,000  accidents 
to  eyes  occur  every  year,  or  about  8.3  per  cent, 
of  the  total  number  of  industrial  accidents. 
Since  it  has  been  sho^NTi  that  it  is  practically 
impossible  to  eliminate  entirely  the  eye  hazard 
in  industry,  it  is  necessary  to  learn  how  to  at- 
tend eflicientlj'  to  accident  cases.  As  an  illus- 
tration of  what  is  needed,  the  writer  describes 
the  eye  room  and  the  service  rendered  in  the 
plant  of  the  R.  K.  Le  Blond  Machine  Tool 
Company.  This  eye  room  is  a  room  4  feet 
square,  painted  black  inside.  It  contains  a 
glass  shelf  with  the  various  eye  solutions  needed 
and   an   adjustable   chair,    and   has   overhead 


84 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


illumination.  The  room  is  used  primarily  for 
the  removal  of  foreign  bodies  from  the  eye  and 
for  subsequent  treatment. 

The  result  of  the  special  attention  given  to 
eye  cases  in  the  plant  has  been,  first,  a  great 
reduction  in  the  numljer  of  eye  cases  and  in  lost 
time  resulting  from  them;  and  secondly,  the 
severity  of  eye  cases  has  been  greatly  reduced, 
largely  on  account  of  educational  propaganda 
dispensed  in  the  eye  room.  The  men  are  taught 
to  appreciate  the  value  of  goggles,  various  types 
of  which  are  supplied  by  the  hospital,  the  most 
popular  type  jjroving  to  be  one  having  a  very 
light  construction  with  leather  nose-piece  and 


side-pieces.  The  results  accomplished  are  in 
every  way  satisfactory  and  encouraging,  and 
the  writer  thinks  that  the  method  used  by  this 
company  is  well  worth  adopting  elsewhere. 
There  is  no  reason,  he  thinks,  why  the  indus- 
trial physician  cannot  attend  to  the  removal 
of  foreign  substances  from  the  eye  in  ordinary 
cases  and  administer  the  necessary  subsecjuent 
treatment  as  well  as  the  sjjecialist.  The  cost  of 
installing  the  equipment  is  slight,  not  more 
than  $S00.  At  the  present  time  there  appear  to 
be  only  three  industrial  plants  in  this  country 
ojjerating  their  own  optical  rooms  in  connection 
with  their  hospitals.  —  G.  E.  Partridge. 


INDUSTRIAL  PERSONAL  AND  COM]MUNITY  HYGIENE: 

HOUSING,  ETC. 


Some  Pkactical  Hospital  Problems  En- 
countered IN  AN  Industrial  Community. 
E.  M.  Stanton.  Boston  Med.  and  Surg.  Jour., 
Nov.  25,  lOSO,  183,  No.  22,  623-628.  —  The 
problem  of  fin-nishing  adequate  medical,  sur- 
gical and  hospital  facilities  to  the  middle  class 
—  90  or  95  per  cent,  of  the  population  — 
of   Schenectady,  N.  Y.,  is   described  and  the 


solution  is  given.  Charity  patients  have  been 
made  municipal  charges  and  sujiported  by  the 
city.  Industrial  plants  are  not  asked  for  en- 
dowments but  are  required  to  pay  for  whatever 
service  is  rendered.  By  these  and  other  means 
the  hospital  has  been  made  self-supporting.  — 
Barnett  Cohen. 


INDUSTRIAL  INVESTIGATIONS  AND  SURVEYS 


Tuberculosis  Survey  of  a  Silk  ]Mill 
Village.  L.  B.  McBrayer.  Am.  Rev.  Tuber- 
culosis, Feb.,  1921,  4,  No.  12,  920-925.  — The 
conclusions  reached  by  the  author  are:  "It  was 
our  opinion,  from  these  studies,  that  the  silk 
mill  per  se  was  not  responsible  for  the  tul>er- 
culosis,  but  that  it  was  a  matter  largely  if  not 


wholly  of  contact  infection,  and  that  all  the 
original  cases  developed  at  some  other  place 
and  moved  into  the  silk  mill  village  and  of 
course  continued  to  communicate  the  disease  to 
those  with  whom  they  associated  most  closely, 
who  in  most  instances  were  the  members  of 
their  own  familv."  —  M.  C.  Shorley. 


INDUSTRIAL  HEALTH  LEGISLATION:    COURT  DECISIONS: 
WORKIVIEN'S  COISIPENSATION  AND  INSURANCE 


New  York  State  Industrial  Code.  N.  Y. 
Bur.  Statis.  and  Information,  1920,  [)p.  248.  — 
A  compilation  of  rules  and  regulations  supple- 
mentary to  the  labor  laws,  which  have  the 
effect  and  force  of  law.  for  the  sanitation,  light- 
ing and  safeguarding  of  all  factories,  foundries, 
building  trades,  etc.,  in  the  state  of  New  York. 
—  M.  Dent. 

Austrian  Legisl.\tion  for  Protection  of 
AVoRKERS  FROM  1913  TO  1920.  Jenny  Adler- 
Herzmark.     Zentralbl.    f.    Gewerbehyg.,    Jan., 


1921,  9,  Xo.  1,  19-24.  — A  resume  is  given  of 
the  emergency  legislation  of  the  war  period 
which  removed  some  restrictions  for  the  sake  of 
production. 

After  the  new  government  came  into  power 
in  November,  1918,  machinery  was  set  in  mo- 
tion for  the  re-employment  of  soldiers  as  soon 
as  they  were  demobilized.  Unemployment  in- 
surance was  provided  up  to  April,  1920,  for  all 
those  who  had  l)een  under  sickness  insurance 
laws  before  the  war,  and  the  former  rules  on 
Sunday  and  holiday  work  were  restored.    The 


ABSTRACTS 


85 


years  1918  and  1919  saw  wide  extensions  of  the 
eight-hour  day  laws;  regulation  of  industry  in 
the  home  was  established,  with  local  cotnmit- 
tees;  child  labor  was  further  regulated  as  to 
hours  and  conditions  of  non-interference  with 
health  and  school.  In  February,  1919,  con- 
solidation of  sick  benefit  organizations  was 
authorized.  ( To  he  concluded.)  —  E.  L.  Se\Ting- 
haus. 

AlSTRIAN  LegISLATIOX  FOK  PlJOTEfTIOX  OF 

WonKEus.  Jentiji  Alder-Hcrzmurk.  Zentralbl. 
f.  Gewerbehyg.,  Feb.,  19-21,  9,  No.  '2.  '25-27. 
(f'o//r/;/.v(Vw.)— The  legislation  for  1919-19-20, 
which  is  reported  in  this  article,  includes  laws 
in)  forbidding  night  work  for  Imtchers;  ih)  re- 
quiring an  cight-iiour  day,  no  night  work,  time 
and  one-half  for  overtime  in  bakeries,  and 
medical  certificates  for  aj)prcntices;  (c)  requir- 
ing tiiat  all  employees  under  17  years  be  given 
an  unintcrru|)tcd  vacation  of  four  weeks  with 
certain  ])aymcnls  in  case  of  illness;  (</)  forliid- 
ding  iiiglit  work  for  women  and  all  persons 
under  19  years;  (c)  granting  \'acations  with  |)ay 
to  ail  emi)loyees — one  week  for  those  who 
have  ser\ed  in  the  industry  a  year  or  more,  two 
weeks  for  those  who  iiave  worked  five  years; 
(/)  permitting  child  labor  in  hotels  and  public 
houses  with  restrictions  as  to  hours  of  sleep  and 
daytime  rest.  —  F.  L.  Sevringhaus. 

The  New  Law  fok  PuoTEfTiox  of  Work- 
ers IX  Hoi.KAM).  //.  ./.  Scliollc.  Zentralbl.  f. 
Ccwerbchyg.,  Feb.,  19'21.  9,  No.  -2,  '27:50.  -  .V 
tabular  ))re.sentation.  with  some  explanations  of 
the  new  law,  shows  the  detailed  specification  of 
the  hours  of  work,  Saturday  half-holiday  and 
Sunday  holiday  provisions,  and  their  apjjlica- 
tion  to  the  men,  women,  or  yoimg  workers. 
Domestic  service,  drugstores,  and  agriculture 
are  excejited  from  the  law.  —  E.  L.  Sevringhaus. 

The  Trend  of  Workiiex'-s  Compens.vtion. 
1('(7/  ./.  French.  U.  S.  Bur.  Labor  Statis., 
Month.  Labor  Rev.,  Nov.,  1920,  11.  No.  5,875- 
883.  —  The  most  important  recent  develop- 
ment of  workmen's  compensation  legislation 
is  in  extending  benefits  to  include  vocational 
re-education  and  rehabilitation.  Federal  aid  is 
given  to  states  that  will  partici[)ate  in  relieving 
crippled  workmen.  Another  development  is 
the  extension  of  workmen's  compensation  acts 
to  broader  coverage  of  industries,  that  is,  be- 
yond the  extra-hazardous  and  the  hazardous 
occupations. 


A  uniform  federal  compensation  act  is  needed 
for  interstate  railway  employees  and  maritime 
workers.  But  this  law  would  infringe  in  the  one 
case  upon  states"  rights,  and  in  the  other  would 
conflict  with  admiralty  laws  and  the  laws  of 
maritinie  states.  A  practical  solution  would  be 
for  Congress  to  enact  a  uniform  federal  measure 
with  a  ])rovision  that  the  difl'ereut  state  com- 
pensation boards  and  connnissions  should  have 
concurrent  jurisdiction  with  the  federal  courts 
in  determining  suits  arising  under  it.  —  Eliza- 
beth ('.  Putnam. 

WOUK-MEX'S  Co.Ml»EXS.\TIOX  LeGISLATIOX  IX 

C.vx.\DA.  Labour  Gaz.,  Aug.,  19-20,  -20,  No.  8, 
101-2 -10-20. — .\.  com])arisou  is  made  of  the 
somewhat  widely  variant  provincial  laws  on 
the  subject  of  workmen's  compensation,  in  the 
interest  of  greater  uniformity  for  the  future, 
("ompensatiou  for  industrial  accidents  has  been 
proxided  for  by  law  in  all  Canadian  ])roviiices 
with  the  exception  of  Prince  Eilward  Island. 
The  Canadian  laws  follow  mainly  the  British 
Employers'  Liability  Act,  which  was  passed  in 
18S(I  and  which  represents  a  change  of  view 
from  the  older  idea  in  regard  to  the  i)roper  in- 
cidence of  the  risk  in  industrial  work.  The 
l)rovince  of  Quebec  forms  the  single  exception, 
since  here  the  civil  law  is  based  on  French  law. 
In  the  i^rovinces  of  .VIbcrta,  British  Colum- 
bia, Manitoba,  New  Brunswick,  Nova  Scotia 
and  Ontario,  the  tendency  has  been  along  the 
line  of  the  German  system  of  workmen's  com- 
l)(Misati()Ti.  The  emjiloyers'  liability  acts  have 
gradually  been  replaced  in  these  provinces  by 
a  plan  of  collective  liability  and  an  exclusive 
state  fund  such  as  the  one  adopted  in  the  state 
of  Washington.  Six  ])rovinces  have  exclusive 
state  insurance;  six  provinces  and  the  "^'ukon 
l)ay  compensation  to  workmen  without  regard 
to  the  amount  of  their  remuneration.  In  all  the 
provinces  and  the  Yukon,  the  burden  of  i)ay- 
ment  rests  on  the  enii)loycr.  but  in  sonic  |)rov- 
inces  the  liability  is  borne  collectively  by  grou])s 
of  employers.  Full  medical  and  hospital  aid  is 
finnished  in  five  provinces.  Six  provinces  make 
injuries  due  to  some  industrial  disea.scs  cora- 
pensatable.  There  is  little  uniformity  in  meet- 
ing the  cost  of  administration.  The  scale  of 
benefits  shows  more  uniformity  in  the  compen- 
sation allowed  in  cases  of  death  than  in  that  for 
disability.  The  survey  as  a  whole  shows  that 
the  majority  of  the  Canadian  provinces  have 
gradually  been  adopting  the  principles  which 
the    commission,    appointed    in    April,    19-20, 


86 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


recommended  as  standard  provisions  for  uni- 
form provincial  laws  on  workmen's  compensa- 
tion. —  G.  E.  Partridge. 

Legislation  Now  Needed  to  Restore 
Compensation  to  Longshoremen.  Joseph  P. 
Chamberlain.  Am.  Labor  Legis.  Rev.,  Dec, 
1920,  10,  No.  4,  241-'245.  — "There  are  two 
classes  of  workmen  in  the  service  of  ships:  one 
class  includes  longshoremen  —  men  employed 
in  loading  and  unloading  the  ship  while  it  is  in 
port,  and  carpenters,  machinists,  painters  and 
repairmen  who  refit  it  for  the  next  voyage;  the 
other  includes  the  men  of  the  sea  —  the  master 
and  the  crew."  The  "men  of  the  sea"  are  a 
class  apart:  they  are  migratory,  touching  in 
many  lands  under  many  laws;  for  them,  uni- 
formity in  law  is  possible  only  vmder  an  act  of 
Congress  administered  through  federal  courts  or 
commissions.  Longshoremen  and  repairmen  are 
in  a  wholly  different  situation.  They  are  at- 
tached to  one  locality;  they  may  be  employed 
on  the  docks  on  strictly  land  jobs;  they  may  be, 
for  instance,  builders'  men  sent  down  for  half  a 
day  to  unload  a  cargo  of  bricks.  It  is  hard  to  see 
why  they  should  not  be  treated  on  the  same 
basis  as  other  local  workmen;  but  because  of 
arbitrary  rules  of  law  their  position  is  anom- 
alous. If  injury  to  such  a  man  occurs  on  a  ship, 
the  question  of  damages  is  decided  on  the  basis 
of  admiralty  law;  if  it  occurs  on  shore  or  even  on 
the  wharf,  but  not  in  direct  relation  to  the  ship, 
the  case  comes  imder  the  state  comj^ensation 
act;  if  the  man  is  injured  while  on  his  way  to  the 
ship,  he  may  neither  sue  in  admiraltj%  since  the 
accident  occurred  on  shore,  nor  be  compen- 
sated under  state  laws,  since  he  is  a  "maritime 
worker."  His  only  redress,  then,  is  to  sue  for 
damages  for  tort  under  the  common  law.  More- 
over, if  the  accident  happens  on  the  gang  plank, 
it  is  doubtful  whether  he  can  be  compensated 
in  any  way.  The  wise  solution  is  for  Congress  to 
enact  promptly  "a  law  restoring  the  protection 
of  state  workmen's  compensation  laws  to  these 
essential  workers  who  are  engaged  in  especially 
hazardous  oc('U])ations  along  every  waterfront 
of  the  country."  —  Elizabeth  C.  Putnam. 

Workmen's  Compensation  Legislation  of 
THE  United  States  and  Canada.  Lindlei/  D. 
Clark  and  Martin  C.  Frincke,  Jr.  U.  S.  Bur. 
Labor  Statis.,  Bull.  272,  Jan.,  1921,  pp.  1211.  — 
This  bulletin  takes  up  the  i)rogress  of  com- 
pensation legislation,  together  with  an  analj-sis 
of  the  principal  features  of  the  laws  and  their 


texts  in  the  various  states  of  the  Union  and  the 
provinces  of  Canada.  —  M.  C.  Shorley. 

Cost  of  Occupational  Dise.\ses  under 
Workmen's  Compensation  Acts  in  the 
United  States.  Carl  Hookstadt.  Month. 
Labor  Rev.,  Feb.,  1921,  12,  No.  2,  154-159.  — 
This  interesting  article  includes  six  tables  illus- 
trating federal  and  state  experience  with 
occupational  diseases.  —  R.  B.  Crain. 

AVorkjuen's  Compensation  and  Social  In- 
surance, Comparison  of  Compensation  In- 
surance Systems  as  to  Cost,  Service,  and 
Security.  C.  Hookstadt.  U.  S.  Bur.  Labor 
Statis.,  Month.  Labor  Rev.,  Dec,  1920,  11,  No. 
6,  135-156.  —  The  writer  has  made  a  detailed 
study  of  compensation  insurance  systems  in 
twenty-one  states  and  two  Canadian  provinces, 
during  which  he  visited  the  industrial  commis- 
sion of  each  of  these  states  and  provinces.  A 
comparative  account  is  given  of:  the  funds;  the 
cost;  the  service  in  regard  to  promptness,  ade- 
quacy or  liberality  of  payment;  accident  pre- 
vention; and  the  security  offered  to  employer 
and  employee. 

Three  main  types  of  states  with  respect  to 
compensation  insurance  are  described:  states 
having  exclusive  state  funds;  states  having 
competitive  state  funds;  and  states  in  which 
there  is  private  insurance.  Under  an  exclusive 
state  fimd  the  cost  to  employers  would  be  30 
per  cent,  less  than  under  stock  insurance  and 
121  per  cent,  less  than  under  mutual  insurance. 
The  total  saving  to  insured  employers  of  the 
United  States,  if  all  were  insured  in  exclusive 
state  funds,  would  be  more  than  $30,000,000 
annually. 

In  promptness  of  payment  there  is  little  dif- 
ference between  the  different  types  of  insur- 
ance carriers.  Some  of  the  state  funds  have  the 
best  records,  while  others  are  among  the  poor- 
est; this  is  true  also  of  stock  companies  and 
mutual  companies.  The  best  managed  state 
fund,  however,  is  more  prompt  in  its  payments 
than  the  best  private  company.  As  regards 
liberality  of  i)aymcnt,  most  of  the  state  funds 
are  more  liljeral  than  either  stock  or  mutual 
companies.  In  accident  prevention  some  of  the 
private  companies  are  doing  excellent  safety 
work,  whereas  few  of  the  state  funds  have  done 
any  effective  safety  work. 

Thus  far  no  injured  workman  has  lost  any 
compensation  due  because  of  the  insolvency  of 
state  insurance  funds,  and  no  large  mutual  in- 


ABSTRACTS 


87 


surance  company  has  become  insolvent.  There 
have  been,  however,  several  bad  failures  of 
private  stock  companies  during  the  past  three 
or  four  years.  The  experience  of  twenty-one 
states  in  respect  to  self-insurance  has  been  re- 
ported. In  fifteen  of  these  states  no  self-in- 
sured employer  has  failed  or  gone  into  the  hands 
of  a  receiver.  Only  twVj  of  the  remaining  si.K 
states  reported  failure  on  the  self-insurance 
plan  resulting  in  claims  being  unpaid,  and  the.se 
involved  only  one  small  company  in  each  of  the 
states.  —  G.  E.  Partridge. 

Prevent.\ble  Losses  in  C.\sualty  In- 
STJR.\NCE.  John  C.  A.  Gerster.  Mod.  Med., 
Nov.,  19'-20,  -2.  Xo.  11.  7'28-7;50.  —  This  article 
contrasts  the  common  negligence  of  casualty 
insurance  companies  regarding  basic  surgical 
principles  with  the  policy  of  life  insurance 
com])anics  in  kcejiing  abreast  witii  medical  and 
surgical  ])n)gr<"ss  affecting  their  interests.  The 
failure  to  appoint  "expert  buyers  of  the  com- 
modity, surgical  treatment,"  is  indicated  as  the 
fundamental  error.  In  the  writer's  opinion, 
no  claim  agent,  however  cajjable,  can  judge  the 
best  surgical  service.  He  believes  that  until 
casualty  insurance  companies  avail  themselves 
of  up-to-date  surgical  service,  as  tried  and 
proN'etl  by  war  experience,  such  comj)anies  will 
continue  to  i)ay  about  twice  as  uuich  as  they 
should  for  disability  following  injury. 

A  few  self-evident  surgical  ])rinciples  upon 
which  claim  departments  shoultl  base  their 
systems  of  adminislralion  are  enumerated. 
Among  these  are  the  provision  of  expert  surgical 
consultants;  the  provision  of  hospital  facilities 
of  the  highest  standards;  and  the  provision  of  a 
medical  intelligence  department  to  keep  track 
of  the  man  from  the  time  he  is  hurt  until  he  is 
well. 

The  writer  believes  that  the  evils  of  the  pres- 
ent system  can  be  promptly  and  economically 
eliminated  by  the  creation  of  a  surgical  depart- 
ment working  in  "close  co-operation  with  the 
claims  department."  The  functions  of  such  a 
surgical  department  would  include,  besides  the 
immediate  technical  functions,  the  following: 
(1)  insistence  upon  immediate  report  of  acci- 
dents by  telephone;  (2)  maintaining  a  daily 
follow-up  system;  (3)  supervising  of  medical 
bills  from  outlying  districts;  (4)  analysis  of 
results. 

Educational  measures  are  advised  for  in- 
structing claim-agents,  employees  and  em- 
ployers in  practical  surgical  principles  with  the 


purpose  of  securing  immediate  and  adequate 
surgical  care  in  all  emergencies.  —  H.  W. 
Stevens. 

A  Statistical  Review  of  Disability  in  the 
Workmen's  Circle.  George  Rubin  and  Joseph 
Bashin.  Mod.  Med.,  Nov.,  19'-20,  2,  Xo.  11, 
7;{()  7.S3.  —  A  study  based  upon  the  experience 
of  this  organization  in  sick  benefits  paid  to  its 
disabled  members. 

For  the  purpose  of  comparison  all  occui)a- 
tions  are  grouped  into  twenty-one  classes,  in- 
cluding housewives  and  a  miscellaneous  group 
termed  "other  occupations."  The  results  of 
the  study  are  presented  in  several  tables. 

Tables  I,  II,  and  III  deal  with  the  relation 
between  age  and  disability.  Table  I,  covering  a 
period  of  four  years,  gives  the  annual  average 
number  of  disability-days  per  member  and  per 
disabled  member  of  each  classified  fi\e-year  age 
grou]).  Table  II  shows  the  deviation  from  the 
average  for  each  age  group,  the  0  deviation 
falling  between  the  groups  thirty  to  thirty-four 
and  thirty-five  to  tliirty-nine.  Table  III  shows 
the  relative  resi)()nsii)ility  of  each  age  group  for 
disability.  Tiiis  is  the  highest  in  the  thirty  to 
thirty-four  group. 

Tables  IV,  V,  and  VI  deal  with  the  relation 
of  occupation  to  disability.  Twenty-one  occu- 
pation groups  are  distinguished.  The  occupa- 
tion of  housewife  shows  the  highest  apparent 
responsibility,  followed  in  order  by  that  of 
laborer,  baker,  painter,  and  machinist. 

Tables  VII  and  X'lli  i)rcsent  the  relations  of 
various  diseases  to  disability.  Influenza,  injury, 
infection  (surgical)  and  digestive  disturbances, 
in  order,  are'  the  leading  causes,  considering  the 
numbers  of  disabled  members;  while  injury, 
tuberculosis,  influenza  and  digestive  disorders 
arc  the  chief  causes  of  disability  measured  in 
days. 

Several  charts  illustrate  graphically  the  facts 
of  the  tables.  —  H.  W.  Stevens. 

The  Social  Hygienic  Results  of  the  Ger- 
man Workmen's  and  Employees'  Insurance 
IN  THE  War  .\nd  its  Problems  in  the  Future. 
If',  llanauer.  Abstracted  as  follows  from 
Veroff.  a.  d.  Geb.  d.  Med.-Verw.,  Vol.  10,  pp. 
483-573,  by  Holtzmann  in  Hyg.  Rundschau, 
Sept.  1,  lO-'O,  30,  Xo.  17,  536-537.  —  "During 
the  war  workingmen's  sick  funds,  labor  unions 
and,  above  all,  state  insurance  organizations 
made  their  resources  and  ability  available  for 
public  health  ends,  for  the  provision  of  hos- 


88 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


pitals  and  comforts  for  the  soldiers  in  the  field. 
The  author  describes  only  those  branches  of 
social  hygienic  care  in  which  the  organs  of  the 
R.  V.  O.  are  concerned. 

"To  fight  tuljerculosis  advance  stations  were 
erected  for  the  sifting  of  material  to  be  sent  to 
the  hospitals  for  lung  cases.  Active  co-opera- 
tion with  the  charitable  organizations  is  to  be 
desired  to  assure  the  carrying  out  of  the  treat- 
ment. The  beginning  of  the  tuberculosis 
campaign  among  children  by  the  insurance 
organizations  is  welcome.  The  battle  against 
venereal  diseases  received  a  great  impulse 
during  the  war.  Consultation  offices  of  dif- 
ferent types  were  erected  by  the  state  insur- 
ance organizations,  the  attendance  at  which, 
•  however,  leaves  more  to  be  desired. 

"In  industrial  hygiene  it  was  discovered 
that  wartime  substitutes  for  oils  increased  skin 
diseases.  The  widespread  use  of  exjjlosives 
gave  occasion,  according  to  Section  5-17  of  the 
R.  V.  O.,  to  a  comparison  of  sickness  due  to 
these  substances  with  injuries  following  acci- 
dents. In  maternity  cases  the  ruling  of  Sept. 
11,  1914  on  aid  during  confinement  in  war  time 
gave  the  workmen's  sick  funds  occasion  for 
energetic  helpfulness.  Experience  gained  in  this 
way  was  crystallized  in  the  imperial  law  for 
maternity  aid  which  affords  to  all  people  of 
small  means  the  benefit  of  care  during  {Jreg- 
nancy  and  confinement.  In  the  matter  of  hous- 
ing, the  local  workmen's  sick  fund  at  Pforzheim 
was  a  pioneer  in  propaganda  and  raising  funds 
for  the  building  of  small  dwellings.  Social 
insurance  and  care  of  war  casualties  are  in  close 
relation;  representatives  of  workmen's  sick 
funds,  labor  unions,  and  insurance  commis- 
sions make  up  the  committees  on  the  care  of 
war  casualties.  Industrial  therapy  for  the  most 
complete  possible  rehabilitation  of  war  cripples 
to  a  self-supporting  state  was  improved  by  the 
unions  in  line  with  the  favorable  experience 
after  the  war. 

"In  conclusion  the  author  suggests  expan- 
sion and  changes  in  social  insurance.  He  de- 
sires officially  appointed  physicians  with  a 
social  hygienic  training  for  the  workmen's  sick 
funds,  as  subordinate  to  whom  the  '  controllers 
of  the  sick  '  might  serve.  The  hypothesis  upon 
which  all  this  is  based  is  that  the  German  people 
will  be  able  to  work  their  way  up  out  of  their 
impoverishment."  —  E.  L.  Sevringhaus. 

Old  Age  Insur.\.n'ce  Legislatiox  Now  up 
TO  THE  St.\.tes.    Frederick  MacKenzie.    Am. 


Labor  Legis.  Rev.,  Dec,  IQ'JO,  10,  No.  4,  254- 
255.  —  The  United  States  is  alone  among  the 
great  civilized  nations  in  not  having  attempted 
a  permanent  solution  of  the  problem  of  old  age 
and  dependency.  A  beginning  has  been  made 
in  several  states,  notably  New  York,  where  a 
law  provides  old  age  retirement  and  disability 
insurance  for  its  jniblic  employees;  and  in  1920, 
after  years  of  agitation,  compulsory,  contribu- 
tory old  age  insurance  has  been  established  for 
federal  employees  in  the  classified  civil  service. 
Social  responsibility  for  protecting  old  age 
against  ])auperisni  is  recognized  on  the  program 
of  the  April.  1921  meeting  of  the  International 
Labor  Conference  of  the  League  of  Nations. 
"With  legislative  sessions  during  1921  in  nearly 
all  states,  the  opportunity  is  at  hand  to  bring 
America  immediately  abreast  of  the  enlight- 
ened standards  and  experience  of  other  great 
industrial  nations.  Bills  must  be  passed  in  all 
the  states  before  the  Unite,d  States  can  be  said 
to  have  met  its  duty  to  those  who  have  grown 
gray  in  the  service  of  the  public  and  of  indus- 
try." —  Elizabeth  C.  Putnam. 

State  Industrial  Accident  Insltjaxce 
Officl\.lly  Acclaimed.  Irene  S.  Chubb.  Am. 
^  Labor  Legis.  Rev.,  Dec,  1920,  10,  No.  4,  258- 
260.  —  The  outcome  of  a  discussion  at  the 
recent  convention  of  the  International  Asso- 
ciation of  Industrial  Accident  Boards  and 
Commissions  concerning  the  relative  service, 
security  and  C(ist  under  commercial,  mutual  and 
state  fluid  insurance,  was  strongly  in  favor  of 
state  funds.   The  benefits  were  found  to  be: 

1.  There  is  security  to  the  workman. 

2.  There  is  security  to  the  employer  when  lie  has  paid 
his  assessments  to  the  state  fund. 

;i.  There  is  better  feeling  between  employer  and  work- 
man, because  the  state  fund  assumes  the  payment  of  com- 
pensation. 

4.  The  industries  of  the  state  benefit  by  only  paying  a 
maximum  of  about  eight  cents  to  get  one  dollar  to  the  work- 
man, against  sixty-six  and  two-thirds  cents  by  stock 
companies. 

5.  Tiie  state  benefits,  because  it  will  never  be  called 
upon  to  make  good  payments  which  should  have  been 
made  by  stock  companies. 

G.  The  employer  is  better  satisfied,  because  he  knows 
that  every  dollar  whieh  he  pays  in  assessment  is  to  be  used 
to  pay  claims  and  legitimate  expenses,  which  will  not 
likely  exceed  7i  per  cent. 

7.  The  employee  is  better  satisfied,  because  he -feels 
that  his  payments  are  in  the  hands  of  a  board  who  have 
every  reason  to  deal  fairly  with  him. 

"Taking  everything  into  consideration,  can 
we  come  to  any  other  conclusion  but  that  the 
exclusive  state  fund  must  be  the  permanent 
system?"  —  Elizabeth  C.  Putnam. 


ABSTRACTS 


89 


REHABILITATION  OF  DISABLED  EMPLOYEES 


Training  at  Iowa  State  College.  Voc. 
Summary,  Nov.,  1920,  3,  No.  7,  99-101.— 
From  district  No.  9  a  report  is  submitted  re- 
garding the  work  being  done  and  the  |)n)gress 
made  by  some  Federal  Board  men  enrolled  in 
Iowa  State  College.  Cases  are  mentioned  to 
demonstrate  the  possibility  of  men  suffering 
from  physical  disabilities  and  lack  of  education 
making  good  in  a  new  vocation.  —  L.  .V.  Slunv. 

Industrl\l  Rehadilitatiox  in  Oregon. 
W.  T.Kirlc.  Month.  Labor  Rev.,  Oct.,  1920, 11, 
No.  4,  1-8.  — This  interesting  investigation  of 
the  work  of  the  Industrial  Accident  Conunis- 
sion  in  Oregon  was  carried  on  with  ai)i)arent]y 
an  unusual  degree  of  freetloni.  Tlie  work  is 
divided  into  three  departments.  One  depart- 
ment is  devoted  to  auditing,  bookkeeping,  etc.; 
another  takes  care  of  the  claims;  and  the  third 
handles  the  statistical  work.  Tiie  work  of  voca- 
tional rehabilitation  falls  to  tiie  claims  depart- 
ment. An  effort  has  been  made  to  simplify  all 
tlie  i)reliniinary  routine  in  acc-c|)ting  candidates 
for  rehabilitation  training  anil  aid,  and  to  treat 
all  eases  with  reference  to  the  es])ecial  needs  and 
conditions  of  the  case.  Existing  educational 
facilities  are  used,  the  co-o])eration  of  an  expert 
in  industrial  education  has  been  ol)taiiu'd,  and 
each  case  is  carefully  studied.  Liberal  inter- 
pretation of  eligibility  to  rehabilitation  aid  has 
been  nuide  (the  rule  is  laid  down  that  all 
should  be  eligible  who  have  lost  oO  per  cent,  or 
more  of  the  use  of  an  arm,  hand,  foot,  or  leg,  or 
sustained  other  permanent  disability  of  eijual 
severity);  and  an  attempt  is  made  to  i)rovide 
adequate  sujijjort  for  the  man  while  he  is  un- 
dergoing training.  Tlie  work  is  too  new,  the 
writer  concludes,  to  allow  definite  statements  of 
results,  but  several  cases  are  presented  as  illus- 
trations of  the  method  of  work  of  the  commis- 
sion. —  G.  E.  Partridge. 

Oregon  Si'stem  of  Medical  Service. 
F.  H.  Thompson.  Mod.  Med.,  Jan.,  1921,  3, 
No.  1,  'iG-'il. — Aside  from  administering  a 
compensation  fund  the  Oregon  law  for  the 
compensation  of  industrial  accidents  makes 
provision  for  the  prevention  of  accidents  as 
well  as  for  the  best  possible  care  of  the  dis- 
abled. To  this  end  there  has  been  established 
a  department  of  physiotherapy  similar  to  that 
in    the    work    of    army    reconstruction.     The 


medical  department  of  the  commission  has  the 
final  decision  as  to  the  treatment  of  all  cases. 
Thus,  though  the  patient  may  originally  choose 
his  own  physician  or  be  treated  by  the  com- 
pany contract  doctor,  ultimately  his  concHtion 
is  passed  upon  by  the  state  authorities  and 
almost  invariably  comes  to  the  state  institu- 
tion for  ])hysiotherapy,  there  being  very  few 
such  facilities  in  jjrivate  i)ractice  as  yet.  Tiie 
law  provides  for  an  expenditure  of  $250  for 
transportation,  hospital  and  surgical  care,  and 
nursing.  .Vuy  further  ex|)enditure  must  lie  ad- 
vised by  the  commission.  This  enables  the 
commission  to  proceed  with  reconstruction 
surgery  and  physiotherapy  if  it  is  needed. 

No  permanent,  partial,  or  complete  dis- 
ability awards  are  made  until  all  ]iossible  res- 
toration of  function  is  accomiilisiicd.  For  tiiis 
liuriKise  there  are  two  fully  equipped  physio- 
therapy departments  with  trained  army  aids 
to  carry  on  work.  Physicians  at  first  resented 
tliis  as  criticism  of  their  work  but  tliis  olijcction 
was  overcome  by  sending  to  each  jihysician  a 
carbon  copy  of  the  order  stating  the  reason  for 
calling  in  the  iiatient,  and  jiaying  him  in  full  for 
his  care  of  the  jiaticnt. 

In  cases  of  amputation,  temporary  total  dis- 
ability is  continued  until  the  artificial  limb 
(paid  for  by  the  state)  is  secured.  Vocational 
retraining  for  major  permanent  disability  cases 
is  strongly  advised.  E.specially  successful 
work  lias  been  done  with  ankylosed  joints  by 
jihysiotiierapy,  and  much  prevention  of  such 
conditions  is  being  made  possible  by  careful 
early  supervision  of  all  cases.  This  law  aims  to 
be  most  helpful  to  the  injured,  most  economic 
to  society  and  most  satisfactory  to  the  em- 
jiloyer.  —  Elinor  1).  Gregg. 

9,500  Partially  Disabled  Employees 
^YoRKING  IN  Ford  Motor  Plant.  Nat. 
Safety  News,  Jan.  17,  1921,  3,  No.  3,  5.  —  The 
Ford  Motor  Company  has  admitted  to  its 
plant  at  Detroit  about  9,500  cripjiled  or  dis- 
eased men.  Among  these  men  there  are  123 
at  work  who  have  suffered  amputation  of  arms, 
forearms  or  hands,  or  who  are  hopelessly  criji- 
pled  in  one  of  these  members.  One  man  has 
lost  both  hands;  4  are  totally  blind;  207  are 
blind  in  one  eye;  253  have  light-perception 
only  in  one  eye;  37  are  deaf  and  dumb;  60  are 
suffering  from  epilepsy;  234  have  had  amputa- 
tion of  one  foot  or  leg,  or  are  hopelessly  crip- 


90 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


pled;  four  have  lost  both  legs  or  feet;  1,560  are 
suffering  from  hernia;  and  900  are  tuber- 
culous men.  —  G.  E.  Partridge. 

The  Industrial  Question:  A  Proposal 
AND  ANNOUNCEiiENT.  Frederic  J.  Cotton.  Bos- 
ton Med.  and  Surg.  Jour.,  Feb.  10,  1921,  184, 
No.  6,  135-137.  —  Industrial  accident  cases  are 
similar  in  many  ways  to  wound  cases  in  the 
army,  and  the  successful  methods  of  treatment 
and  rehabilitation  evolved  for  the  war-wounded 
should  be  applied  to  the  maimed  and  wounded 
in  industry.  Faulty  methods  of  treatment  have, 
in  the  past,  resulted  in  a  great  amount  of  eco- 
nomic and  human  waste.  Large  general 
hospitals  have  been  too  busy  to  handle  such 
cases  properly.    Smaller  community  hospitals 


have  done  better,  but  few  of  them  are  fully 
qualified  for  this  work  in  equipment  and  per- 
sonnel. Pri^'ate  physicians  have  done  surpris- 
ingly well,  perhaps  because  of  greater  interest 
in  their  cases.  Plant  hospitals  affiliated  with 
good  local  hospitals  are  especially  equipped  for 
the  work  and  promise  good  results. 

To  improve  the  chances  of  the  injured  em- 
ployee of  a  small  concern,  two  things  are  advo- 
cated: (1)  a  systematic  review  of  all  cases  on 
compensation  o^•er  a  few  weeks  to  see  what 
shoiJd  be  done  and  whether  it  is  being  done; 
and  (2)  an  arrangement  by  which  serious  cases 
needing  expert  treatment  can  easily  secure  it, 
whether  they  are  under  the  care  of  their  own 
doctor,  of  the  company  doctor,  or  of  the  insur- 
ance company.  —  Barnett  Cohen. 


INDUSTRIAL  MORTALITY  AND  MORBIDITY  STATISTICS 


Diseases  Prevalent  among  Steel  Work- 
ers IN  A  Pennsylv^vnia  City.  D.  K.  Brund- 
age.  U.  S.  Pub.  Health  Ser.,  Pub.  Health  Rep., 
Dec.  31,  1920,  35,  No.  53,  3163.  —  In  connec- 
tion with  the  collection  and  study  of  industrial 
morbidity  statistics,  a  report  of  a  large  em- 
ployee's sick  benefit  association  which  has  been 
furnished  the  Statistical  Office  of  the  U.  S. 
Public  Health  Service  has  been  selected  as 
typical,  and  is  presented  here  for  the  purpose  of 
pointing  out  (1)  what  such  a  report  actually 
shows  and  (2)  what  salient  facts  such  reports 
might  reveal  concerning  the  occurrence  of  dis- 
ease in  the  group  of  industrial  workers  under 
consideration.  —  L.  A.  Shaw. 

Sickness  Frequency  among  Industrial 
Employees.     U.   S.   Pub.   Health   Ser.,   Pub. 


Health  Rep.,  March  4,  1921,  36,  No.  9,  429- 
434.  —  This  is  a  statistical  study  of  morbidity 
among  a  group  of  wage  earners  for  the  first  nine 
months  of  1920.  Only  cases  lasting  over  one 
week  are  reported.  The  sickness  frequency  in 
February  is  the  highest  reported,  being  twice 
that  of  September,  exclusive  of  influenza  cases. 

Apparently,  the  hot  weather  diseases  do  not 
last  as  long  as  one  week.  Diseases  of  the 
pharynx  are  of  very  high  incidence  during  the 
first  three  months  of  the  year.  Rheumatism  is 
high  in  the  first  half  of  the  year.  Occupational 
poisonings  are  becoming  comparatively  rare. 

Tables  are  given  to  illustrate  the  data.  Many 
of  the  interesting  questions  are  stiU  to  be  put 
and  still  to  be  answered.  A  more  complete  re- 
port will  be  given  at  the  end  of  the  year.  — 
Elinor  D.  Gregg. 


V 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


SEPTEMBER,  1921 


Number  5 


CONTENTS 


TAom 

General : 91 

Systemic  Occupational  Diseases:  Occurrence,  Treat- 
ment and  Prevention 94 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc 90 

Dust  Hazards  and  Their  Effects 98 

Occupational  Infectious  Diseases:  Occurrence,  Treat- 
ment and  Prevention 100 

Occupational  Affections  of  the  Skin  and  Special  Senses.  lOi 

Occurrence  and  Prevention  of  Industrial  Accidents  . .  103 

Industrial  Surgery 108 


PAOI 

Industrial  Physiology :  Nutrition,  Metabolism,  Fatigue, 
etc 108 

Hazards  of  Compressed  Air,  Diminished  Pressure, 
Generation  and  Use  of  Electricity,  and  Electrical 
Welding 11-2 

Heat,  Cold  and  Humidity 112 

Women  and  Children  in  Industry Hi 

Industrial  Sanitation:  Factory  Construction,  Illumina- 
tion, \'entilation.  Heating,  Water  Supply,  Sewage 
Disposal 117 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Industrial  Plants 118 


GENERAL 


Industrl\l  Hygiexe.  .S'iV  Thomas  Oliver. 
Interuat.  Labour  Rev.,  Feb.,  lO^l,  1,  No.  '2, 
153-158.  —  Among  the  international  labor 
problem.s  respecting  the  hygiene  of  labor,  the 
smelting  of  lead  ore  and  the  manufacture  and 
use  of  lead  compounds  should  be  considered. 
With  the  exception  of  lead  ore  in  the  form  of 
cerussite  or  carbonate,  lead  mining  has  not 
been  a  cause  of  plumbism,  although  the  miner 
has  been  liable  to  pneiunoeoniosis  and  pul- 
monary phthisis  from  the  inhalation  of  hard 
metallic  dust.  Lead  in  the  form  of  galena,  or 
sulphide,  is  very  insoluble,  but  the  question  has 
been  raised  recently  whether,  tiirough  the 
action  of  air  and  other  as  yet  unknown  agen- 
cies, a  conversion  of  underlying  veins  of  galena 
into  soluble  carbonate  does  not  take  place. 
This  problem  has  been  raised  in  regard  to  the 
Broken  Hill  mines  of  Australia,  but  it  is  of 
general  interest. 


Previous  to  the  war,  ankylostomiasis  had 
been  a  cause  of  ill  health  and  of  death  among 
the  coal  miners  in  Hiuigary  and  Westphalia, 
as  well  as  of  sickness  among  the  tin  miners  of 
Cornwall  and  the  agricultural  laborers  of  the 
United  States,  the  West  Indies  and  other 
places.  With  our  wider  knowledge  of  the  dis- 
ease, ankylostomiasis  should  in  the  future 
claim  fewer  victims. 

Occupation  in  mines  and  factories  still  re- 
sults in  too  large  a  loss  of  life  from  accident. 
Many  factors  call  for  further  consideration, 
such  as  faulty  lighting,  too  long  hours  and 
fatigue,  impaired  eyesight,  the  defective  fac- 
tory plant,  and  the  effects  of  alcohol.  —  G.  E. 
Partridge. 

Health  Conditions  at  Broken  Hill 
Mines.  MeliiUe  Birks.  Jour.  State  Med., 
April,  1921,  29,  No.  4,  121-125.  —The  Broken 


91 


92 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Hill  mines  are  situated  in  New  South  Wales 
and  yield  lead  and  zinc  sulphides  mainly.  The 
workings  are  not  over  1 ,500  feet  deep  and  tem- 
peratures do  not  run  very  high.  The  atmos- 
phere of  the  mines  has  a  high  dust  content. 

Lobar  pneumonia  is  particularly  fatal  for 
the  underground  workers.  The  cause  for  this 
has  not  been  determined,  but  by  a  process  of 
exclusion  the  diist  of  the  sulphide  ore  is  sus- 
pected as  being  in  some  way  the  determining 
factor.  Silicosis  is  only  rarely  produced  by  the 
dust  of  these  mines,  as  over  100  postmortem 
examinations  have  shown.  Some  of  the  mines 
still  produce  some  lead  carbonate  and  in  these 
a  few  cases  of  typical  plumbism  occur;  but  a 
great  many  men  have  symptoms  resembling  a 
chronic  form  of  lead  poisoning  which  is  ap- 
parently caused  by  working  with  the  sulphide 
ore.  Nystagmus  and  hookworm  disease  are 
absent  among  the  miners.  —  Barnett  Cohen. 


The  Soci.\l-Hygienic  Conditions  of 
Hotel  Personnel,  in  Rome.  Abstracted  from 
Bollettino  deirUfficio  Municipale,  1919,  in  II 
Lavoro,  Jan.  31,  1931,  11,  No.  9,  284.  —  It  is 
difficult  to  ascertain  the  conditions  of  work  for 
hotel  employees  on  account  of  the  reticence  of 
hotel  keepers  as  well  as  of  employees.  Condi- 
tions are  good  in  hotels  of  the  first  order,  good 
in  90  per  cent,  of  those  of  the  second  order,  and 
in  21  per  cent,  of  those  of  the  third  order,  but 
mediocre  in  -ii  per  cent.,  and  bad  in  35  per 
cent,  of  those  of  the  third  order.  In  general, 
sleeping  quarters  and  food  are  good,  but  laun- 
dresses seem  to  he  the  exception  to  the  rule. 
They  work  from  eight  to  fifteen  hours  a  day, 
with  the  Simday  rest  not  too  well  observed. 
—  M.  Dent. 

Attendance  of  Workers  in  Moscow 
F.\CTORiES.  Internat.  Labor  Rev.,  Feb.,  1921, 
1,  No.  2,  223-230.  — The  facts  here  given  are 
taken  from  the  report  of  the  Moscow  Section 
of  Labour  Statistics,  which  is  part  of  the  Com- 
missariat of  Labour.  Tables  showing  the  num- 
ber of  days  worked  in  industries  in  ^loscow 
and  the  causes  of  non-attendance  are  included, 
and  figures  in  regard  to  absenteeism  in  Petro- 
grad  are  ofi'ered  for  comparison. 

In  all  industries,  the  average  number  of  days 
worked  in  a  month  for  the  j)eriod  from  October, 
1919  to  June,  1920  was  17.0;  in  the  textile 
industries,  13.9;  and  in  the  metal  industries 
17.1.    The  larger  the  factory,  the  smaller  was 


the  number  of  days  of  work.  Non-attendance 
was  due  to  various  causes;  in  the  textile  in- 
dustries, 5.1  days'  loss  was  due  to  closing  of 
the  factory;  in  the  metal  industries  only  0.2 
days'  loss  was  due  to  this  cause.  There  was 
an  average  of  5.5  days  of  absence  for  all  in- 
dustries, due  to  various  individual  reasons,  the 
metal  industries  showing  6.8  days  —  the  highest 
rate  of  absence  for  these  causes.  Illness  as  a 
cause  of  absence  is  reported  as  amounting  to 
1.8  days.  Holidays  account  for  6.1  days.  The 
figures  for  Petrograd,  given  for  a  shorter 
period  and  with  incomplete  information  as  to 
how  they  were  obtained,  show  a  total  absence 
in  all  industries  of  12.4  days  per  month  — •  7.4 
days  due  to  sickness,  and  5.0  days  to  voluntary 
absence.  Among  leather  workers  the  sickness 
absence  amounted  to  13.2  days  —  the  high- 
est number  reported;  among  needle  workers, 
11.3  days;  among  metal  workers,  8.7  days; 
and  among  landworkers,  2.5  days  —  the  low- 
est number  reported.  A  table  giving  the  figures 
for  another  period  shows  slightly  different  re- 
sults, chemical  workers  and  communal  workers 
ajjpearing  above  the  metal  workers  in  regard 
to  days  of  absence  due  to  sickness,  and  the 
leather  workers  and  needle  workers  appearing 
in  reversed  order.  —  G.  E.  Partridge. 


The  Holrs  of  Work  in  Relation  to 
Quality  of  Oltput.  A.  H.  Ryan  and  P.  S. 
Florence.  U.  S.  Pub.  Health  Ser.,  Pub.  Health 
Rep.,  March  11,  1921,  36,  No.  10,  517-519.  — 
"Three  jobs  —  stam])ing  by  means  of  a  foot- 
press,  threading  tube,  and  grinding  — •  were 
carefully  studied  liour  by  hour  throughout  the 
day  as  regards  the  hourly  output,  the  lost 
time,  both  voluntary  and  involuntary,  and  the 
number  of  errors  or  the  number  of  pieces  of 
spoiled  or  defective  work.  .  .  .  The  principle 
employed  has  been  to  analyze  the  job  in  terms 
of  receptor  stimulus  and  eft'ector  response. 
The  footpress  jol),  for  example,  involves,  as 
regards  spoiled  work,  only  the  visual  receptor, 
whereas  in  the  other  two  jobs  both  the  visual 
and  deep  receptors  are  used." 

"This  analysis  reveals  that  our  three  jobs  are 
vastly  different  from  the  physiological  stand- 
point. Where  a  single  receptor  is  employed, 
with  a  relatively  strong  stimulus,  as  in  the 
footpress  job,  the  percentage  of  scrap  is  low 
and  is  practically  luiiform  throughout  the  day. 
Where  two  receptors  are  employed,  as  in 
grinding  springs  and  rolling  thread,  a  rise  in 


ABSTRACTS 


93 


the  percentage  of  scrap  occurs  toward  the  end 
of  the  spell,  the  highest  two-hour  jjeriod  being 
the  last  two  hours  of  the  day."  —  M.  C. 
Shorley. 

Practical  Experience  with  the  Work 
Week  of  Forty-Eight  Hocrs  or  Less.  Nat. 
Indust.  Conference  Board,  Research  Rep.  No. 
3-2,  Dec,  19^20,  pp.  88. —This  report  "carries 
forward  the  Conference  Board's  earlier  studies 
dealing  with  the  hours-of-work  prohleni."  In 
previous  reports  which  have  been  summarized 
in  this  Journal,  the  effects  of  reduction  of 
hours  upon  output  in  the  cotton,  boot  and 
shoe,  woolen  and  other  industries  liave  been 
followed.  In  these  reports  there  was  also  some 
effort  to  ascertain  the  effect  of  reduced  hours 
upon  the  healtli  of  the  workers  but  since  the 
methods  of  investigation  were  largely  those  of 
the  questionnaire  and  since  there  was  little  or 
no  statistical  knowledge  as  to  health  conditions 
prior  to  reduction  of  hours,  the  results  were 
inadequate  and  disappointing. 

In  report  32  "only  those  establishments 
operating  on  a  schedule  of  48  hours  or  less 
were  included.  .  .  .  Certain  plants  reporting 
a  nominal  .schedule  of  48  hours  per  week  but 
having  actual  working  hours  regularly  in  excess 
of  this  time  were  necessarily  excluded.  l)ecause 
conclusions  as  to  the  effects  of  a  reduction  to 
a  week  of  48  hours  or  less  could  not  properly 
be  drawn  from  the  experiences  of  such  jilants. 
Neither  were  those  plants  included  in  which 
manufacturing  conditions  had  so  radically 
changed  as  to  invalidate  a  comparison  of  out- 
put in  the  periods  before  and  after  the  change 
in  hours." 

The  data  presented  were  again  attained  by 
questionnaires,  "checked  by  correspondence 
and  by  field  work  where  necessary."  No  effort 
of  consequence  was  nuide  to  determine  effects 
of  the  forty-eight  hour  week  upon  health.  A 
few  comments  upon  this  side  of  the  question 
are  included  but  are  of  little  moment.  The 
conclusions  reached  are  as  follows: 

General  Conclusions 
"Changes  in  Weekly  Outpiti.  —  1.  In  87. ^ 
per  cent,  of  the  establishments  studied  a  re- 
duction to  a  work  week  of  48  hours  or  less  was 
accompanied  by  a  decrease  in  weekly  output 
per  worker.  In  8.7  per  cent,  of  the  plants  the 
workers  were  able  to  maintain  weekly  output, 
and  in  a  very  few  cases  (4.1  per  cent.)  weekly 
output  was  increased. 


"Changes  in  Hourly  Output.  —  2.  In  slightly 
more  than  two-fifths  of  those  establishments 
in  which  weekly  output  was  decreased,  the 
same  hourly  output  was  maintained  as  under 
the  previous  schedule  of  hours,  and  the  de- 
crease was  therefore  apjiroximately  in  pro- 
portion to  the  reduction  in  hours.  In  about 
one-fifth  of  the  establishments  which  showed  a 
decline  in  weekly  output,  hourly  output  was 
increased  sufficiently  to  offset  partially  the 
loss  in  working  time,  and  the  loss  in  weekly 
output  was  therefore  less  than  proportional  to 
the  reduction  in  hours.  In  one-sixth  of  the 
establishments  suffering  reduced  weekly  pro- 
duction there  was  a  decrease  in  hourly  as  well 
as  weekly  output,  or  a  decrease  in  weekly  out- 
put greater  than  jjroportional  to  the  reduction 
in  hours.  A  number  of  establishments  reported 
a  decrease  in  output  but  did  not  report  the 
extent  of  such  decrease  per  worker. 

"Effects  on  Health  and  Contentment  of  Work- 
ers. —  3.  The  board  was  unable  to  secure 
information  which  would  warrant  valid  conclu- 
sions regarding  the  effect  of  the  reduction  in 
hours  u])on  the  health  of  the  workers  or  upon 
the  frequency  of  accidents.  In  most  cases  no 
change  in  the  health  of  the  workers  was  re- 
j)orted.  It  is  interesting  to  note,  however,  that 
a  number  of  the  establishments  in  the  various 
industries  which  either  maintained  or  in- 
creased previous  weekly  production,  reported 
better  health  among  their  employees,  either  as 
a  result  of  the  shorter  hours  or  of  improved 
working  conditions. 

"From  the  evidence  contained  in  the  replies 
to  the  questionnaire,  it  was  impossible  to  reach 
any  conclusions  as  to  the  effect  of  the  reduction 
in  hours  ujwn  the  contentment  of  the  workers. 
It  is  probable  that  in  many  cases  the  reduction 
in  working  time  was  at  least  a  contributory 
factor  in  improving  the  contentment  of  the 
worker;  but  so  many  other  factors  also  en- 
tered into  the  problem  and  in  so  many  cases 
apjnirently  completely  counteracted  the  effect 
of  the  reduction  in  hours,  that  it  was  not  pos- 
sible to  draw  any  definite  conclusions  in  regard 
to  the  effect  that  the  one  factor,  shortened 
hours,  may  have  had  in  this  regard. 

"Effects  on  Quality  of  Product.  —  4.  On  the 
whole,  the  quality  of  production  was  main- 
tained. A  very  few  establishments  reported  a 
better  quality  of  production.  In  certain  es- 
tablishments, however,  the  speeding  up  by 
the  workers  to  increase  hourly  output  resulted 
in  an  inferior  quality  of  goods,  and  in  other 


94 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


instances  a  general  slackening  on  the  part  of 
the  workers  caused  a  decline  both  in  quantity 
and  in  quality  of  output. 

Effect  of  Other  Factors  on  Output 

"It  was  clearly  evident  in  this  investigation 
that  a  large  number  of  factors  beside  the  re- 
duction in  working  time  were  involved  in  these 
changes  in  output.  The  findings  of  the  investi- 
gation with  regard  to  these  collateral  factors 
are  summarized  as  follows: 

"  Character  of  the  Work.  —  1.  The  character 
of  the  work,  i.e.,  whether  the  process  was 
largely  handwork  or  machine  work,  for  the 
most  part  determined  whether  or  not  it  was 
possible  for  the  worker  to  increase  hoiu-ly 
output. 

"In  those  industries,  such  as  cotton  manu- 
facturing, where  highly  automatic  machine 
processes  predominated,  the  output  was  limited 
almost  entirely  by  the  speed  of  the  machines. 
In  practically  every  case  a  reduction  in  hours 
was  accompanied  by  a  decrease  in  output.  In 
those  industries,  however,  where  handwork  pre- 
dominated in  the  manufacturing  processes,  or 
where  the  skill  and  speed  of  the  operative  in 
handling  the  machines  were  the  controlling 
factors  —  such  as  in  the  boot  and  shoe  in- 
dustry or  in  certain  kinds  of  metal  manu-* 
facturing,  and  in  certain  miscellaneous  in- 
dustries —  it  was  possible  to  increase  the 
hourly  output  of  the  workers,  in  some  cases 
to  the  extent  of  entirely  compensating  for  the 
loss  in  working  time  or  even  exceeding  the 
previous  weekly  production."  —  C.  K.  Drinker. 

Making  Teme  Studies  Pay.  B.  M.  May- 
nard.  Factory,  May  15, 1921,  26,  No.  10,  1178- 
1183.  —  In  this  article  the  following  eighteen 


betterments  from  time  studies  are  discussed 

and  the    principles    illustrated    by    specific 
examples: 

1.  Just  standards  of  production. 

2.  Most  efficient  size  of  gang. 

3.  Efficient  use  of  machines. 

4.  Subdivision  of  present  operations. 

5.  Combination  of  present  operations. 

6.  Efficiency  of  supplies  and  tools. 

7.  Economy  in  installing  new  machines. 

8.  Best  shop  practice. 

9.  Proper  location  of  work  and  tools. 

10.  Reduction  of  fatigue. 

11.  Best  design  of  tools,  jigs,  and  fixtures. 

12.  Proper  handling  in  previous  operations. 

13.  Possibility  of  using  wage  incentives. 

14.  Setting  price  rates. 

15.  Arrangement  of  machines. 

16.  Getting  equipment  into  balance. 

17.  Fitness  of  man  to  the  work. 

18.  Check  up  faulty  planning  and  manage- 
ment. —  M.  C.  Shorley. 

Health  Education  in  Industry.  C.  E. 
Ford.  Am.  Jour.  Pub.  Health,  June,  1921,  11, 
No.  6,  489-497. —The  industrial  health  de- 
partment can  be  made  the  strong  right  arm  of 
the  public  health  department.  A  part-time 
physician  no  longer  suffices  for  a  plant;  it 
should  have  a  capable,  full-time  man  with 
special  training  covering  the  wide  field  out- 
lined by  the  author  in  this  and  a  previous 
paper.  Emphasis  is  placed  on  the  physician's 
duty  to  educate  the  employees  in  all  matters 
relating  to  health  in  general  and  to  the  par- 
ticular health  factors  of  the  industry.  If  in- 
dustry can  pay  $2.50  per  employee  per  year 
for  health,  the  community  ought  to  increase 
its  health  appropriations.  —  H.  F.  Smyth. 


SYSTElVnC  OCCUPATIONAL  DISEASES:    OCCURRENCE,  TREATMENT 

AND  PRE^^NTION 


CIRCULATORY  SYSTEM 

The  Effort  Syndrome  together  with  .\ 
Consideration  of  the  Significance  of 
Certain  Murmurs.  Alfred  E.  Cohn.  Mil. 
Surgeon,  Feb.,  1921,  48,  No.  2,  186-198.— 
This  paper  is  a  brief  summary  of  army  ex- 
periences relating  to  cardiac  efficiency. 

It  has  proved  desirable  to  reject  individuals 
with  a  diastolic  murmur,  whether  due  to  aortic 
insufficiency  or  mitral  stenosis.  Systolic  mur- 
murs, however,  have  caused  much  discussion 


and  individuals  showing  such  murmurs  are  now 
classified  in  accordance  with  their  relation  to 
certain  other  criteria:  namely,  (1)  the  size  of 
the  heart;  (2)  the  history  of  infection,  espe- 
cially of  rheumatism;  (3)  the  intensity  of  the 
.second  sound  in  the  second  left  interspace  or 
third  left  costochondral  junction;  (4)  the 
reaction  to  exertion. 

Organic  heart  disease,  with  a  systolic  mur- 
mur, is  readily  managed  if  thoroughly  analyzed, 
keeping  these  four  features  in  mind,  but  func- 


ABSTRACTS 


95 


tional  heart  disease  spoken  of  under  the  heading 
of  "irritable  heart"  or  "the  effort  syndrome," 
is  far  harder  to  classify.  Cohn  discusses  the 
symptomatologj'  of  this  condition  and  con- 
cludes with  the  following  sentence:  "The 
attempt  has  been  made  to  show  how  involved 
the  symptom  complex  is,  and  how  it  touches 
intimately  other  domains  in  medicine  aside 
from  cardiovascular.  Its  etiology  caiuiot  now 
be  conscientiously  indicated  nor  its  exact  re- 
lations to  the  numerous  processes  involved, 
which  are  familiar  and  the  connections  of 
which  with  this  entity  immediately  suggest 
themselves." 

The  poorly  defined  nature  of  the  condition 
described  does  not  jjermit  adequate  treatment 
in  a  summary.  Readers  wishing  a  thorough 
discussion  of  a  matter  which  is  certainly  of 
importance  in  industrial  medicine  should  con- 
sult the  original  paper.  —  C.  K.  Drinker. 

Exercise  Toler.xnck  of  Children  with 
Heart  Disease  as  Determiner  nv  Stan- 
dardized Test  Exercises.  May  G.  ]\'il.son. 
Jour.  Am.  Med.  xVssn.,  June  11,  1921,  76,  No. 
24,  IG'-ZD-IGS.S.  —  The  author  reaches  the  fol- 
lowing conclusions: 

"  1.  The  circulatory  reactions  after  test  exer- 
ci.ses  in  forty-five  normal  children,  and  in  116 
children  with  heart  disease,  confirmed  the  re- 
sults obtained  in  the  twenty  normal  ciiildren 
of  the  i)revious  study,  in  all  essential  points. 

"2.  A  working  table  was  formulated  of 
standardized  test  exercises  followed  by  normal 
systolic  l)lood  pressure  curves,  without  symp- 
toms of  dyspnea  and  fatigue.  It  was  standard- 
ized from  an  analysis  of  the  reactions  of  an 
average  group  of  sixty-fi\e  nornud  children 
according  to  age,  weight  and  height. 

"3.  The  degree  of  distress  and  type  of  sys- 
tolic l)lood  pressure  cur\-e  following  standard- 
ized test  exercises  was  used  as  a  gage  in  esti- 
mating the  exercise  tolerance  of  children  with 
heart  disease. 

"4.  Of  the  seventy-one  children  ha\ing  defi- 
nite organic  heart  disease,  without  symptoms 
of  insufficiency,  6!)  per  cent,  had  a  normal 
tolerance  for  standardized  test  exercises,  29 
per  cent,  had  a  fair  tolerance,  and  2  per  cent, 
had  a  poor  tolerance. 

"5.  In  children  with  chronic  organic  heart 
disease,  exercise  tolerance  tests  give  important 
and  useful  information  which  may  be  utilized 
as  a  scientific  basis  for  intelligent  regulation 
of  the  child's  activities.    The  observations  re- 


sulting from  this  investigation  would  seem  to 
indicate  that  the  fear  of  exercise  is  unwarranted, 
and  that  a  wider  latitude  may  be  permitted 
with  safety."  —  C.  K.  Drinker. 

MENTAL 

The  Industrlm.  Cost  of  the  Psycho- 
pathic Employee.  Margaret  J.  Powers.  Ment. 
Hyg.,  Oct.,  1920,  4,  No.  4,  932-939.  —  Miss 
Powers  gives  us  some  very  startling  figures  of  a 
case  (diagnosed  as  paranoid  dementia  praecox) 
covering  a  period  of  ten  years,  which  is  of  in- 
terest because  of  the  accurate  record  which  the 
man  kejit  of  his  activities  and  wanderings  in 
search  of  congenial  employment.  His  earnings 
for  ten  years  amounted  to  $3,316.21.  Using 
a  verj'  conservative  scale,  she  has  estimated 
that  his  charge  on  industry  during  the  same 
period  for  cost  of  hiring,  cost  of  training,  wear 
and  tear,  reduced  production,  and  spoiled 
work  amounted  to  $3,608.50;  his  cost  to 
society  for  a  decent  maintenance  at  $1,200  per 
year  w(iuld  be,  roughly,  $8,700.  Miss  Powers 
has  done  well  to  present  these  figures.  They 
will  succeed  where  generalities,  rhetoric,  and 
appeals  to  humanity  fail.  What  we  need  is 
more  figures,  i)ascd  upon  undisputed  facts. 

Miss  Powers  quotes  the  United  States  Com- 
missioner of  Labor  Statistics  as  saying  that 
unemployment  causes  more  slowing  down  of 
production,  demoralization,  and  suffering  than 
all  other  industrial  misha])s,  and  that  among 
the  various  causes  of  unemployment  are  the 
lack  of  an  intelligent  employment  policy  for 
hiring  and  handling  men,  the  failure  to  gain 
the  goodwill  of  employees,  and  the  failure  to 
make  use  of  the  tremendous  latent  force  lying 
dormant  in  the  workers.  —  Stanley  Cobb. 

RESPIRATORY  SYSTEM 
Clinical  and  Experimental  Observations 
ON  THE  Anaphyl.\ctic  Bronchl\l  Asthma 
OF  Workers  in  Furs.  H.  Curschmann. 
Miinchen.  med.  Wchnschr.,  Feb.  18,  1921,  68, 
No.  7,  195-197. — Several  cases  of  asthma 
in  men  who  work  with  furs  dyed  with  ursol,  a 
paraphenylene-diamine  derivative,  are  reported 
to  show  the  anaphylactic  character  of  the 
disease.  Numerous  references  are  made  to 
other  discussions  of  the  same  disease.  The 
work  of  Gerdon  (abstracted  in  this  Journal, 
May,  1921,  3,  Nos.  1,  4  and  5,  from  the  Zentralbl. 
f.  Gewerbehyg.,  Sept.,  Oct.,  and  Nov.,  1920)  is 
summarized  to  show  the  experimental  basis  in 
guinea-pigs  for  the  conclusion  that  this  is  true 


96 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


anaphylaxis.  Cases  are  reported  where  the 
use  of  calcium  intravenously  or  by  subcutane- 
ous route  has  been  successful  as  a  prophylactic 
against  attack,  or  in  giving  relief  when  admin- 
istered after  the  onset  of  an  attack.    Desensi- 


tization  by  increasing  doses  of  the  dye  seems 
of  no  use.  It  is  proposed  to  try  the  calcium 
treatment  by  the  inhalation  of  solutions  of 
calcium  salts  in  spray  form.  —  E.  L.  Sevring- 
haus. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS:    GASES, 
CHEMICALS,  ETC. 


Permeation  of  Oxygen  Breathing  Ap- 
paratus BY  Gases  and  Vapors.  A.  C.  Field- 
ner,  S.  H.  Katz,  and  S.  P.  Kinney.  U.  S.  Biu-. 
Mines,  Tech.  Paper  27^2,  Jan.,  1921,  pp.  24.  — 
The  investigators  reached  the  following  con- 
clusions: "Tests  were  made  to  determine  the 
permeability  of  the  rubber  bags  of  oxygen  ap- 
paratus to  gases  and  vapors.  The  breathing 
bags  in  vapor  of  volatile  casing-head  gasoline 
showed  dangerous  penetration;  in  one  test 
2.60  per  cent,  of  gasoline  vapor  was  in  a  breath- 
ing bag  after  fifteen  minutes'  exposure  to  air 
containing  about  3-1  per  cent,  of  casing-head 
gasoline  vapor. 

"...  Tests  lasted  two  hours,  which  is  the 
time  the  larger  oxygen  breathing  apparatus  are 
designed  to  be  worn.  All  the  fabrics  now  used 
by  the  Bureau  of  Mines  for  breathing  bags, 
excepting  the  Fleuss,  proved  permeable  to 
gasoline  and  benzene  vapors,  and  undoubtedly 
to  other  similar  organic  vapors.  No  permea- 
tion of  the  fabric  investigated  was  found  for 
carbon  monoxide  or  natural  gas.  The  imperme- 
able (in  two  hours)  Fleuss  material  consisted 
of  heavy  sheet  rubber,  one-sixteenth  inch 
thick,  made  of  high  quality  stock;  no  cloth 
was  used  in  it. 

"Fabrics  made  of  two  rubberized  sheets 
cemented  with  a  glue  and  glycerin  mkture 
were  found  completely  impermeable;  one  such 
fabric  had  a  total  thickness  one-third  that  re- 
quired for  rubber.  Special  tests  for  resistance 
to  rough  mechanical  treatment,  exposure  to 
weather,  hot  dry  air,  and  freezing  temperature 
were  passed  by  this  fabric  without  permeation 
or  loss  of  flexibility.  A  fabric  made  of  cloth 
impregnated  and  coated  on  one  side  with 
pyroxylin  varnish  allowed  only  a  slight  pene- 
tration of  gasoline  and  benzene  vapors  toward 
the  close  of  the  two-hour  test  period,  not 
enough  to  be  dangerous.  A  sliglitly  thicker 
coating  would  entirely  prevent  penetration. 
This  fabric  has  apparently  very  desirable 
proj)erties  for  use  in  breathing  bags,  and  de- 
teriorates less  than  rubber  with  age."  —  M. 
Dent. 


A  New  Tubular  Breathing  Mask.  George 
0.  Smith.  Safety  Engin.,  March,  1921,  41, 
No.  3,  106-107.  —  A  new  mask  which  seems 
to  meet  all  requirements  for  work  in  poisonous 
gases  has  been  devised  by  the  Atmos  Corpora- 
tion. The  new  feature  of  this  mask  is  the 
oxygen  injector  by  which  the  range  of  service 
is  extended  100  feet  without  increasing  the  re- 
sistance to  inhalation  in  the  mask.  "The  mask 
may  be  used  with  safety  in  all  industrial  work 
where  smoke,  dust,  furnace  gases  or  other 
noxious  fumes  exist  .  .  .  and  is  now  in  suc- 
cessful use  in  industrial  plants  and  by  public 
utility  companies."  —  M.  Dent. 

Medical  Decisions  in  Cases  of  Indus- 
trial Poisoning.  F.  Curschv^nnn.  Zentralbl. 
f.  Gewerbehyg.,  March,  1921,  9,  No.  3,  54-61. 
—  ///.  Psychic  Disturbances  in  Connection 
icith  Poisoning  by  Aromatic  Hydrocarbons.  —  A 
man  was  overcome  by  fumes  of  dinitrobenzene, 
and  the  marked  anemia  which  followed  had  not 
returned  to  normal  after  more  than  a  year  in 
spite  of  treatment.  Two  and  a  half  years  later, 
mental  excitement  became  noticeable  in  ad- 
dition to  the  continued  weakness,  and  soon 
attacks  of  mania  followed.  The  continued 
anemia  is  considered  as  demonstrating  the 
essential  chronicity  of  the  poisoning,  and  there- 
fore as  justifying  the  inclusion  of  this  case  in 
the  group  of  cases  with  damage  to  the  central 
nervous  system  from  chronic  poisoning  with 
aromatic  nitro-compounds. 

/r.  Respiration  of  Furnace  Gases  as  a  Cause 
of  Death.  —  A  young  man  who  had  suffered 
from  severe  organic  heart  disease  with  an 
attack  of  decompensation  was  employed  at  a 
furnace  and  was  in  general  good  health.  Near 
the  end  of  a  night  shift  he  l)reathed  a  large 
amount  of  furnace  gas.  About  twelve  hours 
later  he  died,  following  weakness,  head  pains, 
cyanosis,  and  signs  of  cardiac  dilatation  and 
acute  pnhnonary  edema.  It  is  considered  as 
probable  tliat  the  cardiac  di.sease  made  him 
more  subject  to  the  damage  from  the  gases, 
but  the  furnace  gas  was  the  immediate  cause 


ABSTRACTS 


97 


of  death,  through  tlie  effect  of  the  carbon 
monoxide  on  the  blood  and  of  the  sulphur  and 
cyanogen  derivatives  on  the  lungs. 

V.  Aniline  Poisoning  and  Tuberculosis.  — 
A  young  woman  who  was  well  and  robust  was 
employed  in  making  explosives.  After  a  few 
weeks  she  had  an  acute  attack  of  poisoning 
with  a  nitro-conipoimd,  followed  a  few  weeks 
later  by  a  second  attack.  At  this  time  she  was 
found  to  have  an  active  apical  lesion,  and  seven 
months  later  she  died  from  ])ulmonary  tuber- 
culosis. The  claim  for  industrial  compensation 
is  supported  on  the  ground  that  the  anemia 
and  poisoning  may  have  made  jw.ssible  the 
breakdown  of  an  old  and  quiescent  lesion  of 
tuberculosis,  which  was  followed  by  an  ac- 
celerated course  of  the  disease.  —  E.  L. 
Sevringhaus. 

Gangkknk  FHONr  G.\s  PoisoMXG.  Lttignel- 
Lavastinc  and  Alajoiianine.  Abstracted  as  fol- 
lows from  Bull,  et  mem.  See.  nied.  d.  hop.  de 
Par.,  April  15,  19^21,  45,  No.  12,  484,  in  Jour. 
Am.  Med.  Assn..  June  4,  1921,  76,  No.  23. 
1616. — "Al)out  tlirce  weeks  after  severe  jjoisoii- 
ing  with  illuminating  gas,  the  man  tleveloped 
gangrene  of  the  foot  and  phlegmasia  alba 
dolens,  with  final  recovery."  —  C.  K.  Drinker. 

Industulvl  Lead  Poisonixg.  Marvin  D. 
Shie.  Jour.  Am.  Med.  Assn.,  March  26,  1921, 
76,  No.  l.S,  835-842.  —This  is  a  most  excellent 
brief  review  of  the  subject.  The  author's  con- 
clusions are  as  follows: 

"Certain  signs  and  .symptoms  of  plumbism 
have  been  given  somewhat  more  importance  as 
diagnostic  points  than  they  deserve.  These 
are  anemia,  basophilic  degeneration  of  the  red 
cells,  hypertonus  and  constipation. 

"Pronounced  anemia  is  presetit  in  only  rela- 
tively few  cases;  in  many  cases  there  is  no 
anemia  whatever.  The  pallor  that  is  usually 
present  is  therefore  due  to  some  other  cause  — 
possibly  a  constriction  of  the  peripheral  blood 
vessels.  Basophilic  degeneration  of  the  red  cells 
is  rare  in  chronic  cases,  and  its  value  as  a 
diagnostic  point,  even  in  acute  cases,  has  prob- 
ably been  overrated. 

"The  presence  of  hypertonus  is  extremely 
variable.  Among  a  group  of  pottery  workers 
exposed  to  lead  dust,  there  was  practically 
none;  but  among  a  group  of  lead  refiners  ex- 
posed to  lead  fumes,  it  was  present  in  nearly 
every  case.  The  cause  of  this  variance  is  un- 
known; however,  the  difference  in  the  form 
of  the  lead  to  which  the  different  groups  are 


exposed  may  have  something  to  do  with  it. 
H\pertonus  is  nearly  always  present  during 
attacks  of  colic. 

"Although  constipation  is  usual,  it  is  not 
invariably  present.  The  assumi)tion.  there- 
fore, that  a  patient  who  is  not  constipated  does 
not  have  lead  poisoning  is  fallacious.  Many 
cases  of  plumbism  —  especially  acute  cases  — 
occur  without  constij)ation. 

"A  point  of  diagnostic  value,  which  appears 
to  have  escaped  recognition  except  by  Hay- 
hurst,  is  the  presence  of  mononucleosis  in 
chronic  cases.   This  is  almost  invariably  present. 

"The  presence  of  a  lead  line  is  also  extremely 
Variable.  In  my  series  it  was  i)rcsent  in  about 
90  per  cent,  of  the  cases.  Other  investigators 
have  sometimes  found  it  present  in  not  more 
than  20  |)er  cent,  of  their  cases.  This  differ- 
ence, like  that  in  the  case  of  hypertonus,  may 
possibly  be  due  to  the  difference  in  the  form  of 
the  lead  in  which  the  i)atients  were  expo.sed. 

"In  the  treatment  of  i)luml)isni,  |)r()i)hylaxis 
is  of  niiich  more  imi)ortance  than  the  curative 
treatment.  By  means  of  proper  working  condi- 
tions and  medical  supervision  on  the  one  hand, 
and  the  observance  of  the  rules  of  ])ersonal  hy- 
giene and  common  sen.se,  on  the  other,  together 
with  co-oi)eration  between  emi)lovers  and  em- 
ployees, the  incidence  of  plumbism  in  American 
industries  could  be  greatly  decreased.  Proper 
compensation  for  occuiiational  di.sea.ses  is  a 
necessity,  and  would  help  to  decrea.se  both  the 
incidence  and  the  severity  of  lead  poisoning. 

"  If  the  cause  of  the  poi.soning  is  removed,  the 
l)rognosis,  except  in  a  few  cases,  is  good  even 
without  medical  treatment.  If,  however,  the 
lead  continues  to  exert  its  deleterious  effects 
through  small,  steady  doses,  the  case  steadily 
I)rogresses,  finally  terminating  in  some  form  of 
paralysis  or  in  .some  of  the  common  degenera- 
tive diseases.  As  a  rule,  lead  poisoning  is  a  dis- 
abling rather  than  a  fatal  disease,  although  in 
chronic  cases  it  undoubtedly  hastens  death. 

"Mtal  statistics  of  all  occupational  diseases, 
inchiding  lead  poisoning,  are  very  incomplete. 
Rapid  progress  by  state  or  federal  agencies  in 
the  devising  of  methods  for  the  prevention  or 
cure  of  all  such  diseases  cannot  be  made  unless 
there  is  prompt  and  complete  reporting  of  all 
cases."  —  C.  K.  Drinker. 

Occup.vTioNAL  Lead  Poisoning.  W.  H. 
Rand.  U.  S.  Bur.  Labor  Statis.,  Month.  Labor 
Rev.,  Feb.,  1921,  12,  No.  2,  135-148. —The 
author  deals  with  his  subject  under  the  follow- 


98 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ing  main  headings:  portal  of  entrance  into  the 
body;  clinical  signs  and  symptoms;  prevention 
of  plumbism.  —  R.  B.  Grain. 

Report   of  the  First   Course   on   Pro- 

PHYL.\XIS  OF  Le.\D  PoISOXING  FOR  THE  PLu\NT 

Physicians  of  the  GERiL\N  Lead  Color  In- 
dustries. L.  Grohe.  Zentralbl.  f.  Gewerbehyg., 
March,  1921,  9,  No.  3,  52-54. —A  series  of 
lectures,  laboratorj'  demonstrations,  and  con- 
ferences was  arranged  by  the  lead  industries, 
and  given  under  the  direction  of  Dr.  P.  Schmidt, 
at  Halle.  Clinical  and  scientific  aspects  of  the 
problem  were  considered,  and  the  unsolved 
problems  in  early  diagnosis  and  prophylaxis 
were  discussed.  The  group  visited  a  nearby 
plant  to  observe  the  mechanical  and  personal 
means  of  prophylaxis  against  lead  poisoning. 
The  conference  wOl  probably  become  an  annual 
event  in  Germany.  —  E.  L.  Sevringhaus. 

The  Symptoms  of  Acute  Chrom.\te  Poi- 
soning. H.  Brieyer.  Ztschr.  f.  exper.  Path.  u. 
Therap.,  Nov.  12,  1920,  21,  No.  3,  393-408.  — 
A  number  of  cases  of  chromate  poisoning  were 
observed,  which  arose  from  the  use  of  a  salve 
made  up  with  potassium  chromate  by  mistake. 
^Yhere  it  was  applied,  the  skin  became  necrotic, 
and  sloughed;  death  resulted  from  the  infection 
of  the  exposed  areas  in  some  cases.  About  one 
and  a  half  hours  after  the  application  of  the 
ointment,  the  pulse  became  very  weak  and 
thready,  and  markedly  dicrotic.  Clinical  ex- 
amination of  the  heart  was  negative,  but  at 
autopsy  even  the  early  cases  showed  fatty  de- 
generation. The  blood  pressure  did  not  fall, 
as  in  previously  reported  cases.  Localized 
areas  of  cyanosis  appeared  on  the  skin. 


An  acute  nephritis  with  much  albumin  and 
oliguria  gradually  gave  place  to  a  subacute 
form  with  polyuria  and  nitrogen  retention, 
which  finally  disappeared  in  the  cases  which 
survived  long  enough.  There  was  no  edema. 
The  anatomical  changes  consisted  of  hyperemia 
and  tubular  necroses.  The  glomeruli  were  little 
altered. 

The  blood  showed  an  intense,  almost  leu- 
kemic hyperleukocytosis,  the  white  count  in  one 
case  reaching  41,900,  with  immature  polymor- 
phonuclears, myelocytes,  and  myeloblasts  no- 
tably increased.  The  red  cell  coimt  was  not 
markedly  lowered  and  a  hydremia  was  sus- 
pected. Nucleated  red  cells  and  Howell-Jolly 
bodies  were  seen.  The  platelets  were  increased 
in  one  case  to  421,000,  and  giant  platelets  were 
seen.    The  clotting  time  was  unchanged. 

Vomiting  was  an  early  symptom,  and  at 
autopsy  the  gastric  mucosa  was  hyperemic.  No 
constant  changes  were  seen  in  the  central  ner- 
vous system.  In  one  case,  fourteen  days  after 
exposure  to  the  poison,  chromate  was  found  in 
the  body  fluids  in  the  following  amounts: 
blood,  2  to  5  mg.  per  100  c.c. ;  urine,  8  mg.  per 
liter;  stool,  0.61  mg.  per  100  gm.;  stomach  con- 
tents, 0.63  mg.  per  100  c.c. 

The  fate  of  the  patient  depends  on  the  onset 
of  diuresis.  To  hasten  this,  caffein  and  other 
cardiac  and  renal  stimulants  were  given.  Bleed- 
ing and  infusion  of  glucose  solution  were  tried. 
Decapsulation  of  the  kidneys  did  not  seem 
effective.  Polil  advises  alkali  therapy.  The 
affected  skin  should,  of  course,  be  cleared  of  the 
poison  as  completely  as  possible. 

Extensive  references  to  previous  articles  are 
given.  —  T.  J.  Putnam. 


DUST  HAZARDS  AND  THEIR  EFFECTS 


Experiments  in  Control  of  Air  Dusti- 
ness. 0.  M.  Spencer.  Nation's  Health,  ]May, 
1921,  3,  No.  5,  307-309.— This  article  deals 
with  the  results  of  some  recent  studies  made 
by  United  States  Public  Health  officers  of  air 
conditions  prevailing  in  certain  occupations 
and  having  a  tendency  to  cause  tuberculosis. 
It  is  well  known  that  certain  occupations  tend 
to  produce  fibroid  changes  in  the  lungs.  Two 
standard  types  of  air  purification  are  in  com- 
mon usage  today:  wet  grinding,  and  dry 
grinding  under  an  exhaust  system.  Contrary 
to  common  belief,  the  latter  is  the  most  effec- 
tive.   The  control  of  air  dustiness  in  industry 


calls  for:  (1)  the  establishment  of  a  "standard 
dust  table"  of  the  number  of  particles  of  a 
certain  size  permissible  in  all  dust-creating 
occupations;  and  (2)  the  checking  of  the 
efficiency  of  all  dust-removing  systems  at  regu- 
lar intervals  by  an  actual  dust  count. — L.  A. 
Shaw. 

Dust  in  Expired  Air.  From  Foreign 
Letters,  Jour.  Am.  Med.  Assn.,  May  14,  1921, 
76,  No.  20,  1360.  —  "In  a  letter  to  the  Lancet, 
Dr.  J.  S.  Owens,  an  authority  on  atmospheric 
pollution,  has  reported  some  experiments  of 
great  importance,  as  they  traverse  the  current 


ABSTRACTS 


99 


teaching  that  the  air  passages  are  an  efficient 
trap  for  the  removal  of  matter  suspended  in  the 
inspired  air.  Tyndall  stated  that  expired  air  is 
optically  pure,  and  it  is  generally  assumed  that 
air  entering  the  lungs  through  the  nose  is  puri- 
fied from  all  suspended  matter  before  it  reaches 
the  deeper  part  of  the  hmgs.  Having  some 
doubts  as  to  this  assumption.  Dr.  Owens  made 
experiments.  He  tested  a  sami)le  of  air  tluring 
a  slight  smoke  haze  in  November  in  London, 
and  found  that  it  contained  1.9'-2  mg.  of  sus- 
pended matter  per  cubic  meter.  He  then  filled 
a  small  rubber  balloon  with  ordinary  tidal 
expired  air,  taking  care  that  the  balloon  was 
washed  out  by  filling  with  exjiired  air  and 
emptying  several  times.  It  was  found  to  con- 
tain 1.'28  mg.  per  culiic  meter.  'I'ims,  in  ordi- 
nary breathing  the  cxi)ircd  air  containe<l  al)out 
70  per  cent,  of  the  suspended  impurity  wliicli 
entered  during  in.spiration.  noul)tless  some 
of  the  suspenfled  matter  in  the  exi)ire<l  air  was 
deposited  on  the  walls  of  the  balloon,  but  this 
would  not  affect  the  result  much.  A  .similar 
experiment  w^as  then  made  with  'reserve  air.' 
The  balloon  was  thoroughly  wa.shed  out  with 
reserve  air  and  then  filled  after  the  end  of  a 
long  inspiration.  The  reserve  air  was  found 
to  contain  about  60  per  cent,  of  the  dust  of  the 
inspired  air.  These  observations  were  checked 
by  using  an  aj){)aratus  by  wliich  a  jet  of  air 
1  1000  inch  in  diameter  can  be  blown  on  a 
microscojjic  slide  at  a  distance  of  1  16  inch. 
The  result  is  that  a  certain  proportion  of  the 
suspended  particles  strike  and  adhere  to  the 
slide.  A  few  cubic  centimeters  of  orilinary 
London  air  thus  ])roduce  a  black  spot  visible  to 
the  naked  eye.  Expired  'tidal'  and  'reserve' 
air  yielded  a  black  spot.  Ordinary  London  air 
yielded  particles  which  were  all  black  and 
varied  in  diameter  from  1,  100000  to  1  '20000 
inch.  Expired  air  yielded  similar  particles."  — 
C.  K.  Drinker. 

Dividends  from  Collectixg  Dvst.  Fac- 
tory, March  1,  19'21,  26,  No.  5,  608-6 1 -2. — 
There  are  many  reasons  for  giving  attention 
to  the  dust  problem  in  industry.  Dust  causes 
terrible  explosions,  it  is  a  menace  to  health, 
it  injures  machinery  and  increases  fire  risk. 
Adequate  protection  can  be  secured  only  by 
a  dust  collecting  system. 

All  industrial  plants  are  dusty;  only  actual 
du,st  tests  at  the  plane  of  work  show  the  degree, 
and  only  by  determining  the  composition  of 
the    dust    and    interpreting    the    results    with 


reference  to  standard  tables  that  ought  to  be 
worked  out  for  the  various  industries  can  the 
unhealthfulness  of  any  particular  process  be 
determined. 

Experiments  carried  out  by  the  Bureau  of 
Mines  have  shown  that  in  the  case  of  coal  dust 
the  density  necessary  for  explosion  is  0.025 
ounces  ])er  cubic  UmI  of  air,  and  this  density 
may  be  taken  as  a  critical  density  for  any  of 
the  carbonaceous  dusts.  Not  all  dusts  will 
cxjjlode,  but  the  dusts  from  any  material 
which  burns  or  is  readily  oxidized  will  explode 
under  certain  conditions,  and  it  can  be  said 
that,  in  general,  the  finer  the  dust  and  the 
lower  its  moisture  content  the  more  rapidly 
ignition  takes  |)lace,  or  the  greater  the  danger 
of  ex])Iosion.  To  prevent  explosions,  therefore, 
it  is  necessary  not  only  to  eliminate  sources  of 
ignition,  but  to  keep  the  plant  clean  and  free 
from  dust. 

Where  entire  units  of  a  factory  are  exposed 
contimudiy  to  dust,  a  dust-collecting  system 
should  be  installed  which  has  a  capacity  of 
sui)plying  every  man  in  a  unit  w'ith  2>5  cubic 
feet  of  air  every  minute,  and  when  ]K)ssible 
the  ihist  should  be  taken  into  the  dust-collector 
without  being  allowed  to  escajie  into  the  air. 
For  this  purpose  special  intake  hoods  for  every 
machine  are  usually  necessary. 

As  to  the  results,  one  installation,  it  is 
claimed,  has  had  the  effect  of  reducing  absence 
of  emi)loyees  85  per  cent.  A  better  day's  work 
is  obtained  from  the  employees,  and  more  har- 
mony and  satisfaction  prevail.  Clark,  who  re- 
ported this  case,  says  that  a  study  of  carefully 
collected  data  proves  that  death  rates  have 
been  reduced  from  60  to  50  per  cent,  by  in- 
troducing good  ventilating  and  dust-collecting 
systems  in  dusty  jilants. 

A  dust-collecting  .system,  if  correctly  de- 
signed and  properly  installed,  will  in  all  cases 
effect  a  .saving.  The  initial  cost  is  not  great, 
there  is  practically  no  expen.se  for  maintenance, 
and  the  cost  of  power  for  operating  a  fan  is 
slight. 

The  paper  contains  further  useful  informa- 
tion in  regard  to  dust  explosions,  and  should 
be  read  in  detail  by  anyone  who  is  interested 
in  this  subject.  —  G.  E.  Partridge. 

The  Removal  of  Dust  from  Rag-Teaking 
AND  Rag-Be.\ting  Machines.  Morgner.  Zen- 
tralbl.  f.  Gewerbehyg.,  March,  1921,  9,  No.  3, 
65-69.  —  The  use  of  such  machines  in  the  tex- 
tile industries  has  grown  markedly  during  the 


100 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


war  period.  Diagrams  of  the  machines  are  ex- 
plained. The  dust  is  removed  by  centrifugal 
fans  and  the  dusty  air  is  carried  to  dust  cham- 
bers for  sedimentation.  Ventilation  of  the 
rooms  is  not  a  desirable  method  of  dust  control. 
The  necessity  for  tight  and  smooth  air  piping 
from  the  fans  is  emphasized.  —  E.  L.  Sevring- 
haus. 

Dust  in  the  Bootmaking  Industry.  P. 
Sardi.  II  Lavoro,  Feb.  28,  1921,  11,  No.  10, 
289-290.  —  The  author  analyzed  the  dust 
which  arose  from  various  processes  of  boot- 
making  into  its  various  contents  of  water,  fat, 
soot,  tan,  etc.  —  M.  Dent. 

A  Roentgen  Study  of  Dust  Inhalation 
IN  THE  Granite  Industry.  D.  C.  Jarvis. 
Am.  Jour.  Roentgenol.,  May,  1921,  8,  No.  5, 
244-258.  — The  author  concludes  as  follows: 

"1.  Film  densities  are  influenced  by  mouth 
breathing,  nationality  and  occupational  posi- 
tion. 

"2.  The  machinery  must  be  considered  as  a 
source  of  dust  as  well  as  the  material  being 
worked. 

"3.  A  standard  exposure  technique  should 
be  adopted  as  early  as  possible  in  a  study  of 
dust  inhalation  in  order  that  one  may  feel 
sure  of  variations  of  density. 

"4.  While  classification  of  films  is  helpful, 
the  limg  lesion  in  a  dust  worker  is  like  the 
shifting  sand  of  the  sea  and  each  film  should  be 
judged  by  its  own  individual  densities  as  por- 
traying the  pathology  in  the  making  in  that 
particular  individual. 

"5.  Evidence  tends  to  show  that  the  lesion 


always  remains  peripheral  and  the  lung  re- 
action to  an  irritant  is  evidenced  by  densities 
appearing  from  the  hilus  outward. 

"C.  It  seems  possible  to  parallel  films  of 
tuberculosis,  pneumonia  and  various  other 
pathological  conditions  of  the  lungs  with  the 
films  of  granite  cutters,  there  being  an  absence 
of  clinical  activity  in  the  latter,  the  mechanical 
irritant  producing  the  same  lesion  as  a  bacterial 
one. 

"7.  It  would  seem  that  many  densities  are 
being  diagnosed  as  tuberculosis  which  should 
be  considered  as  densities  of  pneumoconiosis." 
—  C.  K.  Drinker. 

Breathing  Rock  Dust.  Abstracted  as 
follows  from  U.  S.  Pub.  Health  Service,  Health 
News,  Nov.,  1920,  in  Physiol.  Abstr.,  Jan.,  1921, 
5,  No.  10,  467.  —  "A  recent  survey  shows  that 
over  200,000,000  tiny  particles  of  dust,  as  sharp 
as  ground  glass,  are  breathed  into  the  lungs  and 
air  passages  with  every  cubic  foot  of  air  in 
some  of  the  factories  in  the  United  States. 
Such  dusts  breathed  into  the  lungs  are  never 
expelled.  Photomicrographs  show  the  particles 
to  be  exceedingly  sharp  and  jagged,  and  chemi- 
cal tests  prove  them  to  be  insoluble.  Work 
under  such  conditions  invites  respiratory  dis- 
eases and  makes  a  real  health  hazard.  As  a 
result  of  the  survey,  industrial  hygiene  engi- 
neers devised  means  for  removing  the  dust 
from  the  air  and  minimizing  hazards  from 
fumes  and  poisonous  gases.  In  spite  of  the 
fact  that  the  installation  of  such  devices  was 
expensive  factory  managements  immediately 
put  them  to  use."  —  McKeen  Cattell. 


OCCUPATIONAL  INFECTIOUS  DISEASES:   OCCURRENCE, 
TREATMENT  AND  PREVENTION 


Bacterial  Content  of  Telephones  with 
Special  Reference  to  Respiratory  Patho- 
gens. C.  C.  Saellwf.  Abstracted  as  follows 
from  Am.  Jour.  Hygiene,  March,  1921,  1,  No. 
2,  234,  in  Jour.  Am.  Med.  Assn.,  April  16,  1921, 
76,  No.  16,  1127.  —  "Hemolytic  .streptococci 
were  isolated  by  Saelhof  in  15.9  per  cent.,  the 
diphtheria  bacillus  in  2  per  cent.,  and  the  i)neu- 
mococcus  in  1  per  cent.,  from  the  transmitters 
and  receivers  of  ninety-four  telephones.  Of 
eleven  strains  of  hemolytic  strcptocf)cci  isolated 
90.0  per  cent,  were  virulent  for  rabbits.  Saelhof 
urges  that  sterilization  of  telephones  .should  be 
practiced  to  prevent  the  spread  of  virulent  or- 


ganisms. Cleansing  with  soap  and  warm  water 
and  subsequent  sterilization  in  mercuric  chlorid, 
compound  solution  of  cresol,  etc.,  for  a  period  of 
ten  minutes,  is  recommended.  In  speaking,  the 
mouth  should  not  come  in  direct  contact  with 
the  transmitter.  The  public  should  be  taught 
how  to  use  the  telephone  hygienically."  — 
C.  K.  Drinker. 

Examination  of  Food  H.vndlers  from 
Standpoint  of  Tuuekco.osis.  M.  J.  Fine. 
Mod.  Med.,  March,  1921,  3,  No.  3,  197-198.  — 
This  article  details  the  policy  of  the  city  of 
Newark,  N.  J.  in  the  matter  of  food  handlers. 


ABSTRACTS 


101 


Employees  are  allowed  to  handle  food  only 
after  securing  a  health  certificate.  The  physi- 
cal examination  includes  a  personal  history, 
Widal  test,  culture  for  diphtheria  from  nose 
and  throat,  vaccination,  Wassermann  on  sus- 
picious evidence,  inspection  for  mucous  patches 
in  nose  and  throat,  rashes,  etc.,  on  the  skin, 
and  of  genitals  in  males  for  gonorrhea  and 
syphilis,  besides  the  usual  lung  tests  for  tuber- 
culosis. Sputum  specimens  are  required  on 
suspicion  and  further  examination  at  later  date 
by  a  s|)ecial  bureau. 

The  reaction  of  the  individual  to  this  health 
requirement  is  so  varied  that  statistics  do  not 
clearly  indicate  existing  conditions.  Twenty 
active  tuberculous  cases  have  been  found  and 
denied  work  as  food  handlers.  Early  diag- 
nosis is  beneficial  to  the  individual  and  the 
protection  from  contagion  is  equally  .so  to  the 
I)ublic.  Education  in  health  mea.sures  is  of 
no  small  benefit  to  the  whole  community.  — 
Elinor  1).  (iregg. 

Miners'  Coxsnipriox  ix  the  Mine.s  of 
Bttte,  Moxtaxa.    Pi<elimix.\rv  Report  of 

AX   IxvESTK; ATION   MADE  IX  THE  Ye.\RS   1916- 

1919.  Daniel  Harrington  and  .1.  J.  Lanza. 
U.  S.  Bur.  Mines.  Tech.  Paper  No.  260,  Feb., 
1921,  pp.  19.  —  Recent  investigations  in  re- 
gard to  miners'  phthisis  in  the  I  iiited  States 
and  England  have  revealed  the  following  facts: 
"(1)  that  tlie  .so-called  miners'  consumption  or 
miners'  i)hthisis  is  ])roduced  by  the  mechanical 
irritation  of  the  hmgs  by  particles  of  ilust  of 
rock  containing  free  silica;  [i)  that  dust  is 
dangerous  in  proportion  to  the  amount  of  free 
silica  or  other  hard,  sharp,  in.soluble  material 
it  contains;  and  (.S)  that  the  ])articlcs  of  dust 
small  enough  to  enter  and  remain  in  the  lungs 
measure  less  than  10  microns,  or  1  2500  of  an 
inch  in  longest  dimension." 

The  results  of  the  physical  examination  of 
1,018  miners  in  the  Butte  mines  showed  that, 
out  of  432  ca.ses  of  miners'  consumption,  44.9 
per  cent,  were  in  the  early  stages;  29.6  per 
cent,  moderately  advanced,  and  25.5  per  cent, 
far  advancetl;  77. .'5  per  cent,  of  these  cases  had 
worked  more  than  five  years  in  Butte  mines. 

The  investigators  make  the  following  recom- 
mendations for  guarding  against  miners'  con- 
sumjition: 

1.  Dry  drilling  should  be  absolutely  elimi- 
nated. Spraying  devices  used  with  dry  drills 
are  very  likely  to  be  inefficient.  "Elimination 
of  dry  drilling  is  largely  a  question  of  drilling 


fewer  upper  (practically  vertical)  holes;  wet 
drills  (Leyners  and  wet  stopers)  can  be  readily 
employed  in  the  drilling  of  all  holes  except 
those  pointed  vertically  upward  or  not  more 
than  .30°  from  the  vertical." 

2.  All  working  places  undergroimd  should 
be  piped  with  pure  city  water  under  pressure. 
Water  should  be  used  to  spray  the  mouths  and 
po.ssibly  the  entire  length  of  ore  chutes;  skip 
chutes  should  be  sprayed  as  well;  where  ilry 
ore  is  handled  in  downcast  shafts  a  complete 
system  of  water  sprays  should  be  used  in  air 
courses  leading  from  the  shaft ;  and  water 
should  be  used  in  sprinkling  the  floors,  sides, 
and  top  or  back  of  haulage  ways,  shaft  stations, 
and  manways  at  all  times  of  the  year. 

•S.  Elimination  of  firing  of  shots  when  the 
shift  is  at  work.  The  shock  to  the  air  from  the 
firing  of  shots  throws  clouds  of  excessively 
dangerous  dust  into  the  air. 

4.  Special  effort  .should  be  made  to  increase 
the  ventilation  of  the  mines.  Air  currents 
should  be  concentrated,  should  flow  through 
the  working  places  with  minimum  hindrance, 
and  then  be  discharged  from  the  mine  as 
quickly  as  possible. 

5.  Underground  men  coining  from  the  mine 
in  winter  should  not  be  exposed  to  the  air  in 
their  wet  clothing  in  order  to  give  their  time. 
Some  other  arrangement  should  be  made.  — 
M.  Dent. 

Anaerobes  IN  H.viR  Dust.  R.  M.  Buchanan. 
.Tour.  State  Med.,  May.  1921,  29,  No.  5,  149- 
151.  —  In  the  course  of  a  search  for  anthrax 
in  hair  used  for  industrial  purjjoses,  it  was 
found  that  anaerobes  causing  gangrenous 
lesions  were  present  very  frequently.  Among 
those  recognized  were:  B.  perfringens,  B.  ede- 
matis  maligni,  B.  sporogenes,  B.  hi.stolyticus,  B. 
cdematicu.1,  B.  fallax  and  B.  putrificus.  —  Bar- 
nett  Cohen. 

IIooKWOR-M  IX  California  Gold  Mixes. 
R.  W.  Xauss.  Am.  Jour.  Pub.  Health,  May, 
1921,  11,  No.  5,  439-451.  —  In  1916-1917,  the 
author  conducted  a  detailed  investigation  of 
soil  infestment  in  various  mines  of  California 
and  of  hookworm  infection  among  miners,  with 
a  view  to  the  control  and  ultimate  eradication  of 
the  disease.    He  obtained  the  following  results: 

"Endemicity  of  hookworm  infection  in 
mines  is  dependent  not  only  on  favorable  con- 
ditions of  temperature,  relative  humidity, 
mine  drainage  and  chemical  character  of  mine 


102 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


drain  water  but  also  on  the  particular  circum- 
stances and  conditions  existing  relative  to  mine 
pollution  and  ova-laden  feces. 

"The  use  of  mine  water  catchment  devices 
and  storage  tanks,  reservoirs,  etc.,  to  receive 
the  evacuations  of  men  while  midergroimd, 
may  be  responsible  for  a  high  incidence  of 
ankylostomiasis  among  workers. 

"Nematode  larvae,  resembling  hookworm 
larvae  morphologically,  were  isolated  from 
mine  soil  in  a  certain  cross-cut  in  mine  '  A  ', 
and  it  was  proved  subsequently  by  infection  of 
puppy -dogs  in  this  same  locality  that  hook- 


worm larvae  capable  of  development  into  adult 
A.  duodenale  were  actually  present  in  the  mine 
soC 

"Ankylostomiasis  among  California  miners 
has  centered  largely  in  a  few  of  the  deepest  gold 
mines  situated  along  one  section  of  the  '  INIother 
Lode  '  in  Amador  County. 

"Surface  infection  did  not  exist  in  the  vicin- 
ity of  '  Mother  Lode  '  mines  since  practically 
all  cases  of  ankylostomiasis  discovered  among 
surface  workers  were  traceable  to  contact  in 
mines  with  infected  mine  soil  or  drain  water." 
—  H.  F.  Smvth. 


OCCUPATIONAL  AFFECTIONS  OF  THE  SKIN  AND  SPECIAL  SENSES 


TRAUiLi  AS  Factor  in  Skin  Dise.\se.  E. 
Aievoli.  Abstracted  as  follows  from  Riforma 
med.,  March  19,  1921,  37,  No.  12,  271,  in 
Jour.  Am.  Med.  Assn.,  May  28,  1921,  76,  No. 
22,  1539.  —  "Aievoli  discusses  this  subject 
from  the  standpoint  of  workmen's  compensa- 
tion. He  comments  on  the  difficulty  of  exclud- 
ing malingering,  and  expresses  approval  of  the 
German  law  which  compels  the  insured  to 
enter  a  hospital  for  treatment  when  the  results 
of  any  trauma  are  exceptionally  prolonged.  If 
the  insured  declines  to  go  to  the  hospital,  the 
indemnity  is  reduced.  Wien  the  French  took 
command  of  Alsace  and  Lorraine  they  kept  this 
law  unmodified,  although  there  is  nothing  of 
the  kind  in  the  rest  of  France."  —  C.  K. 
Drinker. 

Istdustrial  Dermatosis  .\iioxg  Printers. 
W.  J.  McConnell.  U.  S.  Pub.  Health  Ser., 
Pub.  Health  Rep.,  May  6,  1921,  36,  No.  18, 
979-989.  —  Ink  poisoning,  affecting  the  parts  of 
the  arms  and  hands  that  are  much  in  contact 
with  inks  is  common  among  printers.  The  con- 
dition is  attributed  by  foreign  writers  to  the 
substitutes  for  pure  oil  of  turpentine  or  its 
adulterants  which  are  often  used  in  cleaning. 
Inquiries  made  in  this  country  among  printing 
and  engraving  firms  showed  that  dermatosis 
like  that  described  by  foreign  -^Titers  occurs 
when  no  such  substitutes  or  adulterants  are 
used,  and  an  investigation  was  therefore  under- 
taken by  the  L'nited  States  Public  Health  Serv- 
ice to  obtain  further  information. 

The  investigation  was  made  in  one  plant 
only,  since  the  processes  seemed  to  be  the 
same  everywhere,  and  it  included  observation 
of  methods  of  work,  physical  examination  of 


cases,  analysis  of  materials,  observation  of 
methods  used  for  removing  ink  from  hands  and 
arms,  treatment  of  cases,  and  experimental 
work  on  volunteer  subjects.  It  was  found  that 
there  is  constant  contact  with  ink,  especially 
in  work  on  hand  presses,  and  that  in  general 
very  harsh  methods  are  used  in  cleaning;  the 
parts  usually  are  first  immersed  in  a  mineral 
oil,  and  then  soap  and  hot  water  are  applied 
and  often  pumice  soap  and  fine  sand  or  per- 
haps a  stiff  brush.  Examination  of  cases  soon 
showed  that  all  persons  affected  had  drj^  skin, 
that  is,  lacking  in  natural  oiliness.  Experi- 
ments were  made  on  a  numoer  of  persons,  some 
having  dry  and  some  oily  skin.  The  ink  was 
applied  and  allowed  to  remain,  but  produced  no 
irritation;  nor  did  the  cleaning  oil  applied  in 
the  same  way.  But  in  another  series  of  experi- 
ments, in  which  the  ink  was  removed  each 
night  with  soap  and  water  and  a  brush,  irritant 
action  was  produced.  This  was  caused  sooner, 
and  the  condition  became  more  severe  in  those 
having  dry  skin  than  in  those  having  oily 
skin.  Still  other  experiments,  in  which  either 
ink  or  cleansing  oil  was  applied  to  abraded  sur- 
faces, showed  that,  although  ink  retarded 
healing,  the  oil  did  not. 

Treatment  of  dermatosis  was  attempted  by 
the  application  of  calamine  jviint,  the  follow- 
ing prescription  (for  the  use  of  which  rules  are 
given)  being  used:  zinc  ore  (calamine  and  a 
silicate  of  zinc)  pulverized  and  passed  through 
a  100-mesh  sieve,  3  parts;  gelatine,  4  parts; 
glycerine,  5  parts;  water,  6j  parts.  As  a 
general  measure  directions  were  given  to  apply 
lanolin  Vjefore  going  to  the  press  room,  to  wash 
at  the  lunch  period,  using  a  mixture  of  saw- 
dust and  green  soap,  then  apply  lanolin  again 


ABSTRACTS 


103 


before  going  to  work.  The  skin  lesions  re- 
sponded readily  to  the  treatment,  and  it  is 
affirmed  that  if  the  prophylaxis  recommended 
is  used,  dermatosis  will  be  prevented.  — 
G.  E.  Partridge. 

Der.\l\titis  among  Workers  ix  Caxe. 
II  Lavoro,  Jan.  31,  1021,  11,  No.  9,  274-27.5.  — 
From  the  macerated  cane  stalk  comes  a  black 
dust  which,  on  contact  with  the  skin,  is  capable 
of  producing  dermatitis  of  the  forehead,  cheeks, 
eyelids,  nose,  and  lateral  parts  of  the  neck, 
back  of  the  hands,  and  scrotum.  The  conjunc- 
tiva is  involved  in  this  malady,  giving  rise  to 
hyperemia,  photophobia,  and  lacrimation,  and 
sometimes  the  nasal  mucous  membrane  is 
affected,  and  in  grave  cases  frontal  headache 
occurs.  Workers  affected  with  the  disease  com- 
plain of  itching,  burning,  and  slight  pain. 

The  disease  is  due  to  the  chemical  action  of 
the  black  powder  which  is  found  in  the  stalks  of 
old  cane.  Cure  consists  in  rest  and  ai)plication 
of  ointment  to  the  parts  affected.  —  M.  Dent. 

Concerning  the  Occupational  Disease 
OF  Re.\pers  ant)  Winnowers.  G.  Gherardi. 
II  Lavoro,  ,Ian.  31,  1021,  11.  No.  0,  2,)7-2()2.  — 
This  disease  is  an  infection  of  the  cornea  ])ro- 
duced  on  the  corneal  epithelium  by  the  sharp 
points  of  rice  leaves  which  are  blown  about 
during  the  processes  of  reaping  and  winnowing. 
The  evil  is  a  very  real  one  in  the  rice-growing 
districts.  Of  the  infected  cases  10  per  cent, 
suffer  total  loss  of  vision,  43  per  cent,  suffer 
diminution  of  vision,  and  41  per  cent,  recover. 
The  author  suggests  that  glasses  would  help 
in  prevention  work,  and  that  first-aid  stations 
should  be  established  near  the  fields.  —  M. 
Dent. 


AiEvioNLV  Burns  of  the  Corne.\.  Am. 
Jour.  Ophth.,  March,  1921,  Series  3,  4,  No.  3, 
210-211. — This  paper  reports  eight  cases  of 
burns  of  the  cornea  caused  by  ammonia 
scattered  by  a  bursting  ammonia  cylinder. 
The  four  patients  with  first  degree  burns  re- 
covered quickly  with  one  treatment  of  cocain, 
followed  by  boric  solution  and  oil  of  ricini 
every  four  hours.  Two  others  died  before  the 
cornea  began  to  slough.  One  patient  recovered 
with  clear  cornea  after  ten  days,  and  the  other 
sustained  very  deep  sloughing  of  the  cornea 
with  marked  scarring.  He  was  in  the  hospital 
120  days.  In  discussing  these  cases,  it  was 
suggested  that  cocain  should  not  be  used  and 
tliat  hot  compresses  increased  the  vitality  of 
the  tissues  and  diminished  local  pain.  Sterile 
olive  oil  is  preferred  by  some  to  castor  oil.  It 
is  very  difficult  to  determine  the  depth  of  the 
burn  owing  to  the  penetrating  character  of 
the  caustic.  —  Elinor  1).  Gregg. 

Fr.roKOsropY  for  Ocular  Foreign'  Bodies. 
U\  S.  r rem U ill,  F.  C.  Cnrde.%  and  IF.  D. 
Horner.  Am.  Jour.  Ophfh.,  Feb.,  1921,  Series 
3,  4,  No.  2,  123-124.  —  .Mt hough  X-ray  locali- 
zation has  greatly  simplified  the  removal  of 
foreign  bodies  from  the  orbit  and  globe,  there 
are  cases  in  which  tlial  method,  for  one  reason 
or  another,  fails  to  give  a  correct  localization. 
The  improved  Sweet  localizer  is  said  to  be  ac- 
curate to  a  fraction  of  a  millimeter,  but  in 
eyes  having  a  high  degree  of  myopia  or  hy- 
peropia the  method  becomes  unreliable.  In 
some  cases  surgical  exploration  is  necessary. 
In  such  cases,  and  whenever  there  is  doubt 
al)out  the  location,  tiic  fluoroscope  is  a  very 
useful  adjunct,  provided  the  foreign  body  is 
large  enough  to  be  seen  readily  under  the 
screen.  —  G.  E.  Partridge. 


OCCmRENCE  AND  PRE^T.XTION  OF  INDUSTRIAL  ACCIDENTS 


Safety  and  Accident  Prevention.  Fred 
G.  Lntige.  Indust.  Management,  April  1.  1921, 
61,  No.  7,  257-250.  —  With  the  passing  of  a 
state  compensation  law  in  1911  figures  indicat- 
ing the  actual  extent  of  accidents  showed  the 
need  for  adequate  and  imiform  safeguards 
against  industrial  accidents,  and  at  the  same 
time  furnished  the  incentive  to  employers  to 
seek  means  of  reducing  hazards  in  order  to 
avoid  prohibitive  accident  costs.  Scientific  and 
imiform  standards  are  important  because  em- 


ployers will  no  longer  hesitate  to  provide  guards 
which  they  know  are  necessary  and  which  will 
be  permanent  if  installed  according  to  specifi- 
cations. One  of  the  principal  sources  of  acci- 
dents is  the  worker  himself.  Carelessness  and 
ignorance  conspire  to  cause  him  injury.  As  an 
outgrowth  of  this  movement  to  educate  the 
worker  the  "school  safety"  movement  de- 
veloped, with  the  object  of  giving  children  a 
knowledge  of  accident  hazards  and  means  of 
avoiding  them. 


104 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Engineers  have  now  begun  to  realize  the 
importance  of  the  possibihties  of  preventing 
accidents  through  fundamental  changes  in 
structure,  layout,  or  operation.  The  pioneer 
days  when  an  employer  might  spend  thousands 
of  dollars  for  safety  without  any  returns  are 
now  over.  Accident  prevention  has  become  a 
routine  affair  —  the  application  of  known  solu- 
tions to  known  problems.  —  L.  A.  Shaw. 

Reducing  the  Cost  of  Industrial  Acci- 
dents. M.  R.  Lott.  Factory,  May  1,  1921, 
26,  No.  9,  1080-1083.  —This  is  an  account  of 
the  safety  work  in  a  plant  employing  about 
2,000  men  in  the  making  of  scientific  apparatus. 
A  full-time  engineer  was  engaged  to  investigate 
the  safety  problem  and  to  conduct  an  educa- 
tional campaign.  As  a  result  accidents  have 
been  reduced  to  an  average  of  less  than  one  a 
month  among  a  thousand  men,  the  severity  has 
been  decreased  93  per  cent.,  and  the  cost  of 
compensation  96  per  cent.  "These  results 
were  made  possible  through  a  carefully  planned 
organization,  systematic  methods  for  carrj'ing 
on  the  work,  and  a  carefully  selected  personnel 
to  whom  duties  could  be  assigned."  The 
hospital  takes  care  of  minor  surgery  and  all 
first  aid.  Educational  bulletin  boards  are  used, 
and  talks  are  given  to  the  men  at  noon-hour, 
or  just  before  closing  time.  The  plant  is  in- 
spected by  a  committee  of  three  e^'e^y  month. 
By  having  all  cases  requiring  first  aid  report 
to  the  hospital,  instead  of  using  first-aid  boxes, 
many  cases  of  infection  from  small  cuts  and 
abrasions  have  been  prevented.  Careful  and 
systematic  recording  of  all  necessary  data  is 
carried  out,  cases  involving  loss  of  time  are 
immediately  followed  up  by  the  safety  engineer, 
and  a  nurse  or  j)hysician  is  in  constant  attend- 
ance during  factory  and  office  working  hours. 
All  cases  of  absenteeism  are  investigated  by 
the  nurse.  The  yearly  costs  of  the  system, 
which  include  compensation  payments,  medical 
supplies,  salaries,  rental  charge,  interest,  and 
depreciation,  amount  to  from  7  to  10  per  cent. 
of  the  annual  payroll. 

Records  kept  by  the  department  show  that 
the  prevalence  of  illness  means  a  higher  acci- 
dent rate.  During  the  absence  of  the  physician, 
wlien  minor  illness  was  not  treated,  there  was 
a  rise  in  the  number  of  accidents.  Of  all  cases 
treated,  46.3  per  cent,  were  minor  accidents, 
and  53.7  per  cent,  sickness  cases.  Of  the  acci- 
dents, 36.7  i)er  cent,  were  due  to  the  machinery 
operated;    -25.'i,  per  cent,  to  hand  tools;  24.5 


per  cent,  to  carelessness  in  handling  materials; 
13.6  per  cent,  to  miscellaneous  causes,  such  as 
falling  against  benches  and  desks,  etc. 

Curves  showing  monthly  variations  in  lost 
time  and  cases  treated  for  sickness  and  accident 
are  showTi,  and  there  are  some  reproductions  of 
record  cards,  etc.,  used  in  the  work.  —  G.  E. 
Partridge. 

How  AN  Electrical  Company  Cut  Acci- 
dents 78  Per  Cent.  W.  P.  Strickland.  Nat. 
Safety  News,  May,  1921,  3,  No.  15,  10.  —  In 
1913  the  New  York  and  Queens  Electric  Light 
and  Power  Company  began  a  series  of  monthly 
educational  talks  on  safety,  and  organized  and 
expanded  its  safety  work,  with  the  result  that 
the  accidents  reported  have  decreased  78  per 
cent.  A  centralized  safety  bureau  is  main- 
tained from  which  constant  inspection  is  made 
of  the  whole  system.  A  schedule  is  followed, 
by  which  every  man  attends  a  safety-first  lec- 
ture and  resuscitation  drill  once  a  month,  and 
there  is  a  monthly  meeting  of  superintendents 
and  foremen  where  safety  construction  is  dis- 
cussed. Prizes  are  given  quarterly  for  the  best 
suggestions  for  the  prevention  of  accidents.  A 
statement  of  accidents  is  distributed  monthly, 
showing  the  number  of  accidents  occurring  in 
the  resjiective  departments.  Accidents  have 
been  groujied,  analyzed  and  discussed  with  the 
men,  and  remedies  have  been  fomid  in  ten  of 
the  groups,  so  that  they  have  practically  elimi- 
nated accidents. 

The  resuscitation  drills  are  especially 
thorough.  Suspended  animation  from  electric 
shock  is  far  more  serious  than  that  produced 
by  asphyxiation  and  drowning,  and  it  has  been 
foimd  that  the  Schaefer  prone  pressure  method 
is  better  than  any  other  mechanical  means  of 
producing  artificial  respiration,  especially  if 
counter-sliock,  such  as  a  violent  blow  on  the 
jaw  or  hitting  the  soles  of  the  feet,  is  used  with 
it.  In  six  cases  resuscitation  was  effected  by 
dro])ping  the  body  and  striking  the  feet.  — 
G.  E.  Partridge. 

How  Accidents  Are  Prevented  in  our 
FoL^NDRY.  W.  H.  Steele.  Nat.  Safety  News, 
May,  1921,  3,  No.  15.  25.  —  In  the  foundry  of 
the  Locomotive  Stoker  Company  of  Pittsburgh, 
Pa.,  which  has  an  average  daily  pour  of  40  tons 
of  soft  grey  iron  and  3  tons  of  bearing  bronze, 
all  moulding  is  done  by  machines.  Statistics 
show  that  hand  labor  causes  40  per  cent,  more 


ABSTRACTS 


105 


accidents  than  does  machine  work  —  a  fact 
which  is  confirmed  by  the  experiences  of  this 
foundry.  During  19^20  there  were  hut  •iOl 
cases  requiring  treatment,  of  which  twenty- 
one  were  major  accidents  (that  is,  those  re- 
quiring the  attention  of  a  surgeon);  and  during 
five  years  there  has  not  J)een  a  fatal  acci- 
dent, nor  one  causing  any  form  of  permanent 
disabiUty.  This  good  record  is  due  in  part  to 
the  safety  work,  which  has  included  careful 
individual  attention  in  the  fitting  of  goggles 
and  provision  of  corrective  lenses  when  re- 
quired, and  a  thorough  weekly  inspection  of 
machinery,  a  written  report  of  the  results  of 
which  are  sent  to  tiie  master  mechanic.  — 
G.  E.  Partridge." 

Safe  Clothing  Redices  Bcrxs  of  Steel 
Workers  50  Per  Cent.  Nat.  Safety  News, 
March  •■28.  V.Hl,  S,  No.  l.'J,  8.  —  In  the  plant 
of  the  Cambria  Steel  Company  all  men  engaged 
in  pouring  or  handling  in  any  way  molten 
metal  are  required  to  wear  fireproof  leggings, 
aprons,  and  head  and  eye  protectors,  with  the 
result  that  burns  have  been  reduced  50  per 
cent.  A  campaign  for  safe  clothing  began  in 
this  plant  with  the  provision  of  shoes  that 
would  jjpotect  from  falling  objects.  These  were 
bougiit  by  the  company  and  supplie<l  to  the 
men  at  cost.  Later,  leggings,  asbestos  gloves, 
firei)roof  and  waterproof  clothing,  one-piece 
overclothes,  masks,  a|)rons,  helmets  and  shields 
were  distributed  on  the  same  plan.  The  work- 
men have  co-operated  by  suggesting'  improve- 
ments and  by  taking  a  general  interest  in  the 
elimination  of  hazards.  —  G.  E.  Partridge. 

What  Is  Safe  Clothing  for  Factory 
Workers.'  J.  J.  Lamb.  Nat.  Safety  News, 
March  7,  19^21,  3,  No.  10,  5-6.  —  Safe  Practices 
Pamplilet  No.  10,  issued  by  the  National  Safety 
Council,  is  mentioned  as  a  source  of  detailed 
information  on  the  problem  of  clothing  in  its 
relation  to  safety,  only  the  main  points  of 
which  are  touched  upon  in  the  present  pa])er. 

Loose  or  torn  sleeves  and  torn  Irouser  legs 
cause  thousands  of  .serious  accidents  every 
year,  and  there  should  be  persistent  effort  to 
eliminate  this  risk.  Proper  clothing  for  the 
average  workman  consists  of  reasonably  snug 
overalls  and  junipers,  or,  preferably,  a  one- 
piece  suit. 

Injuries  to  the  feet,  resulting  from  accidents, 
constitute  one  of  the  most  troublesome  kind  of 
accident,  and  they  are  esjjecially  prevalent  in 


foundries  where  one-sixth  of  all  injuries  are 
attributed  to  defective  and  unsafe  footwear. 
Laced  shoes,  which  are  hard  to  remo\e  in  an 
emergency  and  are  also  not  sufficiently  proof 
against  the  entrance  of  hot  metal,  are  not  nearly 
so  good  as  "congress"  .shoes.  The  wearing  of 
easily  removable  leggings  is  an  added  protec- 
tion, as  is  also  the  reinforcing  of  the  toes  of 
shoes  to  protect  the  feet  against  heavy  falling 
objects.  Linemen  and  other  electrical  workers 
need  specially  constructed  rubber  shoes,  and 
should  wear  stockings  of  non-conductive  ma- 
terial. In  some  industries,  leggings  are  neces- 
sary parts  of  safe  clothing.  A  flare  at  the 
bottom  to  ])rotect  the  instep  is  invalualile  to 
men  working  about  hot  metals,  liquids,  and 
acids.  Most  industrial  leggings  have  spring 
steel  frames  which  fit  closely  to  the  legs,  and 
have  flaps  that  fold  under  the  leggings  in  the 
back. 

The  essential  points  about  aprons  are  that 
they  should  not  be  worn  near  moving  ma- 
chinery; that  unless  made  of  firejiroof  material 
they  should  not  be  worn  near  fires;  and  tiiat 
waste  should  not  be  carried  in  the  pockets. 
Caps  have  their  uses  —  for  cleanliness  if  for  no 
other  purpose.  Tran.sparent  visors  are  good, 
but  certain  conditions  reepiire  that  these  be 
non-inflannnable.  Helmets  are  to  be  advo- 
cated for  such  work  as  steel  construction  in 
shi[)yards,  etc. 

(iloves  are  one  of  the  safety  man's  hardest 
])roblems.  They  are  a  serious  hazard  if  worn 
about  moving  machinery.  Hand  leathers  so 
fastened  as  to  be  readily  released  are  suitable 
for  some  kinds  of  work.  A  good  fastening  is  a 
coil  si)ring  attachment  covered  with  leather. 
For  operating  machinery  in  very  cold  j)laces, 
loose  mittens  with  only  three  fingers  — one  for 
the  thumb,  one  for  the  forefinger,  and  one  for 
the  other  three  fingers  — are  useful.  Properly 
tested  rubber  gloves,  kept  sealed  and  dated 
until  issued  for  use,  are  necessary  for  elec- 
tricians. They  should  be  kept  in  a  fairly  cool 
temperature  and  tested  every  six  months. 
Gloves  in  use  should  be  tested  at  least  once  a 
week. 

In  many  plants,  it  has  been  found  that  work- 
men can  be  persuaded  more  easily  to  wear  safe 
clothing,'  if  the  plant  has  a  store  where  such 
clothing  can  be  obtained  at  cost.  —  G.  E. 
Partridge. 

Safe  Clothing  for  Chemical  Workers. 
Ira  V.  Kepner.    Nat.  Safety  News,  March  14, 


106 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


1921,  3,  No.  11,  7,  10.  —No  one  type  of  cloth- 
ing can  be  provided  for  chemical  workers  as  the 
hazards  in  each  branch  of  manufacture  are 
different,  and  clothes  considered  safe  in  a  sul- 
phuric acid  area  would  be  dangerous  in  a  plant 
manufacturing  lead  oxides,  nitro  or  amido 
compounds.  A  detailed  outline  is  herein  given 
of  the  various  kinds  of  clothing  which  are  neces- 
sary for  protection  against  burns,  poisonings, 
etc.,  in  the  diverse  operations  of  the  chemical 
industry.  — Elinor  D.  Gregg. 

Hip  Length  Leggings  Protect  Poubers  in 
Foundry.  Nat.  Safety  News,  March  21,  1921, 
3,  No.  12,  14. — A  description  is  given  of  the 
canvas  hip  legging  in  which  pourers  have 
worked  12,871  hours  with  no  accidents.  The 
legging  is  not  tight,  but  hangs  straight  so  that 
there  are  no  wrinkles  to  catch  iron  should  any 
splash.  Thorough  safety  training  also  helps  to 
keep  up  this  excellent  record  of  the  Saginaw 
Products  Company.  —  Elinor  D.  Gregg. 

Safe  Clothing  for  Women  Workers. 
Nesta  Edivards.  Nat.  Safety  News,  March  21, 
1921,  3,  No.  12,  7,  10.  —  Improper  clothes  help 
to  cause  fatigue.  Nine-tenths  of  accidents  are 
due  to  carelessness  which  is  a  result  of  fatigue. 
Shoes,  hair,  and  jewelry  generally  play  some 
part  in  every  accident. 

Safe  clothing  for  women  workers  includes 
comfortable  shoes  with  a  broad  heel  affording 
sufficient  base,  be  it  low  or  high;  shoe  laces  well 
tucked  in;  an  attractive  light-weight  cap  cover- 
ing the  hair;  coveralls  or  overalls,  and  no 
jewelry. 

Time  and  place  to  change  clothing  are  essen- 
tial. It  takes  a  bit  of  tact  to  make  safe  clothing 
popular  in  factories,  but  it  can  be  done  if  the 
employer  is  willing  to  go  half-way  on  the  ex- 
pense involved,  and  if  the  uniforms  are  made  as 
attractive  as  possible.  They  should  only  be  re- 
quired when  necessary  about  machinery.  — 
Elinor  D.  Gregg. 

National  Safety  Code  for  the  Protec- 
tion OF  THE  Heads  and  Eyes  of  Industrial 
Workers.  Bureau  of  Standards  Handbook 
Series,  No.  2,  1921,  pp.  Gl.  —  General  safety 
requirements  are  stated  and  operations  are 
classified  in  nine  groups,  according  to  the  ob- 
jects against  which  protection  is  necessary. 
Protector,  goggles,  face  mask,  helmet,  hood, 
and  shield  are  carefully  defined,  and  general 
directions  are  given  in  respect  to  selection  of 
lenses,  etc.   In  the  following  sections  protectors 


for  nine  different  groups  of  operations  are 
described  and  specifications  and  tests  are  given. 
The  final  section  of  the  code  deals  with  operat- 
ing rules  —  that  is,  sterilization,  supply  and 
fitting  of  goggles,  replacement,  inspection,  tests 
for  frame  and  glass,  etc. 

The  second  half  of  the  handbook  contains  a 
discussion  of  the  rules.  The  need  for  definite 
requirements  to  protect  the  eyes  of  industrial 
workers  is  shown  by  the  fact  that  in  1918,  in 
the  state  of  Pennsylvania  alone,  there  occurred 
705  industrial  accidents  resulting  in  the  loss  of 
one  or  both  eyes.  The  Pennsj'lvania  Railroad 
has  an  active  safety  department  and  furnishes 
goggles  to  shop  workers,  and  yet,  in  1918,  4.6 
per  cent,  of  the  injuries  reported  on  the  eastern 
lines  were  eye  injuries.  Almost  invariably 
these  accidents  occur  to  men  who  fail  to  wear 
protectors.  There  is  need,  therefore,  of  active 
interest  in  the  subject  of  protection,  and  the 
employer  shoidd  feel  it  necessary  so  to  organize 
his  work  as  to  require  workers  to  wear  the 
proper  protectors,  and  should  not  depend  upon 
the  worker  to  judge  whether  the  occupation  he 
is  engaged  in  requires  the  use  of  protectors. 

There  follows  discussion  of  the  rules  in  re- 
spect to  different  occupations,  and  the  report 
ends  with  fifteen  pages  of  general  directions  in 
the  form  of  operating  rules  for  sterilization, 
fitting,  replacement,  tests,  etc.,  elaborating  the 
rules  given  in  the  safety  code.  —  G.  E.  Part- 
ridge. 

Goggles  for  Locomotive  Exginemen. 
Gustave  J.  Soderberg.  Safety  Engin.,  March, 
1921,  41,  No.  3,  102-104.  —  The  demand  for 
more  power  through  increased  fire-bo.\  area 
makes  the  task  of  the  engineer  even  more 
arduous.  Therefore  the  nervous  strain  and 
physical  exertion  should  be  lessened  whenever 
possible,  and  goggles  are  one  means  toward 
such  an  end.  The  objection  is  made  that 
colored-glass  goggles  change  the  color  of  sig- 
nals, especially  at  night.  The  author  main- 
tains that  smoked  glass  goggles  bring  out  more 
clearly  at  night  the  red,  green  and  yellow 
lights.  —  :M.  Dent. 

S.\FETY  TO  Life  in  Ship  Construction. 
S.  Clarice  Brandenstcin.  Safety  Engin.,  March, 
1921,  41,  No.  3,  108-110.— The  author  cites 
the  hull  department  as  lieing  the  most  hazard- 
ous and  outlines  the  hazards  under  the  follow- 
ing heads:  staging,  in  which  the  chief  hazard 
is  lack  of  standardization;  deck  openings;  and 
falling  objects.  —  M.  Dent. 


ABSTRACTS 


107 


Safety  Methods  as  Applied  in  the  Load- 
ing AND  Unloading  op  Steamships.  IT'.  E. 
Welch.  Safety  Engin.,  March,  1921,  41,  No. 
3,  113-114. — The  hazards  of  stevedoring 
parallel  those  of  steel  frame  building  erection. 
Stevedoring  accidents  are  classed  under:  stow- 
age and  discharging;  making  up  of  drafts; 
cargo  falling  from  drafts  and  being  struck  with 
drafts;  when  the  ship's  gear  gives  way;  and 
coal  bunkering,  when  the  men  are  struck  by 
buckets.  To  eliminate  accidents  equipment 
should  be  of  the  best,  carefully  rigged,  and  in- 
spected. —  M.  Dent. 

Safety  Features  of  Ste.\m  Boiler  Ac- 
cessories. Warren  IliUeary.  Nat.  Safety 
News,  April  4,  1921,  3,  No.  14,  5-6.  —  Though 
the  number  of  jjersons  killed  by  boiler  explo- 
sions has  been  very  substantially  reduced  since 
1881,  the  seriousnessof  the  steam  boi!erproi)lem 
even  today  is  attested  by  the  fact  that  in  1919 
there  were  187  deaths  due  to  this  cause.  In 
this  paper  the  author  deals  with  safety  valves, 
water  gauge  glass,  gauge  cocks,  high  and  low 
water  alarms,  pressure  gauge,  and  blow-olf.  — 
L.  A.  Shaw. 

Safety  Features  of  Steam  Boiler  Ac- 
cessories. Warren  Hilleari/.  Nat.  Safety 
News,  May,  1921,  3,  No.  15,  17-18.  —This  is 
the  concluding  section  of  a  paper,  a  part  of 
which  was  published  in  the  National  Safety 
News  of  April  4.  The  present  section  deals 
with  rotary  tube  cleaners,  concrete  floors, 
furnace  door  locks,  steam  flow  meters  and  oil 
burners. 

Rotary  tube  cleaners,  motor  or  turbine 
driven,  are  the  only  mechanical  means  for 
cleaning  the  interiors  of  tubes  of  water  tube 
boilers,  since  with  curved  tubes  the  cleaner 
'  wears  away  the  metal  of  the  tube  at  points 
near  the  bend.  Great  care  should  be  taken  to 
give  proper  instruction  in  the  use  of  the 
cleaner.  The  greater  the  amount  of  scale,  the 
slower  the  cleaner  will  travel,  hence  there  is 
wear  at  points  where  the  cleaner  becomes  sta- 
tionary. Steam  turbine  cleaners  have  an  added 
danger  of  the  steam  hose  bursting. 

Laid  on  any  other  soil  than  dry  .sand,  con- 
crete floors  are  dangerous  when  heated  to  more 
than  212°  F.,  and  there  are  risks  also  in  places 
where  the  atmospheric  temperature  reaches  or 
falls  below  freezing. 

The  installation  of  automatic  door  locks  will 
prevent    a    common    form    of    accident,    i.e.. 


scalding  and  hot  fuel  burns  when  bursting 
tubes  or  flues  push  open  the  fire  or  ash  pit 
doors. 

There  is  no  reason  why  every  boiler  operat- 
ing in  a  battery  with  one  or  more  other  boilers 
should  not  be  equipiied  with  a  steam  flow 
meter,  which  will  show  the  fireman  whether 
each  boiler  is  delivering  its  proper  amount  of 
steam.  Then,  if  necessary,  the  fire  intensity 
can  be  increased  or  decreased  innnediately. 
There  is  less  danger  when  each  boiler  is  doing 
its  share  of  the  work. 

All  steam  or  air  atomized  oil  burners  are 
dangerous,  and  the  equipment  used  in  con- 
nection with  them  becomes  dangerous  through 
their  use.  Since  mechanical  atomization  is 
reasonably  safe,  it  is  probable  that  sooner  or 
later  all  atomization  will  be  done  by  mechani- 
cal processes.  The  one  possible  objection  is 
the  necessity  of  bringing  the  oil  to  high  temp- 
erature before  it  enters  the  burner,  although 
no  accidents  seem  to  have  occurred  from 
temperatures  up  to  275°  F.  Precaution  must 
be  taken  in  the  use  of  oil  to  sec  tli;it  (l:iinpers 
are  thrown  open  before  firing  or  admitting  any 
oil  to  the  furnace. 

Burns  from  hot  gases  passing  through  fur- 
nace doors  are  too  common.  The,'S'  arc  not 
always  caused  by  the  cx])losi()n  of  furnace  gas 
for  if  the  damper  is  suddenly  closed  hot  gases 
and  the  flames  themselves  will  be  likely  to 
come  out.  A  manually  operated  damper 
shoidd  be  weighted  so  as  to  be  held  open.  It 
is  a  bad  practice  to  stand  in  front  of  a  furnace 
door  and  throw  in  wet  coal  or  unabsorbed  water. 

(iuessing  the  time  to  open  the  stop  valve 
from  a  boiler  to  a  header  which  is  being  sup- 
plied from  other  boilers  sometimes  leads  to 
explosion.  A  non-return  valve  should  be  used, 
in  ortler  to  prevent  the  boiler  from  being  cut 
into  the  line  too  soon.  —  G.  E.  Partridge. 

A    C.\.MPVIGN    AGAINST    DEFECTIVE    ^VND    Lm- 

PROPER  H.\ND  Tools.  Nat.  Safety  News, 
April  4,  1921,  3,  No.  14,  3-1.  —  Tools  which 
are  defective  or  which  are  improper  for  the 
purpose  for  which  they  are  used  are  the  im- 
mediate cause  of  many  accidents  in  every  in- 
dustry, although  it  has  been  proved  that  fully 
75  per  cent,  of  such  accidents  can  be  reduced 
by  a  proper  inspection  of  the  tools  and  by  the 
education  of  the  workmen.  The  means  by 
which  such  practical  measures  of  accident  pre- 
vention may  be  taken  are  herewith  briefly 
presented.  —  L.  A.  Shaw. 


108 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


INDUSTRIAL  SURGERY 


Fractuhes  Incident  to  Occupation.  John 
J.  Moorhead.  Proc.  Ninth  Ann.  Congress,  Nat. 
Safety  Council,  Sept.  27,  1920-Oct.  1,  1920, 
123-134. — The  central  idea  of  this  paper  is 
the  treatment  of  fractures  in  relation  to  the 
prognosis  of  deformity  or  disability.  The 
severity  of  the  fracture  is  inversely  dependent 
upon  the  occupation  and  not  upon  the  severity 
of  the  injury.  Four  essentials  of  surgery  are 
given:  (1)  diagnosis;  (2)  reduction  or  setting; 
(3)  retention  or  splinting;  (4)  re-education  or 
functioning.  Reduction  and  re-education  are 
the  most  important.  Only  when  the  patient 
is  returned  to  the  occupation  from  which  he 
came  may  the  surgeon  consider  his  duty  done. 
—  Elinor  D.  Gregg. 

TR.YtmL\Tic  Surgery  Problems.  John  J. 
Moorhead.  Jour.  Am.  Med.  Assn.,  June  11, 
1921,  76,  No.  24,  1642-1646.  —  The  article  is 
summarized  as  follows:  "The  basic  factors  in 
traumatic  surgery  relate  primarily  to  the 
treatment  of  infected  wounds,  burns,  fractures, 
and  joint  injuries. 

"Safety  first,  conservation  next,  are  the  two 
essential  considerations. 

"Sterilization  of  wounds  by  mechanical  or 
chemical  means  is  the  end  in  view,  and  after 
sterilization,  suture  should  be  attempted. 

"Burns  are,  from  a  clinical  standpoint, 
wounds  due  to  heat  and  should  be  placed  in 
the  woimd  class,  as  thereby  our  patients  will 
measurably  profit. 

"Fractures  are  wounds  of  bones,  and  are 
always  associated  with  lesions  of  the  contiguous 
parts.  Splintage  should  be  of  the  removable 
type  to  permit  inspection,  raas.sage  and  motion. 

"Early  moV)ilization  of  joint  injuries  means 
earlier  local  repair,  earlier  return  of  function. 


"Physiotherapy  begins  early  and  should  not 
be  looked  upon  as  applicable  only  to  the  final 
stages  of  treatment. 

"Functional  return  is  the  greatest  aim  in  all 
forms  of  injurj%  and  no  patient  should  be  re- 
garded as  cured  until  function  has  been  re- 
stored to  the  maximum. 

"Traumatic  surgerj'  is  not  trivial  surgery; 
on  the  contrary,  it  often  demands  a  higher 
grade  of  surgical  skill  and  experience  than  the 
average  form  of  general  or  pathologic  surgery." 
—  C.  K.  Drinker. 

The  Pathology  of  So-Called  Sprains  of 
THE  Wrist.  With  a  Note  on  Skiagr.\ms  in 
these  Conditions.  Edgar  F.  Cyriax  and 
Stanley  Melnlle.  N.  Y.  Med.  Jour.,  April  6, 
1921,  113,  No.  11,  538-540. —A  brief  state- 
ment of  the  anatomical  changes  occurring  in 
^\Tist  sprains  with  an  outline  of  methods  for 
reduction.  The  article  itself  is  practically  a 
summary.  —  C.  K.  Drinker. 

Three  Frequent  Causes  of  Weak  and 
Flat  Feet.  /.  T.  Rugh.  Abstracted  as  follows 
from  Ann.  Surg.,  April,  1921,  73,  No.  4,  499, 
in  Jour.  Am.  Med.  Assn.,  May  14,  1921,  76, 
No.  20,  1367. —  "The  first  of  these  causes 
mentioned  by  Rugh  is  a  shortened  Achilles 
tendon.  The  second  condition  that  mechani- 
cally predisposes  to  a  weak  or  flatfoot  is  a  hy- 
pertrophy of  the  inner  end  of  the  scaphoid  bone. 
The  third  factor  found  fre<|uently,  especially 
in  cases  of  congenitally  weak  and  in  flat  feet, 
is  a  supernumerary  tarsal  bone  placed  at  the 
inner  side  of  the  scaj)hoid  and  over  which  runs 
the  tendon  of  the  tibialis  posticus.  This  bone 
is  called  the  tibiale  exteriuim  and  by  some  has 
been  called  a  sesamoid  in  the  posterior  tibial 
tendon."  —  C.  K.  Drinker. 


INDUSTRIAL  PHYSIOLOGY:  NUTRITION,  METABOLISM, 

FATIGUE,  ETC. 


Smoking  and  Mental  and  Motor  Effi- 
ciency. S.  Froeherg.  Abstracted  as  follows 
from  Jour.  Exp.  P.sychol.,  1920,  Vol.  3,  334- 
346,  in  Physiol.  Ab'str.,  April,  1921,  6,  No.  1. 
30.  —  "The  experiments  seem  to  have  been 
rather  severe.  The  students  were  made  to 
smoke  5  cent  cigars;  their  jirevious  experience 
is  not  mentioned,  l)ul  as  the  author  says  many 


smoked  vigorously  for  fear  the  cigar  would  go 
out,  it  looks  as  if  they  were  not  accustomed  to 
tobacco.  They  were  then,  after  half  an  liour's 
smoking,  tested  over  a  range  of  motor  and 
mental  functions.  Steadiness  in  the  former  usu- 
ally decreased;  this  coincides  with  the  belief 
among  marksmen.  The  mental  tests  .showed 
no  marked  departure  from  the  normal;    some 


ABSTRACTS 


109 


students  were  unaffected,  some  a  little  better, 
some  a  little  worse."  —  McKeen  Cattell. 

The  Effects  of  Alcohol  axd  Some  Other 
Drugs  during  Normal  and  Fatiglted  Con- 
ditions. Med.  Research  Council,  Special  Re- 
port Series  No.  56,  London,  1920,  pp.  .34.  — ■ 
The  introduction  to  this  report,  quoted  hclow, 
is  a  very  good  summary  of  the  results  accom- 
plished by  this  investigation. 

"The  j)reseiit  report  is  the  tliird  of  a  .series  of 
memoirs  published  by  the  Medical  Research 
Council  at  the  request  of  the  Central  Cotitrol 
Board  (liquor  traffic).  The  earlier  of  the  experi- 
ments now  described  were  i)art  of  an  investi- 
gation independently  undertaken  before  the 
beginning  of  the  war,  but  the  later  ones  were 
devised  to  answer  problems  suggested  to  the 
authors  by  the  chairman  of  the  Board. 

"In  some  respects  the  value  of  the  experi- 
ments is  enhanced,  in  other  resj)ects  it  is  re- 
stricted by  their  at  once  extensive  and  limited 
character.  They  are  extensive  in  so  far  as  they 
deal  with  certain  mental  effects  not  only  of  al- 
cohol, but  of  opiinn,  strv<-hninc,  tea,  chloro- 
form, etc.  But  any  loss  of  intensiveness  arising 
from  exi)criments  over  .so  wide  a  pharmaco- 
logical field  receives  compensation  from  the 
similar  and  op[)osite  actions  revealed  by  their 
comparison.  These  drugs  appear  to  fail  into 
two  antagonistic  groups,  (1)  alcohol  and  chlo- 
roform, and  {2}  strychnine,  opium,  and  tea,  in 
regard  to  the  tests  ap])iic(l. 

"On  tiie  other  hand,  these  experiments  are 
limited  in  scope  since  they  were  carried  out  by 
only  two  subjects,  the  greater  number  indeed 
being  i)erformed  on  only  one  subject,  who  had 
never  to  her  knowledge  ])rcvi()us]y  taken  al- 
cohol in  any  form.  But  though  caution  nuist  be 
exercised  in  generalizing  from  conclusions  thus 
based,  they  acciuire  more  than  ordinary  value 
inasmuch  as  they  issue  from  two  ex|)erts  well 
trained  to  avt>id  the  inevitable  pitfalls  of  human 
experiment.  Thus  they  have  followed  Dr. 
Rivers's  example  of  disguising  the  drugs  taken 
and  of  employing  control  mixtures,  indistin- 
guishable from  the  disguised  drugs  and  taken 
on  the  days  when  the  latter  were  not  taken,  so 
that  suggestion  arising  from  foreknowledge 
could  play  no  part  in  obscuring  the  true  effect 
of  the  drug. 

"The  writers'  researches  on  the  mental  ef- 
fects of  alcohol  will  naturally  receive  principal 
attention.  They  find  that,  despite  the  subjec- 
tive feelings  of  greater  ease  in  carrying  out  the 


tests,  alcohol  produces  in  them  a  distinct  loss  of 
precision  in  the  dotting  test,  a  well-marked  loss 
of  power  of  recall  in  the  memory  tests,  and  a 
striking  reduction  in  the  rate  of  alternation  of 
phases  in  the  '  windmill '  illusion.  The  last 
named,  indeed,  is  claimed  as  a  very  delicate  in- 
dex of  drug  effects,  the  writers  a.scribing  the 
reduced  rate  of  phase  alternations  to  a  rise  in 
the  resistance  offered  by  the  synapses  of  the 
neurons  to  the  passage  of  the  nervous  impulse. 
Oi)ium  acts  in  a  directly  opposite  manner.  It 
accelerates  the  rate  of  ])hase  alternations  in  the 
'  wiiidMiill  "  ilhision,  while  it  diminishes  the 
errors  in  the  dotting  and  in  the  memory  tests, 
the  attention  being  more  easily  directed  to  the 
task  and  to  the  meaning  of  the  words  learnt, 
and  the  jjroccss  of  recall  being  likewise  facili- 
tated. 

"Applying  the  tlotting  and  other  tests  to  as- 
certain the  influence  of  food  taken  with  alcohol, 
the  writers  find  little  subjective  or  ol)jective 
eU'ects  when  alcohol,  to  an  amount  of  ;i()  c.c,  is 
taken  with  a  meal,  whereas  when  it  is  taken 
from  two  to  five  hours  after  a  meal  the  effects 
are  iMii|uestionable  in  the  tests  cm])loyed.  Ap- 
]jlying  the  dotting  test  to  determine  the  effects 
of  the  degree  of  dilution  of  alcohol,  they  con- 
clude that  the  weaker  the  solution  the  less 
marked  are  its  effects.  Both  tlx-se  results  are  in 
agreement  with  those  of  Dr.  Mellanby  (Report 
No.  31  of  this  series)  and  of  Dr.  Vernon  (Report 
No.  34),  but  they  call  for  further  research. 

"A  more  extended  investigation  is  al.so  neces- 
sary in  the  light  of  the  authors'  interesting  dis- 
covery that  in  the  course  of  the  protracted 
fatigue  effects  following  several  nights'  loss  of 
slec]),  alcohol  acts  deleteriously  during  the 
stages  of  increasing  inefficiency,  whereas  it  acts 
beneficially  as  tlie  subject  later  begins  to  regain 
his  previous  etticiency.  At  the  former  stage  it 
increases  the  errors,  at  the  latter  it  reduces  the 
errors  made  in  the  tests.  This  suggests  that  an 
imj)ortant  cause  of  the  conflicting  results  of 
past  workers  may  be  due  to  the  stage  or  degree 
of  fatigue  when  alcohol  was  taken."  —  C.  K. 
Drinker. 

Alcohol  and  Precision  in  Work.  U.  Jof- 
termann.  Abstracted  as  follows  from  Skand. 
Arch.  f.  Physiol.,  1920,  Vol.  40,  107-116,  in 
Physiol.  Abstr.,  April,  1921,  6,  No.  1,  80.  — 
"The  index  of  skill  was  the  number  of  needles 
which  could  be  tlireaded  with  cotton  in  20 
minutes.  The  subject  (the  author)  had  ab- 
stained from  alcohol  for  6  months  beforehand. 


110 


THE  JOURNAL  OF  INDUSTRL\L  HYGIENE 


During  a  preliminary  period  of  14  days  with- 
out alcohol  the  daily  score  of  needles  rose  to  a 
steady  maximum.  He  then  began  to  take  25 
CO.  of  pure  alcohol,  diluted  to  100  c.c.  with 
water,  daily  at  11  p.m.,  the  experiments  being 
made  daily  at  about  10  a.m.  During  the  first 
few  days  of  alcohol  the  score  rose  slightly, 
then  fell  off  distinctly.  It  rose  again  during  a 
second  period  without  alcohol,  and  fell  again 
during  a  second  period  with  it.  He  concludes 
that,  apart  from  its  immediate  effect,  which  was 
excluded  by  the  inte^^•al  between  drinking  and 
threading,  a  daily  small  ration  of  alcohol  di- 
minishes his  efficiency  in  skilled  work.  The 
experiments  are  few,  and  the  subject  admits 
that  he  may  be  abnormally  susceptible."  — 
McKeen  Cattell. 

The  Relation  of  Postuhe  to  Individual 
Health.  Edith  Hilles.  Nation's  Health,  May, 
1921,  3,  No.  5,  290-293. —The  fundamental 
need  in  industry  is  to  prevent  the  worker  from 
reaching  a  condition  of  over-fatigue.  It  is  now 
recognized  that  posture  in  industry  is  one  of 
the  conspicuous  factors  in  fatigue.  The  cor- 
rect postures  for  both  sitting  and  standing  are 
herein  described.  Emphasis  is  laid  upon  the 
facts  that  posture  should  be  varied;  that  work 
conditions  should  be  such  that  correct  posture 
is  possible;  and  that  rest  periods  should  be 
interposed  where  a  break  in  the  work  is  most 
needed.  —  L.  A.  Shaw. 

The  Therapy  of  Fatigue.  L.  Preii.  II 
Lavoro,  Jan.  31,  1921,  11,  No.  6,  262-268.— 
The  objects  of  fatigue  therapy  are  to  preserve 
strength  and  to  renew  it.  The  author  divides 
the  different  sorts  of  therapy  into:  (1)  cure 
by  rest;  (2)  medicinal  therapy  —  the  momen- 
tary help  given  by  alcohol,  coffee,  and  tea; 
(3)  physical  therapy — water,  electricity,  light, 
and  air;  (4)  hydrotherapy  —  hot  and  cold 
baths  and  douches;  (5)  phototherapy  which 
uses  light  as  its  agent;  (6)  aerotherapy  —  but 
do  not  use  cold  air;  (7)  electrotherapy;  and 
(8)  alimentary  —  one  of  the  best  methods  to 
combat  fatigue.  —  M.  Dent. 

Some  of  the  Preventable  Causes  of 
Fatigue.  A  Common  Sen.se  Summing  Up. 
Secretary,  Committee  on  Industrial  Fatigue. 
Reprinted  from  Indust.  Canada,  Dec,  1920, 
pp.  3.  —  This  paper  takes  up  briefly  the  effects, 
meaning,  and  causes  of  fatigue.  The  chief 
cause  of  fatigue  is  ascribed  to  the  maladapta- 


tion  of  the  worker  to  his  job.  Other  causes  due 
to  working  conditions  are  outlined  under  the 
following  heads:  (1)  hours  of  work;  (2)  en- 
vironment; (3)  phj'sical  and  nervous  strain 
(speed,  rhythm,  rest  periods,  noise  and  vibra- 
tion, monotony,  and  accident  and  health  haz- 
ards); (4)  general  health  maintenance  (food, 
sanitary  facilities,  transportation,  suitable 
clothing);  (5)  psychology  (maladaptation  of  a 
worker  to  his  job,  inexperience,  personnel, 
erratic  management) ;  (6)  wages.  —  M.  Dent. 

Fatigue  and  Efficiency  in  the  Iron 
AND  Steel  Int)ustry.  H.  M.  Vernon.  Indust. 
Fatigue  Research  Board,  Report  No.  5.  H.  M. 
Stationery  Office,  London,  1920,  pp.  99.  — 
This  is  an  important  and  laborious  investiga- 
tion of  the  conditions  of  production  of  pig  iron 
and  steel  in  England,  and  of  the  conditions  in 
steel  rolling,  together  with  a  supplementary 
study  of  the  health  of  the  workers.  The  proc- 
esses employed  and  the  types  of  machinery  are 
described,  and  the  paper  contains  thirty-nine 
tables  besides  charts  and  photographs  of  ma- 
chinery. 

In  the  manufacture  of  pig  iron,  the  hand- 
charging  of  the  furnace  was  found  to  be  a  very 
laborious  operation,  and  of  146  blast  furnaces 
inspected  only  18  per  cent,  were  mechanically 
charged.  The  rate  of  charging  was  16  per  cent, 
less  in  summer  than  in  winter,  and  the  rate  of 
charging  on  long  shifts  was  8  to  15  per  cent,  less 
than  on  eight-hour  shifts.  Reduction  in  the 
hours  of  work  of  blast  furnace  men  from  twelve 
to  eight  per  shift  will  cause  \-ery  little  increase 
of  output,  but  data  are  adduced  which  .show 
that  the  time-keeping  will  be  improved.  No 
signs  of  fatigue  could  be  found  in  men  engaged 
in  charging  furnaces  mechanically,  although 
they  worked  on  twelve-hour  shifts. 

In  steel  i)roduction  some  hea\'j'  work  is  done 
by  the  steel  melters,  the  work  of  "fettling"  or 
mending  the  furnace  floor  being  very  exhaust- 
ing. The  time  occupied  in  this  process  varied  so 
widely  in  different  plants  that  the  author  thinks 
there  is  need  of  an  extended  investigation  of 
the  system  in  order  to  reduce  the  laboriousness 
of  this  work.  In  the  hand-charging  of  furnaces 
in  steel  production,  reduction  of  hours  from 
twelve  to  eight  per  shift  increased  the  output 
9  per  cent,  at  one  plant,  and  2  per  cent,  at  an- 
other, but  the  substitution  of  hot  metal  for  cold 
metal  caused  an  increase  of  30  per  cent.  The 
output  usually  showed  a  sea.sonal  variation,  and 
at  one  works  it  was  11  per  cent,  less  in  the  sum- 


ABSTRACTS 


111 


mer  than  in  the  winter.  There  was  found  also 
an  intermittency  in  the  work  on  some  days, 
which  increased  the  fatigue  of  steel  melters. 
The  Bessemer  process  does  not  necessitate  any 
very  heavy  work.  Tlie  crucible  steel  process 
does,  however,  but  not  so  much  as  the  produc- 
tion of  wrought  iron  by  the  puddling  process. 

In  the  steel  rolling  processes  the  same  sea- 
sonal variation  was  found  as  in  the  other  opera- 
tions. At  two  works  the  output  was  from  9  to 
13  per  cent,  less  in  the  summer  than  in  the 
winter.  Reduction  in  hours  from  twelve  to 
eight  per  shift  did  not  lead  to  any  increase  of 
output,  but  at  one  works,  where  delays  were 
investigated  and  thereby  reduced,  output  rose 
16  per  cent. 

A  classification  of  workers  according  to  the 
fatigue  caused  by  their  work  is  offered,  includ- 
ing five  cla.s.ses  with  subdivisions.  The  most 
difficult  work  of  all  is  done  by  the  open-he<irth 
steel  melters  when  fettling;  then  follows  the 
work  of  j)uddling.  Melters  of  hand-charged 
open  hearth  furnaces,  tin-plate  mill  men,  and 
crucible  steel  jiuilcrs-out  also  have  very  heavy 
work. 

Sickness  records  of  about  "20,000  steel  workers 
for  six  years  were  tabulated.  The  average  of 
lost  time  for  all  causes  was  6.5  days  per  year. 
The  steel  melters  and  pitmen  lost  23  per  cent, 
more  than  the  average,  the  i)ud(llers  '20  pvr 
cent,  more,  the  tin-j)l;ite  mill  men  \i  per  cent, 
more  and  the  rolling  mill  men  8  per  cent.  more. 
Almost  all  of  these  men  frequently  work  at  high 
temperatures.  Men  who  usually  work  at  or- 
dinary temperatures  and  on  less  heavy  work 
showed  8  or  9  per  cent,  less  than  the  average. 
The  excess  of  sickness  in  the  puddlers  was  due 
to  rheumatism  and  resi)iratory  diseases,  caused, 
the  WTiter  thinks,  by  the  custom  of  alternating 
heavy  work  with  periods  of  rest  or  light  work; 
the  tin-plate  mill  men,  who  work  almost  con- 
tinuously, showed  no  excess  of  sickness  from 
these  causes.  During  war-time  (191.5-1918) 
the  men  showed  31  per  cent,  less  sickness  than 
in  the  period  before  the  war  (1913-1914).  Steel 
workers  aged  25  to  65  years  showed  a  5  per 
cent,  lower  death  rate  than  all  males  (occui)ied 
and  retired).  The  steel  melters  had  a  20  ]jer 
cent,  greater  mortality  than  all  males.  The 
blast  furnace  men  had  a  higher  mortality  than 
the  steel  workers. 

There  was  found  a  "  curious  lack  of  provision 
for  the  comfort  of  the  men  on  the  part  of  some 
of  the  employers."  In  most  of  the  iron  works 
the  blast  furnace  barrow-men  work  night  and 


day  in  the  open  without  any  shelter  whatever, 
although  there  is  no  inherent  difficulty  in  pro- 
viding protection.  In  many  of  the  steel  smelt- 
ing shops  there  were  no  proper  seats  j^rovided 
for  the  men,  although  they  are  resting  half  the 
time  when  on  duty.  The  men,  also,  were  very 
negligent  in  matters  of  health,  especially  as  re- 
gards exposure  after  work  in  high  temperatures. 
—  G.  E.  Partridge. 

Fatigue  Charts.  H.  Dausset  and  Boigey. 
Abstracted  as  follows  from  Paris  medical, 
April  16,  1921,  11,  No.  16,  313,  in  Jour.  Am. 
:Med.  Assn.,  May  28,  1921,  76,  Xo.  22,  1538.  — 
"Dausset  and  Boigey  comment  on  the  aid 
afforded  in  physical  training  by  keeping  charts 
showing  the  onset  and  effect  of  fatigue.  They 
describe  with  illustrations  their  method  for 
this."  —  C.  K.  Drinker. 

Spells  of  Rest  and  Physical  Efficiency. 
P.  M.  Dawson  and  L.  A.  Wallrich.  Abstracted 
as  follows  from  Am.  Jour.  Physiol.,  1921,  Vol. 
,55,  314,  in  Physiol.  Abstr.,  June,  1921,  6,  No.  3, 
169.  —  "Bicycling  with  heavy  weights  be- 
comes more  efficient  with  spells  of  rest,  \\itli 
light  weights,  continuous  riding  produced 
better  effects.  With  training  (1  subject)  the 
advantage  of  rest  spells  passed  off."  —  Mc- 
Keen  Cattell. 

Energy  Expenditure  in  Household 
Task-s.  C.  F.  Langicorthi/  and  H.  G.  Barott. 
Abstracted  as  follows  from  Am.  Jour.  Physiol., 
1920,  Vol.  52,  pp.  400-408,  in  Physiol.  Abstr., 
Sept.  and  Oct.,  1920,  5,  Nos.  6  and  7,  310.  — 
"Data  are  given  on  energy  elimination  in  a 
young  woman  performing  various  tasks,  the 
figures  naturally  rising  with  increase  of  work; 
thus  knitting  and  the  like  gave  an  average  of  9 
calories  in  excess  of  the  sitting  quietly  metab- 
olism; for  dish- washing  and  ironing  the  figure 
rose  to  24  to  40,  the  energy  rising  with  the 
height  of  the  table.  Obviously  harder  work 
{e.  g.,  scrubbing  floors)  gave  an  increase  of 
50."  —  McKeen  Cattell. 

The  Phy.siological  Co.st  oJ-  Collier's 
Work.  A.  D.  Waller  and  G.  De  Decker.  Ab- 
stracted as  follows  from  Proc.  Physiol.  Soc, 
1920,  Jour.  Physiol.,  1921,  112-114,  in  Physiol. 
Abstr.,  June,  1921,  6,  No.  3,  204. —  "Ob- 
servations were  made  hourly  upon  2  colliers 
during  the  morning  shift  on  3  successive  days. 
The  procedure  was  to  collect  expired  air  for 
30  seconds  each  hour  from  each  of  the  2  col- 


112 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


liers  at  the  coal  face,  mth  least  possible  inter- 
ruption of  the  work,  which  consisted  of  'getting 
coal'  and  loading  it.  The  volume  of  expired 
air  and  COo  percentage  were  measured  at  once. 
As  the  wage  depended  upon  the  tonnage  got, 
the  work  was  maximal  (4.5,  4.0,  3.5  tons  for 
3  days).    The  pulse  was  taken  during  the  col- 


lection of  expired  air.  Curves  are  given  which 
show  a  parallelism  in  the  rising  and  falling 
ordinates  which  represent  CO2  discharge  and 
pulse  frequency.  The  physiological  cost  of 
walking  60  paces  horizontally  before  7  a.m. 
and  after  2  p.ii.  was  found  to  be  doubled  after 
the  7  hours  of  work."  —  McKeen  Cattell. 


HAZARDS  OF  COMPRESSED  AIR,  DLVONISHED  PRESSLTRE,  GENERATION 
AND  USE  OF  ELECTRICITY,  AND  ELECTRICAL  AYELDING 


Lessons  Learned  from  Forty  Electri- 
cal Fatalities.  S.  E.  Whiting.  Nat.  Safety 
News,  March  28,  1921,  3,  No.  13,  3-5,  12-13. 
■ —  The  writer  extracts  the  practical  lessons  to 
be  learned  from  a  study  of  the  causes  and  con- 
ditions of  the  fatal  accidents  from  electrical 
shock  that  have  come  under  his  notice.  He 
emphasizes  the  danger  and  uncertainty  of  the 
low  voltage  circuit  (from  100  to  600  volts). 
One  case  is  reported  of  a  fatal  accident  when 
the  voltage  was  only  110.  The  low  voltage 
hazard  is  greatest  in  damp  or  otherwise 
grounded  locations,  but  several  dangerous  con- 
ditions can  arise  from  the  ordinary  low  voltage 
circuit.  There  are  se\'eral  precautions  to  be 
taken,  such  as  the  substitution  of  modern  en- 
closed or  "dead  front"  switches  for  all  open 
knife  switches;  keeping  all  open  wiring  out  of 
reach  (preferably  enclosing  all  wiring  in  con- 
duits), using  porcelain  or  weather-proof  lamp 
sockets  which  should  be  kejdess  and  controlled 
from  proper  wall  switches;  and  avoiding  the 
use  of  drop  cords.  All  dead-metal  parts  of  low 
tension  equipment  (with  certain  exceptions) 
should  be  permanently  groimded,  since  there 
have  been  more  low  voltage  fatalities  from  the 
omission  to  ground  dead-metal  parts  than  from 
any  other  single  cause. 

The  high  voltage  circuits  (from  2,000  volts 
up  to  100,000)  are  considered  separately.  Ex- 
po.sure  to  these  high  tension  circuits  is  rela- 
tively small  and  localized,  and  normally  all 
men  exposed  to  these  high  tension  hazards  are 
specially  trained  in  electrical  work.    But  there 


are  some  extraordinarily  careless  practices. 
Enclosing  guards  are  often  omitted,  although 
all  current-carrying  parts  should  be  covered 
by  means  of  fire-proof  doors  or  metal  screens 
to  a  height  of  6  or  7  feet.  Careless  cleaning  of 
high  tension  parts  is  responsible  for  some  fatal 
accidents,  and  the  only  safe  way  is  to  make  all 
high  tension  cleaning  a  special  job  when  the 
parts  are  all  open-circuited  and  grounded  be- 
fore cleaning  begins,  and  where  close  super- 
vision is  given  to  every  detail  of  the  work. 

Directions  are  given  for  proper  protective 
grounding  of  circuit  parts  and  for  the  construc- 
tion of  grounding  devices.  —  G.  E.  Partridge. 


Paralysis  of  the  Radl\l  Nerve  and 
Trophic  Disti'rbances  following  an  Elec- 
TRic.\i  Burn.  Jellinek.  Wicn.  klin.  Wchnschr., 
1920,  33,  873.  —  An  electrical  worker  accident- 
ally touched  his  elbow  to  a  conductor  carrying 
a  5,000  volt,  42-cycle  alternating  current.  In 
spite  of  good  conduction,  a  portion  of  the  cur- 
rent passed  through  the  rest  of  his  body. 
Heart  action  and  respiration  were  restored 
after  a  half  hour  of  artificial  respiration.  The 
burns  were  dressed  with  boric  acid,  and  five 
days  later  a  good  deal  of  the  tissue  of  the  right 
arm,  some  of  it  apparently  normal,  had  necro- 
tized, exposing  the  ulnar  nerve  trimk  and  the 
pulsating  bracliial  artery.  This  wound  healed 
over  after  several  months'  treatment,  but  the 
ulnar  paresis,  motor  and  sensation,  still  re- 
mains. —  Barnett  Cohen. 


HEAT,  COLD  AND  HUMIDITY 


Arterial  Pressure  .\mong  Workers  in 
High  Temperatures.  Tedeschi.  Abstracted 
from  Folia  mcdica,  1920,  No.  27,  in  II  Lavoro, 
Feb.  28,  1921,  11,  No.  10,  300-301.— The 
author  reports  the  results  of  an  investigation 


among  fourteen  stokers  and  five  firemen  work- 
ing in  high  temperatures.  In  the  experiment 
the  temperature  of  tlie  air  was  recorded  and 
the  individual's  tem])erature  was  taken,  to- 
gether  with   his    pulse   and    respiration,    and 


ABSTRACTS 


113 


the  maximum  and  minimum  arterial  pressure. 
The  experiments  were  begun  wlien  the  sub- 
ject first  entered  the  room;  a  count  was  taken 
one  and  a  half  hours  after  his  entrance  (during 
work),  a  half  hour  after  stopping  work,  while 
resting  near  the  engines,  and  finally  after 
leaving  the  engine  room.  The  temperature  of 
the  machine  room  varied  from  30°  C.  to  44°  C'. 
The  author  concludes  that  between  the  limits 
of  temperature  indicated  there  is  an  increase  of 
arterial  pressure  due  to  the  exaggerated  action 
of  the  heart  and  of  the  vasomotor  centers.  — 
M.  Dent. 

Preliminary  Notes  ox  .Vtmospmeric-  Con- 
ditions IX  Boot  and  Shoe  Factories.  W.  J). 
Hamhhf  and  T.  Bedford.  Indust.  Fatigue  Re- 
search Board,  Report  No.  11.  Ilis  Majesty's 
Stationery  Office,  London,  lit'il,  pp.  (ii). — 
The  summary  of  the  pamphlet  is  as  follows: 

"1.  An  atmosphere  which  will  helj)  to  sus- 
tain physical  energy  should  be  cool  rather  tiian 
hot,  dry  rather  than  dam]),  and  there  should  be 
brisk  air  mo\cmcnl.  Neglect  of  these  condi- 
tions may  cause  physical  disability  and  in- 
efficiency. 

"'i.  The  kata-thermometer  is  designed  to 
measure  rates  of  cooling  which  are  de[)ciident 
on  temperatures,  humidities  and  velocities  of 
air  currents.  Rates  of  cooling,  wliich  are  ex- 
pressed in  figures  denoting  heat  lost  per  unit 
area  per  .second,  give  information  with  regard 
to  standards  of  comfort  and  efficiency. 

".'5.  Cheek  temperatures  are  a  valuable  guide 
to  demands  which  are  being  made  on  the  heat- 
regulating  system  of  the  body.  Colour  and 
texture  of  clothing  have  a  marked  eU'ect  on 
skin  temperatures. 

"4.  There  is  some  evidence  to  show  that 
atmospheric  conditions  deteriorate  from  morn- 
ing to  evening  in  the  workslioj);  also  tliat  this 
makes  additional  demantls  on  the  workers' 
energy.  _ 

"5.  Kata-thermometer  records  have  been 
taken  in  3,5  factories,  including  buildings  of  the 
single  and  multi-storey  type,  which  were  situ- 
ated in  urban  and  rural  areas  in  various  parts 
of  the  country. 

"6.  Examination  of  summer  and  winter 
records  taken  at  several  factories  suggests  that 
systems  of  ventilation  which  are  adequate  in 


winter  cannot  always  ensure  desirable  physio- 
logical conditions  under  adverse  outdoor  con- 
ditions in  Slimmer. 

"7.  Machinery  in  motion  has  an  appreciable 
efl'ect  on  atmospheric  movement.  A'entilation 
in  gold  stam])ing  and  other  small  rooms  which 
are  shut  oft'  from  main  air  currents  should  be 
carefully  considered. 

"8.  The  relative  positions  of  inlets  and  out- 
lets for  air  should  be  carefully  determined  in 
order  to  avoid  'short  circuiting'  of  fresh  air 
currents. 

■'!).  Experiments  carried  out  in  an  aircraft 
doping  room  show  the  high  rates  of  cooling 
obtained  by  fr('(|ucnt  air  change  at  high  veloc- 
ity, anil  the  ajjplication  of  a  doping  room  sys- 
tem of  ventilation  to  boot  and  shoe  factories  is 
considered. 

"10.  .\  consideration  of  ventilation  in  single 
and  nudti-storey  buildings  indicates  that  the 
latter  structures  have  slightly  higher  rates  of 
cooling,  a  narrower  range  from  winter  to  sum- 
mer temperatures,  and  a  greater  air  velocity. 

"11.  Deductions  drawn  from  fre({uency 
curves  dealing  with  atmospheric  conditions  in 
principal  departments  suggest: 

"(h)  That  rates  of  cooling  and  temperatures 
were  not  adai)ted  to  the  nature  of  occupations. 

"  \h)  There  is  .some  indication  that  clicking 
rooms  were  too  cold  in  winter  and  too  hot  in 
sununer. 

"((•)  \\r  velocities  in  each  department  are 
greater  in  sununer  than  in  winter.  This  may 
be  due  to  the  opening  of  windows  in  the  former 
sea.son.  The  question  of  making  better  use  of 
outdoor  air  velocities  in  winter,  and  at  the 
same  time  avoiding  draughts,  is  one  of  im- 
portance. 

"{d)  Sununer  rates  of  cooling  in  jjress  rooms 
were  below  standards  recommended. 

"((')  III  lasting  and  finishing  rooms,  where 
lica\y  manual  work  was  in  progress,  rates  of 
cooling  and  temperatures  for  both  summer  and 
winter  were  unsatisfactory  compared  with 
recommended  standards. 

"  (/)  Shoe  rooms  were  found  to  be  too  cold 
in  winter,  and  in  summer  these  departments, 
where  sedentary  work  was  carried  on,  were 
found  to  have  higher  rates  of  cooling  than 
those  experienced  by  heavy  manual  workers  in 
lasting  and  finishing  rooms."  —  C.  K.  Drinker. 


114 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


Health  Problems  of  Women  in  Industry. 
Mary  Anderson.  Nation's  Health,  May,  1921, 
3,  No.  5,  304-307.  —  Although  the  state  has 
the  power  to  make  regulations  affecting  women 
in  industry,  no  two  states  have  adopted  the 
same  standards.  A  program  incorporating  the 
fundamental  standards  necessary  to  insure 
health  has  been  formulated  by  the  Women's 
Bureau,  United  States  Department  of  Labor, 
and  is  herein  outlined.  The  effect  of  repetitive 
processes,  posture  at  work,  lifting  of  weights, 
and  of  certain  gases  and  fumes  upon  the  health 
of  women  industrially  employed  is  briefly  dis- 
cussed. —  L.  A.  Shaw. 


the  records  show  "that  with  a  wage  far  su- 
perior to  that  paid  women  in  many  other 
occupations,  the  woman  ticket  agent  and  collec- 
tor is  an  accepted  and  permanent  fact  in  two 
large  cities." 

The  second  part  of  the  report  contains  the 
statistical  data  collected  in  the  four  cities 
mentioned.  Age,  marital  condition  and  number 
of  dependents,  hours  of  work  and  their  division, 
wages,  etc.,  are  shown  in  tabular  form,  and 
there  are  summaries  of  the  reasons  given  by 
the  employees  for  liking  their  occupation,  and 
of  their  opinions  regarding  legislation  con- 
cerning it.  —  G.  E.  Partridge. 


Women  Street  Car  Conductors  and 
Ticket  Agents.  U.  S.  Dept.  Labor,  Women's 
Bur.,  Bull.  No.  11,  1921,  pp.  90.  —This  is  an 
investigation,  in  part  statistical,  of  the  em- 
ployment and  conditions  of  work  of  women  on 
the  street  railway  systems  in  several  large  cities 
of  the  United  States.  The  conclusion  is  reached 
that,  when  conditions  are  made  favorable, 
there  are  very  few  branches  of  this  occupation 
barred  to  women;  that  while  the  conditions 
must  be  adapted  to  the  requirements  of  women 
workers,  it  is  always  possible  that  too  stringent 
regulations  may  curtail  their  opportunities  for 
profitable  employment.  Protection  of  women 
from  the  ill  effects  of  long  hours  and  unsatis- 
factory working  conditions  must  accompany 
their  entrance  into  any  new  occupation,  and 
in  considering  opportunities  for  them  it  is 
necessary  to  study  the  methods  by  which  the 
needs  of  the  industry  can  be  reconciled  with 
the  legal  regulation  of  hours  and  working  con- 
ditions —  an  especially  difficult  task  in  view 
of  the  unusual  requirements  necessary  for 
transportation  work. 

Studies  were  made  in  four  cities:  Boston, 
Chicago,  Detroit,  and  Kansas  City.  The  con- 
clusion was  reached,  after  the  investigation  in 
Detroit  and  Kansas  City,  that,  although  condi- 
tions were  not  ideal,  there  was  nothing  to  show 
that  the  work  of  a  street  car  conductor  was 
unfit  for  women.  "The  Detroit  women  worked 
longer  hours  at  night,  and  frequently  seven 
days  a  week,  but  their  j>ay  was  good  and  each 
woman  who  was  interviewed  fount!  the  work 
congenial,  not  too  taxing  physically,  and  better 
paid  than  any  work  she  had  ever  done  before." 
As  regards  the  ticket  agents  in  these  two  cities. 


New  British  Legislation  Affecting 
Women  and  Young  Persons.  Internat. 
Labour  Rev..  Jan.  1,  1921,  1,  No.  1,  121-126. 
—  Two  acts  ha\-e  been  passed  by  Parliament  in 
order  to  embody  in  law  certain  provisions  of 
the  Draft  Conventions  and  Recommendations 
adopted  by  the  Washington  and  Genoa  Con- 
ferences. The  first  of  the  acts  brings  the 
British  law  into  conformity  with  the  Wash- 
ington Conventions  concerning-  the  minimum 
age  for  the  admission  of  children  to  industry 
and  the  night  work  of  women  and  young 
persons.  It  fixes  the  minimum  age  for  the 
admission  of  children  to  employment  at  sea  in 
conformity  with  the  Genoa  convention. 

An  amendment  was  moved  which  authorized 
the  Secretary  of  State  to  issue  orders  allowing 
the  employment  of  women  and  young  persons 
over  16  years  in  two  shifts  under  certain  con- 
ditions, but  an  additional  ])roviso  was  made 
that  an  industry  as  a  whole  should  have  the 
power  to  veto  an  order  of  the  Home  Secretary 
applying  to  any  particular  firm  in  that  industry. 
This  gives  joint  representative  bodies  of  em- 
ployers and  workers  in  any  industry  (which  in 
some  cases  will  be  the  Whitley  Councils) 
statutory  power  to  govern  their  own  affairs 
regardless  of  the  wishes  of  the  government, 
which  is  a  remarkable  innovation  in  British 
factory  legistation. 

The  remaining  provisions  of  the  act  merely 
bring  into  operation  certain  provisions  of  the 
Wasliington  Conventions  whidi  differed  from 
existing  provisions  of  the  Britisli  hiw. 

The  act  for  the  better  protection  of  women 
and  young  persons  against  lead  poisoning 
provides  a   new  system  in  British  legislation 


ABSTRACTS 


115 


for  the  protection  of  workers  in  unhealthy 
industries.  The  new  act  imposes  a  set  of  gen- 
eral provisions  to  be  observed  in  all  places 
where  women  or  young  persons  under  18 
years  are  employed  in  any  process  involving 
the  use  of  lead  compounds.  The  act  follows 
closely  the  recommendation  of  the  Washing- 
ton Conference  in  regard  to  the  processes  from 
which  women  and  young  persons  are  to  be 
excluded,  and  provides  that  lead  dust  or  fumes 
shall  be  drawn  off  as  nearly  as  possible  at  the 
point  of  origin;  that  the  i)ersons  concerned 
shall  submit  to  regular  examinations;  that  no 
food  or  drink  or  tobacco  shall  be  brought  into 
a  workroom  where  a  lead  process  is  carried  on; 
that  adequate  and  clean  protective  clothing 
shall  be  provided  by  the  employer  and  worn 
by  the  worker;  that  suitable  cloak-rooms, 
mess-rooms,  and  lavatories  shall  be  i)rovided; 
and  that  workrooms,  tools  and  api)aratus  shall 
be  kept  clean.  There  are  other  jiro visions  in 
regard  to  power  of  inspection  and  the  suspen- 
sion from  work  in  a  lead  process,  if  continu- 
ance therein  would  involve  special  danger  to 
health.  —  G.  E.  Partridge. 

Trend  of  Child  Ladok  ix  the  United 
States,  1913  to  19^20.  Nettie  P.  McGill.  U.  S. 
Dept.  Labor,  Month.  Labor  Rev.,  Ai)ril,  19'21, 
VI,  No.  4,  VIT-T-SO.  — "Within  the  last  few 
months  persistent  newspaper  statements  to  the 
effect  that  children  were  continuing,  des])itc  a 
gradual  return  of  the  country  to  peace-time 
conditions,  to  go  to  work  in  increasing  num- 
bers, cau.sed  the  United  States  Children's 
Bureau  to  bring  up  to  date  statistics  bearing 
on  lunnbers  of  children  entering  gainful  em- 
ployment which  it  had  secured  as  a  result  of 
an  earlier  inquiry." 

The  writer  comments  on  the  ditliculty  of 
securing  reliable  figures  for  analysis.  "Only 
a  few  states  regularly  compile  statistics  of  em- 
ployed children  and  these  cover  only  manu- 
facturing and,  in  some  instances,  mercantile 
pursuits  and  are  so  various  as  not  to  be  com- 
parable." Twenty-nine  representative  cities 
are  selected  for  study  of  the  trend  of  child 
labor  during  the  period  igi.'J-ig'iO,  and  illus- 
trative tables  are  given.  The  subject  is  dis- 
cussed under  the  following  divisions:  child 
labor  before  the  war;  effect  of  the  European 
war  on  child  labor;  child  labor  after  the  United 
States  entered  the  war;  children  illegally  em- 
ployed; post-armistice  conditions;  and  child 
labor  in  19'-20.  —  R.  B.  Grain. 


He.\lth  Needs  of  Working  Children. 
Am.  Child,  Feb.,  1921,  2,  No.  4,  288-291.  — 
This  paper  reports  an  informal  conference  for 
the  eastern  states  on  the  health  needs  of  the  boy 
and  girl  in  industry,  which  was  held  under  the 
auspices  of  the  United  States  Public  Health 
Service  and  the  American  Social  Hygiene  Asso- 
ciation. By  the  "boy  and  girl  in  industry"  is 
meant  all  young  people  imder  2.5  years  of  age 
who  have  left  school  and  are  engaged  in  gainful 
employment.  The  conference  was  largely  di- 
rected at  the  i)roblem  of  venereal  disease. 

The  interest  of  the  employer  in  aU  health 
matters  is  one  of  economy  as  well  as  humanity. 
The  human  waste  in  industry'  is  enormous  and 
must  be  reduced  if  industry  is  to  progress. 
Health  measures  should  originate  within  the 
industry  so  that  employer  and  employee  may 
progress  with  mutual  benefit.  The  trade 
unions  are  co-operating  with  the  United  States 
Public  Health  Service  in  educational  activ- 
ities. 

The  really  significant  consideration  of  such 
discussions  is  the  recognition  of  this  unexplored 
field  of  the  public  health  movement  —  namely, 
the  health  needs  of  the  boy  and  girl  in  industry. 
This  meeting  to  consider  the  prevention  of 
venereal  disease  in  industries  is  an  index  of  a 
larger  problem  in  regard  to  this  group  of  work- 
ers. Our  health  services  must  bring  about:  (1) 
protection  from  the  hazards  of  industry  and 
unhygienic  living;  (2)  provision  of  proper  health 
service  and  health  education.  —  Elinor  D. 
Gregg. 

Child  L.\bor  .\nd  Ment.\l  Hygiene.  R.  G. 
Fuller.  Survey,  March  19,  1921,  45,  No.  25, 
891-892.  — So  far  the  physical  effects  of  child 
labor  have  been  given  more  consideration  than 
the  mental  efi'ects;  and  yet  the  psychical  effects 
are  quite  as  numerous  and  quite  as  menacing  to 
future  happiness  and  efficiency  as  the  physical. 
The  nervous  disorders  and  derangements,  to 
which  child  labor  may  be  a  contributing  cause, 
are  of  great  variety,  and  include  such  diseases 
as  chorea,  dementia  praecox,  hysteria  and 
neurasthenia. 

Child  labor  in  many  of  its  forms  constitutes 
a  repressive  environment,  which  inhibits  the 
functioning  of  the  natural  impulses.  Work  per- 
formed thus,  with  defective  motivation  and  in 
opposition  to  native  tendencies,  leads  to  ner- 
vous disturbance  directly,  through  environ- 
ment, and  indirectly,  through  fatigue.  The 
first  effect  is  emotional.    An  inner  disturbance 


116 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


is  set  in  motion,  which  takes  the  form  of  separa- 
tion of  thought  from  action. 

The  excessive  child  labor  turnover  is  signif- 
icant from  the  standpoint  of  mental  hygiene. 
In  part  it  is  due  to  adolescent  restlessness,  but 
in  part  it  is  caused  by  the  failure  of  the  work  to 
satisfy  normal  instincts.  The  child  is  vainly 
seeking  self-expression,  and  so  goes  from  one 
place  to  another  without  acquiring  any  sound 
training.  —  G.  E.  Partridge. 

Child  Labor  ix  Imperl\l  Valley.  Am. 
Child,  Feb.,  19^21,  -2,  No.  4,  291-294.  —  This 
paper  details  the  publicity  given  to  the  report 
of  Miss  Ennna  Duke  on  child  labor  in  Cali- 
fornia. In  general,  the  press  comments  were 
intelligent.  There  were,  however,  a  few  excep- 
tions in  which  the  report  was  badly  garbled 
and  misquoted. 

It  is  difficult  to  overcome  the  idyllic  concep- 
tion that  children  never  work  in  the  country. 
The  story  of  child  labor  in  agriculture  will  have 
to  be  told  many  times  before  the  weight  of  pub- 
lic opinion  against  it  is  felt  enough  to  oblige  the 
employers  to  change.  The  editorial  published 
in  one  of  the  newspapers  of  the  Imperial  Valley 
not  only  misquotes  the  report  and  denies  the 
statements  of  officials  of  the  state  as  to  school 
attendance  and  child  labor,  but  also  asks  its 
readers  to  deduct  the  children  of  INIexican  con- 
tract labor  from  these  reports.  Why  deduct  the 
Mexican  children.'  Hope  is  expressed  for  state 
funds  to  enforce  the  present  child  labor  laws 
and  the  Board  of  Education  is  arranging  for 
migratory  teachers  to  follow  these  families  as 
they  move  to  new  fields  of  labor.  —  Elinor  D. 
Gregg. 

Night  Employment  of  Yoltng  Persons. 
W.  K.  Beard.  Ann.  Rep.  Chief  Inspect.  Fac- 
tories and  Workshops  for  the  Year  1919,  Lon- 
don, 1920,  pp.  95-103.  —  Night  employment  of 
young  persons  is  allowed  in  some  industries,  and 
this  report  summarizes  the  results  of  a  survey 
of  the  present  extent  and  conditions  of  this 
employment.  It  contains  data  about  blast 
furnaces,  iron  mills,  reverberatory  and  regen- 
erative furnaces,  ]>aper  mills,  letterjiress  print- 
ing, galvanizing  sheet  metal  and  wire,  electrical 


stations,  china  clay  works,  glass  works,  and 
printing  and  newspapers.  The  report  shows 
upon  what  processes  in  these  industries  young 
persons  are  engaged,  and  what  conditions  make 
such  employment  necessary.  The  necessity  for 
night  work  is  foimd  to  arise  in  general  in  con- 
nection with  continuous  processes  and  other 
processes  closely  related  to  them.  It  is  evident 
that  some  of  this  work  is  unsuitable  for  the 
young,  and  although  some  abuses,  such  as  the 
employment  of  boys  on  long  shifts,  as  in  blast 
furnace  work  where  sixteen-hour  shifts  are 
sometimes  required,  have  been  abolished,  there 
still  persists  a  condition  that  is  being  improved 
only  slowly  and  then  mainly  by  changes  in  ma- 
chinery or  in  the  processes  used.  Improvements 
such  as  the  introduction  of  gas-firing  of  furnaces 
are  both  economic  and  favorable  to  the  elimi- 
nation of  imsuitable  night  work,  but  in  some 
industries  no  such  changes  can  readily  be  made. 
In  some  cases,  the  introduction  of  electrical 
driving  for  auxiliary  machinery  has  increased 
the  number  of  boys  employed,  since  the  opera- 
tion of  the  controls  has  been  simplified;  while 
in  other  cases  centralization  of  switches  has 
reduced  the  number  of  boys  engaged  in  these 
processes. 

In  the  paper  mills,  the  work  is  lighter  than  in 
some  of  the  iron  industries,  and  the  present 
conditions  are  favorable  for  the  training  of 
many  boys  to  become  skilled  workmen.  In 
newspaper  work,  increase  in  the  number  of 
linotypes  and  monotypes,  substitution  of  ro- 
tary for  flat-bed  machines,  smaller  and  fewer 
papers,  trade  restrictions  and  the  high  cost  of 
overtime  have  caused  a  decrease  in  the  amount 
of  night  work. 

Glass  works  take  advantage  of  the  special 
exception  which  allows  them  to  employ  boys  of 
14  years  and  upwards,  and  still  carry  on  night 
work  very  generally.  ]\Iany  boys  are  emi^loyed, 
but  only  a  small  proportion  will  ever  have  the 
opportunity  to  become  expert  glass  workers. 
Present  coi^ditions  require  continuity  in  the 
work,  and  there  is  a  tendency  rather  to  increase 
than  to  decrease  the  number  of  young  persons 
enii)loyed  in  the  industry,  although,  in  the 
oi)iiiion  of  the  WTiter,  boys  could  be  dispensed 
with  in  some  parts  of  the  work  in  which  they  are 
now  employed.  —  G.  E.  Partridge. 


ABSTRACTS 


117 


INDUSTRIAL  SANITATION:  FACTORY  CONSTRUCTION,  ILLUME^ATION, 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEWAGE  DISPOSAL 


Painting  Profits  into  your  Factory. 
Factory,  March  1,  1921,  -26,  No.  5,  595-596.  — 
Paint  adds  materially  to  the  better  operation 
of  the  industrial  plant.  The  illuniinatin<;  en- 
gineer, the  plant  oculi.st,  tlie  painter  and  the 
power-plant  engineer  ran  all  work  tofictiier  to 
the  same  end.  White  paint  extends  the  lijiht- 
ing  area  of  every  light  source,  and  by  throw- 
ing light  upon  the  machine  it  makes  faster 
work  ijossible.  The  width  of  a  mill  building 
is  limited  by  the  distance  to  which  light  from 
the  side  windows  can  penetrate;  therefore 
white  paint  adds  to  the  possible  width  of  the 
structure.  Of  all  colors,  white  reflects  the 
greatest  percentage  of  light  striking  at  any 
angle  and  from  all  sources,  the  coefficient  of 
reflection  being  from  (>7  to  08  per  cent.,  while 
light  tints  of  blue  and  green  have  a  coeflicient 
of  only  54  to  55  per  cent.,  and  dark  shades  of 
red  and  green  only  11  to  li  per  cent.  The  rays 
from  powerful  lights  falling  upon  dark  walls 
give  much  less  liglit  tliiin  the  rays  from  less 
strong  lights  falling  upon  walls  painted  in 
light  colors.  There  are  now  available  dust- 
resisting  washable  i)aints,  and  paints  adapted 
for  u.se  in  locker  rooms,  first-aid  rooms  and 
hospitals  which  can  be  cleaned  with  disin- 
fectants and  are  an  aid  in  the  ])revcntion  of 
disease.  —  G.  E.  Partridge. 

Elimin.vting  Vibr.vtion,  an  Exe.my  of 
Production.  Charles  L.  Hubbard.  Factory, 
May  1,  19-21.  26,  No.  9,  1075-1078.  —  Con- 
stant noise  is  fatiguing,  and  fatigue  lowers  pro- 
duction and  causes  accidents.  .Mthoiigh  noise 
cannot  be  eliminated  entirely  from  the  i)roce.s.ses 
of  manufacturing,  there  are  avoidable  noises 
and  vibrations  that  can  be  overcome;  for  ex- 
ample, excessive  vibration  of  buildings  from 
machines  having  heavy  reciprocating  parts, 
such  as  steam  engines,  pumps,  air  comi)ressors, 
and  refrigerating  machinery;  noise  and  vibra- 
tion from  electric  motors  and  ventilating  fans; 
steam  pipe  vibrations;  shrieking  and  fla])ping 
of  belts;  grinding  of  heavy  metal  gears;  noise 
from  valves  with  dry  stems  and  loose  packing; 
roar  of  air  in  ventilating  ducts;  water  hammer 
in  pipes;  explosive  exhaust  from  gas  and 
steam  engines;  the  hum  of  transformer  sta- 
tions;   and  many  other  noi.ses. 

Primary  or  air  vibration  from  high-sjjeed 
motors,  etc.,  may  be  overcome  in  cases  where 


the  motors  are  isolated  or  scattered,  by  j>ro- 
viding  a  wooden  box  or  housing  lined  with 
hea\'y  asbestos  paper.  The  ventilating  spaces 
necessary  at  the  top  and  bottom  of  this  box, 
however,  allow  the  noise  to  be  transmitted  and 
should  be  avoided  in  the  case  of  large  units  by 
making  a  connection  with  the  ventilating  sys- 
tem. In  some  instances  it  is  necessary  to 
consider  rooms  as  units  and  give  attention  to 
construction  to  minimize  the  sound,  etc.  Foun- 
dation A-ibrations  are  corrected  by  two  methods: 
(1)  anchoring  the  machine  to  a  foundation  too 
massive  to  be  set  in  motion;  and  (2)  insulating 
the  mac-hine  by  .some  elastic  material,  ^'arious 
methods  of  foundation  insulation  are  described, 
and  diagrams  are  shown.  For  insulating  ma- 
terial cork,  either  graiudated  and  ])ressed  into 
blocks  with  suitable  binding  material,  or  cut 
in  strips  from  the  natural  bark,  is  probably 
the  most  satisfactory.  Machines  may  be  insu- 
lated separately,  or  in  groups;  sometimes  a 
number  of  units  are  best  handlivi  by  sejjarat- 
ing  the  i)art  of  the  floor  that  supports  them 
from  the  rest  of  the  building.  Such  separation 
may  be  accom]ilished  by  insulating  a  number  of 
floor  beams,  and  this  may  be  done  in  nK>st  cases 
by  placing  layers  of  natural  cork  beneath  the 
bearing  surfaces  of  the  girders.  If  the  floor 
area  is  large,  it  may  be  supported  upon  in- 
dependent ground  foundations. 

Mountings  of  ventilating  fans  in  the  upper 
parts  of  buildings  may  be  anchored  to  heavy 
brick  cross  walls,  or  a  platform  may  be  con- 
structed on  light  girders,  one  end  embedded 
in  a  sitle  wall,  and  the  other  sni)])orted  from 
overhead.  Noises  or  vibrations  from  fans  are 
often  corrected  by  making  a  flexible  connection 
between  the  fan  outlet  and  the  main  duct  by 
means  of  a  short  canvas  sleeve.  The  grinding 
noises  of  metal  gearing  may  be  reduced  by  the 
use  of  wooden  teeth  in  one  of  the  members  for 
the  larger  sizes,  and  rawhide  for  the  smaller. 
Sometimes  silent  chain  drives  can  be  sub- 
stituted. 

Noises  from  steam  jjulsation  and  water  ham- 
mer are  small  in  magnitude  but  the  vibration 
is  readily  transmitted  to  the  building.  The 
practical  way  of  dealing  with  steam  pulsation 
is  to  install  a  receiving  or  equalizing  chamber 
in  the  steam  main  near  the  engines.  When 
there  are  two  or  more  engines  exhausting  into 
the  same  main,  the  branches  should  enter  at 


118 


THE  JOITRNAL  OF  INDUSTRIAL  HYGIENE 


an  angle,  and  the  horizontal  portion  of  the  main 
should  be  increased  over  the  combined  areas  of 
the  branches.  Water  hammer  in  connection 
■witii  a  pump  may  generally  be  eliminated  by 
attaching  air  chambers  and  vacuum  chambers, 
and  in  overhead  and  dry  return  pipes  the 
remedy  is  to  reduce  the  area  of  contact  of 
steam  and  water  to  a  minimum,  and  to  prevent 
their  coming  together  at  slightly  different 
temperatures.  —  G.  E.  Partridge. 

Five  Tests  for  Good  Lighting.  F.  C. 
Norman.  Factory,  Feb.  1,  19^21,  26,  No.  3, 
344.  —  The  following  five  tests  for  good  light- 
ing are  given: 

"1.  The  light  must  furnish  the  user  with 
sufficient  light  so  that  he  can  see  to  work. 

"2.  The  light  must  be  so  placed  that  it  does 
not  cause  the  pupil  of  the  user's  eye  to  change 
in  size  when  he  is  using  the  light  under  normal 
conditions. 

"3.  The  light  must  be  steady. 

"4.  There  shall  not  be  any  polished  surfaces 
that  will  reflect  light  from  bright  spots  within 
the  worker's  line  of  vision. 

"o.  The  light  must  not  shine  in  the  eyes  of 
some  other  worker."  —  M.  C.  Shorley. 

Solving  Lighting  Difficulties.  N.  0. 
Torch.  Factory,  Feb.  1,  1921,  26,  No.  3,  344. 
—  This  paper  has  to  do  with  the  difficulties 
caused  by  gas  lighting.  In  one  factory  where 
incandescent  burners  could  not  be  used  be- 
cause of  the  risk  of  mantles  breaking  owing  to 
the  constant  vibration,  inverted  gas  burners, 
each  of  75  candle-power,  with  anti-vibrating 
springs  and  suitable  shades,  were  fitted  over 
benches  for  local  lighting,  and  a  series  of  lamps 


of  400  candle-power  each  were  fitted  down  the 
center  of  workrooms  for  general  illumination. 
Special  high-pressure  gas  burners  were  used 
and  a  scheme  was  de^•ised  to  prevent  rapid 
clogging  of  burners  by  arranging  for  all  air 
passing  through  the  burners  to  be  drawn  from 
the  outside.  —  M.  C.  Shorley. 

Ventil.\tion.  C.  C.  Sherlock.  Abstracted 
as  follows  from  Am.  Machinist,  March  3,  1921, 
in  Factory,  May  1,  1921,  26,  No.  9,  1134,  1136. 
—  "The  employer's  common  law  liability  is 
predicated  upon  negligence,  and  unless  this 
negligence  is  present,  he  cannot  be  held  to  pay 
for  the  injuries  sustained.  .  .  .  The  basis  of 
liability  under  the  compensation  act  is  not 
upon  negligence,  but  upon  the  fact  that  injury 
has  occiured  as  a  result  of  an  accident  arising 
out  of,  and  in  the  course  of  the  employment. 
...  If  the  employment  increases  the  normal 
hazard,  accidents  as  a  result  of  the  increased 
hazard  are  accidents  within  the  meaning  of  the 
compensation  acts.  .  .  .  Specffic  provisions  in 
the  safety  appliance  acts,  the  factory  acts  or 
the  industrial  codes  relating  to  ventilation 
must  be  strictly  complied  with  without  refer- 
ence to  the  workmen's  compensation  acts. 
The  mere  fact  that  the  employer  is  to  pay  com- 
pensation in  case  injury  occurs  is  not  sufficient 
reason  for  holding  that  the  compensation  acts 
abrogate  the  safety  appliance  acts  or  other 
acts  which  seek  to  prevent  injuries.  .  .  .  There 
is  liability,  under  both  the  common  law  and  the 
specific  acts,  for  insufficient  ventilation  in  the 
place  of  work,  and  it  is  this  sort  of  liability 
that  is  best  met  in  a  preventive  fashion.  It 
pays  to  prevent  when  there  is  a  possibilitj'  of 
legal  liability  attaching."  —  G.  E.  Partridge. 


INDUSTRIAL  IMEDICAL  SERMCE:  AIEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


Health  Service  in  Industry.  Nat.  Indust. 
Conference  Board,  Research  Rep.  No.  34, 
Jan.,  1921,  pp.  61 .  —  This  report  is  a  discussion 
of  the  progress  of  health  work  in  industry  based 
upon  findings  obtained  through  visits  made  in 
1921  to  ninety  New  England  industrial  es- 
tablishments and  upon  other  studies  of  the 
National  Industrial  Conference  Board,  and  pre- 
sents the  following:  (1)  a  review  of  the  func- 
tions of  the  physician  in  industry;  (2)  an 
analysis  of  the  extent  and  character  of  health 


supervision  in  New  England  industries;  (3)  staff 
organization;  (4)  equipment;  (5)  first-aid 
work;  (6)  physical  examinations;  and  (7)  use 
of  medical  records. 

The  development  of  industrial  medical  serv- 
ice is  traced  from  the  time  when  the  plant 
physician  conducted  his  work  much  as  a 
private  practice  to  the  present  time  when  the 
able  industrial  physician  is  concerned  inti- 
mately with  the  multiplicity  of  factors  which 
are  related  to  the  health  of  operatives  and  ex- 


ABSTRACTS 


119 


ecutives,  when  he  is  equipped  with  detailed 
knowledge  of  industrial  health  hazards  and 
of  the  many  intricate  processes  which  are  in- 
volved in  modern  manufacturing.  The  report 
states  that  "the  plant  physician,  more  than  any 
other  member  of  the  industrial  organization, 
is  in  a  position  to  project  himself  without 
evoking  resentment  into  the  home  and  com- 
munity life  of  workers  and  to  assist  in  the 
proper  adjustment  of  disturbing  factors  in 
these  fields."  There  are  suggested  broad  op- 
portunities which  lie  in  the  .scope  of  industrial 
medicine  for  investigative  and  administrative 
work  regarding  preventive  medicine  and  hy- 
giene. 

The  ninety  industrial  plants  of  New  England 
which  were  visited  for  ])urj)oses  of  this  study 
employed  .'517,000  workers.  These  plants  em- 
ployed ;57  full-time  physicians,  with  63  part- 
time  physicians,  and  '•2!5  |)hysicians  on  call. 
There  w(;ro  1  full-time  and  1  |)art-time  oculist, 
7  full-time  anil  (i  part-time  dentists,  -i-l  male 
nurses,  1.55  female  nurses,  '•27  visiting  nurses, 
34  first-aid  attendants,  and  43  clerks.  Twenty- 
five  of  the  establislinicnts  rc(|uircd  physical 
examination,  thougli  in  not  all  instances  was 
this  examination  detailed.  In  forty-four  plants 
the  medical  department  was  responsilile  to  the 
director  of  ])ersoiuiel,  employment  manager  or 
other  sui)()r(liiialc  official  in  the  administra- 
tion. In  four  plants  the  jjhysician  was  in  charge 
of  the  service  department,  including  the  medical 
work.  In  thirty-nine  instances  llie  plant  phy- 
sician was  directly  responsible  to  the  organiza- 
tion executive.  Special  note  was  nuide  of  the 
lack  of  adecjuate  records  in  many  of  the  plants. 
In  but  few  establishments  were  valuable 
records  found. 

In  the  discussion  upon  staff  organization  it 
is  pointed  out  that  the  size  of  the  medical 
staff  is  determined  by  the  nature  of  the  in- 
dustrial processes  rather  than  by  the  number 
of  workers,  and  it  also  varies  with  the  character 
of  the  medical  work  to  be  done.  Investigations 
show  that  there  are  industrial  establishments 
employing  as  few  as  300  workers  which  have  a 
fidl-time  trained  nurse  and  a  physician  on  call. 
Certain  establishments  with  500  or  more 
workers  employ  part-time  physicians,  some  a 
full-time  physician  in  addition  to  a  trained 
nurse,  and  other  jilants  with  1,000  or  more 
workers  employ  a  full-time  physician  and  one 
or  more  nurses.  The  statement  is  made  that 
in  very  large  plants  one  full-time  physician  for 
every  2,000  employees,  together  with  the  neces- 


sary nursing  and  clerical  personnel,  has  been 
found  satisfactory.  The  importance  of  in- 
dustrial dispensary  service  for  groups  of  small 
establishments  is  em{)hasized. 

The  section  on  equipment  presents  the 
standards  of  the  Conference  Board  of  Phy- 
sicians in  Industry  and  recognizes  the  first- 
aid  equi[)nient  suggested  by  this  Board.  It 
is  probable  that  this  equipment,  devised  some 
years  ago,  could  now  be  nuich  improved  upon. 
In  the  section  upon  first-aid  work  the  standard 
first-aid  methods  advanced  by  the  Conference 
Board  of  Physicians  in  Industry  for  ai)plication 
to  various  types  of  injury  are  set  forth. 

Physical  examinations,  the  report  indicates, 
are  particularly  valuable  for  the  detection  of 
ik'fects  and  limitations  of  labor  a])plicants,  and 
where  such  examinations  are  properly  em- 
ployed a  handicapped  worker  may  be  assigned 
to  a  jol)  suitable  for  him.  There  is  emphasized 
flic  o|)i)()rtunify  which  is  thus  brought  about 
for  the  institution  of  corrective  measures  and 
for  the  education  of  the  worker  regarding  his 
health.  It  is  stated  that  on  an  average  from 
3  to  5  ])er  cent,  of  all  ai)i)licants  examined  have 
been  refused  employment  l)ecau.se  of  physical 
defects.  Together  with  a  standardized  method 
of  physical  examination  adopted  by  the  Con- 
ference Hoard  of  Physicians  in  Industry  there 
is  printed  a  standard  record  fcrni  rccoininonded 
by  the  Board.  It  is  doubtful  if  the  record  form 
is  in  accordance  with  the  best  modern  practice 
and  it  might  well  be  revi.scd.  The  average  time 
rc(|uirc(i  in  thirfy-thrce  ])lants  for  the  making 
of  the  routine  examination  was  eleven  minutes 
per  person.  Eliminating  the  plants  in  which 
the  examination  was  thoroughly  made  the 
time  required  was  eight  minutes.  In  many  of 
the  larger  plants  a  satisfactory  examination 
was  given  in  from  four  to  six  minutes.  There 
may  be  some  scepticism  regarding  the  satis- 
factoriness  of  a  four  minute  observation  of  a 
labor  api)licant,  particularly  if  it  is  hoped 
through  physical  examinations  to  establish  a 
basis  for  a  constructive  health  program. 

It  is  of  interest  that  the  restriction  of  em- 
I)loyment  of  defective  workers  is  based  upon 
the  possibility  of  danger  to  themselves,  to 
others,  or  to  property,  and  that  applicants  with 
a  great  variety  of  abnormalities  are  accepted 
for  employment.  Many  plants  accepted  men 
with  hernia,  with  flat  feet  and  with  varicosi- 
ties. Fourteen  plants  reported  re-examinations 
were  conducted  regularly  at  intervals  varying 
from  one  month  to  three  years,  while  a  number 


120 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


of  other  plants  conducted  re-examinations  upon 
request  and  upon  interdepartmental  transfer  of 
workers. 

The  last  section  of  the  report  dealing  with 
the  use  of  medical  records  presents  standards 
of  the  Conference  Board  of  Physicians  in  In- 
dustry regarding  limitations  of  four  classes  of 
physical  fitness  in  relation  to  employment. 
With  this  there  is  offered  a  list  of  examination 
standards  in  reference  to  physical  defects 
necessitating  special  attention.  The  report 
ends  with  a  plea  for  the  development  of  com- 
prehensive information  regarding  industrial 
morbidity  and  injuries,  and  presents  in  tabular 
form  the  minimum  data  which  should  be  re- 
corded in  this  study  of  industrial  absenteeism. 
—  Wade  Wright. 


Cost  of  Health  Service  ix  Industry. 
Nat.  Indust.  Conference  Board,  Research  Rep. 
No.  37,  May,  1921,  pp.  33. —The  value  of 
this  report  hinges  upon  the  question  as  to 
whether  we  can  generalize  upon  the  matters 
involved  in  it.  It  will  be  widely  quoted  and  it 
gives  a  useful  summary  of  the  amount  of 
money  devoted  by  a  number  of  industries  to 
an  item  of  expense  which  they  call  health 
service.  In  our  opinion  data  as  to  the  cost  of 
"health  service"  with  no  direct  critical  ex- 
amination of  what  the  service  in  individual 
cases  may  be  is  of  little  value. 

In  two  previous  investigations  in  1915  and 
191(3  the  cost  of  health  service  averaged  $1.88 
and  $2.50,  respectively,  per  year.  "The  in- 
formation summarized  in  this  report  (No.  37) 
was  gathered  largely  by  means  of  question- 
naires submitted  to  manufacturing  plants  in 
representative  industrial  communities  through- 
out the  country.  ...  In  the  plants  report- 
ing, a  total  of  764,827  workers  were  employed, 
of  whom  631,582  were  males  and  133,245  were 
females.  The  number  of  workers  per  plant 
varied  from  129  to  39,960."  Two  hundred 
and  seven  plants  located  in  twenty-four  states 
make  up  the  group  studied.  "Forty-nine  are 
in  the  New  England  states,  78  in  the  Middle 
Atlantic  group,  68  in  the  Central  group,  7  in 
the  South  Athmtic  region  and  5  in  the  West- 
ern states."  The  conclusions  reached  are  as 
follows : 

"While  this  study  shows  that  the  cost  of 
health  service  per  employee  has  substantially 


doubled  since  the  estimates  of  1916  were  made 
public,  this  increase  has  not  been  out  of  pro- 
portion to  increased  costs  in  general.  The 
average  cost,  as  shown  by  this  investigation, 
ranges  from  $1.84  per  employee  per  year  in 
the  tobacco  industry  to  $24.40  in  the  mining 
industry,  averaging,  for  all  the  industries  re- 
porting. S-i-JfO  per  employee  per  year.  With  the 
increased  cost  of  health  supervision  during  the 
past  four  years,  however,  has  gone  a  much 
greater  increase  in  scope  of  work  and  service 
rendered.  While  medical  service  was  intro- 
duced primarily  to  care  for  industrial  acci- 
dents occurring  within  the  plant,  its  work 
today,  as  shown  by  this  investigation,  reaches 
into  practically  all  departments  and  into  manj' 
activities  of  the  industrial  organization,  and 
in  certain  cases  even  into  the  home  and  com- 
mimity  life  of  the  management  and  workers. 
Thus,  when  the  various  activities  pursued  and 
services  rendered  by  the  medical  department 
are  considered,  it  becomes  plain  that  a  large 
amount  of  constructive  service  is  given  at  a 
very  moderate  cost." 

The  most  substantial  evidence  which  the 
report  contains  bearing  upon  the  character  of 
the  medical  service  under  study  rests  upon  the 
rather  insecure  foundation  that  in  the  207 
plants  241  full-time  physicians  were  employed. 
These  full-time  men  served  in  only  eighty  of 
the  establishments,  and  the  best  average  ratio 
of  physicians  to  number  of  workmen  found  in 
plants  em])]oying  over  10,000  men  is  one  phy- 
sician to  2,770  workers.  If  we  granted  that 
the  plants  possessing  full-time  physicians  were 
invariably  rendering  effective  health  service, 
we  are  able  to  collect  data  from  Tables  IX  to 
XIV,  inclusive,  of  the  rejjort  which  show  that 
the  cost  of  this  service  is  $6.38  per  employee. 
With  a  variation  in  cost  between  $40.46  per 
employee  in  one  instance  and  $1.21  per  em- 
ployee in  another  it  is  obvious  that  the  char- 
acter of  the  service  differs  enormously  and  any 
figure  representing  average  cost  is  of  com- 
paratively little  value.  Finally,  therefore,  it 
would  seem  to  us  that  the  substantial  and  per- 
manent entrance  of  medicine  into  industry 
justified  a  careful  examination  of  a  limited 
number  of  ])lants  and  a  final  estimate  of  cost 
of  health  service  based  upon  the  real  character 
of  the  service  rendered.  Estimates  lacking 
such  analysis  neglect  the  fundamental  neces- 
.sities  of  the  situation.  —  C.  K.  Drinker. 


lai 


ABSTRACT  OF  THE  LITERATURE 

OF 

INDUSTRIAL  HYGIENE 


Volume  III 


(KTOHKR,   lOei 


Number  (i 


CONTENTS 


General. 


Moa 


Systemic  Occupational  Diseases:  Occurrence,  Treat- 
ment and  Prevention 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc 

Dust  Hazards  and  Their  Effects 


Occupational  Infectious  Diseases:  Occurrence,  Treat- 
ment and  Prevention 

Occupational  Affections  of  the  Skin  and  Special  Senses. 

Occurrence  and  Prevention  of  Industrial  Accidents  . . 

Industrial  Surgery 

Industrial  Physiology :  Nutrition,  Metabolism.  Fatigue, 
etc 


Women  and  Children  in  Industry. 


w.-. 

HI! 
H7 

1** 
lis 

i;m) 

i.s.-, 
i;i7 


Indu.strial  Sanitation:  Factory  Construction,  Illumina- 
tion, \'cntiIation,  Heating,  Water  Supply,  Sewage 
Di-sposal 138 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Iu<lustrial  Plants i:i!) 

Industrial  Nursing 1  H 

Industrial  Personal  and  Community  Hygiene:  Hous- 
ing, etc m 

Industrial  Investigations  and  Surveys IK! 

Iiulustrial  Psychology  and  Industrial  Management  in 
Its  Health  Relations 147 

Industrial  Service  and  Mutual  Benefit  Associations  . .   H7 

Industrial  Health  Legislation:  Court  Decisions:  Work- 
men's Compensation  and  Insurance 1  HI 

Hchabililation  of  Disabled  Employees 1 JO 


GENERAL 


lN'i)t"STRiAL  Disease  anii  Immimty.  Sir 
Kenneth  lioadbi/.  At  a  meeting  lield  on  May  ,'50 
at  tlio  Royal  Society  of  Arts,  Adeli)hi,  an  il- 
luiniiiatiiig  and  iiistruetive  lecture  was  de- 
liveretl  hy  Sir  Kenneth  (loadhy  on  the  subject 
of  industrial  disease  and  ininmnity,  derived 
from  nine  years'  experience  as  S]>ecialist  Ref- 
eree (Home  Office)  for  industrial  diseases.  In 
the  course  of  this  address  many  important  facts 
were  hron^lit  to  notice,  and  ]>rominence  was 
given  to  tlie  hitherto  little  studied  (juestion  of 
the  susceptibility  of  workers  to  the  various  dan- 
gers peculiar  to  their  employment.  The  lecturer 
classified  industrial  disea.se  into  primary  or  in- 
trinsic, due  to  the  handling  of  specific  delete- 
rious material,  and  secondary  or  extrinsic,  in 
which  the  nature  of  the  occupation  excites  a 


|)re<lisp()sition  to  general  diseases,  such  as  tu- 
l)er(ulusis  and  arteriosclerosis.  In  tiie  former 
category  he  inclu<led  those  diseases  cau.sed  by 
bacterial  infection,  notably  anthrax,  arising 
from  the  handling  of  infected  hides  and  hair. 
This  very  grave  disease,  in  spite  of  increased 
antiseptic  precautions,  is  still  prevalent,  al- 
though, as  was  shown  by  a  chart,  the  mortality 
from  it  has  been  considerably  reduced  Ijy 
s])ecifi<'  serum  treatment.  The  problem  of 
susceptibility  to  anthrax  is  one  still  unsolved 
and  much  remains  to  be  learned  as  to  why, 
among  the  many  liable  to  infection,  some  con- 
tract the  disease  and  others  go  scotfree.  Possibly 
the  answer  lies  in  the  greater  or  less  protective 
and  phagocytic  power  inherent  in  certain  of 
the  white  cells  of  the  circulating  blood  of  in- 


121 


122 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


dividuals,  or,  as  was  suggested  in  the  discus- 
sion subsequent  to  the  lecture,  in  the  variable 
resisting  properties  of  the  skin.  For  it  is  a  re- 
markable fact  that  the  palms  of  the  hands,  the 
parts  most  exposed  to  infection,  invariably 
escape,  whereas  the  pliant  skin  of  the  arms  and 
neck  appears  to  be  more  vulnerable  and  to  pro- 
vide a  more  suitable  foothold  for  the  anthrax 
bacillus. 

Among  diseases  arising  from  actual  contact 
with  poisonous  material  were  named  poisoning 
from  trinitrotoluene  (T.N.T.)  and  drugs.  The 
former  only  came  into  prominence  during  the 
war  in  the  preparation  of  explosives;  much 
harm  resulted  and  many  fatal  cases  of  T.N.T. 
poisoning  occurred  among  workers  until  its 
deleterious  action  was  recognized  and,  in  some 
measure,  guarded  against  by  adequate  precau- 
tions. As  with  T.N.T.,  so  with  drugs,  individ- 
ual susceptibility  varies  considerably,  and  a 
striking  instance  of  such  susceptibility  was 
quoted  of  an  employee,  who  was  so  sensitive  to 
the  effects  of  belladonna  that  even  after  re- 
moval from  all  contact  with  that  particular 
drug  the  wearing  of  the  overalls,  which  he  had 
used  in  his  former  work  and  which  carried 
traces  of  the  drug,  was  sufficient  to  produce  a 
return  of  the  belladonna  rash  from  which  he  had 
previously  suffered. 

The  third  class  of  primary  diseases  described 
were  those  due  to  dust,  fumes  and  vapors  in 
connection  with  lead,  arsenic,  mercury,  paint 
and  dope.  Much  important  information  was 
forthcoming  on  the  subject  of  white  lead  and 
leadless  paint,  and  the  readiness  with  which 
complaints  were  attributed  to  lead  poisoning 
was  criticized  as  exaggerated  and  inaccurate. 
Comparisons  of  the  amount  of  invaliding  and 
liability  to  the  development  of  secondary  dis- 
ease, particularly  arteriosclerosis,  were  made 
between  workers  in  white  lead  and  painters 
using  leadless  paint. 

Tables  were  given  showing  that  in  both 
classes  the  tendency  to  arteriosclerosis,  as  evi- 
denced by  recorded  blood  pressures,  increased 
during  the  first  year  of  employment,  and  was 
less  marked  in  the  succeeding  three  years,  by 
which  time  workers  had  acquired  some  degree 
of  imnnmity  to  the  effects  of  tlie  poison;  but  in 
subsequent  years  up  to  fifteen  it  was  evident 
that  this  immunity  tended  to  disappear  and  the 
degree  of  arteriosclerosis  became  more  pro- 
nounced. The  striking  feature,  however,  ap- 
pears to  be  that  the  tendency  to  a  iiigher  blood 
pressure  and  consequent  develojmient  of  ar- 


teriosclerosis was  less  marked  among  the 
workers  in  white  lead  than  among  painters 
using  leadless  paint,  and  this  difference  was 
attributed  to  the  effects  of  turpentine  among 
the  latter  class  of  workers  —  a  reversion  in  fact 
to  the  belief,  which  existed  many  years  ago 
among  house  painters,  that  the  harmful  results 
of  a  painter's  employment  and  the  suscep- 
tibility to  the  influence  of  paint  among  occu- 
pants of  a  newlj'  painted  house  were  due  rather 
to  turpentine  than  to  lead. 

Charts  showing  the  various  employments  in 
which  white  lead  and  leadless  paints,  respec- 
tively, are  used  demonstrated  not  only  the 
greater  liability  induced  by  the  latter  to  the 
development  of  high  blood  pressure  and  its 
harmful  effects,  but  also  the  marked  reduction 
in  the  amount  of  sickness,  as  the  result  of  better 
precautions  for  the  benefit  of  the  individual 
worker  and  of  general  hygienic  improvements 
in  factories  in  recent  years.  Particularly  was 
this  evident  in  the  influence  of  more  adequate 
ventilation  and  space  and  greater  cleanliness 
on  the  amount  of  tuberculosis  among  factory 
workers  and  among  persons  working  with  va- 
rious forms  of  dusts.  Part  of  this  amelioration, 
however,  must  be  attributed  to  the  weeding  out 
of  the  weakly  and  unfit  from  unsuitable  occu- 
pations, as  the  result  of  systematic  medical  in- 
spection. 

Much  undoubtedly  remains  to  be  done,  as 
Sir  Kenneth  Goadby  pointed  out,  to  improve 
still  further  the  conditions  of  factory  work  and 
to  maintain  the  fitness  of  workers.  Much,  too, 
has  yet  to  be  learned  on  the  subject  of  predis- 
I)ositioii  to  occupational  disease,  in  jjarticular 
the  part  i)layed  by  minor  diseases  in  lowering 
natural  immunity.  Research  is  needed  along 
the  lines  advocated  and  alreadj^  introduced  by 
the  lecturer  in  reference  to  the  importance  of 
investigations  into  the  blood  pressure  and 
changes  in  the  blood  itself.  "The  application  of 
such  tests  at  the  preliminary  and  subsequent 
medical  examinations  woukl  he!])  in  eliminating 
those  unfitted  for  particular  emi)loyinent,  and 
the  selection  of  workers  for  specially  dangerous 
occujiations  would  proljably  reduce  the  inci- 
dence of  industrial  poisoning  and  possibly 
render  safe  trades  at  present  regarded  as  dan- 
gerous." 'I'iiere  is  nmch  ground  for  belief  in 
the  truth  of  the  assertion  made  by  Sir  Kenneth 
Goadby  that  industrial  disease  is  a  potent  factor 
in  the  causation  of  imem])loyment.  For  that 
reason  alone  the  subject  demands  the  serious 
attention  not  only  of  the  government  authori- 


ABSTRACTS 


123 


ties,  but  esi)ecially  of  the  trade  unions  and  labor 
organizations. 

The  feeling  of  the  meeting  was  al>ly  expressed 
by  the  Right  Honorable  J.  R.  Clyncs,  who  in 
opening  the  discussion  emphasized  the  vital 
importance  of  the  subject  of  industrial  disease. 
He  fully  endorsed  the  lecturer's  call  to  trade 
unions  to  add  to  their  work  of  relieving  actual 
sickne.ss,  the  safeguarding  of  the  health  of 
workers  —  a  matter  of  more  moment  even  than 
the  intricacies  of  the  wage  problems.  The  ef- 
forts demanded  of  the  medical  profession  aiul  of 
factory  insjjectors  in  pursuit  of  such  a  goal  are 
of  no  light  character  and  would  draw  no  eulogy 
from  Parliament  or  I'rcss;  for  sole  reward  there 
would  be  tiie  .sense  of  duty  done  fttr  the  sake  of 
their  fellow  beings  and  in  the  cause  of  the  health 
of  the  nation.  He  greatly  hoped  that  the 
A\niitley  Councils  would  eventually  be  free  to 
deal  with  this  subject  which,  besides  being  a 
matter  of  great  national  iTn|)ortance,  is  of  such 
mutual  interest  and  beneht  alike  to  em]jloyers 
and  employees. 

The  sub.sequent  speakers  included  Dr.  T.  'SI. 
Legge,  who  dwelt  on  the  value  of  the  education 
of  the  worker  in  matters  of  personal  hygiene 
and  cleanliness,  particularly  in  relation  to  his 
employment,  and  claimed  that  the  ])reventive 
side  of  ])rcventive  medicine  was  too  often  neg- 
lected, which  accounted  for  the  still  too  high 
prevalence  of  many  industrial  diseases. 

Dr.  Halford  Ross  described  the  goo<l  results 
attending  the  efforts  of  the  intlustrial  c(unmis- 
sion  in  the  i)rinter's  trade,  the  successful  meas- 
ures adoi)ted  to  counteract  and  overcome  the 
harmful  etfect  of  fibre  dust  in  the  compositor's 
room,  and  the  great  hygienic  advantages  at- 
taching to  the  use  of  the  photographic  process 
for  ])rinting  in  place  of  the  unhealthy  system  of 
handling  and  setting  up  type. 

Professor  H.  E.  Armstrong  made  a  protest 
against  the  amount  of  official  inspection  to 
which  every  individual  is  subjected  and  which 
is  fast  reaching  a  serious  limit  when  one  will  no 
longer  be  allowed  to  work  without  having  to 
submit  to  blood  pressure  tests.  He  considered 
much  of  the  occupational  disease  among  work- 
ers attributable  to  bad  feeding,  particularly 
poor  quality  of  food,  and  to  bad  teeth.  A  pure 
milk  supi>ly  for  the  laboring  classes  would,  in 
his  opinion,  go  far  to  reduce  liability  to  disease 
of  industrial  origin.  —  Graham  Forbes. 

Industrial  Hygiene.  Neville  Chamberlain. 
Jour.  Roy.  Sanitary  Institute,  Jan.,  1921,  41, 


Xo.  3,  '-230-'234.  —  A  brief  resume  of  the  prog- 
ress of  industrial  hygiene  from  the  fearful  con- 
ditions existent  in  1815,  when  children  often 
worked  from  3.30  .\.m.  to  9.30  p.m.  in  the  sum- 
mer, to  the  model  conditions  existent  today  in 
.some  of  our  best  factories.  The  author  goes  on 
to  say  that,  though  there  is  matter  for  con- 
gratulation in  improved  conditions,  there  is 
none  for  complacency,  for  "industrial  hygiene 
is  still  rather  a  collection  of  experiments  than  an 
organi.sed  science."  lie  believes  that  future 
progress  lies  in  prevention  rather  than  in  ciu^e. 
—  M.Dent. 

Industri.\l  He.\lth:  Its  Value  in  Public 
Hi: \LTH  Service.  E.  L.  CoUi.i.  Internat.  Jour. 
Pub.  Health,  March-April,  Wil,  -2,  No.  i2,  123- 
139.  —  During  the  past  two  hundred  years, 
far  greater  changes  have  taken  i)lace  in  the  life 
of  civilized  nations  than  occurretl  during  the 
previous  four  thousand  years,  and  these 
changes,  which  are  so  profound  and  compara- 
tively sudden,  must  react  upon  the  physical  and 
mental  characteristics  of  the  race.  Modern  in- 
dustry has  brougiit  many  new  influences  into 
existence,  and  at  tlie  .same  time  it  has  ])rovided 
uni(|ue  op])ortunities  for  observing  the  reactions 
that  follow. 

\Vc  may  investigate  the  effects  of  different  in- 
fluences i)y  taking  the  records  of:  («)  industrial 
birth,  as  reflected  in  labor  tiu-nover;  (6)  indus- 
trial life,  indicated  by  time  lost,  out])ut,  indus- 
trial fatigue,  and  industrial  unrest;  and  (c)  mor- 
tality, the  final  result  of  the  stress  and  strain  of 
life.  Investigation  has  shown  that  labor  turn- 
over varies  widely;  that  the  great  majority  of 
workers  leave  without  any  sufficient  reason, 
and  that  only  from  10  to  '2.i  per  cent,  give  ill 
health  as  the  reason,  although  ill  health  is  |)rob- 
ably  an  underlying  cause  in  a  larger  i)roportion 
of  instances.  The  rate  of  labor  turnover  is 
highest  during  early  weeks  and  months  after 
engagement  and  varies  with  age,  juveniles  leav- 
ing more  rapidly  than  adults,  and  the  old  more 
rapidly  than  younger  adults.  Moreover,  the 
rate  is  higher  for  women  than  for  men,  and 
higher  for  married  women  than  for  single 
women.  Labor  turnover  may  be  diminished  in 
three  ways:  through  selection  of  workers, 
through  attention  to  conditions  of  work,  and 
through  close  personal  touch  with  the  workers. 
Steps  taken  to  minimize  labor  turnover  react 
favorably  on  the  whole  of  industrial  life. 

Influences  similar  to  those  aft'ecting  labor 
tiu-nover  also  affect  sickness,  which  varies  with 


124 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


sex,  age,  and  length  of  employment,  there  being 
more  sickness  among  new  workers  than  among 
the  more  permanent  staff.  As  regards  fatigue, 
it  has  been  found  that  when  activity  is  at  its 
best,  output,  beginning  Monday  morning, 
quickly  reaches  a  height  which  is  then  slightly 
increased  during  the  day,  and  on  each  succeed- 
ing day  of  the  week  begins  higher  than  the  day 
before,  and  increases  during  the  day.  A  tend- 
ency for  the  output  to  fall  during  the  afternoon 
of  Monday  is  associated  with  a  tendency  for  the 
output  of  Friday  to  fall  below  that  of  Thursday, 
etc.  Associated  with  these  falls  of  output,  and 
proportional  to  them,  are  high  labor  turnover 
and  increased  lost  time  from  sickness  and  acci- 
dents. When,  with  jjroper  physical  conditions, 
the  output  does  not  attain  the  ideal  form,  there 
is  indication  that  rest  periods  ought  to  be  intro- 
duced. 

Industrial  luirest  is  to  be  considered  also 
among  the  physiological  reactions,  and  inquiry 
into  the  amount  and  kinds  of  morbidity  ex- 
perienced by  industrial  groups  most  liable  to 
unrest  might  show  the  way  to  lessen  liability  to 
that  prolific  form  of  economic  loss  —  the  strike. 
Studies  have  already  showTi  in  one  instance  — 
in  connection  with  the  general  coal  strike  in 
England  and  Wales  in  1920  —  a  relation  be- 
tween mortality  rate  and  tendency  to  strike. 
Mortality  as  related  to  the  conditions  of  various 
industries  requires  much  more  investigation. 

With  regard  to  accidents,  there  is  some  re- 
liable information.  About  80  per  cent,  are 
caused  by  carelessness,  and  they  are  also  in- 
fluenced by  hours  of  work,  by  temperature  and 
by  light.  They  appear  to  depend  more  upon 
the  condition  of  the  health  and  upon  alertness 
than  upon  other  conditions,  and  to  prevent 
them  we  must  improve  the  general  health  of  the 
workers  and  educate  them  to  understand  the 
dangers  associated  with  their  work.  — •  G.  E. 
Partridge. 

Mea.sures  for  Incre,\sing  the  Supply  of 
Competent  Health  Officer.s.  John  A.  Fer- 
rell.  Jour.  Am.  Med.  Assn.,  Aug.  13,  1921,  77, 
No.  7,  ,)1.'!-516.  —  The  author's  sunnnary  is  as 
follows:  "The  demand  for  qualified  health  offi- 
cers already  exceeds  the  supply,  and  the  rapid 
expansion  of  public  health  activities  will  be 
limited  by  the  supply  of  ((ualiffed  health  officers 
to  a  much  greater  extent  than  l)y  a  lack  of  funds. 
Measures  that  have  suggested  them.selvcs  for 
increasing  the  supply  of  ((ualified  men  are: 

"  1 .   The  divorce  of  health  work  from  politics. 


"2.  Increase  in  the  compensation  of  health 
officers. 

"3.  The  acquainting  of  students,  medical 
and  academic,  with  the  opportunities  for 
careers  in  preventive  medicine. 

"4.  Provision  of  advanced  training  in  public 
health  in  a  few  institutions  well  equipped  and 
strategically  located. 

"5.  Teaching  of  public  health  in  medical 
schools. 

"6.  Encouragement  of  federal  and  state  in- 
stitutes for  training  health  workers. 

"7.  Education  of  the  public  to  understand 
and  value  health  work. 

"8.  Provision  of  scholarships  and  fellow- 
ships in  schools  of  public  health  for  present  and 
prospective  health  officers."  —  C.  K.  Drinker. 

The  Health  and  Welfare  of  Postal  Em- 
ployees. An  Interview  with  Hon.  Will  H. 
Hays,  Postmaster  General,  Washington,  D.C. 
Nation's  Health,  July  15,  1921,  3,  No.  7,  387- 
388.  —  Postal  buildings  are  under  the  control 
of  the  Treasury  Department  and  any  repairs 
or  improvements  needed  must  be  obtained 
through  that  department.  All  of  the  benefits 
provided  by  p^i^'ate  institutions  for  their  em- 
ployees are  more  or  less  hard  to  secure  from  the 
government.  Postmaster  Hays  purposes :  "(1) 
to  make  such  rectifications  as  in  all  decency  and 
fairness  must  be  made  to  assure  a  square  deal; 
(2)  to  strengthen  and  broaden  the  Civil  Service 
at  every  i)oint  wherever  possilile  to  the  end  that 
merit  may  govern ;  and  (3)  with  absolute  fidel- 
ity to  put  the  entire  service  u]>on  a  purely  busi- 
ness basis  so  sound  and  so  serviceable  that  no 
political  party  will  ever  again  dare  attempt  to 
ignore  or  evade  it  ultimately."  —  M.  Dent. 

C.\R-PusHiNG  IN  Coal  Mines.  Powers  Hap- 
good.  Survey,  June  4,  1921,  46,  No.  10,  310- 
311.  — .John  Brophy,  president  of  District  No. 
2  of  the  United  Mine  Workers,  suggested  a 
study  of  the  conditions  relating  to  car-pushing 
in  coal  mines,  a  study  which  has  since  been  con- 
ducted and  will  soon  be  printed.  Mine  owners 
and  operators  contend  that  the  evils  are  greatly 
exaggerated,  but  the  soft  coal  miners  say  that 
car-pu.shing  is  injurious  to  many  men  and  tends 
to  shorten  the  working  life  of  the  miner,  and 
that  the  miner  is  able  to  do  the  mining  long 
after  he  is  too  old  to  push  cars.  Some  saj'  that 
the  (•()m])anics  ought  to  haul  the  cars  by  mules, 
hoists  or  reel  motors.  Ca.ses  arc  briefiy  described 
to  support  the  contention  that  the  miners  have 
a  real  grievance.  - —  G.  E.  Partridge. 


ABSTRACTS 


125 


SYSTElVnC  OCCUPATIONAL  DISEASES:  OCCURRENCE,  TREAT:MENT 

AND  PREVENTION 


CIRCULATORY  SYSTEM 

Studies  on  the  Resistance  of  the  Red 
Blood  Cells.  Resistance  of  the  Red  Blood 
Cells  in  Health  to  the  Hemolytic  Action 
OF  Sapotoxin.  Charlet;  Hugh  Xeilsoii  and 
Homer  Wheelon.  Jour.  Lab.  and  Clin.  Med., 
May,  10^1,  6,  \o.  8,  4.54-462.  —  The  authors 
conchide  as  follows: 

"I.  A  rapid  method  is  described  for  the 
determination  of  the  dej^ree  of  resistance  of  the 
red  blood  cells  to  a  specific  hemolytic  agent  — 
sapotoxin.  The  average  maximal  resistance  of 
the  corpuscles  in  the  whole  blood  of  !)!)  individ- 
uals chosen  as  normals  was  a  1 :  i:},7(>!)  strength 
saj)otoxin  solution.  Eighty-six  determinations 
on  IL  W.  over  the  course  of  the  experiments 
averagetl  a  1:14,1.'50  strength  solution.  The 
average  of  all  normal  readings  —  18.5  —  was  a 
1:  13,9.37  solution.  The  average  length  of  time 
for  complete  hemolysis  to  occur  in  a  1:  13, 000 
solution  at  a  constant  tcmiicrature  —  '■2.5°C. — 
was  10.7  tninutes.  'I'lic  average  hemoglobin  as 
determined  by  the  Tall(|vist  hemoglobinometer 
was  91  per  cent,  for  all  cases.  Washed  cor- 
puscles from  I'i  normal  cases  suspended  in 
isotonic  salt  solution  were  foimd  to  show  a  min- 
imal degree  of  hemolysis  in  a  1 :  .'J7,;?7.5  sapo- 
toxin .solution.  Findings  in  luetic,  pregnant, 
and  jaundiced  ca.ses  are  also  given.  Washed 
corpuscles  diluted  1 :  1  with  normal  saline  solu- 
tion gave  practically  a  normal  count,  hence 
mass  action  was  ruled  out  because  of  this  dilu- 
tion. Al.so,  washed  corpuscles  diluteil  1 :  1  with 
their  own  serum  demonstrate  jjractically  the 
same  resistance  against  sapotoxin  as  cells  pre- 
sent in  whole  blood.  The  red  blood  cells  nor- 
mally show  a  remarkable  degree  of  constancy 
in  their  resistance  to  a  specific  hemolytic  agent. 

"  n.  Therefore,  it  may  be  concluded  that  the 
presence  of  the  blood  fluid  about  the  red  cells 
acts  in  such  a  manner  as  to  resist  the  hemolytic 
action  of  sapotoxin."  —  C.  K.  Drinker. 

The  Phagocytosis  of  Solid  Particles. 
in.  Carbon  and  Quartz.  Wallace  0.  Fenn. 
Jour.  Gen.  Physiol.,  May  20,  1921,  3,  No.  5, 
575-593.  —  The  author  summarizes  as  follows: 

"1.  The  rates  of  ingestion  of  qiuirtz  and  car- 
bon particles  by  leucocytes,  when  both  are  in 
suspension  in  serum,  were  compared  with  the 
.availability  of  the  two  particles  as  predicted 


from  the  calculated  chances  of  collision  with  the 
leucocytes,  and  it  was  shown  that  carbon  is  in- 
gested about  4  times  as  readily  as  quartz. 

"2.  The  greater  ease  of  ingestion  of  carbon 
was  verified  by  a  new  method  of  measuring 
phagocytosis,  described  as  the  film  method,  in 
which  the  cells  uigest  particles  as  they  creep 
about  on  a  slide. 

"3.  The  relative  rates  of  ingestion  of  carbon 
and  quartz  depend  upon  the  condition  of  the 
cells,  the  difference  increasing  as  the  phago- 
cytic activity  of  the  cells  decreases. 

"4.  Sponge  cells  also  ingest  carbon  about  3 
times  as  readily  as  quartz. 

"5.  The  hy[)othesis  is  suggested  that  the 
cause  of  the  more  rapid  ingestion  of  carbon  may 
be  identical  with  the  cause  of  the  greater  in- 
stability of  the  carbon  suspensions. 

"().  An  inorganic  analogy  to  this  selective 
phagocytic  action  is  offered. 

"7.  The  application  to  opsonins  and  ag- 
glutinins is  discussed."  —  C.  K.  Drinker. 

MENTAL 

Experiment  to  Determine  the  Possibili- 
ties OF  Subnormal  Girls  in  Factory  Work. 
Klizaheth  B.  Bigelow.  Ment.  Hyg.,  April,  1921, 
5,  No.  2,  302-320.  —  Aided  by  the  temporary 
boom  in  business  due  to  the  war,  and  by  the 
consc(|ncnt  lack  of  suflicient  skilled  workers, 
Miss  Bigelow  was  able  to  conduct,  under  the 
auspices  of  Professor  Arnold  Gesell  of  Yale,  a 
very  interesting  experiment  in  determining  and 
iniTcasing  the  efficiency  of  subnormal  factory 
girls.  The  experiment  was  made  in  a  rubber 
factory,  one  of  the  few  remaining  industries 
where  the  finished  product  is  largely  made  by 
liand  and  where  subdivision  of  Labor  is  still  in 
its  infancy. 

A  tiny  "branch"  of  the  factory  was  set  up  in 
a  separate  room,  and  there  a  small  group  of 
girls  (never  more  than  fourteen)  worked  every 
day  for  eight  months  under  the  careful  super- 
vision of  persons  experienced  in  the  psychology 
of  the  subnormal.  Besides  her  work  record  and 
notes  from  personal  observation  in  class,  a  com- 
plete case  history  was  made  of  each  girl,  and  she 
received  the  Stanford  Revision  Tests,  and  tests 
with  concrete  material  as  well  as  tests  in  visual 
and  auditory  memory  and  motor  control. 
Roughly  speaking,  the  girls  were  divided  into 


126 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


two  classes,  the  imbecile  and  the  moron,  their 
work  was  appropriately  apportioned,  conclu- 
sions formed  and  recommendations  made.  The 
imbecile  group  could  perform  simple,  monot- 
onous jobs  requiring  no  skill  or  mentality.  This 
class  is  usually  dull  and  inactive  and  is  very 
little  trouble  when  once  trained.  The  morons, 
from  8  to  11  years  old  mentally,  are  capable  of 
doing  work  requiring  a  limited  degree  of  intelli- 
gence, and  sometimes  attain  to  quite  a  degree  of 
manual  skill.  They  are  usually  slow  and  require 
constant  supervision,  for  they  cannot  be  relied 
upon  to  be  as  conscientious  as  the  lower 
group. 

Although  the  number  of  cases  studied  was 
small  and  the  time  short,  the  following  con- 
clusions are  of  interest:  It  was  found  that  the 
girls  coidd  be  trained  to  take  pains  up  to  a  cer- 
tain point,  beyond  which  they  could  not  pro- 
gress. Neither  could  they  handle  work  which 
was  at  all  complicated.  Production  was  af- 
fected by  physical  conditions  —  lighting,  seat- 
ing, etc.,  and  by  change  of  work  (monotonous 
jobs  seemed  to  suit  them  best).  When  given  the 
proper  training  they  were  reliable  and  their  per- 
sonal loyalty  was  very  great.  They  were  apt  to 
be  careless  and  were  incapable  of  planning  their 
work.  Curiously  enough,  the  pay  envelope  did 
not  seem  to  interest  them  as  much  as  it  does  the 
normal  worker,  but  stimulus  could  be  provided 
by  strict  discipline,  fear  of  losing  their  jobs,  and 
the  influence  of  workers  of  their  own  class. 

Miss  Bigelow  recommends  that  the  training 
of  subnormals  should  be  carried  on  away  from 


other  workers  by  a  supervisor  of  infinite  pa- 
tience and  tact,  and  she  is  at  some  pains  to  ex- 
plain the  best  methods  for  a  supervisor  to  pur- 
sue. She  urges  the  enactment  of  suitable  state 
legislation  with  reference  to  subnormals,  which 
would  permit  them  to  leave  school  and  go  to 
work  prior  to  the  age  limit  at  present  imposed 
in  most  of  our  states.  Closer  co-operation  be- 
tween the  schools  and  the  industries  would  also 
be  desirable  and  it  would  be  worth  while  for  the 
state  to  pay  a  director  for  training  subnormals 
where  the  industries  are  unwilling  to  assume  the 
expense. 

A  vivid  description  quoted  from  Carleton 
Parker  will  give  to  the  unbeliever  some  idea  as 
to  the  value  of  the  subnormal  in  industry: 
"  'Look  at  that  Slovak  woman,'  said  the  super- 
intendent. She  stood  bending  slightly  forward, 
her  dull  eyes  staring  straight  down,  her  elbow 
jerking  back  and  forth,  her  hands  jumping  in 
nervous  haste  to  keep  up  with  the  gang.  .  .  . 
'  She  is  one  of  the  best  workers  we  have! "... 
We  moved  closer  and  glanced  at  her  face.  Then 
we  saw  a  strange  contrast.  The  hands  were 
swift,  precise,  intelligent.  The  face  was  stolid, 
vague,  vacant.  '  It  took  a  long  time  to  poimd 
the  idea  into  her  head,'  continued  the  superin- 
tendent, '  but  when  this  grade  of  woman  once 
absorbs  the  idea,  she  holds  it.  She  is  too  stupid 
to  vary.  She  seems  to  have  no  other  thought  to 
distract  her.  She  is  as  sure  as  a  machine.  For 
much  of  our  work  this  woman  is  the  kind  we 
want. .  Her  mind  is  all  on  the  table.'  "  — 
Stanley  Cobb. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS: 
CHEMICALS,  ETC. 


GASES, 


Formation  of  Poisonous  Gases  by  Cer- 
tain Forms  of  Gas-Fired  Water  Heaters. 
E.  P.  Schoch.  Abstracted  as  follows  from  Am. 
Gas  Assn.  Month.,  1921,  vol.  3,  pp.  131-142,  in 
Chem.  Abstr.,  May  10, 1921, 15,  No.  9, 1386.  — 
"It  is  shown  that  gas-fired  water  heaters  in 
which  the  flames  touch  the  water  vessels  may 
produce  enough  poisonous  gas  to  be  harmful 
and  even  fatal.  Hence  such  heaters  sliould 
never  be  installed  and  operated  without  being 
connected  to  a  flue.  Experiments  were  made  on 
a  type  of  instantaneous  water  heater,  as  is  often 
used  in  bathrooms,  where  the  flame  touches 
extensively  upon  the  metal  surface  and  is 
cooled  thereby  below  the  ignition  points  of  the 


gases,  thus  allowing  them  to  escape  unburned. 
The  amount  of  CO  formed  is  somewhat  propor- 
tional to  the  areas  touched  by  the  flames.  The 
rate  of  formation  of  CO  is  increased  also  by  the 
variation  in  the  draft  of  the  heater,  and  by  the 
increase  in  supersaturation  of  the  air  with  mois- 
ture." 

Hemato-Respiratory  Functions.  XII. 
Respiration  and  Blood  Alkali  during  Car- 
bon MoNoxiD  Asphyxia.  H.  W.  Haggard  and 
Y.  Henderson.  Abstracted  as  follows  from 
Jour.  Biol.  Chem.,  July,  1921,  47,  No.  2,  421,  in 
Jour.  Am.  Med.  Assn.,\\ug.  13,  1921,  77,  No.  7, 
574.  —  "  Carbon  monoxid  asphyxia.  Haggard 


ABSTRACTS 


1^27 


and  Henderson  state,  induces,  not  acidosis,  but 
alkalosis.  The  lowering  of  blood  alkali  is  due  to 
the  acapnial.  not  the  acidotic.  jirocess.  The 
anoxemia  induces  excessive  breathing  (up  to 
300  per  cent,  or  more),  and  the  decrease  of 
blood  alkali  is  an  attempt  at  compensation. 
The  rate  of  oxygen  consinnption  is  scarcely,  if 
at  all,  decreased  until  death  is  innninent,  but 
the  respiratory  ((uotient  may  be  more  than 
doubled.  After  section  of  the  vagi,  on  the  con- 
trary, anoxemia  due  to  carbon  monoxid  causes 
no  overbreathing,  and  no  distinct  lowering  of 
blood  alkali,  even  uj)  to  death.  This  fact  ap- 
pears to  be  a  decisive  demonstration  that  oxy- 
gen deficiency  itself  does  not  directly  cause  in 
the  tissue  and  blood  an  increased  production  of 
organic  acids."  —  C.  K.  Drinker. 

T.N.T.  I'oisoMNt;  AM)  TMK  Katk  ok  T.N.T. 
IN  THE  Animal  Hodv.  Medical  Research  Coun- 
cil. Special  Report  Series  No.  ,58,  H.M.  Station- 
ery Office,  London,  \i)i^. — This  report  con- 
tains a  paper  by  W.  .\.  O'Donovan  approaching 
the  subject  from  tlie  liistorical,  technical,  ad- 
ministrative, and  clinical  aspects,  as  well  as 
papers  on  the  pliannacology  of  experimental 
T.N.T.  poisoning,  on  the  metabolism  and  fate 
of  T.N.T.  in  the  animal  ImhIv.  and  on  the  ])atli- 
ological  chatiges  protluced  by  T.N.T.  in  animals 
experimentally  poisoned  and  in  the  human  vic- 
tims of  factory  poisoning.  —  M.  C.  Shorley. 

Acute  Nitrobkxzol  Poisoxixg:  Studies 
ON  Blood  in  Two  Case.s.  R.  F.  Loeb,  A.  ]'. 
Boclc,  and  R.  FUz.  Abstracted  as  follows  from 
Am.  Jour.  Med.  Sc,  April,  19-2 1,  1(51,  No.  4, 
539,  in  Jour.  Am.  INIed.  Assn.,  Aug.  '20, 19-21,  77, 
No.  8,  6-13.  —  "Two  young  men  bought  six 
bottles  of  Jamaica  ginger  from  a  stranger.  Both 
agreed  that  this  ginger  did  not  taste  like  ordi- 
nary ginger  but  was  drinkable,  so  that  they  par- 
took freely  of  it.  On  subsequent  analysis  the 
liquid  was  found  to  contain  a  high  percentage  of 


nitrobenzol.  In  about  three  lioiu"s  after  begin- 
ning on  the  first  bottle  one  man  began  to  have 
generalized  headache,  nausea  and  blurring  of 
vision.  He  thought  that  he  fell  on  the  sidewalk 
and  remembered  nothing  further  until  he  woke 
up  in  the  hospital.  The  other  man.  at  about  the 
same  time,  began  to  feel  dizzy  and  nauseated. 
He  did  not  lose  consciousness  but  came  to  the 
hospital  with  his  friend.  At  entry  botii  men 
were  of  a  steel  gray-blue  color,  the  unconscious 
man  looking  particularly  dead  while  his  com- 
])ani()n  was  of  a  ghastly  color  but  in  reasonably 
good  shape.  There  was  nothing  else  especially 
notable  except  that  neither  man  excreted  any 
urine  for  at  least  hours  after  entry  into  the  hos- 
l)ital.  The  stomachs  of  both  men  were  washed 
out  at  once.  The  sicker  man  was  bled  100  c.c  of 
blood  and  transfu.sed  with  000  c.c.  of  normal 
blood.  In  the  middle  of  transfusion  he  sud- 
dcidy  woke  up  and  ap])eared  normal.  The 
.second  man  was  also  transfused,  with  less  dra- 
matic elVect.  Both  men,  however,  felt  ])erfectly 
well  on  the  following  day  and  made  normal  re- 
coveries except  that  the  more  seriously  poi- 
•soned  man  developed  a  mild,  uncomplicated 
|)noMm<)nia.  The  oxygen  capacity  of  both 
bloods  on  the  first  observation  was  markedly 
reduced,  in  one  case  being  only  6.4  volumes  per 
cent.  The  total  hemoglobin  was  not  reduced. 
The  fact  that  nietliemoglobin  was  not  detected 
by  spectroscopic  examination  suggests  that  a, 
large  ])roi)ortion  of  the  hemoglobin  was  changed 
to  Filehnc's  nitrobenzol  hemoglobin.  This  com- 
bination, in  turn,  was  an  easily  destroyed  com- 
|)ound  as  demonstrated  by  the  blood  analysis 
made  twenty-four  hours  later.  By  this  time  the 
apjiearance  of  both  patients  was  much  more 
nearly  normal  and  the  bloods  showed  no  dim- 
iinitioii  in  their  total  hemoglobin,  oxyhemo- 
gloi)in  or  oxygen  capacity.  Leukocytosis  de- 
veloped in  one  case.  The  high-colored,  almost 
i)lack.  urine  excreted  by  these  patients  was 
probably  due  to  para-amido-phenol."  —  C.  K. 
Drinker.  •  , 


DUST  HAZARDS  AND  THEIR  EFFECTS 


Pneitmatic  Systems  for  Removal  of  Dust. 
F.  C.  Allen,  Jr.  Safety  Engin.,  May,  1921,  41, 
No.  5,  226-''2!28.  —  Dust  is  noxious,  dangerous, 
valuable,  and  its  removal  is  imperative  for  eco- 
nomic as  well  as  hygienic  reasons.  The  means 
of  removal  are:    (1)  by  brooms;    (2)  washed 


away  with  a  stream  of  water;  (3)  blown  by  a 
blast  of  air  (compressed  air);  and  (4)  drawn 
into  a  duct  or  conduit  by  an  inflowing  air  cur- 
rent of  suction.  The  fourth  method  is  the  ideal 
and  correct  one.  Its  uses  and  advantages  are 
briefly  described.  —  M.  Dent. 


128 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


OCCUPATIONAL  INTECTIOUS  DISEASES:  OCCURRENCE, 
TREATIVIENT  ANT)  PREVENTION 


Studies  ox  TcBERCULors  Ixfection.  VIII. 
Spont.\neous  Pneumokoxiosis  in  the  Guixea 
Pig.  Henry  Stuart  Willis.  Am.  Rev.  Tuber., 
May,  l9-n,  5,  No.  3,  189-^215.  —The  following 
summary  is  given:  "1.  There  are  anatomic 
differences  between  the  lungs  of  old  and  those 
of  young  guinea  pigs.  These  differences  concern 
themselves  chiefly  with  a  larger  amount  of 
lymphoid  tissue  in  the  older  animals.  The  in- 
crease in  the  amount  of  this  tissue  apparently 
parallels  the  increase  in  age  and  in  dust  content. 

"■2.  Spontaneous  pneumokoniosis  occurs  in 
guinea  pigs  that  have  lived  a  cage  life  for  a  year 
or  longer. 


"3.  The  pigment  is  laid  down  under  the 
pleura  in  spots  and  lines  which  mark  oft'  the 
secondary  lobules.  It  is  also  found  in  the  walls 
of  bronchi  and  blood  vessels,  in  lymph  nodes 
and  lymph  masses  throughout  the  lung.  In  the 
tracheobronchial  nodes  it  is  present  in  con- 
siderable quantity.  Practically  all  of  the  dust 
is  intracellular. 

"■i.  Lymphatics  transport  the  dust  cells  but 
these  vessels  on  section  usually  appear  empty. 

"5.  A  very  slight  fibrosis  occurs  in  the  tra- 
cheobronchial nodes,  the  pleura  and  the  walls  of 
alveoli  that  are  in  the  regions  of  the  dust  de- 
posits." —  C.  K.  Drinker. 


OCCUPATIONAL  AFFECTIONS  OF  THE  SKIN  AND  SPECIAL  SENSES 


How  TO  TREi.\T  Skix  Affectioxs  of  Em- 
ployees. Walter  C.  Allen.  Indust.  Manage- 
ment, March  1,  1921,  61,  Xo.  ,5,  180-181.— 
"Furunculosis  from  contaminated  oils  and 
cutting  mixtures  is  widespread  in  the  industrial 
world.  .  .  .  and  workers  whose  hands  and 
arms  tend  to  chap  are  more  liable  to  these  in- 
fections than  others."  To  combat  cases  of 
furunculosis  the  author  suggests  the  following 
steps : 

1.  Fractional  centrifugation,  sedimentation 
and  sterilization  of  all  used  lubrication  and 
cutting  oils  intended  for  re-use. 

2.  Educating  the  employees  in  order  to  pre- 
vent spitting  into  the  oils,  and  to  reduce  infec- 
tion through  cleanliness. 

3.  Provide  spittoons,  individual  towels,  and 
waste  and  wipe  rags. 

4.  Good  washroom  facilities. 

,5.  An  emollient  skin  protective  to  be  ap- 
plied before  going  to  work. 

6.  A  laundfy  service  to  provide  clean  jackets. 

7.  Dispensary  service.  —  M.  C.  Shorley. 

The  Prevextiox  of  Skix  Troubles  from 
Cutting  Oils  and  Emulsions.  Nat.  Safety 
Council,  Safe  Practices  No.  44,  1921,  pp.  8.  — 
Cutting  oils  and  emulsions  are  used  in  the 
process  of  cutting  metal,  and  are  usually  a  mix- 
ture of  oils.  Lard  oil,  formerly  the  standard, 
is  now  seldom  used  in  a  pure  state,  but  is 
generally  mixed  with  mineral  oils  or  replaced  by 
other  oils.   From  the  use  of  these  oils  a  trouble- 


some skin  affection,  taking  the  form  of  black- 
heads, pimples,  or  boils,  is  sometimes  induced, 
although  some  men  may  work  for  years  and 
have  no  serious  effects.  Men  with  aljundant 
hair  on  the  arms  and  those  with  dry  skin  are 
more  liable  to  the  affection. 

Recent  investigations  made  by  E.  F.  Hough- 
ton and  Company  show  that  mineral  oils 
treated  with  sulphuric  acid  have  certain  ingre- 
dients (principally  the  organically  combined 
hydro-carbon  sulphonates)  which  lodge  in  the 
pores  and  hair  pockets  and  irritate  the  lining 
cells,  but  that  these  may  not  be  the  only  chem- 
ical irritants  in  a  mineral  oil.  The  oils  of  the 
paraffin  series  possess  irritating  properties,  and 
animal  and  vegetable  oils  that  have  a  high  per- 
centage of  free  fatty  acids  are  also  irritating 
to  the  skin.  The  cutting  oils  and  pastes  are 
usually  free  from  germs  when  they  come  from 
the  manufacturer,  but  are  likely  to  become  con- 
taminated in  use,  although  more  often  the 
germs  concerned  in  the  skin  affection  are,  prob- 
ably, on  the  skin.  Another  factor  in  causing  the 
trouble  is  the  scratching  of  the  skin  by  metal 
chips  and  jjarticles,  and  especially  by  the  habit 
among  mechanics  of  using  waste  to  rub  the 
hands  and  arms. 

There  are  three  rules  for  prevention:  (1)  Use 
a  cutting  medium  with  a  mineral  oil  content 
free  from  irritants.  (2)  Keep  the  cutting  fluid 
clean  by  filtration  and  sterilization.  (3)  En- 
courage personal  cleanliness  and  hygiene.  Oils 
of  vegetable  or  animal  origin  used  with  mineral 


1 


ABSTRACTS 


129 


oil  should  be  selected  with  care,  and  those  con- 
taining irritating  properties  should  be  avoided 
as  far  as  possible.  Mineral  oils  can  now  be  ob- 
tained free,  or  nearly  free,  from  chemical  irri- 
tants. Cutting  oils  that  are  used  more  than 
once  should  be  filtered  and  sterilized.  Filtration 
is  done  by  running  the  oil  into  a  filter  cal)inet, 
and  the  best  method  of  sterilizing  is  to  heat  to  a 
temi)erature  of  140°  or  180°F.  for  a  i)eriod  of 
from  twenty-five  minutes  to  one  hour.  Germi- 
cides cannot  be  relied  upon  to  keep  the  fluid  in 
safe  condition. 

Personal  cleanliness  is  very  iniporlant.  and  it 
may  be  said  that  a  clean  unbroken  skin  never 
becomes  infected.  Pro])er  washing  facilitie.s, 
with  plenty  of  hot  water,  soap  (preferably 
li(|uid  or  ])owdcred  soaj)),  brushes  and  towels, 
should  be  i)rovided.  Hard,  stiff  brushes  are  to 
be  avoided.  Oil  should  not  be  wipetl  oflf  the 
arms  but  bathed  away  in  flowing  water.  To 
])reveiit  chapping  lanolin,  vaseline,  or  similar 
ointment  should  be  used,  (lloves  and  oil  cloth 
armlets  are  helpful  in  keeping  out  the  oil  and 
fine  metal  i)articles.  Cuts  and  abrasions 
should  l)c  atl(>nded  to,  and  susceptible  men 
sliould  be  transferred  to  other  work. 

i\lild  atfections  nuiy  be  cured  by  fre(|ucnt 
washing  with  soap  and  hot  water,  and  dusting 
the  arms  with  a  powder  of  e(|ual  parts  of  zinc 
oxide  and  starch  is  good.  Dusting  the  arms 
with  the  powder  before  going  to  work  is  some- 
times i)racticed  as  a  i)reventive  measure. 

Diagrams  of  filtering  and  sterilizing  appa- 
ratus arc  shown,  and  |)lates  illustrating  forms  of 
the  aifcction.  There  is  a  descrijjtion  of  mctliods 
of  projjcrly  installing  circulating  systems  for  oil, 
and  the  rules  of  the  United  States  Public 
Health  Service  for  preventing  the  skin  att'ec- 
tions  discussed  in  the  article  are  given.  —  G.  E. 
Partridge. 

Pyrethrltm  Derm.\titis.  a  Record  of  the 
Occurrence  of  ()ccup.\tional  Dermatoses 
AMONG  Workers  in  the  Pyrethhtm  Indus- 
try. Carey  P.  McCord,  C.  H.  Killcer,  and 
Dorothy  K.  Minster.  Jour.  Am.  Med.  Assn., 
Aug.  6,  19-21,  77,  No.  6,  448-449.  —  The  au- 
thors summarize  as  follows:  "An  occupational 
dermatitis  has  been  found  to  occur  among  the 
workers  engaged  in  the  manufacture  of  pyre- 
thrum  insect  powder.  Chemical  analyses  of 
pyrethrum  have  established  various  constit- 
uents having  irritant  properties.  The  lesions 
noted  are,  essentially,  various  forms  of  derma- 
titis venenata.    They  are  of  mild  severity  and 


quickly  disappear  under  ordinary  treatment. 
Re-exposure  frequently  leads  to  the  re-occur- 
rence of  the  di.sease.  This  dermatitis  may  be 
prevented  by  the  introduction  of  trade  proc- 
esses that  eliminate  the  necessity  of  exposure 
of  workers  to  pyrethrum  diLst  and  powder."  — 
C.  K.  Drinker. 

.\  Case  of  Dermatitis  Due  to  Asparagus. 
C.  Brenning.  Abstracted  as  follows  from 
Derniat.  Wchnschr.,  Oct..  19'2n,  Vol.  71.  851,  in 
.\nh.  IVrniat.  and  Sypii..  May.  19-21,  S,  No. 
;■),  (i(i7.  —  "The  author  reports  the  ca.se  of  a 
I)atient  who  suddenly  became  sensitized  to 
asparagus  after  having  worked  with  it  for  eight 
years.  .\  dermatitis  was  produced  on  the  arms 
which  after  healing  was  ex])erimentally  repro- 
duced i)v  application  of  asparagus."  —  M. 
Dent. 

What  Constitutes  Indu.strial  Blind- 
ness.^ Edward  Stiereii.  Nation's  Health,  June 
15,  1931,  3,  No.  6,  369-370. —The  erroneous 
idea  prevails  that  the  fractions  u.sed  by  ojihthal- 
mologists  everywhere  rcitresent  loss  of  vision. 
Visual  acuity  of  '20  SO,  for  example,  does  not 
represent  a  loss  of  one-third  of  vision,  but  a  loss 
of  5  per  cent.  An  acuity  of  20/40  means  10  per 
cent,  loss  of  vision,  and  so  on  until  we  reach 
•20  4'20  when  we  have  industrial  blindness. 
That  is,  an  eye  incapable  of  reading  the  'i'iO 
foot  line  at  20  feet  is  blind  in  the  sense  that  it  is 
not  fit  to  do  any  kind  of  work.  The  most  e(|ui- 
table  adjustment  of  compensation  would  seem 
to  be  to  use  the  percentage  basis  thus  indicated 
and  make  payments  definitely  proj)ortional  to 
the  actual  degree  of  loss  of  vision.  —  G.  E. 
Partridge. 

Superficial  Injuries  to  the  Eye  in  In- 
dustry. Ernest  F.  Hoyer.  Am.  Jour.  Nursing, 
]May,  1921,  21,  No.  8,  530-5.S2.  —Statistics  of 
the  State  Board  of  Labor  and  Industries  in 
Ma.ssachu,setts  show  that  more  than  6,000 
cases  of  injuries  to  the  eyes  have  been  reported 
during  one  year.  An  important  rule  for  nurses 
is  that  "all  injuries  to  the  eye  are  serious."  The 
distinction  between  major  and  minor  injuries  is 
not  applied  to  the  eye,  and  if  an  injured  eye  is 
treated  by  an  unskilled  person,  disastrous  re- 
sults may  follow. 

Four  kinds  of  superficial  affections  of  tlie  eye 
are  mentioned  and  simple  treatment  explained. 
These  are:  foreign  body  in  the  eye;  conjunctivi- 
tis; burns  and  scalds  of  the  eye;  electric  ophthal- 


130 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


mia.  The  treatment  for  foreign  body  in  the 
eye  is:  cleanse  with  boric  acid  sohition,  one  or 
two  drops  of  cocaine  sohition,  evert  the  upper 
lid,  remove  the  foreign  body  with  a  small  piece 
of  cotton  wound  on  a  wooden  applicator.  Ap- 
ply a  drop  or  two  of  10  per  cent,  solution  of 
argj-rol.  Particles  lying  loose  in  the  conjunc- 
ti^•a  or  on  the  cornea  are  easily  removed  with  a 
sterilized  platinuni  wire  loop  fixed  to  a  handle. 
Conjunctivitis  is  treated  with  a  25  per  cent, 
solution  of  argyrol,  followed  by  irrigation  with 
boric  acid  solution.  The  treatment  is  gi\-en 
three  or  four  times  a  day.  Care  should  be  taken 
to  instruct  patients  so  that  they  will  not  infect 
others.  Burns  require  boric  solution,  and  a 
drop  of  '•2  per  cent,  solution  of  cocaine  in  castor 
oil  or  Nujol.  Then  as  later  treatment  2  per 
cent,  picric  acid  ointment,  preceded  by  a  drop 
of  cocaine  two  or  three  times  a  day,  should  be 
used.  Electric  o])hthalmia  is  very  common 
.where  electric  welding  is  done.  There  is  severe 
pain  in  the  eyes,  swelling  of  lids,  and  burning 
sensation.  The  treatment  consists  of  saline 
solution  and  relief  with  cocaine  solution.  After- 
wards colored  glasses  should  be  worn. 

"All  kinds  of  safety  eye  protectors  are  in  use, 
but  the  perfect  protector  —  one  that  does  not 
cut  off  too  much  light,  is  strong,  and  does  not 
rust,  does  not  press  the  face  and  heat  the  eye  — 
has  up  to  the  present  time  not  been  invented." 
Men  will  often  prefer  to  take  risks  rather  than 
wear  something  uncomfortable,  and  even  after 
an  accident  will  accept  the  risk  again.  An  edu- 
cational campaign  would  help  to  produce  better 


co-ordination  between  safety  committee  and 
workingman  and  better  understanding  between 
employer  and  employee.  —  G.  E.  Partridge. 

The  Economic  Aspect  in  Eye  Injuries: 
A  Plea  for  Early  Treatment.  T.  Lister 
Uewellyn.  Brit.  Med.  .Tour.,  Jan.  22,  1921,  1, 
No.  3134,  118-120.  —  This  paper  is  based  on  an 
analysis  of  the  total  accident  claims  on  North 
Staffordshire  coal  and  iron  owners  for  the  past 
two  years.  The  author  takes  as  proof  for  his 
argument  163  eye  cases,  in  which  incapacity 
lasted  four  weeks  or  more  and  compensation 
claims  were  made.  If  these  men  had  had  the 
foreign  bodies  removed  immediately  after  the 
injury  much  needless  waste  would  have  been 
avoided. 

The  author  summarizes  as  follows :  "  What  is 
the  jjosition  of  the  workman  and  employer  at 
the  end  of  the  period  under  review? 

'^Worhmen.  —  Forty-four  men  have  lost  the 
use  of  one  eye  and  nineteen  have  developed 
nystagmus. 

"Settled  for  lump  sum 19 

"Working  full  time 98 

"On  half  difference 11 

"Playing 35 

"Time  lost  at  five  turns  a  week  17,250  shifts. 
"Employer. 

"Loss  of  output  corresponding  to  time  lost  by 
workmen. 

"Expenditure  in  compensation,  £8,286. 
"Liability  of  sixty-eight  unsettled  cases."  — 
M.  Dent. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Accident-Preventing  Education.  H.  H. 
Herdman.  Survey,  May  28,  1921,  46,  No.  9, 
274-275.  —  During  the  nineteen  months  when 
the  country  was  at  war  50,150  American  sol- 
diers were  killed  and  200,000  wounded;  and 
during  the  same  period  126,000  Americans  were 
killed  pursuing  the  arts  of  peace,  and  2,000,000 
were  wounded.  In  the  city  of  Portland,  Oregon, 
there  were,  in  1920,  10,038  traffic  accidents  and 
in  the  logging  industry  for  a  two-year  period 
ending  in  June,  1920  there  were  4,245  lost-time 
accidents. 

The  Oregon  and  Columbia  Basin  Division  of 
the  National  Safety  Coimcil  is  co-operating 
with  the  state  school  department  in  a  plan  for 
accident-preventing  education  to  be  conducted 
as  a  part  of  the  state  curriculum,  the  intention 


being  to  co-ordinate  the  work  with  the  subject 
of  civics,  which  extends  from  the  primary  grade 
through  the  eighth  grade.  A  course  has  been 
prejiared  by  a  committee  of  five  teachers,  which 
will  emphasize  the  positive  aspects  of  the  sub- 
ject. —  G.  E.  Partridge. 

Industrial  Safety  Organization.  Nat. 
Safety  Council,  Safe  Practices  No.  42,  March 
7,  1921,  pp.  16. — The  first  five  pages  of  this 
pamphlet  contain  the  essentials  of  successful 
accident  prevention;  the  remainder  details  sug- 
gestions for  the  safety  engineer,  the  various 
safety  committees,  and  the  foremen. — M.  Dent. 

Safety  Problems  of  Tod.\y.  An  Interview 
with  W.  E.  Worth.    Nat.  Safety  News,  June, 


ABSTRACTS 


131 


1921,  3,  No.  16,  3-4.  —  The  two  big  problems 
of  the  safety  man  today  are:  (1)  convincing  the 
management  that  safety  work  should  be  con- 
tinued without  interruption;  and  {'i)  maintain- 
ing and  improving  the  safety  morale  of  em- 
ployees. 

The  cry  today  in  business  is  economy.  Op- 
erating departments  have  been  cut  and  inves- 
tigations made  into  the  running  of  the  plant 
with  an  eye  to  economy.  If  the  safety  depart- 
ment has  been  improfitable  and  badly  organized, 
it,  too,  should  be  cut.  But  the  careful,  inteUi- 
gent  manager  should  remember  that  an  acci- 
dent now  is  a  more  expensive  proposition  tiian 
the  same  accident  wiicn  his  plant  was  running 
full  blast.  And  at  present,  when  men  do  several 
kinds  of  work  besides  their  regular  job,  the  pos- 
sibility of  accidents  is  far  greater. 

The  present  slack  jieriod  gives  opportunities 
to  make  physical  improvements  for  accident 
prevention  and  to  re-establish  the  personal 
touch  with  the  men  which  has  disappeared  in 
recent  years.  The  safety  man  must  keep  the 
employee  from  worrying  about  losing  liis  job, 
for  a  man  who  is  worried  and  absent-minded  is 
prone  to  accidents. 

"The  industrial  manager  who  di.scontinues  or 
.suspen(Ls  his  safety  work  nuist  realize  that  his 
failure  to  '  carry  on  '  is  not  only  jioor  business, 
so  far  as  his  own  property  is  concerned,  but  a 
detriment  to  the  movement  as  a  whole  anil  to 
the  thousands  of  other  enii)loyers  who  have 
faith  in  it."  —  M.  C.  Shorlev. 


Safety  in  Rel.vtion  to  Electkkai.  Ap- 
PLi.\NCES.  Dana  Pierce.  Safety  Engiii.,  May, 
1921,  41,  No.  5,  206-212.  —  Electricity  may 
cause  accidents  in  two  ways  —  b.^'  shock  and  by 
burns;  to  these  may  be  added  the  liazanLs  of  a 
mechanical  nature.  For  protection  against 
shock  current-carrying  parts  should  be  insu- 
lated, appliances  should  be  grounded,  as  should 
also  the  enclosiu-e  frames  and  non-current 
carrying  metal  parts  of  equipment.  Some  rules 
are  given  for  this  sort  of  protection. 

Enclosing  apparatus  in  tight  cases,  isolating 
it,  providing  goggles  and  protective  clothing  are 
advised  for  protection  against  burns.  The 
hazards  of  a  mechanical  nature  are:  explosions 
of  fuses,  gas  or  dust  explosion,  moving  parts  of  a 
controller,  phase  reversal,  unexpected  starting, 
over-speed,  lack  of  emergency  stop  at  point  of 
operation,  over-travel,  failure  of  power,  and 
over-loaded  current. 


Electricit}^  can  be  made  safe.  New  inventions 
should  be  followed  and  applied  in  safeguarding. 

—  R.  M.  Thomson. 

Dehydration  Equipment  as  Safety'  Field. 
Safety  Engin.,  June,  1921,  41,  No.  6,  283-284. 

—  "To  secure  the  .safe  and  i)roper  construction 
of  dehydrating  i)lants,  the  following  advice  is 
given:  '  The  deiiydrator  proper  should  be  built 
of  incombustible  material  —  either  brick,  con- 
crete or  interlocking  tile.  The  shed  or  structure 
built  over  the  deiiydrator  may  be  of  frame,  but 
it  should  be  o])en,  substantially  built,  and  prop- 
erly insulated  from  the  deiiydrator. 

'"All  air  carriers  from  the  furnace,  if  this  sys- 
tem is  used,  should  be  of  incombustible  ma- 
terial. The  heating  apparatus  should  be  also  of 
such  material  that  it  will  easily  transmit  the 
heat  to  the  surrounding  air,  and  yet  will  per- 
manently .separate  tlie  o])en  flame  from  the  air 
used  in  tiic  deiiydrator.  This  rule  is  of  primary 
importance.  Where  oil  is  the  fuel,  sumps  in 
front  of  the  furnaces  should  be  avoided  if  grav- 
ity fuel  feed  is  used. 

"'.Vll  electric  wiring  should  be  in  conduit. 
Fans,  when  of  the  blower  type,  should  be  pro- 
tected by  a  wire  mesh  screen  that  will  prevent 
entrance  of  sparks  into  the  air  chamber. 

"'Precautions  should  be  taken  to  have  a 
simple  and  easily  manipulated  heat  control  de- 
vice which  shall  be  at  all  times  under  the  ob- 
servation of  the  employee  whose  duty  it  is  to 
control  the  air  drafts.  This,  of  course,  is  as  es- 
sential to  the  ])roper  jjreparation  of  the  product 
as  it  is  for  tire  prevention.'  "  —  M.  Dent. 

Dangers  from  Pulverized  Coal.  Ab- 
stracted from  U.  S.  Bur.  Mines,  Rep.  Investiga- 
tions, 1921,  in  Factory,  July,  1921,  27,  No.  1, 
76,  78.  —  "Since  the  introduction  of  pulverized 
coal  as  a  substitute  fuel  for  natural  gas  in  the 
various  types  of  heating  furnaces  used  in  steel 
mills,  a  number  of  fires  and  explosions  have 
occurred,  resulting  in  lo.ss  of  life  and  property." 
It  is  recommended  that  storage  bins  for  pulver- 
ized coal  should  not  be  placed  in  any  position 
where  they  may  become  heated;  that  pulver- 
ized coal  should  not  be  delivered  to  bins  at  a 
high  temperature;  and  that,  if  a  plant  has  been 
shut  down  for  a  few  days,  coal  should  not  be 
delivered  fom  the  storage  bins  to  the  place  of 
consumption  until  an  examination  is  made  to 
find  out  whether  the  coal  has  become  heated  to 
such  a  point  that  it  will  ignite  when  brought  in 


132 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


contact  with  a  current  or  blast  of  air. 
Shorley. 


M.  C. 


Tests  of  Miners'  Flame  Safety  Lamps  in 
Gaseous,  Coal-Dust-Laden  Atmospheres. 
L.  C.  Ilsley  and  .1.  B.  Hooker.  Abstracted  as 
follows  from  U.  S.  Bur.  Mines,  Rep.  Investiga- 
tions, No.  2199,  19'-20,  in  Chem.  Abstr..  May  20, 
1921,  15,  No.  10,  1424.  —  "Coal  dust  powdered 
to  200-niesh  was  added  to  the  methane-laden 


atmosphere  of  the  special  gallery  at  the  Pitts- 
burgh Station  and  its  effect  on  various  types  of 
safety  lamps  noted.  Thirteen  failures  from  a 
total  of  50  tests  with  unbonneted  lamps  oc- 
curred, 2  of  which  were  caused  by  the  presence 
of  coal  dust.  The  authors  conclude  that  un- 
bonneted lamps  are  less  safe  in  atmospheres 
containing  the  dust,  and  future  tests  of  flame 
lamps  are  to  include  a  certain  proportion  made 
in  dusty  atmospheres." 


INDUSTRIAL  SITRGERY 


Focal  Infections  as  Affecting  Trivial 
Injuries.  C.  D.  Selhij.  Mod.  Med.,  April, 
1921,  3,  No.  4,  229-230.  —  Trivial  injuries  are 
likely  to  be  afl^ected  by  focal  infections,  and  the 
relation  of  infection  to  these  slight  injuries  pre- 
sents problems  in  connection  with  compensa- 
tion that  need  to  be  considered.  We  should 
know  what  kinds  of  trivial  injuries  are  most 
likely  to  be  followed  by  infection  of  focal  origin, 
and  when  injuries  of  this  type  occur,  foci  of  in- 
fection should  be  looked  for  and  eradicated. 
Questions  of  the  validity  of  claims  for  compen- 
sation for  disaliilities  due  to  metastatic  infec- 
tion, said  to  be  caused  by  injuries  in  them- 
selves not  disabling,  are  often  puzzling;  but  if 
the  injury  is  proved,  the  pathology  of  the  af- 
fected part  definite,  and  the  existence  of  the 
focus  of  infection  established,  the  validity  of  the 
claim  has  presumption  in  its  favor. 

The  most  common  kinds  of  slight  injury  in 
which  metastatic  infections  are  to  be  exjjected 
are:  (1)  sim])le  fracture  of  a  terminal  ])halanx; 
(2)  contusion  of  the  end  of  a  digit;  (3)  sprain, 
particularly  of  the  knee,  wrist,  ankle,  elbow, 
shoulder  and  hip  joints;  (4)  strain,  especially  of 
the  back,  deltoid  and  gluteus  muscles.  All 
joint  injuries  and  all  contusions  of  the  muscles 
except  very  trivial  ones,  therefore,  require  pre- 
cautions. The  mouth  should  be  examined  for 
bad  teeth,  the  tonsils  inspected,  the  sinuses  ex- 
amined, and  the  history  should  be  taken  for 
evidence  of  focal  infection,  including  chronic 
intestinal  intoxication  and  gcnito-nrinal  infec- 
tion, for  which  laboratory  tests  should  be  made, 
if  necessary.  If  foci  are  discovered,  they  should 
be  removed,  if  j)ossible.  —  G.  E.  Partridge. 

Studies  in  Wound  Infection.  S.  R.  Doug- 
las, A.  Fleming,  and  L.  Colebrook.  Med.  Re- 
search Council,  Special  Rejxjrt  Series  No.  57, 
H.  M.  Stationery  Office,  London,  1920,  pp.  59. 


—  This  pamphlet  is  divided  into  thee  parts: 
first,  a  statement  of  the  nature  of  the  cases 
treated,  methods  of  treatment  employed,  and 
sonje  of  the  conclusions  arrived  at;  second,  a 
detailed  accoiuit  of  the  characteristics  of  the 
various  bacteria  isolated  from  the  wounds ;  and 
third,  experimental  work  bearing  upon  the  ac- 
tion of  certain  antiseptics  in  infected  wounds. 
The  authors  sunnnarize  the  results  of  their  ex- 
perimental work  as  follows: 

"1.  Two  simple  cup-shaped  wounds  have 
served  us  as  test  tubes  by  means  of  which  the 
action  of  certain  antiseptics  and  of  hypertonic 
salt  solution  —  as  well  as  the  reactions  of  the 
tissues  to  these  substances  —  could  be  studied 
in  vivo. 

"2.  The  ai)plication  of  eusol,  Dakin's  solu- 
tion, and  solutions  of  chloramine  T  to  these 
wounds,  in  such  a  manner  as  to  give  the  anti- 
septic the  best  possible  chance  of  exercising  its 
bactericidal  cH'ect,  caused  no  appreciable  reduc- 
tion in  tlio  bacterial  flora  of  the  wounds.  Owing 
to  technical  difliculties,  the  analogous  experi- 
ment with  flavine  did  not  give  a  clear  result, 
but  it  can  be  .said  that  nothing  like  a  complete 
bactericidal  effect  was  obtained. 

"3.  The  effective  strength  of  eusol  and 
Dakin's  solution  is  very  rapidly  dissipated  by 
contact  with  the  tissues  when  a])])lied  even  to  a 
perfectly  clean  woimd.  Within  ten  minutes 
their  liypochlorite  concentration  is  reduced  by 
at  least  80  ])cr  cent,  and  their  bactericidal  value 
has  become  practically  nil.  Very  much  the 
same  applies  to  chloramine  T.  (It  is  probable 
that  a  still  greater  loss  of  strength  would  have 
been  recorded  if  these  antiseptics  had  been  ap- 
plied to  woimds  in  which  there  was  a  large 
accumulation  of  leucocytes,  a  condition  which 
fretiucntly  olitains  in  surgical  practice  and, 
especially,  when  Carrel's  system  of  intermit- 
tent irrigation  is  employed.) 


ABSTRACTS 


133 


"  In  the  case  of  flavine  a  similar  but  slower  re- 
duction in  strength  occurs  as  the  dye  becomes 
combined  with  the  tissues  of  the  wounds;  and  in 
this  case  —  as  with  all  other  dyes  tested  —  a 
further  serious  loss  of  effective  strength  occurs 
through  fixation  of  the  dye  by  the  cotton  and 
other  faljrics  which  are  habitually  employed  for 
dressing  wounds. 

"4.  In  view  of  these  serious  drains  upon  the 
effective  strength  of  antiseptics  in  a  wound,  the 
question  naturally  arose  —  Is  there  a  sufficient 
amount  of  the  antisei)tic  agent  left  in  the  wound 
to  exercise  a  l)actericidal  effect?  Tiiis  problem 
was  investigated  liy  dctorniining  the  effect  of 
various  strengths  of  antiseptic  solutions  upon 
bacteria  suspended  in  scrum.  In  tiic  case  of 
eusol  and  Dakin's  .solution  it  was  found  that 
a  hypochlorite  concentration,  comparable  to 
that  which  remains  in  a  wound  .)  minutes  after 
its  a])])lication,  was  not  only  incai)able  of  re- 
straining the  growth  of  microbes  in  serinn  but 
actually  xtinnilatcd  the  growth  of  certain  types 
to  a  very  marked  degree.  In  the  case  of  flavine, 
concentrations  of  1  in  I, ()()()  to  1  in  1  (!,(•()()  were 
found  to  be  necessary  to  inhibit  the  growth  of 
Staphylococcus,  according  to  the  number  of 
cocci  emjiloyed  for  the  test  —  and  it  ap])ears 
unlikely  that  such  concentrations  as  this  remain 
active  in  the  wound  for  any  length  of  time 
after  the  application  of  a  1  in  1,000  solution. 

"The  stinmlation  of  microbic  growth  in 
serum  was  not  confined  to  the  hy|)ochlorite 
solutions,  being  demonstrated  al.so  with  car- 
bolic acid,  iodine,  chioramine  T,  and  malachite 
green  solutions.  It  did  not  occur  equally  with 
all  bacteria. 

",5.  In  Section  0  it  is  shown  that  all  the 
antiseptics  in  use  have  a  destructive  action  on 
the  leucocytes,  and  this  destructive  action  oc- 
curs in  a  lower  concentration  than  is  nece.s.sary 
for  a  lethal  action  on  the  bacteria.  Wright, 
Fleming,  and  Colebrook  have  demonstrated  the 
very  striking  bactericidal  efficiency  of  leuco- 
cytes when  provided  with  the  requisite  condi- 
tions for  their  functioning.  In  the  cavity  of  a 
wound  to  which  an  antiseptic  has  been  a])])lied 
such  leucocj'tic  destruction  of  microbes  will  be 
put  out  of  action  for  a  time  varying  with  the 
rate  of  dissipation  of  the  antiseptic,  and  in  this 
way  it  may  again  happen  that  the  balance  of 
advantage,  following  the  employment  of  such 
an  agent,  will  be  with  the  bacteria  rather  than 
the  patient. 

"6.  It  has  been  suggested  that  certain  anti- 
septics, although  incapable  of  exerting  a  di- 


rectly bactericidal  effect  in  the  wound,  may  yet 
contribute  something  indirectly  to  the  anti- 
bacterial processes  by  provoking  a  physiological 
reaction  on  the  part  of  the  tissues.  It  has  also 
been  stated  as  a  fact  of  clinical  ob.servation  that 
the  .sei)aration  of  sloughs  in  infected  wounds  is 
hastened  by  the  use  of  Dakin's  solution.  In 
this  connection  our  experiments  .showed  that 
the  application  of  hypochlorite  .solutions  re- 
sulted in  an  increased  exudation  of  lym])h 
which  sometimes  lasted  over  a  period  of  several 
hours  —  and  al.so  that  this  lymph  differed  from 
that  normally  passing  into  the  wound  in  that  its 
antitryptic  power  was  much  reduced.  This 
latter  result  may  hel])  to  exjilain  how  the  anti- 
septic has  promoted  (sic)  the  se])aration  of 
sloughs.  In  our  experiments  —  which  were 
done  with  clean  wounds  —  its  ap])lication  led 
merely  to  a  diminution  of  the  antitryj)tic 
power  of  the  exuded  lymph  (presumably  by  dis- 
integration of  leucocytes),  but  in  a  foul  wound 
full  t)f  dead  leucocytes,  it  is  probable  that  the 
same  ])rocess  woultl  make  the  discharges  ac- 
tively tryptic,  or  increase  the  amomit  of  tryptic 
ferment  already  liberated  in  the  wound,  and 
thus  lead  to  the  digestion  of  sloughs. 

"  In  a  wound  already  free  from  sloughs,  on 
tiic  other  haiul,  it  would  seem  tliat  no  useful 
l)uri)o.se  can  be  served  by  the  increased  flow  of 
lymph  of  reduced  antitryptic  power  obtained 
by  this  means.  Wright  has  .shown  that  what  is 
re(|uire(l  in  such  a  wound  is  not  so  much  a  flow 
of  lym|)h  as  an  abundant  emigration  of  leuco- 
cytes and  the  maintenance  of  oi)tinuun  con- 
ditions for  their  functioning.  The  u.se  of  anti- 
septic solutions  is  directly  ojjjwsed  to  theseaims. 

"7.  The  effects  of  introducing  hy])ertonic 
salt  solution  into  a  wound  were  studied  and 
found  to  be  as  follows: 

"  (a)  An  immediate  and  marked  increase  in 
the  exudation  occurring  into  the  wound  cavity, 
this  increase  being  greater  than  that  obtained 
by  the  irritant  action  of  any  antisei^tic  solution. 

"(6)  The  exudate  .so  obtained  did  not  con- 
sist merely  of  watery  fluid,  as  had  been  some- 
times alleged,  but  was  rich  in  albuminous  sub- 
stances. 

"(c)  The  emigration  of  leucocytes  into  the 
wound  was  suspended  for  a  time  but  gradually 
returned  to  normal  as  the  sodium  chloride  con- 
centration of  the  fluid  fell  away.  An  abxmdant 
emigration  of  leucocytes  took  place  when  the 
wound  contained  physiological  salt  solution. 

"These  findings  agree  in  every  particular 
with  the  results  of  experiments   in  vitro  pub- 


134 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


lished  by  Wright  in  the  early  days  of  the  war. 
He  also  demonstrated  very  clearly  that  the  dis- 
integrative action  of  5  per  cent,  salt  solution 
upon  the  leucocytes  of  pus  led  to  a  liberation  of 
tryptic  ferment,  and  upon  this  basis  advocated 
the  frequent  aj^plication  of  the  solution  in  the 
treatment  of  slough-covered  wounds. 

"Wright's  work,  together  with  the  series  of 
experiments  here  described,  enables  us  to  piece 
together  the  cycle  of  events  occurring  after  the 
instillation  of  5  per  cent.  s:ilt  solution  into  a 
wound,  somewhat  as  follows: 

"First  20  minutes.  Rapid  exudation  of 
lymph;  liberation  of  tryptic  ferment  by  disin- 
tegration of  leucocytes  present  on  the  surface  of 
the  wound,  in  sloughs,  and  free  in  the  pus  (this 
ferment,  however,  will  not  be  able  to  exert  its 
full  digestive  effect  until  the  salt  concentration 
has  fallen  considerably) ;  emigration  of  fresh 
leucocytes  almost  entirely  suppressed;  con- 
centration of  the  salt  solution  falling  roughly  to 
one-half  its  original  content. 

"  Second  20  minutes.  Less  rapid  exudation  of 
lymph,  but  the  antitryptic  power  has  been  abol- 
ished owing  to  the  disintegration  of  leucocytes 
by  the  salt  solution,  which  has  now  diffused  into 
the  walls  of  the  wound;  digestion  of  sloughs  by 
the  tryptic  ferment  in  the  cavity  of  the  wound 
becoming  very  active;  emigration  of  leucocytes 
recommencing;  concentration  of  salt  solution 
falling  further  —  to  1.5  or  2  per  cent. 

"Third  20  minutes.  Exudation  again  less 
abundant  but  still  more  than  normal  owing  to 
the  high  sodium  chloride  content  of  the  tissues; 
lymph  distinctly  tryptic;  digestion  of  sloughs 
proceeding  at  maximal  rate;  emigration  of  leu- 
cocytes becoming  more  abimdant;  concentra- 
tion of  salt  solution  nearing  the  isotonic  level. 

"Second  hour.  Little  change  in  rate  of  exu- 
dation —  the  lymph  less  tryptic  or  becoming 
slightly  antitryj>tic;  digestion  of  sloughs  con- 
tinuing but  not  quite  so  actively  as  before;  emi- 
gration of  leucocytes  at  normal  rate  and  some 
of  them  undergoing  natural  disintegration,  so 
reinforcing  slightly  the  tryptic  ferment.  As  the 
wound  becomes  progressively  cleaner  the  se- 
rous exudate  will  tend  to  have  a  greater  anti- 
tryptic value  and  will,  therefore,  be  enabled  to 
exert  its  antibacterial  jirojierties  u])on  any 
sero-saprophytic  bacteria  that  niav  be  present." 
—  M.  C.  Shorley. 


The  Treatment  of  Acid  and  Alkali 
Burns.  A.  K.  Smith.  Mod.  Med.,  April,  1921, 
3,  No.  4,  232-233.  —  Strong  caustics,  when  ap- 
plied to  the  skin,  immediately  unite  with  it, 
killing  the  tissues  to  a  depth  proportionate  to 
the  strength  and  quantity  of  the  caustic,  and 
the  wounds  they  cause  are  conveniently  classi- 
fied in  the  same  manner  as  true  burns.  First  aid 
must  be  immediate,  and  probably  the  most 
valuable  treatment  is  the  shower  bath,  which 
should  be  used  before  any  attempt  is  made  to 
remove  clothing,  in  an  effort  to  put  a  large  vol- 
ume of  water  between  the  caustic  soaked  cloth- 
ing and  the  skin.  Then  a  saturated  solution  of 
bicarbonate  of  soda  is  to  be  used  in  the  case  of 
an  acid  burn,  and  a  2  per  cent,  solution  of 
acetic  acid  when  the  injury  is  caused  by  an 
alkali. 

Directions  are  given  for  the  treatment  of  in- 
juries of  each  degree,  for  shock,  and  for  injuries 
to  the  eye  by  caustics.  —  G.  E.  Partridge. 

Musculature  of  Foot  and  its  Treat- 
ment BY  Electricity.  G.  M.  Levick.  Ab- 
stracted as  follows  from  Jour.  Orthop.  Surg., 
July,  1921.  3,  No.  7,  317,  in  Jour.  Am.  Med. 
Assn.,  Aug.  13,  1921,  77,  No.  7,  575.  — 
"Little  describes  a  method  of  electrical  treat- 
ment of  the  foot  which  is  recommended  as  a 
preliminary  to  voluntary  exercise,  as  insepa- 
rable from  the  satisfactory  treatment  of  flat 
foot.  Often  it  is  extremely  difficult  or  impos- 
sible to  redevelop  the  small  muscles  by  volun- 
tary exercise  alone.  This  applies  especially  to 
those  cases  that  have  been  repostured  by  sur- 
gical methods,  so  that  they  are  suddenly  relaxed 
after  a  long  period  of  overstretching  with  its 
accompanying  atony."  —  C.  K.  Drinker. 

Occupational  Deformity  of  Hand.  K. 
Pichler.  Abstracted  as  follows  from  Mitt.  a.  d. 
Grenzgeb.  d.  Med.  u.  Chir.,  1921,  33,  No.  3, 
249,  in  Jour.  Am.  Med.  Assn.,  July  16,  1921,  77, 
No.  3,  2.39.  —  "Pichler  refers  to  the  slanting 
outward  of  the  fingers  in  persons  who  have  done 
much  hard  work.  This  shape  of  the  hand  is 
common  with  old  articular  rheumatism  and  in 
gout,  but  manual  labor,  such  as  carpenter  work, 
is  liable  to  induce  it  in  the  healthy."  — ■  C.  K 
Drinker. 


ABSTRACTS 


135 


INDUSTRIAL  PHYSIOLOGY:  NUTRITION,  IVIETABOLISM, 

FATIGUE,  ETC. 


Relation  of  Posture  to  Industrial 
Health.  Edith  Hilles.  Nation's  Health,  June 
15,  19:21,  3,  No.  6,  339-313.  —  Manufacturers 
are  just  beginning  to  understand  that  a  com- 
fortable position  at  work  saves  energy  units  and 
means  increased  efficiency  in  production.  The 
good  chair  alone,  however,  does  not  assure 
good  posture.  The  bench,  the  chair,  foot  rest, 
place  for  supplies  and  i)lace  for  finished  work 
must  all  be  carefully  adjusted. 

The  New  York  State  Industrial  Commission 
gives  a  general  summary  of  the  principles  of 
correct  seating  as  follows:  "A  seat,  broad  and 
not  too  deej),  slightly  saddle  shaped,  and  with 
the  front  edge  rounded;  the  feet  resting  com- 
fortably on  the  floor  or  on  a  broad  foot  rest  at- 
tached to  the  floor  or  bench;  the  bench  at  a 
height  to  allow  ])lenty  of  room  for  the  knees  be- 
tween the  toj)  of  the  seat  and  under  side  of  the 
bench;  no  brace  or  other  obstruction  interfer- 
ing with  a  comfortable  position  of  the  feet  and 
legs;  a  back  rest  suj)j)<)rting  the  small  of  the 
back  and  not  extending  ii|)  far  enough  to  inter- 
fere with  free  movement  of  the  arms;  supplies 
arranged  so  that  no  excessive  reach  is  involved 
in  the  work.  If  an  oj^erator  is  able  to  rest  her- 
self by  changing  her  jKJsition  at  work  occasion- 
ally, a  great  deal  of  unnecessary  fatigue  can  be 
avoided.  For  many  operations,  the  thing  to  do 
is  to  begin  by  raising  the  bench  and  chair  high 
enough  to  allow  the  operator  to  work  sitting  or 
standing." 

The  best  material  for  a  chair  seat  is  wood. 
Cane  seats  become  saggy,  and  metal  seats  are 
too  hard  or  are  made  with  sharj)  edges.  The 
best  depth  and  tilt  for  the  scat  de])cnd  upon  the 
nature  of  the  work,  as  does  also  the  type  of 
back.  In  general,  backs  are  recommended,  and 
the  American  Posture  League  nuiintains  that 
there  should  be  an  open  space  about  7  inches 
from  the  seat  floor  before  the  back  rest  begins. 
There  should  be  a  support  at  the  small  of  the 
back  at  least  ih  inches  wide  and  slightly  curved. 
There  is  a  difference  of  opinion  as  to  whether 
adjustable  chairs  are  better  or  whether  chairs 
should  be  constructed  in  different  heights  and 
sizes,  and  again,  as  to  whether  a  chair  should  be 
made  so  that  the  worker  himself  may  adjust  it, 
or  so  that  it  can  be  changed  only  by  a  shop  me- 
chanic. Foot  rests  should  always  be  provided  if 
the  feet  cannot  rest  comfortably  on  the  floor, 
and  should  be  adjustable  and  attached  to  the 


floor  or  the  bench,  not  to  the  chair.  Another 
problem  is  the  sitting-standing  bench.  The 
height  of  such  benches,  shown  in  the  report  of 
the  New  York  State  Industrial  Commission  on 
Industrial  Posture  and  Seating  varies  from  33 
to  37  inches.  From  6  to  10  inches  should  be 
left  between  the  under  side  of  the  bench  and  the 
seat. 

An  account  is  given  of  a  standardized  work 
place  adopted  in  a  rubber  overshoe  plant,  and  a 
description  of  the  standards  for  good  posture 
adopted  by  the  California  Industrial  AVelfare 
Commission  is  included  as  follows:  "As  far  as, 
antl  to  whatever  extent,  in  the  judgment  of  the 
commission,  the  nature  of  the  work  permits, 
the  following  provisions  shall  be  effective; 
seats  shall  be  provided  at  work  tables  or  ma- 
chines for  each  and  every  woman  or  minor  em- 
ployed, and  such  seats  shall  be  kept  so  ad- 
justed to  the  work  tables  or  machines  that  the 
position  of  the  worker  relative  to  the  work 
shall  be  substantially  the  same  whether  seated 
or  standing.  Work  tables,  including  cutting 
and  canning  tables  and  sorting  belts,  shall  be  of 
sucii  dimensions  and  design  that  there  are  no 
physical  impediments  to  efficient  work  in 
either  a  sitting  or  a  standing  position,  and  in- 
dividually adjustable  foot  rests  shall  be  pro- 
vided. New  installations  are  to  be  approved  by 
the  conmiission." 

"  So  little  thought  has  been  given  to  the  prob- 
lem of  postiue  in  industry  that  at  the  present 
time  almost  any  plant  can  go  far  in  improving 
conditions  by  even  the  crudest  attempt  to  plan 
the  work  place  so  that  a  fair  chance  for  mini- 
mum ])osture  standards  is  given  the  worker." 

The  article  is  illustrated  by  thirteen  cuts.  — 
G.  E.  Partridge. 

Industrl\l  Posture  and  Seating.  Edith 
Hilles  and  Wilhelmina  Conger.  N.  Y.  State 
Dept.  Labor,  Bur.  Women  in  Industry,  Bull. 
No.  104,  April,  1921,  pp.  56. —  "Fatigue 
should  be  avoided  like  poison,  because,  in  real- 
ity it  is  posion."  The  conclusions  and  recom- 
mendations for  the  avoidance  of  fatigue  reached 
in  this  report  are: 

"First:  that  posture  must  be  varied.  Con- 
tinuous sitting  and  continuous  standing  are 
both  harmful.  Ideally,  conditions  should  allow 
the  worker  to  vary  his  position  at  will,  because 
of  the  rest  and  the  enormous  saving  of  energy 


136 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


that  comes  from  a  change  of  position  during 
working  hours. 

"Second:  that  work  conditions  should  be 
such  that  correct  posture  is  possible  (a)  by  pro- 
viding a  physiologically  good  chair;  (b)  by  in- 
suring a  proper  relationship  of  the  different 
parts  of  the  work  place. 

"There  is  no  one  chair  that  is  best  for  all  in- 
dustrial processes.  To  determine  what  chair  is 
best  for  a  particular  process,  the  nature  of  the 
work  to  be  done,  the  position  of  supplies  and 
finished  work,  the  equipment  at  hand,  i.  e.,  the 
height  of  bench,  chair,  place  for  foot  rest,  etc., 
as  well  as  the  height  of  the  individual  worker  — 
all  these  must  be  considered.  To  provide  a 
good  chair  is  not  enough;  the  important  thing  is 
to  bring  all  parts  of  the  work  place  into  the 
best  possible  relationship."  —  jNI.  Dent. 

Seats  for  Workers  in  Factories  and 
Workshops.  Welfare  Pamphlet,  No.  6,  Lon- 
don, 19'20,  pp.  16.  —  The  provision  of  seats  is 
recognized  as  an  integral  part  of  good  welfare 
arrangements,  and  the  Home  Office  is  em- 
powered to  deal  with  it. 

Three  types  of  seats  are  in  question:  seats  for 
work  that  can  be  done  sitting;  seats  for  oc- 
casional rest  when  work  must  be  done  standing; 
seats  outside  the  workrooms  for  rest  during  in- 
tervals. The  aim  of  every  factory  should  be  to 
have  work  done  sitting  when  possible.  When 
work  cannot  be  done  sitting,  provision  should 
be  made  for  occasional  resting.  In  one  factory, 
in  which  five  minutes'  rest  was  taken  each 
hour  in  a  certain  operation,  output  showed  no 
less  than  a  6.4  per  cent,  increase  in  every  case, 
and  in  four  of  six  cases,  carefully  estimated,  the 
increase  was  over  10.9  per  cent. 

Some  general  rules  for  the  provision  and  con- 
struction of  seats  are  laid  down,  but  the  most 
valuable  part  of  the  report  consists  of  nineteen 
figures  showing  improved  seating  arrangements 
for  various  kinds  of  work,  such  as  standard  ma- 
chine chairs,  swinging  seat  for  press  operators, 
adjustable  seats,  rolling  seats,  a  chair  with 
springs  to  absorb  vibration,  a  seat  for  weavers, 
rest  seats  and  foot  rests,  etc.  —  G.  E.  Partridge. 

Industrial  Efficiency  and  F.\tigue.  Ed- 
gar L.  Collis.  Jour.  Roy.  Sanitary  Institute, 
Jan.,  1921,  41,  No.  3,  2.S.5-'-241.  —  The  introduc- 
tion of  power-driven  niachinery  brought  new 
problems  into  manufacturing.  Up  to  now  these 
problems  have  been  concentrated  in  improving 
the  machinery,  while  the  human  machine  has 


been  neglected.  The  object  in  view  at  present  is 
to  attain  and  maintain  efficiency  and  health  in 
the  hiunan  machine.  Collis  divides  the  means 
into  two  groups:  the  first  concerned  with  fitting 
the  worker  to  his  work,  and  the  second  fitting 
the  work  to  the  worker. 

Under  the  first  are:  (1)  selection  of  workers, 
in  order  to  prevent  labor  turnovers  of  from  100 
to  400  per  cent,  and  the  enormous  waste  in 
labor  turnover  to  industry  which  has  been 
conservatively  estimated  at  £16,000.000;  (2) 
personal  hygiene  —  a  clean  skin  promotes  effi- 
ciency and  postpones  fatigue;  (3)  ventilation, 
which  should  be  contrived  to  maintain  opti- 
mum conditions  for  each  process;  and  (4)  food 
supply. 

Under  the  second  heading,  fitting  the  work  to 
the  worker,  are:  (1)  adapting  height  and  shape 
of  machinery  to  the  man,  instead  of  accepting 
the  height  and  shape  unquestioningly  from  the 
manufacturer;  (2)  correct  seating  and  varied 
posture;  (3)  lighting;  (4)  study  of  hours  of 
labor  and  when  rest  spells  are  most  efficient. 

The  author  concludes  as  follows:  "A  right 
understanding  of  and  attention  to  the  human 
machine,  its  possibilities  and  reactions,  its  med- 
ical and  psychological  aspects,  will  increase 
well-being  and  contentment,  increase  effi- 
ciency and  production,  decrease  chronic  fatigue 
and  discontent,  and  with  them  inefficiency  and 
poverty."  —  M.  C.  Shorley. 

Is  a  Fatigue  Test  Possible?  B.  Muscio. 
Brit.  Jour.  P.sychol.,  Vol.  12,  Part  1,  June, 
1921,  31-40.  —  In  conclusion  tlie  author  .states: 

"  (1)  An  essential  pre-condition  of  experi- 
mentation designed  to  obtain  a  fatigue  test  is 
the  knowledge  that  different  degrees  of  fatigue 
are  jjreseiit  at  certain  times.  This  knowledge 
can  jjrobably  be  obtained  if  it  be  accejjted  that 
fatigue  tends  to  express  itself  in  relatively  poor 
output.  It  would  then  be  necessary  to  develop 
a  technic(ue  such  that  by  it  either  (a)  factors 
which  interfere  with  this  characteristic  expres- 
sion of  fatigue  can  be  eliminated,  or  (b)  the  pres- 
ence of  interfering  factors  can  be  known  and 
their  effects  u])on  out])ut  j)recisely  determined. 

"  If  this  tcclmiquc  could  be  obtained  we  should 
possess  in  it  a  fatigue  test,  that  is,  a  inethod  by 
which  it  could  be  shown  in  what  degree,  if  any, 
fatigue  was  present  at  given  times,  but  we 
should  not  have  a  rapid  and  convenient  fatigue 
test. 

"(2)  Given  any  method  by  which  we  can 
determine  in  what  degree,  if  any,  fatigue  is 


ABSTRACTS 


13' 


present  at  certain  times,  it  is  justifiable  to  ex- 
periment witii  the  object  of  finding  a  rajjid  and 
convenient  fatigue  test.  We  should  proceed 
largely  by  the  method  of  trial  and  error,  our 
object  being  to  find  some  test  that  would 
rapidly  yield  at  any  time  a  characteristic  result 
if  a  given  degree  of  fatigue  were  present.  The 
only  suggested  tests  that  could  po.ssibly  yield 
such  a  result  are  non-])crformance  tests;  and 
consequently  experiments  aiming  to  disco\cr  a 
rapid  test  of  fatigue  must  work  with  sucii  tests. 
If  such  a  test  were  found,  the  degree  of  fatigue 
present  at  any  time  could  be  determined  without 
a  lengthy  and  difiicult  analysis  of  out])ut  figures. 

"(3)  In  view  of  the  foregoing  considerations 
it  is  recommended  that  the  whole  fatigue  test 
problem  be  stated  in  a  form  the  nature  of  which 
may  be  indicated  by  tlic  following  suggestions: 

"(a)  'I'iiat  tiie  term  fali(jite  he  ab.solutely 
banished  from  precise  scientific  discussion,  and 


consequently  that  attempts  to  obtain  a  fatigue 
test  be  abandoned. 

"(6)  That  the  problem  to  be  investigated  be 
defined  as  the  determination  of  the  effects  of 
different  kinds  and  amounts  of  work  (activity) 
upon  mental  and  ])hysiological  functions:  that 
is,  that  tlie  kind  and  amount  of  work  be  cor- 
related directhj  with  changes  in  psycho-phy.s- 
iological  functions,  and  not  (as  at  present) 
iiidirecth/  by  means  of  'fatigue.'  The  varicnis 
proposed  fatigue  '  tests  '  would  then  be  used  to 
determine  effects  of  actinty  and  not  the  presence 
or  absence  of  fatigue.  Thus  stated,  '  fatigue  in- 
vestigation "  seems  to  offer  a  fertile  field  for 
scientific  work. 

"(c)  That,  .so  far  as  practical  purposes  arc 
concerned,  attention  should  be  concentrated  on 
methods,  sucli  as  motion  study,  by  which  the 
amount  of  irorh  re(|uircd  for  a  given  quantity  of 
output  can  be  decreased."  —  C.  K.  Drinker. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


Some  Effects  of  Legisl.\tion  Limiting 
Hours  ok  Wohk  kou  Women.  U.  S.  Dept. 
Labor,  Women's  Ikircau,  IJuil.  No.  15,  1!)'21, 
pp.  'Hi.  —  Tliis  study  of  the  effects  of  legislation 
aft'ecting  women's  hours  of  labor  in  New  Jersey 
and  Massachusetts  is  confined  to  two  industries, 
manufacture  of  rubber  and  of  electrical  ap- 
pliances, and  inchules  ilata  in  regard  to  sixty- 
five  establishments.  It  was  found  that  in 
Massachusetts,  where  compulsory  reduction  of 
hours  was  carried  into  effect,  the  number  of 
women  employed  increased  i).'i  per  cent,  during 
the  periotl  considered,  while  in  New  Jersey, 
where  no  such  change  took  place,  the  number 
decreased  .3.1  per  cent.  The  proportion  of 
women  employed  decreased  .'5.1  per  cent,  in 
New  Jersey  and  0.9  per  cent,  in  Massachusetts. 
A  secondary  cff'ect  of  the  reduction  of  hours  for 
women  was  a  similar  reduction  for  men.  More 
than  one-half  of  the  establishments  in  each 
state  increa.sed  both  their  time  rates  and  piece 
rates  when  hours  were  reduced. 

In  twelve  out  of  twenty-one  plants  in  Massa- 
chusetts, reduction  of  hours  was  followed  by  an 
increase  in  production,  or  maintenance  of 
former  production;  and  eleven  out  of  fourteen 
establishments  in  New  Jersey  reported  in- 
creased or  maintained  production.  There  was 
no  recognizable  definite  relation  between  pro- 
duction and  the  number  of  hours  by  which 
time  was  decreased.    One  plant  in  New  Jersey 


reported  an  increase  in  output  every  time  hours 
were  reduced,  and  in  another  case  reduction 
of  six  iiours  a  week  in  a  i)lant  manufacturing 
electric  lamps  caused  no  decrease  in  jjroduction. 
Ill  but  one  instance  was  there  evidence  that 
the  limiting  of  women's  hours  would  restrict 
their  opportunities.  —  G.  E.  Partridge. 

Hours  of  Women  in  Rest.\ur.\nts  .\nd 

'I'kI.F.PHONE  ExCnAN(iES  IX  MlNNESOT.\.     U.  S. 

l)e|)t.  Labor,  Month.  Labor  Rev.,  April,  1!)'-21, 
hi.  No.  4,  808.  —  "In  Minnesota  hours  of  work 
for  women  are  not  regulated  except  in  cities  of 
the  first  and  second  class,"  with  the  result  that 
in  small  towns  restaurant  employees  work  more 
than  the  fifty-eight  hours  a  week  which  is  the 
limit  for  women  workers  in  the  large  cities  of 
that  state,  and  telephone  operators  have,  in 
.some  small  northern  towns,  been  on  duty 
twenty-four  hours  a  day,  although  nominally 
working  from  6  a.m.  to  10  p.m.  —  R.  B.  ('rain. 

"At  Wh.-vt  Age  Should  Children  Enter 
Industry  ? "  H.  H.  Mitchell.  Am.  Child, 
May,  1921,  3,  No.  1,  ST-Sa.  —  At  the  present 
time  public  opinion  is  against  industrial  labor 
for  the  14  or  15  year  old  child,  and  Montana 
has  a  law  requiring  16  years  as  a  minimum. 
Twenty-seven  state  legislatures  have  made 
provisions  for  physical  examination  and  many 


138 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


states  limit  the  occupations  open  to  children. 
There  are  other  indications  that  public  opinion 
to  a  considerable  extent  recognizes  a  serious 
health  hazard  in  wage  earning  before  maturity. 
Mr.  J.  P.  Murphy,  who  reported  for  the 
Associated  Industries  of  New  York  State,  says 
that  in  the  final  analysis  the  physical  effects  of 
industrial  life  upon  children  will  necessarily  de- 
termine the  question  when  and  how  children 
shall  begin  their  industrial  careers.  But  there 
are  certainly  other  important  aspects,  such  as 
the  educational  and  psychological  sides.  There 
should  be  a  scientific  approach  to  the  study  of 
physical  effects,  fatigue,  etc.,  and  to  problems 
such  as  the  possible  relation  of  physiological  and 
psychological  changes  at  adolescence  to  special 
requirements  as  regards  nutrition.  The  higher 
death  rate  for  tuberculosis  in  cotton-mill  opera- 


tives from  15  to  19  years  of  age,  as  compared 
with  non-operatives,  suggests  further  investiga- 
tions among  industrial  workers  elsewhere, 
where  conditions  are  similar;  and,  finally,  we 
must  have  some  method  of  deciding  what  em- 
ployment, or  under  what  conditions  any  em- 
ployment dejirives  a  child  of  his  proper  healthy 
development.  A  law  excluding  all  children  un- 
der sixteen  from  any  employment  might  be  in 
advance  of  pul)lic  opinion,  but  a  law  providing 
for  health  service  in  continuation  schools  for 
working  children  would  not  be. 

To  study  the  factors  affecting  the  health  of 
employed  children  an  investigation  is  now 
being  made  upon  about  l,'-200  children  in  New- 
ark, another  purpose  being  to  determine  the 
practicability  of  health  service  in  the  con- 
tinuation school.  —  G.  E.  Partridge. 


INDUSTRIAL  SANITATION:   FACTORY  CONSTRUCTION,  ILLUMINATION, 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEWAGE  DISPOSAL 


Paint  as  an  Aid  to  Better  Management. 
John  Dexter.  Abstracted  from  Works  Manage- 
,ment,  April,  1921,  in  Factory,  June  1,  1921,  26, 
No.  11,  1328.  —  "Paint  and  color  are  powerful 
weapons  in  the  hands  of  a  man  whose  business 
it  is  to  control  the  production  of  a  factory. 
Used  skillfully,  they  decrease  the  lighting  bill, 
increase  the  output,  and  prevent  mistakes.  A 
few  dollars  spent  in  paint  may  well  return  a 
hundred  times  the  amount."  —  M.  Dent. 


Keeping  Factory  Temperatcties  Where 
You  Want  Them.  Charles  L.  Hubbard.  Fac- 
tory, May  15,  1921,  26,  No.  10,  1195-1198.  — 
An  important  problem  of  the  industrial  man- 
ager is  the  washing  and  cooling  of  air  for  ven- 
tilation, since  projjcr  ventilation  is  essential 
to  economic  operation.  Understanding  of  the 
problem  requires  a  knowledge  of  various  mat- 
ters such  as  evaporation  and  humidity  (which 
are  briefly  explained). 

The  plan  and  elevation  of  a  typical  air 
washer  are  shown.  "This  is  placed  in  the  main 
airway  leading  to  the  fan,  being  located  be- 
tween two  heaters.  The  first  of  these,  or  tem- 
pering coil,  is  to  r.aise  the  temperature  of  the 
entering  air  above  the  freezing  point,  and  the 
second,  or  reheater,  to  bring  the  temperature  up 
to  the  required  point  for  heating  and  ventila- 
tion." The  i)!an  of  the  washing  ai)paratus  is 
also  shown.    Different  forms  of  spray  are  used 


according  to  the  result  desired,  rain-like  sheets 
being  best  for  removing  dust,  and  a  fine  mist, 
since  it  favors  evaporation,  being  best  for 
cooling.  "In  operation,  the  air  first  passes 
through  the  spray  chamber  where  cleansing 
and  evaporation  take  place,  then  through  the 
scrubbers  and  eliminators  which  remove  the 
coarser  i)articles  of  dirt  and  practically  all  mist 
or  water  wjiich  is  not  evaporated." 

It  is  im])ortant  to  know  that  temperature  is 
not  the  only  factor  in  producing  an  agreeable 
atmosphere.  Low  humidity  gives  a  sense  of 
coolness,  and  the  difference  is  more  marked  if 
the  air  is  moving  perceptibly.  The  relati(ui  be- 
tween temperature  and  humidity  producing 
optimum  comfort  is  expressed  by  the  formula 
T  =  (316  -R)  -1-1.  The  i)roper  humidity  for  a 
room  temj)crature  of  60°  F.  is  76  yiev  cent.;  for 
65°  F.,  56  per  cent.;  for  70°  F.,  36  per  cent.;  for 
75°  F,  16  per  cent.  During  the  heating  season 
any  combination  desired  may  be  obtained,  as 
the  c|Uantily  of  moisture  absorbed  may  l)c  reg- 
ulated by  maintaining  a  jirojier  relation  be- 
tween the  temperature  of  the  air  pa.ssing  from 
the  washer  and  that  of  the  spray  water,  while 
the  room  temperature  may  l)e  regulated  in  the 
usual  manner  without  reference  to  ventilation. 
In  the  summer  the  humidity  cannot  be  con- 
trolled, when  the  cooling  process  is  due  to  evap- 
oration, but  when  the  outside  air  is  compara- 
tively dry,  sufficient  absorption  or  evaporation 
may   often    take  place   to   lower   temperature 


ABSTRACTS 


139 


somewhat  without  raising  humidity  too  mucli 
for  comfort.  The  amount  of  cooling  and  the 
final  humidity  will  depend  upon,  the  relative 
humidity  of  the  entering  air,  the  fineness  of  the 
spray,  the  amount  of  water  used  jjer  unit 
volume  of  air,  the  air  velocity  and  the  length  of 
the  spray  chamber. 

Cooling  by  evaporation  of  the  spray  water 
has  decided  limitations,  but  when  water  is  avail- 
able  in   sufficient  quantities   at   temperatiu"es 


ranging  from  55°  to  60°  the  air  may  be  cooled  by 
direct  transmission  of  heat  to  the  water  with- 
out evaporation,  and  therefore  without  increas- 
ing the  humidity.  Some  further  details  of  air 
cooling  by  the  process  of  direct  transmission 
of  heat  are  given,  and  methods  of  conducting 
the  water  supply,  etc.,  are  described;  and  there 
are  some  suggestions  about  cooling  in  plants 
employing  electric  distribution  of  power.  — 
G.  E.  Partridge. 


INDUSTRIAL  MEDICAL  SERVICE:   MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


Physical  Ex.\mination  of  Employees. 
A.  W.  Colcord.  Proc.  Ninth  Ann.  Congress, 
Nat.  Safety  Council,  Sejjt.  27,  192(M)ct.  1, 
1020,  Part  I,  pp.  l.'5i-14C.  ^  This  excellent 
analysis  of  the  purpose  and  methods  of  phy- 
sical examinations  .should  be  read  by  anyone 
interested  in  the  subjec-t.  Prevention  of  di- 
sease is  the  aim  of  industrial  medicine.  Four 
lines  of  ai)i)roach  are  suggested:  (1)  working 
conditions  in  the  mill;  (2)  living  conditions  in 
the  home;  (3)  finding  and  arresting  disease  in 
its  early  stages;  and  (4)  adjustment  of  the 
man's  life  to  suit  his  [)hysical  condition. 

A  method  of  estimating  and  charting  re- 
sistance is  given,  together  with  a  valuable 
record  of  special  examinations.  Finally,  there 
is  a  summary  of  tlie  inii)ortant  benefits  to  be 
had  through  examination,  with  especial  em- 
phasis laid  on  the  opportunity  to  show  humane- 
ness in  the  purposes  of  the  medical  department. 
—  Elinor  D.  Gregg. 

Why  We  Have  Physical  Examin.\tioxs  at 
Our  Plant.  A.  A.  Bureau.  Factory,  Nov.  15, 
1920,  25,  No.  10,  1575-1577.  —  Physical  ex- 
amination of  workers  is  one  way  of  controlling 
the  number  of  accidents  and  the  cost  of  pro- 
duction, and  it  should  be  regarded  as  an  essen- 
tial part  of  an  industrial  organization.  The 
examination  of  the  future  must,  however,  take 
a  broader  scope  than  that  of  the  present.  The 
work  must  be  more  thorough,  more  emphasis 
nuist  be  placed  upon  the  grading  of  workers  in 
respect  to  physical  fitness  for  the  particular 
work  they  do,  and  there  must  be  more  recon- 
struction work. 

The  wTiter  describes  briefly  the  plan  of  the 
physical  examination  system  conducted  by 
Morris  and  Company.    The  first  step  in  the 


elimination  of  the  unfit  is  taken  by  the  em- 
ployment manager,  who  selects  and  hires  the 
men  who  are  suitable.  The  physical  examina- 
tion takes  place  usually  after  the  men  have 
been  j)laced  at  work.  By  this  plan  the  attitude 
of  the  men  toward  the  examinations  is  made 
more  receptive,  and  the  relations  between  the 
medical  department  and  the  men  are  put  on  a 
better  basis,  the  aim  being  that  the  medical 
examiner  .sluill  need  to  reject  but  few  men  as 
unfit.  The  men  do  not  usually  object  to  ex- 
amination when  they  have  been  hired,  and  the 
examinations,  on  this  plan,  can  be  carried  out 
more  thoroughly  and  with  more  reference  to 
reconstructive  work. 

The  results  of  the  examination  of  855  men  are 
shown  on  a  percentage  basis  with  reference  to 
defects.  Thirtj'  per  cent,  of  the  men  had  flat 
feet;  13.4  per  cent,  organic  heart  disease;  11  per 
cent,  poor  vision  in  both  eyes;  9  per  cent, 
hernia;  0  \wr  cent,  piles;  8  per  cent,  defect  of 
hand  or  arm;  7  per  cent,  varicose  veins;  4  per 
cent,  defect  of  feet;  1  per  cent,  blindness  in  one 
eye;  0.7  per  cent,  venereal  disease. 

The  finding  of  unsuspected  defects  is  the 
greatest  gootl  tliat  can  be  derived  from  a  phys- 
ical examination  department.  If  for  no  other 
rea.son,  this  aid  to  the  individual  employee  will 
justify  the  existence  of  physical  examinations  in 
every  industrial  organization.  Physical  ex- 
aminations are  not  conducted  to  bar  men  from 
industry  but  to  place  them  where  it  is  best  for 
them  to  be  for  the  sake  of  their  own  safety  and 
well-being.  —  G.  E.  Partridge. 

Medical  Department  Directs  Library. 
Harriet  J.  Fort.  Hosp.  Management,  May, 
1921.  11,  No.  5,  70,  72.  —  The  article  describes 
the    activities    carried    on    by    the    Maryland 


140 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Casualty  Company  for  the  welfare  of  its  em- 
ployees, in  which,  apparently,  the  work  of  the 
industrial  nurse  is  the  co-ordinating  factor. 
The  lunchroom,  infirmary  and  library  are  de- 
scribed, and  there  are  some  usefid  models  for 
reports,  etc.  The  nurse  intending  to  do  indus- 
trial nursing  is  advised  first  to  obtain  experience 
in  public  health  work.  —  G.  E.  Partridge. 

Planning  the  Industrial  Dlspensary. 
H.  L.  Davis  and  T.  H.  George.  Hosp.  Manage- 
ment, March,  19-21,  11,  No.  3,  64-65. —Views 
and  a  floor  plan  of  the  dispensary  in  one  of 
the  plants  of  the  Aluminum  ^Manufacturers,  of 
Cleveland,  are  here  shown.  The  dispensary  was 
planned  from  the  beginning  hy  medical  direc- 
tors and  architects  together,  and  attention  was 
given  to  placing  it  with  reference  to  time-saving 
on  the  part  of  the  workers,  and  so  that  it 
should  have  a  direct  entrance  upon  the  street. 
There  is  a  main  dispensary  room,  separate 
rest  rooms  for  men  and  women,  a  doctor's 
oflSce,  a  dentist's  office,  lavatories  and  a  store 
room.  The  whole  equipment  occupies  a  space 
of  about  54X18  feet.  The  arrangement  of 
hand  and  foot  baths,  dressing  tables,  instru- 
ment cabinet,  supply  closets,  etc.,  has  been 
planned  with  reference  to  economy  of  effort 
and  efficiency  in  handling  cases.  Ventilation 
is  direct,  from  windows  opening  over  steam 
wall  coUs.  Windows  have  dust-proof  screens, 
the  floor  is  of  smooth  cement  construction,  and 
all  furniture  and  equipment  are  white  enamel 
with  nickel  trimmings. 

For  details  of  the  medical  and  surgical  equip- 
ment the  article  should  be  read.  —  G.  E. 
Partridge. 

The  Location  and  Equipment  of  Modern 
Industrl\l  Dispensaries.  A.  J.  Lanza. 
Personnel,  April,  1921,  3,  No.  4,  1-2.  —  In- 
dustrial establishments  differ  so  widely  that 
it  is  impossible  to  outline  a  standard  equip- 
ment, but  fundamentally  injuries  are  alike, 
and  the  scientific  principles  of  their  treatment 
do  not  vary.  "The  special  province  of  the  in- 
dustrial physician  is  not  that  he  brings  to  bear 
in  an  injury  case  a  form  of  treatment  differing 
from  the  treatment  of  injuries  el.sewhere,  but 
that  his  position  and  special  knowledge  make 
possible  prompt  treatment,  the  reduction  of 
lost  time  and  continuous  effort  along  the  lines 
of  prevention."  Promptness  is  an  essential  in 
industrial  cases,  and  promptness  depends  upon 
discipline  in  the  shop  and  humane  and  courte- 


ous treatment  in  the  dispensary.  Compared 
with  this,  equipment  is  secondary  in  impor- 
tance. 

Suggestions  are  offered  in  regard  to  equip- 
ment, and  lists  of  articles  needed,  including 
general  equipment,  instruments  and  medicines, 
are  given.  —  G.  E.  Partridge. 

Equipment  and  Personnel  for  Care  of 
Injuries.  A.  J.  Lanza.  Nat.  Safety  News, 
Feb.  21,  1921,  3,  No.  8,  9,  14.  —  No  fixed  rule 
can  be  made  for  the  equipment  of  an  industrial 
dispensary,  since  location  with  reference  to  out- 
side facilities  and  other  variable  factors  must  be 
considered.  No  plant  is  so  small  that  provision 
cannot  be  made  for  the  prompt  treatment  of 
all  injuries.  A  mininuuu  equipment  consists  of 
iodine  solution,  sterile  gauze  in  small  packages, 
some  assorted  bandages,  a  roll  of  adhesive 
plaster,  a  pair  of  scissors,  and  a  tourniquet. 
Telephone  numbers  of  the  physician  to  be 
called,  the  ambulance,  etc.,  should  be  prom- 
inently displayed.  Those  in  charge  of  first-aid 
equipment  should  know  how  to  apply  a  tour- 
niquet, and  how  to  administer  the  Schiifer 
prone-pressure  method  of  artificial  respiration. 
There  should  be  placed  near  the  first-aid  equip- 
ment a  printed  placard  setting  forth  how 
wounds,  burns,  and  foreign  bodies  in  the  eye  are 
to  be  treated.  ^Medicines  should  not  be  kept  on 
hand,  and  the  first-aid  man  must  not  try  to 
practise  amateur  surgery. 

In  the  moderate-sized  plant  there  should  be 
a  room  at  least  12  feet  square  set  aside  for  dis- 
pensary purposes.  There  should  be  running 
hot  and  cold  water,  a  dressing  table,  instru- 
ment case,  spotlight,  closet,  and  cot  near  at 
hand.  Where  there  are  women  employees 
there  should  be  a  rest  room.  The  dispensary 
should  have  a  trained  nurse  in  attendance  at 
all  times  during  the  shift,  and  the  management 
should  insist  that  a  record  be  kept  of  every- 
thing done  for  each  employee  who  goes  to  the 
dispensary.  Once  a  month  these  records 
should  be  summarized  in  a  report  showing  the 
number  and  type  of  injuries  by  departments, 
and  a  cojn-  of  the  report  should  be  furnished 
the  plant  manager  and  the  head  of  each  depart- 
ment. A  series  of  such  reports  is  a  good  index 
of  the  efficiency  of  the  safety  work.  The  phy- 
sician usually  comes  to  the  di.spen.sary  each  day, 
and  he  should  set  forth  a  routine  treatment  for 
wounds  of  various  tyi>es,  burns,  etc. 

A  plant  employing  1,000  men  should  engage 
a  full-time  physician,  and,  indeed,  many  plants 


ABSTRACTS 


141 


employing  between  500  and  1,000  men  have 
found  it  advantageous  to  do  so.  The  large  plant 
should  have,  besides  the  dispensary  proper, 
a  room  for  cots  for  injured  men,  a  separate 
office  for  the  physician,  and  another  room  for 
the  clerk  in  charge  of  records  and  forms.  An 
X-ray  equipment  is  desirable.  Where  physical 
examinations  are  made  a  room  is  tisually  set 
aside  ff)r  this  purpose.  It  should  have  a  measur- 
ing device,  scales,  ej'e  chart,  etc.  —  G.  E.  Part- 
ridge. 

Reportino  Slight  IxjrniKs.  R.  P.  Mntthi/s. 
Hosp.  Management.  April,  19'-21,  11,  No.  4,  (>(>. 
—  In  the  Pullman  Company  the  policy  regard- 
ing slight  injuries  is  to  have  very  simple  first- 
aid  equipment — t)andages,  atlhesive,  picric  acid 
pads  and  a  pair  of  scissors.  This  simplicity 
usually  results  in  at  least  one  dispensary  visit 
for  all  injuries,  whence  they  can  be  inspected 
and  passed  on  if  they  are  serious.  Safety  bulle- 
tins posted  throughout  the  i)lant  gi\c  graphic 
pictures  of  the  results  of  neglect  and  the  safety 
committee  men  all  urge  i)roinpt  care  of  small 
injuries.  —  Elinor  D.  Gregg. 

Dental  Dispexs.\ry  in  ]\I.\gnf;to  Pl.wt. 
A.  D.  Rood.  Hosp.  Management,  Nov.,  1920, 
10,  No.  .5,  5fi.  —  The  American  Bosch  Magneto 
Corporation  has  established  a  system  of  medical 
supervision  which  not  only  includes  the  treat- 
ment of  industrial  casualties  occurring  through- 
out the  plant,  but  also  assumes  a  medical  and 
dental  responsibility  in  treating  both  employees 
and  their  de])endents  in  the  home  as  well  as  in 
the  factory.  The  work,  which  is  in  charge  of  a 
full-time  physician  and  a  half-time  dentist  and 
two  registered  nurses,  is  herewith  briefly  sum- 
marized —  L.  A.  Shaw. 

CALIFORNIA  Associated  Raisin  Co.mpany 
Dental  Service.  H.  L.  Broumell.  Mod. 
Hosp.,  May,  1921,  16,  No.  5,  467. —The 
nature  and  organization  of  this  dental  service 
is  briefly  described.  —  L.  A.  Shaw. 

The  Fr-aminghasi  Demonstration.  No. 
25:  The  Industrial  Clinic.  IlalMead  G. 
Murray.  Bull.  Nat.  Tuberculosis  Assn.,  G,  No. 
7,  4.  —  The  Framingham  industrial  clinic  con- 
sists of  a  waiting  room,  a  treatment  room,  a 
physician's  room,  an  examining  room,  and  two 
rest  rooms  —  one  for  men  and  one  for  women. 
Small  injuries  involving  no  loss  of  time  are 
treated  in  the  clinic,  while  other  injuries  are 


usually  referred  to  the  home  physician  for 
treatment.  All  accidents  are  reported  to  the 
safety  engineer,  but  only  minor  accidents  are 
treated  in  the  clinic.  Defects  which  can  be 
remedied  are  explained,  and  persons  suffering 
from  undernourishment  may  obtain  food. 
Records  are  kept  of  all  visits,  showing  the  dura- 
tion of  illness  and  the  most  fre(|uent  complaints. 
This  enables  tiie  doctor  to  follow  up  ])revious 
advice  and  to  co-operate  more  satisfactorily 
with  outside  doctors. 

For  m<'mbersliip  in  the  Relief  Association  a 
physical  cxaniin;ition  is  required.  Consultants 
from  the  Comnmnity  Health  Station  are  avail- 
able. Health  tags  on  the  prevention  of  simple 
ailments  are  given  out  during  the  year.  Con- 
tagious disease  is  carefully  watched  for  by  the 
physician  and  nurses,  and  their  work  is  made 
more  efl'ective  by  the  co-operation  of  the  local 
board  of  health.  Sanitary  conditions  are  also 
continually  watched  and  reported  ujion.  The 
local  |)hysicians  give  tlieir  co-ojicration,  and 
frc(|uently  ask  that  certain  treatment  be  given 
at  the  clinic.  The  importance  of  regular  medical 
examinations  is  stressed  and  everything  that 
can  jtossibly  be  done  through  education  is 
undertaken.  —  Elinor  D.  Gregg. 

The  Functions  and  Scope  of  an  Indus- 
trial Clinic  in  a  (Jeneral  Hospital.  Harry 
Lliiciitlial.  Jour.  Am.  Med.  Assn.,  ilarch  12, 
1921,  76,  No.  11,  701  705.  —  Lincnthal  out- 
lines the  duties  of  the  industrial  clinic  and 
discusses  cases  of  skin  diseases,  respiratory 
diseases  and  occupation  strains  which  are  not 
instances  of  specific  occupational  disease  in  the 
ordinary  acce])tance  of  the  term,  but  which  are 
all  directly  related  to  the  patients'  work.  He 
remarks  thai  were  the  function  of  the  clinic 
confined  to  liandhng  lead  poisoning  and  similar 
direct  problems  its  conduct  would  be  easy,  but 
its  usefulness  proportionally  limited,  since  "the 
great  function  of  an  industrial  clinic  is  to  trace 
the  i^art  industry  plays  in  jjroducing  the  more 
common  disea.ses  seen  in  all  classes  in  the  com- 
munity." Such  an  end  can  be  reached  only 
through  the  employment  of  physicians  well- 
trained  clinically  and  at  the  same  time  thor- 
oughly informed  as  to  very  \-aried  industrial 
environment.  —  C.  K.  Drinker. 

The  Function  of  the  Plant  Ho.spital. 
Hosp.  Management,  Feb.,  1921,  11,  No.  2,  58, 
60.  —  The  annual  report  of  the  hospital  depart- 
ment of  Fairbanks,  Morse  &  Comjiany  shows  a 


142 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


proportionate  decrease  in  the  number  and 
severity  of  injuries  and  an  actual  decrease  in 
time  lost  during  the  past  year,  due  to  the  excel- 
lent spirit  of  co-operation  on  the  part  of  the 
employees,  foremen,  superintendents,  and  the 
safety  and  hospital  departments.  The  hospital 
department  is  equipped  to  take  care  of  the  first 
treatment  of  all  cases  injured  in  the  plant  and 
of  subsequent  treatment  of  ambulant  patients, 
but  patients  requiring  hospital  care  are  placed 
in  outside  hospitals  as  there  are  no  beds  at  the 
plant  hospital. 

A  special  feature  of  the  safety  work  during 
the  year  was  an  investigation  of  work  shoes,  as 
a  result  of  which  a  shoe  was  adopted  and  sold  to 
the  employees.  —  Elinor  D.  Gregg. 

Plant  Hospital  Essentlu^s.  J.  S.  Dye. 
Hosp.  Management,  April,  1921,  11,  No.  4, 
66.  —  The  essentials  of  a  plant  hospital,  ac- 
cording to  the  Chase  Metal  Works'  surgeon, 
are  as  follows:  (1)  central  location  of  hospital; 
(2)  proficient  and  adequate  personnel;  (3)  suf- 
ficient equipment;  (4)  adequate  records; 
(5)  right  attitude  and  approach  to  patient; 
and  (6)  co-operation  with  other  departments. 
—  Elinor  D.  Gregg. 

Employes  Pl.\n  a  Hospital.  Hosp.  Man- 
agement, Nov.,  1920,  10,  No.  5,  64.  — The  em- 
ployees of  the  Shepard  Electric  Crane  and 
Hoist  Company,  Montour  Falls,  New  York, 
plan  to  establish  a  fifteen-bed  hospital  through 
the  Employes'  Relief  Association.  The  hospital 
is  for  the  use  of  employees,  their  families,  and 
the  general  public.  Members  of  the  Relief 
Association  will  have  preference  for  service,  and 
will  receive  a  discount.  The  company  has 
promi.scd  to  pay  into  the  hospital  the  amount 
that  it  now  costs  to  maintain  its  first-aid  serv- 
ice, and  will  send  all  injured  workmen  to  the 
hospital.  —  M.  Dent. 

Hospital  Department  of  Industri.\l 
Plant  Supervises  Safety  Work.  Sanford 
DeHart.  IMod.  Hospital,  Jan.,  1921,  16,  No.  1, 
74-77.  — The  R.  K.  LeBlond  Machine  Tool 
Company  has  placed  the  accident  prevention 
of  its  plant  under  the  supervision  of  the  hospital 
department.  The  prevailing  hazards  occurring 
in  a  machine  tool  plant  and  the  methods  pur- 
sued in  reducing  accidents  and  absenteeism  are 
herewith  described.  That  the  system  employed 
has  been  highly  successful  is  shown  by  the  fact 
that  absenteeism  due  to  injuries  is  approxi- 


mately 7.7  minutes  per  year  per  man.  —  L.  A. 
Shaw. 

Matron  Service  for  Plant  Hospital.  M. 
Z.  Westervelt.  Hosp.  Management,  ]\Iarch, 
1921.  11,  No.  3,  66,  68.  —The  hospital  of  the 
Winchester  Repeating  Arms  Company,  of  New 
Haven,  consists  of  a  suite  of  ten  rooms  —  wait- 
ing room,  emergency  room,  operating  room, 
women's  ward,  men's  ward,  X-ray  room,  stock 
room  and  drug  room,  doctor's  office,  dressing 
and  retiring  rooms  for  men  and  women,  respec- 
tively. 

An  important  part  of  the  medical  department 
work  is  that  of  the  matrons,  who  make  two 
complete  rounds  of  the  plant  each  day,  each 
matron  reporting  to  the  hospital  every  twenty 
minutes  her  findings  for  the  preceding  period 
and  her  route  for  the  next  period. 

Every  employee  receiving  an  injury,  how- 
ever slight,  is  required  to  report  to  the  office  at 
once,  and  a  continuous  propaganda  is  kept  up 
to  impress  the  importance  of  immediate  atten- 
tion to  all  injuries,  the  result  of  this  being  that 
in  four  years,  during  which  hospital  cases  have 
at  times  averaged  between  300  and  400  a  day, 
there  have  been  but  two  cases  of  loss  of  mem- 
bers from  infected  wounds. 

An  accident  report  is  made  of  every  case, 
which  includes  an  account  of  the  manner  in 
which  the  injurj'  was  received,  the  diagnosis 
and  the  treatment  received,  the  report  of  the 
safety  engineer,  and  finally  the  entries  of  the 
Compensation  Division,  where  the  report  is 
filed.  During  the  year  1920  there  were  13,456 
new  injiu-ies,  and  10,091  cases  of  sickness  cared 
for.  Out  of  these  new  injuries,  only  245  be- 
came lost-time  injuries,  and  only  118  became 
compensation  cases  —  that  is,  lost  seven  days 
or  more.  This  record  is  attributed  to  the  fact 
that  the  injuries  "even  as  small  as  a  slight 
scratch  "  are  taken  care  of  at  once.  The  reduc- 
tion of  lost-time  injuries,  since  the  installation 
of  a  full-time  physician,  has  been  81  per  cent., 
and  of  compensation  cases  60  per  cent.  —  G.  E. 
Partridge. 

Michigan  Mutiial  Liability  Co.mpany 
Service.  H.  N.  Torrey.  Nation's  Health,  June 
15,  1921,  3.  No.  6.  363-366. -The  Michigan 
Mutual  Liability  Company  is  a  mutual  organ- 
ization of  many  Michigan  em])l()yers.  It  main- 
tains its  own  surgical  staff  both  in  Michigan  and 
in  the  city  of  Detroit,  and  has  a  large  hospital. 
The  state  has  been  divided  into  zones  and  the 


ABSTRACTS 


143 


aim  is  to  maintain  the  closest  possible  relations 
between  the  local  work  and  the  central  organ- 
ization. The  plan  is  to  use  local  service  as  far  as 
possible  both  in  city  and  state,  but  to  make  the 
facilities  of  the  central  hospital  available  when 
necessary. 

The  organization  of  the  industrial  hospital  is 
shown  l)y  diagrams,  and  the  work  of  the  various 
departments  is  also  described.  Special  atten- 
tion is  given  to  physiotherapy,  occujjational 
therapy,  and  rehabilitation.  Occupational  ami 
vocational  therajjy  consists  of  the  teaching  of 
various  ])ractical  arts,  elementary  shop  work 
for  ambulatory  cases,  advanced  sliop  work  at 
various  factories  for  the  slightly  disabled,  re- 
education for  other  vocations.  A  "rehabilitii- 
tion  man"  helps  to  .solve  difficult  problems  of 
rehabiHlation  an<l  ])laccment  of  men  for  train- 
ing or  work  during  recovery.  Tliere  is  also  a 
social  service  department.  Among  the  profes- 
sional dci)arlmcnts  tlie  dental  and  the  neurolog- 
ical arc  cmpliasizetl  in  the  report.  The  indus- 
trial clinics  do  not  yet  a|)])reciate  the  great  aid 
that  can  l)e  rendered  by  the  expert  neurologist 
and  psychiatrist  in  the  diagnosis  and  treatment 
of  m;iny  cases. 

The  keeping  of  records,  the  outpatient  de- 
partment, and  plans  for  a  new  hospital  build- 
ing of  six  stories  with  rooms  for  100  beds  are 
described.  —  G.  E.  Partridge. 

Plant  H.\s  24-Hour  Medical  Service. 
Hosp.  Management,  May,  1921,  11,  No.  5,  64- 

65.  —  Continuous  medical  .service  is  provided 
for  the  employees  of  the  Newport  Company  of 
Milwaukee  which  operates  .several  plants.  Tlie 
hospital  of  one  of  tlie  plants  is  described  as  a 
fully  ecpiipped  establishment  having  five  rooms, 
with  the  services  of  two  medical  men  always 
available,  and  iuiving  three  full-time  nurses  be- 
sides two  visiting  nunscs.  When  the  plant  is 
running  with  complete  forces,  there  are  about 
2,000  employees.  Six  thousand  treatments 
were  given  during  the  past  .year,  and  path- 
ological investigations  have  been  carried  on  in 
the  plant  to  determine  the  effect  of  dyes  and 
chemicals.  —  G.  E.  Partridge. 

Copper  Company-  Has  56-Bed  Hospital. 
F.  T.  Hogeland.  Hosp.  Management,  Dec, 
1920,  10,  No.  6,  56-58.  —  This  is  a  description 
of  the  hygienic  difficulties  which  tlie  medical 
service  of  the  Cananea  Consolidated  Copper 
Company    encounters   with   its   Mexican   em- 


ployees, and  the  solutions  which  it  attempts. 
The  company  supplies  medical  service  to  the 
men  and  their  families  at  cost,  and  is  doing  its 
best  to  introduce  physical  examinations  (which 
the  American  workmen  accept  and  the  IMexican 
refuse),  maintain  inspection,  and  educate  its 
employees  hygienically.  —  M.  Dent. 

Ship  Yard  Has  3  Hospitals.  F.  C.  Leupold. 
Hosp.  ^fanagement,  Nov.,  1920,  10,  No.  5,  59. 
—  A  brief  outline  of  the  hospital  organization 
of  the  New  York  Shipbuilding  Corporation  of 
Camden,  New  Jersey.  —  L.  A.  Shaw. 

Field  Hospitals  in  Construction  Work. 
J.  P.  Clean).  Mod.  Med.,  April,  1921,  3,  No.  4, 
230-2.'$2.  —  Field  hospital  service  has  now  ex- 
tended far  beyond  its  original  puri)o.se  of  ren- 
dering first  aid  to  the  injured,  and  includes  the 
care  of  the  general  health  of  the  workmen,  so- 
cial welfare  and  determining  the  fitness  of  the 
man  for  iiis  work.  The  field  hospital  has  ad- 
\-antages  in  making  quick  diagnoses  and  ad- 
ministering early  treatment  and  aid  which 
more  than  off.set  its  cost.  To  be  of  the  greatest 
value,  the  field  hospital  should  be  centrally 
located,  and  whenever  possible  the  employ- 
ment department  should  be  in  close  proximity 
to  it  in  order  to  facilitate  the  examination  of 
applicants  for  work.  The  physician  can  be  of 
the  greatest  value  to  a  construction  organiza- 
tion if,  by  proper  attitude  toward  the  workmen, 
he  can  gain  their  co-operation.  The  field  hos- 
])ital  in  construction  work,  by  examining  ap])li- 
canls  for  contagious  and  infectious  diseases, 
heart  lesions,  impaired  vision,  etc.,  protects 
both  the  men  examined  and  others.  This  work 
is  especially  inii)ortant  in  some  of  its  aspects, 
since  construction  has  many  more  hazards  than 
exist  in  industries  engaged  in  operation. 

In  the  construction  of  a  large  plant,  the  du 
Pont  Engineering  Company  employed  from 
August.  1919,  to  August,  i920,  17,000  men, 
with  a  maximum  at  one  time  of  ,'5, 000  and  a 
mininunn  of  800.  During  the  year  there  were 
4,490  injuries,  including  3,500  medical  cases; 
and  11,219  treatments  were  given.  The  cost  of 
maintaining  and  ecpiipping  the  plant  hospital 
was  $6,800,  of  which  $5,900  was  applied  to  the 
treatment  of  minor  injuries  and  medical  cases. 
The  average  cost  of  these  treatments  was  60 
cents.  The  cost  for  the  protection  of  each  man 
employed  was  estimated  as  37  cents.  —  G.  E. 
Partridge. 


144 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


INDUSTRIAL  NURSING 


What  the  Industrial  Nurse  Does.  Pub. 
Health  Nurse,  April,  19^21.  13,  No.  4,  199.  — 
These  notes  give  an  outline  of  the  activities  of 
an  industrial  nurse  in  a  small  community. 
Sanitation,  social  welfare  work,  first  aid,  home 
nursing  and  a  small  hospital  in  connection  with 
the  first-aid  room  are  the  chief  activities.  In 
the  small  plants  the  nurse  must  of  necessity 
do  work  of  greater  variety  and  less  volume  in 
each  line.  —  Elinor  D.  Gregg. 

Kt)ustrial  Nursing  in  the  South.  Ruth 
A.  Dodd.  Pub.  Health  Nurse,  Feb.,  1921,  13, 
No.  2,  86-88.  —  The  author  presents  the  prob- 
lem of  the  industrial  nurse  in  the  South,  where 
her  field  includes  everything,  and  where  she 
must  be  an  amalgamated  specialist.  The  work 
is  primarily  that  of  educating  a  proud  and 
sensitive  group  of  native  eight-generation 
Americans  to  a  higher  standard  of  living.  First 
aid  is  only  one  entermg  wedge  to  the  family 
life  and  habits. 

In  South  Carolina  there  are  state  organiza- 
tions to  which  the  nurse  can  appeal,  though 
most  of  the  time  she  works  alone.  There  exists 
a  fine  spirit  of  co-operation  among  these  state 
agencies,  and  the  county  luiit  ])lan  of  develop- 
ment has  been  followed  with  success.  Thfs 
gives  the  nurse  a  broader  field  and  a  broader 
outlook,  greater  resources  and  a  firm  backing. 
To  the  people  it  means  a  wider,  more  intelligent 
and  efficient  service.  It  means  a  state  organiza- 
tion which  will  be  of  untold  value  in  impro\-e- 
ment  of  health  conditions.  It  presents  for 
national  use  and  information  an  immense 
amount  of  data  as  to  ways  and  means.    This 


joining  of  forces  in  South  Carolina  shows  a 
broadness  of  vision  and  a  unity  of  purpose 
from  which  alone  can  be  evolved  the  highest 
type  of  Americanism.  —  Elinor  D.  Gregg. 

Industrial  Nurses  in  Metal  Mining 
CoMiiUNiTiES.  George  Martinson.  Mod.  Med., 
March,  1921,  3,  No.  3,  186-187.  —  In  the 
metal  mines  of  jMinnesota  the  greater  number 
of  laborers  are  foreign.  ^Ir.  Martinson  believes 
that  one  of  the  main  duties  of  the  company  is 
to  give  the  employee  the  trmity  of  true  life  — 
laughter,  love,  and  work.  In  selecting  an  in- 
dustrial nurse  technical  skill  and  professional 
training  are  considered  only  as  one  factor  in 
her  fitness  for  her  job.  Of  ecjual  moment  are 
her  personal  education  and  background,  her 
tact  and  friendliness. 

The  policy  of  Pickands,  ^Mather,  and  Com- 
pany is  sunnnarized  in  its  instructions  to  the 
nurse  on  beginning  her  work:  "Here  is  where 
our  people  live.  Go  out  and  do  your  best  to 
keep  their  bodies  healthy  and  their  minds  free 
from  worry.  Sympathize  with  and  help  them 
in  their  sorrows.  Try  to  leave  each  home  hap- 
pier because  you  were  there,  and,  finally,  try 
to  inculcate  in  them  the  spirit  of  love  not  only 
within  the  family  but  for  their  neighbors  and 
for  America.  Remember  always,  that  in  their 
eyes  yoti  are  the  company." 

This  policy  is  so  often  taken  as  a  matter  of 
course  and  all  the  emphasis  laid  u{)on  profes- 
sional skill,  method  and  judgment  that  it  is 
refreshing  to  find  an  occasional  expression  of 
the  i)ersonal  (jualities  that  make  for  a  success- 
ful industrial  nurse.  —  Elinor  D.  Gregg. 


INDUSTRIAL  PERSONAL  AND  COIVIMUNITY  HYGIENE: 

HOUSING,  ETC. 


Advantages  of  Proper  Bathing  for 
Workers.  J.  L.  Mason.  Safety  Engin.,  Feb., 
1921,  41,  No.  2,  60-62.  —  Rheumatism  and 
colds  are  often  contracted  by  men  engaged  in 
dusty,  sweaty  processes,  who  have  long  dis- 
tances to  ride  home  in  their  damp  working 
clothes  because  they  have  no  facilities  for 
changing  and  washing  at  the  factory.  Tlic 
time  to  bathe  is  innnediatcly  after  work,  and 
it  is  the  duty  of  mills  and  factories,  both  from 
the  moral  and  the  physical  standpoint,  to  pro- 
vide showers  for  their  employees.  —  M.  Dent. 


The  Home  and  the  Industry.  A.  H. 
McQuillan.  Indust.  Management,  Dec.  1,  1920, 
60,  No.  6,  43.5-136.  —  Industrial  housing  has 
become  an  important  part  of  the  work  of  in- 
dustrial management.  The  modern  aim  is  to 
build  "homes"  suited  to  the  needs  or  wishes  of 
the  occui)aiits,  with  ea.sy  terms  of  payment  and 
with  the  least  possible  limitation  of  the  inde- 
pendence of  the  worker.  The  modern  idea  also 
is  to  achieve  standardization  —  not  in  imi- 
formity  of  building,  but  one  "through  which 
there  are  no  problems  that  are  not  anticipated 


ABSTRACTS 


Ui. 


and  provided  for  as  a  result  of  accumulated  ex- 
perience in  design,  construction,  and  material, 
out  of  which  economy  is  secured,  uimecessary 
waste  avoided,  and  individuality  of  the  build- 
ings maintained."  The  great  need  for  buildings 
of  all  kinds  at  the  present  time  has  caused  an 
immense  cH'ort  to  discover  and  test,  new  proc- 
esses and  materials,  and  new  economies.  — 
G.  E.  Partridge. 

Method-s  of  Sel'ling  HoisEs  TO  Em- 
ployees. L.  H.  Allen.  Indust.  ^^anagement, 
Dec.  1,  V.hH).  (iO.  Xo.  (i.  4'-27-4.'J^2.  —  This  paper 
considers  a  ])roper  selling  plan  to  overcome  such 
an  evil  as  the  housing  of  employees  by  em- 
ployers at  a  loss  —  a  condition  which  causes  the 
real  estate  values  in  the  conununity  to  de- 
preciate. 

"A  house  that  is  built  for  sale  to  a  workman 
should  l)e  a  single  hou.se  containing  not  less 
than  five  or  more  tiian  six  rooms,  and  should  l)e 
situated  on  a  lot  of  at  least  4,000  square  feel. 
Such  a  house,  including  plumbing,  electric 
lights,  and  hot  air  heating,  on  an  improved  lot 
with  water  sup|)ly,  sidewalks,  sewers  and  roads, 
will  cost  today  Ix-tween  $(),()00  and  $7,000." 
Generally »Npeaking,  an  original  investment  of 
$500  is  to  be  expected  on  the  part  of  the  buyer, 
and  it  is  usually  assumed  that  a  man  who  can- 
not .save  that  amount  is  unpromising.  In  the 
case  of  the  average  buyer,  arrangement  .should 
be  made  for  monthly  or  weekly  payments 
against  interest,  taxes  and  reduction  of  prin- 
cipal, since  the  ordinary  workman  understands 
no  other  kintl  of  financing  and  is  likely  to  get 
into  trouble  otherwise. 

Various  other  reconuiiendations  are  made: 
that  the  buyer  be  jirolected  against  loss  if  lie 
wishes  to  sell  and  leave  town;  that  the  cmi)loyer 
be  allowed  to  ]>rolect  himself  if  prices  ri.se,  re- 
taining an  option  on  the  property  that  can  l)e 
exercised  in  case  the  owner  wishes  to  disjjose  of 
it;  that  .some  of  the  houses  l)uiit  for  sale  be  of- 
fered to  the  iui])lic  at  about  1.5  per  cent,  in 
advance  of  the  jiricc  made  for  employees;  that 
a  manufacturer's  housing  development  be 
handled  l>y  a  subsitliary  company  under  an- 
other name.  Another  promising  plan  is  the 
co-operative  housing  plan,  which  was  adopted 
by  the  English  Garden  City  companies  and 
which  is  now  being  tried  in  .several  New  "i'ork 
apartment  hou.ses.  A  company  is  organized  to 
purchase  and  develop  real  estate  and  each 
stockholder  has  tenant's  rights  in  one  house. 
This  plan  may  also  be  adapted  to  the  housing 


of  employees.  The  advantage  of  co-operative 
ownership  to  the  tenant  is  that  he  has  the  free- 
dom of  the  tenant  and  yet  shares  in  the  profits 
of  the  landlord;  and  he  acquires  by  instalments 
a  li(|uid  investment  in  a  housing  property.  "It 
is  generally  agreed  that  the  workman  who 
owns  his  own  home  is  the  better  man  for  it.  The 
restless  dissatisfaction  that  characterizes  the 
workman  of  today  is  replaced  by  a  steady  con- 
tentment." 

The  article  is  illustrated  with  p]iot()grai)hs  of 
houses  and  gr()U|)s  of  houses,  and  contains  a 
variety  of  plans  for  payment  which  have  been 
worked  out  in  detail.  —  G.  E.  Partridge. 

IIOW     ]\Il  NIC  IP.VLITIKS,    COKPOUATIONS    .VXD 

("o.M.MiNiTiKs  Ake  Solving  the  Housing 
PKOBLE.M.  W.  Gibbs  Asile.  Indust.  Manage- 
ment, Dec.  1,  1920,  60,  No.  6,  4'2,5-4'-27. — 
Poughkeej)sie,  New  York,  has  a  Housing  Cor- 
poration aiming  to  rai.se  a  fund  of  !!!400,000, 
half  of  which  is  to  come  from  nierchants  and 
mamifacturers,  and  half  from  citizens  in  gen- 
eral. Hou.ses  will  be  built  on  a  gradual  ])ayment 
l)lan,  the  local  bank  faking  (>0  per  cent.,  the 
Housing  Corporation,  JJO  j)er  cent.,  the  buyer 
making  an  initial  payment  of  10  per  cent.,  and 
])aying  the  balance  at  such  a  rate  as  will  give 
him  his  home  free  from  mortgage  in  about 
clex'cn  years. 

Morgan  Park,  where  the  superintendents, 
foremen,  and  skilled  men  of  the  Minneapolis 
Steel  Company  live,  is  an  example  of  well- 
dcsigtied  house  {)lamiing.  E.spccial  attention 
has  been  given  to  fireproof  construction  and  to 
low  maintenance  cost. 

The  United  States  League  of  Building  and 
Loan  A.ssociations  is  back  of  a  plan  to  establish 
a  Federal  "Home  Loan"  Bank  .system,  similar 
to  the  Federal  Farm  Land  Bank  system.  The 
I)urpose  is  to  facilitate  further  building  by  pro- 
viding for  building  and  loan  associations  a  way 
of  borrowing  money  on  their  mortgage  holdings 
up  to  80  per  cent,  of  their  value.  In  support  of 
the  plan  it  is  pointed  out  that  the  system  is 
simply  accomplishing  for  the  builder  and  home 
owner  what  the  Federal  Reserve  Banks  and  the 
Land  Banks  do  for  the  farmer.  "The  fact  re- 
mains, however,  that  a  system  designed  pri- 
marily to  aid  non-productive  expenditures  is  a 
novel  experiment  in  American  banking." 

The  Province  of  Ontario,  Canada,  is  assisting 
numicipalities  within  the  province  by  loans; 
during  1919,  1,184  houses  were  built,  of  which 
800  were  six-roomed  houses,  and  all  but  124 


146 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


were  detached  houses.  There  are  other  prac- 
ticable plans  in  operation,  such  as  that  of  the 
Firestone  Tire  and  Rubber  Company  of  Akron, 
Ohio,  which  enables  employees  to  own  homes 
by  making  small  payments.  Another  company 
provides  the  amount  above  mortgage  that  will 
enable  the  employee  to  buUd  or  own  his  house, 
and,  in  general,  it  can  be  said  that  these  efforts 
to  aid  house  builders  have  been  made  ^\-ithout 
profit  on  the  part  of  the  companies,  except  in 
the  increased  efficiency  and  contentment  of  the 
employees.  —  G.  E.  Partridge. 


Mixers'  Housing.  Brit.  Med.  Jour.,  April 
9,  19'21,  1,  No.  3145,  539. —The  National 
Housing  and  Town  Planning  Council  issues  a 
weekly  record  for  the  benefit  of  the  housing 
committees  of  local  authorities.  It  asserts  that 
part  of  the  unrest  found  in  the  mining  districts 
may  be  due  to  improper  housing  conditions; 
that  local  authorities  must  co-operate  with  the 
state;  and  that  the  majoritj'  of  employers  are 
indifferent.  These  assertions  are  herein  ques- 
tioned. —  L.  A.  Shaw. 


INDUSTRIAL  INVESTIGATIONS  AND  SURVEYS 


Survey   of  General  Conditions  of  In- 
dustrial Hygiene   in  Toronto   with   Re- 

SLT.TS  OF   AN    InA'ESTIGATION   INTO  LoST  TlME 

Due  to  Sickness.  Associate  Committee  on 
Industrial  Fatigue.  Council  for  Scientific  and 
Industrial  Research,  Ottowa,  19'21,  pp.  23.  — 
It  was  found  that,  although  there  is  a  wide- 
spread recognition  of  the  value  of  good  work- 
ing conditions,  the  ideas  about  these  conditions 
are  indefinite,  and  there  is  little  appreciation 
of  the  fact  that  they  are  capable  of  scientific 
determination.  There  are  very  few  industrial 
physicians  —  and  most  of  these  part-time  men 
devoted  mainly  to  the  treatment  of  disease 
rather  than  to  prevention.  ^lanagers  install 
various  kinds  of  welfare  activity,  as  a  busi- 
ness proposition,  or  to  attract  employees,  or 
simply  to  be  abreast  of  the  times,  but  with 
little  clear  purpose  in  view.  There  are  various 
obstacles  to  the  extension  of  industrial  hy- 
giene, such  as  disinclination  to  accept  the 
experience  of  other  countries,  opposition  from 
the  employees  themselves,  and  particular 
difficulties  due  to  post-war  conditions,  such  as 
the  belief  that  the  time  is  unpropitious  for 
new  schemes.  The  first  step  usually  taken 
toward  promoting  health  and  efficiency  is  the 
establishment  of  a  visiting  nursing  service, 
but  even  this  has  its  difficulties,  wliich  arise 
especially  from  the  fact  that  emjiloyees  live  so 
far  from  their  work. 

In  the  plants  studied,  the  forty-eight-hour 
week  is  most  common,  and  apart  from  bakeries 
and  dairies,  night  work  is  rare.  One  plant 
only  has  a  full-time  physician,  twenty-four 
have  nurses,  and  some  have  one  nurse  for  both 
dispensary  and  visiting  work.  Where  one 
room  only  is  provided,  equiiiment  and  sup- 
plies do  not  usually  exceed  the  requirements  of 


the  Workmen's  Compensation  Act.  There  is 
no  plant  where  physical  examination  is  con- 
ducted periodically  or  on  change  of  occupation 
within  the  plant. 

Artificial  means  of  ventilation  are  common, 
and  in  the  larger  plants  heating  is  central  and 
therefore  clean  and  efficient,  but  except  where 
the  manufacturing  processes  require  it,  no 
serious  attempt  to  raise  the  humidity  was  ob- 
served. Individual  drinking  cups  were  not 
noticed  but  the  common  cup  is  stiU  prevalent, 
although  there  are  some  vertical  fountains. 
Conditions  in  respect  to  lavatories  are  bad, 
and  "in  comparatively  few  instances  are  the 
recommended  standards  for  number  and  con- 
struction, ordinarily  considered  the  minimum 
requirements,  complied  with." 

Xo  firm  in  Toronto  has  .systematic  job 
analysis  and  compulsory  physical  examination, 
but  there  seems  to  be  general  agreement  that 
there  is  no  general  fatigue  from  too  long  or  too 
strenuous  work.  INIany  olivious  errors  in  pos- 
ture were  ob.served,  and  fatigue  from  compli- 
cated motions  in  work  was  discovered  in  some 
instances.  In  three  plants,  rest  periods  had 
been  introduced,  and  other  improvements, 
such  as  tlie  examination  of  employees  sub- 
jected to  unusual  eyestrain  and  the  provision, 
without  cliarge,  of  suitable  glasses,  were  re- 
corded. ()ccu|)ational  disea.ses  have  not  be- 
come a  problem  in  the  city,  and  there  is  a 
general  lack  of  recognition  of  the  occupational 
factor  in  disease. 

Cafeteria  or  other  systems  of  serving  hot 
refreshments  were  provided  in  eighteen  plants, 
and  recreation  or  rest  rooms  in  nine,  but  dre.s.s- 
ing  rooms  and  lockers  in  the  majority  of  the 
establishments  visited  were  inadequate. 

Special  study  was  made  of  lost  time  from 


ABSTRACTS 


147 


sickness,  and  the  results  are  shown  by  four 
charts.  —  G.  E.  Partridge. 

The  Inspection  of  Bakeries.  Rene  Wibaux. 
Rev.  d'hyg.,  March,  19^21,  43,  No.  3.  178-184. 
—  This  paper  recounts  the  insanitary  condi- 
tions found  in  an  investigation  of  the  bakeries 
of  Lille.  The  baking  process  is  carried  on  by 
hand  and  entirely  in  cellars,  where  generally 
the  only  light  comes  through  a  bulkhead  which 
is  also  used  as  a  means  of  egress.  Apparently 
the  germs  from  dirt  and  infected  water  are  not 
to  be  worried  over  as  they  are  killed  when  the 
bread  is  cooked,  but  the  danger  to  the  health  of 
the  workmen  is  great.   Many  of  them  are  tuber- 


culous, and  the  germ  is,  moreover,  to  be  feared 
in  the  bread.    In  1914  the  mortality  of  bakers 
from  tuberculosis  was  37.5  per  cent,  per  hun-  • 
dred. 

The  author  gives  some  disgusting  details  of 
the  insanitarj'  practices  in  vogue  among  bakers; 
statistics  as  to  the  sanitary  conditions  of  knead- 
ing troughs,  funnels  for  conducting  flour,  walls, 
ceilings,  and  floors;  and  concludes  with  the 
statement  that  there  is  a  hiatus  in  the  legisla- 
tion somewhere  and  that  the  supervision  should 
be  increased.  In  the  meantime,  ijatronize  the 
lesser  evils  among  the  bakeries  and  start  schools 
for  the  study  of  baking  where  hygienic  processes 
may  be  taught.  —  M.  Dent. 


INDUSTRIAL  PSYCHOLOGY  AND  INDUSTRIAL  MANAGEMENT 
IN  ITS  HEALTH  RELATIONS 


Taylohism  A\n  Ixi)[tsthiai>  Sitpkuvisiox. 
A.  Bender.  Zentralbl.  f.  Gewerbchyg.,  March, 
1921,  9,  No.  3,  69-72.  —  Many  of  the  essentials 
of  the  Taylor  efficiency  plan  in  industry  and  the 
aims  of  the  governmental  industrial  suiiervision 
are  identical,  as,  for  instance,  in  the  care  of 
women  and  minors,  the  selection  of  employees 
for  tasks,  accident  and  sickness  jjrevention, 
diminution  of  fatigue,  and  adjustment  of  com- 
pensation to  avoid  driving  employees  too  hard. 
The  various  factors  concerned  in  getting  em- 
ployees and  employers  to  see  that  the  means  of 
improving  the  conditions  of  labor  and  living  of 
the  workmen  are  desirable,  economically  and 
humanely,  are  discussed.  — •  E.  L.  Sevringhaus. 


Mental  Science  and  its  Iaiportance  to 
THE  Industries  and  to  Commerce.  Nat.  Assn. 
Corporation  Training  Bull.,  Jan.,  19'-21,  8,  No.  1, 
4-5.  —  The  army  tests  have  resulted  in  some 
startling  conclusions,  and  if  we  ajiply  the  results 
of  the  tests  to  the  country  as  a  whole,  the  infer- 
ences are  discouraguig.  "It  is  clear  that  if  a  total 
of  only  thirteen  and  one-half  per  cent,  of  all  the 
people  in  the  United  States  can  secure  an  intel- 


ligence rating  of  B  or  higher,  the  great  ma.sses 
must  work  under  the  direction  of  the  relatively 
small  percentage,  and  the  importance  of  having 
those  of  high  intelligence  direct  the  industries 
anil  commerce  cannot  be  overestimated."  — 
G.  E.  Partridge. 

Winning  E.mployes  to  Physical  Tests. 
.1.  L.  Curtin.  Hosp.  Management.  May,  1921, 
11,  Xo.  5,  66,  68. —  Within  the  past  few  years 
physical  examination  of  all  applicants  for  em- 
ployment has  become  a  matter  of  routine  in 
some  of  the  largest  and  best  industrial  plants 
in  the  country.  The  purpose  is  to  protect  the 
men  —  both  the  applicant  and  the  man  on  the 
job;  moreover,  a  healthy,  efficient  working 
force  is  tlie  best  investment  any  company  can 
have.  Examination  should  be  rec(uested  of  all 
"forcefully  and  rationally,"  making  it  prac- 
tically impossible  for  anyorjc  to  refuse.  Exami- 
nation should  not  be  made  for  the  purpose  of 
discharge  except  in  rare  cases.  Men  should  be 
examined  when  beginning  work,  and  thereafter 
quarterly,  semi-annually,  or  annually  depend- 
ing upon  the  hazards  of  their  occupation.  — 
G.  E.  Partridge. 


INDUSTRIAL  SERVICE  AND  MUTUAL  BENEFIT  ASSOCIATIONS 


Does  Welfare  Work  Pay?  D.W.  K.  Pea- 
cock. Factory,  June  1,  1921,  26,  No.  11,  1336. 
— •  Welfare  work  has  come  to  be  considered  as  a 
charity.  This  point  of  view  should  be  abolished. 
Welfare  work  will  pay  if  every  employee  is  con- 


sidered as  a  member  of  a  great  industrial  family 
and  taken  care  of  as  such.  —  M.  Dent. 

Plant  Disability  Funds.  Charles  M.  Mills. 
N.  Y.  State  Dept.  Labor,  Bull.  No.  105,  April, 


148 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


lO-Zl,  pp.  16.  — This  bulletin  deals  with  the 
problem  of  providing  sickness  and  death  bene- 
fits for  employees.  —  M.  C.  Shorley. 

A  Plan  fob  Sick  Leave  with  Pay.  M.  R. 
Machol.  Indu.st.  Management,  Dec.  1,  19^20, 
60,  No.  6,  45S-454.  —  There  is  no  established 
method  or  policy  in  respect  to  sick  leave,  and 
there  is  no  legal  or  moral  obligation  to  make  an 
emploj-er  pay  for  the  time  of  an  employee  which 
he  does  not  receive.  It  has,  however,  long  been 
the  custom  to  take  care  of  salaried  employees 
during  illness,  at  least  for  a  limited  time,  in 
order  to  retain  their  goodwill. 

To  jjiit  the  question  of  sick  leave  on  a  uni- 
form basis,  the  MTiter  offers  a  plan  for  a  notice, 
containing  thirteen  items,  and  too  complex  to 
quote.  Its  main  features  are  as  follows:  Sick 
leave,  with  pay,  is  to  increase  with  length  of 
ser\-ice  after  the  first  year,  one  week  for  each 
completed  six  months  of  service,  and  the  time 
allowed  is  to  be  cumulative.  Sickness  must  be 
reported  immediately.  In  exceptional  cases 
special  consideration  may  be  recommended  by 
the  department  head.  In  the  case  of  the  death 
of  an  employee,  all  sick  leave  with  pay  due  that 
employee  is  to  be  promptly  paid  to  his  or  her 
estate.  Termination  of  service  cancels  all  ac- 
cumulated sick  leave,  although  if  the  employee 
returns  he  is  to  be  credited  with  the  balance  of 
sick  leave  due  him.  Present  employees  will  be 
credited  with  about  75  per  cent,  of  the  amount 
of  sick  leave  that  would  have  been  standing  to 
their  account  if  this  standard  had  been  in  force 
during  the  entire  term  of  their  service. 

Such  a  plan,  the  ^^Tite^  asserts,  has  many  ad- 
vantages. It  prevents  argument,  rumor  and 
criticism,  and  it  discourages  absenteeism,  ex- 
cept for  adequate  reasons.  A  declared  policy 
would  be  a  help  in  obtaining  new  employees  and 
in  inducing  former  ones  to  return.  By  no  means 
the  least  of  its  advantages  is  its  effect  in  reduc- 
ing the  amount  of  labor  turnover.  An  employee 
hesitates  to  throw  away  his  accumulated  sick 
leave  by  making  a  change.  —  G.  E.  Partridge. 

Plant  Lrxtn  Room  Health  Factor.  Snn- 
Jord  DeHart.  Hosp.  Management,  Jan.,  1921, 
11,  No.  1,  62,  64.  —  The  author  states  that  the 
Napoleonic  phrase,  "An  army  travels  on  it's 
stomach,"  is  penetrating  indiistry.  The  res- 
taurant idea  grew  largely  out  of  war  ex])ericnce. 
The  results  of  cold  lunches  are  bad,  but  the 
direct  and  indirect  benefits  of  hot  ones  may  be 
classified  as  follows: 


1.    Marked  improvement  in  health  of  work- 


ers. 


9. 

shop. 


Less  sickness. 

Less  absence  and  broken  time. 
Increased  efficiency  and  output. 
Saving  time  of  worker.  ^ 

Salutarj'  change  from  workshop. 
Le.ss  tendency  to  alcoholism. 
Greater  contentment  of  worker. 
Better    mid-dav    ventilation    of 


work- 


10.  Increase  of  recreation  and  games  in 
spare  time. 

The  type  of  restaurant  used  in  the  R.  K. 
LeBlond  Machine  Tool  Company  is  the  dual 
type  —  one  side  self-service,  and  the  other 
table  d'hote.  The  method  of  service  is  cal- 
culated to  eliminate  waiting,  standing  in  line, 
and  confusion.  A  list  of  equipment  is  given  and 
should  be  helpful  to  anyone  contemplating  the 
installation  of  such  .service.  The  hospital  de- 
partment has  been  able  to  offer  some  construc- 
tive help  on  menus.  —  Elinor  D.  Gregg. 

Ax  Ixdustel\l  Cafeteria,  the  Largest  in 
the  World.  Mod.  Hosp.,  March,  1921,  16, 
No.  3,  294,  296.  —  The  cafeteria  of  the  AVest- 
inghouse  Electric  and  Manufacturing  Company 
of  East  Pittsburgh,  Pa.,  is  so  well  planned  that 
3,000  people  can  enter  the  building,  eat  their 
lunch,  and  leave  in  twenty-two  minutes.  It  has 
every  possible  modern  convenience  and  equip- 
ment, and  is  attractive  both  from  within  and 
without.  This  cafeteria  was  built  not  from 
phiIanthroj)ic  motives,  but  from  strictly  busi- 
ness considerations,  and,  run  on  that  basis,  has 
proved  an  immense  success.  —  M.  Dent. 

The  Factory  Restaurant  as  a  Service 
Nucleus.  Sanford  DeHart.  Indust.  Manage- 
ment, May  1,192],  Gl,  No.  9,  .'538-340.— 
The  industrial  manager  has  long  been  cognizant 
of  the  ill  effects  of  the  indigestible,  old  time 
"free  lunch"  and  the  i)oorly  balanced  diet  of 
the  <iiniier  pail.  How  the  industrial  restaurant 
may  be  made  to  do  service  from  the  efficiency 
angle  is  here  demonstrated  by  a  description 
of  the  restaurant  in  the  LeBlond  Plant.  While 
the  restaurant  is  primarily  u.sed  for  dining,  it 
will  be  seen  that  for  recreational  purposes  such 
as  motion  pictures,  dances,  parties,  lectures, 
plant  inspection,  etc.,  it  performs  a  function 
no  less  vital  to  the  general  welfare  of  the 
workers.  —  L.  A.  Shaw. 


ABSTRACTS 


149 


INDUSTRIAL  HEALTH  LEGISLATION:    COURT  DECISIONS: 
WORKIVIEN'S  COISIPENSATION  AND  INSURANCE 


Review  of  Labor  Legislation  of  1919. 
Lindley  D.  Clark.  V.  S.  Bur.  Labor  Statis., 
Bull.  No.  277,  Jan.,  1921,  pp.  409. —This 
bulletin  comprises  a  review  of  the  various 
branches  of  labor  legislation  provided  for  in 
1919,  together  with  the  laws  of  different  states 
relating  to  labor  and  enacted  since  January  1, 
1919.  —  M.  C.  Shorley. 

Setventeenth  Biexxial  Report  of  the 
Department  of  Labor  and  Ixdistries  of 
the  State  of  Mixtcesota,  1919-1920.  Pp. 
178. — This  report  covers  industrial  accidents 
and  diseases,  benefit  funds,  wage  movements, 
factory  inspection,  llic  Bureau  of  Women  and 
Children  in  Industry,  public  employment 
offices,  mine  inspections,  labor  organizations, 
and  a  division  for  the  deaf.  —  ^L  Dent. 

Tendencies  of  Europe.vn  Labour  Legis- 
L.\TiON  since  the  War.  Internal.  Labour 
Office,  Studies  and  Reports,  Series  .V,  \o.  IG, 
Feb.  11,  1921,  pp.  18.  — -The  rei)ort  announces 
that  the  cessation  of  hostilities  was  accom- 
panied by  the  rajiid  ado])tion  of  labor  laws 
and  regulations  on  subjects  which,  in  1914,  had 
been  regarded  as  entirely  beyond  the  .scope  of 
practical  politics.  It  presents  a  brief  resume 
of  the  changes  made  in  respect  to  the  eight- 
hour  day,  joint  control,  right  of  association 
and  collective  agreements,  arbitration  and  con- 
ciliation, unemployment,  social  insurance,  emi- 
gration, agricultural  labor,  wages,  married 
women,  health  and  safety,  and  compulsory 
labor. 

One  of  the  most  remarkable  results  was  the 
success  in  almost  all  countries  in  obtaining  a 
legal  eight-hour  day,  whereas  in  1914  it  was 
considered  progressive  to  ask,  as  an  inter- 
national standard,  a  ten-hour  day  for  women 
and  children  alone.  There  is  a  tendency  to 
give  workers  a  share  in  the  control  of  their  own 
work  and  to  provide  for  the  settlement  of  trade 
disputes.  There  has  been  some  regulation  in 
regard  to  the  minimum  wage,  and  experimental 
legislative  acts  concerning  compulsory  labor. 

Another  tendency  in  recent  European  legis- 
lation is  toward  increased  protection  of  mar- 
ried women  in  industry.  The  opinions  on  the 
subject  are  widely  varied,  and  there  is  no  pros- 
pect of  uniformity,  except  in  so  far  as  the  Draft 


Convention  adopted  by  the  Washington  Con- 
ference is  applicable. 

The  establishment  of  a  medical  service  of 
inspection  in  Belgium  "is  a  matter  of  impor- 
tance, which  may  prove  to  be  of  international 
influence."  It  provides  for  a  central  office  and 
provincial  medical  officers,  who  will  co-operate 
with  the  ordinary  factory  inspectors,  and  who 
will  pay  si)ecial  attention  to  the  health  of 
pregnant  women. 

Regulations  have  been  issued  in  Belgium 
concerning  the  health  and  safety  of  workers  in 
and  about  mines,  and  in  Germany  for  com- 
pressed air  work  and  for  tiie  manufacture  of 
lead  compounds.  \ew  regulations  for  certain 
dangerous  trades  have  also  been  issued  in  Great 
Britain.  —  G.  E.  Partridge. 

Co.mpensation  for  Industrial  Disease. 
Nation's  Health,  May,  1921,  3,  No.  5,  279.  — 
Eight  of  the  forty-six  states  having  compen- 
sation jurisdiction  provide  compensation  for 
occu|)ational  disea.ses.  Investigation  shows  that 
the  maxinnun  cost  of  occupational  diseases, 
if  included  in  the  workmen's  compensation 
acts,  would  not  be  greater  than  2  per  cent,  of 
the  aggregate  cost  of  industrial  accidents. 
The  term  "occupational  disease"  is  here  clas- 
sified according  to  the  cause  and  nature  of  the 
injury.  —  L.  A.  Shaw. 

Health  Ixsurance.  James  M.  Lynch. 
N.  Y.  State  Federation  of  Labor,  Ninth  Re- 
port, Connnittee  on  Health,  1920,  pp.  19.  — 
Investigations  have  shown  that  sickness,  is  the 
principal  factor  in  from  35  to  80  per  cent,  of 
the  calls  on  organized  charity;  that  30  to  50 
per  cent,  of  loans  to  workers  by  such  agencies 
as  the  Morris  Plan  banks,  are  on  account  of 
sickness;  that  about  one-fourth  of  all  workers 
are  so  sick  that  they  have  to  remain  away  from 
work  for  eight  days  or  more  every  year;  that 
fully  one-third  of  those  too  sick  to  work  are 
without  medical  care;  that  families  with  the 
lowest  wages  have  the  most  sickness;  that 
probably  50  per  cent,  of  this  sickness  is  due  to 
health  hazards  in  industry  over  which  the 
workers  have  no  control;  and  that  one-third 
of  those  in  the  poor-houses  have  been  driven 
there  by  sickness. 


150 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


The  following  plan  has  been  drawn  np:  the 
cost,  amounting  to  approximately  3  per  cent, 
of  wages,  is  to  be  shared  equally  by  employers 
and  workers.  The  benefits  will  be  adminis- 
tered by  local  mutual  organizations  or  funds, 
employers  and  workers  to  have  equal  con- 
trol over  the  funds.  Private  industrial  insur- 
ance companies  operating  for  profit  will  be 
prohibited. 

Experience  has  shown  in  all  instances  that 
while  distribution  of  cost  is  primarily  the 
method,  prevention  is  primarily  the  purpose  of 
insurance  and  certainly  its  result.  —  Elinor 
D.  Gregg. 

Fact  and  Opiniox  as  to  the  British  Na- 
tional   Health    Insiirance    Act.     Ordway 


Tead.  Am.  Labor  Legis.  Rev.,  March,  1921,  11, 
No.  1,  87-93.  —  The  author  stresses  the  point 
that  because  Americans  have  heard  criticisms  of 
the  British  National  Health  Insurance  they 
should  not  condemn  it  without  trial.  The 
opinion  in  England  is  that  the  act  has  come  to 
stay,  but  that  there  are  many  improvements 
still  to  be  made.  As  a  result  of  the  act  "the 
general  level  of  medical  treatment  is  probably 
higher  than  it  ever  was.  And  it  certainly  is 
further  true  that  thousands  more  people  see  a 
doctor  and  see  him  weeks  if  not  months  earlier 
in  the  progress  of  the  disease  than  was  ever  the 
case  before  there  was  any  health  insurance.  It 
is  in  this  sense  that  the  preventive  work  is 
getting  its  best  chance  under  the  act."  —  M.  C. 
Shorley. 


REHABILITATION  OF  DISABLED  ElVIPLOYEES 


The  Nauvoo  Project.  The  Functions  of 
A  Special  School  for  Inactive  Tubercu- 
LOiTs  Cases.  John  W.  Turner.  Voc.  Summary, 
Feb.,  1921,  3,  No.  10,  148-149. —  "At  Nau- 
voo, 111.,  .  .  .  the  Federal  Board  for  Voca- 
tional Education  is  establishing  a  imique  proj- 
ect, a  special  school  for  the  rehabilitation  of 
ex-service  men  who  have  been  discharged  from 
tuberculosis  sanatoria  as  inactive  cases."  The 
function  of  the  school  may  be  summed  up  as 
follows:  "First.  It  prepares  the  tuberculous 
patient  for  real  scientific  vocational  guidance, 
and  fortifies  him  against  a  breakdo-mi,  by  a 
course  in  physiology,  hygiene,  and  job  oppor- 
tunities. 

"Second.  It  adjusts  the  training  to  the  man 
during  the  early  critical  period  of  his  con- 
valescence out  of  the  hospital  by  providing 
the  right  environment  and  medical  supervision. 

"Third.  Its  purpose  and  function  have  been 
completed  when  the  health  of  the  trainee  has 


been  stabilized  to  the  point  where  he  can  carry 
on  with  a  more  limited  medical  supervision." 
—  Elinor  D.  Gregg. 

Occt'P.^TioN  Therapy.  W.  Gilman  Thomp- 
son. Join-.  Am.  Med.  Assn.,  June  4,  1921,  76, 
No.  23,  1597-1598.  —  The  author  describes 
the  purpcses,  achievements,  and  limitations  of~ 
occupation  therapy  as  applied  in  our  large 
hospitals.  He  makes  it  clear  that  the  therapy 
must  be  prescribed  by  the  physician  and  sur- 
geon with  as  much  care  as  is  bestowed  on  any 
branch  of  physiotherapy,  and  evidently  be- 
lieves that  instances  of  ill  success  in  the  use  of 
occupation  therapy  are  due  more  to  errors  in 
practice  than  to  defects  in  the  imderlying 
idea. 

The  article  contains  a  brief  statement  re- 
garding the  work  of  the  reconstruction  hospital 
at  One  Hundredth  Street  and  Central  Park 
West,  New  "i'ork  City.  —  C.  K.  Drinker. 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


XOVEMHEH.   19'21 


Number  7 


CONTENTS 


General 151 

Systemic  Occupational  Diseases:  Occurrence,  Treat- 
ment and  Prevention 1  Jl 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc 155 

Dust  Hazards  and  Their  Effects 158 

Occupational  Infectious  Diseases:  Occurrence,  Treat- 
ment and  Prevention 15!) 

Occupational  Affections  of  the  Skin  and  Special  Senses.  1G() 

Occurrence  and  Prevention  of  Industrial  Accidents  . .  161 

Industrial  Surgery 101 

Industrial  Physiology :  Nutrition,  Metabolism,  Fatigue, 

etc 104 

Women  and  Children  in  Industry 107 


Industrial  Sanitation:  Factory  Construction,  Illumina- 
tion, N'entilation,  Heating,  Water  Supply,  Sewage 
Disposal 108 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Industrial  Plants 169 

Industrial  Nursing 171 

Industrial  Personal  and  Community  Hygiene:  Hous- 
ing, etc 172 

Industrial  Investigations  and  Surveys 172 

Industrial  Psychologj'  and  Industrial  Management  in 
Its  Health  Relations 172 

Industrial  Service  and  Mutual  Benefit  Associations  . .   173 

Industrial  Health  Legislation:  Court  Decisions:  Work- 
men's Compensation  and  Insurance 174 

Rehabilitation  of  Disabled  Employees 175 


GENERAL 


Industrial  Hygiene:  Its  Risk,  Proc;kess 
AND  Opportiinities.  Sir  Tlionuis  Oliver.  Brit. 
Med.  Jour.,  July  23,  19'-21,  No.  3160,  108-116. 
—  Since  the  time  when  Parliament,  ahont  a 
century  ago,  gave  attention  to  the  children 
working  in  mines  anfl  factories  in  England,  in- 
dustrial hygiene,  which  may  be  said  to  iiave 
emerged  oat  of,  or  to  have  continued,  the  work 
of  jiarlianientary  interference  with  the  as- 
sumed rights  of  employers  to  use  labor  almost 
to  the  breaking  point,  has  made  great  ad- 
vances. AVithin  the  last  few  years  its  scope  has 
widened;  it  has  become  of  interest  to  all  en- 
lightened nations;  it  includes  not  only  the  con- 
ditions under  which  work  is  conducted,  and  the 
diseases  associated  with  occupation,  but  also 
the  physical  effects  of  work  as  shown  in  fatigue 


and  output;  and  it  attacks  the  problem  of  as- 
suring maxinniin  of  production  with  minimum 
of  effort.  Medical  examination  of  all  workers, 
aud  attempts  to  determine  tiie  susceptibility  of 
workers  to  particular  poisons,  now  advocated, 
indicate  the  growing  conviction  that  the  lia- 
bility to  occupational  diseases,  as  is  the  case 
with  infectious  maladies,  is  largely  individual. 

Following  the  historical  review,  there  is  a 
discussion  of  the  work  of  industrial  medicine 
and  hj'giene  in  several  of  its  typical  fields: 
lead,  phosphorus  and  carbon  monoxide  poison- 
ing, mining,  fatigue,  and  industrial  diseases  and 
compensation. 

Health  hazards  in  lead  working  commence 
mainly  with  the  smelting  of  the  ore  (lead  min- 
ing in  England  is  free  from  the  hazard  of  lead 


151 


152 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


poisoning),  and  are  continued  in  the  processes 
of  manufacture  and  use  of  white  lead.  But 
since  1900,  regulations  have  gradually  reduced 
the  number  of  cases  of  poisoning,  and  the 
severer  forms  commonly  met  with  thirty  years 
ago  are  now  rarely  seen.  Although  nnich  work 
has  been  done  in  the  study  of  lead  poisoning, 
there  is  still  lack  of  general  knowledge  on  the 
subject,  and  there  are  some  special  problems 
still  to  be  solved.  The  so-called  lead  poisoning 
of  painters,  for  exami)Ie,  needs  further  investi- 
gation. There  is  a  question  whether  much  of  it 
is  not  due  to  the  solvents  used  in  paint,  such  as 
turpentine,  benzine,  etc.,  rather  than  to  the 
lead,  and  experiments  with  animals  tend  to  con- 
firm the  view  that  the  vapors  of  these  spirit- 
uous substances  are  harmful. 

The  writer  takes  exception  to  the  decision  of 
the  International  Labour  Conference  of  the 
League  of  Nations  that  the  use  of  white  lead 
should  be  abolished.  Suggested  substitutes  are 
also  likely  to  be  harmful,  and  since  white  lead  is 
an  important  commodity,  and  since  the  history 
of  the  regulation  of  lead  poisoning  and  the  im- 
provement of  processes  show  such  a  remark- 
able success,  the  indications  are  that  the  need 
is  for  still  further  investigation  and  still  further 
reduction  in  the  risks  involved,  and  not  for 
abolishment  of  the  use  of  white  lead. 

"If  there  is  one  industry  to  which  industrial 
hygiene  has  been  of  the  greatest  service,  it  is 
the  manufacture  of  Inciter  matches."  Bone 
necrosis,  as  well  as  the  constitutional  condition 
known  as  phosphorism,  was  frequently  caused 
by  work  with  phosphorus,  but  now,  except  for 
infrequent  dermatitis  from  contact  with  the 
sesquisulphide  of  phosphorus,  the  whole  indus- 
try has  become  harmless. 

Carbon  monoxide  poisoning  has  still  some 
problematic  points.  The  effects  of  small  quan- 
tities of  the  poison  inhaled  during  a  long  period 
of  time  are  not  fully  understood,  but  probably 
they  are  the  source  of  some  minor  illnesses  not 
diagnosed.  There  is  evidence  that  a  certain 
tolerance  for  carbon  monoxide  can  be  estab- 
lished. Boys  who,  in  their  work,  are  exposed  to 
the  substance  may  pass  through  a  period  in 
which  they  are  subject  to  respiratory  disturb- 
ances and  lassitude,  impaired  digestion  and 
insomnia. 

Mining,  still  a  hazardous  occupation,  is  less 
dangerous  than  it  was.  The  rate  for  fatal  acci- 
dents, for  example,  has  been  reduced  two-thirds 
during  the  jjcriod  from  1851  to  l!)l'-2  —  a  reduc- 
tion which  has  been  effected  by  careful  inspec- 


tion of  the  air  in  particular  workings  before  the 
miner  descends,  better  signalling,  improved 
ventilation  and  better  supervision  of  the 
haulage. 

"If  there  is  one  side  issue  of  industrial  hy- 
giene wliich  has  recently  attracted  attention  . . . 
it  is  the  subject  of  fatigue,"  a  realization  of  the 
importance  of  which  was  especially  enforced 
upon  us  by  the  number  of  persons  who  broke 
down  in  numition  work.  Of  recent  work  on  the 
physiology  of  fatigue,  that  of  Burkard,  who  has 
demonstrated  the  presence  of  a  leukocytosis  in 
the  blood  after  exhausting  work,  is  of  especial 
interest.  The  interpretation  is  that  when  the 
muscles  are  active  they  produce  sulistances 
which  pass  into  the  blood  stream  and  stimu- 
late the  blood-making  tissues  of  the  medulla  of 
bone.  Overwork,  by  causing  a  continuous 
over-production  of  neutrophil  cells  may,  then, 
become  injurious,  not  only  to  the  medullary 
tissue,  but  to  the  body  as  a  whole.  Further 
evidence  of  the  pathological  character  of  fatigue 
is  offered  by  the  type  of  leukocytes  fomid. 

Industrial  poisons  present  problems  of  in- 
terest in  connection  with  compensation.  The 
amoimt  of  poison  absorbed  may  be  so  small 
that  for  a  long  time  no  harmful  effects  appear, 
and  then,  from  no  other  cause  than  perhaps 
some  failure  of  elimination,  the  retention  limit 
is  reached  and  the  .symptoms  suddenly  appear. 
A  case  is  cited  in  which  fatal  lead  poisoning  was 
induced  by  the  use  of  potassium  iodide,  pre- 
scribed for  aortic  aneurism,  in  a  man  who  had 
previously  suffered  from  lead  poisoning,  but 
who  for  two  or  three  years  had  followed  an 
occupation  in  which  he  was  not  subject  to  the 
poison. 

Industrial  medicine  has  come  to  stay,  and  it 
goes  hand  in  hand  with  welfare  work.  Inven- 
tion and  research  tend  to  make  industry  more 
dangerous,  but  tlic  same  skill  which  creates  the 
dangers  shows  itself  able  to  provide  antidotes. 
The  sphere  of  industrial  enterprise  is  ever  en- 
larging, and  herein  lies  the  opportunity  of 
industrial  hygiene.  —  G.  E.  Partridge. 

The  Necessity  for  Greater  Attention 
IN  Industry  to  the  I\L\intenance  of  Effi- 
ciency AND  THE  Prevention  of  Ill-Health. 
Edgar  L.  Collis.  Jour.  State  Med.,  Aug.,  1921, 
29,  No.  8,  229-237.  —  "The  State  is  taking 
steps  to  bring  up  healthy  adolescents  so  that 
they  may  be  healthy  citizens  and  productive 
workers.  Industry  has  the  duty  of  maintaining 
them  in  health  and  efficiency. 


ABSTRACTS 


153 


"Industry  must  provide  hygienic  conditions 
of  work  in  order  to  diminish  hibour  turnover, 
to  prevent  ill-health,  to  accjuire  a  stable  per- 
sonnel, to  increase  efBciency,  and  be  able  to  pay 
high  wages. 

"Medical  supervision,  whicii  may  take  the 
form  of  a  medical  dei)artnK>iit  in  large  estab- 
lishments, is  a  sound  investment,  and  is  the 
means  for  maintaining  efficiency  and  prevent- 
ing ill-health. 

"Industrial  convalescence  is  needed  to  expe- 
dite recovery  and,  when  linked  uf)  with  re-edu- 
cation, can  reclaim  many  useful  workers  from 
the  ranks  of  the  unemployable."  —  Barnett 
Cohen. 

The  Industrial  Sriu;Eox  vxi)  Individ- 
UALiZATiox.  Ralph  B.  Bcttman.  Nation's 
Health,  July  15,  19'21,  3,  No.  7,  4€3.  —  This  is  a 
brief  comment  on  the  necessity  for  an  industrial 
surgeon  to  bear  continually  in  mind  the  eco- 
nomic condition  of  his  jiatient.  The  surgeon 
"must  realize  that  the  time  element  is  an  im- 
portant one,  he  must  question  every  procedure 
to  assure  himself  wlielher  it  could  be  sub- 
stituted by  some  other  method  which  would 
shorten  the  time  of  disaliility.  .Vs  Robert  0.s- 
good  most  aptly  put  it  recently,  'the  impor- 
tance of  gaining  the  largest  amount  of  ftmction 
in  the  shortest  possilile  time  is  paramomit.'  "  — 
Katherine  R.  Drinker. 

He.\ltii  Wokk  i\  Fivk  Ixdistriai.  Plants. 
Alfred  E.  Shipleij.  Nation's  llealth.  July  15, 
1921,  3,  No.  7,  411-414. —This  article  con- 
tains an  analysis  of  the  industrial  health  rec- 
ords of  five  plants  in  New  York  City.  The 
industries  represented  are:  (1)  felt  and  silk 
hats,  and  millinery;  (2)  straw  hats,  cloth  cajjs, 
and  hats;  (3)  cocoa  and  chocolate;  (4)  rubber 
goods;  (5)  paints.  The  figures  presented  con- 
cern principally  the  clinic  services  in  these 
plants,  "although  some  consideration  is  given 
to  the  subject  of  sickness  absence.  No  sum- 
maries of  physical  examination  of  new  and  old 
employes,  or  industrial  hygiene  features  are  in- 
cluded." 

The  total  number  of  treatments  in  the 
clinics  of  the  five  factories  was  11,089,  the 
number  of  new  cases,  both  surgical  and  medical, 
being  5,738.  "In  each  of  the  five  plants,  the 
average  number  of  clinic  treatments  per  month 
may  be  estimated  as  approximately  one  for 
every  two  employes."  For  the  surgical  cases  in 
the  five  plants  there  was  a  remarkable  uni- 


formity in  the  proportion  of  re-visits  as  cpm- 
pared  with  the  first  treatment,  an  average  of 
two  re-visits  being  necessary  for  each  surgical 
case.  Greater  proportions  of  medical  cases 
occurred  in  the  plants  which  employed  large 
numbers  of  women. 

An  interesting  uniformity  is  seen  to  exist  in 
the  character  of  the  clinic  ca.ses  seen  in  the  five 
mdustries.  Of  the  surgical  cases,  approximately 
50  per  cent,  were  finger  cases,  and  from  70  to 
75  per  cent,  conditions  affecting  the  entire 
ui)per  extremity.  In  reviewing  the  causes  of 
accidents  the  author  found  that  very  few  were 
due  to  lack  of  mechanical  guards  but  the  vast 
majority  were  "the  result  of  carelessness,  in- 
attention, jioor  physical  condition  of  the  worker, 
or  some  other  j)ersoiud  factor." 

On  tiie  average,  about  50  per  cent,  of  ab- 
sence was  due  to  sickness,  a  large  proportion 
being  of  the  one  and  two-day  type.  During  a 
period  of  decreasing  demand  for  workers,  there 
was  less  sickness  absence,  showing  that  em- 
ployees are  not  inclined  to  stay  at  home  for 
trivial  illness  when  tiieir  places  can  be  readily 
filled. 

In  conclusion,  the  author  emphasizes  the 
I)ractical  imj)ortance  of  facts  such  as  are  pre- 
sented in  his  report.  "They  are  not  matters 
merely  of  academic  research,  but  to  tliose 
trained  to  interpret  such  readings  they  provide 
the  means  to  administer  industrial  health  .serv- 
ice intelligently  and  effectively.  Furthermore, 
the  keen,  practical  factory  manager  appre- 
ciates facts  which  show  him  the  health  status  of 
the  human  power  imder  his  direction,  and 
enable  him  to  compare  conditions  in  his  own 
plant  with  those  in  other  industries."  —  Kath- 
erine R.  Drinker. 

Occupational  Diseases  in  Chemical  In- 
dustries. How  THE  WOKKERS  IN  CheMICAL 
Pl.\nts  are  Safeguarded.  Frederic  Dan- 
nerth.  Indust.  Management,  Sept.  1,  1921,  62, 
No.  3,  145-147.  —  In  this  article  the  author 
tells  how  the  danger  to  the  lives  of  workers  in 
industries  in  which  white  lead  paint,  wood 
alcohol,  and  carbon  tetrachloride  are  used,  and 
in  industries  in  which  dusts  are  present,  may 
be  reduced  to  a  minimum.  — -  M.  C.  Shorley. 

The  Porcelain  and  Earthenware  Indus- 
tries from  the  Standpoint  of  the  Protec- 
tion OF  THE  Workers  and  the  Neighborhood, 
and  Measures  for  Fighting  the  Danger. 


154 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Thieme.  Zentralbl.  f.  Gewerbehyg.,  May, 
1921,  9,  No.  5,  89-94. —The  sources  of  dust 
from  the  earthen  materials  and  of  lead  from  the 
glazes  are  discussed.  The  use  of  adequate  ven- 
tilation, frequent  cleaning  of  the  workrooms, 
personal  cleanliness,  and  improved  mechanical 
aids  to  re])]ace  hand  work  are  described.  Tuber- 
culosis is  frequent  among  these  workers,  pre- 
sumably due  to  the  excessive  dust.  Lead 
poisoning  is  relatively  rare.  The  only  injury  to 
the  neighborhood  is  from  the  excessive  smoking 
of  the  o\ens.  This  may  be  done  away  with  by 
the  use  of  producer  gas  for  heating.  —  E.  L. 
Sevringhaus. 

Some  Medical  Impressions  of  the  Miners' 
Strike.  Brit.  Med.  Jour.,  July  16,  1921,  No. 
3159,  94.  —  The  writer,  who  is  a  practitioner 
of  twenty  years'  experience  in  a  mining  district, 
records  a  remarkable  improvement  in  the  gen- 
eral health  of  miners  during  a  strike,  when  they 
lived  an  easy  life  and  engaged  in  sports.  The 
number  of  cases  of  sickness  was  greatly  re- 
duced, and  the  appearance  of  the  men  and  their 
ability  to  recuperate  from  illness  were  im- 
IDroved.  The  t[uestion  is  raised  whether  it 
would  not  be  profitable,  both  economically  and 
morally,  to  give  the  collier  fourteen  days  of  rest 
from  work,  with  full  pay,  after  every  three 
months  of  full-time  work. 

There  might  be  established  also,  in  every 
large  colliery,  a  miners'  welfare  committee  com- 
posed of  medical  men.  The  work  of  this  com- 
mittee would  be  to  collect  statistics  and  studj' 
the  hazards  of  mining  as  well  as  the  personal 
hygiene  of  the  miner.  "If  one-half  the  energy 
expended  during  the  war  ...  to  keep  the 
soldier  fit  and  well  could  now  be  devoted  to  im- 
proving the  physical  (and  consequently  the 
moral)  well-being  of  men  engaged  in  uncon- 
genial industries,  we  should  make  much  prog- 
ress in  the  direction  of  increasing  the  efficiency 
and  output  in  these  industries." 


In  regard  to  the  field  of  industrial  medicine, 
Linenthal  is  quoted  approvingly:  "Industrial 
medicine  in  its  wider  meaning  is  a  field  pri- 
marily not  for  the  industrial  physician  but  for 
the  physician  in  the  general  practice  of  medi- 
cine who  must  recognize  that  states  of  ill  health 
are  in  many  instances  due  to  the  hazards  of 
industry."  —  G.  E.  Partridge. 

X-RAY  AND  Radium  Protection.  Brit. 
Med.  Jour.,  June  25,  1921,  No.  3156,  936-937. 
—  This  is  a  re]5ort  of  a  committee  representing 
various  scientific  bodies  having  headquarters  in 
London. 

The  effects  upon  the  operator,  which  are  to 
be  guarded  against,  so  far  as  are  known,  are: 
visil)le  injuries  to  the  superficial  tissues,  de- 
rangements of  internal  organs,  and  changes  in 
the  blood.  As  a  general  preventive  plan,  it  is 
urged  that  there  be  not  more  than  seven  work- 
ing hours  eacli  day,  with  Sundays  and  two 
half-days  free  each  week,  and  a  month  of  vaca- 
tion yearly. 

A  first  precaution  in  all  X-ray  work  is  to  sur- 
roimd  the  X-ray  bulb  as  completely  as  possible 
with  protective  material.  Directions  are  given 
for  protection  in  each  of  the  operations  in  use: 
work  with  X-rays  for  diagnostic  purposes;  for 
superficial  therapy;  for  deep  therapy;  for  in- 
dustrial and  research  purpo.ses;  and  radium 
therapy.  Ventilation  of  X-ray  departments 
and  "electrical  precautions"  are  also  treated. 

Recommendations  for  each  branch  of  the 
work  are  too  numerous  and  too  exj)Iicit  to  be 
jjresenteil  in  a  summary,  and  the  report  should 
be  read  by  anyone  interested  in  the  subject. 

As  a  general  measure  it  is  recommended  that, 
where^-er  possible,  periodic  tests  —  every  three 
months,  perhaps  —  should  be  made  upon  the 
blood  of  those  who  work  with  X-ray  apparatus, 
etc.,  and  are  exj)osed  to  the  risks  under  dis- 
cussion, so  that  changes  may  be  recognized  at 
an  early  stage.  —  G.  E.  Partridge. 


SYSTET^nC  OCCUPATIONAL  DISEASES:    OCCURRENCE,  TREATMENT 

AND  PREVENTION 


MENTAL 

Mextal  Hygiene  in  Industry.  C.  Macfie 
Campbell.  Ment.  Hyg.,  July,  1921,  5,  No.  3, 
468-478.  —  "The  mental  health  of  the  indus- 
trial worker  depends  upon  the  complicated  in- 


terplay of  the  individual  personality,  the 
specific  conditions  of  the  industrial  task,  the 
economic  factor,  the  domestic  and  general 
social  environment. 

"When  dealing  witii  the  disorders  of  the  in- 
dividual worker  and  of  groups  of  workers,  it  is 


ABSTRACTS 


155 


not  always  possible  to  isolate  single  symptoms 
and  supply  specific  remedies,  medical  or  social; 
and  one  must  be  prepared  to  make  a  very  de- 
tailed analysis,  and  the  remedies  may  be  of 
slow  evolution. 

"So  far  there  is  not  available  enoujjh  well 
studied  material  for  useful  constructive  sug- 
gestions to  be  made;  to  gather  such  material  is 
ii  task  of  immediate  importance. 

"The  development  of  an  enlightened  public 
opinion  on  these  tojjics  would  be  a  most  im- 
portant contribution  to  the  mental  health  of 
the  community  and  to  social  and  economic 
stability. 

"Tiie  attention  [)aid  during  war  time  to  the 
mental  health  and  morale  of  those  engaged  in 
the  business  of  destruction  is  no  less  necessary 
during  peace  time  for  purposes  of  construction; 
mental  health  and  good  morale  arc  as  im|)()r- 
tant  in  peace  as  in  war,  and  to  nuiddlc  ahjiig  in 
peace  may  be  as  disastrous  as  to  do  so  in  war." 
—  Stanley  Cobb. 

RESPIRATORY  SYSTEM 

The  Pneumokon'ioses.  Internat.  Jour.  Ptii). 
Health,  July-.\ug.,  19^21,  '■2,  No.  4,  4(tl  4()H.  — 
This  article  is  a  review  of  recent  important 
contributions  to  the  already  extensive  biidi- 
ograi)liy  of  industrial  tuberculosis,  dealing 
princii)ally  with  the  pnemnokonioses. 

"In  ail  industries  under  consideration  want 


of  proper  attention  to  the  welfare  of  the  worker 
is  more  in  evidence  than  a  lack  of  positi^'e 
knowledge  concerning  the  aetiology  and  method 
of  transmission  of  the  diseases. 

"Modern  preventive. medicine  requires  med- 
ical examination  and  X-ray  control,  not  as  a 
luxury  but  as  an  ab.solute  necessity.  A  clinical 
examination  should  also  be  compulsory  for  all 
candidates  wishing  to  enter  a  dangerous  trade, 
subsequent  perioilical  medical  examinations 
l)eing  the  obvious  complement  of  this  first 
examination.  Adults  suffering  from  pneu- 
mokoniosis  after  many  years  of  work  should  l)e 
ai)lc  to  change  their  trade  and  sliould  receive 
iiidcnniity.  Working  conditions  nnist  be  con- 
trolled and  the  quantity  of  dust  in  the  atmos- 
phere breathed  should  be  regulated  by  a  stand- 
ard of  cmniKTation  rather  than  one  of  weight 
per  volume.  The  exact  statistics  of  tuber- 
culosis morijidity  and  mortality  should  be 
brought  into  relation  with  the  scientific  eval- 
uation of  dust  in  the  atmosphere.  Finally,  in 
the  intervals  of  work  opportunities  shoulil  be 
.•ill'drdcd  for  healthy  open-air  rcc-reation. 

"The  medical  profession  may  well  feel  the 
obligation  to  pre])are  public  opinion  for  stricter 
legislation  in  this  direction  in  order  that  the 
tuberculosis  moriiidity  of  adults  threatened 
with  pneumokoniosis  may  be  reduced,  if  not  to 
the  normal  rate,  at  lea.st  to  something  less 
terrible  than  its  present  high  level."  —  M.  C. 
Shorlev. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS: 
CHEMICALS,  ETC. 


GASES, 


Memor/VNdum  on  Le.\d  Poisoning.  —  In- 
ternat.  Labour  Rev.,  May-June.  10-21,  -2,  Xos. 
2-3,  ^.'{l-^.S.'J.  —  This  is  a  sunnnary  of  a  nicm- 
oranduin  on  industrial  lead  jioisoning  issued  by 
the  British  Home  Office. 

Figures  for  the  past  twenty  years  show  a 
marked  reduction  in  the  number  of  ca.ses  of 
lead  i)ois()ning,  except  in  the  electric  accumula- 
tor industry;  and  the  present  memorandum 
shows  also  decrease  in  the  severity  and  in  the 
proportion  of  chronic  cases. 

Two-fifths  of  all  reported  cases  occur  during 
the  first  eighteen  months  of  work,  and  the 
symptoms  mentioned  as  most  frequent  in  the 
Annual  Report  of  the  Chief  Inspector  of  Fac- 
tories are:  gastric  troubles,  anemia,  headache, 
paralysis,    encephalopathy,    and    rheumatism. 


Paralysis  is  more  common  in  men  than  in 
women  but  the  contrary  is  true  of  encephalop- 
atiiy. 

The  number  of  deaths  recorded  during  the 
twenty  years  has  not  diminished  in  proj)ortion 
to  the  number  of  eases,  because  after  the  W(jrk- 
mcn's  Com])ensation  Act  of  1906,  lead  poison- 
ing is  more  often  mentioned  as  associated  cause 
on  the  death  certificates  of  lead  workers  suffer- 
ing from  chronic  nephritis  and  its  sequelae. 
The  attack  rate  per  thousand  is  given  for  ten 
intlustries.  Electric  accunnilators  lead  with  '27; 
white  lead  shows  Hi;  tinning  of  metals  '20; 
paints  and  colors  16;  vitreous  enameling  14; 
smelting  of  metals  13. 

The  memorandum  contains  also  information 
about  processes  in  which  lead  poisoning  is  fre- 


156 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


quent,  symptoms  and  diagnosis,  and  preventive 
measures  that  have  been  taken.  —  G.  E. 
Partridge. 

The  Coxtr.vst  between  the  Brain  Le- 
sions Produced  by  Lead  and  Other  Inor- 
ganic Poisons  andThose  Caused  by  Epidemic 
Encephalitis.  G.  B.  Ha.ssi)i.  Arch.  Neurol, 
and  Psychiat.,  Sept.,  19^21,  6,  No.  3,  ''268-'-285. 
—  The  author  draws  the  following  conclu- 
sions : 

"1.  The  nonsuppurative  inflammations  of 
the  brain  may  be  divided  into  two  large  groups. 
One,  represented  by  epidemic  encephalitis  and 
paralytic  dementia,  is  of  infectious  origin. 
Pathologically,  it  is  characterized  by  excessive, 
widespread  perivascular,  and  sometimes  also 
parenchymatous,  infiltrations,  the  pia-arach- 
noid  changes  being  quite  mild.  This  type  may 
also  be  defined  as  an  infiltrative  encephalitis 
which  thus  includes  all  possible  direct  infections 
of  the  brain  tissue  proper. 

"2.  The  second  group,  mainly  represented 
by  lead  encephalitis,  is  due  to  intoxication  and 
should,  therefore,  be  termed  toxic.  Patho- 
logically, it  shows  a  great  preponderance  of 
proliferative  or  (as  Bonfiglio  puts  it)  '  produc- 
tive '  phenomena  in  the  mesodermic  tissues 
(blood  vessels,  capillaries  and  the  jiia-arach- 
noid).  This  group  may  be  termed  ])roductive 
encephalitis. 

"3.  Microscopically,  it  is  not  only  possible 
to  determine  whether  any  given  case  is  one  of 
a  nousui)purative  encei)halitis,  but  also  whether 
the  encephalitis  is  due  to  an  infection  or  to  an 
intoxication. 

"4.  The  study  of  the  pia-arachnoid  and  the 
subarachnoid  si)ace  is  of  paramount  importance 
in  determining  whether  the  brain  is  normal 
or  ])athologic,  for  these  structures  may  exhibit 
changes  even  when  the  brain  tissues  proper 
appear  normal."  —  M.  Dent. 

Some  of  the  Effects  of  Chronic  Lead 
Poisoning,  with  Special  Reference  to 
Arteriosclerosis.  G.  B.  Page.  Jour.  State 
Med.,  June,  1921,  29,  No.  6,  161-168.  —  It  is 
suggested  that  an  insidious  result  of  mild, 
chronic  lead  poi.soning  is  arteriosclerosis.  The 
lead  damages  the  renal  ])arenchyma,  which  in 
turn  causes  an  increased  arterial  pressure. 
Measurements  on  painters  show  a  higher  blood 
pressure  than  those  on  non-lead  workers.  — 
Barnett  Cohen. 


Chronic  Arsenic  Poisoning.  R.  Stockman. 
Abstracted  as  follows  from  Edinburgh  Med. 
Jour.,  July,  1921,  27,  No.  1,  1,  in  Jour.  Am. 
Med.  Assn.,  Sept.  3,  1921,  77,  No.  10,  816.  — 
"Stockman  claims  that  the  administration  of 
arsenic  compounds  may  be  safely  continued  for 
a  considerable  period  after  pigmentation  of  the 
skin  and  keratosis  have  developed.  If  slight, 
these  clear  off  rapidly  after  the  administration 
is  stopped,  and  seem  to  leave  no  ill  effects. 
Very  deep  pigmentation  may  be  permanent, 
and  in  a  few  cases  the  development  of  cancer 
has  been  noted,  apparently  following  on  local 
irritation.  On  the  other  hand,  its  administra- 
tion should  l)e  stopped  at  once  as  soon  as  the 
slightest  signs  of  neuritis  appear.  The  lesion  is 
always  tedious  and  troublesome  to  get  rid  of, 
and  in  some  cases  is  permanent."  —  C.  K. 
Drinker. 

T.AR  Sarcoma  in  Rabbit.  K.  Yamagiwa,  S. 
Suzuki,  and  K.  Murai/ama.  Abstracted  as  fol- 
lows from  Mitteil.  a.  d.  Med.  Fak.  Univ.,  Dec. 
28,  1920,  25,  No.  2,  189,  in  Jour.  Am.  ]\Ied. 
As.sn.,  Sept.  3,  1921,  77,  No.  10,  823.  —  "The 
fibromyxosarcomatous  tumor  developed  in  the 
manuua  of  a  rabbit  twenty-three  months  after 
the  beginning  of  the  course  of  thirty-one  injec- 
tions of  tar  in  the  mamina.  A  recurrence  de- 
veloped with  metastases  after  excision  of  the 
tumor,  and  scraps  of  it  i)roliferated  when  in- 
jected in  otlier  rabbits.  This  was  the  only 
I)ositi\-e  cancer  produced  among  the  200  rabbits 
in  tiie  tests.    (In  German.)  "  —  C.  K.  Drinker. 

Medical  Opinions  on  Industrial  Poison- 
ings. F.  Cur.schmaiin.  Zentralbl.  f.  Gewer- 
behyg.,  April,  1921,  9,  No.  4,  73-81.-17. 
Death  Folhuring  Employment  with  Trinitrotoluol 
Caused  by  Poi.ynuing  or  by  a  Pre-Fj.ristiug  Lircr 
Di.sease?  —  A  man  who  had  worked  for  some 
months  in  contact  with  trinitrotoluol  came 
down  suddenly  with  a  general  jaundice  and  en- 
larged ]>aiiiful  liver;  after  increasing  mental 
cloudiness  and  the  appearance  of  albiunin  and 
tyrosin  in  the  urine  he  died.  Postmortem 
examination  revealed  what  seemed  a  cirrhosis 
of  the  liver.  It  is  here  given  as  the  ojjinion  that 
this  was  not  cirrhosis  plus  an  acute  poisoning, 
but  a  cunuiiativc  liver  damage  with  a  sudden 
ending,  due  to  nitrated  hydrocarbons. 

VII.  Death  as  a  Sequel  to  Respiration  of 
Trichlorethylene.  —  A  48-year  old  shoemaker 
was  accidentally  exposed  to  considerable 
amounts  of  trichlorethylene.    After  two  days 


ABSTRACTS 


157 


he  recovered  from  the  stupor  and  weakness, 
and  was  again  at  work.  He  continued  to  sutler 
head  pains  and  dizziness  and  became  progres- 
sively more  anemic  and  weak.  He  is  known  to 
have  heon  imdernourished.  Five  months  hiter 
he  became  ill  with  what  was  sujiposed  to  be  in- 
fluenza, and  a  month  later  died.  When  claims 
for  compensation  were  made  the  body  was  ex- 
liinned,  and  an  extensive  brain  abscess  coming 
from  an  old  tuberculous  otitis  was  shown  to  be 
the  cause  of  death.  The  various  possibilities 
that  the  trichlorethylene  poisoning  may  have 
been  a  contributory  c-ause  of  death  are  dis- 
cussed. The  (lucstion  cannot  be  .settled  with 
certainty,  but  it  is  ])robable  that  a  small  part, 
if  any,  was  played  by  the  gas. 

VIII.  Degeneration  of  the  Liver  Followimj 
Dinitrohcnzene  Poisnninij. — An  18-year  old 
girl  began  to  have  jauntlice  after  exjjosnre  to 
dinitrobcnzene  during  two  and  a  half  months' 
work  at  filling  shells.  Following  a  sickness  of 
nearly  two  months,  with  enlarged  li\er,  ab- 
dominal pain,  and  jaundice,  she  died  with  a 
.severe  hemorrhage  from  the  mouth  and  nose. 
The  ca.se  is  very  probably  one  of  acute  diffuse 
he|)atitis  with  fatty  degeneration  of  the  liver, 
.so  frccjuciitly  due  to  nitro-coni])ounds.  — E.  L. 
Sevringhaus. 

Bknzkne    Poisoning    in    RrnnEK    M.wr- 

F.\(Trui.\(;.  Robert  N.  Qitinhi/.  .Abstracted  as 
follows  from  Rubber  .Vge,  1!)"21,  ^"ol.  .S,  4.>1,  in 
Chem.  Abstr.,  May  10,  XMl,  15,  No.  9,  \i-ii. 
—  "A  review  of  the  bulletin  of  the  Rubber 
Association  of  America  on  the  u.se  of  benzene." 

Studies  in  C.vrbon  Monoxide  .\si>iiv.xi.\. 
I.  The  Beh.wior  of  the  He.\kt.  Howard  H'. 
Hayqard.  Am.  Jour.  Physiol.,  July  1,  19'-21,  56, 
No.  .'5,  390-40;?.  —  "Death  under  carbon 
monoxide  asphyxia  is  due  to  failure  of  respira- 
tion. This  is  in  the  nature  of  a  fatal  apnoeavera. 
The  anoxemia  resulting  from  the  formation  of 
carboxyhemoglobin  induces  excessive  breath- 
ing; and  respiratory  failure  follows  the  exces- 
sive loss  of  CO2. 

"Oxygen  deficiency  caused  by  carbon  mon- 
oxide, even  in  advanced  asphyxia,  is  not  in  itself 
sufficient  to  cause  impairment  of  anriculoven- 
tricular  conduction.  Following  resi)iratory 
failure,  however,  the  increased  ano.xemia  from 
this  cause  speedily  results  in  the  development 
of  heart  block  through  its  various  stages. 

"By  restoring  respiration  and  rapidly  elim- 
inating the  carbon  monoxide  by  means  of  in- 


halations of  carbon  dioxide  and  oxj'gen,  cardiac 
conduction  is  restored  to  normal  following  the 
de\-elopment  of  block. 

"The  cardio-inhibitory  center  maintains  its 
activity  longer  than  does  the  respiratory  center. 
This  center  is  stimulated  by  the  increa.sed  Ch 
which  occurs  during  respiratory  failure.  From 
this  there  results  a  temporary  cessation  of 
auricular  activity.  This  i)eriod  of  inhibition  is 
prevented  by  the  administration  of  atroi)ine. 

"When  res|jiratory  failure  is  prevented  by 
means  of  inhalations  of  8  or  10  per  cent,  carbon 
dioxide,  the  carbon  monoxide  coniliination  with 
hemoglobin  rises  to  an  miusually  high  pi-rcent- 
age  without  any  evidence  of  iin])airment  in  a-v 
conduction.  This  indicates  that  there  is  no 
direct  toxic  action  of  carbon  monoxide  upon  the 
cardiac  conducting  .system. 

"  Iliuniiiiatiiig  gas  results  in  an  earlier  de- 
velopment of  resi)iratory  failure  than  does  pure 
carbon  monoxide  in  corresponding  concentra- 
tion. 

"Klectrocardiographic  records  are  given 
frum  two  animals  which  diti'cred  from  the  rest 
in  that  one  developed  a  transient  period  of  al- 
ternation involving  the  R  and  T  waves  and  the 
other  j)re.sented,  during  the  lime  of  comi)lete 
a-v  block,  a  condition  resembling  auricular 
fibrillation  or  flutter."  —  V.  K.  Drinker. 

On  C.\rbon  Monoxide  Poisoning  in  a 
FoiTCDRY.  0.  Clros  and  M.  Koclnnan.  Ab- 
stracted as  follows  from  \'rtlj,schr.  f.  gerichtl. 
Med.,  1!K>I.  (11,  No.  1.  in  Miinchen.  med. 
Wchnschr.,  May  6,  19^21,  (i8.  No.  18,  559.— 
"This  article  contains  the  opinions  of  medical 
ex[)erts  on  the  ((uestion  whether  the  death  of  a 
worker  who  was  suddenly  taken  ill  in  a  foundry 
and  died  two  days  later,  and  in  whose  blood 
carbon  monoxide  was  detected  at  autopsy, 
should  be  considered  as  an  industrial  accident. 
The  quest  ion  was  answered  in  the  affirmative." 
—  M.  C.  Shorley. 

D.^ngers  to  He.vlth  in  .\rTOGENors  Wield- 
ing. Jenny  Adler-Herzmark.  Zentralbl.  f. 
Gewerbehyg.,  May,  Wil,  9,  No.  5,  97-98.— 
The  author  investigated  a  number  of  small  in- 
dustries where  autogenous  welding  is  done  and 
found  that  acute  attacks  resembling  brass 
founder's  ague,  and  probably  identical  with  it, 
are  always  associated  with  the  use  of  hot  brass 
or  zinc.  Zinc  vapors  were  often  visible.  Either 
zinc  or  zinc  oxide  is  the  causative  agent  of  the 


158 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


disease.  It  is  proposed  to  determine  experi- 
mentally whether  the  corrosive  action  of  zinc 
oxide  is  so  extensive  that  after  a  few  hours  the 
absorption  of  the  damaged  tissue  may  cause  a 
fever.  Is  the  more  severe  gastric  part  of  the 
attack  to  be  associated  with  zinc  chloride 
formed  in  the  stomach?  —  E.  L.  Sevringhaus. 

Sickness  and  Death  Due  to  Ferrosili- 
CON.  Thiele.  Zentralbl.  f.  Gewerbehyg.,  May, 
1921,  9,  No.  5,  94-97.  —  The  death  of  three  in- 
dividuals in  one  house  following  a  brief  illness 
marked  by  head  and  body  pains,  vomiting  and 
stupor,  and  the  similar  illness  of  several -other 
occupants  of  the  house  were  at  first  diagnosed 


as  due  to  grippe,  and  later,  to  food  poisoning. 
It  was  finally  found  that  the  occupants  of  the 
house  had  been  poisoned  by  gas.  On  the 
gromid  floor  was  stored  a  large  amount  of  fer- 
rosilicon  which  had  been  wet  by  rain  just  before 
being  brought  in.  Due  to  impurities  in  this 
commercial  ferrosilicon,  phosphine  was  evolved 
and  caused  the  poisoning.  Arsine,  hydrogen 
sulphide,  and  acetylene  were  other  possible 
contaminating  substances,  but  none  of  these 
could  be  demonstrated  as  obtained  from  the 
ferrosilicon.  The  possibility  of  such  gases  being 
formed  from  ferrosilicon  has  been  demon- 
strated before,  several  instances  of  which  are 
cited.  —  E.  L.  Sevringhaus. 


DUST  HAZARDS  AND  THEIR  EFFECTS 


Investigation  of  Dust  in  the  Air  of 
Gr.\nite-Working  Pl.\nts.  S.  H.  Katz.  Ab- 
stracted as  follows  from  U.  S.  Bur.  Mines,  Re- 
ports of  Investigations,  No.  '■2-213,  lO^l,  pp.  2, 
in  Chem.  Abstr.,  May  10,  1921,  15,  No.  9,  1368. 
—  "In  the  pulmonary  disease,  designated  as 
granite  pneumonoconiosis,  to  which  granite 
cutters  are  subject,  it  is  estimated  that  particles 
of  the  hard  insoluble  rock-forming  materials 
about  1  micron  in  diameter  are  most  injurious. 
Smaller  particles  either  do  not  readily  lodge  or 
are  more  easily  eliminated.  In  an  investigation 
of  this  disease  at  Barre,  Vermont,  the  principal 
granite-producing  town  of  America,  the  dust- 
iness of  the  air  was  determined  by  3  methods. 
Two  of  these  methods  involved  the  catching 
upon  a  sticky  glass  plate  the  dust  particles  from 
a  volume  of  air  impinged  at  high  velocity  on  the 
plate  by  a  small  air  pump,  the  particles  caught 
being  counted  by  the  aid  of  a  powerful  mi- 
croscope. In  the  other  method  the  air  was 
filtered  through  a  layer  of  granulated  sugar,  the 
sugar  dissolved  in  H2O,  a  portion  examined 
microscopically  to  count  the  stone  particles, 
then  the  whole  sample  filtered,  the  filter  paper 
ignited  and  the  dust  weighed.  The  dustiness  is 
expressed  in  millions  of  partic'Ics  per  cubic  foot 
and  on  a  weight  basis  in  mg.  per  cubic  foot." 

How  to  Catch  .\nd  Ship  Dust.  M.  R.  Rad- 
ford. Factory,  July,  1921,  27,  No.  1,  68.— 
"The  powder  which  constitutes  the  remarkable 
product  of  this  company  is  stored  in  a  large 
storehouse  from  which  a  c<)\'ered  conveyor 
brings  the  material  alo!ig  under  the  ceiling  of 


the  packing  room  and  feeds  it  into  packing  ma- 
chines, which  mechanically  fill  paper  cartons 
with  the  correct  quantities.  Where  the  nozzle 
of  the  machine  delivers  the  powder  into  the 
cartons  the  process  naturally  breaks  some  of 
the  grains  into  fine  dust,  which  used  to  escape 
and  cloud  the  room.  An  air  exhaust  now  piped 
to  the  deli^"ery  nozzle  of  each  machine  draws 
away  this  dust  before  it  can  scatter. 

"Each  air  pipe  connects  to  a  large  exhaust 
pipe  which  is  suspended  from  the  ceiling.  This 
pipe  passes  out  through  the  wall  of  the  building 
onto  the  top  of  the  adjoining  storehouse.  On 
the  top  of  the  storehouse  are  two  cyclones  or 
extractors  and  settling  boxes.  The  air  pipe  de- 
livers the  dust  to  the  first  extractor;  it  whirls 
around  inside  and  most  of  it  settles  to  the  bot- 
tom, drops  tlirougli  tiie  hole  in  the  roof  of  the 
storehouse,  and  falls  upon  the  pile  of  material 
beneath.  Some  of  the  dust  reaches  the  second 
extractor,  where  it  settles  and  drojjs  through  to 
the  storehouse.  Tints  all  the  dust  is  not  only 
kept  out  of  the  worknjom,  but  is  recovered  and 
is  used  again."  —  M.  Dent. 

Coal-Dust  Hazards  in  Indu.strial  Plants. 
L.  D.  Tracy.  U.  S.  Bur.  Mines,  Reports  of  In- 
vestigations, Serial  No.  2242,  April,  1921,  pp. 
6.  —  Since  the  use  of  i)ulverized  coal  as  fuel  in 
heating  furnaces  in  steel  mills  was  introduced, 
fires  and  explosions  have  occurred.  The  Bureau 
of  Mines,  tiierefore,  investigated  the  conditions, 
and  found  tliat  there  was  a  lack  of  knowledge  of 
the  explosive  character  of  coal  dust.  Tiic  first 
requirement,  consequently,  is  that  in  all  i)lants 


ABSTRACTS 


159 


where  pulverized  coal  is  used  for  fuel,  the  men 
should  be  taught  that  clouds  of  fine  coal  dust 
are  as  dangerous  as  a  body  of  unconfined  natural 
gas. 

Experiments  in  the  mine  of  the  TJureau  of 
Mines  have  shown  that  pressures  as  high  as 
130  pounds  per  square  inch  may  be  produced  in 
coal  dust  explosions,  and  experiments  have  also 
demonstrated  that  a  mixture  of  30  per  cent,  of 
pulverized  coal  dust  and  70  per  cent,  of  finely 
powdered  shale  is  explo.sive.  .Analyses  of  dust 
from  the  interiors  of  buildings  where  pulverized 
coal  is  used  shows  that  the  dust  sometimes 
contains  as  high  as  '■iS^  per  cent,  of  volatile 
matter. 

There  is  danger  al.so  of  spontaneous  combus- 
tion of  pulverized  coal  in  the  bins,  and  studies 
have  been  made  to  determine  the  conditions 
affecting  (jxidation  in  wliicli  it  was  found  that 
oxidation  is  accelerated  with  rise  of  temper- 
ature. If  enough  air  is  present,  jiulverized 
coal,  when  delivered  at  a  storage  bin  at  a  fairly 
higii  Icniperatiirc,  will  in  a  siiort  time  a|)i)roach 
the  point  of  ignition.  As  a  matter  of  fact,  owing 
to  dryers  becoming  overheated,  the  coal  is 
.  likely  to  be  delivered  at  a  temixTalure  making 
combustion  probal)le.  It  is  espcrially  likely  to 
ha])pen  in  the  type  of  dryer  known  as  the  "di- 
rect heat"  dryer.  Storage  bins  for  i)ulverized 
coal  should  not  be  placed  where  they  may  be- 
come heated  from  furnaces,  .steam  ])ipes  or  hot 


flues.  If  a  plant  has  been  shut  down  for  a  few 
days,  coal  should  not  be  delivered  through 
transport  lines  imtil  it  is  known  whether  the 
coal  has  become  heated. 

Some  of  the  fires  in  the  distribution  lines 
have  originated  as  back  fires  from  the  heating 
furnaces,  caused  b\'  sudden  changes  in  the  air 
pressure,  which  may  take  place  in  several  ways. 
So  it  is  im|)ortant  that  no  chance  lie  given  for 
burning  particles  to  enter  into  the  trans])ort 
line,  and  the  line  should  be  cleaned  frequently 
!)>•  allowing  the  fan  to  force  a  current  of  air 
through  it. 

When  furnaces  have  individual  fuel  bins  and 
the  coal  is  delivered  into  the  ])rimary  air  line  by 
means  of  screw  conveyors,  the  fuel  Ijins  should 
be  placed  away  from  the  furnaces;  otherwise 
fatal  accidents,  as  fre(|uently  lia|)i)eiis,  may 
occur  i)y  dust  overflowing  the  line  ami  falling 
down  before  the  furnace  door. 

.Vs  regards  the  pulverizing  plant,  every  pre- 
caution nuist  be  taken  to  prevent  accumulation 
of  (hist.  \o  system  of  ventilation  can  be  relied 
upon,  when  there  is  a  hazard  from  coal  dust,  but 
the  vacuum  cleaner  has  been  found  a  prac- 
ticalile  means  of  kee])ing  tlie  interiors  of  build- 
ings clean.  In  examining  storage  i)ins,  etc., 
electric  light  and  not  an  open  light  should  be 
used,  the  electric  bulb  should  be  |)rolecled  by  a 
wire  guard,  and  the  wire  must  be  properly  in- 
sulated. —  G.  E.  Partridge. 


OCCUPATIONAL  INFECTIOUS  DISEASES:   OCCURRENCE, 
TREATMENT  AND  PREVENTION 


The  Treatment  of  (\t.\neois  .Vxtuhax. 
W.  II.  (hjilrie  and  .1.  W .  Hall.  Brit.  Med. 
Jour..  June  18,  lO^l,  No.  3155,  889-890.  —  The 
authors  (juote  from  Circular  17'2,  issued  by  the 
Ministry  of  Health.  Jan.  '•28,  \9i\,  flgures  with 
regard  to  the  results  of  various  forms  of  treat- 
ment in  800  cases  of  cutaneous  anthrax  which, 
according  to  the  circular,  support  the  conclu- 
sion that  excision  is  imnecessary,  and  comi)are 
with  these  figures  records  from  Guy's  Hospital, 
which  show  that  when  both  excision  and  serum 
are  used  the  death  rate  is  notably  lower  than 
when  either  treatment  is  used  alone.  From 
their  exjjerience  at  Guy's  Hospital  they  con- 
clude that: 

"Excision  by  itself  will  assure  a  cure  in  about 
90  per  cent,   of  cases  in  a  disease  having  a 


natural  mortality  of  something  like  50  per 
cent.,  while  scrum  at  best  cannot  be  relied  upon 
to  avoid  a  fatal  issue  in  all  cases.  In  view  of  the 
danger  of  anthrax  and  the  local  nature  of  the 
infection  in  the  early  stages,  it  therefore  ap- 
|)ears  to  us  to  be  the  wi.ser  course  to  combine 
the  two  methods,  which  are  both  known  to  be 
good  and  which  cannot  be  mutually  antago- 
nistic, and  thus  to  give  the  patient  every  chance. 
Little  or  no  im|)ortance  can  in  the  circinn- 
stances  be  attached  to  the  resulting  scar.  We 
consider,  then,  that  the  combination  of  excision 
and  .serum  treatment  as  used  at  Guy's  Hospital 
is  probably  the  most  rational  and  the  safest 
course  in  all  cases  of  cutaneous  anthrax  which 
have  not  reached  the  stage  of  a  septicaemia." 
—  M.  C.  Shorley. 


160 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


OCCUPATIONAL  AFFECTIONS  OF  THE  SKIN  AND  SPECIAL  SENSES 


Injuries  to  the  Eye  with  Report  of  1051 
Cases.  Don  M.  Campbell  and  John  M.  Carter. 
Am.  Jour.  Ophth.,  May,  1921,  4,  Series  3,  No. 
5,  336-344.  —  "This  is  an  analytic  account  of 
the  cases  seen  in  a  period  of  two  years,  giving 
the  kind  of  history  obtained,  the  clmical  data 
brought  out  in  the  two  classes  of  cases,  minor 
injuries  and  major.  The  diagnosis  including 
the  importance  of  the  history  and  the  use  of  the 
X-rays  is  discussed.  The  removal  of  foreign 
bodies  from  inside  of  the  eye  is  considered  with 
results  from  twenty-four  magnet  extractions. 
The  importance  of  early  diagnosis  and  treat- 
ment is  insisted  upon." 

To  sunnnarize  the  points  of  interest  and 
practical  importance: 

"1.  In  this  series  we  have  two  great  clas.ses 
of  work  responsible  for  most  of  our  cases, 
namely,  emery  grinding  and  steel  or  metal 
work,  the  two  totaling  81.3  per  cent,  of  all  the 
injuries. 

"2.  That  by  far  the  greatest  number  of  our 
major  injuries  occur  in  the  second  group,  i.  e., 
those  working  on  metals. 

"3.  Taking  the  series  as  a  whole,  al)out  one 
case  in  every  thirteen,  or  7.9  per  cent,  were 
major  injuries,  while  in  the  cases  occurring  in 
the  steel  group  one  out  of  e\"ery  eight  cases,  or 
12.9  per  cent.,  were  major  injuries,  the  per- 
centage being  much  higher  in  the  steel  group. 

"4.  That  better  than  one  in  ten  of  all  our 
cases  have  required  an  X-ray,  before  we  coidd 
be  positi^■e  that  a  foreign  body  was  not  inside 
the  eye. 

"5.  117  X-rays  were  taken,  and  100  of  these 
occurred  in  the  steel  grou]). 

"().  20,  or  17  per  cent,  of  the  radiograms 
taken  were  positive  for  foreign  body  inside  of 
the  eye,  and  all  these  occurred  in  the  steel 
group. 

"7.  The  danger  signal  is  that  71  per  cent, 
of  our  major  injuries  occurred  in  the  steel 
group,  all  our  positive  X-rays  occurred  here, 
md  60  per  cent,  of  the  eyes  lost,  or  blind,  were 
I'hargeable  to  metals.  Such  figures  should 
cause  us  to  adopt  the  attitude  that  all  cases  in- 
jured while  working  on  metals  are  .serious,  and 
to  treat  them  as  such. 

"8.  The  magnet  operation,  as  such,  can  be 
considered  quite  successful;  we  were  able  to  re- 
move the  magnetizable  foreign  body  in  95  per 
cent,  of  the  cases. 


"9.  23.8  per  cent,  of  the  cases  on  which  we 
did  an  iridectomy  had  a  normal  vision  following 
the  operation. 

"10.  68.5  per  cent,  of  the  cases  were  seen  at 
our  office  on  the  day  they  were  injured,  43.5  per 
cent,  on  the  second  day  after  their  injury,  17.5 
per  cent,  on  the  third  day,  while  better  than  1/5 
of  the  cases,  or  21.5  per  cent,  waited  four  days 
or  longer,  before  they  applied  at  the  office  for 
treatment.  These  last  figures,  we  believe,  are 
\"erj'  important.  Delay  in  the  making  of  a  cor- 
rect diagnosis,  and  delay  in  the  instituting  of 
proper  treatment  are  two  of  the  most  potent 
factors  responsible  for  permanent  injury  to  the 
eye,  and  are  res])onsible  for  not  a  few  of  the 
artificial  eyes  that  we  see. 

"If  the  residts  here  reported  are  to  be  classed 
as  a  meritorious  showing,  certainly  the  credit  is 
to  be  shared  with  those  surgeons  and  general 
practitioners  who  early  in  their  cases  have 
realized  the  necessity  for  .special  examination  or 
treatment.  If  the  number  of  eyes  enucleated  or 
permanently  imjjaired  is  to  be  materially 
lessened,  then  we  must  strive  to  obtain  a 
higher  grade  of  ophthalmic  judgment,  not  only 
in  the  oculist  but  also  in  the  general  medical 
profession.  The  delay  in  correct  diagnosis  and 
proper  treatment  must  approach  a  minimum." 
—  M.  C.  Shorley. 


C-\TARACT  IN  Iron  Workers.  Abstracted  as 
follows  from  Brit.  Jour.  Ophth.,  May,  1921,  in 
Brit.  Med.  Jour.,  June  18,  1921,  No.  3155,  905. 
—  "The  fact  that  cataract  is  peculiarly  liable  to 
develo])  in  glass-workers  is  well  known,  and 
nuR'h  information  on  the  subject  has  been  pub- 
lished from  time  to  time  in  our  columns.  Evi- 
dence is  now  advanced  that  iron  workers  are 
also  unduly  liable  to  cataract.  Three  ]iai)ers  on 
the  subject  are  jjubiished  in  the  Brilixh  Journal 
of  Uplilliulmologi/  for  May,  1921.  Cridland,  of 
Wolverham])ton,  deals  with  cataract  in  pud- 
dlers,  among  whom  the  cases  are  comparatively 
few.  He  points  out  that  the  number  of  i)ud- 
dlers  is  by  no  means  large,  and  is  likelii'  to 
decrease  in  the  future,  as  steel  replaces  puddled 
iron.  His  contribution  adds  a  few  details  to  the 
well-known  paper  which  he  pul)lislicd  on  this 
subject  in  1915.  St.  Clair  Roberts  has  collected 
notes  on  cases  of  cataract  occurring  in  chain- 
makers  at  Dudley.    In  all  he  found  a  posterior 


I 


ABSTRACTS 


161 


polar  and  cortical  opacity  very  similar  to  that 
described  in  glass-blowers.  In  describing  the 
method  of  chainniaking  by  hand,  he  states  that 
machines  for  making  chains  have  not  proved 
successful,  and  he  tells  us  that  it  is  a  common 
belief  among  the  workers  that  the  sight  should 
fail  between  the  ages  of  50  and  (iO.  In  uncom- 
plicated cases  there  is  no  associated  lesion  of  the 
fundus,  and  the  residts  of  ojjcration  are  good. 
The  most  comprehensive  of  the  three  papers  is 
that  by  Healy  of  Llanelly,  who,  having  pre- 
viously had  experience  of  bottle-makers'  cat- 
aract in  Sunderland,  has  produced  really 
valuable  statistics  of  the  number  of  cataract 
cases  occurring  in  men  of  35  years  of  age  and 
over  engaged  in  the  tinplate  industry  at  T.lan- 
elly.  He  also  de.scril)es  the  nature  of  the  work 
at  length,  and  gives  details  of  '2((!)  cases.  In  his 
cases  the  posterior  cortical  type  of  oj)acity  often 
existed  in  combination  with  cortical  striae. 
His   pajjer  stronglj'   coiifinns    tlic   supposition 


that  it  is  the  infra-red  heat  rays  which  are  the 
important  ones  in  the  etiology  of  this  condition, 
for  in  the  tinplate  mill  the  men  are  not  expo.sed 
to  ultra-violet  rays.  The  atmosphere  of  the 
mills  is  dusty,  and  the  men  perspire  freely; 
they  are  adverse  to  the  wearing  of  protective 
goggles,  but  Hcaly  believes  that  much  might  be 
done  by  suitable  i)ropaganda  to  overcome  this 
I)rejudice.  'J'his  .series  of  papers  offers  weighty 
evidence  in  favor  of  the  suggestion  that  cat- 
aract in  iron  workers  shoidd  be  scheduled  un- 
der the  Workmen's  Comi)ensatioii  Act.  as  well 
as  glass-makers'  cataract.  The  Glass-Workers' 
Cataract  Committee  of  the  Royal  Society  has 
sent  a  deputation  to  Llanelly  to  inquire  into 
Dr.  Ilealy's  cases,  and  there  is  reason  to  ho])e 
tliat  the  Home  Office  will  shortly  jilace  these 
trades  upon  the  schedule.  These  papers  appear 
to  us  to  be  amongst  the  most  important  con- 
tributions to  o])htlialmology  that  have  re- 
cently been  |)ublislicd."  —  M.  (".  Sliorley. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Di.sccssiox  OK  .\N'  Amkkka.v  .Vcciuknt 
Table.  Carl  Ilook.stmlt.  V.  S.  Ilur.  Labor 
Statis.,  Month.  Labor  Rev.,  July,  IJK'l,  l;!.  No. 
1,  1-5.  — The  writer  compares  the  a<'curacy  of 
the  recently  published  American  tal)le  with  the 
standard  accident  table  com|)lcted  by  Dr.  I.  M. 
Robin.son  six  years  ago.  —  R.  IJ.  Crain. 

F.VTAL    Ixnr.STHIAL    .VCCIDKNTS     IN'    CaNADA 

Incre.vse  m  hi.N(!  HhH).  Nat.  Safety  News, 
July,  1921,  4,  No.  1,  28.  —  "There  were  1,170 
fatal  industrial  accidents  in  Canada  during 
1!)20  as  compared  with  l.OOH  in  1!)1!)."  These 
statistics  are  from  the  Canada  Labour  (ia/.cttc, 
and  are  admittedly  incomplete.  — M.  Dent. 

Explosion  of  Gas  Tanks.  Flelirig.  Zen- 
tralbl.  f.  Gewerbehyg.,  April,  1921,  9^  No.  4, 
84-85.  —  The  explosion  of  two  o.xygen  tanks 
in  a  locomotive  shop  is  explained  as  probably 
due  to  one  tank  having  fallen  on  the  other. 
The  tanks  were  not  connected  with  a  burner. 
Other  oxygen  tanks  in  the  lot  were  found  not  to 
contain  explosive  ga.ses  mixed  in  the  oxygen. 
Several  other  ca.ses  of  steel  gas  tanks  exploding 
without  combustion  are  cited.  —  E.  L.  Sevring- 
haus. 

Where  a  Hell-Hole  Might  Have  Been. 
Louis  Resnick.    Nat.  Safety  News,  July,  1921, 


4,  \o.  1,  5-9.  —  The  mining  town  of  yesterday 
is  described  with  its  dirt,  desolation  and 
drunkenness,  and  is  compared  with  a  model 
mining  town  of  today  in  which  the  greatest 
accident  ])roblcnis  in  the  world  —  those  of  coal 
mining  —  are  being  solved.  The  hazards 
peculiar  to  coal  mining  are  described  in  detail 
and  the  following  are  given  as  some  of  the 
.safety  improvements  made  by  this  comi)any  — 
the  Inland  Collieries  Company  of  Indianola. 
The  brattices  are  made  of  stone;  the  trolley 
wire  at  particularly  dangerous  spots  is  pro- 
tected by  a  wooden  channel;  accidents  at 
switches,  cnr\es,  and  doorways  are  avoided  by 
tlic  installation  of  a  single  incandescent  light  at 
every  switch,  door,  and  curve;  a  block  signal 
.system  is  used  which  practically  eliminates  the 
possibilities  of  head-on  or  rear-end  collisions  of 
trains:  and  ventilation  is  carefully  in.spected. 

But  the  safety  engineers  of  this  company 
find  that  the  most  effective  precaution  is  eternal 
\igilance  and  a  ceaseless  propaganda  for  safety 
given  in  the  weekly  first-aid  and  safety  meet- 
ing for  workmen.  —  M.  Dent. 

Remarkable  Record  Made  in  Building 
Concrete  Ships.  L.  D.  Woedtke.  Nat.  Safety 
News,  June,  1921,  3,  No.  16,  25-26.  —  This  is  a 
report  of  successful  accident  prevention  in  con- 
struction work,  which,  the  writer  asserts,  is  un- 


162 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


usually  hazardous.  During  a  full  year  there 
were  no  fatal  accidents  or  serious  permanent 
injuries.  The  average  number  of  employees  was 
506,  and  for  a  total  of  1,.518,334.  hours  worked, 
the  whole  number  of  accidents  causing  time 
lost  for  more  than  the  day  or  shift  was  seventy- 
four.  There  were  in  all  twenty-nine  compensa- 
tion cases.  The  success  is  attributed  to  effec- 
tive co-operation  on  the  part  of  all  concerned, 
and  good  service  rendered  by  insurance  under- 
writers. —  G.  E.  Partridge. 

1,100  Steel  Workers  IVL\ke  60  Days  No 
Accident  Record.  Nat.  Safety  News,  Jime, 
1921,  3,  No.  16,  31.  —  This  is  a  report  from  the 
American  Works  of  the  American  Steel  and 
Wire  Company  at  Cleveland,  Ohio.  Em- 
ployees of  the  carpenter  and  pattern  shop  of 
the  Rankin  Works  of  the  same  company  have 
made  a  record  of  1,'27I  days  without  an  acci- 
dent. Other  departments  have  also  made  good 
records,  and  the  result  is  attributed  to  inter- 
plant  and  inter-department  competition.  —  G. 
E.  Partridge. 

Preventing  Accidents  on  Power  Tr.\ns- 
MissiON  ]VL\chinery.  W.  D.  Keefer.  Nat. 
Safety  News,  June.  1921,  3,  No.  16,"  17-18.  — 
There  are  two  main  ways  of  eliminating  ac- 
cidents from  transmission  machinery:  elim- 
inating, wherever  possible,  the  transmission 
machinery  itself;  and  supplying  proper  guards. 
Another  means  is  the  prohibition  of  all  work  on 
such  machinery  when  it  is  in  motion. 

Rules  for  installing  guards  for  shafts  and 
belts,  and  directions  for  eliminating  various 
hazards  are  given.  There  is  a  diagram  showing 
details  of  a  standard  belt  guard,  and  the  follow- 
ing general  princijjles  are  laid  down: 

The  guard  should  be  so  designed  that  it  will 
prevent  all  accidents. 

The  guarded  jjart  must  be  easily  accessible 
for  oiling,  in.spection  and  repairs. 

The  guard  should  not  interfere  with  produc- 
tion, nor  witli  cleaning  al)out  the  machinery. 

The  guard  nmst  be  strong  enough  to  resist 
injury  and  to  hold  its  shape  (metal  guards  are 
preferable) . 

A  connnittee  of  men  representing  all  inter- 
ested parties  has  been  organized  under  the 
auspices  of  the  American  Engineering  Stand- 
ards Committee  to  draft  a  Safety  Code  on 
Power  Transmission  Machinery.  —  G.  E.  Part- 
ridge. 


Safety  Requirements  of  Woodworking 
Shops.  W.  Dean  Keefer.  Nat.  Safety  News, 
July,  19-21,  4,  No.  1,"  23-25.— The  essential 
consideration  for  safety  is  in  the  arrangement 
of  the  machines  in  regard  to  space  for  the  work- 
men to  move  around  in,  light,  height,  vibration, 
and  the  nearness  of  the  starting  and  stopping 
devices.  Guards  are  described  for  circular  saws, 
rip  and  railroad  saws,  band  saws,  jointers  and 
planers,  shapers,  etc.  —  M.  Dent. 

Circular  Saws  —  Keep  Theii  Sh.uip, 
Safe,  and  Efficient.  E.  Ross  Farra.  Nat. 
Safety  News,  July,  1921,  4,  No.  1,  15-17.  — 
"A  reduction  of  75  per  cent,  in  circular  saw 
accidents  can  be  made  merely  by  keeping  them 
in  good  condition.  ...  A  saw  that  is  not  in 
good  condition  requires  greater  power  from  the 
driving  motor  or  steam  engine,  it  does  not  saw  a 
clean,  straight  cut  in  the  wood  stock,  it  causes 
the  wood  to  bind  on  the  saw  and  kick  back,  and 
it  requires  more  effort  on  the  part  of  the  saw 
operator  to  push  the  wood  tlirough  the  ma- 
chine, thereby  increasing  the  danger  of  his 
slipping  or  losing  his  balance  or  rmuiing  his 
hand  into  contact  with  the  saw  blade."  De- 
tails are  gi\en  as  to  ways  of  keeping  saws  in 
good  condition.  —  M.  Dent. 

Two  New  Protective  Devices  from  the 
Am.sterdam  Safety  Museum.  Scholte.  Zen- 
tralbl.  f.  Gewerbehyg.,  May,  1921,  9,  No.  5, 
101-102.  —  Scholte's  short  paper  describes  and 
diagrams  in  a  purely  technical  manner  a  new 
device  for  pre^•enting  the  hand  of  a  printer  from 
being  crushed  in  a  printing  press.  The  fir.st  of 
these  devices  (for  shafts  on  lathes  and  polishing 
machines)  was  described  in  This  Jouunal, 
Feb.,  1921,  2,  No.  10,  201.  — E.  L.  Sevring- 
haus. 

Strength  of  Hoisting  Cables  Needs 
More  Attention.  Nat.  Safety  News,  .July, 
1921,  4,  No.  1,  22.  —  "The  necessity  of  giving 
greater  attention  lo  a  margin  of  .safety  in  re- 
spect to  the  strength  of  cables  and  chains  u.sed 
in  hoisting  heavy  building  and  other  materials 
is  emijhasized  by  a  recent  accident  in  New  \ork 
City,  in  whicli  twelve  tons  of  steel  beams  fell 
from  the  tenth  story  of  a  skyscraper  under  con- 
struction."—  M.  Dent. 

How  to  Make  Floors  in  the  Pl.\nt  Safe. 
Nat.  Safety  News,  Juno,  1921.  3.  No.  16,  19-20. 


ABSTRACTS 


163 


—  During  the  year  1919,  nearly  1*2,000  people 
were  killed  by  falling,  and  a  very  large  part  of 
these  accidents  can  be  traced  to  bad  floors. 
The  floor  should  be  strong  enough  to  bear  at 
least  four  times  the  standing  load  that  is  to  be 
placed  upon  it,  and  six  times  the  moving  load  to 
which  it  may  be  subjected;  and  it  should  be 
free  from  projections,  depressions  and  splinters, 
and  be  as  nearly  noiseless  as  [Kjssible.  A  good 
wooden  floor  consists  of  narrow  liardwofxl  nui- 
terial,  matched  and  nailed  on  a  wx)oden  under- 
floor;  but  at  best,  wooden  floors  require  nuich 
attention.  Concrete  floors  are  growing  in 
favor;  they  arc  easily  made,  are  safe  as  regards 
slipping,  and  arc  esjiecially  good  when  (lushing 
is  necessary.  Wooden  blocks  also  make  a  good 
floor  material.  Brick  floors,  laid  with  ))aving 
bricks,  and  granite  block  floors  are  suitable  for 
many  jiurposcs. 

A  good  way  of  overcoming  the  slipping  haz- 
ard on  oil-soaked  floors  is  to  apply  powdered 
rosin,  or  to  apply  to  the  floors  about  the  ma- 
chines a  heavy  coat  of  thick,  hot,  wood  flake 
glue  and  sprinkle  fine  sand  over  it  before  it 
cools. 

Clcaidiness  is  important.  One  method  of 
cleaning  greasy  floors  is  to  s|)rinkle  air-slaked 
lime  over  the  floor  so  as  to  cover  it  for  a  depth  of 
about  14  inch.  This  is  left  for  two  or  three 
hours  and  then  removed  with  a  stiff  brush. 
Tliis  method  has  been  used  successfully  on  oily 
cement  floors  that  have  resisted  all  other  clean- 
ing processes. 

Suggestions  are  made  in  regard  to  guarding 
floor  oj)enings,  protection  from  fire  and  heat, 
etc.  —  G.  E.  Partridge. 

How  TO  Prevent  Bitrns.  Nat.  Safety 
News,  June,  1921,  S,  Xo.  16,  29.  —  This  is  a 
discussion  by  several  writers.  The  hazard  from 
the  handling  of  acids  in  cleaning  metal  to  be 
plated  has  been  eliminated  by  one  coni])any  by 
the  substitution  of  the  sand-blast.  A  tapping 
hole  shield  (consisting  principally  of  chains 
lowered  in  front  of  the  tapjiing  hole)  has  been 
foimd  by  another  company  to  be  most  eft'ective 
in  preventing  burns  from  molten  metal.  Similar 
shields  are  used  in  other  processes.  Proper  at- 
tention to  the  condition  of  the  hose  and  liose 
coimections  is  said  to  help  in  j)reventing  steam 
and  hot  water  burns.  Another  concern  reports 
a  great  reduction  in  the  number  of  burns  as  a 
result  of  requiring  every  man  to  wear  proper 


protecting  devices.  One  safet%-  engineer  ex- 
presses the  opinion  that  the  main  solution  lies 
in  education.  —  G.  E.  Partridge. 

]MoRE  Tips  ox  Prevextixg  Btrx.s.  .Ihnon 
P.  Young.  Nat.  Safety  News,  July  1,  1921,  4, 
No.  1,  18. — The  following  points  come  from 
the  General  Electric  Company  at  Fort  Wayne: 
"We  instruct  the  new  men  on  real  dangers  in 
handling  tests,  we  supply  special  insulate(l  dis- 
appearing-tipcontractorshung on  standarils and 
counterweigh  ted  for  circuit  testing.  We  use 
special  rubber  insulated  grips  for  temporary 
comiections  in  testing  departments.  We  have 
remote  control  on  high  tension  lines,  all  lines 
being  run  in  conduits.  We  have  special  fuse 
pulling  devices,  sheet  metal  boxes  around 
starting  rheostats,  guard  rails  and  fences 
around  switch  boards,  test  departments  fenced 
off,  and  high  tension  lines  and  terminals  all 
marked  with  danger  signs.  We  use  screens 
around  arc  welders  to  prevent  burns  from 
radiation,  and  danger  signs  posted,  and  we  siq)- 
]>ly  welders  with  protective  equipment.  We 
have  instructed  plumbers  and  steam  fitters  on 
shutting  off  steam  before  rei)airing  high  pres- 
sure lines.  We  have  post(>d  instructions  for 
operating  gas  burners  and  ovens.  AVe  nave 
supplied  special  e(|uipmcnt  for  handling  hot 
materials  and  special  gloves  or  brakes  for  break- 
ing revolving  test  spindles  and  shafts."  —  M 
Dent. 

Etiology  .\xd  Prevention  of  Injuries  to 
THE  Eye.  Hurnj  V.  Wiirdemann.  Mil.  Sur- 
geon, Aug.,  1921,  49,  No.  2,  176-187. —The 
author  describes  briefly  the  commonest  types 
and  causes  of  eye  injuries,  and  emphasizes  the 
importance  of  protective  apparatus.  Safety 
a])i)lianccs  are  in  use  in  most  dangerous  trades, 
and,  according  to  the  twelfth  census,  have 
markedly  decreased  the  proportion  of  accidents 
within  the  last  ten  years.  Laws  compelling 
such  devices,  with  compensation  and  insurance 
laws,  have  been  enacted  in  thirty-one  states. 
There  is,  however,  much  op])osition  among  the 
workmen  to  the  use  of  these  appliances,  and 
constant  supervision  is  necessary. 

The  procedure  in  the  diagnosis  of  eye  in- 
juries is  described  rather  fully,  and  suggestions 
are  given  for  the  detection  of  malingering  in  the 
examination  of  an  injured  person  from  a  med- 
ico-legal standpoint.  —  M.  C.  Shorley. 


164 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


INDUSTRIAL  SURGERY 


Flat  Foot  as  a  Problem  of  Industrial 
Slthgery.  R.  B.  Bettman.  Nation's  Health, 
Aug.  15,  19^21,  3,  No.  8,  461-462.  —  Flat  foot 
occurs  frequentlj'  in  workers  obliged  to  stand 
for  long  hours  or  to  walk  continually  on  hard 
floors.  It  is  a  disease  of  the  new  employee,  of 
the  worker  transferring  frona  a  sedentary  job  to 
one  requiring  standing  or  walking,  and  of  the 
convalescent  from  a  recent  illness. 

The   symptomatology  of  weak  foot   is   de- 


scribed. Dr.  Bettman  suggests  as  corrective 
measures  change  of  employment  when  the 
condition  is  the  result  of  occupation,  improve- 
ment of^he  patient's  general  physical  condi- 
tion, correct  shoes,  adhesive  strapping  or 
exercises.  Arch  supports  are  said  to  afford 
great  relief  in  many  instances  and  under  such 
conditions  it  is  believed  that  patients  should  be 
allowed  to  wear  them.  —  Wade  Wright. 


INDUSTRIAL  PHYSIOLOGY:  NUTRITION,  METABOLISM, 

FATIGUE,  ETC. 


On  THE  Esti]vl\tion  of  the  Physiological 
Cost  of  Muscul.\r  Work:  The  Significance 
of  the  Respiratory  Quotient  in  Indirect 
Calorimetry.  J.  B.  Orr  and  J.  P.  Kinloch. 
Brit.  Med.  Jour.,  July  9,  1921,  No.  3158,  39-40. 

—  Waller  and  De  Decker  have  described  a 
rapid  method  for  estimating  the  cost  of  mus- 
cular work  based  upon  COi  exhalation  alone, 
1  c.c.  of  COo  being  taken  as  equivalent  to  5.850 
calories.  L.  Hill  and  Campbell  have  criticized 
the  results  of  Waller  and  De  Decker  on  two 
main  counts:  (1)  the  short  duration  of  the 
period  of  taking  the  sample;  and  (2)  the  failure 
to  take  sufficient  account  of  the  increase  of 
metabolism  due  to  taking  food. 

Orr  and  Kinloch  show  that  the  great  source  of 
error  inherent  in  Waller's  rapid  method  is  the 
neglect  of  the  significance  of  the  resjiiratory 
quotient  in  determining  the  caloric  equivalent 
of  the  volume  of  CO2  exhaled.  Variations  in 
diet  are  shown  to  affect  the  respiratory  (juotient 
markedly.  If  this  factor  is  neglected  and  the 
energy  expenditure  calculated  from  the  CO2 
output  alone,  it  is  shown  that  a  15  per  cent, 
error  may  readily  result. 

The  authors  also  show  that  the  respiratory 
quotient  may  fluctuate  as  a  result  of  sudden  in- 
creases and  decreases  of  the  rate  of  work.  They 
therefore  caution  against  the  use  of  the  method 
of  estimating  the  cost  of  work  from  CO-,  exhala- 
tion alone  unless  the  factor  of  diet  is  under  con- 
trol and  unless  the  actual  collection  of  CO2  is 
made  some  minutes  after  the  beginning  of  the 
task  and  when  the  normal  respiratory  relations 
for  the  work  in  question  have  been  established. 

—  C.  K.  Drinker. 


The  Physiological  Cost  of  Muscular 
Work.  Leonard  Hill  and  /.  A.  C.  Campbell. 
Brit.  Med.  Jour.,  May  21,  1921,  No.  3151,  733- 
734.  —  Waller  and  De  Decker  have  given  the 
cost  of  muscular  work  of  colliers,  shoemakers 
and  others  as  measured  by  the  exhalation  of 
CO2.  The  authors  have  carried  out  experiments 
of  a  similar  nature  using  a  bicycle  ergometer 
and  have  comjjared  the  residts  obtained  by 
Waller's  method  of  calcidation  with  those 
gained  by  the  standard  Douglas  bag  method  in 
which  both  the  CO2  output  and  oxA'gen  use  are 
measured  and  the  heat  loss  calcidated  there- 
from. 

The  results  by  the  two  methods  rarely  agree 
and  two  causes  are  assignable:  (1)  Waller's 
method  uses  a  thirty  second  period  for  collec- 
tion of  the  expired  air  —  too  short  a  time  for 
satisfactory  collection;  (2)  the  taking  of  food 
apparently  aft'ects  Waller's  method  markedly. 
—  C.  K.  Drinker. 

The  Correlation  between  Motor  Con- 
trol AND  Rifle  Shooting.  Reynold  A.  Spaeth 
and  George  C.  Dunham.  Am.  -lour.  Physiol., 
June  1,  1921,  56,  No.  2,  249-256.— The  con- 
clusions readied  are  as  follows:  "From  the 
foregoing  exj)erinients  it  is  clear  that  steadiness 
is  definitely  associated  {p  =  +0.61)  with 
marksmanshi])  in  the  ca.se  of  men  who  have  had 
range  experieiue.  The  practical  value  of  a  test 
of  this  sort  lies  in  its  use  as  a  predictive  means  of 
selecting  probable  expert  rifle  material  and 
eliminating  men  who  are  physiologically  un- 
fitted to  qualify  as  marksmen.  Since  the 
steadiness  test  requires  onlj'  about  3  minutes 


ABSTRACTS  165 

per  man,  it  would  be  far  more  efficient  as  re-  heated  to  100°F.,  and  the  time  taken  for  its  fall 

gards  time,  cost  of  munitions  and  the  nerves  of  to  9.5°F.    The  operation  is  rejjeated  under  wet 

men  and  officers  to  select  material  for  elimina-  bull)  conditions  and  the  difference  between  the 

tion  or  range  development  by  this  test  rather  two  determinations  gives  the  evaporative  cool- 

than  by  the  slow  and  costly  method  of  giving  ing  power.    (A  minor  calculation  is  involved.) 
every  man  a   try-out  with   the  rifle.     In   our         Extensive  observation  shows   that   the  dry 

experiments  we  have,  however,  only  tested  the  "kata  "  cooling  power  is  given  b.y  the  figure  0  in 

test  on  men  of  known  ability.    It  remains  for  ordinary  rooms  occupied  by  ^sedentary  workers, 

future  work  to  show  how  extensively  this  test  It  was  often  found  as  low  as  ;5  and  4  in  poorly 

may  be  used  witli  raw  recruits.    Range  ])racticc  ventilated  rooms  i)ut  should  never  fall  so  low. 

may    increase    a    man's    steadiness    and,    con-  When   heavy  work  is  being  done  the  cooling 

versely,    steadiness   practice    may    improve    a  power  of  the  air  should  be  kept  in  proper  rela- 

man's  range  score.    Further  exi)eriments  alone  tion  to  the  work  done  and  the  heat  outjjut  of 

will  tell."  —  C.  K.  Drinker.  the  worker.    The  body  spends   four  times  as 

much  energy  in  heat  as  in  doing  external  work, 

The  Effect  of  Short  Scells  of  Rest  o.\  and  if  the  atmosphere  is  so  regulated  as  to  pre- 

Physical   Efficiency   as   jVIeasuked    by    a  \ent   overheating   and   profuse   sweating   the 

Bicycle  Ergometer.    Lucy  A.  WaUrich  and  worker  will  naturally  be  stimulated  to  a  greater 

Percij  M.  Daw.ion.    Am.  Jour.  Physiol.,  July  1,  output.    The  heat  output  of  dillcrcnt  classes  of 

1921,  50,  No.  3,  460-463.  —  "1.    When  exer-  workers  is  exemplified  by   the  following  esti- 

cise  is  heavy,  efficiency  is  increased  l)y  spells  of  mates: 

rest.  Ailditioiinl  K.  Ca!.  per 

.  .       ,      ,  .  .         ,  Hour  Hcqiiired  for  W  ork 

2.    \>  hen  exercise  is  light,  efficiency  is  de-  TaUor. . .  1 n 

crca.sed  by  .spells  of  rest.  Carr  enter 116-lG-l 

;'3.   The  neutral  point,  viz.,  where  work  is  HC^^.oo;^ : ! : ! ! ! ! ! ! ! ! ! ! ! ! ' ! ! !  3?8 

neither  light  nor  heavy,  varies  with  the  individ- 
ual. Hill  has  calculated  that  the  tailor  would  re- 

"4.  The  neutral  point  varies  in  the  same  in-  (|uirc  a  dry  kata  cooling  jjower  of  (i,  the  cari)en- 
dividual  depending  on  practice  and  jjliysical  Icr  S.IO,  the  stonemason  1.5,  and  the  man  saw- 
condition  (training)."  —  C.  K.  Drinker.  ing  wood  18  to  keep  him  from  sweating. 

Observations    should    be    accunuilated     in 

The  Relation  of  Health  to  Atmospheric  which  working  efficiency  and  cooling  power  of 

Environment.     Leonard  Hill  and    M.  Green-  air  arc  correlated. 

wood.   Internal.  Jour.  Pub.  Health.  ]May-June,  Part  IL  — A  general  statement  of  the  rela- 

1921,  2,  No.  3,  232-247.  —  This  article  consists  tion  of  tuberculosis  to  environment  is  made  the 

of  two  sections.  Part  I  by  Ix-onard  Hill,  and  basis  of  discussion  as  to  progress  in  preventive 

Part  II  bj'  M.  (ircenwood.  medicine.    We  ai)pareiitly  have  a  fairly  good 

Part    /. — The    body    is   fa.shioned    for   the  knowledge  as  to  what  climate,  food,  housing, 

getting  of  food  by  outdoor  e.xercise.    It  is  sin-  etc.,  will  do  to  the  individual.    We  are  inade- 

gularly  adapted   to  resist  cold  and  exposure,  quate  in  mea.suring  how  far  the  rules  we  know 

and  when  assailed  by  the  liothou.se  conditions,  are  or  can  be  obeyed.    "We  have  [jointed  out 

which  make  so  large  a  part  of  man's  environ-  that   in   one   imjjortant   instance,    that   of  at- 

ment,  tends  to  react  unfavorably.    Al)undant  mos|)heric   changes,    the   methods   universally 

outdoor  exercise  in  all  sorts  of  weather  and  the  employed  a  few  years  ago  and  very  generally 

assurance  of  a  favorable  indoor  climate   are  relied  on  now  are  inadequate.    Research  pro.s- 

most  imj)ortant  elements  in  the  attaiiuncnt  of  ecuted   on   these   lines   will   not    lead    to    the 

good  health.    The  author  is  particularly   in-  di.scovery  of  new  specific  'causes'  of  disease; 

terested  in  measures  which  will  result  in  fur-  it  will  fulfill  a  higher  and,  from  the  standpoint 

nishing  a  proper   indoor  climate.     The   most  of   jjreventive   medicine,   far   more    important 

important  feature  which  has  been  neglected  in  purpose,  i>iz.,  the  revelation  of  how  life  may  be 

considerations  of  indoor  life  depends  upon  the  lived  under  physiological  conditions."  —  C.  K. 

cooling  power  of  the  air.    Hill  has  devised  the  Drinker, 
kata-thermometer  to  measure  the  cooling  and 

evaporative  powers  of  air.    The  instrinnent  is         Chemical   Factors   in    Fatigue.     I.   The 

simply  a  large   spirit   thermometer  which   is  Effect  of  Muscular  Exercise  upon  Cer- 


166 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


TAIN    CoiLMON    BlOOD    CONSTITUENTS.      Xorris 

W.  Rakesiraw.  Jour.  Biol.  Cheni.,  Aug.,  IQ^l, 
47,  No.  3,  565-591.  —  "1.  An  investigation 
was  undertaken  on  twenty-one  human  .sub- 
jects to  determine  the  changes  produced  by 
severe  muscular  exercise  upon  the  following 
constituents  of  blood  and  plasma:  non-protein 
nitrogen,  urea,  sugar,  uric  acid,  preformed  and 
total  creatinine,  cholesterol,  and  hemoglobin,  as 
well  as  specific  gravity,  viscosity,  and  the  num- 
ber and  relative  volume  of  corpuscles. 

"2.  Two  types  of  exercise  were  employed, 
representing  short,  strenuous  effort  and  longer, 
more  tedious  work. 

"3.  Short,  strenuous  exercise  was  invariably 
found  to  increase  the  blood  sugar  concentration 
both  in  plasma  and  corpuscles,  while  a  longer 
period  of  exercise  was  generally  accompanied 
by  a  drop  in  blood  sugar,  wliich  was  greater  in 
the  plasma  than  in  the  whole  blood. 

"4.  Both  kinds  of  exercise  were  accom- 
panied by  a  small  increase  in  uric  acid,  of  about 
the  same  order,  which  was  greater  in  the  plasma 
than  in  the  whole  blood. 

"5.  Short,  strenuous  exercise  had  no  effect 
upon  urea  or  non-protein  nitrogen,  but  longer 
work  increased  both  slightly,  in  whole  blood  as 
well  as  plasma. 

"6.  In  both  types  of  exerci.se  the  total 
creatinine  increased  very  little,  while  the 
preformed  creatinine  iniderwent  almost  no 
change. 

"7.  It  is  shown  conclusively  that  there  were 
no  considerable  changes  in  the  total  blood  vol- 
ume during  the  muscular  exercise  and  that 
variations  in  the  concentration  of  the  blood  are 
not,  therefore,  disturbing  factors  in  the  above 
conclusions. 

"8.  Cholesterol  was  found  to  decrease  very 
slightly,  although  results  were  not  thoroughly 
consistent.  The  decrease  seemed  to  be  some- 
what more  noticeable  in  tiie  corpuscles  than  in 
the  plasma. 

"9.  The  specific  gravity,  hemoglobin,  and 
the  number  and  relative  volume  of  corpuscles 
were  found  to  increase  during  the  periods  of 
exerci.se.  The  viscosity  of  the  whole  blood  was 
found  to  increase  considerably  and  that  of  the 
plasma  slightly. 


"  10.  Some  incomplete  data  are  given  suggest- 
ing that  total  nitrogen  is  increased  in  the  blood 
by  exercise  and  that  urea,  non-protein  nitrogen, 
and  uric  acid  continue  to  increase  for  some 
time  after  a  work  period,  while  the  sugar  con- 
centration, on  the  other  hand,  returns  to  nor- 
mal within  two  and  a  half  hours." — A.  S. 
Minot. 

Pr.\ctical  Experiments  in  Seating  in  In- 
dustry. Edith  Hilles.  Nation's  Health,  July 
15,  1921,  3,  No.  7,  399-405.  —  "Fortunately," 
according  to  Miss  Hilles,  it  is  "coming  to  be 
true  that  manufacturers  who  employ  large 
numbers  of  workmen  are  slowly  discovering 
that  it  pays  in  dollars  and  cents  to  study  the 
postural  needs  of  their  employees,  and  to  pro- 
vide for  them  an  environment  suited  to  their 
needs.''  The  author  goes  on  to  discu.ss  practical 
experiments  with  a  good  type  of  adjustable  foot 
rest;  with  a  foot  pedal  which  swings  backward 
and  forward  instead  of  up  and  down,  thereby 
sparing  the  operator  much  fatigue;  and  with 
seats,  both  sliding  and  stationary,  for  different 
types  of  work.  The  discussion  is  accompanied 
by  a  number  of  jjhotographs  which  illustrate 
good  and  bad  points  in  seating  equi])ment. 

The  incentive  for  considering  what  good 
posture  is  and  how  to  provide  for  it  may  be  an 
economic  one  coming  from  the  industrial  en- 
gineer who  wishes  to  increase  production;  the 
management  may  have  a  humanitarian  motive 
in  seeking  to  iiuj)rove  the  seating  facilities  for 
its  employees;  or  the  workers  themselves, 
weary  of  unnecessary  discomfort  and  fatigue, 
may  request  better  seating  equipment.  Miss 
Hilles  quotes  an  interesting  case  of  "a  hosiery 
mill  where  the  workers  in  one  department 
formally  submitted  a  request  that  chairs  be 
used  in  jjlace  of  stools.  They  gave  three  reasons 
for  mttking  tliis  request: 

'"  We  can  do  better  work. 

"'  We  can  increase  production. 

"'  We  can  go  home  at  the  end  of  the  day 
witiiout  i)ains  in  our  backs  and  the  possibility 
of  being  absent  the  next  morning  from  work  be- 
cause of  a  headache  from  the  constant  strain  of 
leaning  over  our  machine  all  day  with  no  chance 
of  relaxation.' "  —  Katherine  R.  Drinker. 


ABSTRACTS 


167 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


The  New  Place  of  Women  in  Industry  — 
VI.  The  New  Industrial  Professions.  Ida 
M.  Tarhell.  Indust.  Management,  Aug.  1, 
1921,  62,  No.  2,  106-108. --"In  this  closing 
paper  of  the  .series,  Miss  Tarbell  discusses  the 
new  professions  which  have  opened  themselves 
for  women  as  an  outgrowth  of  the  expanding  in- 
terest in  personnel  work.  In  all  industry  there 
is  probably  no  work  of  greater  importance, 
surely  none  in  which  a  woman's  special  gifts  of 
tact  and  symjjathy  count  for  more,  than  in  the 
'humanizing'  of  relations  between  employer 
and  emjjloyee."  —  M.  ('.  Shorley. 

Listing  the  Work  of  Women.  M.  E.  Slin- 
bert.  Factory,  July,  1921,  27,  No.  1,  120, 122.  — 
This  is  a  resume  from  the  bulletin  of  the  U.  S. 
Department  of  Labor  of  the  laws  pas.sed  in 
various  states  on  women  in  hazardous  indus- 
tries. Pennsylvania  prohibits  the  handling  of 
lead  by  women;  New  York  i)rohibits  working 
with  abrasives;  Ohio  proliibils  working  wheels 
or  belts  of  any  sort ;  and  I^ouisiana  i)rohil)its  the 
oiling  or  cleaning  of  moving  machinery.  In 
various  states  the  lifting  of  weights  is  regulated 
by  law.  —  M.  Dent. 

Causes  of  Work  Accidents  .v.mong  Wo.me.v. 
Nelle  Sivartz.  Nation's  Health,  June  15,  1921, 
3,  No.  6,  367-369. —This  .same  material  was 
covered  by  Miss  Swartz  in  the  Bulletin  of  the 
New  York  State  Industrial  Conunission,  and 
was  reviewed  in  the  June,  1921  issue  of  This 
JoLTRNAL,  on  page  27  of  the  Abstract  Section.  — 
G.  E.  Partridge. 

Physical  Standards  for  Child  Laborers. 
<S.  Josephine  Baker.  Nation's  Health,  Julv  15, 
1921,  3,  No.  7,  420-423.  —  The  National  Child 
Labor  Committee  has  recently  stated  that : 

"1.  There  are  at  least  five  and  a  half  million 
illiterates  in  the  United  States. 

"2.  Nearly  one-fifth  of  all  American  children 
between  the  ages  of  ten  and  fifteen  are  out  of 
school,  earning  their  own  living. 

"3.  Illinois,  Iowa,  Kansas,  Maryland,  Min- 
nesota, New  York,  Pennsylvania,  Texas  and 
Wisconsin  all  report  a  startling  increase  in  the 
number  of  children  leaving  school  to  go  to 
work  in  the  year  1920." 

According  to  these  statements,  we  have  in 
the  United  States  approximately  2,200,000 
children,  from  10  to  15  years  of  age,  engaged  in 


some  form  of  industrial  occupation,  the  tend- 
ency being  for  this  figure  to  increase  rather  than 
to  decline.  When  we  consider  that  "the  child 
who  goes  to  work  at  fourteen  has  an  earning 
capacity  at  twenty-five  just  half  as  great  as  the 
child  who  stays  in  school  until  he  is  eighteen; 
and  that  the  child  who  goes  to  work  at  fourteen 
is  twice  as  liable  to  sickness  and  disability  as 
the  child  who  stays  in  school,"  we  realize  the 
incalculal)le  loss  to  the  nation  in  health,  effi- 
ciency and  happiness  created  by  premature 
em])loyment. 

Dr.  Baker  believes  that  a  minimum  standard 
age  of  16  years  should  be  estal)li.shcd  in  all 
states  for  the  entrance  of  children  into  industry; 
that  an  employment  certificate  shouUl  always 
be  issued  for  a  particular  job  and  in  the  name 
of  the  employer;  that  no  new  certificate  should 
be  issued  unless  the  child  has  had  a  jihysical 
examination  and  is  shown  to  be  in  .soimd  health 
and  |)hysically  fit  to  i)erform  the  work  he  in- 
tends to  do;  and  that  a  child  continuously  em- 
|)l()yed  in  any  position  for  more  than  one  year 
should  have  a  yearly  physical  examination. 

The  examination  of  any  "child  before  he  en- 
ters industry  should  cover  the  following  jjoints: 
height,  weigiit,  general  i)hysical  condition,  con- 
dition of  nutrition,  maturity,  examination  of 
the  skin,  eyes,  ears,  mouth,  naso])harynx, 
glands,  heart,  lungs  and  abdomen.  Ortlio])edic 
defects  should  be  noted,  and  diseases  of  the 
nervous  system  and  disturbance  of  the  menses 
are  also  of  importance. 

"The  standards  of  height  and  weight  which 
have  been  used  by  the  Department  of  Health 
of  New  York  City  for  a  number  of  years  are; 

"Fourteen  years 58  inches 80  pounds 

"  Fifteen  years     68  incties 85  pounds 

"Sixteen  years     59  inches 90  pounds 

"When  a  child  is  found  to  be  10  per  cent,  be- 
low the  proper  weight  for  his  height,  he  should 
be  examined  by  tw'O  physicians  to  determine 
whether  this  underweight  is  the  result  of  under- 
nourishment or  other  bodily  defect  or  whether 
it  is  a  racial  or  family  characteristic." 

In  the  case  of  certain  types  of  physical  defect 
which  may  be  easily  remedied,  certificates  are 
temi^orarily  withheld  and  only  where  treatment 
is  not  obtained  after  a  reasonable  length  of 
time  is  the  certificate  refused  permanently. 

"Physical  defects  which  justify  permanent 
refusal  are:    (1)   cardiac  di.seases;    (2)   tuber- 


168 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


culosis  or  other  evidence  of  serious  pulmonary 
disease;  (3)  tuberculous  or  syphilitic  disease  of 
joints  and  bones;  (-t)  irremediable  defective 
vision;  (5)  trachoma;  (6)  serious  orthopedic 
defects;  (7)  malnutrition,  equivalent  to  grade 
4  of  the  Dunfermline  scale;  (8)  chorea;  or  (9) 
total  deafness. 

"Every  effort  is  made  to  see  that  children 
who  are  refused  employment  because  of  phys- 
ical defects  are  referred  to  some  appropriate 
person  or  agency  for  whate\-er  medical  or  other 
assistance  is  needed.  Temporary  refusal  is 
based  upon  the  following  defects:  (1)  defective 
vision  subject  to  correction  by  lenses;  ('2)  con- 
tagious eye  and  skin  diseases;  (3)  defective 
teeth;  (4)  malnutrition  equivalent  to  grade  3 
of  the  Dunfermline  scale;  {5)  untreated  hernia; 
(6)  hypertrophied  tonsils,  where  there  is  evi- 
dence of  serious  obstruction  or  diseased  con- 
dition; (7)  defective  nasal  breathing,  causing 
complete  obstruction  of  the  nostrils;  or  (8) 
tuberculous  glands. 

"All  children  who  are  temporarily  refused 
employment  certificates  because  of  the  exist- 
ence of  physical  defects  which  may  be  curable 
under  proper  treatment,  are  referred  to  the 
care  of  the  school  nurse  of  the  Bureau  of  Child 
Hygiene  who  assumes  responsibility  for  the 
case  and  makes  every  effort  to  see  that  the 
necessary  medical  treatment  or  other  care  is 
secured  for  the  child.  When  such  care  has  been 
provided  and  the  physical  defect  has  been  cor- 
rected, the  employment  certificate  is  issued. 


"The  application  of  such  standards  to  New 
York  City  has  resulted,  in  the  year  1919,  in  the 
absolute  refusal  of  3.17  per  cent,  of  all  children 
who  applied  for  employment  certificates,  on 
the  ground  of  physical  defects"  which  could 
not  be  corrected.  "During  1919,  49, '294  em- 
ployment certificates  were  granted  and  ^2,306 
were  refused.  By  far  the  greater  number  of 
these  were  refused  because  of  physical  in- 
capacity (1,688).  The  other  classifications 
were  insufficient  tuition,  44;  insufficient  educa- 
tion, 10;  under  age,  27;  over  age,  557." 

In  determining  the  physical  status  of  a  child 
and  his  fitness  to  be  employed,  race  and  na- 
tionality, age  and  sex,  family  history  and  in- 
tended occupation"  should  all  be  taken  into 
accomit.  —  Katherine  R.  Drinker. 


Effect  of  the  War  on  Working  Children 
IN  Germany.  Anna  Kalef.  U.  S.  Bur.  Labor 
Statis.,  Month.  Labor  Rev.,  July,  1921,  13, 
No.  1,  6-17.  —  This  article  is  based  on  the  re- 
]jorts  of  the  factory  inspectors  of  the  ^"arious 
(lerman  states  for  the  years  1914  to  1918  and 
includes  a  discussion  of  the  following  topics: 
extent  of  child  labor;  suspension  of  legal  re- 
strictions on  child  labor;  difficulties  of  labor 
law  enforcement;  apprenticeship;  continuation 
schools;  exemptions  from  elementary  school 
attendance;  conduct  of  working  children;  in- 
dustrial accidents  to  working  children;  health  of 
working  children.  —  R.  B.  Crain. 


INDUSTRIAL  SANITATION:  FACTORY  CONSTRUCTION,  ILLUMINATION, 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEW^AGE  DISPOSAL 


Industri.vl  Sanit.\tion  Affects  Public 
Health.  S.  Dana  Hubbard.  Nation's  Health, 
July  15,  19^21 ,  3,  No.  7,  415-419.  —The  author 
first  discusses  the  importance  of  proper  water 
closet  facilities  in  industrial  establishments,  the 
necessity  of  regular  cleaning,  of  prompt  repairs 
in  case  of  damage,  and  of  constant  supervision. 
Water  clo.sets  should  be  located  within  the 
factory,  preferably  on  each  floor  and  with  an 
outside  exposure  in  order  to  secure  light  and 
ventilation.  The  water  closets  ".should  be  in 
charge  of  a  committee  of  workers  —  the  shop 
sanitary  committee  —  whose  duty  it  should  be 
regularly  to  inspect  these  places  and  report,  on 
special  cards  furnished,  the  conditions  found  on 
each  inspection.  .   .  .    This  committee  should 


be  changed  sufficiently  often  to  give  each  em- 
I)loyee  of  the  shop  an  ojjportunity  to  serve  and 
in  this  way  become  familiar  with  house  sanita- 
tion"" and  its  necessities.  "Sliortage  of  toilet 
paper  and  the  stopping  up  of  basins  would  be 
detected  promptly  and  opportunity  given  to 
have  such  corrected  before  it  i)ut  the  aj)paratus 
out  of  order.  In  one  cstabiislunent  alone  this 
cut  the  expense  of  toilet  operation  50  per  cent, 
in  less  than  one  year." 

The  following  standard  toilet  equii)ment  is 
suggested  as  .sanitary,  j)raitical  and  efficient: 

"(1)  Location  on  outside  wall,  for  light  and 
ventilation. 

"(2)  Solid  porcelain  clcsets  with  open  front 
type  of  seat  (horseshoe  shaped),  the  seat  auto- 


ABSTRACTS  169 

matically  flushing  the  tank  and  after  use  raises  a  week.  Every  Saturdaj%  for  example,  all  lockers 

so  as  not  to  be  wetted  in  case  this  basin  is  used  may  be  emptied  to  permit  scouring. 

as  a  urinal  by  men.  Each  industrial  establishment  should  jirovide 

"(3)   Each  closet  to  be  enclo.sed  in  metal  and  .suitable  wash  basins,  preferably  supplieil  with 

furnished  with  automatic  closing  doors.    The  hot  and  cold  rimning  water  and  with  soaj)  and 

doors  to  have  an  inside  bolt  to  insure  pri\acy.  individual  towels.   Where  the  trade  invohes  an 

"  (4)  Each  toilet  to  be  at  least  90  cubic  feet  unusual  amount  of  dirt  and  grime,  such  as 

in  area.  firing,  oiling,  coal  handling,  garage  work,  etc., 

"  (5)  Floor  to  be  concrete,  pitched  to  a  floor  wiicre  there  is  nuich  dust,  as  in  flour  and  ])laster 

drain.  mills,  or  where  fumes  or  iioisons  constitute  a 

"(6)  Hose  bibb  water  supjjly  fur  Hushing  anil  hazard,    as    in    dyeing,    shower   or    tub    baths 

washing.    Every  toilet  to  be  washed  with  a  dis-  siionld  be  provided  and  workmen  should   be 

infectant  every  day.  cncouriiged  to  bathe  before  leaving  for  home. 

"(7)  One  toilet  for  every  five  or  multiple  of  Dr.  Hubl)ard  em|)hasize.s  finally  the  value  to 

five  workers.  industrial  establishments  of  lunch  rooms  which 

"(8)   Full  length  porcelain  urinals  equijijjed  supply  economical,  well  balanced,  and  suitable 

with  water  supply  for  constant    flushing  and  lunches  for  emiiloyees.  —  Katiierine  R.  Drinker, 
separated   by   a    full    length    .screen    to    insure 

privacy.    The  uriiud  to  be  .set  on  a  slate  slai)  How  Paixt  Affects  Waste.    P.  F.  O'Sliea. 

with  concrete  border,   tapered  .so  as  to  form  Factory,  July,  1921,  27,  No.  1,  66.  —  When  oil 

drain  to  waste."  tanks  and  gas  containers  are  painted  black  or 

Dr.  Hubbard  next  di.scus.ses  the  importance  of  dark  colors  a   nij)id  ab.sori)tion  of  heat   takes 

aproijcrdrinkitig  water  supply  accessii)lc  to  out-  place    and    considcral)le    lo.ss    by    evaporation 

door  as  well  as  to  indoor  workers,  the  location  of  occurs.    "Black  jjaint  allows  nearly  two  and  a 

the  water  supply  tank,  the  importance  of  pro-  half  times  as  much  heat  as  white  to  penetrate  to 

viding   itidi\idual   drinking  cups   or   installing  the  contents.   .   .   .    The  following  tai)le  shows 

drinking  fountains,  and  the  necessit.v  for  pro-  the  rise  in  temperature  of  benzine,  which  does 

viding  waste  receptacles  for  water  left   in  the  not  dirt'er  nuich  from  ga.soline,  in  small  tanks 

drinking  cups.  when  subjected  to  tiie  rays  of  a  carbon  arc  for 

Workmen  should  have  a  <'leaii,  secure  place  fifteen  minutes: 
to  hang  their  clothes  and  hats  and  to  leave  their  •  foior  Uop-ws Fahnniuit 

lunch  boxes    -  j)referai)l\'  mclal  lockers  on  legs  ''">'i  plate. 10.8 

some  distance  from  the  floor.    Lockers  should  \viIit""paTnt*'"" ^i.t 

be  separate  for  the  sexes,  should  be  fire  and  I.ifrlit  cream  p,iint 23.0 

vermin-i)roof,  shoidd  be  i)laced  in  a  location  .so  '  i'^''*  pi"'^ ^'J- ' 

as  not   to  aosori)    odors,   should    he    ])ropcrly  Uyht  (»rav 2f).3 

ventilated  and  of  sufhcient  size  to  ])ermit  gar-  I.ifilit  green 20.6 

ments    to   be   hung   without   crushing.     Each  Jl'"'', ' T  °^"'^ ff '"^ ' ^-l 

,      ,  ,        ,,,  '^  ,  ,-,      ,        ,  ,^      ■       ,  Dark  Prussian  blue 3b.7 

locker  should  liave  a  key  winch  sliould  be  m  the  Dark  chrome  green 39.9 

possession  of  the  u.ser.    Lockers  should  be  sy.s-  Black  paint 54.0." 

tematically  inspected  and  cleaned  at  least  once  —  M.  Dent. 


INDUSTRIAL  IVIEDICAL  SERVICE:  IVIEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


The  Medical  Department  in  Industry. 
Marrtii  Z.  Westerrelt.  Nation's  Health,  Aug.  1.5, 
1921,  3,  No.  8,  4;J7-461.  — This  article,  ba.sed 
upon  the  activities  of  the  plant  hospital  of  the 
Winchester  Repeating  Arms  Company  at  New 
Haven,  Connecticut,  is  a  presentation  of  the 
problems  of  the  medical  department  in  indus- 
try, considering  its  field,  its  functions,  its  rela- 


tionshi])  to  other  departments  and  its  future. 
There  is  reported  "a  lo.ss  through  infections 
amounting  to  0.00003  per  cent,  for  a  period  of 
three  years."  In  but  two  cases  out  of  54,958 
did  an  employee  lose  any  portion  of  his  body 
due  to  infection.  The  author  emphasizes  the  im- 
portance of  co-ordination  in  the  medical  depart- 
ment with  other  plant  activities. — Wade  Wright. 


170 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


The  Routine  Physical  Examination  of 
THE  Worker  Charles  K.  Ervin.  Nation's 
Health,  Aug.  15,  19^21,  3,  No.  8,  464-466.— 
This  is  a  consideration  of  ijhysical  examination 
in  an  industrial  medical  establishment.  Em- 
phasis is  placed  upon  the  importance  of  a  com- 
plete and  careful  physical  examination,  the 
proper  filing  of  records  and  the  value  of  the 
physician's  examination  of  the  labor  applicant 
as  an  index  of  his  desirability.  —  Wade  Wright. 

The  Health  Service  Side  of  Personnel 
jManagement.  E.  B.  Morgan  and  S.  J.  Rep- 
plier.  Indust.  Management,  July  1,  1921,  62, 
No.  1,  43^47.  —The  aim  of  the  Medical  Divi- 
sion of  the  Curtis  Publishing  Company  is  to  be 
the  family  doctor  of  the  employees,  and  not 
merely  to  examine  applicants  for  refusal  or 
acceptance,  or  to  take  care  of  industrial  acci- 
dent cases.  In  order  to  accomplish  this,  it  was 
necessary  —  in  so  far  as  possible  at  the  time  of 
the  first  contact  with  the  new  employee  —  to 
remove  the  impression  that  the  medical  depart- 
ment was  onlj'  an  examination  bureau.  The 
first  step  was  to  abandon  the  physical  examina- 
tion as  a  requirement,  and  to  substitute  a  con- 
sultation, in  which  the  nature  of  the  work  is 
explained  and  the  man  helped  to  see  whether  he 
is  fitted  to  undertake  it.  The  service  of  the 
medical  division  is  described  before  any  specific 
problems  of  the  health  (4  the  workman  are 
taken  up.  The  course  of  conversation  is  grad- 
ually directed  to  these  personal  points,  but  an 
examination  is  not  given  unless  the  applicant 
has  been  led  to  desire  it  as  a  matter  of  healtli 
service,  except  when  some  exceptional  hazard  is 
suspected. 

Although,  by  not  insisting  uf)on  a  thorough 
routine  examination,  .some  workers  are  ad- 
mitted who  might  otlierwise  be  rejected,  it  is 
believed  that  the  advantages  of  the  plan  more 
than  ofl'set  the  disadvantages.  On  this  new 
plan,  which  has  been  in  operation  for  a  year, 
visits  to  the  hospital  have  trel)le(l.  It  is  argued 
that,  since  the  formal  exaniinatioa  is  of  little 
value  without  re-e.\amination,  the  increased 
opportunity,  on  the  new  plan,  for  ob.serving  the 
condition  of  employees  plus  the  information 
gained  during  the  first  interview  represent  a 
decided  gain.  Another  result  is  that  the  medical 
service  is  used  by  officials  as  well  as  by  the  rank 
and  file.  —  G.  E.  Partridge. 

Health  Service  of  Illinois  Bell  Co. 
W.  E.  Crosley.  Hosp.  Management,  July,  1921, 


12,  No.  1,  56,  58.  —The  health  department  of 
the  Illinois  Bell  Telephone  Company  supervises 
medical  and  accident  service  for  about  15,000 
employees  and  conducts  physical  examinations 
of  all  apjjlicants.  The  number  of  ca.ses  treated 
in  recent  months  has  ranged  from  2,900  to 
4, dip  (including  all  visits  made  to  the  depart- 
ment). Dental  examinations  are  given,  includ- 
ing X-ray,  and  an  arrangement  is  made  with  a 
specialist  for  necessary  examinations  of  the 
lungs  or  chest.  There  are  but  few  hazards-  and 
not  many  serious  accidents,  but  in  each  of  the 
exchanges  there  is  a  first-aid  kit  for  emergency. 
The  health  department  also  has  the  assistance 
of  fifteen  ^'isiting  nurses  who  are  connected 
with  the  welfare  department. 

Applicants  are  graded  in  several  classes  ac- 
cording to  the  results  of  their  physical  examina- 
tions: class  A  includes  all  who  are  in  perfect 
health;  B-lA,  those  having  slight  defects; 
B-IB,  those  who  need  watching;  B-2,  those 
unfit  for  certain  kinds  of  work;  and  C,  the  en- 
tirely unfit.  The  examiner  merely  ascertnins  the 
facts,  and  the  final  authority  is  the  employing 
department. 

The  health  department  does  not  undertake 
treatment,  except  in  simple  cases,  but  devotes 
its  eft'orts  to  ascertaining  conditions,  giving 
advice  and  endeavoring,  without  exerting  any 
compidsion  in  regard  to  its  services,  to  be  help- 
ful to  the  employees  of  the  company.  —  G.  E. 
Partridge. 


Standard  Oil  Company  He.\lth  Service. 
J.  M.  Adain.s-.  Hosp.  Management,  Atig.,  1921, 
12,  No.  2.  90,  92.  — Under  the  "annuities  and 
benefit  i)ian,"  the  employees  of  the  Standard 
Oil  Company  of  Louisiana  have  free  life  insur- 
ance; are  i)aid  half-time  in  case  of  disability 
resulting  from  sickness;  and  are  given  annuity 
in  old  age.  The  annuities  range  from  a  mini- 
mum of  $25  per  month  to  75  per  cent,  of  the 
wages,  and  the  death  benefit  ranges  from  $500 
to  $2,000.  Tiicre  is  a  safety  dei)artinent,  work- 
ing in  co-operation  with  the  medical  depart- 
ment, and  a  meeting,  attended  l)y  all  foremen, 
is  held  each  week  at  which  the  accidents  of  the 
previous  week  are  discussed.  Bulletins  and 
l)()sters  are  displayed  about  the  ])lant,  showing 
the  effects  of  neglecting  slight  injuries.  Work- 
men are  ref(uired  to  report  every  injury,  how- 
ever slight.  Emergency  boxes,  with  stretcher, 
blankets,  touriii(|uet,  and  large  dressing  and 
burn  packets,  and  resuscitation  and  rescue  out- 


ABSTRACTS 


171 


fits  are  provided.    Accidents  are  posted  on  a 
large  bulletin  hoard. 

There  is  a  company  hospital  of  five  rooms,  in 
charge  of  two  full-time  physicians,  two  grad- 
uate nurses,  and  three  first-aid  men.  All  per- 
sons employed  are  examined.  Sickness  cases 
are  supervised  by  a  visiting  nurse.  Tliere  is 
ambulance  service  for  cases  requiring  removal, 
and  .serious  cases  are  sent  to  .sanatoriums  after 
first-aid  treatment.  All  eini)l()yees  who  have 
reached  the  age  of  ()5  years  are  examined  semi- 
annually, as  are  all  persons  who  are  subject 
to  occupational  di.seases.  Special  provision  is 
made  for  the  treatment  of  tuberculosis  ca.ses, 
with  sanat(jrium  treatment  when  advisable, 
and  necessary  aid  is  given  to  dependents  when 
such  cases  require  special  treatment.  —  G.  E. 
Partridge. 


Wi;li  VIU-:  Woiuc  of  Coxtinen'tal  Motok.s. 
Hosp.  Management,  June,  liHi,  11,  No.  6,  56. 
—  The  following  stnumary  of  the  latest  annual 
report  of  the  first-aid  de|)artineiit  of  the  Muske- 
gon Plant,  No.  2,  of  the  Continental  Motors 
Corporation  indicates  in  a  general  way  the 
service  rendered  and  its  cost : 

Number  of  employees,  i.'iOO. 

Injuries  treated  (minor  and  serious),  11,011. 

Redressings,  12,299. 

Total  treatments,  -2:\-2r,0. 

Fatal  infections,  1. 

Days  lost  through  accident,  2,07.5. 

Conipen.sation  paid,  $!),07,5.10. 

Medical  and  ho.sjiital  first  aid,  $7,309.4.5. 

Salaries,  .$8,27:5. 2.-5. 

"The  com])any  handles  its  own  liability  in- 
surance and,  according  to  J.  R.  Anderson  of  the 


compensation  department,  an  actual  saving  of 
$48,233.88  was  made,  this  including  the  i)lant 
at  Detroit  where  there  are  3,000  employees." 
The  first-aid  department  at  Muskegon  is  in 
charge  of  a  full-time  physician,  whose  assist- 
ants include  two  graduate  nur.ses  and  a  stenog- 
rajilier  who  is  also  record  clerk.  All  new  em- 
ployees are  given  a  physical  examiiuition  —  a 
rule  to  which  the  company  has  as  yet  met  no 
opposition. 

The  welfare  de])artment  of  the  Continental 
Corporation  some  time  ago  made  an  investiga- 
tion into  methods  of  inducing  employees  to 
rejKirt  to  the  first-aid  room,  no  nuttter  how 
trivial  their  injuries  might  appear,  and  as  a 
result  of  this  investigation  the  word  "hospital" 
was  di.scarded  ant!  "first-aid  <lepartment"  sub- 
stituted. Many  of  the  employees,  it  was  found, 
disliked  the  thought  of  going  to  a  hospital,  but 
readily  made  u.se  of  the  facilities  of  the  depart- 
ment when  it  was  called  "first-aid."  —  M.  C. 
Shorlev. 


Dk.vtistry  .\.s  .\  Production  Factor  ix  Ix- 
nrsTUY.  .1.  A.  Crocker.  Nat.  Safety  News, 
.lime,  1921,  3,  No.  l(i.  1.5.  —  Dentistry  was 
placed  on  the  safety  j)rograni  of  the  Fourth 
.Vnnual  Safety  Congress  of  the  National  Safety 
Council  in  1915,  and  since  that  time  has  at- 
tracted increasing  attention  in  industry,  until 
now  more  than  one  hundred  and  fifty  com- 
panies operate  dental  clinics.  Exiierience  has 
shown  that  as  a  result  of  the  greater  attention 
to  dental  work,  there  has  been  a  noticeable 
reduction  in  such  trouI)les  as  colds,  headaches, 
rheumatism,  boils  and  nervous  troubles.  —  G. 


E.  Partridge. 


INDUSTRIAL  NURSING 


What  an  Industrial  Nurse  can  do  for  a 
Community.  B.  W.  Adam.s.  Pub.  Health 
Nurse,  .June,  1921,  13,  No.  6,  291-292. —The 
American  Smelting  and  Refining  Company  has 
maintained  at  its  East  Helena  plant  for  the 
past  six  years  a  safety  and  service  department, 
and  about  two  years  ago  an  industrial  nurse 
was  appointed,  whose  work  extends  to  the  wel- 
fare problems  of  the  community.  The  first 
work  taken  up  was  the  examination  of  the  273 
children  attending  the  schools  (199  were  found 
physically  defective),  and  the  correction  of  mal- 


nutrition by  providing  free  milk  for  about  a 
quarter  of  the  children.  A  crusade  for  good 
health  has  been  conducted  in  the  schools.  A 
IMothers"  League  has  been  formed  and  training 
is  given  in  the  care  of  infants  and  young  chil- 
dren. Home  visits  are  made  by  the  nurse,  who 
combines  general  social  service  with  the  special 
work  of  her  profession.  All  this  she  does  in 
addition  to  regular  duties  in  the  plant,  where 
a  dispensary  and  first-aid  stations  are  main- 
tained, and  classes  held,  attendance  upon  which 
is  compulsory  for  foremen. 


17^2 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"The  good  that  a  nurse  can  do  in  a  com- 
munity is  limited  only  by  her  own  capabilities. 
It  is  certain  that  there  is  a  vast  amount  of  work 
that  can  be  accomplished  in  the  average  indus- 


trial community  if  the  proper  steps  are  taken  in 
the  beginning,"  and  the  first  step  is  the  selection 
and  appointment  of  a  qualified  visiting  nurse. 
—  G.  E.  Partridge. 


INDUSTRIAL  PERSONAL  AND  COMMUNITY  HYGIENE: 

HOUSING,  ETC. 


Employees  and  Homes.  R.  E.  Jamieson. 
Factory,  Jime  1,  19^21,  26,  No.  11,  1356. —A 
project  formed  by  employees  of  the  Western 
Electric  Company's  plant  in  Chicago,  which  in- 
cludes two  plans,  "one  with  the  aim  of  learning 
the  cost  for  those  who  desire  to  build,  and  the 
other,  of  financing  a  plan  of  the  building  and 
loan  type."  The  organization  and  different 
sorts  of  stock  are  herein  outlined.  —  M.  C. 
Shorley. 

Framingham  Community  Health  and  Tu- 
berculosis Demon-stration.  Certain  Med- 
ical Results.  Donald  B.  Armstrong  and  P. 
Challis  Bartlctt.  Jour.  Am.  Med.  Assn.,  Aug. 
20,  1921,  77,  No.  8,  585-587. —The  authors 
summarize  as  follows:  "The  chief  factors  that 


seem  to  be  responsible  for  the  late  discovery  of 
tuberculosis  cases  which  give  to  the  community 
every  year  advanced  and  dying  patients  that 
have  not  been  known  or  treated  for  tuber- 
culosis in  the  early  stages  of  the  disease  are:  the 
recluse  tyjje,  which  seems  to  be  the  main  type, 
never  receiving  any  medical  attention;  failure 
of  patients  to  seek  medical  advice  early,  or,  if 
they  do,  not  to  give  the  physician  sufficient 
time  to  make  a  diagnosis;  occasional  failure  of 
physicians  to  detect  disease  early;  failure  of 
both  physician  and  patient  to  use  all  of  the 
services  at  their  command  for  early  diagnosis 
of  tuberculous  disease;  lack  of  complete  an- 
nual medical  examination,  and  lack  of  annual 
factory  and  school  examinations."  —  C.  K. 
Drinker. 


INDUSTRIAL  INVESTIGATIONS  AND  SURVEYS 


A  Statistical  Study  of  Labour  Turnover 
IN  Munition  and  Other  Factories.  Gladys 
M.  Broughton  and  Ethel  M.  Newbold.  Indust. 
Fatigue  Research  Board,  Rep.  No.  13,  London, 
1921,  pp.  92. — The  investigators  conclude  that: 

1.  High  labor  turnover  is  not  confined  to 
war-time  industries. 

2.  Married  women  shift  their  positions  more 
than  single  women. 


3.  The  effect  of  a  permanent  night  shift  can- 
not yet  be  determined. 

4.  It  is  believed  that  former  factory  or 
munition  workers  are  more  unstable  than  those 
drawn  from  other  sources. 

5.  "The  loss  from  possibly  avoidable  rea- 
sons, such  as  ill  health,  incompetence  and  dis- 
satisfaction, is  very  large."  —  M.  Dent. 


INDUSTRIAL  PSYCHOLOGY  AND  INDUSTRIAL  MANAGEMENT 
IN  ITS  HEALTH  RELATIONS 


Personnel  Management  of  the  Metro- 
politan Life  Insurance  Company.  L.  Wash- 
ington. Indust.  Management,  July  1,  1921,  62, 
No.  1,  27-32.  — The  system  of  i)ersonnel  man- 
agement described  is  one  that  is  af)|)lied  to  a 
force  of  about  6,000  workers,  and  includes  em- 
ployment, records  of  turnover,  labor  saving, 
position  analysis,  grades  and  salary  increase, 
ratings,  promotions,  transfers  and  dismissals, 
etc.    A  detailed  procedure  is  followed  in  select- 


ing cm])l()yees,  including  both  mental  and 
physical  examinations.  The  requirements  for 
each  ])osition  are  considered  and  the  depart- 
ment endeavors  to  fill  the  jwsition  with  the 
best  qualified  man.  Very  well  qualified  ai)pli- 
cants  are  sometinies  appointed,  even  if  there  are 
no  positions  open  which  they  could  fill,  and  are 
assigned  to  the  "Utilities  Bureau,"  to  do  such 
work  as  is  available,  and  are  later  assigned  to 
suitable  jjositions.    A  personal  history  is  kept 


ABSTRACTS 


173 


for  each  employee,  and  a  system  of  rating 
somewhat  like  the  army  method  is  carried  out. 
Promotions  and  demotions  are  made  on  the 
basis  of  the  records.  Each  position  in  the 
office  has  been  analyzed,  and  a  grade  assigned 
to  it,  according  to  the  difficulty  and  respon- 
sibility of  the  work,  and  upon  this  basis  the 
salary  is  fixed,  in  connection  with  rating. 
Twenty-nine  different  grades  of  position  are 
recognized.  By  this  system  a  definite  limit  of 
salary  is  placed  upon  every  position,  but  not 
upon  the  individual,  since  he  is  always  poten- 
tially a  candidate  for  a  more  advanced  position. 
There  are  many  provisions  for  the  health  of 
employees,  such  as  a  tuberculosis  sanatorium 
and  rest  house,  luncheons  for  the  employees  of 
the  home  office,  a  free  medical  dispensary,  free 
dental  examinalion  and  prophylaxis  disal)ility 
insurance  (paid  partly  by  the  comjwny  and 
partly  by  the  employee),  free  life  insurance,  a 
staff  savings  fund,  to  which  the  company  con- 
tributes an  amount  equal  to  .)((  jjer  cent,  of 
the  amount  deposited  by  employees,  a  library, 
various- educational  courses  and  other  services. 
Another  part  of  the  work  of  the  jier.sonnel  divi- 
sion is  to  increase  individual  ])n)<hiction  and  to 
j)erfccl  orgaiiizalion  and  melliods. — Ci.  E. 
Partridge. 

A  Note  on  Intelligence  Te.sts.  IV.  John- 
son. Jour.  Neurol,  and  Psychopath.,  Feb., 
IQ'-il,  1,  No.  4,  345.  — The  author  gives  a  brief 
account  of  the  various  tests,  applications  of 
nietliods,  practical  utility  and  scope  of  the 
measurement  of  intelligence,  and  siunmarizes 
as  follows: 

"1.  There  is  no  sharp  demarcation  between 
grades   of   intelligence.    .    .    .      The    so-called 


normal  child  easily  forms  the  largest  propor- 
tion and  composes  the  central  bulk  of  the 
group.  .  .  . 

"2.  The  occurrence  of  high  intelligence  is  as 
frequent  as  that  of  extremely  low  intelligence. 

''3.  There  is  no  particular  year  in  which 
individual  mental  variability  is  especially 
marked,  a  group  of  children  six  years  old  show- 
ing as  nmch  variation  individually  as  does  a 
similar  group,  age  fourteen  years. 

"4.  As  regards  sex,  it  is  found  that  below 
fourteen  years  girls  are  slightly  more  intelligent 
than  boys,  but  after  that  age  the  advantage 
swings  slightly-  to  boys. 

"5.  Children  from  the  higher  social  status 
are  slightly  above  the  normal  intelligence,  and 
those  from  the  inferior  siiglilly  below  it. 

"In  the  course  of  time,  no  doubt,  the  develop- 
ment of  intelligence  tests  will  proceed  towards 
the  directicm  of  its  application  to  adults.  Their 
.scope  will  then  lie  considerably  widened.  They 
may  ])i)ssibly  provide  us  with  the  nnich-needed 
guide  for  the  .selection  of  particular  individuals 
for  particular  work  or  professions,  as  well  as 
]>roviding  a  certain  definite  indication  that  a 
certain  indixidual  is  entirely  unsuited  for  a  cer- 
tain em])l<)yment  or  career.  That  such  im])or- 
tant  decisions  —  which  in  young  adults  are  not 
infrequently  life  decisions  —  are  left  largely  to 
chance  is  a  nii.sfortune  which  doubtless  lias  pro- 
duced, and  will  cotitinue  to  produce,  dire  con- 
se(iuences  in  many  a  life.  From  many  asjjccts, 
therefore,  the  advance  in  the  study  of  compara- 
tive intelligence  will  prove  of  the  greatest  jirac- 
tical  utility.  The  progress  which  has  already 
been  made  in  the  subject  has  estal)lished  it  on  a 
j)ernianent  foundation.  The  superstructure 
remains  to  be  built."  —  C.  K.  Drinker. 


INDUSTRIAL  SERVICE  AND  IVIUTUAL  BENEFIT  ASSOCIATIONS 


Welfare  Provisions  That  Help.  B.  M. 
Thompson.  Factory,  July,  1921,  27,  No.  1, 
116,  118. — The  following  suggestions  are 
made,  taken  from  the  New  Orleans  and  Louisi- 
ana Industrial  Survey:  Every  shop  should 
contain  washing  facilities,  inside  toilets,  work- 
room floors  clean  and  dry,  dressing  rooms  and 
rest  rooms,  modern  ventilation  and  lighting, 
and  drinking  facilities.  The  lunch  hour  should 
be  at  least  forty-five  minutes  long,  there  should 
be    rest    periods    in   the   forenoon   and   after- 


noon, seats  for  women  workers,  and  uniforms- 
"Changes  in  work  or  processes  should  be 
reconnnended  or  ordered  if  necessary,  to  do 
away  with:  constant  standing  or  other  posture 
causing  physical  strain;  repeated  lifting  of 
heavy  weights,  or  other  abnormally-  fatiguing 
motions;  operation  of  mechanical  devices  re- 
cjuiring  undue  strength;  exposure  to  excessive 
heat  or  cold;  exposure  to  dust,  fumes,  or  other 
occupational  poisons,  without  adeciuate  safe- 
guards against  disease."  —  M.  C.  Shorley. 


174 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


INDUSTRIAL  HEALTH  LEGISLATION:    COURT  DECISIONS: 
WORKMEN'S  COMPENSATION  AND  INSURANCE 


New  York  Labor  Laws  Enacted  in  192L 
Henry  D.  Saijer.  N.  Y.  State  Dept.  Labor,  Bull. 
No.  107,  July,  1921,  pp.  68.  —  "This  bulletin 
presents  the  Governor's  recommendations  for 
reorganization  of  the  Department  of  Labor  and 
for  prompt  payment  of  workmen's  compensa- 
tion, the  texts  of  two  legislative  resolutions 
continuing  the  joint  committee  for  recodifica- 
tion and  revision  of  the  labor  statutes  and  the 
texts  of  twenty-nine  labor  cha])ters  of  the  Laws 
of  lO^l.  of  which  four  amend  Chapter  50,  the 
recodified  Labor  Law,  and  three  amend  the 
Workmen's  Compensation  Law.  It  also  out- 
lines the  recodification  of  the  Labor  Law  and 
the  reorganization  of  the  De])artment  of  Labor, 
as  effected  by  Chapter  50,  without  giving  the 
text  of  such  chapter,  and  notices  certain  other 
chapters,  mainly  relating  to  public  employees, 
without  giving  their  texts."  —  M.  Dent. 

Court  Decisions  on  Workmen's  Compen- 
sation Law  January,  1920  —  June,  1921. 
C0N.STITUT10NALITY  AND  Coverage.  L.  G. 
McConachie.  N.  Y.  State  Dept.  Labor,  Bull. 
No.  106,  July,  1921,  pp.  302. —This  bulletin 
covers  the  period,  January  1,  1920  to  July  1, 
1921,  and  taken  with  the  three  previous  bulle- 
tins "presents  court  decisions  and  the  full 
texts  of  court  opinions  upon  the  Constitution- 
ality and  Coverage  of  the  New  York  Work- 
men's Compensation  Law  from  the  time  of  its 
origin."  —  M.  Dent. 

What  Constitutes  a  Fair  Estimate  of 
Loss  OF  Use  of  Eye  in  W'orkmen's  Compen- 
sation Cases.^  William  Held.  Med.  Record, 
May  14,  1921,  99,  No.  20,  826-828.—  Li  eye 
cases  there  is  a  regrettable  lack  of  standardiza- 
tion for  fixing  the  percentage  of  vision  sustained 
by  injury.  The  Snellen  test  is  tlie  usual  means 
of  reporting  upon  ca.ses  but  tlie  interjjretation 
of  findings  varies  markedly  in  ditt'erent  parts  of 
the  country.  Thus  "a  man  whose  central  visual 
acuity  has  been  reduced  to  20/40ths  is  supposed 
to  have  a  50  i)cr  cent,  eye  in  New  York,  an  89 
per  cent,  eye  in  Illinois,  and  a  94  per  cent,  eye  in 
Wisconsin.  In  other  words,  a  man  who  is  told 
in  New  York  that  the  cflicicncy  of  his  injured 
eye  has  been  reduced  by  oiic-half  learns  in  Illi- 
nois that  he  really  lost  only  1 1  jxt  cent.,  and  in 
Wisconsin  he  will  be  assured  that  he  suft'ered  an 


impairment  of  only  6  per  cent."  These  differ- 
ences arise  as  a  result  of  failing  to  permit  the 
figures  of  the  Snellen  test  to  stand  for  what  they 
are.  They  should  be  used  without  any  addi- 
tional interpretation  or  modification.  Then 
20  40ths  means  50  per  cent,  loss  of  vision, 
20/60ths  means  66|  per  cent,  loss,  and  20/80ths 
means  75  per  cent.  loss. 

"Accidents  causing  loss  of  field  (peripheral) 
vision  alone  are  of  such  extremely  rare  occur- 
rence that  the  a\erage  injury  to  the  eye  shoidd 
not  be  minimized  by  the  thought  that  perhaps 
the  field  (peripheral)  vision  had  sustained  a  less 
serious  loss  than  the  central  vision.  And  as  re- 
gards binocular  vision,  I  hold  that  every  im- 
pairment of  central  vision  affects  it  in  some 
measure.  Furthermore,  estimates  of  the  degree 
of  field  vision  which  is  supposed  to  have  been 
lost  would  be  so  much  a  matter  of  jmre  con- 
jecture that  I  doubt  if  any  two  examining 
oculists  would  ever  agree  as  to  its  exact 
amount."  —  C.  K.  Drinker. 

What  Principle  must  Govern  Esti>l\tes 
OF  Visual  Loss  in  Compensation  Cases? 
WiUiam  Mehl.  Med.  Record,  Aug.  6,  1921,  100, 
No.  6,  237-240. —  "Where  the  law  provides 
that  compensation  shall  be  awarded  for  a  par- 
tial reduction  of  vision,  examination  by  Snellen 
tests  will  establish  what  fraction  or  percentage 
of  vision  is  lost.  While  these  tests  are  confined 
to  visual  acuity,  they  are  for  all  i)ractical  pur- 
poses the  only  reliable  means  for  fixing  loss  of 
vision  in  general.  .  .  .  Tables  fixing  what 
amount  of  peri])lieral  vision  shall  be  assumed  to 
exist  when  a  certain  fractional  loss  of  visual 
acuity  has  been  established,  are  arbitrary  and 
unscientific. 

"Loss  of  binocular  vision  is  legally  considered, 
in  the  State  of  \ew  York  at  least,  as  e(|uivalent 
to  the  loss  of  use  of  one  eye.  So  this  factor  can- 
not l)e  lirouglit  in  to  minimize  the  sustained 
impairment. 

"If  inslcad  of  the  principle  of  insurance  of 
I)hysical  inii)airment  jier  ae  there  is  to  be 
suljstituted  the  |)rinciple  of  economic  lo.ss,  then 
the  legislature  will  have  to  make  the  first  move 
and  determine  a  new  governing  basis  for  com- 
|)ensatii)n  awards.  The  logic  of  iiuhistrial, 
occupational,  vocational  or  by  whatever  other 
adjective  the  loss  may  be  characterized,  when 


ABSTRACTS 


175 


the  economic  factor  becomes  the  basic  con- 
sideration, must  of  necessity  lead  to  ultimate 
state  monopoly  of  compensation  insurance. 
These  are  matters  which  are  of  no  direct  con- 
cern to  oculists  as  such  and  may  well  be  left  to 
be  settled  by  experts  in  other  departments  of 
work. 

"I  have  indicated  a  middle  way  which  may 
bridge  over  the  transition  from  com])ensation 
for  the  purely  physical  impairment  of  sight  to 
comj)ensation  for  the  actual  loss  of  earnings 
caused  by  a  traumatic  reduction  of  vision  in 
each  individual  case.  The  middle  course  would 
take  account  of  the  loss  of  useful  vision  in  a 
very  general  way  by  fixing  the  jjoiut  of  indus- 
trial blindness  and  requiring  lesser  impairments 
of  sight  to  be  rated  by  appropriate  percentages. 
This  course,  too,  nuist  first  lia\e  the  sanction 
of  legislative  enactment  before  (■omi)ensation 
boards  can  permit  themselves  to  be  governed  hv 
it."  —  M.  C.  Shorley. 

A  Report  to  the  Medical  Profession  by 

THE    MeI)IC.\L    Ad\I.SORY    COMMITTEE    OF    THE 

Massachusetts  Industrial  Accident  Board. 
Boston  Med.  and  Surg.  Jour.,  June  '■2,  19"21, 
184,  No.  22,  582-586. — A  statement  is  given 


of  the  relation  of  doctors  to  insurers  under  the 
industrial  laws.  The  report  is  mainly  con- 
cerned with  the  compensation  of  physicians  in 
the  operation  of  the  accident  compensation 
law.  —  Barnett  Cohen. 

Results  of  Meniscus  Operations  after 
Industrl\l  Accidents.  J.  Dubs.  Abstracted 
as  follows  from  Schweizerische  med.  Wchnschr., 
June  9,  1921.  51,  Xo.  23,  529,  in  Jour.  Am.  Med. 
Assn.,  Aug.  6,  1921,  77,  No.  6,  496.  —  "Dubs 
discusses  the  remote  results  and  disability  from 
the  standpoint  of  accident  insurance.  His 
tables  show  that  only  17.5  per  cent,  of  the  40  in- 
sured workmen  have  regained  full  earning 
capacity  since  the  operation  on  the  rui)tured 
meniscus,  and  82.5  per  cent,  have  received 
workmen's  comi)cnsation  for  permanent  dis- 
ability. In  Hand's  similar  series  in  men  that 
were  not  insured  against  accidents,  80  per  cent, 
have  regained  full  earning  capacity,  free  from 
any  subjective  or  objective  disturbances.  His 
tabulated  data  teach  that  the  decision  as  to  the 
outcome  of  a  meiiLscus  injury  should  never  be 
made  until  a  year  at  least  after  the  operation. 
Conditions  which  seem  irreparable  at  first  may 
gradually  right  themselves."  —  C.  K.  Drinker. 


REIIABILITATIOX  OF  DISABLED  EMPLOYEES 


Salvaging  Humanity  a  Social  Necessity. 
Jamcf!  P.  Miinroe.  Nation's  Health,  July  15, 
1921,  3,  No.  7,  383  386.  — During  approxi- 
mately three  years  preceding  ^lay  1,  1921,  the 
Federal  Board  for  \'()cati()nal  Education  ren- 
dered decisions,  through  personal  interviews  by 
its  agents,  "upon  the  a])|)lications  of  a])proxi- 
mately  350,000  ex-service  men,  .  .  .  adjudged 
about  two-thirds  of  them  to  be  eligible  for 
training  under  the  rehabilitation  law  and  .  .  . 
placed  in  training  with  maintenance  pay  or 
without  ])ay  .  .  .  ajjproximately  one  hundred 
thousand  men."  In  the  o[)inion  of  Mr.  Munroc, 
vice-chairman  of  the  Federal  Board,  "expe- 
rience with  this  wide  range  of  men,  at  least  half 
of  them  below  the  median  from  the  educa- 
tional standpoint,  and  all  of  them  below  par 
from  the  i)hysical  stanVlpoint,  has  demon- 
strated that,  from  the  economic  aspect  alone, 
the  salvaging  of  men  is  an  investment  which 
brings  in  colossal  returns.  Were  the  work  of 
soldier  rehabilitation  eventually  to  cost  the 
government  half  a  billion  dollars,  it  will  bring 
back  to  the  country,  in  increased  earning  ca- 


pacity of  the  men  .so  trained,  at  least  four  times 
that  sum.  .   .   . 

"The  case  for  the  industrially  disabled  is  nf)t 
.so  clear,  of  course,  as  for  tho.se  injured  in  a  war 
for  national  preservatioiL  It  is  e<|ually  plain,  of 
course,  from  the  economic  standpoint;  but 
from  the  social  point  of  view  one  must  go  a  little 
dcejjer  to  find  full  justification.  That  justifica- 
tion rests  on  the  fact  that,  while  a  certain  pro- 
j)ortion  of  civilian  disabilities  are  due  .solely  to 
a  man's  or  a  woman's  owni  carelessness  or  de- 
fiance of  the  laws  of  health,  by  far  the  greater 
number  are  due  wholly  or  in  great  part  to  the 
conditions  of  economic  or  .social  life  over  which 
the  individual  has  absolutely  no  control,  but 
concerning  which  society  could,  if  it  chose, 
exercise  far  greater  watchfidness  than  in  fact  it 
does.  In  other  words,  the  vast  majority  of  ac- 
cidents and  of  disabling  diseases  are  due  to  the 
increasing  complexities  of  modern  life  only  in 
slight  degree  controlled,  as  yet,  by  social  regu- 
lation. So  large  a  proportion,  therefore,  of 
civilian  disability  is  the  fault  of  society  rather 
than  of  the  individual,  tiiat  there  is  as  sub- 


176 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


stantial  justification,  from  the  social  stand- 
point, for  the  rehabiHtation  of  those  disabled  in 
the  normal  pursuits  of  peace  as  for  those  injured 
in  the  abnormal  pursuits  of  war. 

"Whether,  therefore,  we  view  rehabilitation 
from  the  purely  monetary  aspect,  that  of  con- 
serving workers  who  hithertofore  ha^•e  Ijeen 
most  wastefully  tlirown  aside,  or  whether  we 
regard  it  from  the  deeper  and  more  enduring 
point  of  view  of  the  good  of  civilization,  it  is 
seen  to  justify  itself  as  one  of  the  most  impor- 
tant forward  steps  towards  social  well  being  that 
this  coimtry  has  ever  taken.  Theoretically,  the 
arguments  are  unanswerable,  and  practically, 
those  arguments  have  been  proved  as  sounder 
even  than  their  advocates  believed,  by  the 
.satisfactory  economic  and  social  results  already 
achieved  in  connection  with  the  rehabilitation 
of  ex-service  men.  With  such  a  demonstration 
as  this,  the  states  should  have  no  hesitation  in 
providing  a  generally  similar  scheme  of  re- 
habilitation for  the  immensely  greater  number 
of  those  disabled  in  the  pursuit  of  their  voca- 
tions or  of  their  avocations,  or  even  in  the 
hazardous  process  of  getting,  under  modern 
traffic  conditions,  from  one  place  to  another." 
—  Katherine  R.  Drinker. 

Status  of  Ixdu.strial  Rehabilitatiox. 
Voc.  Summary,  May,  lO'-il,  4,  No.  1,  18-19.  — 
The  present  status  of  industrial  rehal)ilitation, 
as  regards  the  relations  of  state  and  federal 
acts,  is  shown  in  a  table,  in  which  date  of  ac- 
ceptance by  governor  and  by  legislature,  date  of 
certification  to  the  United  States  Treasury, 
federal  appropriation  for  l'J'-20-1921  and  for 
1921-1922,  and  state  appropriation  for  the 
same  periods  are  given.  Between  the  time  of 
the  passage  of  the  act  and  January  1,  1921,  the 
limit  set  for  certification,  to  the  United  States 
Treasury,  of  the  states  entitled  to  receive  fed- 
eral money  for  the  year  ending  June  30,  1921, 
thirty-two  governors  had  ])roclalmed  accept- 
ance of  the  federal  act. 

The  act  requires  that  every  dollar  of  federal 
money  be  matched  by  one  from  the  state,  and 
while  there  are  certain  other  mandatory  pro- 
visions in  the  act,  the  states  have  liberty  to  ad- 
minister and  maintain  industrial  rehabilitation 
as  they  deem  best.  All  of  the  state  acts  provide 
for  the  work  to  be  administered  by  the  state 
boards  for  vocational  education,  but  there  are 
some  slight  variations  as  to  methods  of  admin- 
istration. In  most  of  the  states  the  scope  of  the 
law  is  as  broad  as  the  federal  act,  which  includes 


any  disabled  person  of  employable  age  who  has 
suffered  a  diminution  of  earning  power  because 
of  some  physical  handicap,  congenital  or  attrib- 
utable to  accident  or  disease.  A  few  states 
have  limitations  as  to  length  of  residence  re- 
quired, and  most  of  the  states  do  not  provide 
definitely  for  the  maintenance  of  the  disabled 
person  while  being  trained. 

Minnesota,  by  an  amendment,  now  provides 
for  support  during  training.  The  amount  is 
fixed  at  66f  per  cent,  of  the  wage  at  the  time  of 
the  injury  for  a  period  not  exceeding  twenty- 
five  weeks,  provided  the  injury  received  is  such 
as  to  entitle  to  compensation  for  seventy-five 
weeks  in  the  schedule  of  indemnities  for  per- 
manent impairments,  and  provided  that  the  in- 
dustrial commission  shall  on  ajiplication  find 
that  retraining  is  necessary,  and  shall  make  an 
order  for  such  compensation.  Wyoming  has 
provided  that  $10  a  week  be  given  to  disabled 
persons  for  maintenance  during  training,  for  a 
period  not  exceeding  forty  weeks,  Pennsyl- 
vania makes  provision  of  $10  a  week  with  com- 
pensation (available  only  for  those  injured  in 
industry)  for  not  more  than  twenty  weeks,  im- 
less  extension  be  granted.  North  Carolina  has 
set  apart  a  sum  of  $5,000  to  be  used  for  main- 
tenance of  disabled  persons  during  training.  A 
few  states  have  arranged  for  social  service.  — 
G.  E.  Partridge. 

Industrial  Rehabilitation  in  the  United 
States  of  America.  Internal.  Labour  Rev., 
Feb.,  1921,  1,  No.  2,  259-263.  —The  federal 
government  of  tlie  United  States  has  taken 
three  important  steps  in  promoting  vocational 
education :  (1)  in  1917,  the  provision  for  normal 
persons  in  need  of  training  when  entering  or 
after  entering  an  employment;  (2)  in  1918,  the 
provision  of  special  measures  for  disabled  ex- 
service  men;  and  (3)  in  1920,  the  adoption  of 
a  plan  for  the  vocational  rehabilitation  of  all 
disabled  jiersons.  The  administration  of  all 
the  measures  was  given  to  the  Federal  Board 
for  Vocational  Education,  created  by  the  first 
of  these  acts.  The  most  significant  departure 
in  the  United  States  from  tiie  ordinary  govern- 
mental jirdvision  for  rehabilitation  is  the  recog- 
nition of  the  fact  tha^  it  is  quite  as  important 
to  the  national  interests  to  rehabilitate  the 
victims  of  industrial  as  well  as  of  war  accidents. 

Under  tiie  Vocational  Education  Act,  in 
order  to  receive  an  appropriation  from  the 
government,  a  state  must  formally  accept  the 
act,  and  must  designate  a  state  board  to  co- 


ABSTRACTS 


177 


operate  with  the  federal  board.  The  legislature 
must,  likewise,  accept  the  Industrial  Rehabili- 
tation Act,  if  an  allocation  is  desired.  The 
board  designated  may  be  the  existing  board 
under  the  Vocational  Education  Act,  or  a 
special  board,  but  where  a  state  board  exists 
for  the  administration  of  workmen's  compen- 
sation or  employer's  liability  laws,  the  state 
legislature  must  provide  for  co-operation  be- 
tween the  two  boards.  The  report  of  the  Fed- 
eral Board  for  lO'^O  shows  that  the  Vocational 
Education  Act  has  made  considerable  progress; 
from  1!)18  to  I'.HO,  the  number  of  persons 
enrolled  in  federally-aided  teacher-training 
courses  increa.sed  from  (),,589  to  1'2,456.  In 
19'-20,  twenty-three  states  had  accepted  the 
Industrial  Rehabilitation  Act,  and  the  work 
was  well  begun,  csjiccially  in  the  twelve  states 
where  action  had  been  taken,  before  federal 
aid  was  available,  to  provide  for  general  in- 
dustrial rehabilitation. 

The  American  Association  for  Labor  Legis- 
lation has  advocated  the  supplementing  of 
legislation  under  the  new  act  with  amend- 
ments to  existing  accident  comiKMisation  laws 
in  order  to  co-ordinate  them  more  ert'ccli\ely 
with  the  rehabilitation  program,  or  to  provitle 
the  special  medical  care  that  may  be  necessary 
for  the  restoration  of  cri|)plcs.  It  is  urgetl  that 
if  compensation  laws  can  lie  fitted  into  the 
system  of  industrial  rehabilitation,  so  that 
disabled  persons  may  be  transferred  to  fresh 
occui)ations  to  which  they  are  adai)table,  em- 
ployers will  be  somewiiat  relicxed  of  the  burden 
of  accident  compen.sation  in  cases  of  permanent 
disability,  and  a  solution  will  be  provided  for 
the  problem  of  industrial  accidents  from  the 
point  of  view  of  the  crippled  worker.  Some 
attempt  has  also  been  made  to  prevent  the 
exclusion  of  partially  cripj)led  workers  from 
suitable  occupations,  by  the  action  of  insur- 
ance companies.  —  G.  E.  Partridge. 


The  Industri.^l  Training  of  Disabled 
Men  in  the  United  Kingdoai.  Internat. 
Labour  Rev.,  May-June,  19"21,  2,  Xos.  -3-3, 
'■lil-ilGO.  —  The  history  of  industrial  training  is 
briefly  recounted,  and  the  first  step  in  the  train- 
ing of  disabled  men,  as  carried  on  imder  the 
Ministry  of  Labour,  is  mentioned  as  occurring 
in  1919.  The  purpose  of  the  training  is  to  make 
the  disabled  man  capable  of  carrying  on  a  man- 
ual occupation,  and  only  those  are  eligible  who 
were  disabled  by  the  war,  or  at  least  had  dis- 


ability existing  when  they  were  discharged 
from  the  forces. 

The  administrative  bodies  conducting  the 
work  consist  of:  (1)  a  central  authority,  the 
Training  Department  of  the  Alinistry  of 
Labour;  (2)  seventeen  district  organizations 
with  a  divisional  director  at  the  head  of  each; 
(:5)  about  twenty  National  Trade  Advisory 
Committees  and  about  ,'5,50  local  Technical 
Ad\'isory  Conmiittees. 

Rej)orts  are  j>ublished  by  the  INIinistry  of 
Lai)our  ill  regard  to  openings  in  industry  suit- 
al)le  for  disabled  ex-service  men,  and  thus  far 
there  are  reports  on  twenty-five  sjiecial  trades; 
tailoring,  furnishing,  leather  goods,  hand- 
sewn  i)()ot  and  shoe  making,  and  boot  and  shoe 
repairing,  gold,  silver  and  allied  trades,  dental 
meclianics,  tailoring  (wholesale),  boot  and  shoe 
manufacture,  basket  making,  building,  en- 
gineering, i)rinting,  jiicture-frame  making, 
brush  making,  electricity  (])Ower  and  light), 
distributive  trades,  sign  writing,  musical  instru- 
ments, vehicle  building,  gla.ss,  cotton,  pottery, 
lace,  clog  making,  surgical  boot  making. 

The  main  features  of  tlic  educational  i)lan  are 
said  to  ])e  the  decentralizafion  and  tiie  large 
part  played  by  the  national  and  local  com- 
mittees. The  divisional  directors  have  exten- 
sive powers  in  their  tlistricts  and  this  makes 
])ossil)lc  decisions  with  more  intimate  knowl- 
edge of  cases.  The  general  conditions  of  train- 
ing are  laid  down  by  the  national  committees 
for  each  trade,  and  their  local  apjilication  is 
controlled  I)y  the  local  conuuittees,  which  con- 
sist of  rejiresentatives  of  emi)loyers  and  workers 
in  the  industries  in  question.  The  result  is  that 
definite  conclusions  have  been  reached  about 
the  l)est  methods  of  training  for  each  industry, 
and  i)rogress  has  l)eeu  made  which  must  have 
considerable  effect  upon  general  industrial 
education.  On  this  plan,  the  training  of  the 
disabled  men  and  their  distribution  among  the 
trades  become  rather  more  the  work  of  the  em- 
ployers and  workers  in  the  trades  than  of  the 
government,  which  only  intervenes  to  direct  the 
discussions  and  to  provide  the  practical  means 
of  execution,  plant,  maintenance  allowances, 
etc. 

Training  may  be  gi\en  in  one  of  three  ways: 
(1)  in  private  employers'  workshops;  (2)  in 
technical  schools;  (3)  in  special  centers  estab- 
lished by  the  state.  The  first  way  is  the  most 
economical,  but  has  the  disadvantage  that  the 
man's  special  needs  are  likely  to  be  ignored. 
Training  in  technical  schools  is  especially  suited 


178 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


for  men  who  already  have  a  good  general  educa- 
tion, and  the  special  centers  were  set  up  to  com- 
bine the  advantages  of  the  other  two  methods. 
But  even  this  method  has  its  faults,  since  the 
training  is  likely  to  be  too  theoretical,  although 
it  tends  to  be  more  and  more  in  favor. 

"In  principle,  training  consists  of  two  pe- 
riods: a  preliminary  period  lasting  from  six  to 
eighteen  months,  during  which  disabled  men 
receive  the  maximum  state  allowance,  and  a 
period  of  imi)ro\-ement  lasting  on  an  average 
eighteen  months,  during  which  they  receive  a 
progressively  increasing  wage  and  a  propor- 
tionately decreasing  allowance  from  the  state. 
At  the  end  of  the  period  the  allowance  ceases 
and  the  disabled  man  receives  only  his  pension 
and  his  wages." 

Statistics  are  given  in  regard  to  the  number 
of  men  in  training,  etc.,  and  it  is  said  that  on 
the  whole  the  work  has  been  successful,  al- 


though there  ha^•e  been  delays  and  opposition 
in  some  particulars,  especially  as  unemploy- 
ment has  increased. 

"In  one  year,  or  two  at  the  most,  the  training 
of  men  disabled  in  the  war  will  be  complete,  and 
the  problem  will  then  arise  of  utilizing  the  ex- 
perience which  has  been  accjuired  in  the  training 
of  disabled  men,  and  the  institutions  which 
have  been  established,  for  the  industrial  train- 
ing of  young  persons,  of  men  disabled  in  in- 
dustry, and  of  workers  who  are  obliged  for  any 
reason  to  change  their  trade." — G.  E.  Partridge. 


Report  of  Activities  of  Bureau  of  Re- 
habilitation TO  J.\NUARY  1,  19'-21.  Bull.  Penn. 
•State  Dept.  Labor  and  Industry,  19'21,  Vol.  8, 
No.  2,  pp.  30.  —  This  is  a  profusely  illustrated 
accoiuit  of  the  aims  and  activities  of  the  Bureau 
of  Rehabilitation  in  Pennsvlvania.  —  ^I.  Dent. 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


DECEMBER,  1921 


NtTMBER    8 


CONTENTS 


rxom 

General 17!) 

Systemic  Occupational  Diseases:  Occurrence,  Treat- 
ment and  Prevention 181 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc 182 

Occupational  Infectious  Diseases:  Occurrence,  Treat- 
ment and  Prevention 18G 

Occupational  Affections  of  the  Skin  and  Special  Senses.   187 

Occurrence  and  Prevention  of  Industrial  Accidents  . .    189 

Hazards  of  Compressed  Air,  Diminished  Pressure, 
Generation  and  Use  of  Electricity,  and  Electrical 
Welding 194 


PAOC 

Women  and  Children  in  Industry 195 

Industrial  Sanitation:  Factory  Construction,  Illumina- 
tion, Ventilation,  Heating,  Water  Supply,  Sewage 
Disposal 195 

Industrial  Psychology  and  Industrial  Management  in 
Its  Health  Relations  196 

Industrial  Service  and  Mutual  Benefit  Associations  . .   197 

Industrial  Health  Legislation;  Court  Decisions:  Work- 
men's Compensation  and  Insurance 197 

Rehabilitation  of  Disabled  Employees iOO 

Industrial  Mortality  and  Morbidity  Statistics 202 


GENERAL 


Health  in  Indi\stry  and  Efficient  Pro- 
duction. S.  Dana  Hubbard.  Nation's  Health, 
May,  1921,  3,  No.  5,  812-315.  —A  very  large 
percentage  of  the  industrial  accidents  and  dis- 
eases which  prevail  in  most  industrial  estab- 
lishments are  preventable  through  education. 
There  are  many  individuals  who  utterly  dis- 
regard regulations,  and  well  laid  plans  of  the 
employer  are  frequently  set  at  naught  through 
the  ignorance  of  the  worker. 

Inadequate  medical  supervision  has  been 
responsible  for  an  appalling  number  of  per- 
manently handicapped  individuals.  Preven- 
tive medicine  is  concerned  in  the  careful  study 
of  each  individual  in  order  to  detect  physical 
defects  in  incipiency.  It  is  short-sightedness  to 
seek  medical  aid  only  when  ill.  In  industry  it  is 
short-sightedness  to  try  and  operate  a  plant 
without  medical  sanitary  supervision.  It  is 
likewise  a  grave  error  to  have  cheap,  untrained 
doctors  and  nurses  who  are  already  responsible 
for  too  many  permanently  disabled  workmen. 


In  this  article  much  emphasis  is  laid  upon  the 
importance  of  general  house-cleaning  and  or- 
derliness in  factories,  which  is  conducive  of  a 
belter  morale  as  well  as  better  health.  —  L.  A. 
Shaw. 

Medicine  as  Related  to  Workers  and 
Production.  C.  A.  Andrews.  Nation's  Health, 
Sept.  15,  1921,  3,  No.  9,  505-506.  —  Ten  or 
fifteen  years  ago  no  one  cared  very  much  about 
the  health  of  workers;  but  now,  after  various 
false  starts,  the  problems  of  industrial  welfare 
are  becoming  better  defined.  The  economic  in- 
terests of  both  employer  and  worker  are  seen, 
and  the  more  ideal  values  represented  by  the 
spirit  of  contentment,  optimism  and  good 
Americanism.  Opposition  arose  when  the 
American  Association  of  Industrial  Physicians 
began  its  activities,  but  recent  tendencies  show 
a  quite  different  conception  of  the  responsi- 
bility of  industry.  There  is  now  an  ideal  of 
"mutual  interest  and  mutual  service,  the  med- 


179 


180 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ical  profession  has  aroused  itself  from  its  old 
self-satisfied  orthodoxy,  and  has  produced  a 
virile  group,  traveling  new  paths,  honoring 
themselves  and  their  profession,  and  making 
their  profession  of  greater  value  to  the  com- 
munity than  it  has  been  before."  —  G.  E. 
Partridge. 

The  Physician's  Viewpoint.  Otto  P.  Geler. 
Nation's  Health,  Sept.  15,  1921,  3,  No.  9,  510- 
511.  —  Dr.  Geier  emphasizes  the  importance  of 
industrial  medicine  to  industry  not  only  as  an 
agent  for  improving  output  per  man  but  also  as 
an  important  factor  in  establishing  a  better  re- 
lationship between  labor  and  capital. 

The  need  of  industrial  medical  service  is  in- 
dicated by  the  fact  that  from  35  to  40  per  cent, 
of  our  young  men  proved  unfit  for  military 
service.  "When  we  stop  to  realize  that  our 
present  mode  of  living  and  doing  and  earning 
has  finally  produced  a  type  of  manhood  35  per 
cent,  of  whom  are  deficient  for  war  purposes  we 
naturally  ask  ourselves  whether  tiiis  condition 
does  not  also  measure  the  mental  and  physical 
deficiency  of  society  as  a  whole  in  peace  time. 
Then  we  naturally  ask  ourselves  a  second  ques- 
tion, whetiier  tiiis  physical  and  mental  imfitness 
does  not  explain  a  great  deal  of  the  present  un- 
rest, the  state  of  mind  of  many  men  toward 
society,  toward  labor,  toward  capital,  toward 
organized  industry. 

"From  long  contact  with  the  industrial  clinic 
I  developed  the  hope  that  in  the  industrial  clinic 
we  might  have  produced  a  better  state  of  mind, 
both  in  the  emiiloyee  and  in  the  employer,  that 
will  make  for  a  better  program  of  social  rela- 
tionship, a  better  type  of  citizenship.   .  .   . 

"What  industry  needs  above  all  things  is  to 
have  the  honorable  employer  properly  inter- 
preted to  the  employee,  and  the  honest  em- 
ployee properly  interi)reted  to  the  employer,  if 
we  wish  in  the  future  to  prevent  the  fierce  con- 
flicts between  labor  and  capital.  There  must  be 
a  laying  of  tiie  cards  on  the  table  between  the 
man  at  the  workbench  and  the  man  in  the 
office,  in  order  that  the  fellow  in  the  oflBce  may 
understand  the  mind  of  the  worker  in  the  shop, 
and  rice  rerun  tliat  the  worker  may  understand 
the  man  in  the  office.  They  both  must  get  the 
idea  that  the  other  fellow  is  a  pretty  decent 
chap  after  all  when  you  get  to  know  him. 

"I  believe  tiiat  industrial  medicine  in  a  labor 
policy  is  .sometiiing  industry  nuist  reckon  with. 
I  tiiink  it  can  be  made  a  most  natural  approach 
to  the  subject.  There  is  notiiing  artificial  about 


industrial  medical  service.  It  is  needed,  and  it 
is  used.  It  is  never  looked  upon  by  the  worker 
as  just  another  mechanism  for  tlie  employer's 
advantage,  for  good  service  of  this  type  sells 
itself.  It  is  usually  set  up  by  the  employer  who 
wishes  to  render  a  real  service  to  his  men,  and 
in  this  it  is  unlike  so  many  schemes  of  employee- 
relationship  which  were  hastily  organized  to 
meet  an  emergency  labor  problem.  But  only  a 
doctor  of  the  right  sort,  it  goes  without  saying, 
may  render  such  service.  Industry,  however, 
must  learn  that  out  of  a  cheap  doctor  can  come 
only  a  cheap  result."  —  Katherine  R.  Drinker. 

The  Educative  Potential  in  Industrial 
Medicine.  0.  P.  Geier.  Nation's  Health,  Aug. 
15,  1921,  3,  No.  8,  455-456. —The  industrial 
physician  needs  to  study  the  fundamental  rela- 
tions of  industry  in  order  to  understand  the 
function  of  industry,  the  scope  of  an  industrial 
relations  department,  and  the  place  of  employ- 
ment, training,  health  and  sanitation,  safety 
and  social  welfare  as  functions  of  such  a  de- 
partment. 

Various  aspects  of  the  work  of  the  industrial 
physician  are  discussed:  the  need  of  self-educa- 
tion; the  education  of  the  worker  to  make  use  of 
the  means  of  personal  hygiene,  etc.;  the  educa- 
tion of  executives,  etc.,  to  see  the  economic 
value  of  good  health,  also  to  understand  the 
responsibility  of  industry  toward  community 
health.  The  industrial  physician  must  also 
conduct  an  educational  campaign  in  his  own 
profession,  and  he  must  help  the  movement 
toward  supi)lanting  the  social  reformer  by  the 
social  worker  and  inducing  the  medical  pro- 
fession to  take  a  more  active  part  in  public 
health  matters.  The  health  officer  needs  some 
enlightenment  in  regard  to  industrial  condi- 
tions, and  the  community  as  a  whole  must  be 
made  to  understand  the  basic  value  of  health 
programs.  Influence  should  be  brought  to  bear 
upon  legislators  whenever  legislation  affecting 
the  welfare  of  the  worker  is  to  be  considered, 
and  the  industrial  physician  must  be  thoroughly 
informed  on  all  relevant  subjects. 

All  these  needs  should  be  brought  clearly  to 
the  minds  of  the  governors  of  medical  schools, 
especially  to  impress  the  need  for  men  wlio  will 
think  in  terms  of  the  community.  Finally,  the 
collective  action  of  all  industrial  physicians  is 
needed  to  influence  the  American  Medical 
Association  jiiid  to  bring  about  the  recognition 
of  tiie  industrial  approach  to  medical  problems 
and  all  that  this  implies.  — •  G.  E.  Partridge. 


ABSTRACTS 


181 


SYSTEI^nC  OCCUPATIONAL  DISEASES:  OCCURRENCE,  TREATMENT 

AND  PREVENTION 


CIRCULATORY  SYSTEM 

Arteriosclerosis  Localized  in  the  Ar- 
teries OF  the  Shoulder.  Torraca.  Abstracted 
as  follows  from  Rifornia  med.,  1921,  No.  23,  in 
II  Lavoro,  June  30,  1921,  12,  No.  2,  41^2.— 
A  laundress  62  years  old  liad  hemm  six  months 
before  she  was  seen  by  Torraca  to  be  conscious 
of  an  unusual  sense  of  weakness  in  her  upper 
limbs  and  at  the  same  time  a  pulsation  on  the 
inner  surface  of  both  arms.  Later  on  came 
formication  in  botli  liands  and  lijilittiini;  pains. 
The  two  humeral  arteries  (U])])er  l)rachial,)  ap- 
peared much  dilated  with  serpentine  course  and 
an  energetic  pulsation,  while  ])alpation  showed 
that  they  were  both  uniformly  indurated.  The 
author  considers  that  this  circumscribed  scle- 
rosis was  cau.sed  by  two  factors:  cold,  and  local- 
ized muscular  over-exertion.  The  localization 
of  .sclerosis  in  these  arteries  is  very  rare;  accord- 
ing to  Bregmann  it  comes  last  in  the  list  of 
peripheral  arteries  which  .show  such  sclerosis. 
In  only  .55  i)er  cent,  of  the  cases  oljserved  has 
the  hmneral  artery  been  involved,  in  contrast 
with  94  per  cent,  for  the  cubital  artery  (lower 
brachial),  88  per  cent,  for  the  subclavian,  8(i  per 
cent,  for  the  radial,  and  71  per  cent,  for  the 
axillary,  to  take  only  those  of  the  upper  limbs. 
Pieraccini  and  Devoto  both  emphasize  the  im- 
portance of  ]irolonged  nmscular  fatigue  in  these 
localized  scleroses  and  believe  that  they  con- 
stitute professional  stignuita.  Tliat  excessive 
work  may  produce  va.scular  .sclerosis  was  .shown 
aLso  by  the  observation  of  Marciiand,  who 
found  the  left  femoral  artery  sclerosed  in  an 
individual  with  rigiit  hemijilegia.  According  to 
Erb  another  most  important  factor  is  cold.  — 
Alice  Hamilton. 

MENTAL 

Industrial  Hygiene.  Wade  Wright.  Ment. 
Hyg.,  July,  1921,  5,  No.  3,  497-498.  —  "AH  of 
the  disabilities  of  man  are  not  physical,  and  the 
mental  disabilities  must  be  of  great  concern  to 
the  worker  for  industrial  health.  One  cannot 
consider  the  findings  of  the  army  psychiatrists 
that  70  per  cent,  of  almost  two  million  men  had 
a  mental  age  of  less  than  fifteen  years,  even  dis- 
counting it  generously,  without  realizing  that 
handicapped  minds,  like  sick  bodies,  cause  in- 


dustrial wastage  and  a  vast  amount  of  sorrow 
and  discontent. 

"Little  is  known  of  ways  to  develop  medical 
service  in  industry,  but  less  is  known  of  indus- 
trial [)sychiatry.  For  the  psychiatrist  there  is  a 
splendid  job.  It  promises  much  in  the  way  of 
aid  in  the  difficult  task  of  fitting  men  to  the  jobs 
they  can  best  do  and  jobs  to  the  men  they  need. 
Even  with  such  an  adjustment  consummated, 
industrial  discontent  will  still  be  found  —  but 
it  siiould  be  a  healthier  unrest  than  we  now 
know  and  that  day  a  better  one  than  this."  — 
Stanley  Cobb. 

NEUROMUSCULAR  SYSTEM 

Progressive  Amyotrophy  Resulting  from 
Labor.  Giordano  Vincemo.  Abstracted  as 
follows  from  Hiforma  med.,  1920,  No.  9,  in 
II  Lavoro,  March  31,  1921,  11,  No.  11,  340- 
342.  —  A  young  man  of  21  years  was  em- 
ployed in  a  j)rojeclile  factory  in  such  a  way 
that  he  was  obliged  to  bend  and  extend  his 
right  arm  contiiuially,  at  the  same  time  receiv- 
ing very  rapid  and  strong  vibrations,  while  with 
his  left  arm  he  raised  and  lowered  the  handle  of 
a  pump.  After  nine  months  he  began  to  lose 
strength  in  his  right  hand  and  after  three 
months  more,  in  his  left  hand.  Stabbing  pains, 
especially  at  night,  became  so  severe  that  he 
could  not  sleep  and  at  the  end  of  eighteen 
months  he  was  obliged  to  quit  work.  Vincenzo 
saw  him  two  and  a  half  years  subsequent  to  his 
entrance  in  the  factory  and  after  six  months' 
idleness.  There  was  decided  enlargement  of 
the  hands,  with  flattening  of  the  thenar  and 
hypothenar  eminences,  sinking  of  the  interos- 
seous spaces,  great  difficulty  in  flexion,  espe- 
cially in  the  right  hand.  He  could  not  make  a 
fist  with  his  right  hand.  There  was  no  disturb- 
ance of  sensation,  there  was  a  marked  reaction 
of  degeneration  of  the  median  and  ulnar  nerves. 
Almost  all  the  muscles  of  the  right  hand  failed 
to  react  to  the  galvanic  or  to  the  faradic  cur- 
rent. An  X-ray  examination  showed  bony 
atrophy  and  atrophy  of  the  articular  cartilages 
which  corresponded  to  the  Aran-Duchenne 
type  of  progressive  amyotrophy,  and  the  author 
believes  that  in  this  case  the  work  done  by  the 
man  wa.s  responsible,  the  strong  and  continuous 


182 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


vibrations  breaking  the  relation  between  the 
ganglion  cells  of  the  cord  and  the  striated 
muscles.  —  Alice  Hamilton. 

RESPIRATORY  SYSTEM 

Experimental  Investigations  on  Cal- 
cium Therapy  in  Ursol  Asthma.  OUo  Meld. 
Zentralbl.  f.  Gewerbehyg.,  May,  1921,  9,  No.  5, 
98-101;  Jmie,  1921,  9,  No.  6,  110-115.  —This 
work  was  undertaken  to  provide  an  experi- 
mental basis  for  the  calcium  therapy  as  sug- 
gested by  Dr.  H.  Curschniann.  Work  done  by. 
Curschmann  and  Gerdon  on  the  nature  of  ursol 
asthma,  which  occurs  in  many  persons  handling 
dj'ed  furs  and  skins,  is  here  reviewed.  Con- 
firmatory experiments  are  cited  by  the  author. 
Following  sensitization  with  ursol-D  and  hy- 
drogen peroxide,  administered  by  intravenous 
or  subcutaneous  injection,  anaphylactic  shock 
was  produced  after  eighteen  days  by  intra- 
venous injection,  but  not  by  subcutaneous 
injection  or  by  the  inhalation  of  the  dye  as 
dust.  No  shock  could  be  produced  following  a 
single  sensitization  by  inhalation  of  the  dye. 

Para-phenylenediamine  produces  dyspnea 
by  vagus  stimulation,  with  bronchial  muscle 
spasm;  leukocytic  infiltration  and  exudation 
into  the  respiratory  passages  is  set  up.  Calcium 
is  a  sedative  for  the  whole  nervous  system, 
especially  the  peripheral  motor  neuron;  it 
facilitates  blood  coagulation  and  reduces  the 
permeability  of  the  vessels.  Calcium  seems  a 
hojjeful  antidote  for  the  symptoms  of  ana- 
phylaxis. From  the  various  dosages  and 
methods  of  administration  the  author  chose 
subcutaneous  injection  of  a  5  per  cent,  solution 
of  calcium  chloride,  0.2  gram  per  kilo  of  guinea- 
pig,  given  one  to  one  and  a  half  hours  preceding 


the  precipitation  of  shock.  Guinea-pigs  were 
sensitized  by  intravenous  and  subcutaneous 
injections  with  quinone-diimine.  After  eight- 
een days  shock  was  precipitated.  In  no  case 
where  the  calcium  therapy  preceded  the  shock 
dose  were  there  any  symptoms  of  anaphylaxis. 
There  were  areas  of  "calcium  necrosis"  at  the 
sites  of  injection  of  the  calcium  chloride,  but 
these  healed  spontaneously  in  a  few  days. 
Human  therapy  remains  to  be  tried.  It  must 
be  by  some  other  route  than  injection.  —  E.  L. 
Se\Tinghaus. 

Some  Further  Communications  on  the 
Harmful  Effects  of  Ursol  among  Workers 
IN  Furs.  Ritter.  Milnchen.  med.  Wchnschr., 
March  18,  1921,  68,  No.  11,  333.  —  Dr.  Cursch- 
mann's  report  in  the  Miinchener  viedizinische 
Wochenschriff  for  February  18,  1921  leads  Dr. 
Ritter  to  describe  some  cases  of  his  own  of  the 
same  nature,  examples  of  which  he  sees  every 
summer  in  patients  suffering  from  the  effect  of 
ursol.  These  are  workers  in  furs,  and  the 
cause  of  their  illness  is  the  use  of  ursol  in  the 
dyes  employed.  Some  of  the  cases  show  typical 
asthma  attacks,  others  complain  of  very  per- 
sistent inflanunatory  conditions  of  the  upper 
air  passages.  In  both  types,  there  are  objective 
findings  of  inflammation  of  the  mucous  mem- 
branes, which  make  chemical  lesions  certain. 
Some  patients  have  reported  ulceration,  but 
the  writer  has  never  observed  a  case.  These 
cases  must  be  differentiated  from  the  ordinary 
asthma  to  which  workers  in  skins  are  subject, 
and  which  is  caused  by  dust  and  is  purely  me- 
chanical and  to  be  distinguished  from  the  chem- 
ical (and  mechanical)  effects  of  ursol.  The 
differential  diagnosis  is  usually  readily  made.  — 
G.  E.  Partridge. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS:    GASES, 
CHEMICALS,  ETC. 


The  Detection  of  Carbon  Monoxide.  C. 
R.  Hoover.  Jour.  Indust.  and  Engin.  Chem., 
Sept.,  1921,  13,  No.  9,  770-772.  —  Several 
forms  of  portable  aj)j)aratus  ha^'e  been  devised 
for  the  detection  of  carbon  monoxide  under  in- 
dustrial conditions.  These  have  proved  too 
elaborate,  not  sensitive  enough  or  not  specific 
for  the  gas,  and  in  jiractical  use  mice  or  canaries 
have  been  found  more  trustworthy  detectors. 
But  these  again  have  obvious  disadvantages. 
As  a  result  of  work  done  in  the  Chemical  War- 


fare Service  on  absorbents,  a  chemical  carbon 
monoxide  detector  has  been  developed  which 
answers  the  ref|uirements  very  satisfactorily. 
It  is  sufficiently  sensitive  to  detect  in  a  few 
seconds  smaller  quantities  of  gas  than  are  cap- 
able of  causing  harm  to  man  or  toxic  symptoms 
in  small  animals.  Concentrations  of  carbon 
monoxide  as  low  as  0.005  per  cent,  can  be  de- 
tected. The  greenish  color  developed  is  pro- 
portional to  the  amount  of  carbon  monoxide 
present  and  by  compari.son  with  a  color  scale 


ABSTRACTS 


183 


gives  a  qualitative  and  an  approximately 
quantitative  determination.  The  detector  sub- 
stance "hoolamite"  contains  fuming  sulphiu-ic 
acid,  iodine  pentoxide  and  powdered  pumice 
sealed  in  a  glass  tube.  For  use  the  tips  are 
broken  and  the  tube  connected  with  a  small 
hand  syringe  by  which  a  measured  volume  of 
air,  freed  from  interfering  gases  by  passage 
through  charcoal,  can  be  passed  through  the 
tube.  The  color  change  occurs  immediately 
but  soon  fades  and  should  be  read  without  de- 
lay. A  more  accurately  graduated  syringe  has 
been  designed  for  careful  analyses  and  espe- 
cially for  laboratory  tests. 

The  portable  and  sensitive  detector  de- 
scribed should,  with  the  efficient  carbon  mon- 
oxide gas  mask  recently  put  on  the  market, 
materially  increase  the  safety  of  work  in  mines 
and  other  places  where  dangerous  concentra- 
tions of  carbon  monoxide  are  met.  —  H.  S. 
Forbes. 

Danger  of  Using  Explo.sin  e.s  ix  Cov- 
FiNED  Places.  C.  L.  Colhuni.  Nat.  Safety 
News,  Aug.,  19'21,  4,  No.  2,  8'2. --This  is  an 
account  of  a  mine  accident  in  which  three  of 
four  operators  lost  their  lives,  poi.soned  by 
gases  resulting  from  blasting  in  the  raise.  Upon 
investigation  the  ])owder  used  was  discovered 
to  have  been  S  years  old,  and  was  probably  iii- 
completely  detonated,  giving  otf  unusually 
large  quantities  of  carbon  monoxide  and  oxides 
of  nitrogen.  No  ventilation  had  been  provided 
to  carry  off  the  fumes. 

The  author  enumerates  tlic  insidious  proper- 
ties of  carbon  monoxide  and  urges  greater  care 
against  this  gas  on  the  part  of  all  connected 
with  mines.  There  are  si)ecial  ajjparatus  now 
on  the  market  for  the  detection  of  carbon 
monoxide  which  can  be,  and  are  by  many  com- 
panies, conveniently  installed.  Carbon  mon- 
oxide is  not  only  dangerous  in  mines,  but  also  in 
garages  and  railroad  tunnels  and  stations.  Mr. 
Colburn  refers  the  reader  interested  in  this  sub- 
ject to  the  National  Safety  Council's  pamphlet 
on  Commercial  Explosites;  the  U.  S.  Bureau  of 
Mines  Technical  Paper  No.  11,  The  Use  of 
Mice  and  Birds  for  Detectinij  Carbon  Monoxide; 
and  Bulletin  No.  8,  A  Primer  on  E.rplosires  for 
Metal  Miners  and  Quarry-Men.  —  M.  Dent. 

Accidental  Death  by  Illuminating  Gas 
under  Ordinary  Conditions  of  Work. 
D^Alessio.  Abstracted  as  follows  from  Stampa 
Medica,  March  15,  19^21,  in  II  Lavoro,  May  31, 
1921,  12,  No.  1,  15.  —  On  the  24th  of  Septem- 


ber, 1920,  a  man  who  was  making  connections 
in  gas  pipes  in  an  excavation  about  80  cm.  deep 
in  a  street  in  Naples  was  obliged  to  quit  work 
because  of  dizziness,  difficulty  in  breathing, 
clouding  of  vision  and  a  sense  of  illness.  Fol- 
lowing the  rule  of  the  company  he  was  taken 
home  and  told  not  to  come  back  till  the  next 
day.  He  felt  better  at  first,  ate  his  dinner  as 
usual,  then  suddenly  the  symptoms  returned 
with  great  severity  and  he  was  dead  in  two 
hours.  Suspicions  of  poisoning  were  aroused 
and  a  careful  autopsy  with  chemical  tests  was 
made.  No  change  was  noted  except  pulmonary 
congestion.  The  presence  of  carbon  monoxide 
hemoglobin  was  demonstrated  by  the  methods 
of  Iloppe-Seyler,  of  Jolenisch,  of  Rubner,  and 
of  Katajama,  and  this  although  the  examina- 
tion was  made  four  days  after  death.  Spec- 
troscopic examination  was  also  positive.  — 
Alice  Hamilton. 

The  Injitrious  Action  of  Bu^st  Furnace 
Gas.  Derdack.  Zentralbl.  f  Gewerbehyg., 
June,  1921,  9,  No.  C,  lOJl-110.  —  Furnace 
gases,  both  raw  and  purified,  are  probably  in- 
jurious by  virtue  of  the  carbon  monoxide  con- 
tent. Cyanogen,  arsenic  and  hydrogen  sulphide 
arc  higlily  iiii|)rol)able  as  the  causes  of  poison- 
ing by  virtue  of  their  low  concentration  and  the 
fact  that  they  are  absent  from  some  gases 
known  practically  to  be  injurious.  Lewin's  new 
book  on  Carbon  Monoxide  Poisoning  is  warmly 
recommended.  —  E.  L.  Sevringhaus. 

New  Researches  on  the  Blood  and  the 
Blood-Fokmixg  Organs  in  Benzol  Intoxica- 
tion. 0.  Fonlana.  Abstracted  as  follows  from 
Gior.  d.  clin.  med.,  1921,  No.  3,  in  II  Lavoro, 
March  31,  1921,  11,  No.  11,  329-331.  — The 
action  of  benzol  has  thus  far  been  studied 
chiefly  with  regard  to  the  leukocytes.  Fontana 
directed  his  attention  to  the  red  corpuscles  and 
the  platelets.  Injecting  eight  guinea-pigs  sub- 
cutaneously  with  a  daily  dose  of  1  c.c.  per  kilo- 
gram and  examining  the  blood  every  other  day, 
he  found  that  the  animal  succumbed  on  the 
foiu-th  to  the  tenth  day,  and  that  at  the  mo- 
ment of  death  the  leukocytes  and  the  granular 
erythrocytes  {emazie  granulose)  had  completely 
or  almost  completely  disappeared  from  circula- 
tion. In  one  animal  he  provoked  first,  a  leu- 
kocytosis and  an  increase  of  these  erythrocytes 
by  injecting  nucleinate  of  sodium,  and  then,  by 
the  usual  benzol  injections,  he  reduced  the 
leukocytes  to   1400  and  caused  the  granular 


184 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


erythrocytes  to  disappear  completely.  Con- 
versely, it  was  possible  to  cause  a  reappearance 
of  these  elements  by  administering  nucleinate 
of  sodium.  The  reduction  of  leukocytes  af- 
fected the  polymorphonuclears  especially,  and 
the  last  to  disappear  were  the  lymphocytes. 
In  the  most  rapidly  developing  cases,  however, 
this  inversion  of  the  leukocytic  formula  failed  to 
appear.  The  effect  on  the  reds  was  less  marked, 
the  hemoglobin  was  diminished  by  about  one- 
tenth,  the  red  cell  counts  fell  in  four  days  to 
3,000,000.  The  granular  red  cells  which  have 
hitherto  never  been  studied  in  benzol  intoxica- 
tion always  diminished  progressively  and 
finally  disappeared.  Less  constant  results  were 
obtained  with  the  platelets,  only  about  one- 
half  of  the  animals  showing  a  fairly  well  marked 
diminution.  The  volume  of  the  spleen  was 
diminished  in  all.  The  bone  marrow  was  some- 
times normal,  sometimes  gelatinous.  Subseral 
ecchymoses  were  frequent  and  occasionally 
there  were  parenchymal  hemorrhages.  Micro- 
scopic examination  of  the  femoral  medulla 
showed  scarcity  of  leukocytes,  megakaryocytes 
among  the  red  corpuscles  and  some  polychro- 
matophilia.  There  was  increase  of  medullary 
fat,  also  congestion  and  small  hemorrhages  and 
sometimes  atrophy.  Smears  from  the  spleen 
showed  numerous  white  elements,  chiefly 
mononuclear.  The  spleen  was  usually  con- 
gested with  subcapsular  hemorrhages  and 
atrophy  of  the  malpighian  follicles  and  some- 
times a  diffuse  sclerosis.  The  lymphatic  glands 
frequently  showed  small  hemorrhages;  the 
channels  seemed  empty  of  cells.  There  were 
only  slight  alterations  in  the  liver,  such  as  small 
hemorrhages  and  some  fatty  infiltration. 

The  author  lays  stress  on  the  fact  that  in- 
dividual animals  react  ^'ery  differently  to  the 
same  dose  of  benzol,  some  developing  a  very 
acute  form  of  poisoning,  others  a  slow  form. 
He  also  notes  that  there  does  not  seem  to  be  a 
direct  relation  between  the  blood  picture  and 
the  changes  in  the  bone  marrow,  for  he  has 
found  fairly  extended  areas  of  ajjparently  nor- 
mal marrow  in  animals  in  whose  blood  no 
leukocytes  could  be  demonstrated.  The  total 
disa{)pcarance  of  the  granular  er\'throcytes  (im- 
mature forms)  and  the  diminution  of  the  ma- 
ture forms  show  that,  although  tiie  chief  action 
of  benzol  is  upon  the  leukocytes,  the  red  ele- 
ments also  suffer.  —  Alice  Hamilton. 

Effect  of  Bexzyl  Bexzoate  on  Leuko- 
cytes OF  Rabbit.  L.  A.  Emge  and  /.  P.  Jensen. 


Abstracted  as  follows  from  Jour.  Pharmacol, 
and  Exper.  Therap.,  June,  1921,  17,  No.  o,  415, 
in  Jour.  Am.  Med.  Assn.,  July  9,  19''21,  77,  No. 
2,  153.  —  "The  experimental  work  done  by 
Emge  and  Jensen  showed  that  in  rabbits  a  con- 
tinuous administration  of  benzyl  benzoate  in 
small  doses  leads  to  a  leukocytosis  which  in 
somewhat  larger  doses  is  accompanied  by  an 
increase  in  small  mononuclear  cells.  This 
leukocytosis  is  transient  and  ultimately  ends  in 
a  late  mild  leukopenia.  In  other  words,  the 
behavior  of  the  blood  picture  suggests  also  that 
if  it  is  due  to  some  form  of  benzol  or  some  inter- 
mediate product,  such  substance  is  of  impor- 
tance only  after  a  sufficient  amount  of  benzyl 
benzoate  has  accumulated  in  the  system.  In 
large  but  single  doses  of  benzyl  benzoate  there 
is  a  tendency  to  change  the  even  rise  of  the 
leukocytes  into  a  broken  curve  of  a  diphasic 
character  with  a  distinct  depression  of  the 
polymorphonuclear  element.  Also  here  the 
mild  and  late  leukopenia  occurs.  The  changes 
in  the  blood  curve  are  not  dependent  upon  the 
method  of  the  administration  of  the  drug.  In 
a  very  large,  single,  but  not  fatal  dose  the  pri- 
mary rise  of  the  leukocytes  does  not  occur  neces- 
sarily but  the  blood  curve  assumes  more  of  the 
leukojjenia  character,  of  the  benzol  curve.  This 
leukopenia  presents  also  here  a  diphasic  poly- 
morphonuclear picture.  In  the  presence  of 
latent  or  quiescent  infections  in  rabbits  larger 
doses  produce  an  acute  return  of  the  disease. 
This  is  accompanied  by  sharp  rises  and  sud- 
den drops  in  the  total  as  well  as  the  small 
mononuclear  white  blood  cells  (actual  lympho- 
cytosis). A  leukopenia  was  not  observed  when 
the  recrudescence  was  very  violent  but  when 
the  recrudescence  took  a  milder  course  there 
also  was  a  suggestion  of  a  late  leukopenia.  The 
flaring  up  of  an  infection  in  rabbits  during 
benzyl  benzoate  therapy  suggests  a  similarity 
to  the  action  of  benzol  under  similar  circum- 
stances. Tliese  data  are  in  direct  contradiction 
of  those  of  Heller  and  Steinfield."  —  C.  K. 
Drinker. 

Industrial  Mercury  Poisoning.  II  Lavoro, 
July  31,  19-21,  VI,  No.  3,  85-86.  —At  the  .ses- 
sion of  the  Lombard  Society  of  Sciences.  Ai)ril 
'ii,  Devoto  presented  two  cases  of  mercurial- 
ism.  The  men  were  healthy,  vigorous  individ- 
uals who,  after  working  for  about  three  months 
in  a  dry  battery  plant  where  they  used  a  solder 
containing  mercury,  developed  symptoms  of 
poisoning.     The    most    interesting    feature    in 


ABSTRACTS 


185 


these  cases  was  the  almost  complete  identity  of 
the  early  symptoms,  of  the  course  of  the  dis- 
ease, and  of  its  outcome.  In  both  cases  it  began 
with  a  very  slight  stomatitis,  followed  by 
marked  physical  weakness,  mental  depression, 
tremor,  headache,  and  dizziness.  Mercury  was 
detected  in  the  urine  of  both,  and  in  the  blood 
there  was  a  decided  increase  of  red  corpuscles, 
but  the  hemoglobin  was  diminished  and  in  both 
there  was  present  abundant  granulation  in  the 
lymphocytes.  —  Alice  Hamilton. 

Eabliest  Pcsitive  Sign  of  Le.\d  Absorp- 
tion. U.  S.  Bur.  Labor  Statis.,  Montli.  Labor 
Rev.,  August,  1921,  l.'J,  No.  2.  40.)  408.  —  The 
basophile  granulations  (stippling)  in  the  red 
blood  cells,  while  not  pathognomonic,  are  the 
earliest  sign  of  lead  jioisoning.  The  fact  that 
stippling  occurs  in  malaria,  i)ernicious  anemia, 
and  cancer  does  not  detract  from  its  value  as  a 
diagnostic  sign  in  lead  poi.soning,  since  other 
morbid  conditions  can  be  ruled  out  by  other 
clinical  signs  which  arc  well  known  to  c\ory 
physician.  In  lead  ])oisoniiig  stii)|)ling  a|)poars 
before  any  other  sign  is  manifest.  Its  appear- 
ance is  intermittent,  and  it  is  the  duty  of  the 
industrial  physician  to  make  frccjuent  exam- 
inations of  the  blood  of  lead  workers. — J.  A. 
Key. 

Observations  on  the  Early  Diagnosis  of 
Lead  Poisoning.  liottrich.  Zcntrall)!.  f.  Gewer- 
behyg.,  June,  1921,  9,  No.  (i,  10(i-109.  —  Con- 
trary to  statements  of  Schoenfcld  in  the  Janu- 
ary number  of  the  Zetifralblatt  fur  Gewerhehy- 
giene,  the  author  has  found  lead  ])allor  and  the 
lead  line  to  be  highly  characteristic  of  load 
poisoning.  The  lead  line  may  be  ditt'erentiated 
with  certainty  from  confusing  phenomena.  The 
pallor  should  be  considered  highly  suggestive 
in  a  lead  worker.  Basojihilic  degeneration  is 
emphasized  as  a  diagnostic  sign  of  first  impor- 
tance. On  theoretical  grounds  the  author  con- 
cludes that  the  lead  must  exert  its  toxic  action 
in  solution,  not  as  circulating  particles  of 
metallic  lead.  —  E.  L.  Se\Tinghaus. 

Case  of  Aluminium  Poisoning.  John 
Spqforth.  Lancet,  June  18,  1921,  1,  No.  2.5, 
1301.  —  "I  was  recently  called  to  see  a  man, 
aged  46,  who  was  then  employed  at  a  firm  of 
metalworkers.  He  was  in  a  state  of  great  ex- 
haustion and  suffering  from  very  severe  and 
persistent  vomiting.  The  pulse  was  slow  and 
irregular.    I  suspected  metallic  poisoning  and 


later  sent  a  specimen  of  his  urine  to  — — , 
analytical  chemists,  who  reported  that  it  con- 
tained a  large  amount  of  aluminium,  also  of 
phosphates.  The  patient  said  that  he  had  been 
dipping  red-hot  metal  articles,  contained  in  an 
aluminium  holder,  into  concentrated  nitric 
acid.  Aluminium  produces  a  rather  slow  in- 
toxication. In  this  case  it  caused  loss  of 
memory,  tremor,  jerking  movements  and  im- 
paired co-ordination.  There  was  also  chronic 
constipation  and  incontinence  of  urine."  — 
M.  C.  Shorley. 

Magnesium  Sulfate  in  Arsenic  Poison- 
IN'G.  Olga  S.  Hansen.  Abstracted  as  follows 
from  Jour.  Pharmacol.,  1921,  Vol.  17,  105-113, 
in  Chem.  Abstr.,  June  20,  1921,  15,  No.  12, 
1940.  —  "Definite  conclusions  cannot  be  drawn 
in  regard  to  action  of  MgSOj  in  As  poi-soning 
but  results  may  be  summarized  as  follows: 
MgS()4  has  prolonged  the  average  life  of  a  series 
of  50  rabbits  poisoned  by  As  from  219  hours  to 
415  hours  on  the  average,  but  caimot  be  said  to 
have  saved  life  in  rabbits.  MgSo4  is  toxic  in 
large  doses  and  to  some  extent  in  medium  sized 
doses.  There  is  a  marked  variation  in  individ- 
ual susceptibility  to  As  poisoning." 

"Montanin"  Poisoning.  Krausse.  Zen- 
tralbl.  f.  Gewerbehyg.,  July,  1921,  9,  No.  7, 
141-146.  — A  boy  in  a  brewery  drank  "Mon- 
tanin"  by  mistake  and  died  witiiin  an  hour, 
^lontanin  is  a  strong  solution  of  hydrofluo- 
silicic  acid,  used  widely  in  breweries  and  distil- 
leries for  disinfecting  all  kinds  of  vessels.  It  is 
effective  and  is  easily  washed  out.  The  chem- 
istry, toxicology,  and  technology  of  this  ma- 
terial is  discussed  and  the  postmortem  findings 
given  in  some  detail.  —  E.  L.  Sevringhaus. 

The  Ocular  Menace  of  Wood  Alcohol 
Poisoning.  S.  Lewis  Ziegler.  Jour.  Am.  Med. 
Assn.,  Oct.  8,  1921,  77,  No.  15,  1160-1166.— 
The  author  reaches  the  following  conclusions: 

"1.  AVood  alcohol  is  the  most  deadly  poison 
used  in  daily  commerce. 

"2.  One  teaspoonful  has  been  known  to 
cause  blindness  and  1  ounce  to  cause  death. 

"3.  The  port  of  entry  may  be  through  the 
mouth,  nose  or  skin. 

■'4.  Wood  alcohol  should  be  identified  by 
Robinson's  test. 

"5.  It  is  a  protoplasmic  poison  possessing  a 
selective  affinity  for  the  delicate  nerve  tissues  of 
the  eye. 


186 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"6.  Its  biochemistry  is  modified  by  oxida- 
tion, first  to  formaldehyd  and  then  to  formic 
acid,  both  of  which  are  corrosive  poisons. 

"7.  Formic  acid  is  the  end-product  ex- 
creted by  the  kidneys. 

"8.  If  formic  acid  is  present  in  the  urine,  it 
will  promptly  reduce  Fehling's  solution,  thus 
suggesting  to  the  inexperienced  a  false  diagnosis 
of  diabetes. 

"9.  Van  Slyke's  test  will  re\'eal  acidosis  in 
the  early  stages  and  alkalosis  later. 

"10.  Sudden  blindness  with  vomiting  and 
abdominal  pain  should  always  arouse  suspicion 
of  methyl  alcohol  poisoning;  especially  if 
diplopia  or  ptosis  is  associated. 

"11.  Papillitis,  sector-like  atrophy  and  sud- 
den sclerosis  of  the  nerve-head  are  equally 
typical  fundus  lesions. 

"  12.  Symptoms  of  pituitary  injury  are  most 
suggestive  in  pointing  to  this  as  the  primary 
and  fundamental  lesion. 

"13.  Contracted  fields  and  central  or  para- 
central scotomas  are  usually  present. 

"  14.  Treatment  should  include  early  neutral- 
ization by  alkalis,  and  elimination  by  lavage, 
emetics,  diaphoretics  and  rapid  oxidation,  to- 


gether with  stimulation  of  the  optic  nerve  by 
negative  galvanism  applied  directly  to  the  eye. 
Thyroid  extract  and  pituitary  extract  may  be 
indicated. 

"15.  The  manufacture  and  sale  of  wood 
^alcohol  should  be  prohibited  or  regulated  by 
law. 

"16.  If  sales  are  permitted,  safeguards  and 
warnings  should  be  required  and  the  public  in- 
structed as  to  the  great  danger  to  vision  and  life. 

"17.  A  special  revenue  tax  with  registered 
'poison  sales '  would  regulate  and  record  its  dis- 
tribution and  in  cases  of  poisoning  reveal  the 
soiu-ce. 

"  18.  This  tax  should  equalize  the  cost  of  de- 
natured alcohol  and  methyl  alcohol  and  thus 
remove  the  temptation  to  adulteration  because 
of  cheapness. 

"19.  All  wines,  whiskies,  toilet  articles  and 
'  patent  medicines '  imported  from  foreign 
countries  should  be  tested  for  wood  alcohol 
before  passing  tiirough  the  customs  inspection. 

"20.  The  name  'methanol'  specifically 
designates  this  product  and  yet  avoids  the 
tempting  suggestiveness  of  the  word  '  alcohol.' " 
—  C.  K.  Drinker. 


OCCUPATIONAL  INFECTIOUS  DISEASES:  OCCURRENCE, 
TREATMENT  AND  PREVENTION 


Tuberculosis  in  a  Chemical  Plant.  Ru- 
dolf Bachf  eld.  Zentralbl.  f.  Gewerbehyg.,  .June, 
1921,  9,  No.  6,  118-121;  .July,  1921,  9,  No.  7, 
146-149.  —  Statistical  study  of  the  cases  of 
tuberculosis  among  the  employees  of  a  dye 
works  for  six  years  previous  to  the  war  and  for 
four  years  during  the  war  leads  to  the  conclu-, 
sion  that  close  association  with  the  chemical 
materials  tends  to  increase  the  number  of  cases 
of  tuberculosis,  the  fatality  of  the  disease,  and 
the  loss  of  working  days  due  to  illness  which  is 
later  recovered  from.  Other  employees  in  the 
same  plant,  similarly  fed  but  not  associated 
with  the  chemicals,  form  the  basis  for  compari- 
son. The  number  of  cases  of  tuberculosis  is  too 
small  for  conclusive  proof  or  accurate  ratios. 
Acute  poisoning  with  aromatic  hydrocarbons 
and  derivatives  does  not  seem  to  play  any  role 
in  the  unfavorable  action  of  such  employment. 
- —  E.  L.  Sevringhaus. 

Syphilis  in  Gl.\ss  Blowers.    Bajla.    Ab- 
stracted from    the  Bollettino  dell'  Ordine  dei 


Medici  della  Provincia  di  Milano,  June,  1920;. 
in  II  Lavoro,  July  31,  1921,  12,  No.  3,  83-85.  — 
This  is  the  report  of  an  examination  of  glass 
blowers  in  Milan,  undertaken  in  conseciuence  of 
the  discovery  of  a  case  of  syphilis  in  an  em- 
ployee. The  victim  was  a  boy  of  14  years  em- 
ployed in  a  large  glass  works  and  suffering 
from  primary  lesion  of  the  upper  lip.  The 
municipal  dejiartment  of  hygiene  ordered  an 
examination  of  all  the  glass  blowers,  with  the 
result  that  seven  syphilitics  were  discovered  all 
with  lesions  in  tlie  mouth.  This  was  in  1908, 
and  soon  after  tiiat  regulations  were  passed  by 
the  municipal  government  requiring  medical 
inspection  of  workmen  in  glass  factories  at 
least  once  a  week,  daily  disinfection  by  flame  of 
the  portion  of  the  blower's  pipe  wliicli  comes  in 
contact  with  liis  mouth,  prohibition  of  tiie- 
common  drinking  cup,  compulsory  notification 
of  cases  of  .syi)hilis  developing  among  the  work- 
men, and  also  of  cases  of  pulmonary  tuber- 
culosis. The  improvement  following  this  legis- 
lation has  been  excellent.   During  1908  thirteen 


ABSTRACTS 


187 


cases  of  syphilis  in  glass  blowers  were  discovered 
in  one  establishment,  but  not  a  single  case 
since  then.  Milan  has  the  credit  of  being  the 
first  city  to  attack  this  particular  danger  in  in- 
dustry, but  France  has  since  followed  her 
example  although  the  French  law  is  not  so 
strict.  —  Alice  Hamilton. 

Industri.\l  Applic.\tion  of  Army  .\xd 
Navy  Venereal  Disease  Records.  R.  H. 
Everett  and  M.  A.  Clark.  Am.  Jour.  Pub. 
Health,  Sept.,  1921,  11,  No.  9,  S'jg-SS.S. — 
Venereal  diseases  are  a  much  greater  handicap 
in  industry  than  c.visting  industrial  statistics 
indicate.  This  inference  may  properly  be 
drawn  from  the  1920  reports  of  absences  from 
duty  in  the  army  and  navy.  In  the  former 
more  than  l.'i  per  cent.,  and  in  the  latter  1.5  per 
cent.,  of  all  absences  were  from  venereal  dis- 
eases. 

The  aiitlior  advocates  a  thorough-going 
scientific  study  of  the  many-sided  |)robIem  of 
the  relation  of  venereal  diseases  to  industry. 
He  recommends  as  the  result  of  an  interroga- 
tory to  sixty-three  industrial  ])hysicians  and 
surgeons  four  lines  of  ap))n>a<'li:  e(hicatioiial 
work  among  owners,  directors,  managers,  and 
executives;  more  comprehensive  ((uestionnaires; 
an  investigation  of  conditions  in  one  thoroughly 
organized  corporation;  and  further  develoj)- 
ment  of  medical  service  in  industry. — H.  F. 
Smyth. 

Malignant  Pustule  with  Multiple  Le- 
sions. R.  T.  Grant.  Lancet,  Sei)t.  17,  1921.  2. 
No.  12,  606-007. —A  bulciier  skinned  a  iiul- 
lock,  which  the  following  day  was  found  to  have 


died  from  anthrax.  The  man  washed  his  arms 
and  cleansed  his  underclothes  in  disinfectants, 
but  not  his  outer  clothing.  Eight  days  later  a 
small  pimple  appeared  on  the  back  of  the  right 
hand  between  the  thumb  and  first  finger.  The 
sore  was  very  itchy  and  irritable  and  discharged 
a  thin  clear  fluid.  Three  days  after  its  a[)i)ear- 
ance  it  was  diagnosed  as  a  malignant  pustule. 
A  smaller  pustule,  unobserved  by  tiie  patient, 
was  found  on  the  left  forearm  surrounded  by  a 
zone  of  edema  about  5  inches  in  diameter. 
Smears  from  both  pustules  showed  anthracoid 
organisms,  and  a  guinea-pig  inoculated  from 
the  pustule  died  in  thirty -six  hours,  showing 
the  extreme  virulence  of  the  bacilli  present. 
The  foci  were  excised  and  two  subcutaneous  in- 
jections of  Sclavo's  serum  given.  The  patient 
made  an  uninterrupted  recovery.  —  R.  Prosser 
White. 

Case  of  Human  Anthr.\x  in  Buganda 
Kingdom.  IT'.  L.  Peacock  and  H.  L.  Duke.  Ab- 
stracted as  follows  from  Lancet,  Aug.  13,  1921, 
2,  No.  7, 332,  in  Jour.  Am.  Med.  Assn.,  Sept.  10, 
1921.  77,  No.  11,  891.  —  "A  man  whose  work 
had  nothing  to  do  with  hides  or  cattle,  had  cut 
up  .some  of  the  fle.sh  of  a  bullock.  Three  days 
later  he  noticed  a  small  pajjule  on  his  cheek 
which  he  scratched,  and  it  had  gone  on  increas- 
ing in  size  from  that  time  up  to  his  admission  to 
hosjjital  some  six  days  later.  On  admission  the 
jmstule  was  at  once  excised  and  the  wound 
painted  with  pure  phenol,  partly  closed  by 
stitches,  and  a  wet  phenol  dressing  applied.  A 
smear  examined  immediately  after  the  excision 
showed  typical  anthrax  bacilli  in  pure  ciUture." 
—  C.  K.  Drinker. 


OCCUPATIONAL  AFFECTIONS  OF  THE  SKIN  AND  SPECIAL  SENSES 


Carcino.ma  Cutis  in  an  Anthracene  F.\c- 
TORY.  W.  J.  O'Donovan.  Brit.  Jour.  Dermat. 
and  Syph.,  1921,  Vol.  33,  p.  291.  —The  writer 
prefaces  his  paper  by  giving  references  to  three 
recent  investigations  where  true,  squamous, 
horny  carcinomata  were  experimentally  caused, 
in  animals,  by  the  systematic  application  of 
tar.  In  191,5  Yamagiwa  and  Ichikawa  de- 
scribed successes,  and  in  1918  Isutsui  reported 
the  production  of  hyperkeratosis,  papilloma- 
tous growth  and  carcinoma  in  mice.  The  latest 
is  this  year's  experimental  work  by  J.  Fiebiger 
and  Bang. 


Dr.  O'Donovan  illustrates  the  lesions  of  the 
three  cases  he  describes.  All  tlie  men  were  en- 
gaged in  manii)ulating  the  crude  anthracene 
"cake"  brought  to  the  factory.  It  was  un- 
loaded by  hand  and  broken  down,  and  when 
further  purified  formed  an  intermediate  prod- 
uct in  the  making  of  alizarin  dye. 

Case  1. — Aged  62.  During  the  last  five 
years  he  had  been  employed  in  unloading  boxes 
and  sacks  containing  the  raw  "cake."  His  face 
was  deeply  bronzed,  the  forearms  brown,  but 
the  covered  skin  was  white.  On  the  forearms 
were  many  small  telangiectases  and  follicular 


188 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


keratoses.  The  back  of  the  right  wrist  showed  a 
raised  flat  ulcerating  tumor  which  started  as  a 
small  wart  six  months  previously.  The  growth 
was  removed. 

Case  "2. — The  second  man,  aged  53,  had 
worked  for  thirty  years  in  the  factory  at  grind- 
ing and  loading,  and  he  also  looked  after  the 
centrifuges  in  which  the  anthracene  cake  was 
whizzed.  During  the  last  three  months  he 
noticed  a  pimple  on  the  center  of  the  right 
cheek,  which  rapidly  grew  in  size,  forming  a 
button-like,  raised  growth  the  size  of  a  half 
penny.  It  entirely  disappeared  under  treat- 
ment by  radium. 

Case  3.  —  The  third  man,  aged  59,  had  been 
a  foreman  for  twenty  years  in  the  purifying 
room.  He  had  noticed  an  ulcer  above  the  right 
wrist  joint  for  four  years.  It  had  enlarged 
more  rapidly  during  the  last  six  months,  and 
when  examined  was  3  inches  by  2  inches,  with  a 
hard,  rolled,  raised  border.  There  were  no  en- 
larged regional  glands.  The  ulcer  was  excised 
and  the  wound  skin  grafted. 

Each  of  these  growths  proved  to  be  micro- 
scopically a  squamous  and  horny-celled  cancer. 
At  the  factory  there  was  no  recollection  of  any 
previous  cases  of  persons  employed  in  this  in- 
dustry needing  liospital  treatment  for  similar 
lesions.  Three  cases  of  carcinoma,  occurring  in 
four  months  in  a  plant  employing  about 
twenty-five  men.  Dr.  O'Donovan  considers  "a 
heavy  incidence  of  a  grave  industrial  disease." 
He  concludes  as  follows: 

"Elderly  anthracene  workers  are  liable  to 
carcinomata  of  the  skin  similar  to  those  found 
in  sweeps,  tar,  creosote  and  parafBn  workers. 

"These  growths  are  squamous  and  horny- 
celled  carcinomata;  metastases  have  not  been 
found. 

"Unlike  tar  cases  a  multiplicity  of  growths 
in  any  one  patient  was  not  met  with.  Four 
years  was  the  longest  and  three  months  the 
shortest  duration  of  the  growths. 

"Minor  lesions,  acne,  keratoses,  telangiec- 
tases and  pigmentation,  are  common  features 
in  workers  in  the  plant. 

"A  plant  may  run  for  35  years  before  a  car- 
cinoma case  develops. 

"The  handling  of  purified  anthracene  does 
not  appear  to  hav-e  the  industrial  hazard  attrib- 
uted to  the  handling  of  anthracene  cake."  — 
R.  Prosser  White. 

Dermatitis  Caused  by  Bitter  Orange. 
F.  Anderson  Murray.    Brit.  Med.  Jour.,  May 


21,  1921,  No.  3151,  739. —  "Occupational 
dermatitis  due  to  the  handling  of  certain 
flowers  and  plants  is  well  known,  but  cases  are 
not  very  common,  so  that  they  may  be  rather 
difficult  to  recognize.  In  Sequeira's  Diseases  of 
the  Skin  is  given  a  list  of  over  forty  plants 
which  are  known  to  have  caused  dermatitis. 
Among  them  is  the  bitter  orange,  and  several 
cases  of  this  form  of  dermatitis  recently  came 
under  my  notice  among  girls  engaged  in  peeling 
bitter  oranges  in  a  jam  factory. 

"The  most  marked  case  was  that  of  a  girl, 
aged  25,  who  suffered  from  a  very  acute  derma- 
titis of  the  fingers,  hands,  and  forearms,  and 
also  of  the  face.  There  was  intense  erythema 
and  much  swelling,  especially  of  the  hands  and 
forearms,  the  parts  most  exposed  to  the  juice. 
There  were  numerous  small  vesicles,  a  little 
larger  than  the  size  of  a  pin-head,  all  over  the 
affected  areas.  I  put  the  patient  to  bed  for  one 
week  and  applied  a  lotion  of  zinc  carbonate, 
pulverized  calamine  and  aqua  calcis,  which 
proved  ^'ery  effective,  the  inflammation  en- 
tirely disappearing  after  ten  days.  Idiosyn- 
crasy evidently  plaj^s  a  considerable  part  in  the 
condition,  as  in  spite  of  all  precautions  the 
girl  in  question  had  ultimately  to  give  up  the 
work."  —  M.  C.  Shorley. 

Radiltim  Treatment  of  Roentgen  Derma- 
titis. J.  Bergonie.  Abstracted  as  follows  from 
Medecine,  June,  1921,  2,  No.  9,  675,  in  Jour. 
Am.  Med.  Assn.,  July  30,  1921,  77,  No.  5,  409. 
—  "Bergonie  relates  that  he  has  recently  ex- 
amined three  roentgenologists  who  have  had 
professional  radiodermatitis  benefited  by  appli- 
cation of  radium.  One  of  these  physicians  has 
had  one  finger  amputated  and  amputation  of 
another  finger  of  the  right  hand  was  being  con- 
sidered. Another  has  already  had  four  opera- 
tions on  the  hands;  the  general  condition  was 
bad  and  the  pains  at  times  unbearable.  Under 
exposure  to  radium,  one  of  the  physicians  seems 
completely  cured,  all  symptoms  having  sub- 
sided. The  contemplated  operation  on  the 
second  has  been  abandoned;  there  is  no  more 
pain,  and  the  stiff  joints  have  become  supple. 
The  condition  has  been  notably  improved  in 
the  third;  there  is  now  scarcely  any  pain.  The 
curietherapy  has  thus  proved  its  efficacy  for 
these  roentgen  lesions  except  the  deep  eschars 
involving  the  bone,  with  inadequate  circulation 
and  loss  of  muscle  tissue.  It  seems  to  aggravate 
this  class  of  lesions  as  in  the  third  case  men- 
tioned.   Most  of  this  physician's  lesions  im- 


ABSTRACTS 


185) 


proved,  but  the  deep  eschars  seemed  to  be 
whipped  up  to  a  more  rapid  course."  —  C.  K. 
Drinker. 

Diseases  of  the  Ear  in  Railway  Em- 
ployees Working  at  a  High  Altitude.  A. 
Ciampolini.  Abstracted  as  follows  from  the 
Bollettino  delle  malattie  dell'  orecchio,  della 
gola  e  del  naso,  Vol.  34,  No.  9,  in  II  Lavoro, 
March  31,  1921,  11,  No.  11,  331-33,5.  —  The 
men  who  formed  the  subject  of  this  study  were 
employed  on  the  railway.s  crossinj;  the  Appcn- 
nines  between  Pistoia  and  Bologna  and  between 
Florence  and  Faenza.  The.se  men  are  expo.sed 
to  sudden  changes  of  temperature  and  of  air 
pressure.  The  author  found  affections  of  the 
ear  in  40  per  cent.,  the  affection  having  its 
origin  in  the  pharyngeal  cavity.    In  four  cases 


with  lesions  of  the  internal  ear  he  believed  that 
here  also  the  initial  stage  was  probably  a 
catarrhal  pharyngitis,  then  a  salpingitis  with 
extension  to  the  middle  ear  and  finally  to  the 
bones  of  the  labyrinth.  Fifteen  of  the  men  had 
had  a  marked  reduction  of  hearing;  so  much  so 
that  they  were  obliged  to  give  up  their  work. 
The  age  of  two-thirds  of  the  men  wa.s  between 
40  and  50  years,  and  they  had  worked  on  the 
railways  from  twenty  to  thirty  years.  The 
other  third  were  under  40  years  and  had  worked 
from  six  to  twenty  years.  In  addition  to  the 
variations  in  temperature  and  pressure,  other 
di.sadvantages  on  these  lines  consist  in  an  in- 
crease in  the  noise,  which  is  also  of  a  higher 
pitch,  because  of  the  high  pressure  engines 
used,  and  because  of  the  frequency  of  tunnels. 
—  Alice  Hamilton. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Do  Safety  Drives  Pay?  K.  P.  Rabcock. 
Nat.  Safety  News,  Sept.,  1921,  4,  No.  3,  32-33. 
—  The  two  weeks'  safety  drive  of  the  Gilbert 
and  Barker  Manufacturing  r()ini)aiiy,  an  out- 
line of  which  is  given  in  this  article,  was  a 
powerful  stimulant  for  accident  prevention 
among  the  employees,  and  resulted  in  many  un- 
expected discoveries  which  led  to  the  replacing 
or  repairing  of  a  number  of  machines  and  tools. 
During  the  drive,  the  .safety  conunittee  re- 
ceived 153  safety  recommendations  independ- 
ent of  those  made  by  the  workman's  safety 
committees,  only  three  of  which  were  con- 
sidered ini]iracticablc.  The  ('oin])any  ascril)es 
much  of  the  success  attained  in  its  safety  drive 
to  the  following  practices: 

"(o)  Educate  the  employees  thoroughly  in 
the  work  through  constant  personal  contact 
and  demonstrations  of  actual  results  froTii  im- 
proper acts.  .  .  . 

"  (h)  Do  not  waste  time  and  money  on 
safety  drives  and  other  expensive  i)ublicity 
until  the  employees  are  fully  conversant  with 
what  you  are  attempting  to  do  and  show  a  will- 
ingness to  co-operate  with  you. 

"  (c)  Get  down  to  brass  tacks  on  each  sub- 
ject you  attack  and  stay  there  until  it  is  prop- 
erly rounded  out. 

"  (d)  Make  each  endeavor  count  from  its  own 
weight;  that  is,  make  one  injury  prevent  an- 
other, both  to  the  injured  and  others.  Build 
guards  so  they  will  be  attractive,  effective  antl 
in  no  way  an  obstruction  to  millwTights,  belt- 
men  or  machine  operators.  .  .  . 


"  {e)  Do  not  hurry,  worry,  or  get  angry.  .  .  . 
Make  each  employee  feel  you  are  a  real  fellow; 
one  whom  they  can  tell  their  troubles  to  and 
receive  help  from.  Treat  all  confidences  se- 
riously and  sympathetically  when  necessary. 

"  (/)  Keep  the  management  perfectly  in- 
formed concerning  the  progress  of  the  work.  .  .  . 

"(.</)  Whenever  possible  order  machines  al- 
ready c(|Mipi)ed  with  guards. 

"(/()  Build  guards  as  a  part  of  the  machine. 
.  .  .  Never  neglect  to  get  the  machine  operator 
to  tell  you  how  he  thinks  the  guards  .should  be 
iiuill.  .  .  .  Through  this  course  an  cmijloyee 
thinks  more  of  the  guard  and  will  not  only  use  it 
constantly,  but  will  maintain  it.  He  will  also 
feel  proud  of  its  construction,  and  boast  of  its 
\-alue,  which  greatly  aids  the  work  of  machine 
guarding."  —  M.  C.  Shorley. 

Safety  Work  of  the  Federal  Govern- 
ment. Edward  B.  Rosa  and  Charles  E.  Oakes. 
Safety  Engin..  July,  1921,  42,  No.  1,  10-14.  — 
This  is  a  brief  history  of  the  work  of  the  federal 
government  in  scientific  and  industrial  research 
to  develop  apparatus,  methods  and  processes 
usable  in  industry,  which  will  result  in  the  in- 
creased health  and  safety  of  the  nation. 

Bureau  of  Mines.  —  "Some  of  the  earliest 
work  of  this  bureau  was  concerned  with  the 
determination  of  the  effect  of  carbon  monoxide 
on  men.  Leading  uj)  to  the  development  of  the 
Gibbs  mine-rescue  ai)paratus,  considerable  re- 
search work  was  done  on  the  effect  of  various 
percentages  of  carbon  dioxide  and  of  a  de- 


190 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ficiency  of  oxygen  on  the  human  system.  Sim- 
ilar work  with  poisonous  gases  was  necessary  in 
developing  commercial  and  army  gas  masks. 
Other  research  work  involving  gases  was  the 
determination  of  limits  of  explosive  mixtures  of 
methane,  gasoline  vapors,  and  acetylene  in  air; 
the  volume  and  composition  of  exhaust  gases  of 
gasoline  mine  locomotives  and  of  automobiles 
and  trucks;  and  the  development  of  portable 
instruments  for  the  determination  of  carbon 
monoxide,  carbon  dioxide  and  oxygen  in  mine 
air.  .  .  .  Complete  sets  of  rules  and  regula- 
tions for  metal  mines,  and  for  the  use  of  electric- 
ity in  bitiuninous  coal  mines,  have  been  drawn 
up,  and  both  have  been  used  as  the  basis  of 
state  laws  relative  to  these  subjects." 

Public  Health  Service.  —  "  The  Public  Health 
Service  has  conducted  and  is  now  conducting 
extensive  researches  in  the  field  of  sanitation 
and  health  insofar  as  it  concerns  industry,  in- 
cluding the  efficiency  of  ventilating  systems, 
air  conditions,  dermatic  hazards  from  oil  and 
other  materials  used  in  the  operation  of  ma- 
chinery, lead  poisoning  in  the  pottery  industry,' 
hygienic  practices  in  foundries,  and  industrial 
fatigue." 

Iniersiaic  Commerce  Commission.  — This  or- 
ganization requires  carriers  to  report  any  acci- 
dent resulting  in  death  on  or  about  engines, 
trains,  or  cars,  a  small  percentage  of  which  are 
investigated  by  the  Bureau  of  Safety.  The 
Commission  also  makes  periodic  inspections  of 
locomotives  and  can  order  out  of  service  any 
foinid  defective. 

Bureau  of  Standards.  —  In  a  great  many 
cases  the  researches  of  the  Bureau  of  Standards 
have  led  to  improvements  in  design  and  prac- 
tice for  the  express  purpose  of  preventing 
accidents. 

"An  investigation  of  methods  and  apjjaratus 
for  using  the  magnetic  properties  of  materials 
as  an  indication  of  the  quality  and  mechanical 
properties  has  been  under  way  for  several 
years.  .  .  .  Other  researches  toward  the  stand- 
ardization of  safety  practices,  which  may  be 
cited  as  examples,  are:  an  investigation  of 
glasses  for  protecting  the  eyes  from  injurious 
radiation  encoimtered  in  industrial  ])ursuits, 
such  as  arc  welding,  .  .  .  tests  on  the  fire- 
resistive  properties  of  structural  materials,  and 
an  investigation  of  the  effectiveness  of  elevator 
interlocks." 

Bureau  of  Labor  Stati.itics.  —  This  bureau  has 
collected  and  published  labor  laws  "for  the  in- 
formation of  manufacturers  and  the  public," 


and  has  given  "considerable  attention  to  the 
standardization  of  accident  reports." 

The  authors  conclude  with  an  account  of  the 
hearty  co-operation  that  exists  between  gov- 
ernment bureaus,  state  authorities,  technical 
societies,  and  manufacturers'  organizations;  of 
the  exjjenditures  of  the  federal  and  state  gov- 
ernments "for  accident  prevention  and  sanita- 
tion work  in  all  industries  of  the  country;"  and 
of  the  efforts  to  standardize  the  work.  —  M. 
Dent. 

Why  Should  We  Not  Prevent  Accidents. 
S.  Dana  Hubbard.  Safety  Engin.,  July,  1921, 
42,  No.  1,  24-26.  —  Accident  statistics,  such  as 
that  in  the  United  States  35,000  workers  are 
killed  and  2,000,000  injured  annually  through 
accidents,  are  reviewed,  and  a  plea  is  made  for 
more  care,  ceaseless  propaganda,  and  untiring 
efforts  to  reduce  these  frightful  figures.  Dr. 
Hubbard  classifies  the  causes  of  accidents  into 
the  iiuman  element  in  industry,  the  mechanical 
or  physical,  and  the  conditions  of  environment. 
Ninety  per  cent,  of  all  accidents  are  caused  by 
the  human  element,  and  it  is,  therefore,  for  that 
element  that  propaganda  should  be  used.  But 
in  keeping  machinery  safe  and  efficient,  and  in 
having  the  factory  as  far  as  possible  an  ideal 
place  to  work  in,  the  human  element  will  not 
play  so  important  a  part  as  hitherto. 

There  are  social  reasons  of  pure  humanita- 
rianism  which  demand  accident  safeguarding, 
and  economic  reasons  of  the  effect  on  the  morale 
of  workers  when  an  accident  occurs  and  of  the 
monetary  loss  .when  a  trained  man  is  injured 
and  must  be  replaced  by  an  unskilled  work- 
man. —  M.  Dent. 

Safety  Where  the  Bessemer  Blows. 
Louis  Resnick.  Nat.  Safety  News,  Aug.,  1921, 
4,  No.  2,  3-8.  —  This  is  an  enthusiastic  account 
of  the  very  real  work  done  by  the  United  States 
Steel  Corporation  and  its  subsidiary  com- 
panies. The  United  States  SteeL  Corporation 
was  a  pioneer  in  safety  and  is  still  one  of  the 
most  efficient  examples  of  careful  safety  work. 
Its  policy  is  "first,  to  lock  the  stable  before  the 
horse  is  stolen;  second,  tliat  there  is  real  safety 
discipline  in  the  steel  corjxirat ion's  properties; 
third,  that  the  cost  of  any  accident  prevention 
device  or  activity  is  the  last  thing  to  be  con- 
sidereti,  if  it  is  considered  at  all.  .  .  ." 

A  brief  outline  of  its  jiolicy  is  as  follows: 
"the  steel  corporation  has  a  general  plan  of 
safety    organization    for    its    subsidiary    com- 


ABSTRACTS 


191 


panies,  and  the  companies  hav-e  a  general  plan 
for  their  respective  plants;  but  each  company 
and  each  plant  is  allowed  to  work  out  its  own 
detail  safety  problems  in  its  own  way,  and  in 
much  the  same  manner  every  superintendent 
and  every  foreman  is  given  free  rein  in  safety 
work  so  long  as  he  gets  results.  The  safety 
bureau  of  each  company  acts  as  a  clearing 
house  of  information  for  its  constituent  plants, 
and  the  bureau  of  safety,  sanitation  and  wel- 
fare of  the  corjxjration  is  the  clearing  house  for 
the  entire  family  of  the  subsidiary  companies 
operating  several  hundred  plants  and  emploj'- 
ing  a  quarter  million  men  and  women."  — • 
M.  C.  Shorley. 

The  Group  "Poisonous  Substances  and 
Gases"  in  the  Accident  Statistics  of  the 
Trades  Unions.  Rheirifel.i.  Zentralbl.  f. 
Gewerbehyg.,  June,  1921,  9,  No.  (i,  115-118.  — 
A  discussion  of  the  proper  definition  of  the  term 
poison  and  the  classification  of  accidents  more 
accurately  as  to  cause.  —  E.  L.  Se%Tinghaus. 

Engineering  Revision  —  The  Engineer's 
Part  in  Safety.  C.  P.  Tolman.  Nat.  Safety 
News,  July,  1921,  4,  No.  1,  10-12.  —Mr.  Tol- 
man states  that  an  annual  waste  of  a  billion 
dollars  a  year  occurs  from  industrial  accidents. 
In  his  article  he  suggests  safety  methods  for 
better  lighting  and  guarding  of  machinery,  and 
for  better  ventilation  of  buildings.  The  em- 
ployee who  is  interested  in  his  work  takes 
chances  in  order  to  hurry  that  work  up  and 
produce  his  finished  article.  The  safety  en- 
gineer should  "make  it  easiest  and  most  effec- 
tive" for  him  to  do  his  job  in  the  right  way  and 
thus  eliminate  needless  risks.  Statistics  are 
given  as  to  the  money  returns  on  various  guards 
for  presses  and  saws  which  result  from  the  pos- 
sibility of  speeding  up  production  without 
risk.  —  M.  Dent. 

Industrial  Accident  Frequency  in  Wis- 
consin, 191.5  TO  1920.  A.  J.  Altmeijer.  U.  S. 
Bur.  Labor  Statis.,  Month.  Labor  Rev.,  June, 
1921,  12,  No.  6,  1117-1121.  — "Most  states 
which  have  workmen's  copipensation  laws  col- 
lect statistics  on  industrial  accidents,  but  no 
state  calculates  accident  frequency  rates  or 
accident  severity  rates  for  the  state  as  a  whole, 
to  say  nothing  about  the  various  industries.  It 
would  be  of  great  value  if  this  could  be  done, 
since  it  would  place  safety  work  on  a  more 
scientific  basis."  —  R.  B.  Grain. 


Statistical  Study*  of  Electric.vl  Acci- 
dents. Hans  Jaeger.  Zentralbl.  f.  GeWer- 
behyg.,  Aug.,  1921,  9,  No.  8,  153-168.  —  Swiss 
statistics  for  the  period  1904-1920  are  analyzed 
and  discussed  at  length.  Nine  hundred  and 
sixty-nine  cases  of  electrical  accidents  are  re- 
ported. The  annual  number  is  increasing,  but 
there  is  a  decrease  relative  to  the  increasing 
extent  of  electric  installations.  Increasing  use 
of  safety  devices,  official  supervision,  and  edu- 
cation are  held  responsible  for  the  improve- 
ment. The  excessive  accident  rate  in  the 
summer  months  is  attributed  to  the  greater 
perspiration  and  greater  fatigue,  with  careless- 
ness following. 

Railway  accidents  are  one-fifth  of  the  total, 
the  other  four-fifths  are  industrial.  The  in- 
crcca.se  is  in  this  latter  group.  The  immber  of 
accidents  among  the  unskilled  group  of  work- 
ers indicates  that  training  and  warning  must  be 
made  very  general  to  be  effective.  High  and  low 
tension  lines  are  both  extremely  dangerous,  with 
high  mortality  for  accidents  where  more  than 
100- volt  lines  are  involved. — E.  L.  Sevringhaus. 

Protection  and  the  Eye.  Safety  Engin., 
July,  1921,  42,  No.  1,  42-44.-1.  Chipping, 
calking,  and  hot  riveting  require  goggles  with 
rigid  non-adjustable  bridge  or  adjustable  metal- 
lic bridge,  side  shields,  and  lens  able  to  with- 
stand a  blow  from  a  "sjiherical  steel  ball 
weighing  at  least  one-half  ounce  and  dropped 
from  a  height  of  21  inches  at  least  ten  times" 
onto  the  surface  of  the  lens. 

2.  For  scaling  and  grinding  of  metals,  stone 
dressing  and  sand  paper  or  emery  cloth  wood 
tlressing,  any  sort  of  goggles  may  be  worn  but 
goggles  with  side  shields  are  advisable,  and  the 
lens  should  be  able  to  withstand  a  blow  such  as 
flying  chips  from  an  emery  wheel  would  give. 

3.  "Babbitting,  casting  of  hot  metal,  and 
dipping  in  hot  metals  require  protection  from 
splashing  and  small  explosions  caused  by  hot 
metal  coming  in  contact  with  steam.  Goggles 
of  any  style  may  be  used  depending  upon  the 
particular  hazard." 

4.  When  handling  acids  and  caustics  eye- 
cup  goggles,  hoods,  and  face  masks  will  j)revent 
the  fumes  and  liquids  from  entering  the  eyes. 

5.  For  sandblasting,  a  hood  which  will  en- 
tirely cover  the  head  and  reach  below  the  neck 
is  necessary. 

6.  For  furnace  work  and  heat  treatment 
goggles  with  tinted  lenses  should  be  worn  as  a 
protection  against  glare. 


192 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


7.  In  oxyacetylene  welding  and  furnace  work 
the  eyes  must  be  protected  from  harmful  light 
rays,  heat  and  flying  particles.  "The  lens  of 
the  goggle,  shield,  helmet  or  face  mask  used  has 
been  fairly  well  standardized  among  manufac- 
turers, and  any  reputable  goggle  manufacturer 
can  fiu-nish  the  proper  lens,  knowing  the  con- 
ditions under  which  it  is  to  be  used." 

8.  In  electric  arc  welding  the  radiation  is  so 
intense  that  serious  burning  of  the  skin  as  well 
as  injuries  to  the  eye  may  result.  Helmet  and 
shield  are  recommended. 

9.  A  light-weight  goggle  without  side  shields 
is  all  that  is  necessary  for  machining  of  hard 
or  brittle  metals.  —  M.  Dent. 

The  Rel.\tive  Safety  of  Brass,  Copper, 
AND  Steel  Gauzes  in  Mixers'  Fl-^me  Safety- 
Lamps.  L.  C.  Ilsley  and  A.  B.  Hooker.  U.  S. 
Bur.  Mines,  Tech.  Paper  228,  1921,  pp.  39.  — 
The  following  conclusions  are  reached:  "The 
behavior  of  the  different  gauze  fabrics  has  in  a 
general  way  checked  the  results  obtained  by 
Belgian  investigators.  When  the  differences  in 
the  materials  tested,  together  with  possible  dif- 
ferences in  the  test  conditions,  are  considered, 
it  is  remarkable  that  the  results  in  many  tests 
follow  so  closely  the  conclusions  of  investiga- 
tors abroad. 

"For  conditions  of  high  temperatiu"e,  steel 
proved  superior  to  either  brass  or  copper.  For 
low  temperatiu-es,  the  advantage  of  steel  over 
brass  or  copper  is  little.  Brass  or  copper  might 
be  preferred  by  some,  although  one  who  knows 
the  insecurity  of  such  gauzes  at  high  tempera- 
ture might  be  unwilling  to  trust  them,  even 
though  the  probability  of  high  temperatures 
was  remote. 

"Brass  proved  more  satisfactory  than  cop- 
per, but  the  brass  gauzes  tested  had  a  high 
proportion  of  copper  and  therefore  may  have 
given  much  better  results  than  would  have  been 
obtained  with  some  other  brass. 

"In  conducting  the  tests  of  the  gauze  fabrics 
imder  various  possible  conditions  of  service 
certain  points  were  brought  out  forcibly.  The 
least  safe  of  all  the  lamps  tested  is  the  single- 
gauze  unbonneted  lamp  of  the  Davy  type.  In 
fact,  compared  with  a  bonneted  lamp  of  modern 
design  it  should  not  be  classified  as  a  safety 
lamp.  The  condemnation  of  the  Da\-y  lamp  as 
a  safety  device  for  present-day  conditions  does 
not  belittle  the  great  work  done  by  Davy,  for 
almost  every  modern  lamp  uses  principles  he 
advocated. 


"The  double-gauze  unbonneted  lamp  is 
somewhat  safer  than  a  single-gauze  lamp,  but  is 
not  dependable  in  high-\'elocity  air  mixtures. 

"The  single-gauze  bonneted  lamp  proved 
safer  than  either  type  of  unbonneted  lamp;  the 
omission  of  a  gauze  is  more  than  offset  by  the 
bonnet. 

"The  safest  lamp  tested  was  the  double- 
gauze  bonneted  lamp,  which  has  the  protective 
features  of  the  single-gauze  bonneted  lamp  and 
the  added  safety  of  another  gauze  in  case  either 
gauze  of  a  pair  shoidd  become  damaged.  In 
this  investigation  the  Hailwood  combustion- 
tube  lamp  was  not  tested,  but  previous  tests  by 
the  bureau  have  shown  it  to  be  as  safe  as  a 
double-gauze  bonneted  lamp  of  the  Koehler 
type. 

"The  chief  object  of  the  investigation  was  to 
determine  whether  the  gauze  specifications  of 
Schedule  7  needed  revision.  The  results  indi- 
cate that  present  specifications,  though  perhaps 
not  detailed  enough  rest  on  a  sound  founda- 
tion, and  that  a  lamp  meeting  these  require- 
ments would  have  a  high  standard  of  safety. 
It  may  later  be  deemed  best  to  permit  the  use  of 
brass  gauze  in  bonneted  lamps,  but  until  the 
subject  is  investigated  further  the  schedule 
should  not  be  changed  in  that  respect.  A  re- 
quirement that  only  bonneted  lamps  be  ad- 
mitted as  permissible  for  use  in  gaseous  mines 
could  well  be  added  as  a  step  toward  greater 
safety. 

"The  posjiibility  of  using  monel  metal  or 
nickel  for  flame-lamp  gauze  has  been  suggested, 
as  these  materials  have  a  higher  melting  point 
than  steel,  have  about  the  same  heat  conduc- 
tivity, and  resist  oxidation  at  atmospheric  and 
at  high  temperatures.  These  materials  should 
be  investigated."  —  M.  Dent. 

Gas  Mask  for  Carbon  Monoxide  Per- 
fected. Safety  Engin.,  July,  1921,  42,  No.  1, 
51-52.  —  A  public  demonstration  of  the  gas 
mask  for  protection  against  carbon  monoxide, 
manufactured  by  the  Mines  Safety  Appliances 
Company,  Pittsburgh,  and  in  which  is  used  the 
chemical  mixture  Hopcalite,  developed  by  the 
U.  S.  Bureau  of  Mines  and  Chemical  Warfare 
Service,  U.  S.  -Vrmy,  was  given  May  2(i  in  the 
special  smoke  room  of  the  U.  S.  Bureau  of 
Mines,  Pittsl)iirgh.  In  this  test  two  men  en- 
tered the  smoke  room,  which  contained  I  per 
cent,  of  carl)()n  monoxide  gas  in  the  air.  One  of 
the  men  carried  a  canary  bird  into  the  room  to 
indicate  to  the  observers  the  poisonous  nature 


ABSTRACTS 


193 


of  the  atmosphere.  The  canary  bird  collapsed 
in  forty-five  seconds  and  was  removed.  The 
wearers  of  the  masks  remained  in  the  atmos- 
phere for  thirty  minutes  doing  vigorous  work 
part  of  the  time,  and  experienced  no  ill  effects 
what.soever  from  the  poisonous  carbon  mon- 
oxide gas.  —  R.  M.  Thomson. 

ExpLO.sioNS  IN  Air  Compressors.  Safety 
Engin.,  June,  19'21,  41,  No.  6,  285.  —  The 
elimination  of  heat  geiicratod  in  air  compressors 
is  largely  accom])lislied  l)y  lubrication  and 
water  cooling  jackets.  The  danger  from  inter- 
nal explosions  are:  (1)  oil  vapor;  {'-2)  car- 
bonized lubricating  oil,  which  deposits  and 
prevents  vah'es  from  closing. 

Carlion  accumulation  may  be  lessened  by 
selecting  i)roper  oil,  the  feeding  of  oil  being 
kept  down  to  a  minimum  for  safety;  and  by 
thoroughly  cleaning  the  compressor  ap|)aratus 
by  disconnecting  the  oil  and  feeding  .soapy 
water  or  lye  solution  for  a  time.  Xo  inflam- 
mables should  be  used  in  cleaning.  —  R.  M. 
Thomson. 

ACETYLENK         GeNER.\TOR         PRECAUTIONS. 

Safety  Engin.,  June.  lOST,  41,  No.  fi,  271.— 
This  brief  article  gives  an  account  of  an  ex])lo- 
sion  of  an  acetylene  generator  through  careless 
inspection  of  the  ecjuiijinent  before  charging.  — 
R.  M.  Thomson. 

Safe  Practices  on  Metal  Working  Ma- 
chinery. W.  Dean  Kccfer.  Nat.  Safety  News, 
Aug.,  Wil,  4,  No.  2,  13-14.  —The  guards  de- 
scribed in  this  article  can  all  be  made  in  the 
plant,  and  are  for  lathes,  turret  lathes,  auto- 
matic screw  machines,  drill  presses,  milling 
machines,  planers,  and  boring  mills. 

The  imjiortant  feature  of  safety  lathe  dogs 
is  the  elimination  of  the  protruding  set  screw, 
which  may  be  done  by  designing  the  dogs 
without  protruding  parts,  or  by  inserting  coun- 
tersunk set  screws.  The  best  practice  for 
overcoming  the  hazard  of  revolving  stocks  on 
turret  lathes  and  automatic  screw  machines  is 
to  install  "sections  of  piping  through  which  the 
bar  stock  is  fed  to  the  machine,"  and  which  can 
be  made  in  short  lengths,  so  that  they  will 
telescope  and  the  guard  can  be  shortened  as  the 
stock  is  used  up. 

To  guard  against  flying  chips,  a  shield 
should  be  used  on  lathes  and  shapers.  "A  satis- 
factory shield  for  a  lathe  may  be  cheaply  made' 
of  fine  wire  mesh.    Take  a  piece  of  mesh  about 


8  to  12  inches  square  and  cut  a  hole  through  it 
near  one  edge;  then  by  fitting  the  hole  over  tool 
post,  the  shield  may  be  bent  in  any  desired 
position  to  stop  chips."  On  milling  machines  a 
guard  should  be  provided  for  the  cutter  which 
is  a  frequent  cause  of  accident.  Openings  under 
planer  tables,  where  workmen  can  conxeniently 
throw  their  hammers,  wrenches,  etc.,  should 
never  be  left.  Sheet  iron  can  be  used  to  cover 
the  ojjcnings  between  the  planer  ways,  or  a 
solid  web  installed  between  the  ruiuvays. 

In  order  to  avoid  minor  accidents  which  fre- 
fiuently  occur  while  workmen  are  sharpening 
tools,  a  tool  room  should  be  installed  in  charge 
of  a  man  skilled  in  .shari)cniiig  machine  tools. 
Besides  the  lessening  of  injuries  there  will  be  a 
considerable  saving  in  tool  steel  which  inex- 
perienced workmen  often  overheat  and  ruin 
the  temper  of. 

Headers  who  arc  interested  in  a  more  de- 
tailed account  will  find  it  in  the  National  Safety 
(^juncil's  Pamphlet  on  Machine  Shoj)  Ma- 
chinery. —  M.  Dent. 

Safety  Standards  for  Trench  Construc- 
tion. John  R.  BroiimeU.  Nat.  Safety  News, 
Aug.,  1921,  4,  No.  2,  15-16.  —  California  is  the 
only  slate  which  has  definite  re(|uiremcnts  for 
safe  construction  of  trenches.  A  resume  of  its 
principal  points  is  as  follows: 

1.  "All  materials  used  for  sheeting  and 
sheet-piling  shall  be  in  good  condition,  and  all 
timbers  used  shall  be  .sound,  straight,  free  from 
cracks,  shakes  and  large  or  loose  knots,  and  of 
the  required  dimensions  throughout. 

2.  "  Where  running  material  is  encountered, 
the  sides  of  all  trenches  four  feet  or  more  in 
depth  shall  be  secured  I)y  the  use  of  sheet- 
piling  and  suitable  braces,  as  defined  in  these 
orders. 

3.  "Where  trench  is  between  four  feet  and 
seven  feet  in  depth,  wooden  sheet-piling  shall  be 
not  less  than  two  inches  in  thickness.  .  .  . 

4.  "The  sides  of  all  trenches  in  hard,  com- 
pact material  which  are  five  feet  or  more  in 
depth  and  over  eight  feet  in  length  shall  be 
securely  held  by  shoring  and  bracing.  .  .  . 

5.  "All  trenches  of  over  eight  feet  in  length 
and  five  feet  or  more  in  depth  in  hard,  compact 
material  shall  be  braced  at  intervals  not  ex- 
ceeding eight  feet  with  two  inch  by  six  inch 
planks,  or  heavier  material,  placed  vertically  in 
the  trench  opposite  each  other  against  the  walls. 
These  braces  shall,  if  possible,  extend  to  the 
bottom  of  the  trench.  ... 


194 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


6.  "The  braces  in  treiicHes  shall  be  sup- 
ported by  screw  jacks  or  by  timbers  placed  nor- 
mal to  both  braces,  eleated,  and  rigidly  screwed 
or  wedged. 

7.  "The  number  of  horizontal  strut  braces, 
either  screw  jacks  or  timbers,  required  for  each 
pair  of  vertical  braces  shall  be  determined  by 
the  number  of  zones  of  four  feet  each  into  which 
the  depth  of  trench  may  be  divided.  One  hori- 
zontal brace  shall  be  required  for  each  of  these 
zones.  .  .  . 

8.  "The  bracing  and  shoring  of  trenches 
must  be  carried  along  with  the  excavation.  .  .  . 

9.  "Stringers  shall  be  not  less  in  strength 
than  two  by  six  inch  clear  timber. 

10.  "Trenches  in  saturated,  filled  or  un- 
stable material  (not  running  material)  shall  be 
sheeted  to  an  extent  adequate  to  hold  the  ma- 
terial in  place.  .  .  . 

11.  "Excavated  material  shall  not  be  placed 
nearer  than  one  foot  to  the  edge  of  the  trench. 

12.  "All  trenches  five  feet  or  more  in  depth 
shall  be  supplied  with  at  least  one  ladder  for 
each  '•JOO  feet  in  length  or  fraction  thereof, 
which  ladder  shall  extend  from  the  bottom  of 
the  trench  to  at  least  two  feet  above  the  top." 
—  M.  Dent. 

Increasing  the  Safety  from  Accident 
AND  Fire  in  the  Wood  Working  Indus- 
tries. P.  M.  Grempe.  Zentralbl.  f.  Gewer- 
behyg.,  July,  1921,  9,  No.  7,  151-152.  —  Safety 
from  accident  and  fire  is  being  attained  in  many 
plants  by  the  use  of  lighting  circuits  operating 


at  12  to  20  volts,  the  current  being  derived 
from  special  transformers  connected  with  the 
higher  voltage  lines  and  specially  insulated 
against  short  circuits.  —  E.  L.  Sevringhaus. 

Safety  Devices  for  AuTO^L\TIc  Barrel 
Washers.  Behr.  Zentralbl.  f.  Gewerbehyg., 
June,  19*21,  9,  No.  6,  127-128. —  The  author 
gives  diagrams  and  a  description  of  moving 
apparatus  arranged  to  prevent  workmen  from 
getting  in  contact  with  the  moving  parts  of 
machinery  for  washing  barrels.  —  E.  L.  Sev- 
ringhaus. 

The  Question  of  the  Fall  of  Elevators, 
WITH  Special  Reference  to  Safety  Brakes. 
E.  Dorn.  Zentralbl.  f.  Gewerbehyg.,  July, 
1921,  9,  No.  7,  129-141.  —This  is  a  technical 
discussion  of  the  elements  of  danger  in  elevator 
construction,  with  special  reference  to  the  com- 
mon brake  devices.  Diagrams  and  explana- 
tions of  improved  braking  apparatus  are  in- 
cluded. —  E.  L.  Sevringhaus. 

Finger  Guard  for  Eccentric  Presses. 
M.  Eckstein.  Zentralbl.  f.  Gewerbehyg.,  June, 
1921,  9,  No.  6,  125-127. —  This  article  con- 
tains diagrams  and  description  of  the  construc- 
tion and  operation  of  a  guard  for  eccentric 
stamping  presses,  which  is  entirely  automatic  in 
action,  does  not  hinder  work,  and  which  stops 
the  press  if  anything  is  in  danger  of  injury 
from  the  action  of  the  press.  —  E.  L.  Se^Ting- 
haus. 


HAZARDS  OF  COMPRESSED  AIR,  DIMINISHED  PRESSURE,  GENERATION 
AND  USE  OF  ELECTRICITY,  AND  ELECTRICAL  WELDING 


Electrical  Hazards  and  their  Safe- 
guarding. H.  S.  Balliet.  Safety  Engin.,  June, 
1921,  41,  No.  6,  272-274.  —  This  paper  was  ab- 
stracted from  the  original  address  as  delivered 
by  the  American  Society  of  Safety  Engineers, 
so  as  to  contain  the  essential  safety  matter,  and 
deals  with  the  general  practices  of  the  New 
York  Central  Railroad  in  grounding  high  ten- 
sion lines  both  underground  and  overhead,  the 
safeguarding  of  employees  by  the  use  of  screens, 
etc.,  and  the  safeguarding  of  equipment  by  me- 
chanical devices.  The  work  of  transmission  de- 
partment and  signal  department  employees  is 
definitely  laid  out  as  to  what  is  required  of 
each  in  the  operation  and  maintenance  of  the 


equipment,  and  the  wearing  of  rubber  gloves 
and  the  using  of  other  protective  appliances  are 
insisted  upon.  —  R.  M.  Thomson. 

Safety  Features  on  High  Voltage  Trans- 
mission Lines.  C.  0.  von  Dannenherg.  Safety 
Engin.,  July,  1921,  42,  No.  1, 15-17.  —  This  is  a 
brief  review  of  certain  features  in  high  voltage 
electrical  installations,  to  which  it  is  believed 
particular  consideration  and  attention  .should 
be  given  in  order  to  obtain  a  maximum  degree 
of  protection  and  safety.  The  points  under 
consideration  are  referred  to  in  a  general  way: 
viz.,  line  structures;  line  disconnecting  switches; 
grounding;  telephone  equipment  for  high  ten- 


ABSTRACTS 


195 


sion  lines;  and  working  on  live  lines.  As  a  gen- 
eral rule  it  may  be  said  that  fewer  accidents  re- 
sult in  the  operation  of  high  voltage  than  in  low 
voltage  equipment.  This  statement  is  some- 
what misleading  for  the  following  rea|ons:  (1) 
The  number  of  persons  handling  high  voltage 
equipment  is  much  smaller,  as  low  voltage  is  in 


far  greater  use.  (2)  High  voltage  equipment  is 
much  less  accessible  and  is  usually  placed  out  of 
reach.  (3)  The  persons  handling  high  voltage 
equipment  are  usually  of  greater  intelligence. 
(4)  The  knowledge  that  a  high  voltage  exists 
tends  to  lead  to  greater  care  in  handling  equip- 
ment. —  R.  M.  Thomson. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


Work  .\nd  F.\tigue  in  the  Puekpekai. 
State.  Pericle  Carlini.  Abstracted  as  follows 
from  Annali  di  Ostetricia  e  Ginccologia,  1920, 
in  II  Lavoro,  April  SO,  1921,  11,  No.  12,  360- 
361.  —  The  author  used  the  dynamometer  and 
the  ergograph  of  Mos.so  to  determine  the  ca- 
pacity for  work  of  healthy  women  at  various 
periods  of  pregnancy.  He  concludes  that  the 
capacity  for  work  of  pregnant  women  begins  to 
diminish  in  the  sixth  month  and  decreases  in 
geometrical  progression  up  to  parturition,  after 
which  it  increases,  reaching  the  normal  toward 
the  end  of  the  third  month.  The  daily  record 
shows  a  slow  rise  of  output  reaching  its  niaxi- 


numi  during  the  third  hour,  being  sustained  for 
only  a  short  time,  while  the  midday  rest  is  not 
followed  by  a  second  rise  but  by  a  progressive 
fall.  Twenty-six  women  tested  with  the  ergo- 
grai)h  showed  a  diminution  of  mu.scular 
strength  from  the  second  or  third  month  of 
pregnancy,  a  retiu-n  to  almost  normal  limits 
from  the  fourth  to  the  sixth  months,  and  then 
a  decided  drop  lasting  through  the  first  month 
of  the  puerperium  with  a  return  to  normal 
limits  in  the  second  month  of  the  puerperium  in 
women  who  were  not  suckling  their  children, 
and  in  the  fifth  month  in  women  who  were 
suckling.  —  Alice  Hamilton. 


INDUSTRIAL  SANITATION:    FACTORY  CONSTRUCTION,  ILLUMINATION, 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEWAGE  DISPOSAL 


Labor  Camp  Sanitation  —  A  Basis  for 
Education  and  Citizenship.  R.  Justin  Miller. 
Am.  Jour.  Pub.  Health,  Aug.,  1921,  11,  No.  8, 
697-702.  —  This  article  describes  the  filthy 
conditions  prevalent  in  labor  camps  in  Cali- 
fornia prior  to  1913  when  the  first  Labor  Camp 
Sanitation  Act  was  passed  by  the  California 
legislature.  The  act,  a  model  of  simi)licity  and 
brevity,  requires  the  following: 

"1.  Bunkhouses  or  other  sleeping  quarters 
sufficient  to  protect  the  occupants  frona  the  ele- 
ments, kept  cleanly,  and  located  on  clean  and 
properly  situated  camp  grounds. 

"2.    Beds  or  bunks. 

"3.  Screened  and  otherwise  sanitary  dining 
quarters  and  rooms  for  storage  and  preparation 
of  food. 

"4.   Adequate  and  sanitary  toilet  facilities. 

"5.   Sanitary  facilities  for  garbage  disposal. 

"6.   Adequate  bathing  facilities. 

"  7.  Appointment  of  '  a  responsible  person  to 
assist  in  keeping  the  camp  clean.'  " 

The  inspection,  advisory,  and  educational 
work  of  the  Commission  of  Tmmigration  and 
Housing,  which  since  1915  has  had  full  control 


of  the  enforcement  of  the  act,  is  described.  As 
a  result  of  this  act  and  its  enforcement,  labor 
camps  in  California  have  proved  a  new  and  sub- 
stantial basis  for  citizenship  on  the  part  of  a 
class  heretofore  scarcely  considered  in  the  jjrob- 
lem  of  government.  With  camps  having  proper 
sanitation  the  lower  type  of  labor  and  the  agi- 
tator are  eliminated.  Camps  of  today  aid  the 
inspector  by  giving  notice  of  bad  sanitary  con- 
ditions. —  H.  F.  Smyth. 

A  Year's  Develop.ments  in  the  Science  op 
Industrial  Lighting.  Safety  Engin.,  Aug., 
1921,  42,  No.  2,  54-57.  —  An  outline  of  a  report 
presented  at  the  Forty-Fourth  Annual  Con- 
vention at  Chicago,  May  31-June  3,  1921,  by 
the  Lighting  Sales  Bureau  of  the  National  Elec- 
tric Light  Association.  A  few  figures  and  graphs 
support  the  reviewer's  claim  of  increased  pro- 
duction resulting  from  the  installation  of  mod- 
ern lighting  in  factories,  this  increase  being  due 
to  lower  accident  rate,  lessened  eye-fatigue, 
improved  health  and  morale,  lessening  of  super- 
vision and  labor  turnover,  and  reduction  of  unit 
cost.  — •  Philip  Drinker. 


196 


THE  JOURNAL  OP  INDUSTRIAL  HYGIENE 


Light  Much  Neglected  in  Efficiency 
Promotion.  S.  E.  Doane.  Nation's  Health, 
Aug.  15,  1921,  3,  No.  8,  440-442.  —  The  eye  is 
much  abused  in  industry,  in  part  because  its 
adaptations,  being  unconscious,  are  not  con- 
sidered, and  it  was  only  on  account  of  the  de- 
mands made  by  the  war  that  illuminating 
became  a  serious  problem  in  efficiency. 

Recent  statistics  of  insurance  companies  at- 
tribute 15  per  cent,  of  all  accidents  to  poor 
lighting,  and  to  the  same  cause  three  hundred 
and  fifty  millions  of  dollars  of  wastage  annually 
in  the  United  States  is  charged. 

There  are  sometimes  peculiar  and  unobserved 
effects  due  to  lighting,  as  in  the  case  of  a  drill, 
in  the  working  of  which  accidents  were  con- 
stantly occurring.    The  cause  was  traced  to  a 


slight  regular  reflection  of  light.  Sometimes  the 
effect  of  bad  light  may  be  very  pronounced,  and 
at  the  same  time  entirely  unperceived  by  the 
worker.  Glare  will  often  produce  a  mental  state 
unfavorakle  to  work.  All  lamps  should  be 
shielded  by  dift'using  glassware  or  other  med- 
ium. Color  quality  of  light,  its  direction  and  its 
uniformity  are  important  considerations. 

The  work  of  the  Illuminating  Engineering 
Society  is  mentioned,  and  the  transactions  of 
the  society  are  recommended  as  a  source  of  in- 
formation on  the  subject  of  lighting. 

The  article  contains  four  diagrams  showing 
effects  of  increase  of  intensitj'  of  light  on 
acuity,  speed  of  discrimination,  and  adjust- 
ment for  distances.  —  G.  E.  Partridge. 


INDUSTRIAL  PSYCHOLOGY  AND  INDUSTRIAL  MANAGEMENT 
IN  ITS  HEALTH  RELATIONS 


Has  Mental  Hygiene  a  Practical  Use  in 
Industry?  Boyd  Fisher.  Ment.  Hyg.,  July, 
1921,  5,  No.  3,  479-496.  —  This  rather  long  and 
discursive  paper  gives  a  good  review  of  the  sub- 
ject from  a  layman's  viewpoint,  with  certain 
humorous  criticisms  of  the  medical  point  of 
view  and  several  interesting  examples  of  good 
work  done  by  physicians  and  others  in  applying 
mental  hygiene  to  industry.  Mr.  Fisher  speaks 
as  an  employment  manager  reviewing  the 
question  of  the  practical  application  of  the 
principles  of  mental  hygiene  in  industry  and 
offers  the  following  suggestions : 

"First,  that  we  consider  for  the  present  only 
the  modern  medical  approach  to  the  subject; 
second,  that  we  strive  to  clear  up  misconcep- 
tion on  the  subject  of  mental  hygiene;  third, 
that  we  recognize  wherein  we  are  already  em- 
ploying mental  hygiene  in  industry;  and  finally, 
that  we  make  a  cautious  approach  toward  a 
more  scientific  and  technical  direction  of  the 
work  we  are  already  doing.  The  caution  is 
needed  not  only  because  we  lack  experience  to 
guide  us,  and  lack  even  an  adequate  body  of 
medical  specialists,  but  also,  especially,  because 
the  education  of  the  public  takes  time,  and 
prejudices  die  hard. 

"...  Obviously,  the  first  step  is  further  en- 
lightenment of  the  employment  managers  and 
physicians  already  doing  a  general  sort  of  men- 


tal-hygiene work  in  industry.  To  this  end  I 
suggest  conferences  of  such  workers  at  which 
papers  on  the  subject  are  read,  if  possible  by 
psychiatrists.  When  these  workers  are  in- 
formed, an  effort  should  be  made  to  clarify  the 
minds  of  general  executives  on  the  subject,  so 
that  any  later  steps  can  be  taken  with  proper 
assent.  Perhaps  it  will  then  be  possible  to 
make  a  mental-hygiene  survey  of  an  industry. 
Such  a  survey  would  be  a  study  of  both  the 
conditions  affecting  the  mental  attitude  of  the 
workers  and  an  examination  of  social  histories 
as  shown  on  the  records.  Only  rarely  would  in- 
dividual personal  examinations  be  necessary. 
These  would  be  conducted  so  as  not  to  indicate 
doul>t  of  the  employee's  sanity,  and  perhaps 
would  be  incidental  to  an  interview  brought 
about  ostensibly  for  some  other  purpose. 

"Such  a  survey  would  then  be  used  as  a 
basis  for  further  study  and  training  or  action  by 
the  regularly  employed  service  workers.  The 
professional  psychiatrist  would  need  to  come  in 
only  as  a  consultant  and  trainer  for  the  other 
personnel  workers.   .  .   . 

"With  all  due  cautions,  however,  and  with 
all  acknowledgements  to  the  present  state  of 
the  public  understanding  of  the  subject,  mental 
hygiene  has,  in  my  opinion,  a  real  and  impor- 
tant place  in  industry  and  offers  great  promise 
of  public  service."  — Stanley  Cobb. 


ABSTRACTS 


W, 


INDUSTRIAL  SER\^CE  AND  MUTUAL  BENEFIT  ASSOCIATIONS 


Promoting  the  Health  of  the  Employee  : 
How  THE  Bethlehem  Shipbuilding  Corpora- 
tion Provides  Good  Food,  Well  Served, 
FOR  ITS  Shipbuilders.  Calif.  State  Board  of 
Health,  Month.  Bull.,  July,  \iH\,  17,  No.  1,  10- 
18.  —  The  Bethlehem  Shii)buil(ling  Corpora- 
tion, in  order  to  do  away  with  the  insanitary 
eating  houses  which  formerly  crowded  aroiuid 
the  shipyards,  has  provided  cafeterias  for  its 
employees,  which  are  run  by  a  committee  of 


workmen,  and  at  which  the  food  is  served  at 
cost.  "The  management  is  greatly  pleased 
with  the  results.  Not  only  are  the  workmen  able 
to  do  better  work  when  they  secure  better  food 
but  there  has  developed  a  better  spirit  among 
the  shipworkers.  ...  It  is  not  purely  an 
altruistic  movement  for  it  has  been  found  that 
the  inauguration  of  this  service  brings  returns 
in  dollars  and  cents."  —  M.  Dent. 


INDUSTRIAL  HEALTH  LEGISLATION:    COURT  DECISIONS: 
WORKMEN'S  COMPENSATION  AND  INSURANCE 


New  York  State  Labor  Law  with  Amend- 
ments, Additions  and  Annotations  to  Au- 
gust 1,  W-21.  N.  Y.  State  Dejit.  Labor,  10-21, 
pp.  141. — This  pamphlet  contains  the  labor 
law  of  the  state  of  New  York,  recodified  and 
amended  by  the  legislature  of  VJi\,  and  "cer- 
tain section.s  of  the  penal  law  pertinent  thereto." 
—  M.  C.  Shorley. 

Labor  Agreement  Laws  and  Industrial 
Supervision.  Bender.  Zentralbl.  f.  Gewer- 
behyg.,  July,  19^21,  9,  No.  7.  149  151.  —This  is 
a  discussion  of  the  proposed  legislation  for  in- 
dustrial self-government,  in  which  scheme  the 
supervision  of  health,  child  labor,  women's 
work,  and  such  matters  would  be  done  by 
officials  responsible  to  employer  and  laborer, 
while  larger  public  interests  might  not  be  well 
conserved.  —  E.  L.  Sevriughaus. 

Provisional  Regulations  Regarding  Po- 
licing, Safety,  and  Health  in  the  Nitrate 
Plants.  Abstracted  as  follows  from  Caliche, 
1919,  Vol.  1,  241,  in  ChenL  Abstr.,  July  10, 
1921,  15,  No.  13,  2155. —  "Transcription  of 
presidential  decree  revising  ])()lice,  safety  and 
health  regulations  operative  in  the  nitrate 
works." 

The  Conflict  of  Jurisdiction  in  Compen- 
sation for  Maritime  Workers.  J.  P.  Cham- 
berlain. Am.  Labor  Legis.  Rev.,  June,  1921,  11, 
No.  2,  133-142.  —  The  position  of  the  sailor 
gives  rise  to  some  difScidt  problems  of  compen- 
sation. When  compensation  first  took  the 
place  of  damages,  it  was  assumed  by  the  state 
courts  that  the  state  rules  would  apjjly,  but  the 


states  could  not  make  compensation  the  sole 
remedy  for  maritime  accidents,  since  they 
could  not  deprive  maritime  workers  of  their 
right  to  bring  action  in  the  federal  courts. 

Decisions  of  courts  up  to  the  present  time 
have  not  cleared  up  the  difficulties,  since,  as  the 
matter  now  stands,  the  longshoreman  in  load- 
ing a  vessel  is  suliject  to  maritime  law  while  he 
is  on  the  siiip,  and  to  local  law  wiiile  he  is  on 
shore.  The  New  York  courts  have  held  that  a 
longshoreman  coidd  not  get  compensation  even 
if  tiie  accident  happened  on  the  dock,  if  he  was 
actually  engaged  in  loading  or  uidoading  a  ship, 
but  he  nuist  go  to  the  state  courts  and  sue  there 
under  the  state  law  of  torts.  The  result  was 
that  the  same  man,  doing  the  same  work,  for 
tlie  same  employer,  in  the  same  place,  was  sub- 
ject to  three  different  systems  of  law.  INIany 
industries  situated  near  shore  employ  men  in 
such  a  way  as  to  bring  them  under  all  three 
jurisdictions  and  are  obliged  therefore  to  carry 
three  kinds  of  insurance. 

A  federal  comi)ensation  act  for  seamen  is  the 
only  way  out  of  the  difficulty,  but  reason  also 
argues  strongly  for  the  adoption  of  legislation 
by  Congress  permitting  the  states  to  extend 
their  compensation  to  land  workers  if  employed 
occasionally  on  vessels.  —  G.  E.  Partridge. 

Legislative  Program  of  Accident  Com- 
pensation for  "Mariti.me"  Workers.  J.  B. 
Andrews.  Am.  Labor  Legis.  Rev.,  June,  1921, 
11,  No.  2,  152-153. — A  committee  of  the 
American  Association  for  Labor  Legislation 
reports  in  favor  of  extending  the  benefits  of 
compensation  to  longshoremen  and  ship-re- 
pairers.    Two  bills  have  been  drafted.     One 


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THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


tries  by  an  amendment  to  the  Federal  Judicial 
Code  to  reserve  to  the  local  workmen  rights 
under  existing  state  compensation  laws,  and 
the  second  bill  is  a  comprehensive  Federal 
Workmen's  Accident  Compensation  measure 
for  seamen  for  whom  there  is  needed  such  uni- 
formity of  treatment  as  can  be  secm-ed  only 
through  a  national  law.  The  principal  pro- 
visions of  the  bill  are  in  most  respects  identical 
with  those  of  the  Federal  Compensation  Act  for 
Civilian  Employees,  which  was  passfed  by  Con- 
gress in  1916.  —  G.  E.  Partridge. 

Proposed  Death  Benefit  Schedule  of 
California.  U.  S.  Bur.  Labor  Statis.,  Month. 
Labor  Rev.,  May,  1921,  12,  No.  5,  1056-1057. 
—  After  making  a  careful  study  of  674  families, 
involving  1,686  dependents,  receiving  compen- 
sation, the  California  Industrial  Accident  Com- 
mission has  submitted  to  the  legislature  a  new 
death  benefit  schedule  which  it  considers  ra- 
tional. The  present  workmen's  compensation 
law  provides  that  the  dependents  of  a  workman 
killed  in  industry  shall  receive  three  times  his 
average  annual  wages,  the  total  not  to  exceed 
$5,000  nor  to  be  less  than  .$1,000.  This  death 
benefit  was  found  to  be  just  sufficient  in  260  of 
the  674  cases  studied,  and  seriously  insufficient 
in  298  cases;  in  49  cases  it  was  impossible  to  tell 
"whether  the  compensation  would  last  long 
enough  to  meet  the  requirements,  and  in  67 
cases  only  was  the  compensation  more  than 
adequate." 

The  stud}^  revealed  that  such  insufficient 
compensation  results  in  a  marked  deterioration 
of  the  health  of  dependents,  a  lowered  standard 
of  living,  the  sjjlitting  up  of  families  when  the 
children  must  be  placed  in  orphanages  or  with 
relatives,  an  increase  of  children  leaving  school 
to  go  to  work,  and  of  homes  where  the  mother 
works  all  day  and  the  children  run  wild  upon 
the  streets. 

"Under  the  new  schedule  a  widow,  without 
children  and  without  any  incurable  disease, 
under  60  years  of  age  is  to  receive  40  per  cent, 
of  the  wages  of  her  deceased  husband  for  two 
years  and  also  may  be  given  such  aid  as  to 
education  and  industrial  training  as  will  enable 
her  to  become  self-supporting.  Because  of  the 
difficulty  of  any  woman  of  60  or  over  to  find 
remunerative  employment  and  of  the  improba- 
bility of  widows,  whose  average  age  is  37,  while 
supporting  themselves,  being  able  to  save 
enough  to  provide  for  the  time  after  they  are  60, 
it  is  proposed  that  all  widows  who  upon  attain- 


ing the  age  of  60  have  not  remarried  shall  be  en- 
titled to  a  life  pension  of  40  per  cent,  of  the 
wages  of  their  deceased  husbands.  A  widow 
with  an  incurable  disease  which  incapacitates 
her  from  earning  is  to  receive  40  per  cent,  of  the 
wages  of  her  husband  as  long  as  such  incapacity 
continues. 

"For  widows  with  children  the  new  schedule 
provides  that  the  widow  is  to  receive  for  herself 
40  per  cent,  of  the  earnings  of  her  husband,  to 
be  paid  until  two  years  after  her  youngest  child 
has  ceased  to  be  dependent,  provision  being 
made  for  a  life  pension  after  reaching  the  age  of 
60.  For  one  child  there  is  to  be  paid  her  15  per 
cent,  of  the  wages  of  her  husband  and  for  each 
additional  child  10  per  cent.,  with  a  maximum 
of  100  per  cent. 

"If  the  widow  remarries  the  payment  of  one 
year's  compensation  in  a  lump  sum  is  to  close 
her  case,  but  the  children's  compensation  will 
continue  until  they  severally  reach  the  age  of 
16.  .  .  . 

"To  meet  these  reasonable  needs  the  new 
schedule  provides  that  the  death  benefit  shall 
equal  four  times  the  average  annual  earnings  of 
the  deceased  employee,  to  be  paid  by  the  em- 
ployer or  insurance  carrier  for  each  employee 
killed,  whether  or  not  there  are  dependents. 
Security  of  the  payments  to  widows  and 
children  is  provided  through  the  creation  of  a 
special  trust  fund,  into  which  the  employer  or 
insurance  carrier  shall  pay  the  death  benefit,  in 
reasonable  installments.  This  fund  shall  be 
administered  by  the  state  compensation  insur- 
ance fund,  which  shall  pay  therefrom  the 
benefits  awarded  by  the  commission.  The  fund 
shall  be  invested  and  reinvested  as  other  funds 
of  the  state  compensation  insurance  fund  are, 
the  only  cost  to  be  the  reasonable  expense  of 
administration,  any  lapses  or  interest  to  go  into 
the  death  benefit  fund."  —  M.  Dent. 

Old  Age  Pensions  Legislation  in  France. 
Internat.  Labour  Rev.,  April,  1921,  2,  No.  1, 
67-88.  —  Workers'  and  peasants'  pensions  in 
France  date  from  1910,  but  the  original  legisla- 
tion relating  to  them  has  since  been  amended. 
The  act  has  reference  to  compulsory  insurance 
and  voluntary  insurance.  Compulsory  insur- 
ance applies  to  wage  earners  of  both  sexes,  but 
does  not  as  a  rule  include  state  employees. 
Every  insured  person  nmst  pay  an  annual 
amount,  deducted  from  his  earnings  by  the 
employer.  The  pensions  are  commonly  an- 
nuities.  In  1912  the  pension  age  was  fixed  at  60- 


ABSTRACTS 


19» 


years,  and  at  that  age  the  worker  becomes 
beneficiary  of  the  fund  accumulated  by  his  own 
savings,  the  contributions  of  employers  and  an 
additional  amount  of  100  francs  per  year  pro- 
vided by  the  government  under  certain  con- 
ditions, and  increased  if  the  insured  person  has 
brought  up  to  the  age  of  16  at  least  three  chil- 
dren. Persons  totally  or  permanently  incapac- 
itated may  have  anticipated  payment  of  their 
pensions.  The  survivors  of  an  insured  person  — 
under  certain  specified  conditions  —  receive 
stipends.  The  administration  of  insurance  is 
intrusted  to  the  National  Old  Age  Pensions 
Fund,  but  certain  private  organizations,  such 
as  mutual  aid  societies,  are  accepted. 

Voluntary  insurance  "is  especially  intended 
to  bring  within  the  scope  of  the  act  groups 
which  are  economically  independent,  but  which 
live  under  conditions  similar  to  those  under 
which  the  workers  live."  The.se  iiiclude  tenant 
farmers,  metayers,  independent  farmers,  arti- 
sans, small  employers  who  for  the  most  j>art 
work  alone,  and  other  classes  e.xemjjt  from 
compulsory  insurance.  All  these  have  the 
same  rights  as  those  compuLsorily  insured. 

In  the  administration  of  the  act  a  s|)ccial 
committee  in  each  commune,  comi)oscd  of  the 
mayor,  one  employer,  and  one  wage  earner, 
takes  an  important  part,  but  all  clainis  come 
before  the  magistrates,  and  are  dealt  with,  in 
ca.se  of  dispute,  in  conunon  law.  \'ari(ms  difli- 
culties  have  been  met  in  the  administration  of 
the  act,  and  it  is  especially  noticeable  that 
voluntary  insurance  has  been  taken  advantage' 
of  in  disproportionate  amount  by  persons  of 
advanced  age. 

The  working  of  the  act  has  not  been  in  the 
highest  degree  satisfactory,  evidence  of  which 
is  a  decrease  in  the  number  of  registrations,  and 
the  fact  that  in  1913  only  ■15,50(),()()0  of  the 
177,000,000  francs  expected  were  paid  in:  that 
is,  of  a  total  of  about  7,000,000  persons  liable  to 
compulsory  insurance,  less  than  3,000.000  com- 
plied with  the  regulations.  The  war  U])set  the 
working  of  the  plan,  but  there  are  other  factors 
affecting  its  satisfactory  operation.  The  report 
for  1917  to  1918,  for  example,  shows  that 
whereas  the  act  is  relatively  satisfactory  in  the 
eastern  industrial  districts,  where  .social  educa- 
tion is  more  advanced,  and  in  the  central 
agricultural  districts,  where  contributions  for 
volimtary  insurance  have  been  made  in  large 
numbers,  the  act  has  been  less  fully  complied 
with  in  the  western  agricultural  districts. 
Domestic  servants  (especially  women  servants) 


and  agricultural  workers  (especially  farm  serv- 
ants) have  not  kept  well  the  provisions  of  the 
law.  Opposition  on  the  part  of  employers  has 
added  to  the  difficulties  —  the  small  employer 
and  the  farmer  class  especially  disliking  the 
plan,  which  involves  additional  expense.  The 
opposition  is  often  covert,  and  the  employee 
fears  dismissal  if  he  attempts  to  fulfil  his  part. 

The  conclusion  nuist  be  made  tiiat  the 
Workers'  Old  Age  Pensions  Act  has  been  inade- 
quate. An  amendment  is  needed  to  make  effec- 
tive the  compulsory  nature  of  the  act.  It  is 
suggested  in  an  oflicial  report  that  employers 
should  be  penalized  for  failing  to  deduct  the 
worker's  contribution,  even  when  the  latter 
docs  not  present  his  card.  This,  however, 
would  remove  only  a  part  of  the  obstacles, 
since  cmi)loyees  thcm.selves  havelacked  interest. 
Statistics  of  the  mutual  aid  societies  confirm 
other  evidence  of  this.  As  regards  remedy,  "it 
would  seem  essential  considerably  to  raise  the 
amounts  of  the  benefits  and  to  require  much 
larger  contributions  on  the  part  of  the  bene- 
ficiaries, the  employers  and  the  state."  A  bill 
now  pending,  which  attem|)ts  a  transformation 
of  the  Workers'  and  Peasants'  Old  Age  Pen- 
sions A<'t  into  a  new  system  calcidated  to  be 
really  popular  with  the  working  classes  is 
wisely  projected. 

The  article  contains  eight  tables,  and,  be- 
sides the  matter  summarized,  other  data  some- 
what local  in  interest.  —  G.  E.  Partridge. 


Social  Insurance  Systems  in  Portugal. 
Abstracted  as  follows  from  bulletin  du  minis- 
tere  du  Travail,  1920,  Nos.  11  and  12,  in  II. 
Lavoro,  April  30,  1921,  11,  No.  12,  368-370.  — 
Compulsory  insurance  against  accidents,  sick- 
ness, invalidity,  and  old  age  was  required  in 
Portugal  by  a  measure  passed  in  May,  1919. 
The  administration  of  the  law  is  intrusted  to  a 
special  institute  which  supervises  the  work  of 
diflferent  insurance  societies  and  of  workmen's 
organizations.  This  institute  is  supported  by 
the  state  and  by  these  societies.  All  citizens 
between  the  ages  of  15  and  75  years  must  take 
out  insurance  against  sickness  in  some  mutual 
society.  Two  clas.ses  of  insured  are  recognized: 
the  first  Comprising  persons  with  an  income 
above  900  milreis*,  who  pay  a  monthly  sum 
of  from  50  to  300  reis  without  state  subsidy;  the 
second  consisting  of  persons  with  an  income 
less  than  this  who  receive  state  subsidy  and 
*  One  mUreis  =  1,000  reis  =  $1.07^ 


200 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


pay  from  50  down  to  30  reis  monthly.  At  the 
end  of  three  months  the  insured  has  a  right 
to  medical  care  at  home  or  in  a  hospital,  and 
also  to  reimbursement  for  the  expenses  in  case 
of  sickness  of  his  wife  and  of  his  children  under 
15  years  of  age  or  of  other  persons  whom  he 
supports.  After  six  months  of  insurance  he  is 
entitled  to  receive  a  subsidy  which  varies  ac- 
cording to  his  wages  and  the  duration  of  his 
sickness. 

Insurance  against  accidents  was  provided  by 
a  law  of  1913.  The  present  measure  renders 
obligatory  insurance  against  accidents,  and 
places  the  insuring  bodies  under  the  institute. 
Any  lesion,  external  or  internal,  including 
nervous  and  psychic  lesions  caused  by  an  ex- 
ternal agent  during  the  hours  of  employment, 
is  reckoned  as  an  accident.  In  case  of  death  the 
wife  of  the  deceased,  even  if  legally  separated 
from  him,  receives  a  pension  equal  to  f20  per 
cent,  of  the  annual  wages  of  the  deceased.  The 
orphans  up  to  the  age  of  14  years  receive  an 
additional  20  per  cent.,  the  whole  not  to  exceed 
60  per  cent.  Girls  have  a  right  to  such  pension 
up  to  16  years  of  age.   Funeral  expenses,  not  to 


exceed  fifteen  times  the  daily  wage  of  the  de- 
ceased, must  be  paid  by  the  employer. 

Insurance  against  invalidity  and  old  age  pro- 
vides for  the  underwriting  by  the  commune  or 
parish,  and  the  insured  are  divided  into  those 
who  work  for  wages  at  home  or  in  factories  or  on 
the  land  and  whose  income  is  under  900  milreis, 
and  the  non-wage  earners  of  the  agricultural, 
industrial,  commercial,  and  professional  classes. 
Employees  must  contribute  1  j  per  cent,  of  the 
daily  wage,  the  employer  6  per  cent,  of  his  pay- 
roll. If  the  insured  dies  after  having  made  five 
annual  payments  his  children  or  his  childless 
widow  receives  a  pension  of  50  milreis  payable 
in  six  months.  The  jjension  for  old  age  begins 
at  70  years  and  is  equal  to  the  entire  salary. 

This  law  also  reorganizes  the  bureaus  of  labor 
in  Lisbon  and  Porto,  placing  them  under  the 
ministry  of  labor.  They  collect  information 
from  their  localities  and  undertake  to  decide 
controversial  matters.  Each  is  represented  by 
a  commission  of  five  members,  two  of  whom  are 
elected  by  the  trade  unions  and  three,  including 
the  president,  are  appointed  by  the  govern- 
ment. —  Alice  Hamilton. 


REHABILITATION  OF  DISABLED  EMPLOYEES 


Vocational  Training  vs.  Occupational 
Therapy.  Philip  King  Brown.  Nation's 
Health,  Sept.  15, 1921,  3,  No.  9,  536,  22  Adv.  — 
The  principles  of  ergotherapy  as  worked  out 
under  strict  medical  supervision  at  the  Are- 
quipa  Sanatorium  for  tuberculous  wage-earn- 
ing women  are  herewith  presented  in  brief.  It 
seems  that  a  growing  emphasis  is  being  put 
upon  such  occupations  as  may  lead  to  some 
practical  advantage  to  the  patient.  Ergo- 
therapy may  be  criticized  because  too  often 
work  is  assigned  which  has  neither  commercial, 
educational,  nor  artistic  value.  On  the  other 
hand,  the  attempt  to  attain  any  one  of  these 
values  often  causes  the  patient  and  the  director 
to  lose  sight  of  the  possible  dangers  of  over- 
effort,  if  the  procedure  is  at  all  forced.  —  L.  A. 
Shaw. 

Chicago  Service  League  Restores  Handi- 
capped TO  Industry.  Mod.  Hosp.,  June,  1921, 
16,  No.  6,  527-529.  —  "The  Service  League  for 
the  Handicapped,  in  Chicago,  is  'organized 
effectively  to  reconstruct,  re-educate,  and  re- 
train the  handicapped  from  disease  or  accident, 
and   to  replace  them   in   self-supporting  posi- 


tions.' It  is  the  object  of  the  league  to  retrain 
the  handica  lulled  along  the  lines  in  which  they 
were  useful  before  they  became  handicapped, 
thus  restoring  to  the  comnuuiity  as  much  of  the 
service  and  efficiency  that  belonged  to  it  before, 
as  it  is  possible  to  do.  The  mental  effect  of  this 
method  is  also  good,  for  it  is  more  normal  to  go 
on  doing  as  nearly  as  possible  the  same  thing 
that  one  is  used  to  doing  than  to  have  the  new 
conditions  emphasized  by  taking  up  a  strange 
vocation." 

The  applicants  come  to  the  league  from  many 
different  sources,  such  as  the  Red  Cross,  chari- 
table organizations,  and  individuals.  When  a 
man  comes  into  the  league,  he  is  given  a  regis- 
tration blank  to  fill  out,  giving  the  usual  infor- 
mation concerning  education,  the  cause  of  the 
handicap,  treatment  undergone,  former  em- 
ployment, and  references.  He  is  then  sent  to 
one  of  the  members  of  the  medical  board  who 
are  connected  with  various  hospitals  of  the 
city,  for  a  free  medical  examination.  This 
diagnosis  determines  the  man's  classification. 
If  he  needs  hosjiital  treatment,  or  observation 
in  a  liospital  for  a  time,  he  pays  $3  a  day  if  he 
can  afford  it,  if  not,  either  the  league  pays  it,  or 


ABSTRACTS 


'201 


a  free  bed  is  secured.  If  the  man  needs  re-edu- 
cation, he  is  put  in  the  training  school  which  the 
league  maintains.  If  he  can  be  placed  imme- 
diately, and  a  suitable  position  is  available, 
that  is  done. 

The  men  are  classified  according  to  the  char- 
acter of  the  position  wanted:  factory,  store, 
business,  etc.  The  league  has  a  list  of  •iW)  firms 
in  Chicago  and  from  this  list  an  effort  is  made 
to  pick  out  those  most  likely  to  have  the  de- 
sired position,  and  to  place  the  ajiplicanl  there. 
—  M.  C.  Shorley. 

Problems  of  INL^intenance  in  Voc.vtional 
Rehabilitation.  John  A.  Kratz.  Voc.  Sum- 
mary, May,  1921,  i.  No.  1,  10-17.  —  In  voca- 
tional rehabilitation,  the  first  matter  to  be  con- 
sidered is  maintenance  during  training.  Persons 
eligible  to  compensation  under  compensation 
laws  usually  receive  enough  to  ])rovide  for  this, 
but  in  many  other  cases  the  question  of  main- 
tenance is  one  which  has  to  be  solved.  A  large 
proportion  of  potential  cases  also  must  be 
sought  out  and  persuaded  to  accej^t  the  services 
of  the  rehabilitation  agency,  es])ecially  if  there 
has  been  large  compensation. 

In  many  instances  men  arc  found  to  have 
savings  sufficient  for  undergoing  training.  The 
immediate  problem  of  the  rehabilitation  agent 
in  such  ca.ses  is  to  convince  the  man  of  the  wis- 
dom of  investing  his  savings  in  training.  When 
there  are  no  savings  or  pri\'ate  income,  an 
industrial  bank,  a  ^lorris  plan  bank,  the  em- 
ployer, or  relatives,  or  some  organization  or 
disinterested  persons  may  be  appealed  to. 
Sometimes  the  only  solution  is  to  place  the 
handicapped  person  immediately  in  some  tyi>e 
of  emi)loyment  that  makes  j)ossible  self-sui)- 
port  during  the  training  period.  —  G.  E. 
Partridge. 

On  the  Severely  but  not  Totally  Dis- 
abled IN  Industry,  with  Special  Reference 
to  the  One-Armed.  Leo  Eloesser.  Boston 
Med.  and  Surg.  Jour.,  May  12,  1921,  184,  No. 
19,  489-495. — The  author  concludes  as  fol- 
lows: "1.  Compensation  for  the  severely  but 
not  totally  disabled  should  be  made  on  a  com- 
bined basis  of:  (a)  physical  impairment  due  to 
injury;    (6)  previous  occupation. 

"2.  All  severely  injured  should  be  given  op- 
portunity for  vocational  training. 

"3.  The  new  career  should  utilize  and  be 
based  upon  the  injured  man's  previous  knowl- 
edge and  experience. 


"4.  Whether  to  continue  training  should  de- 
pend upon  the  man's  intelligence  and  fitness 
for  a  new  career. 

"o.  Training  should  be  stopped  if  progress 
does  not  warrant  its  continuance. 

"6.  Laborers  trained  in  agriculture  should 
be  oft'ered  inducements  to  accept  compensation 
in  land  instead  t)f  money. 

"7.  Compensation  should  be  contingent 
upon  the  injured  engaging  in  profitable  occu- 
pation. 

"8.  Suitable  employment  should  be  furn- 
ished by  the  state,  if  necessary."  —  Barnett 
Cohen. 

Occip.\TioNs  IN  the  Automobile  Indu.stry 
AS  Employment  Objectives  for  the  Dis- 
abled. Voc.  Summary,  May,  1921,  4,  No.  1, 
4-5.  —  Physical  ability  to  do  the  work  for 
which  the  man  is  trained  is  the  main  factor  in 
the  i)roblcm  of  rehabilitating  ex-service  men  for 
permanent  occupation.  Ilirschmann  has  re- 
cently compiled  a  report  on  Disabilities  and 
their  Relationship  to  Occupation  in  the  Auto- 
mobile Iniliistr)/,  based  upon  an  inspection  of 
the  United  States  Army  Motor  Transport 
School  at  Cam])  Ilolabird.  Md.,  in  which  it  is 
shown  that  in  this  work  disabilities  may  be  a 
serious  handicap.  A  large  part  of  the  work  is 
heavy  work,  and  some  branches  of  it  are  un- 
suitable for  men  having  affections  of  the  lungs, 
on  account  of  the  prevalence  of  dust.  Work  in 
the  repair  shop,  tearing  down  and  repairing,  is 
contraindicated  for  men  having  injuries  to  the 
liack;  it  also  requires  the  use  of  two  good  arms. 
The  fumes  from  engines  and  exhausts  are  also 
bad  for  some  men.  Work  in  the  woodworking 
shop  is  also  heavy  and  not  suitable  for  men  with 
orthopedic  conditions.  Acetylene  welding  re- 
quires normal  vision  and  sound  respiratory  or- 
gans. Noise  and  smoke  that  prevail  in  the 
blacksmithing  work  are  bad  for  men  with  func- 
tional nervous  diseases  or  respiratory  condi- 
tions, and  blacksmithing  is  too  heavy  for  men 
with  heart  affections.  Vulcanizing,  upholster- 
ing and  painting  are  all  processes  that  are  bad 
for  certain  types  of  men. 

"It  would  seem,  then,  that  almost  any  type 
of  general  auto  mechanics  except  lighting,  start- 
ing, ignition,  and  diagnostician  work  is  con- 
traindicative  for  men  with  serious  disabilities." 
And  for  these  types  of  work  good  vision,  free 
use  of  the  hands,  and  a  good  general  knowl- 
edge of  the  automobile  are  necessary.  —  G.  E. 
Partridge. 


202 


THE  JOURNAL  OF  INDUSTRIAL*  HYGIENE 


INDUSTRIAL  MORTALITY  AND  MORBIDITY  STATISTICS 


Sickness  Frequency  among  Indtjstrial 
Employees.  U.  S.  Pub.  Health  Ser.,  Pub. 
Health  Rep.,  July  1,  lO'^l,  36,  No.  26,  1497- 
1502.  —  The  figures  upou  which  this  report  is 
based  were  supplied  by  sick-benefit  associations 
of  employees,  and  are  for  the  entire  year  1920. 
The  existence  of  waiting  periods  and  limitations 
as  regards  age  placed  by  the  associations  pre- 
vents the  results  from  being  entirely  compar- 
able with  other  reports  of  similar  materials. 

The  data  are  presented  in  a  table  and  a 
graph.  The  table  shows  the  frequency  of  types 
of  disease,  and  of  the  main  diseases  within  each 
group,  and  also  the  frequency  of  all  diseases 
given  in  each  case  for  each  month.  Sickness 
was  least  during  September,  and  if  we  take  this 
month  as  the  beginning  of  the  cycle,  the  rate  in- 
creases through  February  and  then  declines  to 
the  end  of  the  period.  The  graph  shows  the 
frequency  for  all  diseases,  for  all  diseases  ex- 
clusive of  influenza,  for  diseases  of  the  digestive 
system,  for  diseases  of  the  nervous  system,  and 
for  general  diseases  exclusive  of  influenza. 
"One  of  the  striking  facts  to  be  noted  in  this 
graph  is  the  tendency  for  disability  from  all 
causes,  after  taking  out  influenza,  and  for  ill- 
ness due  to  diseases  of  the  respiratory  system, 
to  be  relatively  high  during  the  influenza 
epidemic."  —  G.  E.  Partridge. 

Sickness  among  New  York  State  Factory 
Workers  in  1919.  New  York  State  Dept. 
Labor,  Special  Bull.  No.  108,  Aug.,  1921,  pp. 
29.  —  "1.  This  survey  covered  more  definitely 
the  people  who  would  be  insured  under  a  health 
insurance  law  than  any  other  survey  of  similar 
scope. 

"2.  The  method  of  investigation  gives  in- 
formation regarding  the  prevalence  and  trend 
of  the  various  diseases  in  successive  months  of 
the  year. 


"3.  The  approximate  loss  of  time  among 
factory  employees  covered  by  this  survey  that 
would  be  compensable  under  a  health  insurance 
law,  such  as  has  been  proposed  in  this  state, 
was  1.1  days  per  employee  for  the  last  half  of 
1919.  As  health  conditions  were  probably 
above  normal  during  that  period,  the  minimum 
estimate  for  a  full  year  to  be  derived  from  the 
above  figure  is  2|  days  per  employee. 

"4.  This  estimate  must  not  be  interpreted 
as  covering  all  sickness  among  factory  workers. 
Similarly,  it  should  not  be  assumed  that  all 
sickness  among  factory  workers  would  be  com- 
pensable under  proposed  health  insurance 
measures. 

"5.  The  annual  wage  loss  among  factory 
workers  of  New  York  State  for  time  that  would 
be  compensable  under  a  compulsory  health  in- 
surance law,  such  as  has  been  proposed,  is  not 
less  than  $13,000,000  at  the  wage  rates  prevail- 
ing during  the  last  half  of  1919.  This  estimate 
is  based  on  the  assumption  that  1,500,000  fac- 
tory workers  are  employed  in  this  state,  as  in- 
dicated by  the  factory  inspection  records  for 
the  year  1919-1920. 

"6.  The  majority  of  the  cases  of  sickness  re- 
ported in  this  survey  were  not  covered  by  any 
form  of  health  insurance." 

The  appendix  contains  tables  showing  sick- 
ness among  factory  workers,  by  months;  sick- 
ness among  factory  workers,  by  industry; 
distribution  of  cases  of  sickness,  by  disease; 
distribution  of  cases  of  sickness  for  each  sex,  by 
disease;  distribution  of  cases  of  sickness,  by 
months  and  disease;  percentage  distribution  of 
cases  of  sickness,  by  months  and  disease;  dis- 
tribution of  cases  of  sickness,  by  length  of  dis- 
ability and  disease;  distribution  of  cases  of 
sickness  and  time  and  wage  loss,  by  length  of 
disability;  and  wage  rates  reported  on  sickness 
records.  —  M.  C.  Shorley. 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


JAMAKY.   hH-l 


X0MBER    9 


CONTENTS 


General iOS 

Systemic  Occupational  Diseases:  Occurrence,  Treat- 
ment and  Prevention 205 

Poisonous  Hazards  and  Their  Effects:  Gases,  Chemi- 
cals, etc iOG 

Dust  Hazards  and  Their  Effects iOd 

Occupational  Infectious  Diseases:  Occurrence,  Treat- 
ment and  Prevention . .  2119 

Occupational  Affections  of  the  Skin  and  Special  Senses.  Hi 

Occurrence  and  Prevention  of  Industrial  Accidents  . .  Hi 

Industrial  Surgery in 

Industrial  Physiology:  Nutrition,  Metabolism,  Fatigue, 

etc 217 


Hazards  of  Compressed  Air,  Diminished  Pressure, 
Generation  and  Use  of  Electricity,  and  Electrical 
\Yelding 218 

Women  and  Children  in  Industry 218 

Industrial  Sanitation:  Factory  Construction,  Illumina- 
tion, Ventilation,  Heating,  Water  Supply,  Sewage 
Disposal 220 

Industrial  Medical  Service:  Medical  Dispensaries  and 
Hospitals  in  Industrial  Plants 221 

Industrial  Psychologj'  and  Industrial  Management  in 
Its  Health  Relations  225 

Industrial  Health  Legislation;  Court  Decisions:  Work- 
men's Compensation  and  Insurance 225 


GENERAL 


War  and  Industrial  Diskases.  L.  Teleky. 
Internat.  Labour  Rev.,  .July~Aug.,  19'-21,  3, 
Nos.  l-i,  51-77.  — ■  This  i.s  a  valuable  paper,  in 
which  the  \\Titor  lias  reviewed  in  eoiisideralile 
detail  the  experienees  of  the  industries  during 
the  w-ar,  especially  with  respect  to  poisons.  He 
treats  metal  poisonings  (plunibisni,  mercury 
and  arsenic  poisoning),  poisoning  by  nitrogen 
fumes,  anthrax  poisoning,  poisoning  from  in- 
jurious substitutes,  from  oils  and  fats  and  their 
substitutes,  from  nitro-compounds,  T.N.T., 
and  D.N.B.,  and  "poisoning  from  various 
causes."  The  information  is  taken  from  the  re- 
jjorts  of  factory  inspectors  in  Germany.  Aus- 
tria, the  United  Kingdom,  the  Netherlands, 
and  Switzerland,  and  from  other  sources. 

British  reports  show  that  the  manufacture  of 
lead  containers  for  acids,  etc.,  gave  rise  to 
cases  of  plumbism,  and  in  1915  there  was  a  con- 
siderable increase  in  the  number  of  cases  of 


poisoning  occurring  in  the  manufacture  of 
accumulators.  The  use  of  iron  oxide  and  mi- 
caceous paints  has  been  so  widespread  in  Ger- 
many that  "in  future  it  is  to  be  hoped  that 
leadless  paints  will  be  used  altogether. 

INIercury  poisoning  was  caused  by  the  use  of 
mercury  for  alloys  which  had  formerly  been 
-made  with  tin.  Koelsch  reports  at  least  116 
cases  of  mercury  poisoning  in  a  chemical  works 
preparing  mercury  and  oxide  of  mercury. 
There  were  a  large  number  of  cases  of  injuries 
traceable  to  fulminate  of  mercury,  among  them 
inflannnation  of  the  gums,  blackening  and  brit- 
tleness  of  the  teeth  (produced  presumably  by 
fulminic  acid,  HO-N-C),  irritation  of  the  con- 
junctiva and  upper  bronchial  passages,  and 
especially  exanthema  and  erythema.  Many 
workers  in  German  and  Austrian  factories  em- 
ployed on  fulminate  of  mercury  or  fulminate 
salts  suffered  from  these  disorders. 


203 


204 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Two  forms  of  the  effects  of  arsenic  poison- 
ing have  been  noticed:  the  effect  of  arsenates, 
especially  on  the  skin;  and  poisoning  by  ar- 
seniuretted  hydrogen.  The  development  of  the 
dye  industry  in  England  led  to  frecjuent  poison- 
ing by  arseninretted  hydrogen,  many  cases  end- 
ing fatally;  and  many  mild  cases  occurred  in 
crews  of  submarines,  as  a  result  of  the  produc- 
tion of  arseninretted  hydrogen  by  the  accumula- 
tors. 

Poisoning  by  nitrogen  fumes  happened  in 
mimitions  manufacture  and  in  various  indus- 
tries. Cases  occurred  in  the  making  of  nitric 
acid,  and  there  were  some  from  the  use  of  sul- 
phxu-ic  acid  which  was  a  by-product  of  the 
manufacture  of  explosives  and  contained  nitric 
acid  and  nitrogen  substances.  Nitrogen  poison- 
ing also  occurred  freciuently  in  England  in  the 
manufacture  of  nitric  acid,  and  there  were  some 
cases  in  the  making  of  picric  acid  and  trinitro- 
toluol and  also  gun-cotton. 

INIany  cases  of  skin  disease  were  caused  in 
certain  industries  by  lubricating  oils,  poli.shes, 
varnishes  and  lacs.  Substitutes  were  used  not 
only  for  animal  and  vegetable  fats  but  for 
mineral  oil  products  and  resin.  Distillation  of 
coal  tar  and  lignite  tar  was  resorted  to,  and 
these  substances  caused  many  cases  of  skin  dis- 
ease. Fischer  reports  "tar  oil  with  resinous 
mixtures"  as  a  cause  of  "oil  itch."  The  .sub- 
stitute lubricants  were  widely  used  in  a  variety 
of  industries,  and  the  skin  diseases  were  \\ide- 
spread.  Many  injuries  were  caused  by  the 
medical  u.se  of  "war  vaseline,"  etc.  Tar  i)rod- 
ucts,  also,  produced  skin  diseases. 

Poisoning  was  caused  by  the  use  of  benzol  as 
a  solvent,  as  in  varnishes,  on  account  of  short- 
age of  oil  of  turpentine  and  benzine;  and  other 
jiaint  and  variiish  solvents,  such  as  solvent 
naphtha  and  acetone,  caused  cases  of  poison- 
ing. EsiJCfially  the  varnish  used  for  aeroplanes 
and  aerojilane  wings  was  often  dangerous. 
Acetylcellulose  \\as  used,  the  most  important 
solvent  of  which  is  tetrachlorethane  which  ])ro- 
duces  an  effect  similar  to  that  of  chloroform, 
but  is  four  times  as  poisonous,  and  its  hemat- 
olytic  effect  is  7.6  times  as  great.  Its  effects 
take  partly  the  form  of  nervous  symptoms 
(trenil)ling,  paresthesia,  disa])])earance  of  the 
jjatellar  reflex,  etc.)  and  partly  occur  as 
nausea,  acute  jaundice  and  atrophy  of  the 
liver.  Realization  of  the  dangers  led  to  the  use 
of  substitutes,  but  these  are  l)y  no  means  harm- 
less.   Formic  acid,  ketone,  methylated  alcohol, 


and  acetone  and  its  derivatives  were  all  causes 
of  more  or  less  severe  illness. 

Much  use  was  made  in  the  war  industries  of 
nitro-compounds,  and  particularly  of  aromatic 
nitro-compounds,  especially  dinitrobenzol  and 
dinitrotoluene,  poisons  which  could  be  intro- 
duced into  the  system  not  only  by  inhalation 
l)ut  by  absorption  through  the  skin.  Aromatic 
nitro-compounds  act  principally  as  blood 
poisons,  causing  the  formation  of  methemo- 
globin  and  the  destruction  of  red  corpuscles, 
women  being  particularly  susceptible  —  al- 
though there  are  some  doubtful  points  in  regard 
to  this.  The  use  of  alcohol  greatly  aggravates 
the  effects.  But  everywhere  improved  working 
arrangements,  shortening  of  hours,  and  medical 
inspection,  proved  beneficial  in  reducing  the 
amount  of  poisoning  from  the  nitro-comjiounds. 

In  Germany  dinitrobenzol  was  chiefly  used 
as  an  explosive,  sometimes  alone  and  sometimes  , 
in  combination;  but  in  England  and  the  United 
States  trinitrotoluene  played  a  preponderant 
part.  Whether  trinitrotoluene  is  or  is  not  a 
poison  is  still  an  unsolved  problem.  The  use  of 
it  in  the  war  certainly  led  to  severe  cases  of 
poisoning,  but  both  Koelsch  and  Fischer  came 
to  the  conclusion  that  T.N.T.  is  in  itself  non- 
poisonous,  and  that  impurities  w'hich,  under 
certain  circumstances,  adhere  to  T.N.T.  when 
used  in  manufacture  have  been  the  cause  of  the 
])oisonous  effects.  In  England,  during  the  war, 
there  were  many  cases  of  jaundice,  some  of  pro- 
gressive anemia,  and  a  great  number  of  cases  of 
debility,  disturbance  of  digestion,  etc.;  and 
"the  position  in  the  American  factories  was 
terrible"  —  17,000  cases  in  the  first  seven  and  a 
half  months,  with  475  deaths. 

The  T.N.T.  manufactured  in  England  and 
America  must  clearly  have  been  poisonous,  and 
susceptibility  of  individuals,  etc.,  is  not  a  satis- 
factory explanation.  The  probable  cause  of  the 
difference  of  findings  in  difl'crent  countries  is 
the  diversity  of  the  substances  themselves  as 
regards  imjjuritics.  Some  of  the  imjiurities  are 
known:  c.  cj.,  tetranitromethane.  an  und()ul)ted 
cause  of  certain  symptoms,  dinitrotoluene  and 
mononitrotoluene  (dinitrotoluene,  however,  ap- 
pearing to  bo  no  more  i)oisonous  than  T.N.T. 
itself). 

Other  i)oisonous  bodies  of  the  aromatic  .series 
are  trinitroiiaphthaline,  which  in  the  form  of 
])owder  i)roduced  an  acute  irritation  of  the  skin; 
Irinitroanisol,  also  strongly  irritating  to  the 
.skin;  nitroglycol,  causing  giddiness,  etc.;  dini- 


ABSTRACTS 


205 


trochlorobenzol,  producing  severe  dermatitis; 
picric  acid,  producing  such  symptoms  as  head- 
ache, giddiness  and  stomach  troubles;  tetrani- 
tromethane,  a  strong  irritant  of  tlie  respiratory 
tract;  and  phosgene  gas.  Precautionary  meas- 
ures were  effective  in  reducing  tiie  amoiuit  of 
injury  —  instruction,  provision  of  oxygen  appa- 
ratus and  medicines,  medical  selection  and 
supervision  of  workers  (very  necessary  and 
useful);  and  the  war  has  shown  the  very  great 
value  of  collaboration  of  tiie  medical  profession 
in  factory  inspection.  Medical  knowledge  alone 
can  detect  the  appearance  of  new  diseases  and 
ensure  the  prevention  of  industrial  sickness.  As 
a  result  of  the  exi)eriences  of  the  war,  also,  the 
introduction  or  extension  of  compul.sory  notifi- 
cation of  industrial  diseases  is  being  discussed 
in  Germany  —  a  measure  which  had  many 
years  before  been  introduced  in  Hngland  where, 
in  the  opinion  of  the  writer,  there  was  much  l)et- 


ter  preparation  for  the  prevention  of  war  in- 
dustrial diseases.  —  G.  E.  Partridge. 

The  Problem  of  Industrial  Hygiene  and 
THE  Co-operation  of  Physiclvns  in  Ixdus- 
TRL\L  Supervision.  H.  Ranch.  Zentralbl.  f. 
Gewerbehyg.,  Aug.,  1921,  9,  No.  8,  168-171.  — 
This  is  a  general  discussion  calling  attention  to 
the  many  kinds  of  situations  in  which  medical 
men  must  be  called  ui)on  for  help  in  industrial 
hygiene  work.  —  E.  L.  Sevringhaus. 

DlSfUS.SION  OF  THE  IMPORTANCE  OF  INDUS- 
TRIAL Medicine  to  the  Community.  Edgar  L. 
Collin.  Brit.  Med.  Jour.,  Aug.  -Z7,  IQ'ii,  No. 
316.5,  315-317. — This  article  covers  material 
similar  to  that  contained  in  the  International 
Journal  of  Public  Health,  :March-April.  \[n\, 
antl  abstracteil  in  This  Journal,  Oct.,  19^21,  3, 
No.  (!.  US.  —  M.  Dent. 


SYSTEIVnC  OCCUPATIONAL  DISEASES:  OCCURRENCE,  TREATIVIENT 

AND  PREVENTION 


CENTRAI>  NERVOUS  SYSTEM 

Neuroses  in  Business  Like.  L.  Ca.faiiMijor. 
Abstracted  as  follows  from  Neurol.  Bull.,  July, 
19''21,  3,  No.  7,  237,  in  Jour.  Am.  :Med.  Assii., 
Oct.  15,  1921,  77,  No.  16,  12S5.  —  '•Casamajor 
presents  illustrative  cases  which  fall  into  three 
groups:  (1)  the  inadequate;  (2)  Ihedi.s.satisHed; 
(3)  the  generally  maladjusted.  The  dissatisfied 
grou])  is  the  largest,  for  it  includes  the  great 
majority  of  the  neuroses  of  business  life.  The 
neurosis  arises  in  the  individual  who  likes  the 
remuneration  he  gets  from  his  work  but  dislikes 
the  work  itself  and  the  type  of  life  it  forces  him 
to  lead.  The  symptoms  are  not  usually  severe 
and  most  of  these  patients  struggle  on  without 
applying  for  medical  aid.  However,  should  the 
patient  suffer  an  accident  for  which  the  em- 
ployer could  be  held  resiionsible,  a  ty])ical 
traumatic,  litigation  neurosis  might  easily  ap- 
pear. The  difficulties  of  the  generally  mal- 
adjusted in  business  life  are  only  a  part  of  their 
general  maladjustment.  The  maladjustment 
to  the  home  life  is  of  much  greater  imijortance, 
and  the  work  is  a  means  of  escape  from  the 
home.  The  similarity  between  the  neuroses  of 
business  life  and  the  war  neuroses  is  quite 
obvious.   Dissatisfaction  is  ever  rife  throughout 


industrial  life  and  the  neurosis  is  a  way  out  of  a 
diliicult  ])roblem."  —  C.  K.  Drinker. 

CIRCULATORY  SYSTEM 

The  Effect  of  Increased  Protection  from 
Radiation  upon  the  Blood  Condition  of 
Radiim  Workers.  J.C.  Mutlram.  Abstracted 
as  follows  from  Arch.  Radiol,  and  Electroth., 
1921,  Vol.  25.  308,  in  Med.  Sc,  Nov.,  1921,  5, 
No.  2,  186. —  "In  1920  the  author  published 
his  findings  upon  the  corpuscular  content  of  the 
blood  in  workers  in.  the  Radium  Institute,  Lon- 
don. He  tlescribed  a  profound  leueopenia  af- 
fecting both  ])olynuclears  and  lyni])hocytes 
together  with  a  mild  anaemia  accompanied  by  a 
high-colour  index.  Since  these  investigations 
were  made  increased  protection  from  irradia- 
tion was  afforded  the  workers,  and  the  present 
])aiier  indicates  the  results  after  such  increased 
protection  had  been  in  operation  for  six  months. 
The  observations  bear  upon  five  males  and  five 
females.  In  respect  of  red  cells  the  blood  count 
in  all  the  females  and  two  of  the  males  had 
risen,  and  now  presents  approximately  a  median 
value  which  is  regarded  as  5.5  million  for  males 
and  4.9  million  for  females.  In  one  male  the 
value  has  risen  slightly  but  is  still  low,  and  in 


206 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


the  remaining  two  males  a  fall  has  occurred 
which  may  be  partially  explicable  on  other 
grounds.  In  respect  of  polynuclear  cells  the 
five  lowest  original  coimts  show  considerable 
approaches  towards  the  normal,  and  the  two 
lowest  lymphocyte  counts  also  show  a  rise, 
otherwise  little  change  is  noted  in  the  leucocytic 
counts.  The  actual  protective  devices  em- 
ployed consist  in  protection  from  emanation, 
improved  ventilation  of  the  rooms,  maniinila- 
tion  of  emanation  applicators  before  the  active 
deposit  has  been  fully  formed,  use  of  long- 
handled  wooden  forceps,  diminished  handling 
of  the  applicators  during  transit  and,  in  actual 
clmical  use,  leather  lined  lead  rubber  gloves. 
In  the  screening  of  applicators  and  against 
gamma  radiation  generally  temporary  workers 
are  used  as  far  as  possible.  The  lead  screens  on 
the  tables  and  those  behind  which  the  manipu- 
lations are  carried  out  are  5  cm.  thick.  Due 
instruction  is  also  given  the  workers  as  to  how 
advantage  may  be  taken  of  these  protective 
devices."  —  AI.  Dent. 


RESPmATORY  SYSTEM 

A  Case  of  Secondary  Infection  with  a 
Parasitic  Mold  in  a  Coal  Heaver.  Pezzali. 
Abstracted  from  Gior.  di  Clinica  Med.,  April 
10, 1921,  No.  6,  in  II  Lavoro,  Aug.  31, 1921, 12, 
No.  4,  110-111.  —  A  workman  of  60  years  em- 
ployed in  unloading  coal  came  to  the  hospital 
with  inflammation  of  the  lungs  and  after  eigh- 
teen days  died  of  exhaustion.  There  were  symp- 
toms of  infiltration  of  both  apices,  moist  rales 
over  the  whole  chest,  and  a  muco-purulent 
anthracotic  sputum  which  contained  no  tu- 
bercle bacilli,  but  in  addition  to  staphylococci 
and  diplococci,  numerous  spore  bearing  clubs, 
conidia  of  Ascomycetes.  Cultures  produced  an 
abundant  growth  of  filaments  forming  a  myce- 
lium of  the  mold  Penicillium.  This  case  is  very 
exceptional  since,  according  to  the  author, 
Castellani  is  the  only  one  who  has  described 
cases  of  bronchitis  and  broncho  alveolitis  ac- 
companied liy  the  growth  of  Penicillium.  In 
other  cases  the  fungus  has  proved  to  be  Asper- 
gillus. —  Alice  Hamilton. 


POISONOUS  HAZARDS  AND  THEIR  EFFECTS: 
CHEMICALS,  ETC. 


GASES, 


The  Treatment  of  Carbon  Monoxid 
Poisoning.  Howard  ]V.  Haggard  and  Yandcll 
Henderson.  Jour.  Am.  Med.  A.ssn.,  Oct.  1, 
1921,  77,  No.  14,  1065-1067.  —  Carbon  mon- 
oxide asphyxia  is  of  extremely  common  occur- 
rence and  is  a  condition  upon  \\hich  both  the 
public  and  the  medical  profession  entertain 
most  erroneous  ideas. 

In  the  course  of  a  large  series  of  investiga- 
tions the  authors  and  their  associates  have 
marked  out  the  following  standard  for  exposure: 
"Multiply  the  time  of  exjjosure  in  hours  l)y  the 
concentration  of  the  gas  in  parts  per  10,000  of 
air.  If  the  product  equals  3  or  less  there  is  no 
appreciable  physiologic  efi'ect.  If  it  equals  6, 
there  is  sometimes  slight  malaise.  If  it  equals 
9,  a  headache  with  some  nausea  is  produced  in 
most  people.  If  it  equals  15,  the  conditions  are 
dangerous  for  anything  beyond  brief  exposure. 
If  it  is  more  than  15  they  are  extremely  dan- 
gerous even  for  brief  exposure." 

In  the  proposed  vehicular  tunnel  under  the 
Hudson,  carbon  monoxide  is  not  to  be  per- 
mitted to  rise  above  4  to  5  parts  per  10,000, 
and  tlie  time  for  passage  will  lie  from  fifteen 
to  thirty  minutes.     Fieldner  and  his  associates 


have  shown  that  an  automobile  engine  may 
produce  from  1  to  2  cubic  feet  of  carbon 
monoxide  per  minute.  Thus,  a  car  warm- 
ing up  in  a  small  closed  garage  can  make 
an  atmosphere  dangerous  to  life  within  five 
minutes.  Production  of  carbon  monoxide  in- 
creases on  a  rich  mixture  and  decreases  on  a 
thin  one. 

The  whole  toxicity  of  carbon  monoxide  has_ 
been  shown  to  depend  upon  its  union  with 
hemoglobin.  Illuminating  gas  and  exhaust  gas 
from  automobiles  contain  other  substances,  for 
exami)le  benzene,  which  add  to  their  poLsonous 
properties.  Search  should  be  made  for  these 
and  i^ressure  ajjplied  to  prevent  their  appear- 
ance in  illuminating  gas. 

The  therajiy  of  carbon  monoxide  poisoning 
depends  on  the  hemoglobin  combination  men- 
tioned above  and  n])on  the  fact  that  this  com- 
bination is  readily  reversible.  Wien  jioisoning 
begins,  the  blood  gradually  takes  up  carbon 
monoxide  and  the  resulting  oxygen  deficiency 
induces  an  augmentation  of  the  volume  of  air 
breathed  per  minute.  This  results  in  bringing 
more  carbon  monoxide  into  the  alveoli  per 
minute    and   in   washing    out    carbon   dioxide 


ABSTRACTS 


207 


which  is  the  normal  stimuhis  for  l)reathing.  If 
after  such  a  process  has  progressed  the  patient 
is  removed  to  the  open  air,  carbon  dioxide  re- 
moval may  have  progressed  so  far  as  to  cause 
respiration  to  stop  for  lack  of  this  stimulus  or 
else  respiration  is  so  feeble  that  elimination  of 
carbon  monoxide  occurs  with  extreme  slow- 
ness. If  breathing  could  be  made  vigorous  the 
patient  would  not  only  spare  his  tissues  further 
asphyxiation  but  would  actively  rid  himself  of 
the  poison  already  present.  The  autlu)rs  pro- 
pose that  inhalations  of  oxygen  containing  from 
8  to  10  per  cent,  of  carbon  dioxide  be  u.sed.  Tlie 
carbon  dioxide  in  this  mixture  will  induce  full 
respiration  and  the  mass  action  of  the  oxygen 
•KJW  disj)lace  carbon  monoxide  from  the  blood. 
—  C.  K.  Drinker. 

Acute  C.\rbox  Mo.voxidk  Poisoning.  M. 
Nicloux.  Abstracted  as  follows  from  Presse 
med.,  Sept.  3,  19'21,  -29,  No.  71.  701,  in  Jour. 
Am.  ]Med.  As.sn.,  Oct.  1.5,  1921,  77,  No.  Hi, 
l-2Si).  —  "Xickmx  emphasizes  that  the  blood 
corpuscles  even  saturated  with  carbon  mon- 
oxid  are  not  devitalized  at  all,  but  are  ready  to 
resume  functioning  with  a  little  aid,  that  is, 
when  sujjplicd  with  oxygen.  In  a  case  de- 
scribed, seventy-five  minutes  after  the  poison- 
ing, and  after  650  liters  of  oxygen  had  been 
administered  by  the  ]nilmotor.  the  blood  still 
contained  !).08  per  cent,  carbon  monoxitl, 
showing  that  41. ,'5  per  cent,  of  the  hemoglobin 
was  saturated  with  it.  The  oxygen  was  pushed, 
and  in  about  an  liour  this  percentage  was  only 
2.5.4,  and  four  hours  later,  H.ti.  The  survival  of 
this  i)atient  after  apparent  death  for  twenty- 
five  minutes  shows  that  even  9.08  per  cent,  of 
carbon  monoxid  in  the  blood  is  not  fatal.  In 
the  cases  on  record  in  which  death  occurred 
with  poisoning  of  0.1,  0.3  or  even  0.4,  Nicloux  is 
convinced  that  some  other  factor  than  this 
poison  was  responsible  for  the  fatality.  Hart- 
ridge  experimented  on  himself,  and  found  that 
distressing  symptoms  did  not  follow  until  he 
had  surpassed  the  figures  reached  in  this  case. 
The  slightest  movement  is  liable  to  bring  on 
vertigo  and  loss  of  consciousness.  This  oc- 
curred twice  in  this  ca.se,  the  man  saying  he  felt 
well  and  wanted  to  go  home,  and  becoming  un- 
conscious when  he  started  to  get  up.  The  pul- 
motor  had  been  used  beginning  five  minutes 
after  apparent  death  which  kept  up  for  twenty 
minutes  longer.  About  650  liters  of  oxygen  had 
been  used  and  more  was  given  in  the  hospital, 
for  twenty  minutes  each  hour,  to  a  total  of 


1,500  liters.  The  headache  and  vertigo  dis- 
appeared after  the  first  inhalation."  —  C.  K. 
Drinker. 

Personal  Experience  of  Poisoning  by 
Arsike.  H.  Kunz-Kraime.  Vrtljschr.  f.  gerichtl. 
Med.,  April.  1921,  61,  No.  2,  161.  — At  11 
o'clock  one  morning,  upon  opening  an  old  cup- 
board which  was  used  for  storing  waste  chem- 
icals, the  author  was  greeted  by  a  strong  garlic- 
like odor,  as  of  arsine.  He  thought  nothing 
more  of  it  till  8  p.m.,  when  he  began  to  feel 
mildly  indisposed.  His  distress  increased  so 
much  in  an  hour  that  he  was  muible  to  eat  his 
supper.  He  retired  soon  afterwards  and  went 
to  sleep,  but  at  midnight  he  awoke  with  severe 
dysjinea,  and  a  thready  and  weak  jndse.  The 
desire  for  air  was  so  great  that  lie  rushed  to  the 
window  and  felt  an  almost  irresistible  inclina- 
tion to  throw  himself  out.  He  was  helped  to  a 
nearliy  physician's  office,  where  he  recovered 
sufficiently  by  4  a.m.  to  take  some  mild  alkaline 
mineral  water.  His  alarming  .symptoms  and 
accomijanying  nausea  subsided  so  that  by  5 
o'clock  he  could  return  to  bed.  The  resulting 
depression  wore  off  in  the  course  of  the  next 
day. 

The  professor  explained  the  presence  of 
arsine  by  the  fact  that,  as  he  afterwards  dis- 
covered, a  container  of  arsenic  had  leaked  into 
the  cuplioard.  and  tliat  molds  (such  as  Penicil- 
liuni  brevicaulej  had  formed  this  poison  gas  or 
possibly  diethylarsine.  — H.  G.  Noyes. 

The  Local  Effect  of  Dimethylsulphate. 
Jo.ief  Bodenstein.  Wien.  klin.  Wchnschr.,  ]May 
12,  1921,  34,  No.  19,  226-227.  —  Dimethyl- 
suljihate  has  been  used  in  chemical  industry 
since  1900  as  an  alkylating  agent  in  place  of 
methyl  iodide.  The  sulphate  is  very  toxic.  In- 
halation of  the  "gray  vapor"  from  an  open 
kettle  resulted  in  acute  irritation  of  the  respira- 
tory mucosa  and  death  from  lung  edema  and 
lobular  pneumonia.  In  the  less  fatal  cases, 
there  is  a  persistent  laryngitis,  tracheitis, 
bronchitis  and  conjunctivitis  lasting  for  months. 
The  local  effect  is  probably  due  to  the  free  acid 
liberated,  while  damage  to  the  central  nervous 
system  and  the  parenchymatous  organs  is  due 
to  the  whole  molecule. 

A  case  is  described  in  which  a  few  drops,  at 
most,  of  dimethylsulphate  were  swallowed. 
The  burn  produced  was  similar  to  that  made  by 
sulphuric  acid.  Recovery  was  very  slow.  — 
Barnett  Cohen. 


208 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


A  Simpler  Method  of  Blood  Examination 
FOR  Suspected  Cases  of  Lead  Poisoning.  L. 
Schwarz.  Med.  Klin.,  May  29,  lO'Sl,  17,  No. 
22,  659  660.  —  Much  time  and  costly  reagents 
may  be  saved  when  testing  l)lood  for  suspected 
lead  poisoning  in  large  groujjs  of  workers  in  the 
lead  industry,  if  thick  drops  are  used  instead  of 
the  usual  thin  smears.  The  stain  is  Manson's 
borax  methylene  blue,  made  from  5  gm.  borax 
in  100  c.c.  boiling,  distilled  water  plus  2  gm. 
methylene  blue.  This  will  keep  for  six  weeks. 
For  staining,  thin  it  in  a  reagent  glass  until 
transparent.  Stain  the  unfixed  thick  drop  ten 
minutes.  Basophilia  may  then  be  ruled  out  by 
examination  of  only  ten  to  twenty  fields, 
whereas  200  or  more  must  be  gone  over  in  a 
thin  smear.  —  H.  G.  Noyes. 

On  Blood  Ex.\iiination  by  the  Thick 
Drop  Method  in  Suspected  Lead  Poisoning. 
L.  Schicarz.  Zentralbl.  f.  Gewerbehyg.,  Sept., 
1921,  9,  No.  9,  192-194.  — By  the  author's 
thick  drop  method  the  detection  of  stippled 
cells  is  much  easier  and  less  time  consuming 
than  by  the  ordinary  thin  smear  methods.  He 
states  that  the  examination  of  ten  fields  in  a 
thick  drop  preparation  discloses  more  stippled 
cells  than  does  the  examination  of  200  fields  in 
an  ordinary  smear  preparation.  He  was  able  to 
collect  stains  and  examine  the  blood  of  fifty-one 
cases  in  three  and  one-half  hours.  The  technic 
is  published  in  Medizinischc  Klinik,  1921,  17, 
No.  22,  659,  see  preceding  abstract. — J.  A.  Key. 

For  the  Complete  Suppression  of  Indu.s- 
trlal  Saturnism.  L.  Devote.  II  Lavoro,  Aug. 
31,  1921,  12,  No.  4,  97-100.— Devoto  has 
found,  after  a  study  of  lead  poisoning  in  Milan 
between  1910  and  1920,  that  the  latter  has  been 
diminishing  to  a  very  gratifying  extent  both  in 
incidence  and  in  severity.  He  warns,  however, 
against  any  relaxation  of  the  precautions  which 
are  in  part  responsible  for  this  imjirovemcnt, 
for  the  protection  of  the  workman  can  be  pro- 
vided only  by  appropriate  legislation.  It  is  im- 
possible for  him  to  protect  himself.  Since  one  of 
tlie  chief  causes  of  the  diminution  of  industrial 
l)lumhism  must  be  attributed  to  the  lessened 
production  and  use  of  white  lead  after  1914, 
Devoto  feels  that  with  the  resumption  of  in- 
dustry the  evil  may  return,  and  he  therefore 
advocates  strongly  the  propo.sal  that  the  Inter- 
national Congress  of  Labour  at  its  October 
meeting  in  Geneva  should  adopt  a  resolution 
for  the  prohibition  of  white  lead  manufacture 


and  the  use  of  white  lead  in  industry.  —  Alice 
Hamilton. 

Prohibition  of  the  Use  of  White  Lead  ^ 
IN  Painting.  Internat.  Labour  Office,  Studies 
and  Reports,  Series  F.,  Oct.  24,  1921,  No.  5, 
pp.  27.  —  This  memorandum  was  issued  by  the 
Union  of  Painters,  Varnishers,  Decorators, 
Color  Workers,  and  Whitewashers  of  Germany 
for  the  purpose  of  sulimitting  to  the  Interna- 
tional Labour  Conference  for  discussion  ma- 
terial collected  on  the  subject  of  lead  poisoning 
in  industry.  The  following  tojjics  are  treated 
rather  fully;  working  and  living  conditions  in 
the  painting  and  varnishing  trades;  character- 
istic symptoms  of  disease  among  painters; 
genesis  of  lead  poisoning;  diagnosis  of  lead 
poisoning;  symptoms  of  lead  poisoning;  causes 
of  lead  poisoning  in  the  painting  industry; 
statistics  of  lead  poisoning;  substitutes  for  white 
lead. 

"It  is  clear  from  the  above  report  that  the 
use  of  poisonous  lead  paints  places  the  workers 
in  the  painting  and  varnishing  trades  in  danger 
of  the  most  serious  injury  to  health  and,  in  its 
remoter  conseciuences,  of  degeneration  and 
moral  deterioration. 

"  These  dangers  are  further  greatly  increased : 

"  (1)  by  the  difficulty  of  diagnosing  plumbism 
and  by  the  insidious  development  of  this  disease; 

'■(2)  by  the  unsatisfactory  social  conditions 
of  workers  in  the  painting  trade,  which  are  due 
to  economic  causes  and  the  conditions  of  their 
work; 

'■  (3)  by  the  impossibility  of  carrying  out  ef- 
fective measures  of  protection,  which  is  due  to 
the  fact  that  painting  is  a  small-scale  industry 
and  that  the  places  of  work,  outside  the  actual 
workshop,  are  constantly  changing  and  are 
generally  equipped  in  a  very  primitive  way. 

"It  would,  therefore,  be  consistent  to  de- 
mand a  general  i)rohibition  of  the  use  of  lead 
l^aints.  In  consitleration,  however,  of  the  very 
small  quantities  of  mixed  lead-containing 
))aints  and  of  certain  paints  for  protection 
against  rust  which  are  used,  we  confine  our 
claims  to  the  i)rohibition  of  white  lead,  which  is 
used  in  very  considerable  fiuantities  and  is 
particularly  dangerous  to  health  on  account  of 
the  large  amount  of  poison  which  it  contains. 
We  therefore  demand,  in  the  interest  of  the 
workers  whom  we  represent  and  on  general 
grounds  of  public  welfare,  the  prohibition  of  the 
use  of  white  lead  in  both  indoor  and  outdoor 
painting."  —  M.  C.  Shorley. 


ABSTRACTS 


209 


DUST  HAZARDS  AXD  THEIR  EFFECTS 


Is  Prophylaxis  Feasiblp:  ix  Arsenous 
Dust?  Safety  Engin.,  Sept..  1!)'21,  -i-J,  No.  3, 
100  lO'i.  —  Dr.  Lawrence  G.  Dunlaj),  in  an 
article  publi.shed  in  the  Journal  of  the  American 
Medical  Ansociation,  mentioned  "among  the 
preventive  nieasnres  ineffective  in  connection 
witli  the  hreatliing  of  arsenou.s  dust,  gas  masks, 
because  '  not  feasible  for  a  workman  on  an 
8-hour  .shift,'  and  nose  guards,  respirators,  etc., 
as    leading    to    severe    dermatitis.     Campiior- 


mentliol  ointment  and  'baghou.se  .salve"  were 
the  only  proj)liylactics  endorsed  by  Dr.  Dun- 
lap,  and  he  cautioned  that  their  use  must  be 
constant."  The  editors  of  Safcti/  Engineering 
a.sked  prominent  manufacturers  for  an  e.\])res- 
sion  of  their  opinions  as  to  these  statements  of 
Dr.  Dunlap's.  and  the  answers  which  were  re- 
ceived are  printed  here,  together  with  a  rejjly 
from  Dr.  Dunlap.  — M.  Dent. 


OCCUPATIONAL  INFECTIOUS  DISEASES:  OCCURRENCE, 
TREATJMENT  AND  PREVENTION 


Case  of  PNEinviocoNiosis.  K.  iirahn.  \h- 
stracted  as  follows  from  Tubercle.  Sept..  19^21, 
2,  No.  1-2,  .54'->,  in  Jour.  Am.  Med.  A.s.sn..  Oct. 
22,  1921,  77,  No.  17,  1.S72.  —  "Clinically 
Grahn's  case  seemed  to  be  one  of  advanced 
tuberculosis,  and  it  was  ciiicfly  the  ai)|H"ar.ince 
of  the  expectoration  and  the  lack  of  tiibercle 
bacilli  in  the  latter  as  well  as  the  limited  dis- 
tribution of  the  rales  that  claused  him  to  doubt 
the  existence  of  tuberculosis.  The  patient's 
general  health  prevented  roentgenologic  ex- 
amination."—  C.  K.  Drinker. 

Tuberculosis  after  Industrial  Acci- 
dents. .1.  liroca.  .Vbstracted  as  follows  from 
Bull,  de  I'Acad.  dc  nied..  May  .'$1.  19'21.  \ol.  8.5. 
(i29,  in  Am.  Rev.  Tuberc,  Oct.,  1921,  .■>,  No.  8. 
b5.'5.  —  "Hroca  recalls  that  there  is  a  history  of 
vi.sceral  or  glandular  tuberc\dosis  in  practically 
every  case  of  tuberculous  lesions  in  bones  or 
joints.  On  the  other  hand,  tubercle  bacilli  arc 
very  rarely  found  in  the  blood  in  the  chronic 
tuberculous.  Still  another  argument  against 
the  traumatic  origin  of  Ixme  and  joint  tuijer- 
culosis  is  his  discovery  that  none  of  500  children 
whom  he  has  treated  for  contusions,  sprains  or 
other  trauma  before  19i;5  has  develojjeil  a  tuber- 
culous i)rocess  since  in  the  region  of  the  injury. 
The  industrial  accident  which  every  one  is  so 
prone  to  hold  responsible  for  the  tuberculous 
lesion  in  reality  probably  merely  revealed  its 
unsuspected  })re.sence.  The  movement  which 
reveals  the  i)athological  condition  may  not  be 
greater  or  more  vigorous  than  the  ordinary 
movements,  although  claimed  as  trauma  by  the 
subject.  Two  imjjortant  practical  conclusions 
arc  evident  from  his  data.    One  is  that  every 


accident  involving  a  bone  or  joint  should  be 
radiograi)hed  inunediately;  this  would  do 
away  with  the  necessity  for  nmch  litigation. 
The  other  conclusion  is  that  any  history  of  a 
tuberculous  bone  or  joint  all'ection  should 
exemi)t  from  military  service,  with  its  right  to  a 
pension,  for  any  affection  de<lared  or  aggra- 
vated later  than  sixty  days  after  being  en- 
rolled." —  M.  C.  Shoriey. 

Tuberculosis  in  New  York  City  Attacks 
Men  Especially.  Godias  J.  Drolet.  Revised 
from  Bull.  N.  Y.  Tuberc.  Assn.,  Sept.  Oct., 
1921,  2,  No.  4,  1-2.  —  Almost  twice  as  many 
nien  as  women  die  from  tuberculosis  in  New 
York  City.  Since  1910  the  number  of  deaths  of 
women  and  female  children,  from  all  forms  of 
tuberculosis,  has  been  ,S1,148,  whereas  the 
deaths  of  men  and  male  children  in  the  .same 
period  have  totalled  67,748.  The  percentage  is 
(i4  for  men  and  '56  for  women. 

The  federal  census  figures  now  at  hand  show 
that  the  population  in  New 'S'ork  is  practically 
evenly  divided  between  the  male  and  female 
sexes,  there  having  been  found  2.802,038  males 
and  2,817,410  females  at  the  time  of  the  enum- 
eration on  January  1.  1920.  The  death  rate  per 
100.000  in  each  sex  is  shown  in  the  accompany- 
ing table. 

In  1910  the  death  rate  in  New  York  City 
from  all  forms  of  tuberculosis  was  266  per 
100.000  among  males  and  155  among  females. 
In  1920  it  had  come  down  to  149  in  the  male 
sex.  and  103  in  the  female.  The  first  striking 
difference,  of  course,  is  the  constantly  higher 
death  rate  among  those  of  the  male  sex;  and, 
secondly,  the  decline  in  both  groups,  namely. 


210 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


■ii  per  cent,  reduction  in  the  death  rate  among 
males  as  against  33  per  cent,  among  females. 
This  decline  has  continued  so  far  this  year,  and 
we  therefore  have  the  encouraging  knowledge 
that  in  the  past  eleven  years  alone  the  death 

NEW  YORK  CITY  — DEATHS  FROM  ALL  FORMS 
OF  TUBERCULOSIS  IX  EACH  SEX,  1910  TO  1S20 


Number  of  Deaths 

Death  Rate  per  100,000 

Year 

Males 

Females 

Per  Cent. 
Males 

Males 

Females 

1910 

1911 

1912 

1913 

1914 

1915 

1916 

1917 

1918 

1919 

1920 

6,352 
6,548 
6,465 
6,362 
6,716 
6,638 
6,185 
6,607 
6,318 
5,346 
4,211 

3,722 
3,702 
3,516 
3,669 
3,574 
3,611 
3,463 
3,535 
3,780 
3,152 
2,924 

•  63.1 
63.9 
6i.8 
63.^ 
65.3 
6U.8 
6i.l 
65.3 
62.6 
62.9. 
59.0 

266 
269 
261 
252 
262 
254 
233 
245 
231 
192 
149 

155 
152 
142 
145 
139 
138 
130 
131 
137 
113 
103 

rate  from  tuberculosis  in  this  city  has  been  cut 
in  half.  Among  females,  the  reduction  has 
slackened  since  1917  when,  probably,  in  greater 
numbers  they  also  entered  into  war  work  or 
into  industrial  establishments. 

In  the  study  of  the  death  rate  of  each  year, 
it  is  interesting  to  note  the  variations,  apart 
from  the  general  reduction  in  both  sexes.  In 
191-i,  among  men,  there  was  a  rise  not  occurring 
among  women.  War  is  first  of  all  a  man's  bur- 
den; and  the  effect  of  overtime  work  in  1917  is 
shown  in  the  rise  of  the  death  rate  from  tuber- 
culosis in  that  year  among  men.  On  the  other 
hand,  a  rise  only  among  women  in  1918  might 
suggest  that  the  influenza  epidemic  had  its 
greater  effect  upon  them.  It  is  but  necessary -to 
recall  the  insufficiency  of  nursing  assistance 
during  the  widely  raging  epidemic  of  that  year 
to  realize  how  much  of  the  burden  of  the  care  of 
the  sick  must  have  fallen  upon  the  women  at 
home. 

Looking  at  the  apparently  permanent  and 
greater  prevalence  of  tuberculosis  among  men 
in  this  city,  the  main  difl'erence  in  the  habits  of 
the  two  sexes  must  be  studied  if  we  are  going  to 
understand  the  cause  of  this  difference  and  to 
develop  measures  for  the  pre\ention  of  the 
greater  danger  to  men.  Home  conditions  and 
food  sujiplies  are  probably  fairly  the  same,  or 
at  least  coni[Kirable,  among  the  two  sexes.  The 
main  difference,  then,  lies  in  the  workshop  as 
against  tlie  home.  Men,  in  much  greater  pro- 
portion than  women,  are  at  work  outside  the 
home —  physical,  laborious  work  is  more  their 


lot;  and  the  lessening  of  the  death  toll  among 
them  will  be  achieved  by  improving,  if  possible, 
their  special  conditions  of  work.  Overwork  and 
unliygienic  conditions  in  the  shop,  or  in  trades 
followed,  are  the  special  dangers  that  men  are 
compelled  to  encounter. 

One  cannot  help  but  wonder  at  the  one-sided 
plan  of  attack  against  tuberculosis  in  the  pres- 
ent develojjment  of  dispensary  work.  The 
brunt  of  fighting  the  disease,  or  caring  for  those 
not  in  institutions  in  New  York  City,  is  carried 
on  by  these  tuberculosis  dispensaries.  The  re- 
ports of  the  Association  of  Tuberculosis  Clinics 
of  New  York  City,  and  those  of  the  Depart- 
ment of  Health,  show  that  in  1920,  alone,  146,- 
054  ^•isits  were  made  liy  nurses  for  the  educa- 
tion of  patients  and  the  prevention  of  disease. 
But  all  of  these  visits  were  made  to  homes. 
Each  one  of  the  nurses  most  carefullj'  avoided 
places  of  work. 

No  criticism  is  to  be  made  of  the  value  of 
home  work.  The  improvement  of  the  home, 
where  all  spend  quite  a  proportion  of  time,  and 
where  the  protection  of  childhood  demands  it, 
is  useful  and  necessary;  but  it  does  not  begin  to 
touch  the  correction  of  conditions  which  in  a 
large  measure  are  responsible  for  a  death  toll  of 
over  67,000  boys  and  men  in  New  York  alone 
.since  1910. 

There  are  also  dangerous  conditions  to  be 
watched  for  in  respect  to  the  protection  of 
women  against  tuberculosis,  which  are  re- 
vealed by  a  closer  study  of  the  age  at  death  of 
women  in  New  York.  There  is  a  shifting  of  the 
crest  of  mortality,  especially  since  1917,  among 
women,  from  older  to  younger  age  groups  — 
namely,  a  cliange  of  the  crest  from  '25-29  years 
to  ^O-^-t  years.  It  is  at  this  latter  age,  espe- 
cially, that  a  great  number  of  girls  leave  home 
to  work  out.  Attention  to  the  conditions  of 
work;  understanding  the  vital  need  of  taking 
sufficient  rest  and  of  eating  sufficient  lunches; 
taking  care  to  wear  sufficient  clothing  in  incle- 
ment weather  —  all  these  are  necessary  if  the 
increased  danger  to  women  is  to  be  lessened. 

Presence,  Absence  and  Location  of 
Rales  in  the  Prognosis  of  PuLiioNARY 
Tuberculosis.  Francis  B.  Trudeau.  Jour. 
Am.  Med.  As.sn.,  Oct.  22,  1921,  77,  No.  17, 
1326  1327.  —  Dr.  Trudeau  reports  upon  this 
question  by  means  of  an  analysis  of  1,000  con- 
secutive admissions  to  the  Trudeau  Sana- 
torium during  the  years  1907  to  1913.  The 
conclusions  reached  are: 


ABSTRACTS 


211 


"1.  Cases  in  which  no  rales  were  found, 
either  on  admission  or  on  discharjie  examina- 
tion, show  the  highest  percentage  of  *  cures." 

"2.  Tliose  patients  who  entered  the  institu- 
tion with  riiles  but  who  lost  them  during  their 
stay  form  nearly  as  fa\'orable  a  group  as  those 
showing  no  rales  at  any  time. 

"3.  In  patients  who  entered  the  institution 
•nathout  rales  hut  who  develoi)ed  them  during 
treatment,  the  prognosis  is  much  more  grave 
than  in  either  of  the  two  above-mentioned 
groups. 

"4.  In  spite  of  the  greater  frequency  and 
the  more  common  findings  of  the  tubercle 
bacilli  in  right  ujiper  lesions  as  contrasted  with 
left  upper,  the  prognosis  is  considerably  more 
favorable  in  the  former  class  of  patients.   . 

"5.  .Basal  rdles  should  not  be  diagnosed  as 
non tuberculous  too  lightly,  for  in  nearly  .50  per 
cent,  in  our  series,  tubercle  i)acilli  were  found  in 
the  sputum,  and  nearly  -Kt  ])er  cent,  of  these 
develoijed  apical  rales  during  their  stay  in  the 
sanatorium. 

"6.  The  prognosis  among  our  cases  in  whicli 
the  riiles  were  limited  to  one  or  both  bases  was 
not  more  grave  than  in  those  i)atients  with 
rales  over  one  or  both  upper  lolies."  —  C.  K. 
Drinker. 

The  Employment  ok  tiik  Tr]!Euci'L(>r.s. 
C.  F.  Rogers.  Pub.  Health  Nurse,  Oct.,  19^21, 
1.3,  No.  10,  S.'JS-ol.S.  —  Tuberculosis,  by  its 
nature,  imposes  upon  workers  affected  by  it 
certain  conditions  and  limitations  in  respect  to 
place  of  employment,  physical  conditions  out- 
side the  .shop,  materials  u.sed  in  the  work,  and 
the  general  character  of  the  work. 

Formerly,  physicians  insisted  upon  outdoor 
work  as  the  only  suitable  kind  for  the  jiatient 
after  treatment  at  a  sanatorium,  but  now  the 
necessity  of  compromise  is  often  recognized, 
and  exjjerience  has  shown  the  non-harmful 
effects  of  indoor  work  imder  proper  conditions 
for  those  who  have  previously  been  engaged  in 
it.  In  some  cases  indoor  work  is  not  only  per- 
missible but  preferable. 

Distance  to  and  from  work  must  be  con- 
sidered for  the  tuberculous  worker.  Not  more 
than  forty  minutes  should  be  occupied  in  car- 
riding,  and  there  should  be  no  uphill  walk  at  the 
end  of  the  day. 

High  temperature  in  the  shop,  "or  high 
temperature  combined  with  a  relatively  high 
humidity"  is  to  be  avoided,  and  care  must  be 
taken  in  regard  to  the  kind  of  materials  and 


by-products  with  which  the  worker  is  brought 
into  contact.  Dusts  which  carry  easily  various 
germs,  and  those  which  come  from  emery  and 
steel  and  may  irritate  or  cut  lung  tissue:  fumes 
in  a  japanning  room;  and  poisons  that  may  be 
inhaled  are  dangerous.  Posture  in  the  work 
nnist  be  looked  after — work  that  requires  a 
stooping  position  is  bad.  The  eight-hour  day 
and  the  forty-four  hour  week  should  be  taken  as 
a  maxinuun  at  the  beginning,  and  a  siiorter  dav 
is  the  ideal.  What  is  needed  is  a  series  of  tests 
"in  which  patients  with  given  amounts  of 
tuberculous  infection  and  possessed  of  given 
amoimts  of  nniscular  develo])ment  would  be 
compelled  to  i)crform  certain  shoj)  tasks  requir- 
ing the  expenditure  of  specified  amounts  of 
nniscular  energy  with  a  view  to  determining 
the  amoimt  of  work  a  per.son  who  has  rea<hed  a 
certain  degree  in  the  stage  of  recovering  frotn 
tubercidosis  can  safely  perform."  The  amount 
of  nerve  strain  involved  in  the  work  must  also 
be  duly  considered. 

General  intelligence,  education,  industrial 
training,  the  amount  of  financial  renumeration 
demanded,  individual  preference,  adaptability, 
temperament,  age,  sex,  and  sometimes  race  are 
factors  that  must  be  taken  account  of  in  |)lac- 
ing  the  tuberculous  worker.  Financial  con- 
siderations nmst  be  kept  from  dominating  the 
situation,  and  sufficient  relief  from  local  chari- 
ties should  be  called  in  to  obviate  this,  if  neces- 
sary. It  is  very  imj)ortant  to  direct  the  man  to 
the  very  best  situation  for  him,  and  his  adai)ta- 
bility  should  be  understood,  so  that  he  may,  if 
it  is  advisable,  be  directed  away  from  some 
preferred  occupation  in  which  there  are  ob- 
stacles not  found  in  another. 

The  interests  of  both  the  individual  and  the 
industry  must  be  considered.  The  employ- 
ment agent  has  a  precise  problem  to  solve  in 
finding  a  suitable  jjosition  which  the  man  is 
quite  capable  of  filling,  and  "any  employment 
agency  which  places  its  work  on  a  semi-chari- 
table basis  rather  than  upon  a  foundation 
similar  to  that  upon  which  all  industry  rests  is 
doomed  to  ultimate  disappointment." 

Other  conditions  being  favorable,  the  best 
position  is  the  former  task  with  the  former  em- 
ployer, and  the  second  best  is  a  similar  task  in 
another  industry  or  with  another  employer.  — 
G.  E.  Partridge. 

Prevention  of  Anthr.^jc  among  Indus- 
trial Workers:  Memorandum  on  the  Dis- 
infecting Station  Established  in  Great 


212 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Britain  for  Disinfection  of  Wool  and 
Hair.  His  Majesty's  Stationery  Office,  Lon- 
don, 19'21,  pp.  15.  —  A  departmental  commit- 
tee of  the  Home  Office  was  appointed  to  inves- 
tigate the  occurrence  of  anthrax  among  workers 
in  wool  and  hair  and  in  other  industries.  The 
report  was  that  precautionary  measures  were 
not  enough,  and  therefore  an  extensive  experi- 
mental investigation  was  made  as  to  the  possi- 
bility of  disinfecting  wool  on  a  commercial 
scale  without  injury  to  the  material.  A  satis- 
factory method  was  devised,  and  it  was  recom- 
mended that  compulsory  disinfection  of  the 
raw  material  should  be  adopted.  A  trial 
station  has  been  established  and  equipped, 
and  the  present  paper  is  a  detailed  report 
of  the  method  used  and  of  the  machinery 
employed. 

•  Experiments  showed  that  disinfection  by  any 
methods  harmless  to  the  material,  in  bales  and 
even  in  fleeces,  is  always  vmreliable.  A  new 
method  was  therefore  devised  which  comprises 
three  processes;  (1)  exposure  to  an  alkaline 
solution  at  a  temperature  of  102°F.  for  about 
thirty  minutes;  (2)  exposure  for  twenty  minutes 
to  a  ii  per  cent,  .solution  for  formaldehyde; 
(3)  drying  in  a  current  of  hot  air.    The  ma- 


chinery is  so  arranged  that  no  handling  of  the 
material  is  required. 

The  remainder  of  the  paper  is  given  to  a 
description  of  the  engineering  aspects  of  the 
problem.  The  i:)lan  and  general  arrangement  of 
the  trial  disinfecting  station  are  given,  with 
drawings,  and  the  construction  and  arrange- 
ment of  the  machinery  are  described,  with 
especial  reference  to  the  automatic  devices  pro- 
vided for  eliminating  handling.  Everything  is 
done  by  machinery  from  the  time  the  untreated 
bales  are  opened  until  re-baling  has  been  com- 
pleted. Machinery  is  u.sed  also  for  sterilizing, 
washing  and  drying  overalls  worn  by  the  work- 
men and  the  bale  coverings  taken  from  the 
original  bales.  Apparatus  is  under  considera- 
tion also  for  purification  of  the  formaldehyde 
solution  for  re-use. 

A  cubicle  containing  separate  accommoda- 
tion for  overalls  and  ordinary  clothing  and  a 
hot  and  cold  shower  bath  is  provided  for  each 
workman,  besides  ordinary  lavatory  basins  in  a 
separate  lavatory.  A  list  of  items  of  the  plant, 
with  their  cost,  is  given,  and  reference  is  made 
to  Volume  I  of  the  report  of  the  committee,  in 
which  the  process  of  disinfection  is  fully  de- 
scribed. —  G.  E.  Partridge. 


OCCUPATIONAL  AFFECTIONS  OF  THE  SKIN  AND  SPECIAL  SENSES 


An  Occupational  Dermatocoxiosis  among 
Zinc  Oxide  Workers.  John  A.  Turner.  U.S. 
Pub.  Health  Service,  Pub.  Health  Rep.,  Nov. 
4,  1921,  3G,  No.  -11,  2727-2732.  —  The  author 
describes  the  condition  he  observed  as  follows: 

"The  zinc  oxide,  body  debris,  and  bacteria 
are  forced  into  the  sebaceous  glands,  dis- 
tending them.  This  action  is  aided  by  free 
perspiration,  and  the  rubbing  together  of  two 
body  surfaces.  It  is  probable  that  the  presence 
of  the  foreign  substances,  acting  as  a  mechan- 
ical block  to  the  outlet  of  the  glands,  and  the 
increased  tension  due  to  the  retained  secretion, 
produce  sufficient  irritation  of  the  gland  walls  to 
allow  an  invasion  of  the  bacteria  and  a  resulting 
infection. 

"The  di.seasc  occurs  most  frequently  during 
the  sununer  months,  and  to  a  lesser  degree 
duriiTg  the  winter  months.  The  consensus 
of  opinion  among  the  workmen  is  that  the  oc- 
currence of  the  disease  depends  entirely  upon 
personal  cleanliness,  and  that  if  they  take  daily 
baths  no  trouble  is  experienced." 


He  thus  makes  it  clear  that  this  skin  condi- 
tion does  not  depend  upon  any  poisonous  prop- 
erty of  zinc  but  upon  the  fineness  of  the  oxide 
dust  and  its  consequent  ability  to  enter  and 
plug  sebaceous  glands.  Protective  clothing  and 
cleanliness  constitute  the  obvious  remedies.  If 
viewed  thoughtlessly,  the  report  seems  to  add 
another  count  to  tlie  problem  of  the  toxicity  of 
zinc,  but  tiiis  it  does  not  do,  nor  do  we  as  yet 
have  reliable  evidence  that  this  metal  has 
specific  poisonous  properties  either  superficially 
or  internally.  Even  the  widely  accepted  con- 
tention that  zinc  is  the  offender  in  brass  casting 
still  lacks  confirmation  in  terms  of  unimpeach- 
able evidence  and  readers  should  not  over- 
interi)ret  the  observations  submitted  in  this 
pamphlet.  —  C.  K.  Drinker. 

M\tch  Box  Dermatitis  and  Conjunctiv- 
itis. C.  Rasch.  Abstracted  as  follows  from 
Ugeskrift  for  Lacger,  Aug.  25,  1921,  83,  No.  3-*, 
1119,  in  Jour.  Am.  Med.  A.ssn.,  Oct.  15,  1921, 
77,  No.  16,  1296. — -"Rasch  has  encountered 


ABSTRACTS 


213 


thirteen  new  cases  of  dermatitis  from  carrying 
or  handling  a  Vwx  of  safety  matdies,  and  relates 
that  one  of  the  more  recent  cases  was  quite 
severe,  the  dermatitis  on  fingers,  neck  and  face 
lasting  for  two  weeks  and  being  accompanied  by 
severe  conjunctivitis,  the  eyelids  swollen  to- 
gether. The  asjject  and  course  is  like  that  with 
poisoning  from  Primula  (ihconica.  The  matches 
were  all  of  Swedish  make  with  the  trade  mark 
of  a  ship,  and  the  poisoning  is  ascribed  to  the 
phosjjhonis  ses(|nisulplii(l  (PjS.i)  used  in  them 
when  am()rj)h(>us  phos])horus  couhl  not  be  ob- 
tained. In  men  the  dermatitis  generally  corre- 
sponds to  the  trou.sers  jiockct,  but  women  who 
smoke  a  great  deal  and  u.se  many  malches  are 
affected  in  the  fingers  and  conjunctiva."  — 
C.  K.  Drinker. 

ScLEKODACTVLiA.  ./.  //.  Seqiieirii.  Ab- 
stracted as  follows  from  I'roc.  Roy.  Soc,  July, 
1921,  Vol.  14,  7;5,  in  Arch.  Dermat.  and  Syph., 
Nov.,  1921,  4,  No.  5,  708. —  "A  w(mian.  a 
machinist,  aged  .50,  who  gave  a  history  of 
mimcrous  whitlows  in  early  life,  had  noticed 
swelling  of  tlic  han<ls  two  months  bi'fore  pres- 
entation. 'IMie  swelling  persisted  about  a 
month  and  then  disapi)eared  spontaneously, 
leaving  the  fingers  stiff.  The  skin  over  the 
hands,  wrists  and  fingers  was  hart!  and  fixed. 
Isolated  sclerodermatous  lesions  were  present 
on  the  forearms  and  chest."  —  M.  C.  Shorlcy. 

Dermatiti.s  .\mong  Workehs  rx  1'iiknoi, 
Resixs.  0.  Sachs.  Abstracted  as  follows  from 
Wien.  klin.  Wchnschr.,  July  -21,  1921,  34,  No. 
29,  3.56,  in  Jour.  Am.  Med.  Assn.,  Oct.  8,  1921, 
77,  No.  1.5,  1210.  —  "Sachs  warns  that  in  view 
of  the  increased  manufacture  of  artificial  amber 
or  phenol  resins  (l)akelite)  great  precautions 
should  be  taken  to  prevent  the  development  of 
dermatitis.  In  the  process  of  manufacture  the 
fumes  of  phenol,  formaldehyd  and  ammonia 
escape  into  the  room.  In  several  patients  ob- 
served by  Sachs,  the  dermatitis  was  localized 
on  the  face,  forearms  and  hands.  Many  of  the 
patients  presented  also  a  conjunctivitis  and 
several,  bronchitis.  The  dermatitis  was  ac- 
companied by  intense  reddening,  some  swelling 
and  exudation,  and  was  of  a  severe  type  in 
most  of  the  cases.  The  patients  were  all  women, 
as  no  men  were  employed  in  the  factory. 
Nearly  all  the  employees  were  affected.  Treat- 
ment consisted  in  the  application  of  Burow's 
solution.  After  the  acute  manifestations  dis- 
appeared, a  bandage  with  an  ointment  of  3  per 


cent,  boric  acid  in  rectified  wool  fat  on  Las.sar's 
zinc  paste  was  applied.  The  course  of  treat- 
ment extended,  on  the  average,  over  from  four 
to  six  weeks.  Many  patients  changed  their 
employment  rather  than  expose  themselves 
again  to  the  inconveniences.  It  is  the  duty  of 
factory  inspectors  to  see  to  it  that  the  necessary 
ventilation  apparatus  is  installed  and  that  other 
precautionary  measures  are  taken.  This  arti- 
ficial amber  is  used  in  making  billiard  balls, 
buttons,  etc.  Some  of  the  employees  had  pro- 
tected them.selves  by  smearing  the  face  with 
petrolatum."  —  C.  K.  Drinker. 

A  Case  of  Billois  Eruption  Caused  by 
May-Weed.  J .  H .  Scqueira.  Lancet,  Sejjt.  10, 
1921,  2,  No.  11.  5G0.  —  A  strong,  healthy 
woman,  aged  51,  presented  herself  at  the  Lon- 
don Hospital  with  a  remarkable  eruption  of 
blebs  on  the  left  elbow  and  both  wrists.  She 
had  been  engaged  in  i)icking  peas  in  Essex. 

The  eruption  came  on  acutely  three  days 
previously.  The  blister  on  the  elbow  was  enor- 
mous, irregular  and  flaccid.  It  extended  down 
the  back  of  the  ft)rearm  for  3.;.  to  4  inches.  A 
similar  bleb  3  inches  by  2  inches  was  present 
over  the  ulnar  aspect  of  the  back  of  the  left 
wrist,  and  a  rather  larger  l>ulla  on  the  same 
position  of  the  right  wrist.  The  fluid  in  the 
blebs  was  clear;  there  was  no  zone  of  redness 
around  them.  The  patient  complained  of  pain 
and  .some  irritation.  She  a.scribed  the  lesions  to 
])oisoning  with  ^Lly-weed,  a  common  field 
weed.  Abrasions,  prtxluced  by  her  occupation 
of  pea  picking,  apparently  preceded  the  lesions. 
She  described  other  cases  among  workers 
similarly  em|)loyed.  Scqueira,  on  making  in- 
quiries in  South  Essex  and  Kent,  (obtained  the 
histories  of  other  cases  in  which  individuals  had 
been  obliged  to  give  up  work  for  some  weeks.  — 
R.  Prosser  White. 

Dermatitis  Venenata  Caused  by  the 
Oak.  M.  L.  Spillmann.  Bull,  de  Dermat.  et  de 
Syph.,  1921,  No.  6,  p.  33.  —  In  the  month  of 
February  a  laborer  was  engaged  near  Toxd  in 
France  in  carrying  on  his  right  shoiddcr  the  wet 
liranches  of  a  recently  felled  oak  tree  {Querciis 
robur).  The  same  evening  the  right  cheek,  ear 
and  both  hands  felt  painful  and  smarted.  Next 
day  these  parts  were  red,  swollen  and  intensely 
itchy.  A  few  hours  later  the  whole  of  the 
genital  region  developed  an  identical  eruption 
in  which  exudation  and  crusting  were  prom- 
inent features.    Under  treatment  the  man  was 


214 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


cured  in  twelve  days.  The  man's  grandfather, 
one  of  liis  uncles,  and  some  of  the  villagers  are 
kiiowni  to  have  suffered  in  exactly  the  same  way 
when  manipulating  freshly  cut  oak. 

The  -nTiter  is  able  to  exclude  ivy,  primula 
euphorbia,  etc.,  as  possible  causes  of  this  derma- 
tosis. He  is  uncertain  whether  the  juice  of  the 
oak  bark,  or.  some  vegetable  growth  on  the  bark 
was  responsible  for  the  condition.  He  believes 
this-  to  be  the  first  reported  instance  of  oak  bark 
dermatitis.  —  R.  Prosser  ^Tiite. 

Skjx  Lesioxs  IX  Briquette-^L\kers  axd 
THEIR  Rel.\tiox  to  War-Melaxoses.  Rudolf 
Scharer.  Schweiz.  med.  Wchnschr.,  March  31, 
lO'Jl,  51,  No.  13,  296-299. —  The  lesions  con- 
sisted in: 

1.  Diffuse  dark  to  red-browTi  pigmentation, 
especially  in  places  whete  the  skin  was  exposed 
to  light  or  to  the  pressure  of  clothes  (waist  and 
axilla).  The  conjimctivae  were  dirty  brown, 
particularly  at  the  palpebral  fissures. 

2.  Hji^erkeratoses,  with  comedones. 

3.  An  eruption  of  acneform  efflorescence  at 
all  stages  of  development. 

■i.  Epithelial  proliferation  at  circumscribed 
spots. 

The  cause  in  all  cases  was  undoubtedly  ex- 
posure to  tar  and  its  products.  The  author 
concludes,  after  careful  histological  study,  that 


these  lesions  are  the  same  as  the  so-called  war- 
melanoses.  The  condition  cleared  up  gradually 
with  resorcin  (3  to  6  per  cent.)  and  Lassar's 
paste.  —  H.  G.  Noyes. 

OcuL-iR  Nystagmus  a^sid  Railroad  Nystag- 
mus. R.  Bdrdny.  Abstracted  as 'follows  from 
Upsala  Liikareforenings  Forhandlingar,  Sept. 
1,  1921,  26,  No.  5-6,  in  Joiir.  Am.  Med.  Assn., 
Oct.  29,  1921,  77,  No.  18,  1457.— "Barany 
offers  here  an  explanation  of  the  phenomenon 
observed  by  him  of  nystagmus  in  an  abnormal 
direction  in  testing  for  'railroad  nystagmus.'" 
—  C.  K.  Drinker. 

Prevextable  Vocatioxal  Eye  Injuries. 
William  B.  White.  New  Orleans  Med.  and 
Surg.  Jour.,  Aug.,  1921,  74,  No.  2,  126.  —This 
paper  re\"iews  the  advances  made  in  the  direc- 
tion of  eye  protection,  and  various  statistics 
proving  the  need  for  more  stringent  laws,  and 
gives  the  nine  rules  promulgated  by  the  Bu- 
reau of  Standards  in  its  code  for  the  protection 
of  the  head  and  eyes  of  industrial  workers.  The 
objections  made  by  employees  to  the  wearing  of 
goggles  are  cited,  but  the  author  believes  that 
the  responsibility  for  the  enforcing  of  the  Na- 
tional Safety  Code  belongs  to  a  certain  extent 
"to  the  general  practitioner."  —  M.  Dent. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Safety  ix  the  Factory.  E.  L.  M.  Franklin. 
Indust.  Management,  Sept.  1,  1921,  62,  No.  3, 
159-160.  —  This  article  contains  helpful  sug- 
gestions from  several  companies  for  various 
improvements  around  the  factory.  These  are, 
in  brief: 

Glass  shields  placed  between  the  man  and  his 
work  are  in  many  instances  better  than  goggles. 
They  can  be  tinted  when  the  prevention  of  glare 
is  necessary,  and  can  be  made  of  fire  glass 
which  has  wire  mesh  embedded  in  it  so  that  if  it 
cracks  the  pieces  will  not  fly. 

Gears,  encased  in  woven  wire  guards  which 
are  reinforced  and  are  so  strong  that  a  man  fall- 
ing against  them  will  not  cause  them  to  cave  in, 
are  used  in  one  factory.  Another  adds  two 
little  feet  beneath  each  ladder  which  absolutely 
prevent  it  from  slipping.  Another  plant  finds 
it  useful  to  provide  separate  exits  for  women 
workers  so  that  they  will  not  be  crowded  and 


crushed  by  the  men  at  the  noon  hour  or  at 
closing  time.  This  same  company  runs  the 
freight  ele\-ator  for  a  quarter  of  an  hour  be- 
fore starting  time,  and  again  at  noon  for  the 
benefit  of  women  employees.  At  no  other 
times  are  the  elevators  used  for  employees. — 
M.  Dent. 

Educatiox  IX  Safety  Exgixeering  as 
Given  AT  the  Lyxn  General  Electric  En- 
gixeerixg  -VXD  Apprextice  School.  N.  M. 
DuChemin.  Safety  Engin.,  Sept.,  1921,  42,  No. 
3,  106-112.  —  This  article  is  an  outline  of  ten 
lectures  given  at  the  Lynn  School  and  adjusted 
to  plant  conditions  of  the  Lynn  General  Elec- 
tric Company.    Tlie  lectures  are  on: 

1.  Explanation  of  the  introduction  of  the 
Workmen's  Com])ensation  Acts  in  European 
countries  and  the  United  States,  and  also  of 
industrial  insurance. 


ABSTRACTS 


215 


2.  Fire  prevention. 

3.  Safety  in  the  boiler  room  and  power 
station. 

4.  Power  transmission. 

5.  Wood-working  machinery. 

6.  Metal-working  machinery. 

7.  Plant  equipment. 

8.  Organization. 

9.  Adverti-sing. 

10.   Selling  safety.  —  R.  M.  Thomson. 

What  Are  the  Dangerous  Jons?  Jamex  .1 . 
Tobey.  Safety  Engin.,  Sept.,  1921,  42,  No.  3, 
102-105. — This  article  gives  in  two  figures 
and  a  table  the  nnniber  of  persons  killed  in  the 
United  States  during  1!)18  Ijy  industries,  the 
total  number  of  accidental  deaths  in  1018  in  the 
United  States,  and  industrial  accidental  deaths 
during  1918.  Coal  and  metal  mining,  naviga- 
tion, fisheries,  electricians,  steam  and  street 
railways  lead  the  list  of  the  most  dangerous  in- 
dustries. During  1918  accidental  deaths  con- 
stituted 4.6  per  cent,  of  deaths  from  all  causes 
in  tiie  United  States. 

The  author  concludes  with  a  plea  for  more 
and  even  more  intensive  accident  prevention 
work.  "The  control  of  accidents  is 'one  of  the 
big  i)r<)blems  of  our  energetic  American  life.  It 
is  one  that  nuist  be  faced  and  faced  now."  — 
M.  Dent. 

Advertise  Prone  Pressure  Resu.scita- 
TiON.  Charles  II.  Lauffcr.  Nation's  Health, 
Sept.  1.5,  1921,3,  \o.  9,  519-521.  — Dr.  Lauffer 
first  emphasizes  the  necessity  of  ad\'ertising 
more  widely  the  advantages  and  the  exact 
technic  of  the  prone-pressure  method  of  artificial 
respiration,  the  methoil  which  is  believed  by 
the  best  authorities  to  be  the  most  efficient 
manual  method  of  resuscitation,  and  to  be 
superior  to  any  commercial  mechanical  ap- 
paratus yet  devised  for  giving  artificial  respira- 
tion. The  advantages  of  the  prone-pressure 
method  are  summarized  as  follows: 

"1.  Prone  pressure  is  a  one-man  method.  It 
is  easy  to  learn  and  easy  to  api)ly.  Under 
proper  technic,  one  person  can  keep  it  up  an 
hour  without  undue  fatigue.  A  single  operator, 
alone  and  unassisted,  with  no  devices  other 
than  his  hands,  and  with  no  assistance  from 
any  other  instructed  person,  can  successfully 
resuscitate  the  victim  of  accidental  drowning, 
gas  asphyxiation,  electric  shock,  or  other  con- 
dition requiring  immediate  efforts  at  artificial 
respiration. 


"2.  No  time  is  lost  hunting  up  mechanical 
devices,  in  which  the  persons  applying  them 
may  be  unskilled,  or  which  may  not  be  in  work- 
ing condition.  .  .  . 

"3.  Even  if  a  serviceable  mechanical  device 
can  be  obtained,  it  may  not  be  inuuediately 
available.  It  is  unfair  to  the  prone  pressure 
method  to  say  that  the  mechanical  device  has 
resuscitated  the  victim,  when  the  victim  has 
been  kept  going  l)y  the  maiuiai  method,  and  is 
practically  resuscitated  before  mechanical  de- 
vices reach  the  scene. 

"4.  The  manual  method  elevates  the  dia- 
phragm, pumps  venous  blood  from  the  liver  and 
splanchnic  area  to  the  heart  —  which  is  enii>ty 
in  electric  shock  —  and,  by  distending  the 
heart  and  blood  vessels  by  the  massage  of  these 
parts,  it  aids  in  the  restoration  of  circulation. 
As  is  well  known,  in  electric  shock  the  heart 
action  may  be  suspended  before  resjiiration  is 
arrested,  consequently  the  manual  method,  by 
stimulating  cardiac  function,  holds  out  the 
greater  ])rospect  of  restoring  animation  in  the 
victim  of  electric  shock. 

"5.  The  use  of  mechanical  devices  of  the 
bellows  type  requires  a  degree  of  pressure  to  in- 
flate the  lungs,  and  a  degree  of  suction  to  em])ty 
the  lung.s,  that  is  incompatii)ie  with  normal 
physiologic  breathing.  In  other  words,  the 
mechanical  devices  are  the  more  liable  to  do 
violence  to  the  pulmonary  tissues  than  are 
mamial  methods.  The  manual  methods  more 
closely  imitate  nature. 

"(i.  The  water  in  the  lungs  encountered  in 
drowning,  and  the  edema  of  the  lungs  en- 
countered in  electric  shock,  and  occasionally 
observed  in  asphyxiation  by  gases,  require  that 
the  patient  be  in  a  i)rone  position.  The  prone 
I)osition  not  only  facilitates  the  removal  of 
liquids  from  the  lungs  and  air  passages,  but  it 
permits  the  tongue  to  gravitate  forward, 
thereby  making  it  po.ssible  for  one  man,  alone 
and  unassisted,  to  resuscitate  a  comrade  in 
distress." 

Dr.  Lauffer  next  discusses  in  detail  faults  of 
technic  which  may  lead  to  failure  of  resuscita- 
tion and  which  bring  unwarranted  discredit  on 
the  prone-pressure  method,  and  concludes  with 
an  enumeration  of  non-essential  points  of 
divergence  in  technic.  —  Katherine  R.  Drinker. 

How  Accidents  Are  Reduced  in  an  Oil 
Refinery.  E.  C.  Esterly.  Nat.  Safety  News, 
Aug.,  1921,  4,  No.  2,  28-29.  —The  conditions 
in  the  works  of  the  Atlantic  Refinery  Company 


216 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


of  Philadelphia  are  somewhat  unusual,  the 
shops  and  various  departments  being  located  at 
distances  from  each  other;  hence  a  different 
sort  of  safety  department  was  organized,  con- 
sisting of  seven  inspectors.  A  daily  system  of 
inspection  was  laid  out  which  covers  every  inch 
of  the  plants.  Conditions  which  should  be 
remedied  are  reported  to  the  superintendents 
of  the  various  departments  for  criticism  and 
action. 

The  safety  department  maintains  a  small 
shop  for  the  manufacturing  of  guards  for  ma- 
chinery. It  makes  an  analysis  of  the  most 
prolific  sources  of  accidents  and  concentrates 
its  efforts  on  those  causes.  In  order  to  cope 
with  fatalities  from  asphyxiating  gases  200  em- 
ployees were  trained  in  the  use  of  self-contained 
oxj'gen  rescue  apparatus,  and  in  the  jiractice  of 
the  Schiifer  prone-pressure  method  of  resus- 
citation. A  few  employees  were  taken  for  this 
training  from  each  department  and  each  shift, 
so  that  some  men  will  always  be  on  duty  who 
are  trained  in  that  particular  branch  of  rescue 
work. 

The  number  of  guards  installed,  repaired, 
departments  inspected,  etc.,  is  given  in  order  to 
show  in  more  detail  what  the  safety  depart- 
ment has  done  for  the  plant.  —  M.  Dent. 

Safety  Hook  Prevents  Mine  Car  Grade 
Accidents.  Nat.  Safety  News,  Sept.,  lO'il,  4, 
No.  3,  30.  — This  is  a  brief  illustrated  descrip- 
tion of  the  Buck  Safety  Hook  and  of  its  use  on 
mine  cars  to  prevent  them  from  running  away 
down  the  steep  grade  in  case  the  cable  breaks. 
—  M.  C.  Shorley. 

Metal-Mine  Accidents  in  the  United 
States  di-ring  the  Calendar  Year  1919. 
William  W.  Adams.  U.  S.  Bur.  Mines,  Tech. 
Paper  286,  1921,  pp.  99.  —  This  report  covers 
copper  mines,  gold,  silver  and  miscellaneous 
metal  mines,  iron,  lead  and  zinc,  and  non- 
metallic  mineral  mines.  It  represents  3,383 
mine  operators  employing  145,262  men  for  an 
average  of  281  days  each.  "The  reports  for 
1919  show  that  for  every  thousand  men  em- 
ployed during  a  full-time  year  of  .'{((O  working 
days,  3.43  men  were  killed  and  231. IS  men  were 
injured,  an  injury  signifying  disal)ility  for  at 
least  one  day.  The  fatality  rate  was  the  lowest 
on  record  for  the  metal-mining  industry  in  the 
United  States,  and  the  injury  rate  was  lower 
than  for  any  year  since  1914."  —  M.  Dent. 


Coal-Mine  Fatalities  in  the  United 
States,  1920.  William  W.  Adams.  U.  S.  Bur. 
Mines,  Tech.  Paper  288,  1921,  pp.  112.— 
"According  to  reports  received  by  the  United 
States  Bureau  of  Mines  from  the  various  state 
mine  inspectors,  2,260  men  were  killed  by  ac- 
cidents at  coal  mines  during  the  calendar  year 

1920,  a  decrease  of  57  fatalities  from  the  record 
of  the  year  before.  This  reduction  in  the  num- 
ber of  lives  lost  is  particularly  gratifying  be- 
cause it  was  accompanied  by  an  increase  of 
more  than  18  per  cent,  in  the  output  of  coal.  .  .  . 
Considered  by  causes,  there  was  a  decrease  of 
64  per  cent,  in  fatalities  due  to  mine  fires,  38 
per  cent,  in  fatal  accidents  caused  by  explo- 
sives, and  14  per  cent,  in  deaths  residting  from 
explosions  of  gas  and  coal  dust.  There  was  also 
a  decrease  of  16  per  cent,  in  haulage  accidents 
above  ground.  An  increa.se  of  10  per  cent,  is 
noted  in  the  underground  accidents  due  to 
electricitj%  6  per  cent,  in  fatalities  caused  by 
underground  haulage,  and  about  2.5  per  cent, 
in  deaths  caused  by  falls  of  roof  and  coal."  — 
M.  Dent. 

Accidents  in  Mines  and  Quarries  of  the 
United  Kincdom  in  1920.  U.  S.  Bur.  Labor 
Statis.,  Month.  Labor  Rev.,  Sept.,  1921,  13, 
No.  3,  658.  —  "The  report  of  the  Mines  De- 
partment of  the  British  Board  of  Trade  (Part  I. 
—  Divisional  Sfaiisfics)  gives  detailed  statistics 
of  accidents  in  mines  and  quarries  of  Great 
Britain  and  Ireland  (in  the  case  of  metalliferous 
mines  and  quarries,  including  also  the  Isle  of 
Man)  during  1920."  A  summary  of  these 
figures  is  given  in  a  table.  —  M.  Dent. 

An  Explosion  of  H.\rd  Rubber  Dust. 
Darid  J.  Price  and  Hijlton  R.  Brown.  Ab- 
stracted  as  follows  from   (^hem.   Met.   Eng., 

1921.  Vol.  24,  737-740,  in  Chem.  Ab.str.,  July 
20,  1921.  15,  No.  14,  2358.  —  "Although  not 
heretofore  considered  as  such,  hard  rubber  dust 
is  combustible  and  forms  explosive  mixtures 
with  air.  This  accident,  through  whidi  8  were 
killed,  1  injured  and  property  valued  at  $25,- 
000  destroyed,  occurred  in  the  course  of  reduc- 
tion of  hard  rubber  to  dust  by  grinding  for 
rc-nse.  Tiic  circumstances  and  precise  cause  of 
the  accident  were  not  definitely  determined,  but 
a  set  of  recommendations  covering  possible 
causes  is  offered." 

A  Recently  Developed  Dust  Explosion 
AND  Fire  Hazard.  Darid  ./.  Price  and  Ilylton 
R.  Brown.    Abstracted  as  follows  from  U.  S. 


ABSTRACTS 


217 


Dept.  Agri.,  Circular  171,  lO^l,  pp.  7,  in  Chem. 
Abstr.,  July  20,  1921,  15,  No.  14,  2356.— 
"This  deals  with  explosions  of  dust-air  mix- 
tures ignited  hy  incandescent  electric  lamps, 
either  from  the  dust  accumulated  on  the  bulb 
becoming  heated  to  incandescence  or  from  dust 
clouds  becoming  ignited  when  the  bull)  of  a 
glowing  incandescent  electric  lamp  was  broken. 
A  descriiJtion,  with  drawings,  of  the  method  de- 
vised for  testing  the  latter  is  given  and  ex- 
plosions of  dust-air  were  obtained  with  both 
vacuum  and  gas-filled  lam])s,  except  vacuum 
tungsten  and  carlxxi  lamps  of  very  low  wattage. 
'All  electric  latnpn  in  places  where  inflammable 
and  combustible  dust  exist  should  be  equipped 
with  vapor-proof  globes,  protected  by  heanj  (juards 
to  prevent  breakage." 


Administrative  Methods  for  Technical 
Supervision  of  the  Paper  ^YoRKI^•G  Unions. 
jR.  Hiitt.  Zentralbl.  f.  Gewerbehyg.,  Aug., 
1921,  9,  No.  8,  177-180.  —This  article  gives  a 
detailed  description  of  office  methods  for  classi- 
fication of  accidents  from  all  standpoints,  and 
examples  of  the  results  obtained  by  such 
methods.  —  E.  L.  Sevringhaus. 


Safety-Trip  for  Punch  Presses.  C.  E. 
Wihloner.  Safety  Engin.,  .Vug..  1921.  42,  No.  2, 
01-02.  —  A  simple  safety  trip  arrangement  for 
punch  presses  accompanied  by  illustrations. 
The  device  is  not  patented,  and  has  the  ad- 
vantages of  low  cost  and  easy  installation.  — 
R.  M.  Thomson. 


IXDUSTRIAL  SURGERY 


Observations  Based  on  a  Study  of  In- 
juries to  Elbow.  /.  Cohn.  Abstracted  as  fol- 
lows from  .\rcli.  Surg.,  Sept.,  1921,  .'5,  No.  2, 
357,  in  Jour.  Am.  Med.  Assn.,  Sept.  24,  1921, 
77,  No.  i;5,  1047.  —  "Cohn  is  of  the  opinion 
that  three  things  are  neces.sary  in  the  treatment 
of  fractures:  a  clear  knowledge  of  the  normal  on 
the  part  of  the  roentgenolofiist ;  a  more  careful 
examination   of   the   patient,   to  (>liminate  un- 


necessary work,  and;  last,  a  closer  co-operation 
between  the  roentgenologist  and  surgeon  which 
will  prove  helpful  to  all.  .V  suggestion  from  the 
roentgenologist  that,  as  a  result  of  his  study  of 
the  picture,  he  would  make  a  prognosis  of  a  de- 
formity if  the  fracture  is  allowed  to  remain  in 
the  position  that  it  was  in  when  the  i)atient  was 
sent  to  him,  will  i)revent  many  fuliu-e  disa- 
bilities and  deformities."  —  C  K.  Drinker. 


INDUSTRIAL  PHYSIOLOGY:  NUTRITION,  METABOLISM, 

FATIGUE,  ETC. 


The  Heart  during  Physical  Exercise. 
Boigey.  Abstracted  as  follows  from  Presse 
med.,  Aug.  17,  1921,  29,  No.  (iO.  054,  in  Jour. 
Am.  Med.  Assn.,  Oct.  1,  1921,  77,  No.  14. 
1137.  —  "Boigey  is  the  physician  in  charge  of 
the  Ecole  d'  education  physique  at  Joinville. 
His  numerous  tests  have  demonstrated  that  a 
pha.se  of  relaxation  and  i)assive  distention  fol- 
lows when  the  first  phase  of  hypertonicity  — 
which  accompanies  every  physical  effort  —  is 
past.  The  exercise  should  never  be  allowed  to 
progress  as  far  as  this  second  pha.se."  —  C.  K. 
Drinker. 

Histologic  Changes  in  the  Kidney'  Pro- 
duced BY  Chilling.  Cicconardi.  Abstracted 
from  the  Arch.  p.  le  sc.  med..  Vol.  43,  No.  5-6,  in 
II  Lavoro,  Aug.  31,  1921,  12,  No.  4,  106-107.  — 
The  author  applied  to  rabbits  a  freezing  mix- 


ture over  the  left  lumbar  region;  a  rubber  ice 
bag  directly  on  the  exposed  kidney;  inuuersion 
of  the  whole  animal  in  ice  water  until  there  was 
a  decided  fall  of  body  temperature.  The  kid- 
neys in  certain  of  the  experiments  were  stained 
during  life  by  intravenous  injection  of  a  solu- 
tion of  lithium  carmine.  The  conclusions 
obtained  from  eighteen  experiments  are  as 
follows:  The  effect  of  cold  on  the  kidneys  of 
rabbits  is  to  produce  alteration  of  function  as 
shown  by  albuminiu'ia  and  the  production  of 
granular  casts.  Histologically  the  changes  con- 
sist in  modification  of  the  reaction  to  vital  stain 
with  carmine,  the  presence  of  desiiuamated 
epithelimn  in  the  tubules,  degenerative  changes 
and  hemorrhagic  infiltration.  These  changes 
appear  during  the  first  twenty-four  hours  after 
the  action  of  the  cold,  diminish  during  the 
following  days,  and  disappear  with  complete 


218 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


restitution  of  integniiii  in  about  two  weeks. 
Wlien  the  cold  was  aijplied  to  one  kidney  onl}% 
the  other  also  luiderwent  these  changes  and 
general  immersion  of  the  body  in  cold  water 
was  productive  of  more  serious  lesions  than  the 
local  application  of  cold  —  sometimes  even  a 
true  hemorrhagic  nejihritis  resulted.  The  fact 
that  the  real  alterations  disappear  so  rapidly 
seems  to  show  that  cold  cannot  be  considered 
as  the  cause  of  incurable  nephritis.  —  Alice 
Hamilton. 

Practical  Methods  of  Fatigue  Elimina- 
tion. Frank  B.  GUbreth.  Nation's  Health, 
Sept.  15,  19''21,  3,  No.  9,  523-5'-25.— This  article 
deals  with  the  organization  and  functions  of  the 
Committee  for  the  Elimination  of  Unnecessary 


Fatigue.  Its  membership  is  drawn  from  many 
and  diverse  fields  of  activity:  research  workers 
in  medicine,  in  psychology,  in  physiology  and 
in  psychiatry;  economists,  statisticians,  educa- 
tors, etc.  It  is  the  object  of  the  committee  to 
investigate  fatigue  conditions  in  all  parts  of  the 
world  in  all  industries  having  fatigue  problems. 
Up  to  the  present  time  the  work  of  the  com- 
mittee has  consisted  in  arousing  interest  and 
sur\'eying  present  practice  and  in  showing 
what  has  actually  been  done  in  fatigue  elim- 
ination and  its  study.  Many  suggestions  are 
herein  made  respecting  the  future  activities  of 
the  committee,  chief  of  whicli  will  be  the  es- 
tablishment of  fatigue  elimination  standards, 
which  are  predicted  to  add  to  the  comfort  and 
happiness  of  all  workers.  —  L.  A.  Shaw. 


HAZARDS  OF  COMPRESSED  AIR,  DUVONTSHED  PRESSLTRE,  GENERATION 
AND  USE  OF  ELECTRICITY,  AND  ELECTRICAL  WELDING 


Rupture  of  Large  Intestine  from  Com- 
pressed xA.iR.  G.  Jean.  Abstracted  as  follows 
from  Presse  med.,  Aug.  24,  1})'-21,  29,  No.  68, 
675,  in  Jour.  Am.  Med.  Assn.,  Oct.  1,  1921,  77, 
No.  14, 1137.  —  "Jean  reports  two  cases  of  this 
kind  with  recovery  of  both  patients  after  resec- 
tion of  the  severely  damaged  and  rujitured 
bowel  and  the  making  of  a  definitive  median 
abdominal  anus.  The  injury  was  from  the  burst- 
ing of  a  pipe  conveying  condensed  air  or  a  jet 
from  the  nozzle.  In  Ijoth  cases  the  pijie  had  been 
10  or  20  cm.  from  the  skin."  —  C.  K.  Drinker. 


Safety  Features  in  High  Tension  Gen- 
ERATmG  Stations  and  Substations.  M.  M. 
Samuels.  Safety  Engin.,  Sept.,  1921,  42,  No.  3, 
112-115. — This  article  deals  with  safety  fea- 
tures in  substation  design,  safeguarding  trans- 
formers and  generators,  lightning  arresters  and 
bus  structures,  improvements  in  safety  de- 
vices, need  of  signal  lamps,  rigid  bus  outdoor 
substations  and  illumination  of  stations.  The 
best  design  for  all  these  features  and  for  sta- 
tions in  general  is  a  simple  one.  —  R.  M. 
Thomson. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


The  Employment  of  Women  in  5  and  10 
Cent  Stores.  New  York  State  Dept.  Labor, 
Special  Bull.  No.  109,  Sept.,  1921,  pp.  68.  — 
Seventeen  cities,  besides  New  York  and  Brook- 
lyn, and  a  total  of  seventy  stores,  sixty  of  them 
under  chain  management,  were  included  in  this 
investigation.  The  plan  and  general  jiolicy  of 
the  stores  are  described  and  the  \'arious  require- 
ments made  of  employees,  wages,  etc.,  are 
recorded.  Data  are  jiresented  in  respect  to 
2,626  employees,  of  whom  2,325  are  women. 
Thirty  per  cent,  of  the  total  number  of  women 
were  working  on  a  part-time  basis,  and  among 
these  there  were  many  school  girls  —  in  New 
York  City  one-fourth  of  the  jiart-time  workers 
being  of  this  class. 

As  to  physical  conditions  of  work,  fourteen  of 


the  stores  had  a  main  floor  and  basement,  and 
in  some  cases  ventilation  in  the  basement  was 
poor.  Most  of  the  stores  had  drop  seats  behind 
the  counters.  Nine  stores  had  special  drinking 
water  stands  or  bubblers.  Toilet  facilities  were 
fairly  good,  although  "the  basement  wash-  and 
toilet-rooms,  which  were  found  in  21  stores, 
were  poorly  liglitcd  and  ill-ventilated  places." 
Seven  establishments  provided  a  common 
roller  towel.  Ten  jirovided  no  rest  room.  Seven- 
teen of  the  rest  rooms  were  in  the  ba.sements, 
many  of  them  ])oorly  ventilated.  Twenty-nine 
stores  had  rest  rooms  above  the  main  floor.  One 
chain  had  made  an  effort  as  a  management 
policy  to  see  to  it  that  employees  had  not  only 
sanitary  but  also  comfortable  rest  rooms. 
The  regular  working  hours  of  98  per  cent,  of 


ABSTRACTS 


219 


the  women  were  less  than  the  legal  maximiini, 
which  is  fifty-four  hours  a  week.  Of  the  seventy 
stores,  twelve  closed  every  day,  except  Satur- 
day, at  5.30  P.M.,  and  fifty-five  closed  at  6.00 
P.M.  The  closing  time  of  forty-nine  stores  on 
Saturday  was  9.00  p.m.  or  later,  twenty-one 
keeping  open  imtil  10  p.m.  Sixteen  per  cent,  of 
the  women  were  found  to  be  working  eleven 
hours  on  Saturday.  No  store  had  rcguhir  rest 
times  for  its  emj)loyees,  except  tluring  the  meal 
hours.  In  some  cases,  where  there  was  a  heavy 
noon  trade,  some  of  the  workers  were  obliged  to 
go  to  the  mid-day  meal  as  early  as  10.45  A.^r. 

Of  all  the  full-time  women  workers,  one-half 
received  less  than  $13.49  a  week,  and  two- 
thirds  less  than  $15.00.  Of  the  whole  number  of 
full-time  women  workers,  1,'-.J98  were  sales 
clerks,  receiving  a  "flat  wage."  The  largest 
group  of  saleswomen  received  ^I'-i.oti,  and  half 
received  less  than  $12.91.  A  very  large  per- 
centage of  the  .salaries  ])aid  fall  below  the 
mininuun  standards  of  cost  of  living  for  New 
York,  according  to  available  figures. 

Some  other  topics  arc  mentioned,  for  ex- 
ample, food  handling  by  the  5  and  10  cent 
stores,  a  subject  which  a])i)areiitly  needs  fur- 
ther attention.  The  i)aper  contains  nineteen 
charts  and  tables.  —  G.  E.  Partridge. 

The  Relation  of  Child  Labour  to  Child 
Health.  Arthur  Butler  Chandler.  Pub.  Health 
Jour.,  Sept.,  lO-^l,  VI,  No.  9,  397-401.  — We 
must  not  lay  too  much  stress  on  the  physiologic 
damages  \\TOught  by  child  labor,  for  even  with- 
out these  the  mental  and  moral  effect  of  child 
labor  is  bad  enough  to  warrant  its  ])n)liibitioii. 
It  must  be  remembered  that  a  child  is  in  "j^roc- 
ess  of  constant  physical  formation"  and  variety 
in  his  daily  life  is  necessary. 

"Fourteen  years  must  be  the  miniimnn  for 
all  kinds  of  employment,  including  farm  labour 
and  domestic  service.  Sixteen  years  should  be 
the  mininuun  where  the  work  entails  any  haz- 
ard, and  eighteen  years  for  those  occupations 
which  are  extra  hazardous." 

Forbidden  occupations  should  include  the 
following : 

"1.  Processes  involving  exposure  to  poi- 
sonous dust,  e.  (J.,  the  manufactiue  of  paint  or 
phunbing  supplies,  typesetting,  file-cutting, 
certain  occupations  in  the  manufacture  of  rub- 
ber and  storage  batteries. 

"2.  Processes  mvolvmg  exposure  to  irritant 
dust,  e.  g.,  (1)  graphite  dust  as  used  in  stove 
polish;  (2)  bronzing  in  lithographing;  (3)  cut- 


ting, grinding  or  polishing  with  emery;  (4)  talc 
dusting  in  rubber  works;  (5)  sorting,  dusting, 
cutting  or  grinding  rags;  (6)  all  work  in  and 
about  mines. 

"3.  Processes  involving  exposure  to  poi- 
sonoiis  gases  and  fumes,  e.  g.,  using  naphtha  in 
the  manufacture  of  rubber  goods,  japanned  or 
patent  leather;  gases  from  lead  processes. 

"4.  Irritating  gases  and  fumes,  e.g.,  (1)  gas- 
sing in  textile  factories;  ('■2)  singeing  in  i)rint 
works,  bleaching  and  dyeing  works;  (3)  di])i)ing 
metal  in  acid  .solution. 

"5.  Expo.surc  to  extremes  of  heat  and  other 
conditions  wliicii  i)roniote  susce])tibility  to 
disease. 

"A  glance  at  our  school  children  only  serves 
to  strengthen  the  ca.se  against  child  laboiu-. 
There  is  no  (iis])utiiig  the  fact  that  251  per 
cent,  of  all  sciiool  children  arc  suffering  from 
malnutrition.  ...  As  the  worst  school  is 
safer  for  the  child  than  the  best  factory  one 
might  well  indict  all  child  labour  as  being  unfit 
for  a  child."  —  M.  Dent. 

The  International  Labour  Office  and 
the  Protection'  of  Children.  Internat. 
Labour  Rev.,  July-August.  1921,  3,  Nos.  1-2, 
3-25.  —  This  article  contains,  for  the  most 
part,  historical  data  in  regard  to  the  protection 
of  chililren  in  iiulustry,  brought  together  espe- 
cially with  reference  to  the  jjrotection  of  child 
labor  by  the  International  Labour  Office,  under 
whose  jurisdiction  this  problem  is  plainly 
thought  to  come.  An  account  is  given  of  the 
work  of  the  first  International  Labour  Con- 
ference which  was  held  at  Berlin  in  1890,  and 
of  the  conference  at  Zurich  in  1912. 

The  Paris  Conference  for  the  preparation  of 
the  Peace  Treaty,  in  January,  1919,  set  up  a 
commission  especially  entrusted  with  preparing 
the  articles  of  the  treaty  dealing  with  labor 
problems,  and  the  Preamble  of  Part  XIII  pro- 
vides for  the  protection  of  children,  yoimg  per- 
sons and  women.  The  agenda  of  the  first  Inter- 
national Labour  Conference  following  the  war, 
that  of  October,  1919,  included  several  items 
relating  to  children  and  similar  consideration  of 
the  problem  of  the  protection  of  motherhood. 
Three  questions  were  brought  up:  minimimi 
age  for  industrial  employment;  night  work; 
and  unhealthy  work.  The  Washington  Con- 
ference decided  unanimously  to  place  the  age 
limit  at  14  years,  India  being  made  an  excep- 
tion. The  minimum  age  for  night  work  was 
fixed  at   18  years,   although  exceptions  were 


220 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


allowed  to  Japan  and  India.  Since  complete 
information  was  lacking  on  the  subject  of  un- 
healthy employments,  nothing  further  was 
done  than  to  ask  for  the  prohibition  of  employ- 
ment of  women  and  young  persons  under  18 
in  a  number  of  occupations  employing  lead  and 
lead  compounds. 

The  history  of  national  action  upon  the 
recommendations,  etc.,  of  the  conference  is 
given  liriefly.  There  is  a  record  of  the  decision 
of  the  conference  to  refer  problems  of  work  at 
sea  to  a  special  conference,  and  information  is 
given  in  regard  to  the  treatment  of  these  prob- 
lems up  to  the  present. 

The  notable  advance  in  international  legisla- 
tion, the  wide  area  over  which  recommenda- 
tions are  now  operative,  and  the  reciprocal 
treatment  granted  between  states  are  com- 
mented on.  —  G.  E.  Partridge. 

Enforcement  of  Child  Labor  Laws  in 
West  Virginia.  Ethel  H.  Vaii  Bitskirk.  Am. 
Child,  Aug.,  1921,  3,  No.  2,  123-151.  —  This  is 
a  report  of  an  investigation  carried  on  in  eight 
cities  of  West  \'irginia,  during  which  the  records 
of  2,780  children  were  examined,  and  about  200 
children  interviewed. 

Dm-ing  the  first  eighteen  montlis  of  the  opera- 
tion of  the  law  (May  11,  1919  to  Novemljer  30, 
1920),  about  3,900  children  between  the  ages  of 
12  and  16  received  jjcrniits  to  go  to  work.  The 
chief  industries  employing  children  are  the 
glass,  pottery,  laundry,  furniture  and  wood- 
carving,  cigar,  cigarette,  stogie  or  some  branch 
of  the  tobacco  industry,  stamping,  tool  and 
sanitary  works,  telegraph  companies,  depart- 
ment stores,  markets,  bowling  alleys,  restau- 
rants, printing  offices,  and  shoe  shining  parlors. 
In  general,  children  are  engaged  in  mechanical 
and  automatic  work. 


Investigation  as  to  the  extent  to  which  the 
regulations  of  state  and  federal  law  were  carried 
out  showed  that  the  weakest  point  is  in  respect 
to  physical  fitness  for  a  specified  occupation.  In 
some  places  jihysical  examination  was  omitted 
entirely,  and  physicians  comjilain  that  there 
are  no  standards  and  no  way  of  knowing  the 
character  of  a  child's  prospective  employment 
or  environment.  There  was  found  conflict  of 
legal  responsibility,  and  confusion,  especially  in 
the  matter  of  special  permits;  a  curious  situa- 
tion existed,  due  to  the  fact  that  children  under 
14  niay  be  allowed  to  work  during  the  school 
term  after  school  hours,  who  cannot  legally 
work  during  the  summer  vacation. 

Of  the  200  children  interviewed,  only  thirty- 
eight  were  actually  working  legally  —  that  is, 
had  met  the  rec[uirements  for  a  jjermit  and 
were  working  in  accordance  with  lioth  federal 
and  state  laws,  ^'iolations  were  of  various 
kinds,  but  the  most  serious  and  frequent  were 
in  cases  in  which  children  between  12  and  16 
years  of  age  were  working  in  forbidden  indus- 
tries or  were  working  overtime. 

Several  recommendations  are  made  for  im- 
proving the  situation:  strict  supervision  of  local 
l)ermit-issuing  offices  by  inspectors;  appoint- 
ment of  additional  labor  inspectors,  one  of 
whom  shovdd  be  a  woman;  establishment  of 
standards  of  health  fitness;  drastic  prosecutions 
for  emjiloying  children  mider  12  years  of  age 
and  for  employing  children  between  12  and  16 
years  more  than  eiglit  hours  a  day  or  in  night 
work.  It  is  also  recommended  that  special  ])er- 
mits  for  boys  under  14  be  abolished,  a  penalty 
established  for  non-attendance  at  school  of 
children  ])etween  14  and  16,  and  a  penalty  for 
violating  the  law  (to  be  effective  in  July,  1922) 
compelling  the  establi.shmcnt  of  part-time 
schools  or  classes.  —  G.  E.  Partridge. 


INDUSTRIAL  SANITATION:   FACTORY  CONSTRUCTION   ILLUMINATION 
VENTILATION,  HEATING,  WATER  SUPPLY,  SEWAGE  DISPOSAL 


Paint  as  an  Accident  Reducer.  Gardner 
Tillinyhast.  Safety  Engin.,  Aug.,  1921,  42,  No. 
2,  59-60.  —  From  insurance  figures,  the  im- 
perfect light  through  ])oor  diffusion  from  walls 
and  ceilings  not  painted  white  is  the  cau.se  of 
numerous  industrial  accidents.  A  workman 
fatigued  because  of  poor  light  is  more  careless, 
and  statistics  show  that  the  majority  of  acci- 
dents occur  then.  Managers  and  owners  realize 
the  advantage  of  white  paint  on  ceilings  and 


walls  as  a  light  reflector  in  reducing  accidents, 
creating  contentment  and  doing  away  with  the 
greatest  enemy  of  the  inside  workman  —  fac- 
tory fatigue,  the  indirect  cause  of  many  acci- 
dents oliierwise  classified. — R.  M.  Thomson. 


The  Eye  Is  Mightier  than  the  Hand. 
Archibald  V.  Reid.  Safety  Engin.,  Aug.,  1921, 
42,  No.  2, 58-59.  —  This  short  article  deals  with 


ABSTRACTS 


221 


the  advantage  of  good  lighting  and  painting  in 
modern  establishments.  Brighter  surroundings 
given  by  proper  lighting  and  suitable  coatings 


for  floors,  walls,  ceilings  and  equipment,  will 
relieve  eyestrain  and  increase  the  efficiency 
and  morale  of  employees.  —  R.  M.  Thomson. 


INDUSTRIAL  MEDICAL  SERVICE:   MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


The  Consultant  in  Industrial  Medical 
Service.  Wade  Wright.  Nation's  Health, 
Sept.  15,  1!>21.  3,  No."  9,  508-509.  —  "Indus- 
trial health  is  .so  nearly  identical  with  public 
health  tliat  it  would  seem  as  if  industrial  hy- 
giene were  properly  a  unit  of  the  connnunity 
health  service.  The  fact  remains,  however, 
that  in  few  communities  has  medical  organiza- 
tion developed  clliciciit  means  of  recognizing 
and  prom])lly  treating  iiicii)icnt  di.sea.se.  If 
such  service  is  desired  in  in(histry,  industry 
must  provide  it. 

"The  character  of  a  community  is  governed 
largely  by  industrial  conditions  and  tiirougli 
such  means  as  the  physical  examination  of 
labor,  the  periodic  re-examination  of  employees 
.  .  .  tiie  development  of  good  will  and  con- 
fidence of  workers  in  the  medical  department 
and  the  con.seciuent  appeal  for  the  a<lvicc  of  I  lie 
plant  physician,  .  .  .  are  .afforded  imlimited 
<)]i|)ortunities  for  constructive  healtii  work. 

"Service  of  this  ciiaracter  can  oidy  be  ren- 
dered by  alile  |)crs()iinel  and  it  is  economic  folly 
for  the  administration  of  an  industrial  organ- 
ization to  believe  that  practically  any  doctor  or 
any  mu'se  can  be  deijcuded  u])on  to  do  work  of 
a  satisfactorily  high  standard.  The  interests  of 
successful  industrial  physicians  and  nurses  can- 
not be  their  own  interests  or  the  company's 
interests,  but  rather  a  ju.'jt  mingling  of  the 
com])any"s  interests  with  those  of  the  |)atients 
who  cDine  to  them  for  professional  service.  .  .  . 
Competent  physicians  cannot  be  secured  unless 
their  compensatiou  be  roughly  commensurate 
with  their  worth. 

"(iood  industrial  metlical  service  is  not  to  be 
had  cheaply,  yet  it  seems  that  it  is  worth  wiiat 
it  costs  and  more,  for  ill  health  is  so  costly.  .  .  . 
Establishments  installing  medical  service  do  not 
abandon  it.  Tiiey  may  reduce  it  in  times  of  de- 
pression, but  the  tendency  is  almost  invariably 
toward  development,  toward  an  increase  in 
the  range  of  health  department  activities."  — 
Katherine  R.  Drinker. 

Production  Manager's  Interest  in  In- 
dustrial Health.  J.Spence.  Nation's  Health, 


Sept.  15,  1921,  3,  No.  9,  506-507.  —  In  the  gen- 
eral business  retrenchment,  the  shop  doctor  and 
the  hospital  will  be  closely  examined  to  prove 
their  value.  Experience  has  shown  tliat  they 
are  important  parts  of  the  industrial  organiza- 
tion. Industrial  medical  service  has  done  more 
than  introduce  sanitary  treatment  of  injuries; 
it  has  also  |)layed  an  imjjortant  ]iart  in  promot- 
ing the  proper  sJio))  s|)irit.  To  l)e  successful,  a 
liiant  iiiiysician  nuist  have  al)ility  as  an  organ- 
izer and  leader;  otherwise  he  will  not  be  able  to 
enlist  the  co-operation  of  foremen  in  furthering 
l>lans  for  tiie  execution  of  wiiich  the  foreman's 
sym])atiiy  is  essential.  In  general.  ])aternalisra 
is  not  good  in  industry,  but  re-examination  of 
men  who  are  failing,  investigation  of  ab.sen- 
teeism  and  advice  when  needed  are  desiraljie. 

Departments  having  to  do  with  sanitation, 
.safety  and  health  are  .so  closely  related  that 
when  the  right  medical  director  can  be  found, 
they  should  come  under  the  same  head.  ]\Iore- 
over,  the  director  should  be  conceriuvl  with  wel- 
fare work  and  bettering  living  conditions  in 
general.  The  medical  service  i)ays  for  itself  in 
jjroductive  hours  and  in  the  saving  of  turnover, 
and  it  is  es])ecially  u.seful  in  the  preservation  of 
the  health  of  important  men  who  are  valuable 
and  who,  because  of  great  skill  and  expert 
knowledge,  cannot  be  .spared. 

The  attitude  of  the  shop  doctor  necessarily 
is  different  from  that  of  the  private  practi- 
tioner. He  is  able  to  follow  up  his  cases  more 
thoroughly  and  he  is  affected  by  the  spirit  of 
co-operation.  Figures  (for  the  Norton  Grind- 
ing Company)  show  that  the  entire  cost  of  ho.s- 
pital  work  is  only  three-tenths  per  capita  of 
what  is  paid  for  shop  cleaning.  "Both  are 
necessary,  and  both  in  the  long  run  pay  divi- 
dends." —  G.  E.  Partridge. 

Practices  and  Fitnctions  of  the  Medical 
Department.  Robert  E.  Andrews.  Indust. 
Management,  Oct.,  1921,  62,  No.  4,  206-211.  — 
Dr.  Andrews  gives  a  very  detailed  outline  of  the 
highly  organized  medical  department  of  the 
Ludlow  Manufacturing  Associates,  where  the 
routine  procedure  is  worked  out  to  the  minutest 


QQQ 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


detail.  Each  applicant  for  employment  is  given 
a  physical  examination  by  the  physician  to 
determine  whether  he  is : 

"  (Ifl)  Fitted  for  any  hut  a  dusty  job. 
"  (16)   Fitted  for  any  but  a  wet  job.    . 
"(Ic)    Fitted   for   any   but   a   weight-lifting 
job." 

All  the  data  from  this  examination  are  care- 
fully filed  away  and  are  used  for  comparison 
with  later  health  records  of  the  particular  in- 
dividual, thus  "serving  as  a  basis  for  the  study 
of  the  effect  of  the  job"  on  his  health. 

Surgical  cases  are  given  free  treatment,  either 
hospital,  consulting  or  special  treatment.  Con- 
sultation cases,  common  medical  and  surgical 
supplies  are  free;  glasses  are  furnished  at  cost. 
A  system  of  passes  and  cards  has  been  worked 
out  to  prevent  malingering  and  loafing  of  the 
employee  between  the  mill  and  the  clmic. 
Cards  are  made  out  by  the  foreman  with  the 
time  the  employee  left  the  mill  stated  thereon, 
and  must  be  presented  on  his  arrival  at  the 
clinic.  Until  the  foreman  receives  notice  from 
the  clinic  he  continues  to  send  that  particular 
employee  to  the  clinic  regularly  for  treatment. 
Passes  to  leave  the  grounds  must  be  applied  for 
to  the  physician  by  the  employee  desiring 
them.  Wages  are  paid  to  employees  taking 
time  off  to  attend  the  medical  clinic,  and  to 
those  sent  home  on  accoxmt  of  sickness  or  injiu-y 
up  to  the  time  the  pass  is  issued  to  go  home. 

A  convenient  first-aid  room,  with  only  suffi- 
cient equipment  for  first  aid  and  redressings, 
is  maintained  in  a  plant  which  is  too  far  away 
from  the  regular  clinic.  In  the  same  mill  a  rest 
room  is  provided  for  women  employees.  There 
is  also  a  prenatal  clinic  for  the  entire  plant.  No 
woman  is  allowed  to  work  beyond  the  seventh 
month. 

"The  most  important  problems  which  the 
plant  physician  has  had  to  meet  "  are  not 
those  of  consultation  and  treatment,  but  of 
gaining  the  co-operation  of  all  the  other  de- 
partments of  the  ])laiit.  This  has  been  under- 
taken with  the  ultimate  aim  of  more  efficient 
and  increased  production  at  lower  cost,  through 
the  service  of  the  medical  department.  It  has 
been  essential  to  arrange  that  employees  at  all 
times  have  easy  access  to  the  clinic.  All  red 
tape  and  paper  work  have  been  reduced  as  far 
as  possible.  Tactful,  friendly,  helpful  relation- 
ships have  been  instituted,  based  on  a  study  of 
the  characteristics  and  mental  attitude  of  the 
employees,  especially  of  the  foreign  born."  — 
M.  Dent. 


St.  Louis  Southwestern  Railway  Med- 
ical Service.  ^4.  E.  Chace.  Nation's  Health, 
Sept.  15,  1921,  3,  No.  9,  515-518.  —The  med- 
ical service  of  the  St.  Louis  Southwestern  Rail- 
way is  one  of  the  oldest  industrial  medical 
organizations  in  the  country,  having  been 
founded  in  1887.  At  the  present  time  10,000 
employees  are  provided  for,  and  to  meet  the  in- 
creasing demands  a  new  hospital  has  been  built 
with  a  capacity  for  treating  200  patients.  Be- 
sides the  central  hospital  the  railway  maintains 
fifteen  emergency  stations  and  eighty  part- 
time  physicians.  All  baggage  cars  are  provided 
with  cots  or  stretchers,  and  first-aid  material 
is  kept  ready  for  distribution. 

Funds  for  the  support  of  the  medical  depart- 
ment are  derived  from  two  sources — the  com- 
pany, which  provides  for  the  capital  expenses 
and  any  deficit  in  running  expenses,  and  the 
employees,  who  contribute  funds  for  operation, 
on  a  basis  of  salary  earned.  The  right  of  em- 
ployees as  regards  the  service  are  clearly  de- 
fined, and  the  work  is  systematically  regulated. 
There  is  a  sanitary  engineer,  with  a  corps  of 
assistants,  reporting  directly  to  the  president 
and  having  charge  of  such  work  as  malaria  con- 
trol, water  supplies,  sanitation  and  inspection. 
A  superintendent  of  safety,  reporting  to  the 
vice-president  in  charge  of  operation,  has  over- 
sight in  the  shops  and  on  the  line. 

Examination  of  applicants  is  thorough  and 
complex.  It  involves  job  analysis,  psychological 
tests,  estimation  of  moral  risk,  complete  rec- 
ords, advice,  and  follow-up  work.  Re-exam- 
ination is  made  every  three  months  of  food 
handlers  and  of  those  whom  it  is  thought  neces- 
sary to  watch.  Venereal  cases  are  treated  free  at 
the  hospital,  and  are  subjected  to  special  rules. 
Most  dental  work  is  also  free. 

"This  medical  department  is  in  the  stage  of 
transition  from  the  better  class  of  medical  and 
surgical  work  in  industry  to  the  highly  tech- 
nical combination  which  we  all  hope  will  be 
better  appreciated  by  all  industry  in  the  near 
future."  —  G.  E.  Partridge. 

The  Medic^vl  Department  PRO^'ES  its 
Value.  J.  A.  Robertson.  Nation's  Health, 
Sept.  15,  1921,  3,  No.  9,  509-510. —  In  this 
article  Mr.  Robertson,  the  manager  of  the 
Camera  Works  of  the  Eastman  Kodak  Com- 
pany, sketches  briefly  the  introduction  into  and 
the  development  of  the  industrial  medical  serv- 
ice in  the  company.  First  came  a  safety  com- 
mittee,   next    a   part-time,    then    a   full-time 


ABSTRACTS 


223 


doctor,  next  additional  doctors,  nurses  and  at- 
tendants, and  finally  in  May,  1920,  the  estab- 
lishment of  health  benefits  paid  during  illness 
and  in  proportion  to  length  of  service.  Mr. 
Robertson  emphasizes  the  belief  of  the  East- 
man Kodak  Company  in  its  medical  service  as 
a  paying  projjosition  and  as  a  valuable  asset  in 
the  development  of  "real  red-blooded  citizens." 
—  Katherine  R.  Drinker. 

Medical  Service  as  Affecting  Lvdistrial 
Rel.\tions.  Howell  Cheney.  Nation's  Health, 
Sept.  1.5,  19-21,  3,  \o.  9,  51-2-5U.  —  In  this 
article  Mr.  Cheney  discusses,  from  the  i)oint  of 
view  of  the  industrial  physician,  of  the  worker, 
and  of  the  employer,  the  situation  in  which  in- 
dustrial medieval  .service  finds  itself  today,  and 
the  direction  in  which  it  is  going.  Guide  posts 
along  the  road  of  i)rogress  are  the  insurance  of  a 
personal  relation  between  the  physician  and  the 
patient  —  a  relation  in  which  all  communica- 
tion from  the  patient  to  the  |)liysician  is  invio- 
late—  and  the  jjreservalion  of  friendly  rela- 
tions between  the  industrial  physician  and  his 
fellow  j)ractitioners.  The  employer  nuist  keep 
it  clearly  in  mind  that  society  insists  more  and 
more  that  he  can  use  his  capital  to  make  a  profit 
only  so  long  as  he  does  not  injure  the  com- 
munity or  his  fellow-man. 

Tlie  load  whic-h  indnstrial  medicine  has  to 
carry,  according  to  Mr.  Cheney,  includes:  "  (1) 
examinations  for  employment;  ('•2)  the  first  aid 
treatment  of  all  minor  disabilities  occurring 
witiiiu  the  plant;  (3)  the  entire  treatment  of  all 
industrial  accidents;  (4)  a  far  more  thorough 
examination  and  research  into  all  of  the  pro- 
duction problems  connected  with  health  that 
are  becoming  more  and  more  important  to  the 
industrial  capacities  of  our  plant;  (,>)  life  ex- 
tension work  .  .  .  ;  and  (6)  finally,  the  medical 
administration  of  mutual  benefit  or  fraternal 
associations.  They  especially  have  been  a  con- 
stant force  for  education  in  helping  to  carry  all 
of  the  various  parts  of  the  program." 

Mr.  Cheney  next  discusses  the  types  of 
vehicle  used  to  carry  this  load  —  first,  the  part- 
time  physician  whom  he  pronounces  a  failure; 
and  second,  the  full-time  physician,  who,  in 
order  to  be  successful,  must  recognize  clearlj-  his 
relations  to  the  industry  and  his  relations  to  the 
employee,  and  must  make  no  effort  to  treat 
bedside  cases  or  cases  of  acute  illness.  Mr. 
Cheney  says: 

"We  must  offer  every  facility  for  diagnosis 
and  for  consultation  but,  except  in  the  treat- 


ment of  ambulatory  cases,  our  whole  effort 
must  be  to  give  the  actual  care  of  acute  illness  to 
the  family  physician.  That  is  the  only  possible 
way  in  such  cases.  It  is  the  only  way  in  which 
all  of  the  parts  of  the  treatment  of  the  case  can 
be  covered.  No  one  in  industry  has  yet  any 
conception  of  the  possibility  of  taking  on  the 
whole  load  of  medical  treatment.  .Vs  I  look  on 
it,  it  is  impossible  from  either  a  social  or  an  eco- 
nomic point  of  view. 

"There  is  a  third  vehicle  —  suggested  by  the 
valuable  work  that  the  Life  Extension  Institute 
has  done  —  of  an  association  of  pliysicians 
offering  their  services  to  both  employers  and 
employees,  combining  in  one  co-ojierative 
association  all  the  most  highly  developed  diag- 
nostic aids  available,  which  jjrobably  would  be 
beyond  the  reach  of  any  single  piiysician;  often, 
by  calling  in  a  specialist  in  consultation  for 
special  cases,  dividing  the  expense,  which  at 
])resent  is  a  difficult  matter  to  divide.  But,  on 
tlic  whole,  the  part  that  can  be  charged  to  the 
employer  is  becoming  plain.  He  nmst  pay  for 
the  examinations  for  employment,  for  the  cost 
of  accidents,  and  for  the  most  valuable  work  in 
research.  He  can  afi'ord  to  |)ay  a  large  ])art  of 
tlic  burden  of  exi)ense  for  capital  equipment, 
but  when  it  comes  to  the  burden  of  individual 
treatment  of  sickness,  that  nmst  be  borne  by 
the  individual  patient.  But  you  indnstrial  phy- 
sicians can  make  it  possible  for  the  day  laborer 
to  have  every  diagnostic  facility  and  to  have 
within  his  call  specialists  for  consultation. 
When  you  have  done  that,  yon  will  have  solved 
the  relationship  with  the  indivitlual,  as  you 
have  already  solved  the  relationship  with  the 
industry." 

The  article  concludes  with  a  brief  discussion 
of  the  goal  of  industrial  medicine.  —  Katherine 
R.  Drinker. 

The  Industrial  Medical  Department  of 
the  Future.  A.  E.  Cliace.  Jour.  Ark.  Med. 
Soc,  Sept.,  1921,  17,  No.  4,  81-83.  — The  au- 
thor believes  that  the  work  to  be  done  by  the 
medical  department  varies  with  the  character 
of  the  industry  and  the  management,  but  that 
in  order  to  accomplish  this  work  the  four  essen- 
tial requirements  are: 

1.  Adequate  means  of  financing  the  work. 

2.  The  best  modern  technic  should  be  used 
in  the  work. 

3.  The  records  should  be  complete  and  "so 
summarized  as  to  be  profitable." 

4.  The  department  should  be  used  "as  a 


224 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


teaching  institution  to  give  esprit  dii  corps  and 
incentive  to  tlie  workers  and  to  further  the 
legitimate  aims  of  industrial  medicine  and 
surgery." 

Each  of  these  suggestions  is  dealt  with  in  full 
and  the  following  summary  is  given : 

"If  all  industry  is  organized  in  some  such 
manner  as  I  have  outlined,  what  is  to  become 
of  the  physician  in  private  practice?  Last  fall, 
at  Montreal,  Dr.  Will  Mayo  said  something  to 
the  effect  that  group  meilicine  must  come  or  the 
physician  would  lose  his  caste,  if  not  his  income. 
Is  not  this  another  way  of  saying  that  the  phy- 
sician must  cease  to  be  a  social  hermit  and  be- 
come a  component  part  of  our  social  structure? 
Social  structure  in  the  sense  of  co-operative 
effort  for  the  community. 

"Medical  literature  has  been  glutted  with 
what  surgeons  have  learned  from  the  war,  or 
how  little  we  have  learned.  Of  one  thing  there 
can  be  no  doubt  —  we  did  learn  co-operation. 
Industry  learned  the  value  of  co-operative 
effort  in  medicine  and  surgery.  We  have  al- 
ready forgotten,  many  of  us,  this  lesson.  In- 
dustry never  will.  Industry  requires  money, 
and  those  who  have  the  handling  of  it  have 
learned  that  lesson  for  all  time.  The  healthy 
community  is  the  prosperous  one.  The  healthy 
industrial  personnel  is  the  efficient  one.  Both  of 
these  ideals  will  be  served  by  the  correlated 
work  of  physicians  and  sm-geons,  who  have  for- 
gotten the  small  things  and  grasped  the  big 
opportunity  for  .service,  taking  with  them  those 
scientists  whose  labor  is  essential  to  the  jjur- 
pose."  — M.  C.  Shorley. 

A  Room  that  Stops  Sneezing.  Sanjord  De 
Hart.  Factorj',  Oct.,  19-21,  "21,  No.  4,  48^2-483. 
—  There  is  more  time  lost  in  industry  from  the 
common  cold  than  from  any  other  one  cause. 
Every  plant  has  this  proljlem  to  deal  with  and 
the  R.  K.  Le  Blond  Machine  Tool  Company 
has  solved  it  by  installing  in  its  hospital  a  nose 
and  throat  room  which  is  used  prmiarily  for  the 
treatment  of  colds,  sore  throats,  stiff  necks  and 
kindred  diseases. 

"The  equipment  consists  of  a  tankless  com- 
pressed air  apparatus  with  six  atomizers  and  a 
high  frecpiency  apparatus  with  special  surface 
and  inlernal  electrodes  for  all  parts  of  the  body. 
The   atomizing   apparatus   and   the   high   fre- 


quency apparatus,  together  with  the  com- 
pressed air  pump,  are  combined  in  one  cabinet 
and  operated  on  a  110- volt  direct  current.  The 
atomizer  solutions  are  largely  alkalines,  and  are 
used  for  spraying  the  nose  and  throat.  The 
high  frequency  apparatus  is  applied  to  painful 
areas  of  rheumatic  or  neuralgic  origin." 

No  man  is  treated  who  has  any  elevation  of 
temperature  as  he  is  looked  upon  as  a  possible 
focus  of  infection  to  fellow  employees,  and  he 
is  advised  to  go  home  and  see  his  doctor.  "A 
man  with  a  cold  wants  immediate  relief  or  he 
goes  home"  which  is  just  what  the  company 
does  not  want  if  he  is  well  enough  to  work,  and 
by  urging  every  man  with  a  cold  to  come  to  the 
nose  and  throat  room  this  company  was  able 
to  cut  absenteeism,  during  the  influenza  epi- 
demic, "down  to  9  per  cent,  of  our  total  work- 
ing force,  while  some  other  plants  had  as  high 
as  50  per  cent,  absent."  —  M.  Dent. 

Dental-Oculist  Service  for  Workers. 
L.  E.  Hastings.  Hosp.  Management,  Sept., 
19^21,  12,  No.  3,  72,  74.  —  Dr.  Hastings  out- 
lines the  growth  of  the  dispensary  of  the  J.  G. 
Brill  Company  of  Philadelphia  from  its  be- 
ginning, in  1913,  as  a  first-aid  room  in  charge  of 
a  part-time  physician  and  a  full-time  assistant 
up  to  the  j)resent  time  when  the  personnel  com- 
prises a  dentist,  a  physician,  a  graduate  nurse, 
and  a  clerk.  A  report  of  the  work  of  the  dis- 
pensary during  the  past  four  and  a  half  years  is 
included  which  shows  a  notable  reduction  in  the 
number  of  accidents  and  in  time  lost.  —  M.  C. 
Shorley. 

Per.sonal  Call  on  Employees.  W.  T. 
Barbour.  Hosp.  Management,  Sept.,  1921,  12, 
No.  3,  80.  —  The  medical  service  of  the  Detroit 
Stove  Works  includes  first  aid  and  follow-up 
dressings  for  all  accident  cases,  or  hospital  care, 
if  necessary;  tcm])orary  care  for  all  cases  of 
illness  occurring  in  the  factory,  followed  by 
care  at  home,  to  see  if  the  patient  is  receiving 
proper  medical  attention.  One  of  the  impor- 
tant duties  of  the  nurse  who  is  in  charge  of  the 
department  is  to  call  ui)on  each  em])loyee  in  his 
home  for  the  i)urpose  of  investigating  his  living 
conditions  and  his  ajjparent  circumstances. 
A  co])y  of  the  blank  used  for  recording  this  in- 
formation is  included.  — M.  C.  Shorley. 


ABSTRACTS 


lOr, 


INDUSTRIAL  PSYCHOLOGY  AND  INDUSTRIAL  I^IANAGEMENT 
IN  ITS  HEALTH  RELATIONS 


Scientific  Method  ix  Job  Analysis.  //.  D. 
Kitson.  Reprinted  from  Jour.  Pol.  Econ., 
June,  1921,  29,  No.  6,  508-514.  —  Usually  joh 
analysis  is  crudely  done,  and  consists  of  a 
rough  ob.servation  hy  the  employment  manager 
in  consultation  with  the  foreman,  master  me- 
chanic or  expert  operator.  Tlie  unit  ojjerations 
thus  found  are  written  up  in  tlic  form  called 
job  specification. 

Suggested  improvements  are  two:  thai  ob- 
servations should  be  more  accurate  and  minute; 
and  that  they  should  be  rcjjcatcd  luidcr  con- 
tniilcd  conditions  giving  (luantitative  results. 
Thus  far  only  one-half  of  the  jiroblem  luis  been 
attended  to  —  the  analysis  of  individuals  to 
deteriuine  thcir(|ualifi(ati(>ns  in  terms  of  general 
infcliigcucc,  s|)C(ial  abilities,  etc. 

To  illustrate  tiie  methods  of  scientific  job 
analysis,  a  brief  reiK)rt  is  made  of  a  sIikIv  of 
some  of  the  proce.s.ses  of  jiroof  reading.    'l'al)lcs 


show  the  amount  of  work  done  by  eleven  work- 
ers, and  the  fre<|uency  of  errors;  and  a  method 
used  for  studying  eye  movements  is  described, 
with  some  graphic  records.  From  all  this  some 
of  the  qualities  of  a  good  proof  reader  as  com- 
pared with  a  poor  one  are  determined. 

Such  detailed  analy.ses,  the  writer  says,  may 
l)e  used  by  the  employment  nuinager  to  sup])le- 
mcnt  the  measurements  made  of  applicants, 
furnishing  an  intelligible  and  concrete  jjattern 
into  which  the  analyzed  abilities  of  the  a|)pli- 
cant  may  be  fitted;  tiie  educational  director 
nuiy  u.se  the  results  in  training  new  workers; 
the  production  manager  may  use  this  method 
in  discovering  the  wastes  in  oi)erations  ami  so 
devise  more  efhcient  metiiods  of  work;  and, 
finally,  the  co.st  accountant,  with  the  measure- 
ments of  the  factors  of  a  job  at  hand,  may  make 
better  estimates  of  tlie  cost  of  new  joI)s  ai)out  to 
be  contracted  for.  —  G.  E.  Tarlridge. 


INDUSTRIAL  HEALTH  LEGISLATION:    COURT  DECISIONS: 
WORKMEN'S  COMPENSATION  AND  INSURANCE 


Twenty-Ninth  Annual  Report  ok  the 
Maryland  State  Hoard  of  Labor  and 
St.\tisti(s,  1920.  Maryland  State  Hoard  of 
Labor  and  Statistics,  1921,  pp.  129.  — This  is  a 
rc|)()rl  of  the  enforcement  of  laws  relating  to 
ciiild  labor,  hours  of  emi)loyment  for  women, 
and  factory  and  mining  in.spection.  and  also 
contains  information  concerning  industrial 
registration,  employment  service,  strikes,  agri- 
culture, cost  of  living,  census  and  a  financial 
statement.  —  M.  Dent. 

Labour  Legisl.\tion  in  France  dirinu 
and  after  the  W.ui.  R.  Picard.  Internat. 
Labour  Rev.,  July-Aug.,  1921,  3,  Nos.  1-2.  27 
40. — This  article  reviews  the  legislation 
adopted  in  France  during  the  war  to  ])rovide 
exemptions  from  restrictions  on  hours  of  work, 
etc.;  the  later  reaction  toward  protection  and 
enforcement  of  regidations;  the  manner  in 
wdiich  the  unemployment  {)rol)lem  was  dealt 
with;  prevention  of  too  much  influx  of  foreign 
labor;  regulation  of  the  work  of  \vomen.  and 
the  efforts  to  reduce  to  a  minimum  the  amount 
of  women's  employment  in  munition  work; 
control  of  wages  paid  by  the  army  contractors; 


ami  encouragement  of  consumers'  co-operative 
societies.  There  is  al.so  a  brief  survey  of  the 
law  in  France  instituting  the  eight-hour  day 
and  affecting  the  .system  of  collective  bargain- 
ing, of  trade  unionism,  and  of  arbitration  com- 
mittees, and  there  is  a  coimnent  (m  the  present 
unfavorable  lack  of  ])rotcction  of  the  agricul- 
tural laborer  in  France,  who  is  not  included  in 
the  eight-hour  day  restriction.  The  most  im- 
I)orlant  feature  of  recent  legislation,  the  writer 
concludes,  is  the  attempt  that  is  made  to  bring 
in  the  worker  and  employer  to  help  in  the  work 
of  legislation,  "whether  by  consultation,  or  by 
entrusting  them  with  the  management  of  new 
institutions,  or  by  increasing  the  power  of  their 
organizations  and  allowing  them  to  fornndate 
their  own  laws."  —  G.  E.  Partridge. 

New  York  State  Workmen's  Compensa- 
tion Law,  with  Amendments,  Additions  and 
Annotations  to  September  1,  1921.  N.  Y. 
State  Dept.  Labor.  1921,  pp.  120.  —  This 
pamphlet  contains  the  New  York  State  Work- 
men's Compensation  law  amended  to  1921,  and 
includes  coverage  and  definitions,  compensa- 
tion, occupational  diseases,  insurance  methods 


326 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


and  regulations,  powers  and  duties  of  commis- 
sioner and  board,  custody  and  management  of 
state  insurance  fund,  miscellaneous  jjrovisions, 
repealed  laws,  and  also  an  "index  and  an  alpha- 
betical finding  list  of  employments  covered  by 
the  law."  —  M.  Dent. 


Flexion  Power  as  an  Index  to  Func- 
tional, Efficiency  in  the  Appraisement  of 
Disability  in  the  Upper  Extremity,  Re- 
sulting from  Industrial  Injuries.  Frank  L. 
Barnes.  Texas  State  Jour.  Med.,  Sept.,  1921, 
17,  No.  5,  247-249. —The  Workmen's  Com- 
pensation Law,  or  Employers'  Liability  Act,  of 
Texas,  makes  the  general  provision  that  "while 
the  incapacity  resulting  from  the  injury  is  total 
the  workman  shall  receive  60  per  cent,  of  lus 
average  weekly  wages,  but  not  more  than 
$15.00  per  week  nor  less  than  $5.00,  for  a  period 
not  greater  than  401  weeks  from  the  date  of  in- 
jury. When  the  incapacity  is  partial  or  be- 
comes partial,  his  weekly  compensation  shall 
be  equal  to  60  per  cent,  of  the  difference  be- 
tween his  average  weekly  wage  before  injury, 
and  his  average  weekly  earning  capacity  diu-ing 
the  existence  of  such  partial  incapacity,  in  no 
case  to  exceed  $15.00  per  week,  and  for  no 
greater  time  than  300  weeks.  The  period  of 
compensation  for  both  total  and  partial  dis- 
ability not  to  exceed  410  weeks  from  the  date 
of  injury." 

The  loss  of  both  hands  at  or  above  the  wrists 
and  a  similar  loss  of  one  hand  and  one  foot  are, 
according  to  the  law,  total  and  permanent  in- 


juries. In  the  case  of  certain  other  injuries, 
which  the  author  enumerates,  specified  com- 
pensation for  fixed  periods  of  time  is  provided. 
There  are,  howe\er,  no  provisions  made  for 
"injuries  which  have  reached  a  more  or  less 
final  condition  nor  for  those  which  have  pro- 
duced a  greater  or  less  residue  of  disability," 
and  it  is  these  conditions  which  the  author  dis- 
cusses particularly.  He  outlines  certain  prin- 
ciples for  estimating  the  degree  of  functional 
loss  in  all  cases  of  disability  and  then  gives 
special  consideration  to  the  upper  extremitj'. 
"Practically  all  of  the  movements  of  the  upper 
extremity  are  for  the  purpose  of  bringing  the 
hand  into  position  to  function  or  to  assist  or  to 
augment  its  power  of  function.  The  hand, 
then,  is  the  essential  part  of  the  upper  extremity 
and  its  chief  function,  including  that  of  the 
fingers,  is  flexion." 

From  his  experience  in  a  great  nimiber  of 
cases  of  fractiu-es  and  dislocations  in  the  upper 
extremity,  the  author  estimates  that  at  least 
80  per  cent,  of  the  disability  is  found  to  be 
what  may  be  termed  flexor  disability.  In  con- 
clusion he  states  that  "since,  then,  flexion  is  the 
chief  function  of  the  industrial  worker's  upper 
extremity  and  all  other  movements  are  sub- 
sidiary to  it,  I  maintain  that  the  amount  of 
flexion  that  can  be  volimtarily  exercised  by  an 
upper  extremity  in  a  regular,  co-ordinated  and 
correlated  way,  is  the  proper  index  of  its  effi- 
ciency, and  that  the  amount  of  ^'oluntary 
flexion  power  that  is  lost  by  reason  of  injiu-y 
fairly  represents  its  residue  of  disability."  — 
M.  C.  Shorley. 


ABSTRACT  OF  THE  LITERATURE 

OF 

INDUSTRIAL  HYGIENE 


Volume  hi 


FEBRUARY,  1922 


Number  10 


CONTENTS 


General     227 

Systemic    Occupational   Diseases :   Occurrence. 

Treatment  and   Prevention    229 

Poisonous  Hazards  and  Their  Effects:   Gases, 

Ohemieiils,    etc 220 

Oecui>ation;U  Infectious  Diseases:  Occurrence, 

Treatment  and  Prevention    232 

Occurrence  and  Prevention  of  Industrial  Acci- 
dents         2.12 

Industrial  Surgery    2.'?4 

Industrial  Pliysiology:  Nutrition.  Metabolism. 
Fatigue,    etc 2:i') 

Hazards  of  Compressed  Air,  Diminislie<i  Pres- 
sure, Generation  and  t'se  of  Electricity,  and 
Electrical  Welding   23(; 

Heat,  Cold  and  Humidity   2-37 


PAO£ 

Women  and   Children   in   Industry   237 

Industrial  Sanitation :  Factory  Construction. 
Illumination.    Ventilation.    Heating.    Water 

Supply,   Sewage  Disposal    2.S7 

Industrial  Medical  Service:  M<Hlical  Dispen- 
saries and  Hospitals  in  Industrial  Plants.  . .  238 

Industrial    Nursing     2.39 

Industrial    Investigations  and    Surveys    2.39 

Industrial  Psychology  and  Industrial  Manage- 
ment  in   Its   Health   Helations 240, 

Industrial  Service  and  Mutual  Benefit  Asso- 
ciations       241 

Industrial  Health  lyogislation  :  Court  Dt^'i- 
sions:  Workmen's  Comivensation  and  Insur- 
ance        242 

Industrial   Mortality   and   Morbidity   Statistics  243 


GENERAL 


The  Industrial  Physician  and  the  Hos- 
pital. Harrii  Linenthal.  Nation's  Health, 
Oct.  15,  1921,  3,  No.  10,  562-564.— In  this  arti- 
cle Dr.  Linenthal  disctisses  briefly  tlie  oppor- 
tunities for  co-operation  between  the  indus- 
trial physician  and  the  general  hospital.  The 
industrial  physician  when  confronted  with  a 
case  wdiich  is  obscure  and  which  his  neces- 
sarily limited  diagnostic  facilities  do  not  en- 
able him  to  solve,  can  send  his  patient  to  the 
general  liospital  and  so  secure  the  services  of 
its  corps  of  experts  and  of  its  laboratory  facil- 
ities. The  general  hospital  will  gain  from  such 
a  relation  because  its  physicians  will  be 
brought  in  contact  with  tlie  wide  field  of  in- 
dustrial liealth  relations  and  Avith  the  broad 
social  aspects  of  medicine. 

"To  have  such  co-operation  between  indus- 
trj^  and  hospital  most  effective  it  is  presup- 
posed that  the  hospital  has  a  special  interest 


in  conditions  of  employment  and  industrial 
hazards,  in  other  words  that  the  hospital  has 
a  special  clinic  with  physicians  in  charge  who 
are  interested  in  healtli  problems  in  industry 
and  in  the  possible  etiologic  relations  of  vari- 
ous health  hazards." 

Such  a  clinic  ought  to  be  an  agent  for  carry- 
ing on  further  research  on  the  effects  of  in- 
dustry upon  health.  "Our  lack  of  knowl- 
edge of  the  general  effects  of  industry  on 
health  is  due  to  our  inaccurate  records  and 
inexact  tabulations.  It  is  true  we  have  a  good 
deal  of  definite  knowledge  of  the  specific  in- 
dustrial diseases,  the  occupational  intoxica- 
tions and  infections,  we  are  also  able  to  recog- 
nize the  etiologic  value  of  such  industrial 
hazards  as  dust  and  fumes,  postural  strains, 
etc. 

"But  what  the  eft'ects  are  of  certain  occu- 
pations on  health,  the  frequency  of  morbid- 


227 


228 


THE   JOURNAL  OF  INDUSTRIAL  HYGIENE 


ity  and  mortality  from  certain  common  dis- 
eases among:  certain  groups  of  operatives ;  the 
effects  of  the  general  stress  of  industry,  the 
speeding  up,  the  monotony,  the  general  fa- 
tigue effects  we  know  but  very  little. 

"Such  additional  knowledge  is,"  Dr.  Lin- 
enthal  believes,  "to  be  obtained  from  the  an- 
alysis of  large  numbers  of  records  with  a  view 
of  establishing  a  correlation  between  the  oc- 
cupations and  the  diseases. 

"It  is  only  the  tabulation  of  vast  mimbers 
of  cases  that  will  permit  deductions  as  to  the 
relative  frecjuency  of  certain  diseases  among 
certain  groups  of  workers. 

"That  valuable  information  can  be  gained 
by  such  statistical  studies  and  that  facts  of 
importance  can  be  brought  out  which  do  not 
become  obvious  even  in  the  careful  handling 
and  study  of  the  individual  case  is  illustrated 
in  an  analysis  of  even  as  small  a  number  as 
10,360  admissions  of  persons  in  industry  to 
the  Out-Patient  Department  of  the  Massachu- 
setts General  Hospital. ' '    To  cite  one  instance : 

"In  the  10,360  cases  tabulated  the  diagno- 
sis of  gastric  ulcer  was  made  79  times ;  26  of 
these,  or  more  than  34  per  cent,  occurred 
among  workers  in  candy  factories.  The  diag- 
nosis of  gallstones  was  made  46  times,  26  of 
these,  or  more  than  56  per  cent,  occurred 
among  the  same  group  of  workers.  Yet  the 
entire  number  of  candy  workers  was  205,  or 
less  than  2  per  cent,  of  the  number  of  admis- 
sions." 

Dr.  Linenthal  concludes  with  an  expression 
of  his  opinion  that  the  industrial  clinic  "be- 
cause of  its  special  interest  in  research  in  in- 
dustrial problems  and  because  of  its  intimate 
contact  with  industrial  physicians  through  co- 
operation along  the  lines  indicated  above  can 
well  serve  as  a  center  where  the  experiences 
of  all  physicians  in  industrial  plants  can  be 
collected  and  progress  made  in  our  knowl- 
edge of  the  effects  of  industi-y  on  health." — 
Katherine  R.  Drinker. 


The  Practitioner  and  the  Industrial 
Phtsicun.  Charles  Edward  Mongan.  Na- 
tion's Health,  Nov.  15,  1921,  3,  No.  11,  609- 
612. — In  1912  the  first  workmen's  compensa- 
tion law  was  passed  in  Massachusetts,  and  by 
this  law  the  individual  was  denied  the  right  to 
select  his  own  doctor.  This  caused  consider- 
able   resentment    and    the    law    was    later 


changed,  restoring  to  the  individual  the  right 
of  free  choice  of  his  physician. 

The  entrance  of  the  private  practitioner 
into  the  field  of  industrial  medicine  has 
brought  up  the  question  of  the  proper  fees  to 
be  paid  to  the  practitioner  by  the  insurer, 
both  in  hospitals  and  at  the  patient's  home. 
There  is  a  question  also  as  to  the  extent  that 
the  industrial  physician  Ls  justified  in  carry- 
ing on  his  work  beyond  the  waUs  of  the  fac- 
tory, thus  encroaching  upon  the  legitimate 
field  of  the  practitioner.  The  author  of  this 
article,  as  a  member  of  the  Medical  Advisory 
Committee  of  the  Industrial  Accident  Board, 
discusses  these  questions  with  a  view  to  pro- 
moting co-operation  between  the  industrial 
physician,  the  private  practitioner,  and  the 
insurer. — L.  A.  Shaw. 

The  Health  of  Seamen  and  How  to. Safe- 
guard It.  E.  J.  Mackeown.  Jour.  State  Med., 
Oct.,  1921,  29,  No.  10,  289-296.— It  is  strongly 
urged  that  (1)  there  be  created  by  represen- 
tations to  the  Board  of  Trade,  Ministry  of 
Health,  Admiralties  and  the  Council  of  the 
League  of  Nations,  an  international  standard 
of  accommodation  on  board  ships  for  seamen ; 
and  that  (2)  legislation  be  established  provid- 
ing that  all  plans  of  ships  to  be  built  must  be 
submitted  to  a  central  authority  in  each  na- 
tion. Plans  must  show  the  accommodation 
provided  for  the  crew,  and  work  on  the  ships 
is  not  to  be  proceeded  with  until  the  accommo- 
dation plans  have  been  approved.  Inspection 
must  follow  regularly  during  construction. — 
Barnett  Cohen. 

The  Influence  op  Night  Work  on  the 
Health  of  Workers.  Hermann  Bruckner. 
Zentralbl.  f.  Gewerbehyg.,  Oct.,  1921,  9,  No. 
10,  217-224. — Basing  his  conclusions  on  inter- 
views with  many  workmen  and  on  statistics 
covering  a  seven-month  period  in  a  large 
plant,  the  author  decides  that  night  work  is 
the  safest  of  the  three  shifts.  It  is  com- 
plained of  as  unpleasant  but  not  as  a  cause 
of  disease.  Difficult}-  in  sleeping  in  the  day 
time  is  a  possible  factor  in  the  poor  health 
of  neurasthenics,  justifjing  their  exclusion 
from  night  work.  Accidents  and  intoxications 
are  less  frequent  at  night,  probably  because 
the  work  is  less  intense  and  only  the  essential 
and  mechanical  processes  are  carried  on  then. 
— E.  L.  Sevringhaus. 


ABSTRACTS 


229 


SYSTEMIC  OCCUPATIONAL   DISEASES:  OCCURRENCE,  TREAT- 
MENT AND  PREVENTION 


MENTAL 

The  Place  op  Occupational  Therapy  in 

Mental  Hygiene.  Norman  L.  Burnett e.  Pub. 

Health  Jour.,  March,  1921,  12,  No.  3,  103-106. 

— The  author  recapitulates  the  benefits  to  be 


derived  from  having  the  mind  occupied,  and 
claims  that  if  more  occupational  therapy  were 
taught  to  the  maimed  and  sick  in  hospitals 
there  would  be  a  less  steady  tide  flowing  asy- 
lunnvard. — M.  Dent. 


POISONOUS 


IIAZ.XRDS    AND  THEIR   EFFECTS:  GASES, 
CHEMICALS.  ETC. 


Memorandum  on  Carbon  Monoxide  Poi- 
soning IN  Factories.  Form  827,  July,  1921, 
Factory  Department,  Home  Office,  London, 
pp.  13. — Gases  containing  a  considerable  pro- 
portion of  carbon  monoxide  are  now  used  ex- 
tensively in  industries  for  such  purposes  a.s 
driving  gas  engines,  heating  furnaces,  kilns, 
retorts,  ovens  and  boilers,  and  welding  aiul 
soldering  metals.  Similar  gases  are  produced 
as  by-pi-oducts  in  various  metallurgical  and 
other  i)rocesses.  A  list  of  the  various  types 
of  these  gases  is  given. 

Air  containing  over  0.2  jicr  cent,  of  carbon 
monoxide  is  d;inserous  to  life,  and  smaller 
quantities  JTilialed  over  long  periods  jjroduce 
ill-health,  as  the  gas  forms  a  definite  com- 
pound with  the  hemogloliin.  The  Annual  Re- 
port of  the  Chief  Inspector  of  Factories  sliows 
that  tliere  is  an  increasing  number  of  re- 
ported cases  of  industrial  poisoning  by  carbon 
monoxide.  These  cases  of  poisoning  are  due 
to  ignorance  of  the  danger,  to  the  inodorous 
nature  of  the  gas  in  certain  forms,  to  work- 
ing alone,  and  to  lack  of  rescue  appliances  or 
failure  to  maintain  them  properly. 

The  principal  causes  of  accidents  are  these: 

"Producer  gas. —  (1)  Cliarging,  stoking, 
cleaning,  and  repairing  the  generating  plant; 
(2)  starting  the  engine;  (3)  escape  from  the 
vent  or  exhaust  pipe  of  the  engine  directly 
into  the  workroom,  or  indirectly  into  the 
workrooms  through  open  windows  in  the  case 
of  pipes  discharging  outside;  (4)  leaky  fit- 
tings and  pipes;  (5)  defective  valves,  water 
seals,  etc.;  (6)  conveyance  bj'  the  wind;  (7) 
persons  lying  down  or  sleeping  near  a  gas 
engine  or  plant;  (8)  percolation  through  the 
soil  or  brickwork  from  underground  pipes. 

"Blast  furnace  gas. — From  (1)  charging; 
(2)  gauging  the  furnace;  (3)  repairing  fur- 
naces, flues,  etc.;    (4)   cleaning  flues  or  cul- 


verts without  efficient  disconnection;  (.'i)  un- 
suspected escape  from  underground  flues 
into  weigh  cabins,  offices,  etc.;  (6)  carriage  of 
gas  by  the  wind  from  one  furnace  to  the  gan- 
try staging  of  another  or  elsewhere. 

"  Gases  from  other  sources. — From  (1)  open 
braziers  or  coke  stoves  used  for  drying  pur- 
poses in  confined  spaces  on  ships,  in  garages 
and  elsewhere;  (2)  coke  ovens;  (3)  lime  and 
cement  kilns;  (4)  bakers'  ovens  through 
broken  tiles;  (5)  coke  fire  of  galvanizing  and 
other  plants;  (6)  fires  for  heating  rivets;  (7) 
subterranean  fires;  and  (8)  exhaust  gases 
from  the  testing  and  running  of  internal  com- 
bustion engines. 

"Coal  gas. —  (a)  In  gas  works  from  (1) 
cleaning  ascension  and  other  pipes;  (2)  re- 
pairing cracks  in  retorts;  (3)  drawing  gas  re- 
torts; (4)  attending  to  purifiers;  (o)  leaky 
water  seals  and  valves;  ((i)  drilling'  mains  and 
branch  pipes;  (7)  repairing  gas  holders;  and 
(&)  in  distribution  in  workrooms  from  (1) 
defective  pipe  joints,  taps,  and  other  fittings; 
(2)  faulty  gas  irons  or  gas  blowpipes;  (3)  in- 
adequately ventilated  gas  stoves  or  heaters; 
(4)  back  lighting  or  ineffective  draught  at 
muffle  and  other  furnaces,  drying  ovens,  etc." 

Preventive  measures  are  suggested  for  the 
hazard  of  carbon  monoxide  poisoning  in  its 
general  aspects  and  for  each  of  the  classes 
above  mentioned.  The  general  precautions  in- 
clude such  as  these : 

Occupiers  of  factories,  managers,  and  others 
concerned  should  take  all  possible  steps  to 
ensure  that  workers  are  aware  of  the  danger 
from,  and  the  symptoms  of,  carbon  monoxide 
poisoning  wherever  gases  of  which  this  is  a 
constituent  are  produced  or  used. 

Persons  should  not  be  permitted  to  enter 
any  place  where  carbon  monoxide  gas  is  liable 


230 


THE  TOURNAL  OF  INDUSTRIAL  HYGIEXE 


to  accumulate  until  such  place  has  been  well 
flushed  out  by  fi'esh  air. 

In  the  case  of  i^roducer  gas  emphasis  is 
laid  upon  the  facts  that  eleaniiio:  and  repair- 
ing on  the  producer  should  be  done  by  day- 
light, and  no  fire,  naked  light,  or  smoking 
should  be  allowed  near  the  plant.  After  the 
generator  fire  is  out  air  must  be  blown  through 
by  the  fan  and  the  generator  doors  opened; 
and  the  plant  should  be  left  for  several  hours 
before  any  cleaning  is  done. 

A  large  number  of  cases  of  poisoning  occur 
in  connection  with  the  cleaning  and  repairing 
of  flues,  culverts,  furnaces,  stoves,  etc.,  many 
of  which  could  be  avoided  if  more  care  were 
taken  to  see  that  the  parts  to  be  cleaned  or 
repaired  were  properly  cut  off  from  any  sup- 
ply of  gas,  the  parts  thoroughly  flushed  out, 
plenty  of  time  allowed  for  cooling  and  for 
ventilation,  and  to  see  that  every  workman 
wore  a  lifebelt  to  which  a  line  is  attached, 
held  continually  by  some  person  outside  the 
furnace,  flue,  etc. 

Open  braziers  or  coke  stoves  are  frequently 
used  for  drying  purposes  in  confined  spaces, 
and  persons  entering  such  places  before  they 
are  thoroughly  flushed  may  be  overcome.  In 
the  case  of  coke  ovens,  lime  and  cement  kilns, 
danger  usually  arises  fi-om  men  entering  the 
ovens,  kilns,  or  flues  before  adequate  meas- 
ures have  been  taken  to  remove  the  gas  by 
proper  ventilation. 

The  most  serious  cases  of  gassing  fi-om  coal 
gas  usually  occur  in  connection  with  cleaning 
and  repairing  plants  in  gas  works.  Special 
precautions  should  be  taken  to  cut  off  all  gas 
supply,  10  flush  out  residual  gas,  and  when 
there  is  danger  apparatus  should  be  worn  en- 
abling the  workman  to  obtain  a  supply  of 
fresh  air  from  outside,  and  a  life-belt  should 
be  worn.  The  rescue  apparatus  most  suitable 
for  industrial  work  consists  of  a  facepiece 
connected  by  equalizing  tubing  with  a  flexible 
hose  pipe  50  feet  long,  the  free  end  remaining 
in  an  outside  atmosphere.  This  apparatus  is 
preferred  to  the  complicated,  self-contained 
breathing  apparatus  required  in  mines. 

Symptoms  of  carbon  monoxide  poisoning 
are:  giddiness,  swimming  sensations,  con- 
striction in  the  head  and  oppression  on  the 
chest,  throbbing  of  the  heart  and  larger  blood 
vessels,  lo.ss  of  power  in  the  legs,  followed  by 
complete  helplessness  and  unconsciousness. 
The  after-effects  are:  headache,  bronchial 
symptoms,  depression,  prostration,  loss  of  vi- 


tality, and  tachycardia.  Sequelae  such  as  par- 
alysis, paraplegia,  hemiplegia,  and  loss  of 
memory  with  affection  of  speech,  occiir. 

A  method  of  examination  of  the  blood  for 
carbon  monoxide  poisoning  is  given — the  com- 
parison of  the  tint  of  a  greatly  diluted  solu- 
tion of  the  suspected  sample  with  that  of  nor- 
mal blood.  The  latter  is  yellow,  while  blood 
containing  even  very  small  traces  of  carbon 
monoxide  is  pink. 

Respirators  of  the  ordinary  type  are  useless 
against  the  inhalation  of  carbon  monoxide, 
and  reliance  on  a  folded  handkerchief  has 
cost  many  a  rescuer  his  life.  Workers  are 
especially  warned  against  adopting  the  meth- 
od employed  by  ignorant  persons  of  placing 
men  on  their  faces  with  the  mouth  over  a  hole 
in  the  ground.  The  combination  of  artificial 
respiration  with  oxygen  administration  is  de- 
cidedly preferable  to  the  use  of  apparatus  for 
inflating  and  deflating  the  lungs  with  com- 
pressed ox,vgen.  Warmth  iS  essential  in  the 
treatment ;  the  patient  should  be  wrapped  in 
dry  blankets  and  hot-water  bottles  applied. 
The  restoration  of  breathing  is  the  first  and 
immediate  object,  and  then  promotion  of 
warmth  and  circulation.  The  efforts  to  resus- 
citate a  victim  should  be  continued  for  a  long 
time,  siiice  life  may  be  saved  in  cases  that 
seem  hopeless.  Phenacetin,  aspirin,  etc.,  should 
never  be  given  to  relieve  the  headache  from 
inhaling  carbon  monoxide  gas. 

Reference  is  made  to  a  new  gas  mask  to  be 
used  as  a  protection  against  carbon  monoxide, 
which  is  described  in  a  paper  on  Industrial 
Respirators,  by  hevj  and  West,  read  before 
the  Society  of  Chemical  Industry,  June,  1921 
(to  be  reviewed  in  the  next  issue  of  the  JotiJ- 
XAL).— G.  E.  Partridge. 

MEMORANDrSI  ON  IXDU-STRIAL  LeAD  POISON- 
ING. Form  324,  Jan.,  1921,  Factory  Depart- 
ment, Home  Ofiice,  London,  pp.  16. — Valuable 
information  is  to  be  obtained  as  a  result  of 
the  statutory  requirement  that  the  Chief  In- 
spector of  Factories  must  be  notified  of  eases 
of  lead  poisoning  in  Great  Britain  and  Ire- 
land. 

Industrial  plumbism  is  practically  always 
a  result  of  inhalation  and  absorption,  from  the 
alimentary  or  pulmonary  tract,  of  dust  and 
fumes.  Figures  for  the  potterj'  industry  seem 
to  show  that  women  are  about  twice  as  sus- 
ceptible as  men.  but  this  may  be  due  to  the 


ABSTRACTS 


231 


relatively  greater  dangers  from  the  processes, 
or  to  the  average  shorter  term  of  eniploj-ment. 
Two-iifths  of  all  reported  cases  occur  during 
the  first  eighteen  months. 

A  table  shows  the  number  of  eases  of  plumb- 
ism  and  the  number  of  deaths  occurring  in 
various  industries  during  the  past  twenty 
years,  the  average  being  given  for  each  half- 
decade.  The  totals  of  cases  for  the  four  half- 
decades  are:  1900-1904,  753;  1905-1909,  599: 
1910-1914,  548;  1915-1919,  279.  The  statistics 
show  also  a  reduction  in  the  severity  of  the 
attacks  and  a  decreasing  proportion  of  recur- 
rent attacks  (for  the  three  periods  from  1900 
to  1915). 

The  figures  ai-e  recorded  also  in  regard  to 
the  frequency  of  different  symptoms  for  the 
three  periods,  and  of  the  different  forms  of 
paralysis  and  encephaloiiathy.  The  numbers 
employed  in  the  main  industries  in  which  lead 
poisoning  occurs,  and  the  attack  rate  per  thou- 
sand for  these  industries  are  given. 

Some  attempt  is  made  to  analyze  the  indus- 
tries and  to  show  the  processes  in  which  the 
hazards  occur,  also  to  indicate  the  sources  of 
improvements  that  have  been  made.  The  elec- 
tric accumulator  industry  is  shown  to  be  the 
one  now  exposing  workers  to  the  greatest  risk. 
A  section  is  devoted  to  symptoms  and  diagno- 
sis, with  special  reference  to  anemia,  colic, 
arthralgia,  effects  upon  the  nervous  system, 
paral\sis,  interstitial  nei)hritis,  and  gout. 

Special  attention  should  be  given  to  new 
workers,  as  the  appearance  of  symptoms  of 
poii^oiiing  in  them  constitutes  the  surest  guide 
to  defects  in  the  processes.  The  most  deli- 
cate test  for  the  detection  of  early  extensor 
paralysis  is  to  have  the  surgeon  place  the  tip 
of  his  forefinger  on  the  outstretched  hand  of 
the  worker  and  the  ball  of  his  thumb  on  the 
extreme  tip  of  each  finger,  then  gently  pull 
it  down  and  note  the  spring  present  in  the 
muscles. 

Approximately  2  mg.  is  the  lowest  daily 
dose  which,  inhaled  as  fume  or  dust,  may.  in 
the  course  of  years  set  up  chronic  plumbism. 
Probably  if  the  air  breathed  contained  less 
than  5  mg.  per  10  cubic  metres  of  air,  cases  of 
encephalopathy  would  never  occur,  and  cases 
of  colic  would  occur  ver.y  rarely.  And  this  is 
a  quite  practical  figure  to  keep  the  dust  down 
to  in  anj-  process  amenable  to  exhaust  venti- 
lation. 

As  to  notification,  suspension  and  warning, 


necessity  for  notification  arises  only  when 
lead  poisoning  is  diagnosed,  and  in  general 
only  when  the  symptoms  are  of  such  a  nature 
as  to  retjuire  absence  from  work.  Liability  to 
injurious  effects  may  be  hidicated  by  present 
or  past  attacks  of  lead  poisoning,  by  tendency 
to  epilejjsy  or  hysteria,  by  marked  anemia,  ex- 
tensive oral  sepsis,  mental  weakness,  and  care- 
less habits.  Persons  who  have  suft'ered  from 
malaria  or  any  condition  which  has  brought 
about  blood  destruction,  and  ex-soldiers  who 
have  been  gassed  should  not  be  subjected  to 
the  risks  under  discussion.  "Where  the  diag- 
nosis of  acute  plumbism  is  clearly  established, 
suspension  from  emi)Ioyment  should  be  or- 
dered. 

Codes  of  regulations  for  medical  examina- 
tion and  inspection  in  various  industries  are 
given,  and  also  directions  in  regard  to  the 
keeping  of  health  registers. — G.  E.  Partridge. 

The  Clinical  and  Pathological  Manifes- 
TATio.v.^  OP  Lead  Poisoning.  P.  Pinchcrk.  11 
Lavoro,  Oct.  31,  1921,  12,  No.  6,  161-168.— 
The  author  examined  the  urea  content  of 
blood  in  urine  in  twenty  patients  suffering 
from  lead  poisoning  and  made  use  of  the  so- 
dium hypobromite  method.  Sixteen  of  the 
twenty  cases  showed  a  concentration  of  urine 
in  the  blood  above  the  normal,  the  quantity 
running  from  0.45  gm.  to  ,1.7  gm.  per  thou- 
sand. The  lesions  found  at  three  autopsies 
were  typical  of  the  contracted  kidney  of 
chronic  saturnism. — Alice  Hamilton. 

CoxiPARisoN  OF  Mumps  and  Chronic  Lead 
Poisoning  from  the  Standpoint  of  the  To- 
tality OP  SvMPTOMS.  Conrad  Wcsselhoeft. 
Abstracted  as  follows  from  Jour.  Am.  Inst. 
Homeopathy,  1921,  Vol.  14,  pp.  13-29,  in 
Chem.  Abstr.,  Sept.  10,  1921.  15,  No.  17,  2922. 
— '"The  symptoms  of  chronic  lead  poisonmg 
and  those  of  mumps  resemble  each  other  in 
many  respects.  The  most  striking  similarity  is 
the  parotitis,  commonly  complicated  by  or- 
chitis which  is  often  followed  by  testicular 
atrophy.  A  bibliography  of  67  references  is 
appended." 

Prohibition  of  the  Use  of  White  Lead  in 
Painting.  Official  Bulletin,  International  La- 
bour Office,  June  22,  1921,  3,  No.  24,  686-690. 
— This  paper  reports  the  views  of  the  White 
Lead  Corroders'  Trade  Section  of  the  London 


^ 


232 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Chamber  of  Commerce  on  the  subject  of  pro- 
hibition of  white  lead  in  painting.  It  is  ar- 
gued that : 

1.  Because  of  the  complexity  of  the  sub- 
ject, difference  of  views,  etc.,  this  question 
should  be  submitted  to  the  Advisory  Commit- 
tee whicTi,  the  Washington  Conference  re- 
solved should  be  established  to  deal  with  such 
questions  in  industrial  hygiene. 

2.  The  statistics  of  lead  poisoning  do  not 
warrant  prohibition.  Many  cases  are  wrongly 
diagnosed.  Tests  made  at  the  Leipzig  Insti- 
tute of  Hygiene  by  the  objective  basophilic 
granulation  method  confirmed  only  38  per 
cent,  of  the  cases  ascribed  to  lead  poisoning  by 
subjective  clinical  diagnosis.  "There  is  reason 
to  believe  that  the  risk  of  paint  poisoning 
among  painters  in  England  is  not  more  than 
an  ordinary  industrial  risk." 


3.  There  is  no  effective  all-round  substitute 
for  white  lead  in  painting. 

4.  The  pi-ohibition  of  white  lead  would  not 
remove  all  the  chief  causes  of  painter's  sick- 
ness. Turpentine,  benzol,  methyl  alcohol,  etc., 
have  poisonous  properties  which  are  believed 
to  be  the  cause  of  the  frequency  of  kidney 
diseases  and  gout  among  painters,  but  workers 
in  white  lead  factories  do  not  commonly  suffer 
from  these  diseases.  The  dangers  from  lead 
are,  moreover,  readily  avoided  by  simple  reg- 
ulations, by  substitution  of  wet  processes  in 
rubbing,  etc.,  by  general  cleanliness  and  avoid- 
ance of  such  obvious  risks  as  those  from 
paint-soiled  hands. 

5.  Prohibition  would  be  very  costly,  would 
be  difficult  to  enforce  and  of  doubtful  effect. 

6.  Regulations  alone  would  effectively  deal 
with  the  cause  of  paint  poisoning  among 
painters. — G.  E.  Partridge. 


r OCCUPATIONAL  INFECTIOUS  DISEASES:   OCCURRENCE, 
TREATMENT  AND  PREVENTION 


A  Memorandum  on  the  Occupational 
Study  of  Syphilis,  with  Special  Reference 
to  Farmers.  John  H.  Stokes  and  Helen  E. 
Brehmcr.  Am.  Jour.  Med.  Sc,  Oct.,  1921, 
162,  No.  4,  572-575. — The  authors  made  an  in- 
vestigation of  syphilis  in  100  railway  men  in 
January,  1919,  and  later  a  survey  of  100  farm- 
ers was  undertaken  in  order  to  "determine 
whether  occupation  as  such  could  serve  as  a 
factor  of  predisposing  or  modifying  influence 
in  the  course  of  the  disease. ' '  The  conclusions 
reached  are  as  follows : 

"1.  A  survey  of  syphilis  in  100  farmers 
whose  records  were  taken  at  random  from  the 
files  of  the  section  of  dermatology  and  syphil- 
ology  in  the  Clinic  (Mayo  Clinic)  reveals  no 
distinctive  difference  between  the  clinical  pic- 
ture of  the  disease  in  farmers  and  that  in 
railroad  men. 

"2.    This  result  is  not  to  be  interpreted  as 


precluding  the  possibility  of  special  occupa- 
tional types  in  the  disease.  For  the  determi- 
nation of  such  types  the  investigation  must  be 
taken  to  the  groups  instead  of  subjecting  the 
group  to  a  species  of  unconscious  medical  se- 
lection involved  in  resort  to  a  diagnostic 
clinic. 

"3.  The  figures  given  in  the  table,  there- 
fore, present  essentially  the  diagnostic  prob- 
lem of  late  syphilis  in  general  medicine.  They 
suggest  further  that  physicians  at  large  could 
profitably  give  less  attention  to  the  history  of 
infection  and  the  serum  Wassermann  test  and 
more  attention  to  the  spinal  fluid  test  and  to 
the  physical  and  especially  the  neurological 
and  ophthalmic  findings  in  their  effort  to  rec- 
ognize late  syphilis  and  to  interpret  the  medi- 
cal picture  presented  by  a  given  patient." — 
C.  K.  Drinker. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 

week.  During  the  week  which  ended  August 
28,  1,208  deaths  by  accident  occurred;  of 
these  "no  fewer  than  758,  or  67.7  per  cent., 
were  the  result  of  public  accidents;  359,  or 
29.7  per  cent.,  were  the  result  of  indusfrial 
accidents;  and  the  remainder,  91,  or  7.5  per 


How  We  Die  from  Accidents  in  Careless 
America.  Frederick  S.  Crum.  Nat.  Safety 
News,  Oct.,  1921,  4,  No.  4,  17-18.— An  effort 
was  made  by  the  National  Safety  Council  to 
determine  the  approximate  number  and  causes 
of  fatalities  in  the  United  States  during  one 


ABSTRACTS 


233 


cent.,  were  the  result  of  home  accidents." — 
M.  Dent. 

HOT'RS    BEFORE    NoON    AND    QuiTTIXG    TiME 

Most  Prolific  of  Accidents.  Howard  Van 
Antwerp,  Jr.  Nat.  Safety  News,  Nov.,  1921, 
4,  No.  5,  30.— With  the  Ashland  Iron  and 
Mininf?  Company  the  peak  hours  for  accidents 
are  from  10  to  11  A.  M.,  and  .3  to  4  P.  M., 
these  being  the  hours  when  production  is  most 
speeded  up  at  this  plant,  and  when  hunger 
and  fatigue  play  a  very  important  part  in 
carelessness.  The  company's  emergency  hos- 
pital has  more  than  paid  for  itself  in  the  re- 
duction of  time  of  recovery,  and  a  campaign 
against  eye  injuries  resulted  in  a  reduction  of 
from  $3,000  paid  out  during  one  year  for 
this  class  of  accident  to  .$6.5  for  the  eight 
months  following  the  campaign. — M.  Dent. 

Campaign  against  "Dropsy,"  the  Care- 
less Handling  op  Materials.  Fred  M.  Roxse- 
land.  Nat.  Safety  News,  Oct.,  1921,  4,  No.  4, 
15-16. — The  handling  of  materials  in  indus- 
try is  a  very  serious  cause  of  accidents.  Men 
are  naturally  careless  in  handling  materials 
unless  liie  slogan  of  care  is  repeated  very 
often.  Another  source  of  danger  is  carelessly 
piled  material.  During  the  past  ten  years 
many  successful  inventions  for  the  handling 
of  materials  have  been  placed  upon  the  mar- 
ket, and  the  use  of  these,  together  witli  safety 
propaganda,  should  be  insisted  on  by  all  plant 
managers. — M.  Dent. 

Trends  in  Management.  The  Direction 
Indi'strial  Fire  Prevention  Is  Taking.  W. 
E.  MaUalieu.  Factory,  Oct.,  1921,  27,  No.  4, 
478-480. — We  should  learn  a  great  deal  from 
the  very  efficient  tire  prevention  work  done 
diiring  the  war  for  the  protection  of  wooden 
cantonments,  naval  properties,  food  storage 
and  munition  factories.  The  per  capita  fire 
loss  in  wooden  cantonments  averaged  approxi- 
mately one-fifth  that  of  civilian  cities. 

Industrial  fire  inspection  can  see  to  it  that 
the  building  is  rendered  safe  as  far  as  is  pos- 
sible bj'  fire  escapes,  and  can  oversee  the  em- 
ployees and  do  away  with  careless  habits 
which  may  cause  fire.  The  article  gives  details 
on  watclunen,  sprinklers,  fire  drills,  and  an 
orderly  factory. — M.  Dent. 

"Give  Me  Another  Pair  of  Goggles — 
Just  Broke  Mine.  "  Fred  M.  Rosseland.  Nat. 


Safety  News,  Nov.,  1921,  4,  No.  5,  31-32.— 
Goggles  should  only  be  required  when  no 
other  form  of  protection  is  adequate.  Glass 
screens  on  emery  wheels  and  screens  between 
workers  and  machines  from  which  flying  part- 
icles proceed  are  better  than  goggles. 

The  quoted  procedure  should  be  followed 
in  undertaking  an  eye  protection  campaign  in 
any  plant: 

"1.  Check  up  the  various  jobs  and  find  just 
where  safety  goggles  are  necessary — where  no 
other  protection  will  be  adequate. 

"2.  Check  up  the  goggles  worn  by  each 
employee  and  determine  whether  they  fit 
properly  and  whether  they  give  adequate  pro- 
tection. 

"3.    As  fast  as  possible  locate  employees 
who  are  encountering  difiiculties  in  wearing 
goggles,  and  investigate  each  case 
Here  attention  should  be  given  to  tlie  subject 
of  vision. 

"4.  At  the  same  time  a  course  of  education 
in  eye  protection  should  be  carried  on." — M. 
Dent. 

The  Sources  of  Danger  from  Accidents  in 
Bi'iLDiNO  Industries.  R.  Qitarij.  Zcutralbl. 
f.  Gewerbehyg.,  Oct.,  1921,  9,  No.  10,  229-232. 
— Statistical  study  of  the  accidents  in  the 
building  industries  of  Thuringia  during  1920, 
with  an  attempt  to  fix  the  responsibility  for 
accidents  when  possible,  leads  to  the  certain 
conclusion  that  a  large  percentage  is  due  to 
the  carelessness  of  workers  and  employers, 
and  to  failure  to  observe  the  rules.  Indus- 
trial supervision  must  include  not  only  form- 
ulating rules  and  introducing  devices,  but 
also  the  education  of  the  workers  in  safe 
practices. — E.  L.  Sevringhaus. 

A  Peek  behind  the  Scenes  at  R.ulroad 
Safety.  Louis  Resnick.  Nat.  Safety  News, 
Oct.,  1921,  4,  No.  4,  9-12.— This  article  de- 
scribes the  nervous  strain  that  is  put  upon  the 
engineer  of  an  express  train  while  making 
runs,  and  shows  how  thoughtless  people  are 
in  matters  of  safety  when  they  calmly  walk 
on  the  tracks  until  the  train  is  almost  on  top 
of  them,  or  speed  up  their  motors  in  order 
to  beat  the  train  to  a  crossing — for  all  of 
which  the  engineer  pays  in  fearful  mental 
anxiety. 

The  safety  work  of  the  Baltimore  and  Ohio 
Railroad  is  described.    It  consists  in  ceaseless 


234 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


inspection  and  ceaseless  vigilance.  No  loco- 
motive is  used  more  than  five  hours  during  a 
trip,  and  each  locomotive  is  inspected  by  a 
gang  of  men  before  each  trip.  The  company 
has  no  difficulty  in  educating  its  employees 
but  has  great  difficulty  in  educating  the  pub- 
lic—M.  Dent. 

Safety  in  Steel  Making.  R.  C.  SaUsburtj. 
Nat.  Safety  News,  Nov.,  1921,  4,  No.  5,  32.— 
This  article  outlines  briefly  the  safety  features 
installed  in  the  new  merchant  mill  of  the  In- 
terstate Iron  and  Steel  Company  at  Chicago, 
and  the  safety  policy  of  the  company. — M. 
Dent. 

Accident  Frequency  Eates  in  the  Iron 
AND  Steel  Industry,  by  Causes,  1913  to 
1920.  Lucian  W.  CJianey.  U.  S.  Bur.  Labor 
Statis.,  Month.  Labor  Rev.,  Sept.,  1921,  13, 
No.  3,  487-492. — "For  some  years  past  the 
Bureau  of  Labor  Statistics  has  been  able  to 
secure  for  the  iron  and  steel  industry  a  very 
considerable  body  of  accident  data  classified 
by  accident  causes.  These  data  brought  down 
to  the  end  of  1920  are  presented  herewith." 

"Table  1  shows  the  variations  in  the  fre- 
quency rates  for  accidents  from  the  several 
causes  from  year  to  year,  1913  to  1920. 

"Table  2  presents  the  frequency  rates  for 
the  whole  period  arranged  according  to  pro- 
duction groups. 

"Table  3  shows  the  variations  in  the  rates 
for  the  several  production  groups,  by  years, 
during  the  8-j-ear  period." — R.  B.  Crain. 

Accident  Frequency  and  Severity  Rates 
FOB  the  Iron  and  Steel  Industry  and  its 


Principal  Departments,  1907  to  1920.  Lu- 
cian W.  Chaney.  V.  S.  Bur.  Labor  Statis., 
Month.  Labor  Rev.,  Oct.,  1921,  13,  Xo.  4,  886. 
— "It  should  ...  be  noted  that  the 
figures  in  this  presentation  are  restricted 
to  accidents  for  which  severity  as  well  as  fre- 
quency rates  could  be  computed.  They  are 
not,  therefore,  comparable  in  any  case  with 
the  figures  slio%vn  in  the  article  on  'Accident 
frequency  rates  in  the  iron  and  steel  industry, 
by  causes,  1913  to  1920,'  in  the  September, 
1921,  issue  of  the  Monthly  Labor  Review  (pp. 
1  to  6 ) ,  which  covered  a  much  larger  number 
of  accidents,  for  which  frequency  rates  could 
be  shown,  but  for  which  severity  rates  could 
not  in  all  cases  be  computed." 

Steam  Boilers  or  Steam  Pressure  Appar- 
atus .'  Sch'ippc.  Zentralbl.  f.  Gewerbehyg., 
Oct.,  1921,  9,  No.  10,  238-244.— The  legal  reg- 
ulations concerning  steam  boilers,  piping  and 
steam  driven  machinery  are  discussed,  with 
special  attention  to  bordei-line  cases  between 
the  different  classifications,  such  as  the  fire- 
less  steam  locomotives. — E.  L.  Sevringhaus. 

STKiM  Boiler  Safety  and  Operation.  J. 
A.  Snijder.  Nat.  Safety  News,  Oct.,  1921,  4, 
No.  4,  19-20,  31. — This  article,  after  an  intro- 
duction concerning  the  number  of  steam  boiler 
explosions  in  the  past  forty  years,  outlines 
briefly  the  rules  and  regulations  of  the  Ameri- 
can Society  of  Mechanical  Engineers  for  the 
safe  design  and  construction  of  steam  boilers, 
taking  up  factors  of  safety,  safety  valves, 
steam  gages,  water  columns,  blow-off  valves 
and  pipes,  accessories,  valves,  repairs,  common 
defects,  and  low  pressure  boilers. — M.  Dent. 


INDUSTRIAL    SURGERY 


Standardized  First  Aid  in  Industrial 
Plants.  R.  A.  BrintnaU.  Nation's  Health, 
Oct.  15,  1921,  3,  No.  10,  543-547.— "Since  the 
winter  of  1912-1913,  the  Bell  Telephone  Com- 
pany of  Pennsylvania  has  l)een  training  its 
men  in  first  aid  work  and  life  saving.  The 
training  has  been  given  to  the  employees  by 
forming  units  in  each  town  and  in  each  line 
of  telephone  work  so  that  there  are  available 
at  all  times  one  or  two  men  in  each  depart- 
ment aljle  to  render  first  aid  to  the  in.iured. 
In  this  manner  much  has  been  accomplished 
in  the  way  of  concrete  results,  one  significant 


indication  being  the  reduction  in  the  number 
of  lost-time  accidents  as  sho-wn  by  the  follow- 
ing comparisons: 

"Lost  time  per  evei-y  100  employees  was 
—in  1916.  10.47;  in  1917,  7.62;  in  1918.  5.66; 
in  1919,  3.98:  in  1920,  2.69,— which  means 
that  they  have  succeeded  in  reducing  tlie  lost- 
time  accidents  in  1920,  7.78  as  compared  with 
1916. 

"As  the  training  of  these  groups  had  been 
carried  on  for  a  number  of  years,  it  was  con- 
ceived that  active  competitive  effort  between 
groups  would  help  to  maintain  a  continued 


ABSTRACTS 


235 


and  well-sustained  safety  activity.  To  this 
end  there  were  org:aiiizcd  safety  meets  m 
which  the  groups  of  the  different  divisions 
competed  with  each  other  for  a  record.  These 
have  been  carried  on  by  the  Bell  Telephone 
Company  since  191C." 

Mr.  Brintnall  's  article  concludes  with  an  in- 
teresting description  of  a  first-aid  contest  held 
early  in  1921  under  the  auspices  of  the  Phila- 
delphia Division  of  the  Bell  Telephone  Com- 
pany and  the  American  Red  Cross  and  in 
which  eleven  company  teams  competed. — 
Katherine  R.  Drinker. 

The  Tran.sportation  of  the  Inji'Rf:i>.  R. 
R.  Saycrs.  Nation's  Health,  Oct.  15,  1921,  3, 
No.  10,  569-572.— Dr.  Sayers'  article  deals 
with  the  transportation  of  the  in.iured  in 
metal  mines  and  coal  mines,  and  contains 
illustrations  and  descriptions  of  different 
types  of  transporting  apparatus.  The  paper 
concludes  with  the  following  summary: 


"The  reasons  for  transportation  are  to  get 
the  injured  man  to  a  place  of  greater  safety, 
to  make  him  more  comfortable,  to  prevent 
further  injury  through  handling,  and  finally 
to  get  him  where  he  may  receive  proper  treat- 
ment. 

"How  to  transport,  or  the  method  of  trans- 
portation, may  be  one-man,  two-man,  stretcher 
squad,  or  car  transportation — any  one  or  all 
of  which  may  be  used  for  one  or  more  injured 
persons. 

"When  to  transport  an  injured  person  will 
depend  upon  the  nature  of  the  injury — for  he 
often  must  receive  proper  first-aid  or  emergen- 
cy treatment  prior  to  transportation — whether 
the  present  location  of  the  patient  is  safe  or 
not,  and  the  availability  of  assistance  for 
transportation,  and  the  availability  of  capable 
and  efficient  equipment  and  personnel  for 
treatment." — Katherine  R.  Drinker. 


I  INDUSTRIAL 


ril\SlULC)(iV:    NUTRITION,    METABOLIS.M, 
FATIGUE,  ETC. 


R6i,E  OF  Diet  in  Etiology  and  Treat.ment 

OF  MiORAINE  AND  OtHER  TyPES  OF  HEADACHE. 

Thomas  li.  Brown.  Jour.  Am.  Med.  Assn., 
Oct.  29,  1921,  77,  No.  18,  139l)-1.399.— "I  have 
attempted  to  sketch  very  briefly  in  this  article 
the  arguments  in  favor  of  the  role  played  by 
diet  in  the  production  of  migraine  and  other 
forms  of  headache,  offering,  it  is  true,  argu- 
ments based  mainly  on  clinical  data,  although 
supported  in  certain  cases  by  laboratory  find- 
ings. I  feel  from  the  study  of  my  cases  that  in 
certain  cases  of  migraine  and  other  forms  of 
headache,  whatever  the  primary  cause,  diet 
plays  some  part  in  producing  the  symptoms 
of  which  the  patient  complains,  and  that  by 
modifying  the  diet  cure  may  be  obtained  in 
a  few  cases,  and  a  very  considerable  ameliora- 
tion of  symptoms  in  many  cases.  In  my  series 
of  fifty  or  more  eases,  carbohydrates  seemed 
to  have  played  the  predominant  role  in  the 
largest  number  of  cases;  animal-protein  food 
in  almost  as  many;  special  foods,  notably 
sugar  or  eggs,  in  a  very  few  eases,  while  in  an 
occasional  case  the  headache  might  be  regard- 
ed as  a  definite  expression  of  intestinal  tox- 
emia or  bacteremia  or  of  an  error  in  purin 
metabolism.  That  some  disturbance  in  liver 
function  plays  a  part  in  these  headaches  is 
suggested  by  the  fact  that  there  is  in  some 


cases  a  temporary  enlargement  of  the  liver 
during  and  after  the  acut6  symptoms.  While 
it  is  not  always  possible  to  determine  to  which 
special  form  of  dietetic  error  the  individual 
headache  may  be  ascribed,  nevertheless  in 
manj-  cases  a  very  careful  clinical  analysis, 
supported  by  certain  laboratory  tests,  offers 
us  a  clue  as  to  the  materia  peccans,  carbohy- 
drate, animal-protein,  or  purin-rieh  food  as 
the  case  may  be.  In  cases  in  which  it  is  abso- 
lutely imiwssible  from  the  clinical  evidence  to 
incriminate  anj'  special  food  or  foods,  it  is 
wise  to  place  the  patient  first  on  a  carbohy- 
drate-free diet  for  a  considerable  period  of 
time,  and  if  this  proves  unsuccessful,  then  on 
an  animal-protein-free  diet.  In  certain  cases 
such  treatment  will  bring  about  a  very  marked 
improvement  in  symptoms,  in  a  very  few  ap- 
parent clinical  cure,  although,  of  course,  in  a 
large  number  of  cases  no  effect  whatsoever. 
Finally,  in  this  group  of  cases  the  treatment 
of  which  is  peculiarly  unsatisfactory,  by  many 
regarded  as  almost  hopeless,  this  point  of 
view  is  not  justifiable,  unless  one  realizes  that 
in  certain  of  these  cases  diet  unquestionably 
plays  a  role,  and  that  a  proper  recognition  of 
this  fact  should  manifest  itself  in  the  appro- 
priate dietetic  therapy." — C.  K.  Drinker. 


236 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Respiratory  Efficiency  in  Relation  to 
Health  and  Disease.  Martin  Flack.  Lancet, 
Sept.  17, 1921,  2,  No.  12,  593-599.— This  paper 
was  read  as  one  of  the  Milroy  lectures  which 
were  founded  with  a  view  to  f urthermg  knowl- 
edge concerning  industrial  diseases.  The  au- 
thor shows  by  the  results  of  experiments  in 
the  Medical  Service  of  the  Royal  Air  Force 
that  "physical  ineiSciency  is  frequently  asso- 
ciated with  a  state  of  respiratoi-y  insufficien- 
cy." Statistics  of  the  medical  examination  of 
drafted  men  are  cited,  such  as  that  "out  of 
every  9  men  called  up  3  were  placed  in  Grade 
1,  2  in  Grade  2,  3  in  Grade  3,  and  1  in  Grade 
4,"  and  the  army  type  of  grading  measures 
far  below  Keith's  standard  of  grading. 

This  low  physical  status  of  drafted  men  was 
due  to :  (1)  poor  physique  and  presence  of 
physical  defects;  (2)  tuberculosis;  and  (3) 
diseases  and  degeneration  of  the  heart  and 
blood  vessels.  "Apart  from  these,  however, 
a  very  important  cause  of  defects  of  physique 
and  of  degeneration  was  the  effect  of  occupa- 
tion on  workers. ' ' 

Of  the  causes  of  the  diseases  and  degenera- 
tion of  the  heart  rheumatic  inflammation  of 
the  heart  was  the  greatest.  "On  the  other 
hand,  one  of  the  most  important  forms  of 
circulatory  troubles  was  veneris  varix  in  some 
form.  The  amount  of  this  was  surprising 
.  especially  in  industrial  districts  and 
among  older  men.  Varicosity  of  the  veins  of 
the  lower  extremities  to  an  extent  sufficient 
to  disable  or  be  dangerous  was  found  to  be 
very  common.  It  may  be  pointed  out  that 
such  diseases  are  largely  associated  with  de- 
ficiency' of  the  respiratory  mechanism." 

The  author  goes  on  to  state  that  ph.ysical 
inefficiency  is  largely  preventable  with  better 
sanitation  and  diet;  and  then  proceeds  to  re- 
view our  present  knowledge  concerning  the 
respiratory  function.  He  then  takes  up  in 
great  detail  correct  expiration,  thoracic  anat- 
omy (extensibility  of  the  lung),  movements  of 


the  ribs,  mechanism  of  circulation  and  com- 
pensatory mechanism. — M.  Dent. 

Respiratory  Efficiency  in  Relation  to 
Health  and  Disease.  Martin  Flack.  Lancet, 
Sept.  24,  1921,  2,  No.  13,  637-641.— This  lec- 
ture, the  second  of  the  Milroy  lectures  on 
respiratory  efficiency,  deals  with  the  nature 
and  value  of  the  tests  employed  with  the  fly- 
ing force,  special  routine  tests,  the  determina- 
tion of  vital  capacity,  and  the  diminution  of 
vital  capacity  during  disease.  "Further  ob- 
servations quickly  confirmed  the  view  that  in 
officers  suffering  from  strain  the  diminution 
of  the  vital  capacity  was  due  to  their  inability 
to  expire  sufficiently  to  empty  the  lungs  to 
their  full  capacity." — M.  Dent. 

Respiratory  Efficiency  in  Relation  to 
Health  and  Disease.  Martin  Flack.  Lancet, 
Oct.  8,  1921,  2,  No.  15,  741-744.— For  bodily 
efficiency  efficient  respiration  is  necessary. 
After  a  period  of  bodily  activity  in  infancy 
and  childhood  most  people  of  the  present  day 
settle  Aovni  to  a  sedentary  life.  "By  virtue 
of  lack  of  exercise,  trade  occupations,  mode 
of  clothing,  etc.,  the  inspiration  of  many  peo- 
ple of  the  present  day  is  defective, ' '  and  there 
is  a  marked  deterioration  between  the  ages  of 
18  and  23. 

But  the  effects  of  indiscriminate  physical 
training  are  bad.  The  author  believes  that 
one  of  the  most  urgent  needs  of  the  times  is 
a  set  of  simple  exercises  for  sedentary  workers. 
These  he  has  worked  out  and  presents  in  full 
in  this  article.  They  take  about  ten  minutes 
daily  to  perform  and  incorporate  natural 
movements  of  the  body.  These  exercises  will 
preserve  the  physical  efficiency  of  sedentary 
workers  and  will  enable  them  to  take  occasion- 
al strenuous  outdoor  exercise  without  undue 
fatigue.  Tliey  are  "in  no  way  designed  to  sup- 
plant recreational  exercise  nor  to  replace  more 
elaborate  .systems  of  physical  training." — M. 
Dent. 


HAZARDS  OF  COAIPRESSED  AIR.  DLANXISllED  PRESSURE,  GEN- 
ERATION AND  USE  OF  ELECTRICITY,  AND  ELECTRICAL 

WELDING 


The  Lethal  Power  of  Electricity.  M. 
D'Halluin.  Abstracted  as  follows  from  Jour, 
de  radiol.  et  d'electrol.,  1920,  Vol.  4,  254,  in 
Phj^iol.  Abstr.,  Oct.-Nov.,  1921,  6,  Nos.  7  and 
8,  455. — "Death  from  electricity  may  be  of 


respiratory  or  cardiac  origin.  Tlie  serious 
nature  of  the  latter,  though  often  ignored,  is 
due  to  persistent  fibrillation,  which  must  be 
distinguished  from  'folic  ondulatoire,'  from 
which  recovery  occurs.    Low-tension  currents 


ABSTRACT3 


237 


specially  affect  the  heart.  High-tension  cur- 
rents (1,200  volts  upwards)  inhibit  the  me- 
dulla and  kill  by  asphyxia.  Currents  of  240 
to  600  voltage  produce  both  effects.  Low- 
tension  currents  are  not  therefore  harmless, 
but  are  most  dangerous.  Respiratory  failure 
must  be  treated  by  accepted  methods,  but  car- 
diac failure  (diagnostic  points  are  given)  can 
only  be  restored  by  direct  massage  and  oxy- 
genation of  the  blood;  intravenous  injection  of 
KCl  (a  per  cent.)  helps.  In  dogs  massage 
alone  revived  37  per  cent. ;  massage  plus  KCl 
65  per  cent.  The  toxicity  of  KCl  depends 
rather  on  injection  rate  than  on  dose.  In 
dogs  the  lethal  dose  is  14  cgm.  per  kilo  if  in- 


jected 20  mgm.  per  minute,  but  is  42  cgm.  at 
the  rate  of  4  mgm.  per  minute  per  kilo  of 
bodj'-weight. ' ' — McKeen  Cattell. 

The  Pathology  op  Electric  Current 
BuRxs.  Stefo7i  Jellinek.  Wien.  klin.  Wchn- 
schr.,  May  29,  1921,  34,  No.  20,  239-240.— 
Electric  current  injury  of  the  skin  is  not  sim- 
ply a  "burn,"  but  a  definite  and  specific  his- 
tological picture  different  from  anything  else. 
The  basal  cells  of  the  rete  malpighii  are 
lengthened  3  to  6  times  into  bundles  parallel- 
ing the  direction  of  the  current.  Such  effects 
must  therefore  be  considered  in  a  new  light. 
— Barnett  Cohen. 


HEAT,    COLD    AND    HUMIDITY 


Experimental  Researches  on  "Autocol- 
loidoclasie"  from  Chilling.  F.  Widal,  P. 
Abraini,  and  E.  Brissaud.  Abstracted  as  fol- 
lows from  Conipt.  rend.,  1921,  Vol.  173,  207- 
212,  in  Physiol.  Abstr.,  Oct.-Nov.,  1921,  6, 
Nos.  7  and  8,  455. — "Dogs  were  exposed  to 
cold  b.y  immersion  in  water  at  2°  to  5°  C.  for 
varying  periods.  According  to  the  length  of 
time  of  immersion  the.v  suffered  from  mani- 
festations of  shock  in  varying  degree.  Short 
periods  produced  only  a  'crise  hi'-modasinue' 
consisting  of  (1)  leucopenia,  white  cells  di- 
miiiisliing  in  45  minutes  from  12,000  to  5.000; 


(2)  increase  of  lymphocytes  and  decrease  of 
polymorph  cells;  (3)  large  decrease  in  clot 
ting-time  of  the  blood;  and  (4)  diminution  of 
the  refractive  index  of  serum.  Further  symp- 
toms  were  pyrexia,  d.vspnea,  nausea,  edema, 
urticaria,  and  fiiudly  hemoglobinuria.  These 
symptoms  are  identical  with  those  following 
intravenous  injection  of  foreign  protein  in 
the  dog,  and  with  those  of  anaphylactic  shock 
in  the  dog.  These  forms  of  shock  are  therefore 
all  three  identical;  tlie  authors  give  the  name 
'colloidoclasie'  to  the  process  involved." — 
McKeen  CatteU. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


Working  Conditions  of  "Women  Wage- 
Earners  IN  Georgia.  U.  S.  Bur.  Labor  Statis., 
Month.  Labor  Rev.,  Oct.,  1921,  13,  No.  4,  877- 
881. — This  is  a  survey  of  the  working  condi- 
tions of  women  in  Atlanta,  Georgia.  The  in- 
dustrial opportunities  seem  less  varied  in 
Georgia  than  in  other  southern  states.  The 
survey  takes  up  the  number  of  colored  as 
against  white  women  employed  (the  colored 
women  generally  in  more  menial  positions), 
hours  of  labor,  earnings  (ranging  from  under 


$2  to  over  $20),  and  working  conditions  which 
vary  greatly  with  different  establishments.  A 
serious  feature  "was  the  frequency  of  unnec- 
essary hazard,  such  as  unguarded  machinery, 
uninelosed  elevator  shafts,  and  the  like,  53 
plants  being  found  to  present  such  dangers. 
Drinking  facilities  were  often  insufficient  or 
lacking,  as  were  facilities  for  cleanliness.  Rest 
rooms,  lunch  rooms,  first-aid  equipment,  and 
hospital  rooms  were  rare." — M.  Dent. 


INDUSTRIAL  SANITATION:    FACTORY  CONSTRUCTION,   ILLU- 
MINATION, VENTILATION,  HEATING,    WATER    SUPPLY,    SEW- 
AGE DISPOSAL 


Illumination  as  a  Factor  Favoring  Pro- 
duction. R.  E.  Harrington.  Nation's  Health, 
Oct.  15,  1921,  3,  No.  10,  547-550.— In  this 
article  Mr.  Harrington  emphasizes  the  fact 
that  although  correct  and  adequate  artificial 


illumination  is  a  form  of  expenditure  which 
brings  the  greatest  return  for  the  money  in- 
vested, nevertheless  many  plant  managers 
have  neglected  this  opportunity  to  increase 
the  overall  efficiency  of  their  plants. 


238 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"With  a  properly  designed  and  installed 
lighting  system  there  will  result,  as  contrasted 
with  the  conditions  under  a  poor  system,  bet- 
ter health  conditions,  less  labor  turnover, 
greater  activities,  better  workmanship,  fewer 
accidents  and  decreased  spoilage.  All  of  these 
factors  combined  assist  toward  the  desired  end 
— increased  production." 

Under  the  heading  Health  of  the  Worker 
Mr.  Harrington  discusses  the  reduction  of  eye- 
strain and  the  consequent  reduction  of  fa- 
tigue and  the  increase  of  bodily  efficiency, 
which  adequate  and  properly  planned  illumi- 
nation brings  about.  "Bad  lighting  will  react 
to  produce  nervous,  irritable,  discontented 
employees ; ' '  good  lighting,  on  the  other  hand, 
is  "reflected  in  the  faces  of  the  operators,  in 
the  form  of  healthful,  buoj-ant  spirits. ' ' 

C4ood  lighting  leads  to  material  improve- 
ment in  the  general  appearance  of  a  plant. 
There  are  no  longer  dark  corners  to  collect 
dirt  and  refuse.  Clean,  well-lighted  work- 
rooms are  a  factor  i]i  attracting  workers  and 
tend  to  reduce  discontent  and  the  amount  of 
labor  turnover.     With  adecjuate  illumination 


accidents  are  reduced  and  there  is  less  spoiled 
work  because  workers  can  see  moving  parts 
more  distinctly  and  can  gage  their  work  more 
accurately. 

Mr.  Harrington  next  gives  figures  to  prove 
that  the  points  that  he  brings  out  are  not 
theoretical,  but  that  the  cost  of  installing  and 
operating  a  good  system  of  lightmg  is  more 
than  compensated  for  in  actual  money  by  the 
saving  of  the  employees'  time. 

"In  order  for  the  plant  manager  to  deter- 
mine the  lighting  intensities  throughout  his 
plant,  it  is  desirable  to  have  available  an  in- 
strument, by  means  of  which  this  may  be  done 
easily  and  quickly  The  foot-candle  meter  is 
an  instrument  self-contained  and  portable 
which  meets  these  requirements.  By  means 
of  this  instrument  a  check  may  be  kept  on 
the  lighting  conditions  in  the  plant.  The 
manager  or  superintendent  may  easily  deter- 
mine whether  or  not  the  illumination  for  any 
given  operation  is  comparable  with  what  is 
considered  sufficient  for  that  operation." — 
Katherine  R.  Drinker. 


INDUSTRIAL  MEDICAL  SERVICE:  MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


Liable  for  Examination.  Eric  G.  Under- 
wood. Hosp.  Management,  Oct.,  1921,  12,  No. 
4^  62. — This  is  a  brief  description  of  the  medi- 
cal department  of  Thomas  de  la  Rue  and 
Company  of  London.  All  employees  of  the 
company  accept  employment  on  the  under- 
standing that  they  are  liable  to  medical  ex- 
amination, although  actual  medical  examina- 
tion is  not  made  in  every  case  at  the  time  of 
employment.  The  medical  advisor  satisfies 
himself,  however,  that  new  employees  are  not 
suffering  from  any  serious  illness  or  disease 
which  might  affect  the  general  well-being  of 
the  community.  The  present  uncertain  condi- 
tion of  the  labor  market  is  given  as  the  rea- 
son for  not  insisting  ujion  medical  examina- 
tion. 

In  each  department  of  the  factory  there  is 
employed  a  member  of  the  voluntary  ambu- 
lance brigade  for  treating  accidents,  illness, 
etc.,  and  in  each  room  there  is  a  supply  of 
first-aid  materials.  All  injuries,  no  matter 
how  slight,  are  reported  to  the  medical  depart- 
ment in  order  that  a  complete  record  may  be 
on  file  in  case  of  necessity. — M.  C.  Shorley. 


Plant  Hospital  Paltlts.  Hosp.  Manage- 
ment, Oct.,  1921,  12,  No.  4,  64,  66.— Before 
establishing  an  employees'  health  service,  the 
Champion  Coated  Paper  Company  of  Hamil- 
ton, Ohio,  had  its  medical  director  inspect  a 
number  of  industrial  hospital  departments. 
Among  the  faults  most  commonly  noted  were 
(1)  the  absence  of  a  systematic  method  of 
handling  sickness,  (2)  the  failure  to  arrange 
quarters  and  equipment  properly,  and  (3)  the 
lack  of  co-operation  between  the  welfare  de- 
partment or  industrial  relations  department 
and  the  health  department — faults  which  this 
company  aimed  to  avoid. 

Under  the  present  arrangement  each  appli- 
cant for  work  in  the  Champion  Coated  Paper 
Company  is  given  a  pliysical  examination  and 
is  then  classified  according  to  the  following 
groups:  those  without  any  phj'sical  defect; 
those  having  some  minor  imperfections;  those 
having  graver  ailments  which  are  curable; 
and  those  having  some  disease  or  impediment 
which  makes  them  unfit  for  employment.  At 
first,  objections  to  medical  treatment  and  ex- 
amination were  made  by  some  old  employees, 


ABSTRACTS 


239 


but  this  viewpoint  has  gradually  been  changed 
by  the  presentation  of  logical  reasons.  Lec- 
tures and  advisory  talks  are  given  which  help 
the  employees  to  keep  themselves  fit. 

A  report  of  the  work  of  the  health  service 


for  the  first  year  is  given,  together  with  com- 
parative figures  for  the  first  month  of  the  sec- 
ond year  which  show  a  definite  reduction  in 
time  lost  through  accidents  and  illness.— M. 
C.  Shorley. 


INDUSTRIAL  NURSING 


Nurses  in  the  Guise  op  Industrial  Phys- 
icians. William  Alfred  Sawyer.  Nation's 
Health,  Oct.  15,  1921,  3,  No.  10,  566-568.— In 
this  article.  Dr.  Sawyer  discusses  the  extent  to 
which  nurses  should  be  permitted  to  relieve 
industrial  ])hysicians  of  routine  duties — a  dis- 
cussion Avhicli  makes  it  quite  clear  tliat  the 
nurse's  whole  authority  should  be  the  i)hys- 
ician's  orders,  and  tiiat  nursing  care  is  not 
medical  service.  Dr.  Sawyer  goes  on  to  say 
that  if  the  industrial  physician  contents  him- 


self with  routine  giving  of  pills  and  bandag- 
ing of  injured  parts,  or  if  he  interests  himself 
onlj'  in  activities  in  which  a  nurse  can  be  con- 
sidered as  able  to  supplant  him,  he  cannot 
expect  industrial  medicine  to  offer  him  any 
real  future.  "The  science  of  industrial  medi- 
cine is  j^et  to  evolve,  but  it  is  in  process,"  and 
the  futui-e  is  to  the  honest,  far-seeing  "worker 
who  neglects  none  of  his  tasks  and  delegates 
none  of  his  responsibilities." — ^Katherine  R. 
Drinker. 


1NI)USTKIAL    INVESTIGATIONS  AND  SURVEYS 


A  Study  ov  In-dustrial  Absenteeism.  Eoh- 
ert  S.  Qiiinhy.  Nation's  Health,  Oct.  15,  1921, 
3,  No.  10,  572-576. — This  paper  contains  a 
very  interesting  account  of  tlie  results  of  an 
investigation,  covering  a  period  of  twenty- 
eight  montiis,  into  the  cause  of  absence  among 
6,700  factory  employees  of  the  Hood  Rubber 
Company.  The  group  studied  was  made  uji  of 
05  per  cent,  males  and  35  per  cent,  females, 
of  whom  55  per  cent,  were  married,  and  45 
per  cent,  single. 

The  employees  included  in  the  investigation 
are  classified  by  nationality,  by  age,  according 
to  the  location  of  residence,  and  according  to 
the  length  of  employment.  Next  follows  an 
account  of  the  benefit  plan  which  necessitated 
this  detailed  and  accurate  investigation  into 
absenteeism.  Finally,  the  following  outstand- 
ing features  in  regard  to  the  absence  expei'i- 
■ence  of  the  Hood  Rubber  Company  during 
these  twenty-eight  months  are  given  : 

"The  employees  in  the  group  covered  by 
this  investigation  lost  an  aggregate  of  245,442 
days  from  work  during  the  twenty-eight 
months  of  study.  When  reduced  to  days-lost- 
per-employee-per-year  this  represents  lost 
time  as  follows:"'  sickness,  6.61  days  per  em- 
ployee :  industrial  accidents,  0.45 ;  non-indus- 
trial accidents,  0.25;  personal  reasons,  10.95; 
total  for  all  causes,  18.26. 

' '  The  total  average  lost  time  from  all  causes 
•during  this  period  has  been  5^  per  cent,  of 


the  working  time,  of  which  approximately  2 
per  cent,  was  lost  time  on  account  of  sickness, 
0.14  per  cent,  on  account  of  industrial  acci- 
dents, and  0.08  per  cent,  because  of  non-in- 
dustrial accidents.  A  study  of  our  experi- 
ence would  indicate  that,  except  in  ver,y  un- 
usual periods,  sickness  disabilities  should  not 
exceed  2  per  cent,  of  the  working  time,  or, 
in  other  words,  six  days  per  emjiloyee,  based 
on  the  threc-hundred-day  working  year." 

Absenteeism  due  to  sickness  and  accident 
when  classified  by  sex  and  marital  conditions 
shows  some  very  interesting  variations.  "Sin- 
gle employees  lost  much  less  time  than  uuir- 
ried  persons,  single  males  less  than  single  fe- 
males. Married  males  lost  2  per  cent,  more 
time  than  single  males,  widowed  and  divorced 
males  21  i)er  cent,  more,  single  females  40  per 
cent,  more,  widowed  and  divorced  females  154 
per  cent,  more,  while  married  females  lost  175 
per  cent.  more. 

"It  is  generally  admitted  that  both  mar- 
ried males  and  females  show  a  lesser  labor 
turnover  than  single  persons,  but  a  portion  of 
this  employment  stability  is  sacrificed  for  the 
higher  absentee  rate  of  these  married  individ- 
uals, and  from  the  standpoint  of  absenteeism 
alone,  our  experience  indicates  that  married 
and  divorced  individuals  are  a  considerable 
liability." 

Absenteeism  "by  age  groups  indicates, 
first,  that  male  employees  lost  on  account  of 


240 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


sickness  and  accident  on  an  average  of  five 
days,  whereas  female  employees  lost  approxi- 
mateh'  eight  and  three-fonrths  days. 

"Below  the  age  of  forty,  the  lost  time  by 
males  is  below  the  average  male  disability, 
while  beyond  the  age  of  45,  males  show  a 
rapidly  increasing  morbidity  rate.  In  the 
case  of  females,  the  rate  remains  less  than  the 
average  up  to  the  age  of  thirty,  while  beyond 
that  age  the  rate  increases.  Prom  an  employ- 
ment standpoint,  therefore,  we  might  well 
give  careful  consideration  to  women  over  the 
age  of  thirty,  and  men  over  foi-ty. " 

Dr.  Quinby  goes  on  to  consider  disability 
according  to  nationality,  according  to  physi- 
cal examination  classifieations,  by  day  of  the 
week,  and  by  months  of  the  year.  The  article 
concludes  with  the  list  given  below  of  the 
diseases  causing  lost  time,  and  with  figures 
upon  the  length  of  disability  from  sickness 
and  accident. 

Diseases  causing  lost  time  were  as  follows : 

"General  diseases — including  tuberculosis, 
rheumatism,  influenza,  diphtheria,  scarlet 
fever,  typhoid,  etc. — caused  1.46  days  disa- 
bility per  person. 

"Respiratory  diseases  —  including  colds, 
bronchitis,  pneumonia,  pleurisj',  etc. — caused 
1.26  days  disability  per  person. 

"Diseases  of  the  digestive  system  caused 
1.11  days  disability  per  person. 

"Ill-defined  and  unclassified  sicknesses 
caused  1.09  days  disability  per  person. 

"Affections  produced  by  external  causes 
caused  0.41  days  disability  per  person. 

"Diseases  of  the  bones  and  organs  of  loco- 
motion caused  0.32  days  disability  per  person. 


"Diseases  of  the  nervous  system  and  organs 
of  special  senses  caused  0.22  days  disability 
per  person. 

"Diseases  of  the  circulatory  sj'stem  caused 
0.16  days  disability  per  person. 

"Non-venereal  diseases  of  the  genito-urin- 
ary  system  caused  0.15  days  disability  per 
person. 

"Diseases  of  the  skin  and  cellular  tissue 
caused  0.09  days  disability  per  person. 

"The  puerperal  state  caused  0.05  days  dis- 
ability per  person. 

"Malformations  caused  0.005  days  disabil- 
ity per  person. 

' '  Considered  from  the  viewpomt  of  individ- 
ual diseases,  the  more  important  follow  in 
order : 

"Influenza  caiLsed  0.718  days  disability  per 
person  ;  colds,  0.53  ;  tonsillitis,  0.341 ;  bronchi- 
tis, 0.312. 

"Piilmonary  tuberculosis  caused  0.24  days 
disability  per  person. 

"Rheumatism  caused  0.235  days  disability 
per  person. 

"Appendicitis  caused  0.171  days  disability 
per  person. 

"Broncho-  and  lobar  pneumonias  caused 
0.169  daA's  disability  per  person. 

"Pleurisy  caused  0.095  days  disability  per 
person,  while  hernias  caused  0.091  days  dis- 
ability per  person. 

"If  we  combined  influenza,  pulmonary  tu- 
berculosis, broncho-  and  lobar  pneumonia, 
pleurisy,  and  other  respiratoiy  diseases,  our 
experience  in  1920  indicates  that  this  group 
caused  more  than  35  per  cent,  of  our  total 
disabilit}^  on  account  of  sickness  and  accidents 
combined." — Katherine  R.  Drinker. 


INDUSTRIAL  PSYCHOLOGY  AND  INDUSTRIAL   MANAGEMENT 

IX  ITS  HEALTH  RELATIONS 


Critical  Survey  of  Intelligence  Testing. 
Peter  Snndiford.  Canadian  Jour.  Ment.  Hyg., 
July,  1921,  3,  No.  2,  37-46.— The  first  part  of 
this  paper  consists  of  an  historical  review  of 
the  development  of  intelligence  testing.  The 
author  goes  on  to  elaborate  on  the  nature  of 
intelligence  (is  it  multi-focal  or  unifocal?); 
on  definitions  as  to  what  it  is;  on  standardiza- 
tion of  tests  (often  those  from  one  locality 
are  applied  to  a  locality  where  the  average  of 
intelligence  is  higher  or  vice  versa)  ;  and  on 
methods  of  expressing  the  results  of  the  meas- 


urements of  intelligence  (in  which  connection 
there  are  still  two  important  unsettled  prob- 
lems.- the  amount  of  yearly  increments  of  in- 
telligence, and  the  age  of  maturity  of  intelli- 
gence).— M.  Dent. 

The  Hr.MAN  Factor  in  Tndi'stry.  C.  H. 
Norfhcott.  Indnst.  Management,  Oct.,  1921, 
62,  No.  4,  195-198;  Nov.,  1921,  No.  5,  292- 
297. — One  would  expect  to  find  the  human 
factor  in  industry  exalted  in  both  history  and 
practice,  but  the  actual  record  is  one  of  neg- 


ABSTRACTS 


241 


leet,  despite  the  fact  that  industrial  history 
is  a  story  of  the  emergence  of  this  human  fac- 
tor from  a  position  of  inferiority,  and  despite 
the  instances  of  collective  recognition  of  the 
place  of  hximan  beings  as  the  supreme  factors 
in  industry.  The  Clayton  Act  of  1914  estab- 
lishing the  principle  that  "the  labor  of  human 
beings  is  not  a  commodity  or  article  of  com- 
merce," and  the  world-wide  consensus  of 
opinion  on  the  rights  of  labor  represented  by 
the  principles  laid  down  by  the  Peace  Com- 
mission on  Intornational  Labor  Legislation  in 
1919,  are  expressions  of  this  recognition  of 
human  rights  in  industry. 

The  human  factor  has  now  been  exalted 
also  bj'  a  wider  social  conception.  The  war 
has  affected  the  attitude  toward  labor,  and 
the  impoverishment  of  the  world  by  war  has 
made  it  important  to  utilize  the  services  of 
human  beings  to  the  utmost — a  thing  wiiich 
cannot  be  accomplished  under  conditions  that 
do  not  ennoble  men  and  women.  Men  must  be 
decently  fed,  clothed  and  housed  before  they 
can  make  their  best  effort. 

We  cannot  properly  treat  human  beings  as 
a  part  of  the  mechanical  system  of  industry. 
Man  is  greater  than  the  machine.  His  driving 
force  is  in  himself;  lie  has  a  ])ei-sonality,  and 
desires  and  as|)irations  which  industry  should 
meet.  The  exaltation  of  the  human  factor, 
therefore,  implies  more  efficient  use  of  ma- 
chinery by  men  and  women  who  know  their 
own  needs  and  limits,  wlio  liave  adjusted 
mechanized  industry  to  themselves,  and  ap- 
plied its  ])ro(luets  to  their  own  physical  and 
mental  benefit. 

In  order  to  fit  men  and  women  into  indus- 
try without  waste  and  friction,  account  nulst 
be  taken  of  their  diversities,  and  in  this  re- 
gard probably  mental  qualities  are  even  more 
important  than  pli.vsical.  Industi-ial  psyehol- 
ogj'  must  be  applied,  both  to  the  study  of 
fitness  and  to  the  analysis  of  the  work  itself. 

Since  manual  toil  consists  of  a  multitude  of 


muscular  movements,  attention  must  be  given 
to  the  quality  of  these  movements.  Opposition 
arises  from  the  fear  that  this  form  of  study 
will  turn  men  into  automatons,  but  this  fear 
is  misguided.  All  important  operations 
should  be  analyzed  and  the  best  movements 
taught  to  each  begiiuier;  experience  has 
shown  that  this  is  a  practicable  plan.  In  this 
connection  attention  should  be  given  to  the 
laws  of  practice,  and  it  may  be  said  that  the 
desire  of  many  persons  to  work  along  their 
own  lines  is  often  in  direct  opposition  to  their 
best  interests. 

Account  must  be  taken  also  of  fatigue  and 
its  causes,  since  there  is  an  enormous  waste 
from  neglecting  this  factor.  In  fatigue  need- 
less motions  are  an  element  to  be  considered, 
and  the  length  of  the  working  day  is  an  im- 
portant one;  it  is  hard  to  find  any  justifica- 
tion for  a  day  longer  than  eight  hours.  In 
regard  to  the  essential  factor  of  rest  periods 
in  preventing  fatigue,  the  fact  that  different 
individuals  probably  demand  different  treat- 
ment should  be  taken  into  consideration. 
There  is  a  natural  rate  of  working  and  a  na- 
tural rhythm  for  each  individual  and  fatigue 
is  caused  when  operations  are  not  adjusted  to 
these;  but  at  the  same  time  it  should  be 
known  that  it  is  quite  possible  for  a  rhythm 
to  become  habitual  that  is  at  once  more  fa- 
tiguing and  less  productive  than  one  that  is 
faster.  Noise  and  vil)ration  cause  fatigue, 
and  the  factors  of  lighting  and  ventilation 
still  need  to  be  more  generally  considered. 
(It  is  stated  in  a  report  of  the  British  Indus- 
trial Fatigue  Research  Board  that  an  output 
increase  of  12  per  cent,  might  be  expected  in 
the  tin-plate  industry  in  South  Wales  from 
more  efficient  ventilation.)  Humidity  also  is 
a  potent  factor  in  fatigue.  In  a  word,  man,  as 
a  purely  physical  being,  needs  much  consid- 
eration if  he  is  to  play  his  part  in  industry. — 
G.  E.  Partridge. 


INDUSTRIAL  SERA^CE  AND  ^lUTUAL   BENEFIT  ASSOCIATIONS 


Medical  Depabtment  Helps  Cafeterl\. 
E.  II.  AnscU.  Hosp.  Management,  Oct.,  1921, 
12,  No.  4,  56,  58,  60.— During  the  war  the 
author  served  upon  the  Food  Administration 
Board  and,  as  his  work  embraced  the  indus- 
trial and  school  lunches  m  New  England, 
splendid  opportunity  was  afforded  him  to 
study  luncheon  methods,   equipment,  menus 


and  finances.  Consequently,  upon  returning 
to  his  position  with  the  New  England  Tele- 
phone Company  at  the  close  of  the  war  he  was 
able  to  put  his  experience  to  practical  use. 

It  is  the  author's  opinion  that  the  cafeteria 
patronage  of  the  New  England  Telephone 
Company  is  due  to  (1)  prices  that  entice,  (2) 
the  appetizing  appearance  of  the  food,    (3) 


242 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


the  quality  of  the  supplies,  and  (4)  the  va- 
riety of  the  menus.  There  are  seventy-five  dif- 
ferent menus,  a  sample  of  which  is  given,  with 
prices  included.  Each  menu  is  supplemented 
by  cooking  instructions  to  the  matrons  so  that 
all  foods  may  be  uniformly  prepared.  For- 
merly the  menu  showed  each  food  item  sepa- 
rately, but  the  present  menu  provides  for 
food  combinations.  This  change  in  system  is 
due  to  the  fact  that  during  the  last  year  of 
the  war  the  medical  department  reported  that 
the  health  of  the  young  women  employees  of 
the  company  was  from  10  to  20  per  cent, 
below  par,  and  recommended  that  larger  por- 
tions be  given  in  the  cafeterias.  When  the 
matter  was  referred  to  Mr.  Ansell,  he  made 
rather  extensive  observations  in  the  com- 
pany's lunchrooms  and  discovered  that  only 
about  18  per  cent,  of  the  women  employees 
were  selecting  a  good  working  ration.  It 
seemed  evident  to  him  that  increasing  the 
size  of  the  portions  would  not  solve  the  prob- 
lem, but  another  solution  was  found — namely, 
that  of  making  attractive  combinations  cover- 
ing meat  portions  plus  bread  and  butter  for 
the  same  price  that  was  formerly  charged  for 
meat  alone.  Frequently,  a  side  order  of  spin- 
ach or  carrots  is  added  in  order  to  make  a 
well-balanced  ration.  In  addition,  the  price 
of  milk  was  reduced  to  2  cents  per  glass  and 
the  size  of  the  glass  increased  from  8  to  10 
ounces.  In  order  to  meet  the  requirements 
of  employees  who  bring  a  lunch  and  who  wish 
to  supplement  it,  various  items  on  the  menu 
are  sold  separately. 


A  marked  increase  in  the  health  of  the  com- 
pany's employees  was  quickly  noticed  after 
this  change  in  menu — a  factor  which  sujiports 
the  author's  contention  that  there  should  be 
closer  co-operation  between  the  luncheon  and 
the  medical  department  executives.  In  clos- 
ing, the  author  emphasizes  the  importance  of 
industrial  lunchrooms  as  educational  meas- 
ures and  outlines  the  opportunities  open  to 
industrial  plants  for  physically  building  up 
their  forces. — M.  C.  Shorley. 

Serving  Meals  at  a  Loss.  E.  Hobart.  Fac- 
tory, Nov.,  1921,  27,  No.  5,  701.— At  the  White 
Motor  Company  a  soup  kitchen,  two  cafeteria 
lunch  counters  and  a  restaurant  are  main- 
tained. "An  effort  is  made  to  serve  the  best 
and  most  healthful  meals  and  to  give  the  most 
efficient  service.  The  restaurants  and  cafe- 
terias are  run  at  a  loss,  which  is  taken  care 
of  by  a  special  fund  set  aside  for  this  purpose 
by  the  company." — M.  Dent. 

This  Provides  Recreation.    T.  W.  Altman. 


Factory,   Nov.,    1921,   27,   No.   5,   700.- 


'To 


provide  a  suitable  place  for  recreational  activ- 
ities, the  Clark  Equipment  Company  has  a 
model  theater,  Iniilt  right  in  among  the  fac- 
tory buildings  .  .  .  The  auditorium  of 
the  theater  will  comfortably  seat  a  thousand 
people.  It  has  a  large  stage  with  footlights, 
and  is  fully  equipped."  The  theater  is  used 
for  many  purposes,  dances,  musicales,  "mo- 
vies," etc.,  and  is  operated  without  profit. — 
M.  Dent. 


INDUSTRIAL  HEALTH  LEGISLATION:  COURT  DECISIONS: 
A\ORKMEN'S  COMPENSATION  AND  INSURANCE 


The  British  Industrial  Court.  W.  Mac- 
Jce/nzic.  Internat.  Labour  Rev.,  July-Aug., 
1921,  3,  Nos.  1-2,  41-50.— The  Avriter  reviews 
the  efforts  made  in  Great  Britain  to  provide 
for  peaceable  settlement  of  industrial  differ- 
ences, and  traces  their  history  back  to  the 
Elizabethan  Statute  of  1562.  An  attempt  was 
made  during  the  early  part  of  the  nineteenth 
century  to  introduce  compulsion  into  arbitra- 
tion, but  this  was  abandoned  in  favor  of  per- 
suasion and  argument,  until  during  the  Great 
War  "the  element  of  compulsion  in  arbitra- 
tion was  again  introduced  and  tliis  time  with 
effect."  The  Committee  on  Production  was 
given  power  to  deal  with  industrial  disputes, 


and  this  committee  accumulated  an  extensive 
knowledge  of  industrial  conditions,  and  in  the 
course  of  its  work  made  .3,754  awards. 

The  successor  of  the  committee  as  an  arbi- 
tration tribunal  was  the  Interim  Court  of 
Arbitration  (establi.shed  under  the  Wages 
Act  of  1018),  which  made  about  850  awards, 
only  three  of  which  were  disputed  and  fol- 
lowed by  interruption  of  work.  The  Interim 
Court  came  to  an  end  with  the  passing  of  the 
Industrial  Courts  Act  in  November,  1919,  and 
except  as  to  temporary  action  in  regard  to 
questions  of  prescribed  rates,  all  compulsion 
was  done  away  with.  The  Industrial  Courts 
Act    establishes    arbitration    machinery,    and 


ABSTRACTS 


243 


also  provides  Courts  of  Enquiry.  The  aim  is 
to  give  the  parties  of  a  dispute  as  wide  a 
choice  as  possible  as  to  the  kinil  of  tribunal 
to  which  the  difference  shall  be  submitted. 
A  permanent  liulustrial  Court  is  set  up,  but 
disputes  may  also  be  referred  to  persons  or 
boards  api)ointed  by  the  Minister  of  Labor, 
or  to  a  board  of  arbitration  nominated  by  the 
parties  to  the  dispute.  The  Industrial  Court 
itself  consists  of  thirteen  persons,  api)ointed 
by  the  Minister  of  Labor,  and  constitutes  an 
independent  tribunal. 

Arl)itration  as  provided  for  in  the  Indus- 
trial Court  is  on  a  wholly  voluntary  basis. 
The  parties  must  agree  to  refer  to  the  court, 
and  the  finding  of  the  Court  depeiuls  for  its 
observance  on  the  honor  and  civic  sense  of  the 
applicants.  Experience  iuis  sliown  that  ap- 
peal to  a  sense  of  fair-jilay  is  practicable, 
since  the  number  of  repudiated  awards  is 
almost  negligible;- — G.  E.  Partridge. 

Workmen's  Compensation  for  Loss  of 
One  Eye.  Sicurixf.  Abstracted  as  follows 
from  Schweiz.  med.  Wehnsehr.,  Sept.  1,  l!l'21, 
51,  No.  35,  801,  in  Jour.  Am.  Med.  Assn..  Nov. 
5,  1921,  77,  No.  19,  1528.— "The  Swiss  social 
insurance  has  been  in  the  habit  of  allowing  10 
per  cent,  compensation  for  the  loss  of  an  eye 
for  the  mutilation,  with  an  additional  10  to 
23  per  cent,  for  the  incapacity,  and  nothing 
more.  This  has  lately  been  changed  to  10  per 
cent,  for  the  mutilation  and  nothing  more 
unless  vision  i.s  lost  in  the  other  eye.  If  this 
occurs  from  an  insured  mishap,  the  workman 
receives  100  per  cent.;  if  from  sickness  or  an 
uninsured  accident,  he  receives  50  per  cent. 
If  vision  is  not  totally  lost,  the  percentage  is 
modified  to  correspond.  Siegrist  discusses 
these  i-egulations.  The  Swiss  ()i)lithalmologic 
Society  appointed  a  committee  to  stiuly  tlic 
matter,  and  adopted  resolutions  approving  the 
new  regulations,  but  demanding  a  higher  rate 
for  the  mutilation,  20  or  25  per  cent,  accord- 
ing as  the  eye  had  been  enucleated  or  not. 
The  society  also  urged  that  opportunity  for 
revision  be  allowed  at  any  time."  —  C.  K. 
Drinker. 


Report  of  Ix^'estigation  into  the  Opera- 
tion OF  THE  British  Health  Insprance  Act. 
Williaiii  T.  I\<t))isc!i  and  Onlwuy  Tead.  Am. 
Labor  Legis.  Rev.,' Sept.,  1921,  11,  No.  3,  233- 
278. — "It  may  be  said  at  once  that  in  the 
main  and  considering  the  haiulicaps  and  ob- 
structions sutfered  during  five  years  of  war 
the  act  is  in  reasonablj'  successful  operation 
and  is  beginning  to  produce  some  of  the  bene- 
fits that  were  initially  urged  ui  its  behalf. 

"In  the  second  place  the  afl"ected  groups  in 
the  community  are  now  working  the  act  with 
a  remai-kable  degree  of  co-operation  and  with 
an  all  but  universal  recognition  of  th'^  value 
of  the  legislation.  F'ew  in  the  community 
would  seriously  advocate  or  even  contemplate 
its  repeal  or  withdrawal.  The  tendency  and 
common  desire  is  in  (piite  the  opposite  direc- 
tions to  make  the  act  in  fact  as  well  as  in 
name  a  national  act  which  will  really  assure 
good  healtli  throughout  the  country. 

"In  the  third  place,  as  this  report  will 
presently  develop,  it  is  highly  jji-obalde  that 
much  may  be  learned  from  the  failures  and 
the  shortcomings  of  the  present  operation; 
and  any  rigid  copying  of  the  British  act 
would  certainly  be  rpiite  unwarranted  wlien 
the  peculiar  conditions  under  wliicli  it  has 
developed  are  understood. 

"Points  at  which  the  British  experience 
can  most  certaiidy  i)rovide  a  useful  warning 
are  the  following : 

"1.  The  ca.sh  benefits  should  not  be  paid 
through  approved  societies,  but  through  local 
bodies  publicly  constituted. 

"2.  The  cash  benefit  should  be  at  least  50 
per  cent,  of  wages. 

"3.  The  medical  benefits  should  not  be 
limited  to  the  insured  workers,  but  should  ex- 
tend to  their  families. 

"4.  Hospital  care,  consultant  services  and 
specialized  diagnostic  facilities  in  the  form  of 
clinics  and  laboratories  should  not  be  left  out 
of  the  plan,  but  should  be  incorporated  as 
part  of  tlie  medical  benefit." 

The  report  amplifies  and  explains  the  above 
statements. — M.  Dent. 


INDUSTRIAL  MORTALITY  AND   MORBIDITY     STATISTICS 


Sickness  among  Telephone  Employees  among  the  staff  of  the  state  telephone  service 
IN  Italy.  Internat.  Labour  Rev.,  Nov.,  1921,  in  the  Florence  di.strict  from  1912  to  1920 
4,  No.  2,  143-144. — Investigations  of  sickness     show  that  the  average  individual  sickness  rate- 


244 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


in  the  permanent  male  staff  (given  for  the 
years  1917-1919  for  the  whole  country)  was 
41.08,  and  in  Florence  for  the  years  1912-1919 
11.55  for  the  permanent  staff  and  9.25  for  the 
temporary  staff.  The  corresponding  averages 
for  women  were  53..3,  .32.84,  and  13.67.  The 
writer  concludes  that  with  efScient  health  and 
sanitary  inspection  the  averages  could  be  re- 
duced by  one-third,  so  that  a  satisfactoi-y 
average  sickness  rate  may  be  taken  as  13.6 
for  men  and  22.18  for  women. — G.  E.  Part- 
ridge. 

Sickness  and  Death  Rates  among  Ger- 
man Printers.  Internat.  Labour  Rev.,  Nov., 
1921,  4,  No.  2, 142-143.— In  its  report  for  1920 
the  German  Printers'  Union  presents  statis- 
tics in  regard  to  18,439  cases  of  sickness.  A 
table  shows  that  of  a  total  of  6,892  cases  (how 
selected?)  the  largest  class  is  malign  tumors, 
1,479  cases;  followed  by  nervous  diseases, 
1,442 ;  affections  of  the  stomach,  934 ;  gout  and 
rheumatism,  805 ;  respiratory  diseases,  712 ; 
heart  diseases,  420 ;  affections  of  the  eye,  310 ; 
affections  of  the  bones  and  joints,  305;  affec- 
tions of  the  bladder  and  intestines,  260;  lead 
poisoning,  204;  tuberculosis,  21. — G.  E.  Part- 
ridge. 

The  Mortality  of  Masons.  G.  Gherardi. 
II  Lavoro,  Sept.  30,  1921,  12,  No.  5,  130-136.— 
The  masons  in  Italy  have  a  mortality  lower 
than  that  of  males  above  the  age  of  15  years, 


16.1  per  thousand  as  against  18.7.  This  speaks 
for  the  healthfulness  of  their  trade,  which  is 
carried  on  out-of-doors,  is  not  as  strenuous  as 
many  other  sorts  of  labor,  and  permits  of  the 
harmonious  development  of  the  whole  body. 
There  is  no  evidence  of  any  occupational  dis- 
ease among  them,  but  the  accident  rate  is  not 
only  much  higher  than  that  of  other  adult 
males,  but  has  undergone  a  greater  propor- 
tional increase  during  the  last  ten  years  than 
has  that  of  the  male  population  in  general. 
The  mortality  from  accidents  for  men  above 
15  years  was  42.8  per  thousand  during  twenty 
years  ending  1916 ;  for  the  masons  it  was  79.3. 
The  rate  for  the  first  class  had  increased  dur- 
ing the  second  decennium  from  39.8  to  45.8, 
but  for  the  masons  from  66.4  to  91.7.  The 
question  is  raised  whether  the  excessively  high 
rate  indicates  that  masons'  work  is  growing 
continually  more  dangerous,  but  the  author 
believes  that  this  is  not  true,  and  thinks  that 
the  cause  lies  in  greater  recklessness.  He  urges 
the  building  trades  to  undertake  the  same  in- 
tensive efforts  for  the  prevention  of  accidents 
which  in  the  steel  industry  have  resulted  in  a 
reduction  of  casualties  from  1,392  in  1906  to 
thirty-nine  in  1911.  The  chief  dangers  in  the 
building  trades  are  to  be  found  in  faulty  con- 
struction of  scaffolds,  lack  of  adequate  super- 
vision, and  failure  to  select  the  most  depend- 
able workmen  for  the  most  dangerous  jobs. — 
Alice  Hamilton. 


ABSTRACT  OF  THE  LITERATURE 

OF 

INDUSTRIAL  HYGIENE 


Volume  III 


MARCTT.  1922 


Number  11 


CONTENTS 


PAGE 

General   245 

Systeiiiii-  (Kcuiiationiil  Kiseiises:   Occurrfiife, 

TreatiiiLMit  and  rrovcntion 1140 

Poisonous  Hazards  and  Their  Effects:  Gases, 

Clieniieals,  etc -4(i 

]  >ust  Hazards  and  Their  Effects 251 

Occupational  Infectious  Diseases:  Occurrenw. 

Troatniont  anil  I'revcntion 251 

Occupational    Affections    of    the    Skin    and 

Special  Senses  25^1 

Occurrence  and  Prevention  of  Industrial  Acci- 
dents        257 

Industrial  Physiology  :  Nutrition.  Metalxili.sni. 
Fatigue,  etc 259 


PAGE 

Women  and  Children  in  Industry 202 

Industrial  Sanitation:  Factory  Construction, 
Illumination,  \'entilation.  Heating,  Water 
Supply,  Sewage  Disposal 264 

Industrial  Medical  Service:  Medical  Dispen- 
saries and  Hospitals  in  Industrial  Plants..     265 

Industrial  Investigations  and  Surveys 266 

Industrial  Psychology  and  Industrial  Man- 
agement  in    Its  Health   Relations 266 

Industrial  Service  and  Mutual  Benefit  Asso- 
ciations        26S 

Rehabilitation  of  Disabled  Employees 268 


GENERAL 


Problems  op  Industrial  Hygiene  in  Rela- 
tion TO  PtiBLic  Health.  Sir  Thomas  Oliver. 
Jour.  State  Med.,  Nov.,  1921.  29,  No.  11,  321- 
332. — Women  have  entered  indu.stry  in  large 
numbers  to  stay,  and  they  constitute  a  distinct 
problem.  Welfare  work  has  been  an  impor- 
tant aid  in  handling  this  problem.  Capacity 
for  work  decreases  after  the  sixth  montli  of 
pregnancy  up  to  parturition,  after  wliieh  the 
curve  rises  to  normal  about  three  mouths  after 
childbirth.  Women  shoidd  be  spared  heavy 
work  during  the  last  two  months  of  preg- 
nancy. There  is  nothing  to  sliow  tliat  ordin- 
ary factory  work  unfits  women  for  domestic 
life. 

Vocational  fitness  of  men  and  women  should 
be  considered  early  so  that  labor  turnover  and 
"misfits"  may  be  reduced  to  a  minimum. 
Experience  in  England  and  the  United  States 
shows  that  disability  increases  with  age  after 
35  or  40  years.  Industrial  accidents  are  too 
high,  and  steps  should  be  taken  to  procure 


reduction  by  securing  the  active  co-operation 
of  all  concerned.  Return  to  work  after  ilbiess 
or  accident  should  be  gradual.  The  mental 
diversion  and  development  of  the  modern  fac- 
tory worker  should  be  looked  to  if  constructive 
progress  is  expected. — Barnett  Cohen. 

Ini)UStrl\l  Wastes.  Abstracted  from  Chem. 
Met.  Engin.,  1921,  Vol.  25,  in  Chem.  Abstr., 
Oct.  20,  1921, 15,  No.  20,  3534.— The  following 
articles  are  listed  for  the  benefit  of  interested 
readers:  "Human  Waste  in  Industry,"  by 
Harry  E.  Mock,  p.  369;  "Waste  Due  to  Poor 
Engineering  and  Management,"  by  Dexter  S. 
Kimball,  p.  375;  "The  Educational  Waste  in 
Industry,"  by  Hollis  Godfrey,  p.  378;  "The 
Role  of  Research  in  Waste  Elimination,"  by 
Harrison  E.  Howe,  p.  379;  "Waste  Due  to 
Lack  of  Standardization,  of  Chemicals,"  by 
Wallace  P.  Cohoe,  p.  383;  "The  Personal 
Problem:  To  Eliminate  the  Waste  of  Human 
Effort,"  by  L.  B.  Hopkms,  p.  385;  "Disclosing 


245 


246 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Waste  through  Better  Cost  Methods,"  by 
Ernest  J.  Wessen,  p.  389 ;  "  The  Elimination 
of  Construction  Wastes,"  by  George  W. 
Burpee,  p.  394;  "Some  Consideration  on  Fire 
Waste,"  by  Nicholas  Richardson,  p.  397 ;  "Lo- 
cation as  a  Factor  in  Eliminating  Industrial 
Waste,"  by  Victor  V.  Kelsey,  p.  401;  "Re- 
duction of  Waste  through  Accident  Preven- 
tion," by  L.  A.  DeBlois,  p.  403;  "Elimination 
of  Waste  in  Industry  Due  to  Poor  Lighting," 
by  Ward  Harrison,  p.  407;  "Eliminating 
Manufacturing  Wastes  with  Machinery,"  by 
J.  E.  Hires,  p.  410;  "Elimination  of  Waste 
in  Industrial  Power  Plants,"  by  David  M. 


Myers,  p.  413;  "The  Elimination  of  Waste 
in  Mai'ketmg,"  by  William  R.  Basset,  p.  420; 
"Wastes  in  Litigation,"  by  Wellington  Gus- 
tin,  p.  423 :  "Eliminating  Waste  and  Nuisance 
in  Smoke,  Fume  and  Gas,"  by  P.  E.  Landolt, 
p.  428 ;  ' '  The  Wastes  Caused  by  Careless- 
ness," by  Philip  DeWolf,  p.  433.  In  addition 
to  the  papers  noted  here  this  special  number 
of  Chemical  and  Metallurgical  Engineering 
contains  a  number  of  brief  articles  on  wastes 
in  specific  industries  which  are  referred  to  sep- 
arately in  the  appropriate  sections  of  this 
number  of  Chemical  Abstracts. 


SYSTEMIC   OCCUPATIONAL   DISEASES:  OCCURRENCE,  TREAT- 
MENT AND  PREVENTION 


Visceroptosis  :  Normal  iNciDEisrcE :  A  Pre- 
liminary Report.  John  Bryant.  Jour.  Am. 
Med.  Assn.,  Oct.  29,  1921,  77,  No.  18,  1400- 
1402. — "1.  Visceroptosis  is,  in  general,  not 
progressive  with  age.  This  is  due  to  the  fact 
that,  although  the  percentage  of  ptosis  of 
certain  viscera  increases  with  age,  this  per- 
centage increase  is  offset  by  a  decreasing 
frequency  with  age  in  respect  to  other  viscera. 

"2.  Visceroptosis  affecting  one  or  more 
organs  was  present  to  some  extent  in  48  per 
cent,  of  aU  cases  examined,  it  being  extreme 
in  10.2  per  cent,  of  the  males  and  19.7  per 
cent,  of  the  females. 

"3.  Visceroptosis  affecting  the  liver,  right 
and  left  kidney,  stomach  and  pylorus,  is 
acquired. 

"4.  Visceroptosis  affecting  the  large  intes- 
tine is  in  both  sexes  largely  congenital  or  de- 
velopmental. The  percentage  frequency  of 
ptosis  of  certain  portions  of  the  large  intestine 
does,  however,  further  increase  with  age  in 


both  sexes.  The  greatest  discrepancy  between 
the  male  and  female  in  regard  to  the  percent- 
age frequency  of  coloptosis  in  the  adult  occurs 
at  the  ileocecal  valve.  Thus,  this  portion  of 
the  colon  shows  an  extreme  degree  of  ptosis 
in  12.1  per  cent,  of  the  males  of  all  ages;  this 
contrasts  with  an  extreme  degree  of  ptosis 
at  the  ileocecal  valve  in  39.4  per  cent,  of  the 
females  of  aU  ages. 

"5.  No  normal  standard  of  frequency  of 
visceroptosis,  based  on  unselected  material, 
exists. 

"In  the  absence  of  such  a  normal  standard, 
proper  evaluation  of  the  degree  of  deviation 
reported  in  any  selected  roentgenologic  or 
other  series  of  cases  is  impossible. 

"A  standard  of  frequency  of  visceroptosis 
which  may  be  considered  adequate  until  cor- 
rected by  future  investigators  is  made  avail- 
able in  tabular  form  in  the  present  article." 
— C.  K.  Drinker. 


POISONOUS 


HAZARDS    AND  THEIR   EFFECTS:  GASES, 
CHEMICALS,  ETC. 


Industrial  Poisonings  and  their  Preven- 
tion. Ernst  Brezina.  Abstracted  as  follows 
from  Chem.  Ztg.,  1921,  Vol.  45,  599-602,  624- 
626,  647-649,  694-696,  in  Chem.  Abstr.,  Nov. 
10,  1921,  15,  No.  21,  3685.— "An  extended 
lecture  on  individual  toxicology  covering 
many  inorganic  and  organic  poisoning  agents, 


symptoms,  'ests,  methods  of  treatment,  means 
for  prevention,  statistics  and  bibliography." 

Blast    Furnace    Gas    Poisoning.      Otto 
Johannsen.    Abstracted  as  follows  from  Stahl. 
u.  Eisen,  1921,  Vol.  41,  1141,  in  Chem.  Abstr., 
Oct.  20,  1921,  15,  No.  20,  3438.— "The  dulling 


ABSTRACTS 


247 


of  the  mental  faculties  observed  in  several 
cases  of  severe  blast  furnace  gas  poisoning 
has  nothing  to  do  with  the  purity  or  kind  of 
purification  of  the  gas.  This  phenomenon  is 
not  caused  by  an  unknown  poison,  but  is  a 
typical  symptom  of  CO  poisoning.  Although 
pure  gas  is  just  as  dangerous  as  crude  gas, 
and  blast  furnace  gas  is  being  more  and  more 
widely  used,  no  increase  in  gas  poisoning  is 
to  be  feared  because  of  better  arrangements 
for  its  use." 

Poisoning  from  Acetylene.  S.  Pontopid- 
dan.  Abstracted  as  follows  from  Ugeskrift  for 
Laeger,  Sept.  1,  1921,  83,  No.  35,  1222,  in 
Jour.  Am.  Med.  Assn.,  Nov.  26,  1921,  77,  No. 
22,  1778. — "The  symptoms  and  circumstances 
indicated  phosphoretted  hydrogen  poisoning 
in  the  young  mechanic  who  had  been  using  a 
blow-flame  of  oxygen  and  acetylene.  Acety- 
lene gas  is  supposed  to  be  harmless  when  pure, 
but  it  often  contains  phosphoretted  hydrogen, 
and  the  symptoms  presented  by  the  young 
man  indicated  poisoning  with  this  substance. 
They  included  vomiting,  headache,  dizziness, 
insomnia,  paresthesias  and  nervousness  and 
slight  jaundice.  The  importance  is  obvious  of 
detecting  this  poisoning  in  time  to  ward  off 
serious  injury  of  parenchymatous  organs. 
Harbitz  states  that  a  few  tenths  per  thousand 
of  phosphoretted  hydrogen  are  enough  to 
cause  fatal  poisoning,  and  the  acetylene  gas 
in  common  use  frequently  contains  it.  (The 
Danish  term  used-  is  fosforbrinteforgift- 
ning.)" — C.  K.  Drinker. 

Properties  and  Uses  of  Para-Dichlorben- 
zene.  Witt.  Zentralbl.  f.  Gewerbehyg.,  Oct., 
1921,  9,  No.  10,  244-245.— This  readily  vola- 
tile solid  is  being  used  in  industries  as  a  sub- 
stitute for  the  common  naphthalene  moth 
balls.  It  is  known  to  cause  discomfort,  but 
not  known  to  be  poisonous.  A  death  is  re- 
ported as  possibly  due  to  fainting  from  di- 
chlorbenzene  fumes,  followed  by  asphyxia- 
tion with  gas.  Caution  is  urged  in  the  use  of 
the  substance. — E.  L.  Sevringhaus. 

Case  of  Gasoline  or  Gas  Poisoning.  W. 
M.  Kraus.  Arch.  Neurol,  and  Psychiat.,  Dec, 
1921,  6,  No.  6,  707.— "The  patient  had  been 
working  about  a  gas  engine,  exposed  to  the 
fumes  from  the  exhavist.  He  started  at  that 
particular  job  in  August,  1920,  and  entered 
Bellevue  Hospital  in  June,  1921.  At  that 
time  he  was  troubled  with  numbness,  weak- 


ness and  coldness  in  the  legs,  hands  and  fore- 
arms. This  trouble  had  begun  the  previous 
February,  when  he  complained  of  dizziness, 
some  nausea,  frontal  headache  and  general 
malaise.  He  had  had  no  stomach  attacks  be- 
fore that.  His  legs  slowly  became  weaker, 
so  that  by  April  he  could  not  walk.  He  had 
no  other  symptoms. 

"Examination  revealed  that  his  cranial 
nerves  were  normal.  He  had  a  bilateral  hy- 
pesthesia  of  a  stocking  variety  almost  to  the 
knees,  and  in  the  toes  a  slight  defect  in  sense 
of  position.  He  was  unable  to  stand.  Six 
blood  Wassermann  tests  and  three  spinal 
fluid  Wassermann  tests  were  negative.  The 
last  blood  Wassermann  test  was  followed  in 
about  three  weeks  by  administration  of  ars- 
phenamin. 

"At  present  he  shows  marked  atrophy  of 
all  extremities.  He  has  no  more  fibrillary 
twitching.  His  superficial  reflexes  are  still 
present.  He  shows  no  signs  of  involvement 
of  any  of  the  other  nerves. 

"About  three  years  ago  three  men  in  one 
garage  complained  of  the  same  symptoms,  and 
they  told  me  at  the  time  that  this  disease  was 
not  infrequent  among  chauffeurs.  Since  then 
I  have  had  another  case,  but  it  has  not  shown 
the  profound  atrophy  found  in  this  case." — 
M.  Dent. 

Industrial  Respirators.  Leonard  Levy 
and  D.  W.  West.  Jour.  Soc.  Chem.  Industry, 
Oct.  15,  1921,  40,  No.  19,  234T-237T.— This 
paper  was  presented  before  the  June  meeting 
of  the  London  Section  of  the  Society  of  Chem- 
ical Industry.  In  it  the  authors  show  the 
transition  from  war  gas  masks  to  industrial 
masks  applicable  to  present-day  industries. 
Besides  portability  and  comfort  to  the  wearer, 
industrial  masks  or  respirators  must  contain 
absorbent  media  of  certain  "capacity  and  re- 
activity" dependent  on  the  substances  in  the 
atmosphere  to  be  breathed.  The  authors  give 
physiological  and  chemical  data  on  the  detec- 
tion and  absorption  of  toxic  substances  in 
the  respirators  recommended.  They  describe 
respirators  for  ( 1 )  ammonia,  in  which  crystal- 
line copper  sulphate  is  the  absorbent;  (2)  neu- 
tral vapors,  for  which  activated  vegetable 
charcoal  is  the  absorbent;  and  (3)  acid  fumes, 
for  which  special  alkaline  granules,  often  with 
a  highly  activated  charcoal,  are  necessary. 
With  acid  fumes  a  high  degree  of  reactivity 


248 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


is  essential  as  the  gases  encountered  are  usu- 
ally highly  toxic. 

Particulate  clouds  require  special  filters  and 
absorbents  for  which  no  general  rule  can  be 
made.  Where  protection  to  the  eyes  is  re- 
quired the  mask  must  be  modified  accordingly. 

Carbon  monoxide  has  been  successfully  re- 
moved only  by  oxidation.  Results  are  cited 
which  were  obtained  by  the  American  Chemi- 
cal Warfare  Society  when  using  a  catalyst  of 
finely  divided  mixed  oxides  of  manganese, 
copper,  cobalt,  and  silver,  with  a  preliminary 
layer  of  calcium  chloride  to  .absorb  moisture. 
For  industrial  purposes  a  detector  is  recom- 
mended which  will  produce  a  lachrymatorj' 
effect.  The  authors  claim  that  iodine  pentox- 
ide  and  fuming  sulphuric  acid  impregnated 
into  pumice  give  a  liberation  of  iodine  suf- 
ficient to  produce  this  effect.  The  discus- 
sion which  follows  shows  that  this  respirator 
and  detector  is  limited  to  atmospheres  in 
which  there  is  no  poverty  in  oxygen. — Philip 
Drinker. 

Eespiratort  Apparatus  for  Protection 
AGAINST  Carbon  Monoxide.  A.  Desgret,  H. 
G-uillemard,  A.  Hemmerdinger  and  A.  Labat. 
Chimie  et  Industrie,  Oct.,  1921,  6,  No.  4,  536- 
538. — This  respirator  is  based  on  the  oxidizing 
reaction  of  iodine  pentoxide  and  sulphuric 
acid  on  carbon  monoxide.  The  efficacy  of  the 
active  agents  is  enhanced  by  the  fineness  of 
the  pumicestone  granules  on  which  these  re- 
agents are  deposited.  A  size  of  4  mm.  is  rec- 
ommended. The  granules  are  first  impreg- 
nated with  sulphuric  acid  of  at  least  66°  Be. 
strength,  to  which  fuming  sulphuric  is  often 
added,  and  the  iodine  pentoxide  added  with 
shaking.  Eighty  gm.  of  iodine  pentoxide  with 
25  c.e.  of  acid  are  required  for  treating  270 
gm.  of  pumice.  Iodic  acid  is  sometimes  used 
but  the  iodates  have  not  been  employed  with 
success. 

The  apparatus  may  be  made  with  or  with- 
out valves.  In  the  latter  case  the  filtering  box 
is  parallelopipedic  in  shape,  and  made  of  two 
unequal  metallic  compartments  connected  at 
the  bottom,  but  separated  at  the  top  by  a  par- 
tition. The  larger  compartment  is  open  to 
the  atmosphere  and  filled  witli  the  oxidizing 
mixture,  while  the  smaller  compartment  is  di- 
rectly connected  with  the  respiratory  pas- 
sages and  is  filled  with  granulated  ox-ylith  to 
serve    the    threefold    function   of  absorbing 


moisture  from  respiration,  absorbing  iodine 
and  carbon  dioxide,  and  furnishing  oxygen. 
The  authors  claim  that  this  apparatus,  of  1.5 
liters'  capacity,  has  been  used  successfully 
for  one  hour  by  a  subject  breathing  air  con- 
taining 10  per  cent,  carbon  monoxide. 

The  respirator  with  a  valve  functions  simi- 
larty  but  is  made  in  two  separate  compart- 
ments connected  by  a  tube  which  is  not  put  in 
place  until  the  apparatus  is  ready  for  use.  By 
storing  oxidizing  and  absorbing  reagents 
in  separate  compartments  the  oxidizing  re- 
agent is  kept  free  from  moisture,  which  is  es- 
sential, as  the  mixture  is  strongly  hygroscopic. 
The  authors  claim  priority  of  the  French  over 
the  Americans  in  the  development  of  this  res- 
pirator and  state  that  the  latter  employ  only 
one  compartment  for  the  oxidizing  and  ab- 
sorbing reagents  which  results  in  the  metal  of 
the  compartment  being  attacked. — Philip 
Drinker. 

Bureau  of  Mines  Experimental  Tunnel 
FOR  Studying  the  Removal  of  Automotive 
Exhaust  Gas.  A.  C.  Fieldner  and  J.  W. 
Paul.  U.  S.  Bur.  Mines,  Reports  of  Investiga- 
tions, Serial  No.  2288,  Oct.,  1921.— This  paper 
gives  a  description  of  the  tunnel  constructed 
near  Pittsburgh.  While  designed  particularly 
for  investigations  bearing  on  the  proposed 
Hudson  River  vehicular  tubes,  the  studies  to 
be  conducted  at  Pittsburgh  comprise:  "(1) 
The  diffusion  of  exhaust  gases  in  the  cross- 
section  of  the  tunnel  by  transverse  ventilation, 
bottom  to  top,  and  top  to  bottom;  (2)  tem- 
perature and  smoke  conditions  as  affected  by 
the  operation  of  motor  cars;  (3)  physiological 
and  p.sychologieal  effects  of  temperature,  ex- 
haust gases  and  smoke  under  operating  con- 
ditions; (4)  final  check  on  all  previous  inves- 
tigations and  practical  demonstration  of  the 
solution  of  the  pi-oblem  of  ventilating  tunnels 
traversed  liy  vehicles."' 

The  Pittsburgh  tunnel  will  be,  in  effect,  an 
"underground  oval  track,"  with  an  axial 
length  of  400  feet,  a  cross  section  9  feet 
wide  and  8  feet  high,  a  3-foot  air  duct  above 
the  ceiling  and  a  2V:>-foot  duct  below  the  floor. 
Ample  and  elaborate  provisions  are  made  for 
sampling  the  air,  for  the  determination  of 
air  flow,  humidity,  temperature,  etc.  Physio- 
logical examinations  will  be  made  contempo- 
raneously with  the  physical  and  chemical 
observations. — Philip  Drinker. 


ABSTRACTS 


249 


A  Possible  Source  of  Lead  Poisoxing.  ^4. 
F.  G.  Cadenhead  and  A.  G.  Jacques.  Ab- 
stracted as  follows  from  Can.  Chem.  Met., 
1921,  Vol.  5,  260,  in  Chem.  Abstr.,  Nov.  10, 
1921,  15,  No.  21,  3685.— "The  object  of  the 
experiments  Avas  to  demonstrate  whether  Pb 
accidentally  mixed  with  smoking  tobacco  is 
carried  over  in  the  smoke.  By  du|)lieating  the 
conditions  present  in  pipe  .smoking  it  was 
proved  that  a  very  small  proportion  of  Pb 
would  be  inhaled,  but  most  of  it  remains  in 
the  ash  and  tar  as  Pb  and  PbO." 

Rei-ation  or  Lead  Poi.soni.vg  in  Vtah  to 
Mining.  Arthur  L.  Murrai/.  U.  8.  Bur. 
Mines,  Reports  of  Investifrations,  Serial  No. 
2274,  Aug.,  1921.— "The  case  rate  from  lead 
poisoning  in  Utah  is  so  far  out  of  proportion 
to  the  death  rate,  that  the  death  rate  cannot 
be  taken  as  an  index  to  the  number  of  cases 
prevalent.  Prom  the  reports  received  during 
this  investigation,  the  metal-mining  industry 
as  represented  by  the  metal  mines  and  smelt- 
ers is  i-psponsil)k'  for  at  least  95  jht  cent,  of  the 
industrial  lead  poisoning  in  Utah.  This  was 
to  be  expected,  as  mining  and  smelting  are 
among  tlie  i)rinci]ial  industries  of  the  State, 
with  relatively  few  other  industries  in  which 
-workers  might  be  exposed  to  salts  of  lead." 

Dangerous   and   Unhealthy    Industries. 

Statutory  Rules  and  Orders,  Xo.  144:?,  Lon- 
don, Aug.  23,  1921,  pp.  6. — This  pamphlet  con- 
tains regulations  for  the  manufacture  of  cer- 
tain eomiionnds  of  lead,  namely,  any  carbon- 
ate, snljdiate,  nitrate  or  acetate  of  lead,  and 
states  definitely  the  precautions  to  be  observed 
by  occupiers  and  persons  employed. — M.  C. 
Shorlcy. 

/  The  Use  of  White  Lead  in  Painting.  In- 
ternat.  Labour  Office,  Studies  and  Reports, 
Series  P,  No.  4,  Oct.  24,  1921.— The  movement 
^.gainst  the  use  of  white  lead  originated  in 
France  and  spread  from  that  country  to  Ger- 
many, and  now  several  countries  have  laws 
prohibiting  or  regulating  the  use  of  the  ma- 
terial. A  regulation  which  came  into  force 
in  Gei'many  in  1906  contained  several  provi- 
sions about  the  use  of  lead,  but  did  not  pro- 
hibit it.  In  1910  the  Society  for  Social  Re- 
form presented  a  petition  to  the  Ministr.v  of 
the  Interior  asking  for  a  far-reaching  pro- 
liibition  of  the  use  of  lead  paints,  and  the 


Minister  of  Public  Works  issued  a  circular  in 
1913,  which  was,  however,  only  advisory. 

The  most  far-reaching  prohibition  is  con- 
tained in  a  regulation  of  the  Central  Railway 
Office  ordering  substitution  of  non-poisonous 
paints  for  white  lead  in  all  coach-building 
works.  This  is  in  contradiction  of  an  order 
issued  in  1907.  The  governing  body  of  the  In- 
ternational Labour  Conference  held  in  Wash- 
ington in  1919  has  placed  the  prohibition  of 
white  lead  in  painting  on  the  agenda  of  the 
1921  conference. 

Opinions  differ  in  Germany  about  substi- 
tutes for  lead  paints.  Most  workers  and  their 
representatives  state  that  zinc  oxide  and  litho- 
jihone  are  satisfactory  substitutes,  but  they 
have  not  sufliciently  proved  their  ease.  In 
indoor  painting,  it  seems  to  be  agreed,  white 
lead  is  not  indispensable,  at  any  rate  for  top 
coats,  but  there  is  evidence  that  for  outdoor 
work  it  is  necessary.  The  connnercial  ob.iee- 
tions,  therefore,  are  not  valid,  and  the  oidy 
remaining  reason  for  the  prohibition  is  the 
danger  of  lead  jioisoning. 

Oi>inions  in  Germany  on  tlie  danger  from 
white  lead  vary  greatly.  The  master  painters' 
guilds,  so  far  as  asked,  report  almost  imani- 
mously  that  tlie  number  of  cases  of  ])oisoiiing 
has  greatly  decreased  in  recent  years.  The 
sick  fund  of  the  Dortmund  Painters'  Guild, 
out  of  an  average  of  1,000  members,  had  six 
cases  of  lead  poisoning  in  1911,  and  none  in 
1919  when  the  number  of  members  was  500. 
Statistics  of  two  other  funds  show  a  decrease 
from  1903  to  1911.  But  no  statistics  of  the 
pre-war  period  are  entirely  reliable,  since  it 
is  now  shown  by  blood  tests  that  diagnosis 
of  lead  poisoning  had  previously  been  very 
loose. 

If,  despite  all  preventive  measures,  cases 
of  lead  poisoning  still  occur,  they  are  princi- 
pally due  to  the  fact  that  it  has  been  impos- 
sible as  yet  to  abolish  carelessness,  stupidity 
and  lack  of  cleanliness  as  completely  as  could 
be  wished.  Lehmann  and  Koelsch  state  that 
the  whole  question  of  lead  is  more  or  less  a 
question  of  cleanliness. 

If  there  are  difficulties  in  the  supervision 
of  regidations  enforcing  prohibition  of  the  use 
of  white  lead,  there  would  be  stiU  greater  dif- 
ficulty if  the  use  of  colors  containing  a  certain 
proportion  of  lead  were  allowed,  as  is  provided 
for  in  the  memorandum  of  the  International 
Labour  Office.  It  has  been  shown  by  experience 


250 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


also  that  the  worker  is  generally  compara- 
tively careful  in  using  paints  which  he  knows 
to  be  poisonous,  but  the  less  poisonous  the 
paint  the  less  care  will  be  taken. — G.  E. 
Partridge. 

The  Pharmacologic  Action  op  Lead  in 
Organic  Combination.  E.  C.  Mason.  Ab- 
stracted as  follows  from  Jour.  Lab.  Clin.  Med., 
1921,  Vol.  6,  427-453,  in  Chem.  Abstr.,  Sept. 
20,  1921,  15,  No.  18,  3145.— "  (C^H J  gPb-Pb 
(CaHJa  and  its  salts  stimulate  the  higher 
centers  of  the  central  nervous  system,  the  in- 
jection of  0.0025-0.0050  g.  producing  comnil- 
sions  in  a  medium-sized  dog.  An  extreme  fall 
in  blood  pressure  follows  the  first  injection, 
owing  to  stimulation  of  the  inhibitory  vagus 
center  for  the  heart,  sudden  dilatation  of 
visceral  vessels,  and  direct  depressant  action 
on  the  heart.  A  prolonged  rise  in  blood  pres- 
sure follows  subsequent  injections,  owing  to 
constriction  of  visceral  vessels  and  stimulation 
of  the  sympathetic  nerves  to  the  heart.  Res- 
piration is  stopped  by  first  injections  and  in- 
creased by  subsequent  ones.  Dyspnea  occurs, 
owing  to  direct  action  on  the  respiratory 
center.  Intestinal  activity  is  increased.  Kid- 
ney and  spleen  volumes  increase  first  and 
then  decrease.  Subsequent  injections  produce 
only  decrease." 

Importance  op  Industrul  Medicine  to 
THE  Commt;nity.  Sir  Kenneth  Goadbij.  Lan- 
cet, Sept.  3,  1921,  201,  No.  5114,  489-491.— 
One  is  struck  with  the  frank  opposition  of 
employers  and  employees  in  matters  of  health 
innovation.  An  example  of  this  is  in  the  so- 
called  questionnaire  published  by  the  Interna- 
tional Labour  Office  denying  that  dust  is  a 
serious  cause  of  poisoning  in  the  painting 
trades. 

The  health  of  painters  and  the  diseases  from 
which  they  suffer  is  a  much  debated  problem. 
The  absence  of  a  high  incidence  of  diseases  of 
the  alimentary  and  nervous  systems,  and  the 
presence  of  a  high  incidence  of  diseases  of  the 
respiratory  tract  are  difficult  to  reconcile  with 
the  supposedly  great  amount  of  lead  poisoning 
among  painters.  In  an  examination  of  white 
lead  workers  and  painters  the  average  blood 
pressure  was  found  to  be  higher  than  that  of 
lead  woi-kers.  This  higher  arterial  tension  of 
painters  is  the  more  striking  since  less  muscu- 
lar effort  is  required  to  wield  a  paint  brush 


than  to  carry  half -hundred-weights  of  lead. 
This  appeal's  to  support  the  growing  opinion 
that  the  cause  of  disease  is  in  the  volatile  por- 
tions of  the  paint  rather  than  in  its  solid  con- 
stituents.— M.  Dent. 

Trinitrotoluene  Poisoning.  L.  Lewin. 
Abstracted  as  follows  from  Arch.  Exper. 
Path.  Pharm.,  1921,  Vol.  89,  340-359,  in  Chem. 
Abstr.,  Oct.  10,  1921,  15,  No.  19,  3332.— "The- 
local  and  generalized  reactions  of  the  body  to 
trinitrotoluene  are  described.  In  the  animal 
body  the  compound  is  readilj'  decomposed;  it 
cannot  be  found  in  either  blood  or  urine. 
Hematin  formation  and  decrease  in  erythro- 
cyte counts  are  observed." 

The  Anatomical  Diagnosis  and  Histol- 
ogy OP  Phosphorus  Poisoning.  Elsie  Petri. 
Abstracted  as  follows  from  Frankfurter  Z. 
Path.,  1921,  Vol.  25, 195-215,  in  Chem.  Abstr., 
Sept.  20,  1921,  15.  No.  18,  3137.— "The  liver 
in  phosphorous  poisoning  cannot  be  distin- 
guished from  acute  yellow  atrophy.  By  the- 
use  of  elective  histochemical  methods  in  five 
cases  of  phosphorus  poisoning,  lipoids  were 
demonstrated  in  the  liver,  kidneys  and  stom- 
ach belonging  to  the  group  of  phosphatids,  as 
well  as  neutral  fats  and  mixtures  of  neutral 
fats  and  lipoids.  The  presence  of  lipoids 
speaks  against  the  assumption  that  the  fat  in 
the  liver  is  entirely  infiltrated  fat.  There 
must  be  in  addition  a  fatty  phanerosis.  Phos- 
phorus belongs  to  the  toxic  substances  of 
known  and  unknown  origin  which  produce 
acute  yellow  atrophy,  and  the  anatomical  and 
clinical  picture  of  phosphorus  poisoning  is 
not  a  separate  entity  but  belongs  to  the  large 
group  associated  with  acute  yellow  atrophy 
of  the  liver." 

Fatal  Intoxications  by  Arsenic  in  Viti- 
cultural  Districts.  Paul  Cazeneuve.  Ab- 
stracted as  follows  fi'om  Bull.  acad.  med., 
1921,  Vol.  85,  660-671,  in  Chem.  Abstr.,  Sept. 
20,  1921,  15,  No.  18,  3147.— "  Several  cases 
of  As  poisoning  are  reported,  due  to  the  use 
of  arsenic  compounds  in  the  cultivation  of 
grapes. ' ' 

Action  of  Mercury.  W.  Salant  and  iV. 
Kleitman.  Abstracted  as  follows  from  Proc. 
Soc.  Exper.  Biol,  and  Med.,  1921,  Vol.  18,  249- 
250,  in  Physiol.  Abstr.,  Oct.-Nov.,  1921,  6,  Nos. 


ABSTRACTS 


251 


7  and  8,  453. — "The  action  of  mercury  ben- 
zoate,  succinate,  and  acetate,  injected  intra- 
venously into  dogs  and  cats  in  a  concentra- 
tion of  1 :5000,  was  studied.  Small  doses  in- 
creased the  frequency  ajid  depth  of  respira- 
tion ;  larger  doses  produced  the  opposite  effect, 
as  also  did  repeated  small  doses.    Small  doses 


either  had  no  effect  upon  the  blood  pressure, 
or  caused  a  temporary  rise;  repeated  small 
doses  caused  a  fall  in  blood-pressure  and  slow- 
ing; or  arrest  of  the  heart,  the  fall  in  pressure 
being  less  abrupt  and  lasting  longer  if  the 
vagi  had  been  cut  previously." — Mckeen  Cat- 
tell. 


DUST  HAZARDS  AND  THEIR  EFFECTS 


Tobacco  Pneumokoniosis.  F.  Palitzsch. 
Zentralbl.  f.  Gewerbchyg.,  Oct.,  1921,  9,  No. 
10,  225-229. — This  article  is  a  clinical  report 
and  discussion  of  a  case  of  chronic  pulmonary 
affection.  The  varied  synii)toms,  the  X-ray 
findings,  the  negative  findings  for  tubercu- 
losis, and  the  long  and  favorable  course  are 
explained  on  the  diagnosis  of  pneumokoniosis. 
The  exciting  cause  is  believed  to  be  the  con- 
tinued inspiration  of  fine  tobacco  dust  from 
a  machine  for  grinding  cigarette  filling. — E. 
L.  Sevringhaus. 

Pneumokoniosis  and  Asthmatic  Attacks 
IN  Woodworkers.  P.  Pinchcrle.  II  Lavoro, 
Oct.  31.  1921,  12,  No.  6,  181-182.— There  is 
very  little  concerning  wood  dusts  in  the  liter- 
ature of  pneumokoniosis.  Kurt  Gade  of  Ros- 
tock, examining  Avood  dust  under  the  micro- 
scope, found  particles  rich  in  sharp  points, 
capable  of  injuring  the  o]iitlieliuin  of  tlie  nose 


and  also  of  the  trachea  and  bronchi.  It  is 
chiefly  this  mechanical  effect  that  is  of  im- 
portance, although  there  is  also  a  chemical 
action  in  the  case  of  such  woods  a-s  mahogany, 
satin  wood,  sandalwood,  and  teak.  The  au- 
thor reports  a  case  of  asthma  following  the  as- 
piration of  wood  dusts.  The  sputum  did  not 
show  the  findings  pathognomonic  for  asthma, 
i.e.,  Curschinaiin  spirals,  Chareot-Lcyden 
crystals,  nor  was  there  any  reason  to  suspect 
the  presence  of  a  toxic  agent  or  of  bodies 
provoking  anaphylaxis.  The  cause  of  the 
asthma  was  a  chronic  bronchitis  provoked  by 
the  breathing  of  wood  powder.  Twenty  wood- 
workers were  then  examined,  fourteen  of 
whom  showed  morbid  conditions  of  the  respir- 
atory tract,  viz.,  seven  with  bronchial  catarrh 
more  or  less  intense,  and  seven  with  asthmatic 
attacks.  Curschmann  spirals  were  found 
twice,  Charcot-Leyden  crystals  once. — Alice 
Hamilton. 


OCCUPATIONAL  INFECTIOUS  DISEASES:   OCCURRENCE, 
TREATMENT  AND  PREVENTION 


Preventing  Preventable  Diseases  in  New 
York  City.  Occupational  Clinic.  L.  I. 
Harris.  New  York  City  Dept.  Health,  Month. 
Bull.,  Sept.,  1921,  11,  No.  9,  214-221.— During 
1920,  17,143  food-handlers  were  examined  in 
the  clinics  of  the  Bureau  of  Preventable  Dis- 
eases of  New  York.  Comparison  with  55,673 
examinations  made  by  private  physicians 
during  the  same  time  leads  to  the  suspicion 
that  "the  private  physicians  are  not  all  con- 
tributing conscientiously  to  the  protection  of 
the  public  health  from  food-handlers  who  may 
be  affected  witli  communicable  diseases."  Of 
a  total  of  16,484  cases  suitable  for  computa- 
tion, 28  per  cent,  were  found  with  physical 
defects  of  significant  character.  Some  of 
these  were  excluded  outright  from  work  as 


food-handlers  and  some  were  put  on  probation. 
In  Manhattan,  123  food-liandlers  of  the 
4,780  examined  were  placed  on  probation  as 
suspected  of  having  active  tuberculosis,  or 
because  of  signs  of  apparently  arrested  tuber- 
culosis. The  same  proportion  holding,  there 
are  19,000  or  more  such  cases  in  the  city  of 
New  York.  A  proportion  of  65  per  10,000 
examined  showed  an  apparently  active  syphi- 
litic condition.  It  is  estimated  that  there  are 
about  10.000  cases  of  latent  or  inactive  syphi- 
lis among  the  750,000  food-handlers  of  the 
city.  On  the  same  presumptions  as  regards 
the  relation  of  the  number  tested  to  the  whole 
group,  there  would  be  somewhat  more  than 
21,000  "suspected  typhoid  carriers."  The 
examinations  for  gonorrhea  were  too  incom- 


252 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


plete  to  give  satisfactory  estimates.  Parasitic 
skin  affections  and  some  miscellaneous  condi- 
tions caused  522  probations. 

A  table  is  presented  showing  in  detail  the 
different  disease  groups,  the  records  of  exam- 
inations made  by  private  physicians  during 
1920  for  each  district,  and  on  this  evidence  if 
is  concluded  that  "since  the  examination  of 
food-handlers  has  been  demonstrated  to  be  an 
activity  of  the  Department  which  is  of  vital 
importance  as  a  public  health  measure,  it 
would  seem  to  be  necessary,  in  the  interest  of 
the  public  welfare,  to  discontinue  delegating 
this  important  function  to  private  physi- 
cians. ' ' 

Activities  of  the  veterinary  service  of  the 
Bureau  are  also  briefly  summarized,  and  there 
are  some  details  in  regard  to  the  work  of 
nurses. — G.  F.  Partridge. 

The  Management  of  a  Diphtheru  Out- 
break IN  A  Private  School.  E.  C.  Fleisch- 
ner  and  E.  B.  Shaw.  Jour.  Am.  Med.  Assn., 
Nov.  26,  1921,  77,  No.  22,  1714-1717.— "The 
following  facts  may  be  given  as  a  means  of 
controlling  a  diphtheria  outbreak  in  a  board- 
ing school : 

"1.  Immediate  isolation  and  treatment  of 
the  sick  children. 

"2.  Immediate,  carefully  supervised  nose 
and  throat  cultures  on  all  members  of  the 
school. 

"3.  Schick  tests  with  proper  controls  on  all 
members  of  the  school  within  twenty-four 
hours. 

"4.  Administration  of  1,000  units  of  anti- 
toxin subcutaneously  to  all  children  having 
positive  Schick  reactions  at  the  end  of  forty- 
eight  hours. 

"5.  Reculture  of  noses  and  throats  of  all 
contacts  two  days  after  the  primary  culture. 

"6.  Isolation  of  all  ill  children  from  the 
healthy  children  and  from  the  tnie  diphthe- 
ritics  until  a  positive  diagnosis  is  established. 

"7.  Immediate  isolation  of  all  the  carriers 
and,  when  it  is  possible,  employment  of  tox- 
icity tests  to  avoid  the  exposure  of  those  chil- 
dren having  avirulent  diphtheroids  to  those 
with  true  virulent  organisms. 

"8.  "When  the  outbreak  is  controlled,  the 
conferring  of  active  immunity  on  all  children 
with  positive  Schick  reactions  by  the  proper 
injections  of  toxin-antitoxin  mixtures." — C. 
K.  Drinker. 


Clinical  Aspects  of  Ankylostomiasis. 
Ignazio  di  Giovanni.  II  Lavoro,  Oct.  31,  1921, 
12,  No.  6,  175-178.— At  the  sixth  Congress  of 
the  Sicilian  Medical  Society,  di  Giovanni  dis- 
cussed the  question  whether  it  was  possible  to 
diagnose  ankylostomiasis  without  the  aid  of 
the  microscope,  or  whether,  as  is  apparently 
held  bj''  physicians  of  the  Rockefeller  Founda- 
tion, there  is  a  clear-cut,  clinical  picture  of 
this  infection.  His  investigation  was  carried 
on  in  the  mines  of  Tallarita  and  Cozzodisi  with 
1,000  miners  each,  a  large  percentage  of  whom 
are  infected.  The  majority  denied  that  they 
felt  any  symptom  of  ill  health  and  only  after 
they  had  been  assured  that  they  harbored  the 
parasite  would  they  admit  a  sense  of  weari- 
ness in  their  legs.  This  was  as  a  usual  thing 
the  only  symptom,  and  although  many  of 
them  showed  more  or  less  pallor  of  the  face 
and  of  the  visible  mucous  membranes,  still 
this  was  also  noted  in  individuals  without 
parasitic  infection,  and  it  is,  according  to  the 
author,  a  true  professional  stigma  for  sulphur 
miners  which  he  believes  to  be  referable  to  the 
hemolytic  action  of  sulphur  and  its  acid  de- 
rivatives. 

At  the  Central  Station  for  the  Prevention 
of  Ankylostomiasis  in  Caltanissetta,  the  au- 
thor examined  146  miners  w^ith  ankylostomo- 
anemia  of  marked  degree,  but  even  among 
these  the  clinical  picture  did  not  present  any 
element  which  could  arrest  attention  as  of 
pathognomonic  significance.  The  only  con- 
stant symptom  noted  was  anemia.  The  author 
dissents  from  the  school  of  Padua,  the  school 
of  Cairo,  and  the  American  investigators  in 
that  he  was  never  able  to  detect  albumin  in 
the  urine  (supposedly  constant  in  ankylosto- 
mo-anemia),  nor  blood  in  the  feces,  much  less 
intestinal  hemorrhage,  nor  any  characteristic 
disturbance  of  the  gastro-intestinal  tract  or 
of  any  organ.  He  concludes  that  the  only  con- 
stant picture  is  that  of  anemia,  with  its  usual 
train  of  phenomena. 

The  blood  findings  are  not  diagnostic,  con- 
sisting only  in  a  diminution  of  the  number  of 
erythrocytes,  increase  of  lymphocytes,  low 
hemoglobin,  eosinophilia,  and  i)oikilocytosis. 
It  is  absolutely  essential  to  subject  the  de- 
jecta to  microscopic  examination  in  order  to 
arrive  at  a  diagnosis  of  ankj'lostomiasis. — 
Alice  Hamilton. 


ABSTRACT^ 


25a 


Report  of  the  United  States  Interde- 
partmental Social  Hygiene  Board  for  the 
Fiscal  Year  Ended  June  30,  1921.  Washing- 
ton, Govt.  Printing  Office,  1921,  pp.  198. 
— This  report  summarizes  in  a  broad  and 
interesting  manner  the  general  methods  of 
attack  upon  venereal  disease  used  by  this  new- 
governmental  ageiicj-  durincr  the  past  year. 

Industrial  hygienists  will  find  the  section 
on  Educational  Research  and  Development 
particularly  worth  while  since  it  indicates 
types  of  progress  and  methods  of  advance 
which  should  be  directly  applicable  to  indus- 
try. For  example,  the  idea  of  making  the 
physical  examination  a  basis  for  the  health 
education  of  the  individual  is  beginning  to 
find  a  firm  basis  in  school  and  college  hygiene, 
but  as  yet  has  little  or  no  place  in  industrial 
preventive  medicine. 

The  report  contains  a  certain  amount  of 
statistical  matter  upon  the  control  of  venereal 
disease  in  the  army  and  na\y.  Since  much  of 
this  control  has  depended  upon  active  meas- 
ures resulting  in  the  abolition  of  red  light 
districts,  the  experience  naturally  applies  very 
directly  to  industrial  communities  and  the  re- 
port thus  furnishes  valuable  evidence  of  what 
can  be  aecoinplisliod  tiirongii  determined  at- 
tack by  competent  agents. — C.  K.  Drinker. 

A  Clinical  Picti're  of  Anthrax.  John 
Randolph  Graham.  New  York  City  Dept. 
Health,  Month.  Bull.,  Nov.,  1921,  11,  No.  11. 
284-286. — This  is  a  description  of  the  picture 
presented  by  the  surface  lesion  caused  by 
anthrax.  The  importance  of  prompt  recog- 
nition of  this  disease,  without  waiting  for  veri- 
fication by  the  bacteriologist,  will  be  appre- 
ciated when  it  is  realized  that  death  may  fol- 
low only  forty-eight  hours  after  the  first  sign 
of  trouble,  and  that  therefore  the  life  of  a 
patient  depends  upon  early  inoculation. — 
L.  A.  Shaw. 

The  Advantage  op  Serum  Therapy  as 
Shown  by  a  Comparison  of  Various  Meth- 
ods op  Treatment  of  Anthrax.  Joseph  C. 
Regan.  Am.  Jour.  Med.  Sc,  Sept.,  1921,  162, 
No.  3,  40G-423. — The  author  reviews  the  vari- 
ous measures  of  therapy  in  use  in  the  treat- 
ment of  malignant  pustule  and  quotes  statis- 
tics showing  the  comparative  mortality  with 
different  treatment.  He  discusses  the  various 
measures  of  local  therapy  in  common  use, 
pointing  out  the  dangers  that  many  of  them 
possess,  and  concludes  that : 


"1.  The  measures  of  local  therapy  of  an- 
thrax in  common  use  should  be  abandoned, 
owing  to  the  disadvantages  or  even  dangers 
thej'  possess.  .  . 

"2.  The  value,  both  prophylactic  and  cura- 
tive, of  anti-anthrax  serum  must  now  be  re- 
garded as  establislied  by  statistics.  .  .  .  The 
mortality  from  malignant  i)ustule  will  be  re 
duced  to  a  minimum  by  prompt  recognition 
and  early  serum  treatment. 

"3.  No  case  of  anthrax  septicemia  should 
be  considered  beyond  hope  until  intensive 
serum  therapy  has  failed. 

"4.  The  serum  prepared  by  the  Bureau  of 
Animal  Industry  or  according  to  their  method 
has  been  proved  of  marked  potency,  being  ac- 
cording to  certain  reports  twice  the  strength 
of  the  European  preparations. 

"5.  As  originally  described  by  the  writer, 
the  local  injection  of  anthrax  serum  into  the 
pustule  is  apparentl.v  the  most  effective  means 
of  local  therapy  and  should  always  be  used 
a.s  a  supplementary  measure  to  the  general 
administration  of  serum. 

"6.  Anthrax  senmi  fulfills  best  the  points 
requisite  for  an  ideal  method  of  treatment  of 
anthrax:  (1)  It  is  appliable  to  all  forms  and 
locations  of  the  disease;  (2)  yields  on  average 
the  lowest  mortality  rate;  (3)  is  a  specific 
measure;  (4)  is  a  safeguard  against  generali- 
zation of  the  local  disease  if  used  in  time; 
{'•))  offers  the  lea.st  amount  of  scarring  and  de- 
formity; (6)  causes  a  mininuim  of  pain;  (7) 
demands  on  an  average  the  shortest  absence 
from  employment." — M.  C.  Shorley. 

Normal  Beef  Serum  in  Treatment  op 
Anthrax.  R.  Kraus  and  P.  Beltrami.  Ab- 
stracted as  follows  from  Revista  del  Instituto 
Bacteriologico,  March,  1921,  2,  No.  6,  249,  in 
Jour.  Am.  Med.  Assn.,  Nov.  12,  1921,  77,  No. 
20,  1608. — "Kraus  and  Beltrami  i-eport  addi- 
tional experimental  research  which  confirms, 
they  say,  the  efficacy  of  normal  beef  serum  in 
treatment  of  anthrax." — C.  K.  Drinker. 

The  Problem  of  the  Tuberculous  Em- 
ployee in  Industry.  Harry  E.  Mock  and 
John  D.  Ellis.  Nat.  Safety  News,  Nov.,  1921, 
4,  No.  5,  17-19. — Pulmonary  tuberculosis  is 
the  greatest  of  all  occupational  diseases.  As 
industrial  communities  increased,  living  and 
working  conditions  became  more  congested; 
and  tuberculosis  mortality  and  moi-bidity 
reach  their  highest  point  in  crowded  and  in- 


254 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


sanitary  quarters.  It  is  true  that  primary 
tuberculous  infection  frequently  occurs  in 
cliildliood,  but  it  is  also  true  that  overcrowded 
and  insanitary  living  and  working  conditions 
are  just  as  responsible  for  the  spread  of  tu- 
berculosis. 

"The  irrefutable  argument  for  discovering 
and  removing  the  tubercular  employee  from 
the  workmg  force  lies  in  the  fact  that  in  those 
industries  where  an  active  fight  against  this 
disease  has  been  made  the  tuberculosis  rate 
has  rapidly  decreased." 

In  some  industries  the  relationship  of  occu- 
pation to  the  development  of  tuberculosis  is 
slight,  while  in  others  it  is  almost  a  causal 
factor.  Dr.  CoUis  attributes  the  production 
of  the  tuberculous  employee  to  three  basic  in- 
fluences: (1)  insufficient  food ;  (2)  patholog- 
ical fatigue;  and  (3)  inadequate  ventilation. 
All  of  these  causes  are  as  associated  with  the 
man's  working  conditions  as  with  his  living. 

It  is  estimated  that  about  5,500,000  em- 
ployees of  both  sexes,  or  "12.5  per  cent,  of 
the  total  wage-earning  force  of  the  country 
work  under  conditions  where  this  atmospheric 
pollution  is  very  prevalent  and  of  known 
hazard  to  employees."  Metallic  dusts  are 
probably  most  harmful.  Specific  industries  in 
this  group  which  show  an  exceptionally  high 
mortality  from  lung  diseases  are  cutlery  and 
file  making,  metal  grinding  and  polishing, 
brass  working,  printing,  engraving,  tool  mak- 
ing and  gold  beating.  Mineral  dusts,  vegeta- 
ble dusts  from  cotton  and  linen  textile  mills, 
and  from  woodworking  and  paper  making, 
and  animal  and  mixed  fiber  dust,  such  as  is 
found  in  hat  making,  all  cause  a  high  tuber- 
culosis mortality  rate. 

Necessary  measures  for  prevention  among 
employees  are: 

"(a)  elimination  of  the  tubercidous  from 
the  working  force; 

"(&)  protection  of  employees  from  predis- 
posing causes; 

"(c)  supervision  of  the  physical  condition 
of  the  workers  by  medical  examinations." 

In     combatting     tuberculosis,     ventilation, 


whicli  includes  dust  removal,  temperature,  hu- 
midit}-,  and  cleanliness  of  working  rooms,  is 
the  most  important  general  condition  for  in- 
dustry to  consider.  The  salvaging  of  dust 
alone  in  some  industries  has  paid  for  the  in- 
stallation of  the  system  for  dust  removal. 

The  Pennsylvania  and  New  Jersej^  Depart- 
ments of  Industry  and  Labor  and  the  United 
States  Department  of  Labor  have  published 
very  good  reports  on  the  reduction  of  disease 
m  certain  hazardous  occupations  by  the  use 
of  devices,  and  the  education  of  employees  to 
their  use.  State  sanatoria  are  recommended 
for  the  use  of  tuberculous  employees,  and 
sickness  insurance  to  provide  for  their  de- 
pendents while  they  are  undergoing  treat- 
ment.— M.  Dent. 

The  Effect  op  Nitrous  Oxide,  Nattoal 
Gas  and  Formaldehtde  on  Experimental 
Tuberculosis.  Jonathan  B.  Rogers.  Am. 
Rev.  Tuberc,  Oct.,  1921,  5,  No.  8,  637-642.— 
"Neither  repeated  nitrous  oxide  and  oxygen 
anesthesia,  nor  formaldehyde  nor  natural  gas 
influence  the  development  or  progress  of  the 
tubercle  in  guinea  pigs  infected  through  the 
respiratory  route  with  a  watery  solution  of 
tubercle  bacilli  positive  sputum."  —  C.  K. 
Drinker. 

TuBERcui^osis  op  Husband  and  Wife. 
Harry  Lee  Barnes.  Am.  Rev.  Tuberc,  Oct., 
1921,  5,  No.  8,  670-673.—"!.  The  histories  of 
229  consecutive  widowed  patients  admitted  to 
the  Rhode  Island  State  Sanatoriimi,  1905  to 
1921,  .show  that  93,  or  40  per  cent.,  lost  their 
consorts  by  death  from  tuberculosis,  a  tuber- 
culosis mortality  over  three  times  that  of  the 
married  people  of  the  community. 

"2.  Immunity  from  many  diseases  is  short 
lived  and  until  much  more  convincing  evi- 
dence of  permanent  immunity  against  tuber- 
culosis conferred  by  childhood  infections  is 
forthcoming,  a  cautious  logic  will  not  accept 
the  confident  statements  that  are  being  made 
as  to  the  impossibility  or  rarity  of  adult  in- 
fection."—C.  K.  Drinker. 


OCCUPATIONAL 


AFFECTIONS    OF  THE 
SENSES 


SKIN   AND    SPECIAL 


Matchbox  Dermatitis.    .¥.  Prci.   Abstract- 
ed as  follows  from  Med.  Klin.,  1921,  No.  16,  in 


Arch.  Dermat.  and  Syph.,  Dec,  1921,  4,  No. 
6,   830. — "Several   cases   of   dermatitis  were 


ABSTRACTS 


255 


seen  at  the  Jadassohn  Clinic,  undoubtedly  due 
to  matchboxes.  The  lesions  were  in  the  pocket 
area,  also  on  the  hands  and  face.  The  causa- 
tive factor  was  a  phosphorous  sulphur  com- 
pound which  was  traced  to  one  special  fac- 
tory. Investigation  proved  that  owing  to  a 
shortage  of  amorphous  phosphorus  a  substi- 
tute (phosphorsesquisulfid)  had  been  used.  A 
certain  predisposition  of  the  patient  seems  to 
be  necessary.  Similar  cases  have  been  seen  in 
Sweden  and  Denmark." 

Folliculitis.  Arch.  Derniat.  and  Syph., 
Soc.  Tr.,  Dec,  1921,  4,  No.  6,  850.— "A  black- 
smith, aged  .36,  showed  a  folliculitis  involving 
the  beard,  scalp,  chest,  abdomen  and  thighs. 
The  eruption  had  recurred  every  summer,  re- 
gardless of  the  kind  of  work  he  engaged  in. 
Dr.  Lane  believed  the  condition  to  be  due  to 
sodium  borate,  which  the  patient  used  in  weld- 
ing. The  freedom  from  perspiration  explained 
the  lack  of  .symptoms  in  winter." 

The  Ocular  Factor  in  Headache.  J.  A. 
Kearney.  N.  Y.  Med.  Jour.,  Nov.  16,  1921, 
114,  No.  10,  565-566.— The  ocular  factor  in 
all  forms  of  headache  is  far  greater  than  is 
•supposed,  being  probably  not  less  than  40  per 
•cent.  Headaches  due  to  eyestrain  are  invari- 
ably bilateral,  and  usually  dull  in  character. 
Glasses  are  not  always  a  sign  that  refraction 
erroi-  has  been  corrected;  often  Ihey  were  pre- 
scribed long  ago,  or  without  the  use  of  a 
mydriatic.  "The  site  of  the  headache,  when 
eyestrain  is  responsible,  is  often  misleading  as 
to  the  character  of  tlic  existing  error  of  re- 
fraction. In  a  general  way,  a  frontal  or  su- 
praorbital headache  indicates  hyperopic  error ; 
■occipital,  an  imbalance  of  the  extrinsic  ocular 
■muscles;  and  temporal,  an  astigmatic  error." 

Sometimes  a  patient  suffers  from  headaches 
that  seem  to  be  caused  by  eyestrain,  but  upon 
examination  no  error  of  refraction  can  be 
found.  "In  a  number  of  these  cases,  by  turn- 
ing tlie  lids  and  carefully  scrutinizing  the 
conjunctiva,  it  may  disclose  changes  from  loss 
■of  lustre  to  decided  disease." 

"Not  one  of  the  routine  determinations  of 
the  many  that  go  to  make  up  a  complete  eye 
examination  should  be  omitted  when  a  head- 
ache patient  consults  for  relief,  and  if  our 
best  efforts  are  not  sufficient  to  allay  the  dis- 
tress entirely,  advice  should  always  be  given 
the  sufferers  to  seek  for  possible  source  else- 
where."— M.  C.  Shorley. 


Report  of  Committee  on  Local  Anesthet- 
ics IN  Ophthalmic  Work.  Jour.  Am.  Med. 
Assn.,  Nov.  26,  1921,  77,  No.  22,  1730-1735.— 
"In  analj-zing  the  results  of  this  investigation, 
so  far  as  our  present  knowledge  of  ophthalmic 
work  is  concerned,  your  committee  feels  justi- 
fied in  arriving  at  the  following  conclusions: 

"1.  For  surface  anesthesia,  cocain  in  4  per 
cent,  solution,  freshlj'  made,  possesses  distinct 
advantages  over  all  other  local  anestjietics, 
particularly  for  operative  work. 

"Concerning  cocain  anesthesia  the  follow- 
ing is  offered : 

"(a)  In  all  instances,  the  anesthesia  is 
equal  to  and  in  most  cases  it  is  greater  than 
that  produced  by  any  other  local  anestlietie. 

"(6)  Its  toxicity  when  used  in  the  small 
dosage  required  for  ocular  anesthesia  is  al- 
most negligible  and  does  not  count  as  a  seri- 
ous objection. 

"(c)  The  desiccation  and  disturbance  of 
nutrition  of  the  cornea  produced  by  it  are 
negligible  or  entirely  avoided  if  cai'e  is  ob- 
served in  keeping  the  eyelids  closed  after  the 
instillations  of  the  cocain  solution  and  up  to 
the  time  that  the  operative  work  is  to  begin. 

"(d)  The  dilatation  produced  by  the  co- 
cain is  of  short  duration,  does  not  often  occa- 
sion inconvenience,  and  may  be  overcome 
promptly  by  the  counter  effect  of  a  weak  mi- 
otic. 

"(e)  The  penetrating  effect  of  cocain  so- 
lution is  increased  by  the  addition  of  0.5  per 
cent,  solution  of  sodium  bicarbonate. 

"  (/)  The  efficiency  of  cocain  solution  is 
not  impaired  by  boiling. 

"  (f/)  The  efficiency  of  cocain  solutions  is 
not  aft'ected  either  as  to  intensity  or  prolonga- 
tion of  anesthesia  by  the  addition  of  epineph- 
rin. 

"  (/i)  The  use  of  stronger  solutions  than  the 
one  recommended  are  at  the  risk  of  seriously 
disturbing  the  nutrition  of  the  cornea  and 
interfering  with  the  healing  process. 

"2.  Phenacain  in  2  per  cent,  solution 
stands  next  to  cocain  in  efficiency. 

"Concerning  phenacain  anesthesia  the  fol- 
lowing is  offered : 

"  (a)  It  has  the  advantage  of  producing  a 
quicker  effect  than  cocain  and  a  slight  anti- 
septic action. 

"  (&)  It  does  not  dilate  the  pupil,  hence  is 
valuable  in  producing  surface  anesthesia  for 
tonometry,  therapeusis  and  removal  of  for- 
eign bodies  from  the  cornea. 


256 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"  (c)  It  does  not  produce  desiccation  of  the 
cornea,  nor,  so  far  as  known,  disturb  nutri- 
tion. 

"  (d)  The  solutions  are  not  affected  by  boil- 
ing. 

"(e)  Epinephrin  does  not  add  to  its  effi- 
ciency in  any  way. 

"  (/)  Alkalis  should  not  be  added  to  phena- 
cain  solutions  as  they  cause  precipitation. 

"(fir)  Phenacain  offers  the  distinct  disad- 
vantage of  producing  more  or  less  irritation, 
which  is  very  objectionable  to  sensitive  pa- 
tients. 

"  (h)  Phenacain  is  incompatible  with  al- 
kalis and  their  carbonate  bases,  and  the  use  of 
glass  vessels  should  be  avoided  in  preparing 
the  solution,  porcelain  being  used  instead. 

"3.  Procain  (novocain)  in  2  per  cent,  so- 
lution is  the  anesthetic  of  choice  for  infiltra- 
tion anesthesia. 

"(a)  The  addition  of  epinephrin  does  not 
inere?ise  efficiency,  but  does  delay  absorption 
and  diminish  the  chances  of  accidental  poison- 
ing. 

"(b)  Procain  (novocain)  solutions  should 
be  injected  slowly  to  aid  in  the  avoidance  of 
toxic  effects. 

"(c)  The  efficiency  of  procain  (novocain) 
solutions  is  not  increased  by  the  addition  of 
alkalis."— C.  K.  Drinker. 

A  New  Test  Card.  J.  Monroe  Thorincjton. 
Am.  Jour.  Opth.,  Oct.,  1921,  4,  No.  10,  740- 
741. — On  the  test  card  here  described  and 
illustrated,  Gothic  letters  are  employed. 
With  the  exception  of  the  two  letters  at  the 
top,  the  rows  of  letters  are  numbered,  the 
numerals  being  red  to  assist  in  detecting  the 
most  common  variety  of  color  blindness.  By 
the  use  of  these  figures,  the  patient  is  en- 
abled to  indicate  readily  the  number  of  the 
lowest  row  of  letters  which  he  can  read,  with- 
out having  to  count  the  lines. 

There  is  a  very  gradual  diminution  in  the 
size  of  the  letters  on  the  varioiis  lines  from 
above  downward,  and  all  letters  are  con- 
structed on  the  angle  of  four  minutes.  Care 
has  been  taken  that  a  proper  proportion  of 
round,  diagonal  and  square  letters  is  main- 
tained in  each  line  and  in  each  column.  The 
letters  B  and  S,  so  often  confused,  have  been 
eliminated,  as  well  as  the  letters  R  and  K 
which  have  a  marked  resemblance  to  the  letter 
A.  G  and  Q  have  also  been  omitted  since  they 
are  not  good  round  letters. 


Patients  do  not  readily  commit  this  test 
card  to  memory  as  they  do  the  Snellen  cards. 
The  visual  acuity  in  feet  and  metric  distance 
is  indicated  by  Roman  letters  and  Arabic 
characters  at  the  right  of  each  line.  Copies 
of  this  test  card  may  be  secured  from  Messrs. 
Wall  and  Ochs,  1716  Chestnut  Street,  Phila- 
delphia. It  may  be  had  with  red  numerals 
and  yellow  letters  on  black,  with  red  numerals 
and  white  letters  on  black,  and  with  red 
numerals  and  black  letters  on  white. — M.  C. 
Shorley. 

Foreign  Body  Spud  Illuminator.  W.  HoI- 
brook  Loivell.  Am.  Jour.  Ophth.,  Oct.,  1921, 
4,  No.  10,  739.— This  is  a  brief,  illustrated  de- 
scription of  an  illuminator  for  foreign  body 
spud  or  similar  instrument,  which  has  been 
devised  by  Dr.  Lowell.  "It  consists  of  a 
fountain  pen  light  with  spring  contact 
switch ;  to  which  is  attached  a  .smaller  parallel 
barrel,  equal  in  length,  with  a  sliding  member 
in  this  superimposed  barrel.  When  the  whole 
attachment  is  rotated  on  the  fountain  pen 
barrel,  a  tempered  spring  slides  over  the  con- 
tact switch  spring,  thus  giving  a  constant 
steady  light.  The  spud  is  fastened  in  this 
sliding  member.  When  pushed  forward  with 
the  light  on,  the  spud  point  and  cornea  are 
well  illuminated  and  the  light  is  where  you 
want  it  when  you  want  it,  and  the  left  hand  is 
free  to  control  the  lids.  The  spud  is  protected 
when  not  in  use  by  sliding  it  back  into  the 
barrel." — C.  K.  Drinker. 

Late  Traumatic  Detachment  of  Retina 
Its  Prophylaxis  and  Importance  from  a 
Disability  Compensation  Standpoint.  Har- 
old Gifford.  Am.  Jour.  Ophth.,  Nov.,  1921,  4, 
No.  11,  803-805. — "A  large  proportion  of  the 
detachments  of  early  life,  in  unpredisposed 
eyes,  are  of  the  late  traumatic  class. 

"As  a  matter  of  prophylaxis  against  such 
detachments,  a  jx'riod  of  as  complete  rest  as 
possible  (including  binocular  bandage)  is  de- 
sirable in  the  treatment  of  the  eye. 

"The  possible  occurrence  of  late  detachment 
should  always  be  provided  for  in  settlements 
for  damages,  or  disability  compensation  in 
cases  of  serious  contasions  of  the  eye.  This 
applies  with  equal  force  to  cases  of  deep  per- 
forating wounds  with  or  without  intraocular 
foreign  bodies,  or  to  accidents  where  the  head 
or  whole  body  has  received  severe  shock." 


ABSTRACTS 


257 


Eye  Findings  in  Brain  Injuries.  Nelson 
M.  Black.  Am.  Jour.  Ophth.,  Nov.,  1921,  4, 
No.  11,  819-823. — This  paper  presents  a  sum- 
mary of  the  ociilar  conditions  likely  to  be 
found  in  connection  with  brain  injuries,  with 
some  mention  of  other  symptoms  frequently 
associated  with  them. 

"Examination  of  the  eye  grounds  should 
always  be  a  part  of  the  routine  of  the  exam- 
ination of  any  case  of  head  injury,  and  the  de- 
termination of  the  visual  fields  when  possi- 
ble.   When  choked  disc  is  found  together  with 


other  symptoms  of  increased  intracranial  ten- 
sion, operative  interference  is  imperative.  The 
relief  of  pressure  in  practically  every  in- 
stance prevents  consecutive  atrophy  of  the 
optic  nerve  when  done  in  time.  Tlie  finding 
of  the  symptoms  of  choked  disc  without  other 
sj'mptoms  of  intracranial  pressure  is  not  suf- 
ficient indication  for  operation,  unless  the  in- 
traocular manifestations  are  progressive  in 
character;  on  the  other  hand,  the  absence  of 
choked  disc  should  in  no  wise  preclude  op- 
erative interference  when  other  symptoms 
indicate  its  necessity." — M.  C.  Shorley. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


Patioie  Study  and  Safety  Work  Co-ordi- 
nate. Frank  B.  Gitbrclh  and  Lillian  M.  Gil- 
breth.  Safety  Eiigin.,  Oct.,  1921,  -12.  No.  4. 
167-1G9. — The  problems  of  fatigue  and  safety 
could  be  conveniently  analyzed  through  a  fa- 
tigue survey,  which  would  improve  accident 
causing  conditions  as  well  as  motion  study 
conditions.  The  suggestion  .system,  home 
reading  box,  museum  and  information  bureau 
are  activities  which  the  writers  believe  are 
useful  and  can  be  used  as  "work  in  common" 
in  safety  and  fatigue  investigations.  These 
can  be  supplemented  and  developed  by  a  more 
scientific  investigation  if  that  seems  ncces- 
saiy. — R.  M.  Thomson. 

The  Engineering  Factor.  W.  77.  Forstcr. 
Nat.  Safety  News,  Dec,  1921,  4,  No.  6,  13-14. 
— According  to  the  author,  real  engineering 
capacity  enables  a  man  to  attack  a  safetj*  prob- 
lem in  the  following  manner: 

"1.    To  see  the  basic  hazard. 

"2.  To  see  the  conditions  producing  this 
hazard,  whether  due  to  equipment,  process  or 
worker. 

"3.  To  consider  the  pros  and  cons  of  the 
various  methods  of  eliminating  these  condi- 
tions. 

"4.  To  reach  a  wise  conclusion  as  to  the 
proper  procedure. 

"5.  To  present  the  case  so  that  it  goes 
through  with  the  controlling  powers. 

"6.  To  organize  to  produce  the  desired 
result. 

"7.  To  put  the  proposition  through  with 
the  co-operation  of  all  parties  at  interest." 

But  engineering  capacity  and  correct  engi- 


neering must  go  hand  in  hand  with  education- 
al propaganda  among  the  workmen. — M. 
Dent. 

The  Day  of  the  Safety  Engineer.  David 
S.  Beiicr.  Safety  Engin.,  Nov.,  1921.  42,  No. 
f),  227. — This  short  article  em])hasizcs  the  fact 
that  a  real  safety  engineer  does  not  merely 
attend  to  mechanical  safeguards,  but  an- 
alyzes accidents  and  tells  what  is  needed  to 
prevent  them. — R.  M.  Thomson. 

Accident  Prevention  and  First  Aid  Work 
IN  the  Telephone  Field.  F.  M.  Downeij. 
Safety  Engin.,  Oct.,  1921,  42,  No.  4,  170-173. 
— This  is  a  discussion  of  the  growth  and 
achievements  of  the  Bell  Telephone  Com- 
pany's line  force  in  accident  prevention  and 
first-aid  work.  The  results  obtained  over  a 
number  of  years  are  shown,  and  the  vital  im- 
portance of  the  hearty  co-operation,  support 
and  interest  of  all  parties,  of  competitive 
first-aid  demonstrations,  and  of  the  publish- 
ing and  distribution  of  bulletins  is  empha- 
sized.— R.  M.  Thomson. 

How  We  Licked  the  Goggle  Problem  in 
OUR  Plant.  G.  A.  Euechenmeisfrr.  Nat. 
Safety  News,  Dec,  1921,  4.  No.  6,  23-24.— This 
is  the  story  of  how  the  order  for  wearing  gog- 
gles was  successfully  enforced  in  the  plant  of 
the  Dominion  Forge  and  Stamping  Company, 
Ontario,  Canada.  It  took  a  great  deal  of  tact 
in  dealing  with  recalcitrant  subjects,  and  in 
one  or  two  instances  employees  had  to  be  dis- 
missed, but  the  safety  idea  of  goggles  won 
out  in  the  end.    During  the  process  of  fitting 


258 


THE   JOURNAL  OF  INDUSTRIAL  HYGIENE 


for  goggles  the  company  had  an  opportunity 
to  persuade  several  men  to  go  to  the  oculist 
and  have  their  eyes  examined,  with  the  result 
that  their  goggle  frames  were  fitted  with  spe- 
cial lenses,  and  their  efficiency  and  dispositions 
were  greatly  bettered. — M.  Dent. 

Explosions  Hazakd  and  its  Prevention. 
Joseph  F.  Shadgen.  Abstracted  as  follows 
from  Iron  Age,  1921,  Vol.  108,  127-130,  in 
Chem.  Abstr.,  Nov.  10,  1921,  15,  No.  21,  3751. 
— "This  is  a  thoughtful  review  of  the  litera- 
ture on  explosive  mixtures  of  solids,  liquids 
and  gases,  the  characteristics  of  fuels  being 
analyzed  with  special  reference  to  powdered- 
coal  installations  and  the  means  for  preven- 
tion of  explosions.  Numerous  tables,  photo- 
graphs of  flame  propagation  and  graphs  are 
given." 

Making  Coal  Mining  a  Safer  Job.  Safety 
Engin.,  Nov.,  1921.  42,  No.  5,  221-223.— A 
short  review  indicating  that  accident  preven- 
tion work  in  the  coal  mining  industry  is  show- 
ing results.^R.  M.  Thomson. 

CoKE-OvEN  Accidents  in  the  United 
States  ditring  the  Calendar  Year  1920. — 
William  W.  Adams.  U.  S.  Bur.  Mines,  Tech. 
Paper  293,  July,  1921,  pp.  32.— Accidents  at 
coke  ovens  during  1920  caused  the  death  of 
49  and  the  injury  of  3,415  employees.  This 
represents  a  decrease  of  four  fatalities  and 
616  injuries  as  compared  with  the  record  for 

1919.  The  number  of  men  employed  during 

1920,  however,  was  28,139,  a  decrease  of  602, 
or  2  per  cent,  below  the  number  employed  in 
1919. 

Reducing  the  average  number  of  men  em- 
ployed to  its  equivalent  in  300-day  workers, 
the  fatality  rate  for  1920  was  1.64  per  thou- 
sand men  employed,  and  the  injury  rate  was 
114.13,  as  compared  with  1.92  and  145.66,  re- 
spectively, for  1919 — a  decrease  in  fatal  acci- 
dents of  0.28  per  thousand  and  in  non-fatal 
injuries  of  31.53  per  thousand. 

The  chief  causes  of  fatalities  at  all  coke 
ovens  during  1920  were,  in  the  order  of  fre- 
quency, haulage  equipment,  burns,  falls  of 
persons,  and  falling  objects.  Non-fatal  in- 
juries resulted  principally  from  burns,  falls 
of  persons,  falling  objects,  haulage  equipment 
and  hand  tools. 

Tables  are  given  showing  the  number  and 


classification  of  injuries,  1916  to  1920 ;  acci- 
dents in  all  coke  ovens  during  1920  by  states, 
and  by  causes  and  by  states;  accidents  in 
beehive  and  by-product  coke  ovens  during 
1920  classified  by  states,  by  causes  and  by 
states,  and  by  character  of  disability;  and 
number  of  widows  and  orphans  caused  by  fatal 
accidents  in  all  coke  ovens,  by  states,  during 
the  years  1914-1920,  inclusive. 

At  the  end  of  the  report  two  tables  are  in- 
cluded giving  a  summary  of  the  fatality  and 
injury  rates  for  various  branches  of  the  min- 
eral industry  in  the  United  States  for  all 
years  for  which  comparable  statistics  for  the 
country  as  a  whole  are  available. — M.  C. 
Shorley. 

The  Need  op  a  Safety  Code  for  Ladders. 
F.  A.  Davidson.  Safety  Engin.,  Oct.,  1921, 
42,  No.  4,  180-182.— The  author  discusses  the 
need  of  a  National  Safety  Code  for  Ladders. 
A  ladder  code  will  help  to  reduce  accidents 
through  the  focusing  of  public  attention  on 
the  danger  of  using  poor  ladders,  by  educat- 
ing the  public  as  to  what  is  a  safe  ladder,  by 
serving  as  a  guide  to  state  local  and  insurance 
inspectors,  and,  finally,  by  the  sanction  of  law 
in  compelling  safe  conditions. — R.  M.  Thom- 
son. 

The  Essentials  of  a  Nation.\l  Safety 
Code  for  Ladders.  Clifford  B.  Connelley. 
Safety  Engin..  Oct..  1921,  42,  No.  4,  165-166. 
— The  following  essentials  are  suggested  for 
ladder  code  making : 

"1.  Gathering  and  compiling  information 
on  ladders,  including  a  historical  statement  of 
the  development  of  the  industry. 

"2.  Setting  forth  the  specifications  for 
construction  of  ladders  of  the  various  types. 

"3.  Suggesting  rules  for  use,  backed  by 
authentic  data  in  the  form  of  discussions. 

"4.    Using  abundant  illustrations. 

"5.  Furnishing  data  on  the  properties  and 
strengths  of  various  woods. 

"6.    Describing  ladder  appliances. 

"7.  Pointing  out  safety  methods  and  prac- 
tices." 

It  is  also  suggested  that  the  National  Code 
for  Ladders  be  in  reality  a  textbook  rather 
than  a  law  book,  an  authoritative  manual  for 
making  rules,  and  not  a  rule  book. — R.  M. 
Thomson. 


ABSTRACTS 


259 


INDUSTRIAL    PHYSIOLOGY:  NUTRITION,    METABOLISM, 

FATIGUE,  ETC. 


Influence  of  Alcohol  on  the  Function 
OF  THE  Heart.    G.  Pantunki.    Abstracted  as 
follows  from  Arch,  di  fisiol.,  1920,  Vol.  18, 
67,  in  Med.  Sc.,  Dec.,  1921,  5,  No.  3,  2.57.— 
"The  present   research  was  undertaken   be- 
cause no  definite  conclusions  appear  to  have 
as  yet  been  reached  in  regard  to  the  action 
of  alcohol  on  the  function  of  the  heart.    Some 
authors  hold  that  it  chiefly  increases  the  car- 
diac activity;  others  a^aiii  are  of  the  opinion 
that  its  action  is  essentially  depressive;  and 
yet  others  think  that  very  small  doses  act  in 
an  excitinsr  manner  wliile  larpre  ones  have  an 
opposite  ollVct.      Moreover,   no  one  seems  to 
have  studied  the  action  of  alcohol  on  the  ex- 
citability of  the  myocardium,  to  which  the 
author  has  paid  particular  attention.    In  ad- 
dition, lie  has  investigated  the  effect  of  the 
excitation  of  the  vagus  and  the  contraction 
cun^e  of  the  frog's  heart.    This  was  exposed 
and  suspeiided  to  a  lever  according  to   En- 
gelmann's  method.      After   taking  a   normal 
tracing,  varj'ing  quantities  of  ethyl  alcohol 
diluted  with  Ringer's  solution  were  injected 
into  the  frogs  and  other  tracings  taken  at  in- 
tervals of  from  5  to  20  minutes.    Tiie  results 
obtained,  which  are  of  general  interest,  have 
been  summarized  by  the  author  approximate- 
ly as  follows:    (1)    Ethyl  alcohol  noticeably 
modifies  tlie  activity  and  functional  properties 
of  the  heart.     (2)  This  action  manifests  itself 
in  a  slackening  of  the  heart's  rhythm,  which 
is  chiefly  due  to  a  remarkable  prolongation  of 
the  systolic  phase  when  small  doses  are  used, 
to  a  prolongation  of  the  diastolic  phase  in  the 
case  of  large  ones.     (3)   The  excitability  of 
the  myocardium  is  constantly  increased  by 
small  doses  of  alcohol,  but  this  fact  is  less  and 
less    appai'ent   as   the   doses   become    larger, 
until    excitability  may  even    be  diminished, 
with  a  corresponding  elevation  of  its  thres- 
hold.    (4)  The  period  of  latency  is  constantly 
shortened  by  minimal  doses  of  alcohol ;  some- 
what larger  ones  do  not  appear  to  have  al- 
ways the  same  effect.    (5)  The  length  of  the 
refractory  period  does  not  show  any  percepti- 
ble modification   in   the   experimental  condi- 
tions adopted  by  the  author.     (6)  The  excita- 
bility threshold  of  the  vagus  is  increased  by 
alcohol.     (7)  Under  the  influence  of  alcohol 
the  heart  stopped  by  means  of  a  proper  stim- 
ulation of  the  vagus  re-starts  its  automatic 


acti\nty  more  slowly  than  in  normal  condi- 
tions. (8)  After  stimulation  of  tlic  vagus 
it  takes  a  longer  time  for  the  automatic 
rhythm  to  become  normal  when  alcohol  is  in- 
troduced into  the  organism  than  in  the  case 
of  the  same  heart  before  undergoing  intoxica- 
tion."—M.  C.  Shorley. 

The  Effect  of  Coolin-g  Power  of  the  At- 
mosphere ox  Body  Metabolism.  J.  A.  Camp- 
bell,  D.  Hargood-Ash,  and  L.  Hill.  Abstracted 
as  follows  from  -Tour.  Physiol.,  1921.  Vol.  55,  ^ 
259-2C4,  in  Physiol.  Abstr.,  Oct.-.\ov.,  1921,  6, 
Nos.  7  and  8,  440. — "Basal  metabolism  of  the 
body  cells  is  raised  by  cool  out-of-door  condi- 
tions, even  when  shivering  does  not  occur; 
metabolism  is  controlled  by  cooling  power,  not 
by  temperature.  Formulae  are  given  for  rapid 
calculation  of  heat  production  of  the  I'esting 
sub,iect,  the  information  required  being  the 
dr,v  kata-thermometer  cooling  power,  the  dry 
bulb  air  temperature,  and  the  cheek  temper- 
ature. "—McKeen  Cattell. 

On  the  Carbon  Excretion  of  Man  in 
Wrestling  and  in  Fencing.  R.  Gtillichsen 
and  J.  L.  Soiaalon-Soininen.  Abstracted  as 
follows  from  Skandin.  Arch.  f.  Physiol.,  1921, 
Vol.  41,  188,  in  Med.  Sc,  Dec,  1921,  5,  No.  3, 
277. — "Observations  on  six  persons  in  the 
respiration  chamber  on  the  energy  liberated 
in  fencing  and  in  wrestling  as  measured  by 
the  carbon  dioxide  excretion.  The  results 
show  that  the  musciilar  work  involved  in  these 
exercises  is  of  a  very  high  order  of  magnitude 
when  compared  with  other  occupations  in- 
volving heavy  work." — M.  C.  Shorley. 

Increase  in  Capacity  for  Work  Due  to 
Administration  op  Phosphate.  G.  Emhden, 
E.  Grafe,  and  E.  Schmitz.  Abstracted  as  fol- 
lows from  Ztschr.  f.  physiol.  Chem.,  1921,  Vol. 
113,  67,  in  Med.  Sc,  Dec,  1921,  5,  No.  3, 
278. — "Experiments  on  soldiers  and  minei's 
showed  that  the  administration  of  7.5  gm.  of 
sodium  dihydrogen  phosphate  per  day  result- 
ed in  an  increased  capacity  for  muscular 
work,  presumably  by  facilitating  the  resyn- 
thesis  of  'lactacidogen'.  A  favorable  effect 
on  the  nervous  system  is  also  claimed." — M. 
C.  Shorley. 


260 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


On  the  Size  of  the  Heart,  Blood  Pres- 
sure AND  Pulse,  before,  during  and  after 
Short  Periods  of  Heavy  Physical  Labor. 
0.  Bruns.  Abstracted  as  follows  from  IMiiii- 
chen.  med.  Wehnschr.,  1921,  Vol.  68,  907- 
908,  in  Physiol.  Abstr.,  Oct.-Nov.,  1921,  6, 
Nos.  7  and  8,  427. — "Observations  on  the  size 
of  the  heart  as  seen  by  X-ray  illumination  dur- 
ing- .short  periods  of  hea\nK'  work.  The  author 
failed  to  ^'et  any  appreciable  increase  in  heai"t 
volume  T^-hen  the  blood-pressure  rose  30  or  40 
mm. ;  he  points  out  that  this  is  in  complete 
contrast  to  the  results  of  animal  experiments 
carried  out  bj'  Starling  and  Straub.  He  con- 
siders that  the  discrepancy  is  due  to  the  diffi- 
culty of  standardising  conditions  when  deal- 
ing with  human  subjects,  and,  moreover, 
amongst  other  things,  to  the  inotropic  influ- 
ence of  the  sympathetic. ' ' — McKeen  Cattell. 

The  Physiological  Cost  of  Muscular 
"Work  :  A  Kefly  to  Objections.  A.  D.  Wal- 
ler and  G.  Dc  Decker.  Brit.  Med.  Jour.,  Oct. 
22, 1921,  No.  3173,  627-630.— Waller's  method 
consists  in  collecting  the  expired  air  for  a 
period  of  thirty  to  sixty  seconds  during  work 
and  for  one  to  two  minutes  during  rest.  By 
determining  the  percentage  of  carbon  dioxide 
in  the  expired  air,  and  knowing  the  volume 
of  air  expired  during  a  given  period,  the  car- 
bon dioxide  in  cubic  centimeters  per  minute 
may  be  calculated.  With  these  data  and  by 
assuming  a  respii-atory  quotient  of  0.85,  the 
number  of  calories  expended  during  a  given 
amount  of  work  is  computed  by  referring  to 
the  tables  of  the  calorific  value  of  carbon  di- 
oxide for  a  given  respiratoiy  quotient,  as  de- 
termined by  Zunst  {Pfliiger's  Archiv,  1897, 
68,  p.  201).  Later  it  was  thought  preferable 
to  assume  a  respiratory  quotient  of  1.00  and 
calculate  the  calories  accordingly.  By  this 
method  an  endeavor  has  been  made  to  ob- 
tain a  knowledge  of  the  physiological  cost  of 
a  variety  of  types  of  industrial  work.  Follow- 
ing a  summary  of  the  investigations  by  Wal- 
ler and  De  Decker  {Brit.  Med.  Jour.,  May  7, 
1921),  Leonard  Hill  and  J.  A.  Campbell 
{Ibid.,  May.  21,  1921)  and  J.  B.  Orr  and  J.  P. 
Ivinloch  {ibid..  July  9,  1921)  published  arti- 
cles criticizing  the  validity  of  Waller's  meth- 
od. Waller  and  De  Decker  have  replied  to 
these  objections  in  the  present  communica- 
tion. 

They  answer  the  first  objection,  that  the 
period    (half   a   minute)    during   which   the 


samples  of  expired  air  were  taken  was  -too 
short,  as  follows :  They  admit  that  longer 
periods  were  desirable  but  impracticable  as  a 
laborer  could  not  be  interrupted  from  work 
for  any  length  of  time.  Furthermore,  the 
minute-volume  of  expired  air  is  increased  dur- 
ing work  and  it  would  not  be  convenient  to  fit 
the  subject  with  a  bag  to  collect  as  much  as 
80  to  100  liters  of  air.  Their  present  method 
permits  the  use  of  a  bag  of  20  to  30  liters' 
capacity.  They  have  concluded  by  repeated 
trials  that  the  error  inherent  in  such  short 
periods  is  much  less  serious  than  anticipated. 
To  reduce  the  error  further  they  calculate 
their  results  from  the  average  of  a  series  of 
periods. 

In  answer  to  the  second  criticism  that  they 
have  failed  to  place  sufficient  emphasis  on 
the  influence  of  food  on  carbon  dioxide  elim- 
ination. Waller  and  De  Decker  state  that  they 
consider  the  increase  in  carbon  dioxide  output 
following  food  might  amount  to  one-fifth  of 
the  resting  value,  but  that  this  is  negligible  as 
compared  to  the  more  marked  increase  follow- 
ing muscular  work.  They  believe  this  is  justi- 
fiable considering  the  conclusion  of  Benedict 
and  Murschausen  "that  the  increment  [of 
energy  discharge]  due  to  the  work  of  forward 
progression  was  constant,  irrespective  of 
whether  the  subject  was  with  or  without 
food."  Furthermore,  the  authors  state  that 
they  were  concerned  with  the  carbon  dioxide 
output  of  workers  under  their  normal  condi- 
tions of  life. 

The  third  objection  to  Waller's  method  is 
that  the  respiratoiy  quotient  has  been  neg- 
lected in  determining  the  caloric  equivalent 
of  the  volume  of  carbon  dioxide  exhaled.  Wal- 
ler and  De  Decker  concede  that  this  objection 
is  fundamental  and  theoretically  the  most  im- 
portant of  the  three.  They  feel  that  the  ap- 
parent inaccuracy  of  their  method  is  compen- 
sated for  by  the  ease  with  which  a  relatively 
large  number  of  observations  may  be  made 
and  readily  computed.  They  consider  that 
their  method  is  best  adapted  for  use  in  the 
factory  and  on  the  road  for  the  necessary  pre- 
liminary survey  on  an  extensive  field.  They 
conclude  with  Orr  and  Kinloch  that  at  the 
beginning  and  end  of  exercise  there  might  be 
a  "washing  out"  or  retention  of  carbon  diox- 
ide which  would  render  a  false  respiratory 
quotient,  but  tliey  consider  this  error  elim- 
inated by  mca.suring  the  output  only  after  a 
constant  regime  of  work  is  established. 


ABSTRACTS 


261 


A  fourth  point  of  controversy  relates  to  the 
mterpretation  of  the  observation  that  the  car- 
bon dioxide  excretion,  when  determined  at 
regular  intervals  during  several  hours'  work, 
exhibits  a  progressive  increase.  This  occurs 
even  though  the  amount  of  work  remains  con- 
stant. Waller  and  De  Decker  object  to  the 
suggestion  of  Hill  and  ("ampbcll  that  this  in- 
crease is  due  to  food  and  oifer  as  a  possible 
explanation  that  it  is  due  to  the  decreasing  ef- 
ficiency of  the  laborer,  though  they  feel  that 
this  point  will  require  careful  discussion  after 
furtiier  investigation. — Cynis  C.  Sturgis. 

Fatigue  Tests  at  Purdue  University.  G. 
II.  Shepard.  Indust.  Management,  Nov.,  1921, 
&2,  No.  '),  281-l28(i.— The  main  object  of  the 
tests  reported  here  was  to  discover  the  mini- 
mum proportion  of  periods  of  rest  to  the  total 
of  working  hours,  by  which  workers  on  liglit- 
heavy  musctdar  work  can  ap|)roximate  their 
maximum  output  (light-heavy  muscular  work 
being  defined  as  work  in  which  the  mu.scular 
system  is  continually  under  load  during  the 
operation,  the  load  not  being  heavy  enough  to 
produce  a  sensation  of  muscular  strain,  but 
being  repeated  so  many  times  that  the  worker 
l)ecomes  sensibly  fatigued  by  the  end  of  the 
day). 

The  experiments  were  made  by  a  single 
operator,  the  work  being  performed  on  chest 
weights,  the  industrial  day  represented  as 
closely  as  i>ossible  by  a  day  of  nine  working 
hotirs  during  wliich  one  liour  was  allowed  for 
lunch,  between  tlie  lit'tli  and  sixth  hours.  Nine 
full  days'  work  was  done,  varying  the  work- 
ing pei'iod  fi'om  twenty-five  to  sixty  min- 
utes, but  allowing  in  each  case  a  rest  period 
of  eight  minutes.  The.  forty-five-minute 
period  was  the  most  productive,  increase  of 
the  work  period  from  that  ])oint  causing  a 
steady  decline  in  outjiut,  while  shortening  of 
the  period  also  caused  decrease,  although  not 
so  uniformly.  The  thirty-five-minute  period 
day  was  about  as  productive  as  the  forty-five- 
minute  i)eriod  day,  but  between  the  thirty- 
minute  period  and  the  twenty-five-minute 
period  there  was  a  decided  difference. 

The  conclusion  is  reached  that  a  worker  on 
light-heavy  work  and  a  nine-hour  working 
day  cannot  give  his  maximum  output  unless 
he  rests  at  least  15.1  per  cent,  of  the  time  dur- 
ing woi-king  hours.  But  in  order  to  be  sure 
that  rest  perio^^ds  will  increase  production  the 
worker  should  have  been  interested  by  effi- 


ciency reward  and  other  means  to  such  an  ex- 
tent that  he  is  seeking  at  all  times  to  deliver 
his  maximum  output.  It  was  further  shown 
that  the  expenditure  of  energy  as  measured 
by  loss  of  weight  was  greater  (for  100,000 
foot-pounds  of  work)  when  the  forty-five-min- 
ute period  was  required  than  in  the  forty- 
miiuite  period  day.  Therefore  it  is  concluded 
that  probably  an  industrial  worker  perform- 
ing light-heavy  work  day  after  day  will  not 
maintain  his  maximum  output  unless  he  rests 
at  least  16  2/3  per  cent,  of  the  time  during 
working  hours. 

Further  study  of  the  data  in  regard  to  the 
forty-five-minute  period  day  gives  evidence 
that  the  total  output  of  the  day  might  have 
been  increased  by  using  a  longer  working 
period  at  the  beginning  of  the  day  and  gradu- 
ally shortening  it  as  the  operator  became  fa- 
tigued. 

Other  problems  remain  to  be  solved,  such  as 
whether,  by  shortening  the  working  day  and 
thereby  sacrificing  the  reduced  output  of  the 
later  hours,  the  output  during  earlier  hours 
can  be  so  increased  as  to  give  a  greater  out- 
put for  the  day;  and,  if  so,  what  length  of 
day  would  give  the  maximum  output. 

Two  days  of  low  temperature  and  high  hu- 
midity show  a  falling  off  in  output,  which  may 
be  charged  to  the  temperature,  for  it  is  not 
surprising  that  exposing  the  body  of  a  worker 
to  an  excessive  direct  heat  loss  should  produce 
a  loss  of  output,  just  as  steam-plant  horse- 
power would  be  reduced  by  running  with  bare 
steam  pipes. 

In  some  preliminary  tests  the  operator  was 
allowed  to  work  and  rest  as  he  wished.  The 
average  of  four  periods  shows  that  the  natural 
choice  provided  for  15.6  per  cent,  of  rest;  but 
whether  this  approximation  to  the  proportion 
j'ielding  the  greatest  efficiency  is  a  general 
tendency  or  is  merely  peculiar  to  the  operator 
tested  remains  to  be  determined. — G.  E.  Par- 
tridge. 

The  Phtsiologt  op  Fatigue.  Phtsico- 
Chemical  Manifestations  op  Fatigue  in  the 
Blood.  Albert  Baird  Hastings.  U.  S.  Pub. 
Health  Service,  Pub.  Health  Bull.  No.  117, 
1921,  pp.  42. — "1.  Certain  phases  of  muscular 
fatigue  have  been  investigated  with  special 
attention  to  the  gaseous  and  osmotic  relation- 
ships in  the  blood  of  dogs. 

"2.  Hemolysis  in  vivo  occurs  in  untrained 
dogs  after  severe  exercise. 


262 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"3.  The  resistance  of  the  red  blood  cor- 
puscles to  laking  by  hypotonic  salt  solutions 
is  increased  bj^  exercise. 

"4.  The  carbon  dioxide  content  of  the 
blood  is  decreased  in  both  arterial  and  venous 
blood  by  exercise. 

"5.  The  degree  to  which  the  hemoglobin  is 
saturated  with  oxygen  is  increased  in  arterial 
and  dimuiished  in  venous  blood  by  exercise. 

"6.  These  changes  in  gases  result  in  a  mi- 
gration of  acids,  of  which  CI'  is  an  example, 
into  the  plasma.  A  diminished  osmotic  pres- 
sure within  the  corpuscles  results  and  is  indi- 
cated by  an  increase  iu  resistance  to  laking 
by  hypotonic  salt  solutions. 


"7.  Certain  of  these  changes  are  modified 
by  long  continued  exercise.  This  failure  in 
the  efficiency  of  the  processes  of  the  organ- 
ism is  regarded  as  fatigue. 

"8.  The  significance  to  the  cardio-vascular 
and  respiratory  systems  of  the  changes  in  the 
blood  gases  and  the  osmotic  relation-ships  is 
briefly  considered."- — C.  K.  Drinker. 

Study  op  Movements.  L.  Binet.  Abstract- 
ed as  follows  from  Med.,  Sept.,  1921,  2,  No. 
12,  964,  in  Jour.  Am.  Med.  Assn.,  Nov.  5, 
1921,  77,  No.  19,  1527.— "Binet  describes  the 
methods  and  findings  with  the  ergograph  and 
recording  apparatus. ' ' 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


Women,  a  New  Force  in  Industry.  Ida 
M.  Tarbell.  Nat.  Safety  News,  Nov.,  1921,  4, 
No.  5, 13. — Miss  Tarbell  makes  a  plea  to  enlist 
the  great  body  of  women  outside  of  industry 
in  the  safety  movement.  These  women  would 
work  and  work  well,  as  evidenced  by  our  ex- 
perience with  women's  organizations  during 
the  war,  and  would  be  a  great  power  behind 
the  cause  of  industrial  and  public  safety. — 
M.  Dent. 

Standards  for  the  Employment  of 
Women  in  Industry.  U.  S.  Dept.  Labor, 
Women's  Bur.,  Bull.  Xo.  3,  Third  Edition, 
Oct.  15,  1921,  pp.  8.— This  pamphlet  presents, 
in  revised  form,  the  standards  recommended 
by  the  Women's  Bureau  for  the  employment 
of  women  in  industry.  Standards  are  set 
foi-th  for  the  regulation  of:  hours  of  labor; 
wages;  working  conditions,  including  comfort 
and  sanitation,  posture  at  work,  safety,  condi- 
tions needing  reform  and  prohibited  occupa- 
tions; home  work;  and  employment  manage- 
ment. The  federal  government  urges  the 
industries  of  the  country  to  co-operate  with 
state  and  federal  agencies  in  maintaining 
these  standards  as  a  vital  part  of  the  indus- 
trial program  of  the  nation. — M.  C.  Shorley. 

Women  and  Young  Persons  (Employ- 
ment IN  Lead  Processes).  Statutory  Rules 
and  Orders,  Nos.  1713, 1714  and  1715,  London, 
Nov.,  1921. — These  three  orders  were  prepared 
by  the  Home  Secretary  in  pursuance  of  the 
Women  and  Young  Persons  Act,  1920:  "(a) 


declaring  what  is  a  lead  compound  for  the 
purposes  of  the  Act,  and  prescribing  the 
method  of  ascertaining  whether  any  compound 
is  a  lead  compound  within  the  definition; 
(b)  prescribing  the  periodic  medical  exam- 
ination reciuired  under  section  2  (1)  (b )  of 
the  Act;  and  (c)  prescribing  the  cloakroom, 
messroom  and  washing  accommodation  to  be 
provided  under  section  2  {l)(e)."  Para- 
graph 2  of  Order  No.  1714,  prescribing  the 
medical  examinations,  requires  the  employer 
to  supply  every  woman  and  yomig  person 
employed  in  any  process  to  which  the  order 
applies  with  a  healtli  register  in  the  approved 
form.  Copies  of  this  register  (Form  616) 
and  copies  of  the  orders  may  be  obtained  from 
H.  M.  Stationery  Office,  Kingsway,  London, 
W.C.2.— :\I.  C.  Shorley. 

Child  Labor.  Analysis  op  Work  Permits 
Issued  dishing  Biennium  Ending  June  30, 
1920.  State  of  Iowa,  Bur.  Labor  Statis.,  Bull. 
No.  4,  1921,  pp.  37. — According  to  the  child 
labor  laws  of  Iowa,  a  work  permit  must  be 
issued  for  every  child  between  the  ages  of 
14  and  16  years  wishing  to  obtain  a  position 
in  certain  specified  industries,  and  no  child 
under  14  can  be  employed  under  any  circum- 
stances in  said  industries.  The  laws  within 
which  the  child  may  be  employed  as  well  as 
the  total  number  of  hours  of  labor  in  the  week 
are  defined  by  this  law.  A  certificate  from 
the  superintendent  of  schools  testifying  to  the 
educational  standing  of  the  child,  a  certificate 
from  the  medical  inspector,  and  evidence  of 


ABSTRACTS 


263 


the  child's  afie  are  all  requisites  of  the  work 
permit.  Thus  the  Iowa  law  provides  for 
minimum  age  for  entrance  into  certain  indus- 
tries; a  certain  minimum  of  education;  a  cer- 
tain definite  physical  development;  and  good 
evidence  of  the  child's  age. 

Statistics  follow  which  "were  secured  from 
7,469  work  permits  issued  during  the  biennial 
period  to  4,832  boys  and  2.637  girls,  and  these 
have  been  tabulated  and  classified  so  as  to 
show  the  number,  by  age,  school  grade,  height 
and  weight,  for  twenty-nine  cities  of  the  state 
besides  a  few  towns  combined  into  a  miscel- 
laneous group."  A  report  of  the  United 
States  Children's  Bureau,  December,  1919, 
has  made  child  labor  requirements  somewhat 
more  stringent  than  those  provided  by  most 
of  the  states. — L.  A.  Shaw. 

Child  Labor  versus  Children's  Work. 
Raymond  G.  Fuller.  Am.  Child,  Nov.,  1921. 
3,  No.  3,  281-286.— There  is  a  wide  belief  that 
the  child  labor  reform  is  predicated  on  the 
assumption  that  children  should  have  no  work 
whatever.  This  is  far  from  the  truth,  but 
little  has  been  done  to  establish  children's 
work  on  a  proper  basis. 

Psychologically,  the  basic  eharaeteristie  of 
child  labor  is  unmntivated  activity,  or  activity 
motivated  from  without;  and  it  is  child  labor 
in  the  school  that  is  one  of  the  main  causes 
of  child  labor  in  industry  and  agriculture. 

Children's  work  is  activity  that  leaves 
plenty  of  time  for  schooling  and  play ;  is  per- 
formed in  suitable  places;  is  favorable  to  de- 
velopment and  liealth;  is  educational  as  a 
means  of  accumulating  knowledge;  and  is  a 
supervised  activity,  the  supervision  being  in 
the  interest  of  the  child.  Children  have  work 
impulses  and  needs  as  well  as  play  iniindses 
and  needs,  and  they  should  have  the  discipline 
of  proper  work  The  school  should  help  to- 
ward a  more  intelligent  usefulness  in  the 
home. 

Vocational  training  and  part-time  schools 
are  recommended  with  too  little  thought 
about  their  development  value;  the  voca- 
tional education  of  today  is  almost  as  far 
from  meeting  the  needs  of  children  as  the 
older  education  was.  Growth  is  the  important 
consideration,  and  educationally  the  voca- 
tional curriculum  has  an  advantage  because  it 
involves  more  action  and  deals  with  the  con- 
crete and  the  practical. — G.  E.  Partridge. 


Control  of  the  Employment  of  Chu^dren 
IN  Agriculture  in  Europe.  Internat.  Labour 
Rev.,  Nov.,  1921,  4,  No.  2,  190-227.— There  is 
but  little  direct  legislation  in  Europe  regu- 
lating the  labor  of  children  in  agriculture 
but  at  the  same  time,  and  as  if  by  common 
consent,  most  of  the  European  states  have 
tried,  through  the  indirect  method  of  educa- 
tion laws,  to  provide  safeguards  for  children 
in  the  rural  districts.  On  the  other  hand, 
thei-e  are  labor  laws  which  siiocifically  ex- 
clude agriculture  from  the  regulations  affect- 
ing other  industries. 

There  are  a  few  laws  ajiplying  definitely  to 
the  work  of  children  in  agriculture.  In  Switz- 
erland, children  may  not  be  employed  under 
the  age  of  12  in  any  agricultural  undertaking 
other  than  that  of  their  parents,  and  a  limit 
is  fixed  of  six  hours'  work  a  day  during  the 
whole  i)eriod  of  compulsory  school  attendance 
and  of  two  hours  in  the  school  term.  In  Den- 
mark, children  under  10  are  unconditionally 
prnliibited  from  working  with  machinery — - 
and  there  are  a  few  more  such  laws.  In  Great 
Britain  and  Ireland  the  labor  of  children  in 
agriculture  is  more  severely  controlled.  The 
Eni])loyment  of  Children  Act,  1903,  governs 
conditions  for  children  in  general  employ- 
ment, and  its  provisions  were  amended  in 
1918,  by  Section  13  of  the  Education  Act 
(England  and  Wales).  By  this  the  employ- 
ment of  any  child  of  "12  or  upwards"  is  pro- 
hibited on  Sundays;  during  school  hours  on 
any  day  when  the  school  is  open ;  and  on  any 
day  before  6  o'clock  in  the  morning  or  after 
8  o'clock  in  the  evening. 

A  system  of  rural  inspection  that  would 
give  the  child  in  agriculture  protection  such 
as  is  provided  by  an  efficient  system  of  factory 
legislation  has  not  yet  been  formulated.  Ex- 
emptions from  attendance  at  school  compli- 
cate the  whole  question.  Half-time  or  other 
partial  exemption,  exemption  for  seasonal 
work,  the  reduction  of  the  school  year  for 
agricultural  ])urposes  in  a  given  locality,  all 
take  part  in  depriving  the  country  child  of 
the  protection  which  it  is  the  aim  of  the  best 
kind  of  educational  legislation  to  give. 

Data  are  given,  in  the  form  of  tables,  in 
regard  to  the  ages  between  which  every  child 
must  attend  school  unless  exempted,  the  mini- 
mum period  of  compulsory  school  attendance, 
and  the  conditions  under  which  absence  from 
school  may  be  allowed,  as  established  in  the 
countries  of  Europe. — 6.  B.  Partridge. 


264 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


The  Adolescent  and  the  Community.  E. 
L.  CoUis.  Welsh  Outlook,  Oct.,  1921.  (Review 
by  autJior.) — In  this  paper  it  is  pointed  out 
that  the  adolescent  costs  the  community  con- 
siderable sums  of  money  expended  on 
health  supervision  and  education.  Never- 
theless, there  are  no  adequate  channels 
through  which  he  is  passed  on  from  school  life 
to  an  occupation.  This  lack  is  due  to  the 
facts  that  education  has  too  little  regard  for 
occupation,  and  that  industry  establishes  too 
few  occupational  ladders.  The  result  of  this 
disregard  for  the  adolescent  is  shown  in  an  ex- 
cessive tendency  for  youthful  labor  to  wander 
from  place  to   place  endeavoring   to   find   a 


roimd  hole  to  fit  into,  which  migration  is  a 
trying  and  wasteful  proceeding,  a  social  evil, 
and  an  economic  loss.  The  wanderlust  so  ac- 
quired lasts  throughout  occupational  life.  The 
remedy  is  to  be  found  in  vocational  guidance 
during  education,  and  in  vocational  selection 
when  new  workers  are  engaged.  In  particular, 
committees  are  needed  to  stand  between  the 
schools  and  occupations,  which  should  pay  par- 
ticular attention  to  promoting  medical  super- 
vision in  occupations,  and  to  establishing  co- 
operation between  it  and  medical  supervision 
in  schools.  Throughout  the  article  statements 
made  are  supported  by  appeal  to  definite  sta- 
tistical data. 


INDUSTRIAL  SANITATION:  FACTORY  CONSTRUCTION,  ILLU- 
MINATION, VENTILATION,  HEATING,  WATER  SUPPLY,  SEW- 
KT"-"'  AGE  DISPOSAL 


Sanitary  Control  in  the  Manufacture 
OP  Foods  and  its  Economic  Importance. 
George  Grindrod.  Am.  Jour.  Pub.  Health, 
Oct.,  1921,  11,  No.  10,  920-922.— "Within  re- 
cent years  two  fundamental  changes  have 
taken  place  in  the  production,  preparation  and 
handling  of  foods;  these  developments  have 
had  such  effects  on  centralization  of  popula- 
tion, and  dependence  on  manufactured  foods 
as  to  make  them  of  vital  importance. 

"The  first  development  has  been  in  the 
preservation  of  foods  so  as  to  permit  their 
storage  for  indefinite  periods  and  their  trans- 
portation. This  is  essentially  the  dehydrating 
and  canning  industry. 

"The  second  development  has  been  in  the 
ti-ansportation,  purification  and  synthesis  of 
foods.  This  is  a  natural  though  rapid  out- 
growth of  the  canning  industry.  The  extensive 
production  of  foodstuffs  from  natural  mate- 
rials never  before  available  for  use  as  foods 
marks  the  begiiming  of  an  industrial  develop- 
ment of  inestimable  extent. ' ' 

The  author  cites  the  production  of  canned 
milk  as  an  example  of  specialized  sanitary  con- 
trol and  of  the  application  of  bacteriology  in 
the  service  of  the  public.  lie  concludes  by  say- 
ing that  "The  development  of  scientific  con- 
trol of  raw  food  materials,  of  the  processing 
and  the  inspection   of  the  finished   product 


brought  manufactured  foods  into  the  position 
where  they  are  not  regarded  as  substitutes  for 
fresh  foods,  but  as  essentials." — M.  C.  Shor- 
ley. 

Sanitation  of  Fruit  and  Vegetable  Can- 
neries. Harry  M.  Miller.  Am.  Jour.  Pub. 
Health,  Oct.,  1921,  11,  No.  10,  922-923.— The 
elimination  of  handwork  by  the  invention  of 
machines  has  done  much  to  improve  the  sani- 
tary conditions  in  fruit  and  vegetable  can- 
neries. "In  general,  every  part  of  the  fruit 
and  vegetable  canning  industry  has  kept  pace 
with  the  mechanical  development  so  that  to- 
day a  large  portion  of  our  food  supply  is  pro- 
duced in  modern  sanitary  buildings,  pro- 
vided with  concrete  floors,  flooded  with  direct 
sunlight,  the  interior  painted  white,  properly 
screened  against  the  invasion  of  flies,  bees  and 
other  insects,  with  adjoining  grounds  oiled  or 
regularly  sprinkled  with  water  to  keep  down 
dust." 

As  in  all  problems  of  sanitation,  the  educa- 
tional feature  is  the  most  vital  factor  to  be 
considered  as  well  as  the  most  difficult  to 
handle.  The  fruit  and  vegetable  canning  in- 
dustry has  made  remarkable  progress  within 
the  past  few  j'ears  and,  with  few  exceptions, 
canners  arc  fairly  well  versed  in  the  conse- 
quences of  running  a  plant  under  faulty  sani- 
tary conditions. — M.  C.  Shorley. 


ABSTRACTS 


265 


Monitor  Ventilation.  Walter  A.  Griffin. 
Boston  Med.  and  Surg.  Jour.,  Nov.  10,  1921, 
185,  No.  19,  572-574. — A  report  i.s  given  of  two 
years'  experience  with  the  monitor  system  in 
the  Sharon  Sanitarium,  where  the  results  were 
.satisfactory.  The  Canton,  Massachusetts, 
school  also  uses  this  .system  and  finds  that  it 
works  well.  It  is  urged  that  the  monitor  sys- 
tem can  be  used  under  a  variety  of  conditions 
when  numbers  of  people  are  congregated.  The 
system  has  the  disadvantage  of  requiring 
somewhat  more  coal  and  of  being  best  suited 
to  one-story  structures,  but  these  are  not  seri- 
ous objections.^ — Barnett  Cohen. 

Ventilation,  Weather,  and  the  Common- 
Cold.  George  T.  Palmer.  Jour.  Lab.  and 
Clin.  Med.,  Oct.,  1921,  7,  \o.  1,  39-52.— "From 
the  result.s  of  this  study  there  appears  to  be 
something  inherent  in  the  indirect  method  of 
ventilating  schoolrooms  by  means  of  forced 
draught  and  gravity  exhaust,  as  practised  in 
this  study,  that  is  prndnetive  of  respiratory 
affections,  something  which  is  not  present  in 
rooms  ventilated  with  windows  and  gravity 
exhaust."  Among  these  unfavorable  elements 
are  higher  temperature,  and  luiiformity  of 
temperature  and  air  flow.  "In  an  unvarying 
atmosphere  the  occupants  miss  that  pleasant 
stimulating  effect.    Evidentlv  the  absence  of 


this  quality  affects  health  adversely  as  well 
as  comfort. 

"The  temperature  of  window  ventilated 
schoolrooms  may  be  reduced  as  low  as  59  de- 
grees without  increasing  the  prevalence  of 
colds. 

"In  spite  of  our  inadequate  knowledge  of 
window  ventilation  at  its  best,  the  fact  re- 
mains that  the  window  rooms  of  this  study, 
even  though  of  crude  arrangement  and  not 
built  originallj-  for  the  purpose,  competed  on 
favorable  terms,  from  a  hygienic  and  aesthet- 
ic standpoint,  with  the  most  elaborate  and 
costly  fan  and  duet  equipment. 

"Xatural  ventilation  has  its  limitations. 
That  the  schoolroom  is  not  beyond  these  limi- 
tations is  the  indication  of  this  study.    .     .     . 

"In  its  quantitative  effect  on  respiratory 
illiii'ss  school  vi'iitilation  is  of  nuicii  less  mo- 
ment than  the  outdoor  weather  influence.  Res- 
piratory affections  increase  with  the  onset  of 
cold  weather.  They  diminish  with  the  advent 
of  mild  weather  in  tlie  spring.  Wind  and  hu- 
midity accentuate  the  temperature  influence. 
Sunlight  exerts  at  least  a  warming  influence 
sulTicient  to  modify  the  unfavorable  effect  of 
cold.  Abrupt  changes  in  temperature  do  not 
influence  respiratory  illness  as  much  as  one 
might  expect  from  everyday  experience." 
M.  0.  Shorley. 


INDUSTRIAL  MEDICAL  SERVICE:  MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 


Do  Workers  Prefer  to  Pat  ?  M.  F.  Morri- 
son. Factory,  Nov.,  1921,  27,  No.  5,  702.— An 
investigation  of  dental  work  in  other  plants 
convinced  the  officials  of  the  New  England 
branch  of  a  large  rubber  concern  that  there 
would  be  a  greater  response  from  the  em- 
ployees if  a  charge  were  made  for  dental 
work.  Free  dental  service  impresses  the  em- 
ployees with  the  fact  that  they  are  receiving 
charity  from  their  employers,  whereas  they 
consider  ser\nce  from  a  plant  doctor  as  having 
been  necessitated  bj'  the  industry  and  hence 
due  them.  In  this  plant  the  dentist  may  be 
consulted  without  charge  and  a  toothache  re- 
lieved without  expense,  but  nominal  charges 
are  made  for  extractions,  cleaning  and  filling, 
the  lowest  charge  being  10  cents  for  cleaning 
and  the  highest,  75  cents  for  porcelain  fillings. 
— M.  Dent. 


Cutler-Hammer  Hospital.  Hosp.  Man- 
agement, Oct.,  1921,  12,  No.  4,  60,  62.— "The 
medical  department  at  the  Cutler-Hammer 
Manufacturing  Company  is  under  the  direc- 
tion of  the  welfare  manager  and  safety  en- 
gineer. Its  personnel  consists  of  a  doctor,  a 
registered  nurse  and  an  orderly.  The  depart- 
ment is  furnished  with  an  automobile,  en- 
abling the  nurse  to  visit  employees'  families 
where  sickness  is  reported. 

"Under  an  arrangement  with  a  Milwaukee 
dental  clinic,  arrangements  have  been  made 
for  a  dentist  to  visit  the  plant  each  day  for  an 
hour.  Free  dental  inspections  and  treat- 
ments are  thus  provided  for  the  employees." 

The  company  feels  repaid  many  times  over 
for  the  expense  of  installing  and  operating  its 
medical  department  by  the  material  reduction 
in  compensation  costs  which  has  been  effected. 


266 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


and  by  the  goodwill  which  has  been   estab-     of  the  work  of  the  department  during  1920 
lished  among  its  employees.     A  brief  report      is  included. — M.  C.  Shorley. 

INDUSTRIAL   INVESTIGATIONS  AND  SURVEYS 


Physique  of  German  Workers.  Internat, 
Labour  Rev.,  Nov.,  1921,  4,  No.  2,  144-146.— 
Tables  are  reproduced  from  an  article  by  ilein- 
ighausen  showing  the  height  of  workers  in 
various  occupations  (in  1892),  chest  measure- 
ments, and  weight  (the  lists  of  occupations 
given  are  all  different).  Comparison  as  to 
height  shows  that  students,  professors,  etc., 
are  the  tallest,  followed  by  engineers,  while 
painters,  plasterers  and  tailors  appear  at  the 
end  of  the  list.  Millers,  wheelwrights  and 
blacksmiths  have  the  greatest  chest  circum- 
ference (of  the  nine  classes  included)  ;  clerks, 
shopkeepers  and  bookbinders  are  at  the  bot- 


tom of  the  list.  Brewers,  cooks  and  butchers 
lead  in  weight,  and  painters,  plasterers  and 
bookbinders  are  last.  Meinighausen  does  not 
accept  as  universally  correct  the  view  that 
men  are  influenced  in  their  choice  of  occupa- 
tion by  their  physical  health  and  strength, 
and  that  strong  youths  have  a  preference  for 
heavy  work  and  the  less  robust  choose  lightei 
trades.  Physique  influences  occupation  to 
some  extent,  but  occupation  in  turn  affects 
phj'sique  very  considerably.  It  is  concluded 
that  there  are  a  larger  number  of  physically 
robust  workers  in  the  country  than  in  the 
towns. — G.  E.  Partridge. 


INDUSTRIAL  PSYCHOLOGY  AND  INDUSTRIAL 

IN  ITS  HEALTH  RELATIONS 


MANAGEMENT 


Five  Wats  to  Gain  Better  Co-operation. 
E.  K.  Hall.  Factory,  Dec,  1921,  27,  No.  6, 
804. — "Better  industrial  relations  will  pre- 
vail if  the  employee  is  given  a  definite  status 
and  a  real  interest  in  the  business. 

"1.  Make  it  possible  for  employees  to  be- 
come stockholders. 

"2.  Teach  employees  the  economics  of 
business. 

"3.  Explain  fully  to  employees  the  policy 
of  the  business. 

"4.  Make  employees  feel  that  they  are  a 
definite  part  of  the  business. 

"5.  Do  not  confine  organization  chart  to 
officials  of  a  business,  but  carry  down  to  the 
janitor  or  the  very  last  man  in  the  organiza- 
tion."—M.  Dent. 

The  Taylor  System  in  Europe.  Factory, 
Dec,  1921,  27,  No.  6,  814.— "The  July  issue  of 
Technos  (Paris)  reports  two  European  views 
of  the  Taylor  system.  The  first  of  these,  taken 
from  Engineering,  says  that  the  efforts  to 
transplant  the  Taylor  system  fi-om  the  United 
States  to  the  United  Kingdom  have  not  been 
successful.  The  British  worker  is  absolutely 
opposed  to  it,  and  one  does  not  have  to  search 
long  for  the  reason  why.  The  reason  lies  first 
in  the  difference  in  working  conditions  be- 


tween the  two  countries.  A  deeper  reason  is 
that,  conceived  by  an  engineer  and  spread  by 
engineers,  the  system  is  so  bound  up  in  the 
mechanism  of  production  that  it  sees  in  the 
human  being  only  a  machine;  it  does  not  ac- 
count for  the  human  elements  in  the  problem ; 
it  cannot  succeed  generally  or  pennanently  in 
any  civilized  country.  It  is  significant  that 
even  engineers  are  commencing  to  withdraw 
their  support  of  the  plan,  as  evidenced  in  a 
recent  meeting  at  London. 

"A  second  view  of  the  Taylor  methods  of 
management,  and  one  which  comprehends  a 
broader  development  of  the  system,  is  given 
by  M.  de  FreminviUe.  .  .  .  This  French 
executive  believes  that  Taylor  has  crj-stallized 
for  the  first  time,  and  after  long  and  arduous 
research,  the  principles  which  should  govern 
a  scientific  organization  of  work. 

' '  '  Smooth  out  the  difficulties  before  requir- 
ing any  human  effort'  is  M.  de  FreminviUe 's 
interj)retation  of  the  fundamentals  of  the 
Taylor  method.  He  believes  the  method  is  to 
guide  the  workman,  collaborate  in  his  work, 
help  him  to  produce  more,  and  at  the  same 
time  assure  him  a  good  wage." — M.  Dent. 

Defects  Affectino  Fifteen  Hundred 
Men.    B.  Franl-Jin  Buzhy.    Nation's  Health, 


ABSTRACTS 


267 


Nov.  15,  1921,  3,  No.  11,  612-616.— The  work 
reported  was  done  at  the  plants  of  the  Key- 
stone Leather  Company  and  the  Joseph  Camp- 
bell Company,  both  in  Camden,  New  Jersey. 
All  the  subjects  examined  were  males  and  all 
received  .substantially  the  same  examination. 
The  question  is  stiU  open  as  to  what  means 
should  be  employed  to  improve  the  health  of 
the  worker.  Is  it  to  be  force,  persuasion,  or 
sugge.stion  ?  The  first  two  methods  should  be 
discai-dcd;  the  better  method,  £is  in  private 
practice,  is  merely  to  tell  the  man  the  condi- 
tions found,  enumerate  the  procedures  that 
could  be  undertaken  for  relief,  and  then  let 
him  select  his  own  method  of  treatment.  It 
has  been  the  rule  in  this  series  to  tell  every 
man  of  his  exact  physical  condition  in  addi- 
tion to  making  accurate  notes  upon  it.  For 
how  else  is  the  man  to  be  made  happy  in  a 
chanp:e  of  work  unless  he  knows  it  is  for  his 
own  benefit  aiul  is  willinp;  to  co-operate? 
Again,  in  a  general  way,  how  shall  applicants 
for  work  be  treated,  as  cnmiiared  to  the  em- 
ployees already  at  work,  when  found  to  be  de- 
fective? Every  applicant  for  work  rejected 
for  disabilities  should  be  told  the  cause  of  re- 
jection and,  in  case  the  defect  is  remediable, 
he  should  be  advised  accordingly.  If  tlie  de- 
fect is  not  remediable,  the  man  is  told  just 
why  he  is  a  menace.  The  idea  in  physical  ex- 
aminations of  new  employees  is  that  the  em- 
ployer can  keep  the  unfit  out  of  his  ))Iant 
until  their  defects  are  corrected  and  thus  actu- 
ally force  health  on  applicants  for  work.  The 
following  major  defects  are  herein  briefly  dis- 
cussed :  defective  vision,  diseased  tectli  and 
gums,  nose  and  throat  conditions,  cardiac  con- 
ditions, incidence  of  tuberculosis,  surgical  con- 
ditions, high  blood  pressure  and  disease  of 
the  kidneys. — L.  A.  Shaw. 

Our  False  Standards  of  Disahilitv  in-  Ix- 
DtTSTRY.  W.  Irving  Clark.  Nation's  Health, 
Oct.  If),  1921,  3,  No.  10,  564-566.— Dr.  Clark  in 
this  article  first  discusses  the  physical  exajn- 
ination  standards  which  were  adopted  in  1915 
by  the  Conference  Board  of  Physicians  in 
Industry  for  use  in  industry,  and  gives  fig- 
iires,  based  on  the  study  of  a  number  of  dif- 
ferent industries,  on  the  percentage  of  men 
rejected  because  of  physical  disability.  The 
present  tendency  is  to  reduce  the  standards 
of  rejection  and  to  show  that  in  every  large 
factory  men  with  almost  any  type  of  defect 
can  be  placed  at  work. 


Dr.  Clark  goes  on  to  discuss  the  experience 
with  physical  examinations  in  his  own  clinic, 
particularly  in  regard  to  defects  which  have 
frequently  been  overlooked  hitherto  and  the 
importance  of  which  is  just  beginning  to  be 
recognized.  Using  his  own  clinic  experience 
as  a  basis.  Dr.  Clark  feels  warranted  in  draw- 
ing the  following  conclusions: 

"Applicants  having  the  following  defects 
may  be  admitted  to  most  factories  without 
undue  risk,  provided  they  are  selectively 
placed  and  watched: 

"(a)  Hernia  of  long  duration  which  is 
complete  or  well  held  by  a  tru.ss  provided  the 
applicant  has  done  work  similar  to  that  for 
whicli  lie  is  hired  for  the  four  weeks  preced- 
ing. 

"(b)  Varicose  veins,  provided  ulcer  and 
edema  of  ankles  are  absent. 

"(c)  Varicocele  supported  by  suspensory. 

"(d)  Plat  foot  if  without  symptoms,  that 
is  pain  in  foot  when  applicant  walks  on  toes. 
Pain  in  back  on  bending  over. 

"(e)  Deafness,  except  in  special  depart- 
ments. 

"(f)  Vision,  depending  on  hazard  and  de- 
partment. 

"(g)   Arteriosclerosis. 

"(h)  Endocarditis,  unaccompanied  by 
marked  myocarditis. 

"(i)  Arrested  tuliiTculosis — in  s])ecial  de- 
partments. 

"Special  search  should  be  made  for  the 
detection  of : 

"(1)  Arthritis  of  spine  or  sacroiliac  re- 
gion. 

"  (2)   Arthritis  of  joints  of  long  bones. 

"(3)  Old  injurj'  to  bones  entering  into  a 
joint. 

"(4)  Infected  tonsils  and  those  suggesting 
tendency  to  infection. 

"(5)  Potential  hernia  in  southern  Euro- 
peans of  tlu'  stocky  build  who  have  protruding 
abdomens  and  have  not  been  doing  heavy 
work  for  three  or  more  weeks  preceding  hir- 
ing. These  men  present  a  rather  relaxed  ex- 
ternal ring  and  there  is  slight  bulging  along 
the  inguinal  canal  on  cough. 

"From  our  experience  we  consider  these 
five  types  of  defect  specially  hazardous.  They 
seem  to  figure  largely  in  all  industrial  disa- 
bility records." — Katherine  R.  Drinker. 


268  THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 

INDUSTRIAL  SERVICE  AND  MUTUAL   BENEFIT  ASSOCIATIONS 


An  Association  That  Pays.  0.  R.  Barth. 
Factory,  Nov.,  1921,  27,  No.  5,  700-702.— The 
Westingliouse  Electric  and  Manufacturing 
Company  has  a  Victory  Garden  Association 
to  which  any  employee  of  the  company  or 
person  of  the  surrounding  community  is  eli- 
gible to  belong  by  paying  dues  of  $1  a  year. 
' '  Each  person  joining  the  Association  is  given 
a  plot  of  ground  to  cultivate,  and  at  the  end 
of  the  season  cash  prizes  are  awarded  for  pro- 
duction, the  most  artistic  garden  and  the  best 
cultivation  .  .  .  Some  of  the  members 
have  canned  quantities  of  vegetables  while 
others  have  realized  additional  benefit  in  the 
way  of  a  profit  from  the  sale  of  their  products 
on  the  market." — M.  Dent. 


A  Shipyard  Cafeteria.  Nation's  Health, 
Dee.  15,  1921,  3,  No.  12,  Adv.  30.— This  arti- 
cle is  a  brief  description  of  the  cafeteria  for 
employees  of  the  Morse  Dry  Dock  and  Repair 
Company,  at  Brooklyn,  N.  Y.,  a  ship  repair 
yard  with  4,000  workmen.  The  cafeteria 
which  is  conducted  as  a  private  enterprise 
under  the  direction  of  two  women  employees 
of  the  Morse  Company,  provides  good,  sub- 
stantial, well-cooked  food  in  immaculate  sur- 
roundings and  at  a  moderate  price.  Prompt 
service  is  a  valuable  feature  of  this  restau- 
rant, actual  practice  showing  that  250  men 
can  be  easily  and  effectively  cared  for  in 
twenty  minutes. — Katheriiie  R.  Drinker. 


REHABILITATION   OF   DISABLED  EMPLOYEES 


Taking  Care  of  the  Industrial  Cripple. 
Lewis  T.  Bryant.  Safety  Engin.,  Nov.,  1921, 
42,  No.  5,  217-218. — This  is  a  very  brief  de- 
scription of  how  the  Rehabilitation  Commis- 
sion of  New  Jersey  is  handling  the  subject  of 
the  industrial  cripple.  Through  the  co-ordi- 
nation of  the  work  of  the  commission  with  the 
activities  of  the  compensation  courts  and  the 
employment  offices,  industrial  units  have  been 
established  throughout  the  principal  indus- 
trial portions  of  the  state.  Each  unit  has  a 
very  complete  clinical  equipment,  rooms  for 
compensation  hearings  and  employment  ser- 
vice.— R.  M.  Thomson. 

The  Influence  of  Physical  Therapy  in 
Reducing  Disability  Time  in  Fractures  of 
THE  Long  Bones.  Jonathan  M.  Wainwright. 
Ann.  Surg.,  Sept.,  1921,  74,  No.  3,  304-305.— 


The  author  presents  a  table  showing  the  re- 
duction of  disability  time  in  simple  fractures 
among  mine  and  railroad  employees  after  the 
establishment  of  a  physical  therapy  gymna- 
sium at  the  Moses  Taylor  Hospital,  Scranton, 
Pa.  Each  group  comprised  about  125  cases 
and  the  percentage  improvement  in  disability 
time  varied  from  12  in  fracture  of  the  clavicle 
to  28  in  fracture  of  the  humerus. 

"A  study  of  this  table  gives  very  convinc- 
ing mathematical  evidence  of  the  great  eco- 
nomic value  of  physical  therapy,"  the  saving 
in  time  of  disability  for  these  eases  represent- 
ing about  $4,000  to  the  employers  annually. 
"The  most  important  deduction  to  be  made 
from  this  study  is  the  great  advantage,  almost 
the  necessity  for  the  establishment  of  a  physi- 
cal therapy  department  in  every  large  general 
hospital."— M.  Dent. 


ABSTRACT  OF  THE  LITERATURE 


OF 


INDUSTRIAL  HYGIENE 


Volume  III 


APRIL,  1922 


Number   13 


CONTENTS 


111(1   tlieir  Effects:   Gases, 


General    

I'disoiious    IljiziiiU 

('hemieals,  etc.   . 

I'list   lliizards  and   llicir  Kft'ects 

Occupational   Infectious  Diseases:  Occurrence. 

Trealinciit    and    Prevention 

Occupational     AITcctions     of     the     Skin     and 

Special    Senst's    

Occurrence     and     I'revention     of     Industrial 

Accidents    

Industrial   Surgery   

Industrial      IMiysioloK.v :      Nutrition.      Metaliol- 

isni.    Fatiguo.    etc 


I'.M.K 

•-•(>'J 

270 

2T1 


L>74 


Hazards  of  Compressed  Air.  Diminished  Pres- 
sure, (Jcneration  and  Ise  of  Klec'trieity,  and 
Electrical    Welding    

Women  and  Children  in  Industry 

Industrial  Sanitation:  Factory  Construction, 
Illumination.  Ventilation.  Heating.  Water 
Supply,    Sewage    Disposal 

Industrial  Medical  Service:  Medical  Dispen- 
saries and  Hospitals  in  Industrial  Plants.. 

Industrial  Nursing   

Industrial    Investigations  and  Surveys 


276 
270. 

279 

280 
2S2 
283 


GENERAL 


Annual  Report  op  the  Medical  Resicujch 
Council  for  1!)l'()-1921.  II.  M.  Statimici-y 
Office. — Any  i-ciidcf.  aftci-  perusiiifr  thi.s  re- 
port, mast  be  astounded  to  find  that  the  ex- 
traordinary  amount  of  worlf  completed  and 
in  progress  is  beiii<r  nrcraiiized  at  a  cost  of  only 
£130,000.  Hardly  one  of  the  numerous  prob- 
lems of  interest  to  the  medical  world  is 
omitted;  research  is  in  progrress  relating?  to 
tuberculosis;  cerebrospinal  fever;  influenza; 
pneumonia;  rheumatic  fever;  dysentery;  dipli- 
theria;  venereal  di.seases;  problems  of  child 
life;  rickets;  accessory  food  factors;  anox- 
emia; biochemistry  and  chemotherapy;  radio- 
therapy; status  lyniphatieiis;  mctazoan  parasi- 
tology; and  disorders  of  the  cardiovascular, 
respiratory,  excretory,  and  nervous  systems. 
The  Council  controls  all  this  work  by  appoint- 
ing expert  committees  to  supervise  each 
branch  of  research.  The  services  of  university 
profe.s.sors  and  the  facilities  which  theiV 
laboratories  afford  are  captured  by  compara- 
tively small  grants,  while  at  the  same  time 
administrative  expenses  are  kept  at  a  mini- 
mum. 

Our  readers  will  be  particularly  interested 


in  activities  relating  to  indu.strial  hygiene; 
here  work  is  in  progress,  directed  by  commit- 
tees, dealing  with  the  incidence  of  phthisis 
in  occupations,  miners'  nystagmus,  iiulastrial 
health  statistics,  physiology  of  nuiseidar  work, 
industrial  physiology  of  the  cardiovascular 
atid  respiratory  systems,  and  industrial  psy- 
chology, and  finally  work  directed  by  the  In- 
dustrial Fatigue  Research  Board.  The  press- 
ing need  for  national  economy  in  the  spring 
of  the  year  nearly  brought  the  whole  of  this 
industrial  work  to  a  standstill;  but  a  reor- 
ganization, with  adoption  of  the  Board  as  an 
integral  part  of  the  organization  of  the  Medi- 
cal Research  Council,  saved  the  situation. 

A  telling  example  of  the  value  of  industrial 
investigation  in  relation  to  disease  is  reported 
in  the  work  of  Dr.  W.  E.  Gye,  who  had  found 
from  his  experiments  with  BaciUus  tetani  that 
for  true  infection  with  multiplication  of  bacilli 
to  take  place,  the  local  defence  of  the  tissues 
must  be  broken  down  by  some  such  agents  as 
ionizable  calcium  salts  or  colloidal  silica.  The 
curious  association  of  dust  phthisis  in  indus- 
tries with  the  inhalation  of  silica,  completely 
established  by  Professor  Collis,  Dr.  Haldane 


369 


270 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


and  others,  was  then  brought  to  his  attention, 
and  he  has  now  found  that,  when  tubercle 
bacilli  and  colloidal  silica  are  together  injected 
siibcutaneously  into  animals  which  are  normal- 
ly unsusceptible  to  tuberculous  infection,  in- 
fection takes  place,  a  local  lesion  being  pro- 
duced in  which  tlie  bacilli  grow  rapidly.  Hence 
it  appears  probable  that  the  local  defensive 
mechanism  has  been  completely  inhibited; 
later,  the  bacilli  may  become  disseminated 
throughout  the  body  and  cause  a  generalized 
tuberculosis.  The  scientific  interest  of  this 
work  and  its  importance  to  metalliferous  min- 
ing and  other  industries  is  hard  to  overesti- 
mate ;  moreover  it  is  disclosing  a  possible  rela- 
tion between  excretion  of  soluble  silica  by  the 
urine  and  some  of  the  forms  of  kidney  disease 
so  common  in  adult  life. 

Much  work  has  been  carried  out  with  the 
kata-thermometer,  devised  by  Dr.  Leonard 
Hill.  The  instrument  has  been  extensively 
used  in  factories  and  mills,  in  post  ofSce  build- 
ings, and  in  South  African  mines.  Further, 
steps  have  been  taken  to  standardize  the  in- 
strument, to  devise  an  electrically  heated  kata- 
thermometer  and  construct  a  recording  instru- 
ment. Means  are  thus  provided  for  readily 
measuring  and  standardizing  movements  of 
air,  cooling  power  and  evaporation,  for  work- 
shops, factories,  mines,  cinemas,  theatres,  or 
other  crowded  places. 


An  interesting  investigation  by  Prof.  R.  T. 
Leiper  into  the  present  position  of  hookworm 
infection  in  certain  Cornish  tin  mines  is  re- 
ferred to.  The  infection  was  still  found  to 
exist,  and  six  men  out  of  twenty-two  at  one 
mine  were  found  infected,  but  the  presence 
of  other  parasitic  worms  was  also  brought  to 
light.  Thus,  among  130  persons  examined 
14.6  per  cent,  harbored  Ascaris  lumbricoides ; 
14.2  per  cent,  Trichocephalus ;  2.3  per  cent., 
Oxyuris  vermicularis ;  and  5.4  per  cent., 
Strongyloides  intestinalis ;  while  in  twelve 
persons,  i.e.,  9.2  per  cent.,  were  found  the 
eggs  of  mites,  a  species  of  Glycyphagus  which 
commonly  occurs  in  wheat,  cheese,  and  sugar. 
One  species  of  Glycyphagus  gives  rise  to  vari- 
ous skin  lesions,  among  which  "grocers'  itch" 
is  the  best  known. — E.  L.  Collis. 

The  Sanction  of  the  Eight-Hour  Day. 
Bur.  Research,  Railway  Employees'  Dept., 
Am.  Fed.  Labor,  Chicago,  1921,  pp.  36.— The 
trend  towards  an  eight-hour  day  in  the  United 
States  and  foreign  countries  -is  reviewed,  fol- 
lowed by  a  discussion  of  the  eight-hour  day 
and  output,  the  eight-hour  day  in  relation  to 
health  and  efficiency,  and  the  social  impor- 
tance of  the  eight-hour  day.  The  report  con- 
eludes  with  general  statements,  recommenda- 
tions, and  decisions  relative  to  the  shorter 
workday. — M.  Dent. 


POISONOUS    HAZARDS    AND  THEIR   EFFECTS:  GASES, 

CHEMICALS.  ETC. 


The  Treatment  op  Carbon  Monoxide 
Poisoning.  R.  B.  Bayers  and  H.  R.  O'Brien. 
U.  S.  Bur.  Mines,  Reports  of  Investigations, 
Serial  No.  2304,  Dec,  1921.— The  authors 
have  found  that,  in  spite  of  the  common  occur- 
rence of  carbon  monoxide  poisoning,  there  ap- 
pears to  be  no  uniformly  recognized  treatment 
for  a  person  overcome  by  carbon  monoxide. 
In  the  rescue  work  of  the  LT.  S.  Bureau  of 
Mines,  however,  a  method  has  been  developed 
which  has  been  supported  by  laboratoiy  in- 
vestigation, and  which  has  proved  successful 
in  practical  experience,  over  a  period  of  years. 
The  method  is  outlined  in  this  report,  follow- 
ing a  general  description  of  the  action  of 
carbon  monoxide  and  the  symptoms  of  acute 
and  chronic  poisoning.  The  treatment  is 
summarized  as  follows : 


"1.  Administer  oxygen  as  quickly  as  pos- 
sible, and  in  as  pure  a  form  as  is  obtainable, 
preferably  from  a  cylinder  of  oxygen  through 
an  inhalator  mask. 

' '  2.  Remove  from  atmosphere  containing 
carbon  monoxide. 

"3.  If  breathing  is  feeble,  at  once  start 
artificial  respiration  by  the  prone  pressure 
method.        • 

"4.    Keep  the  victim  flat,  quiet  and  warm. 

"5.  Afterward  give  plenty  of  rest." — M. 
C.  Shorley. 

Aniline  Poisoning.  J.  Kawamura.  Ab- 
stracted as  follows  by  Holtzmann  from  Wien. 
med.  Wchnschr.,  1921,  No.  13,  p.  597.  in  Hyg. 
Rund.schau,  Nov.  15,  1921,  31,  No.  22,  701.— 
"We  learn  from  this  article  chiefly  that  since 


ABSTRACTS 


271 


the  War  aniline  colors,  which  were  formerly 
imported  from  Germany,  have  been  manu- 
factured in  Japan  to  a  great  extent.  A  not 
insignificant  number  of  eases  of  poisoning  (40) 
have  occurred  in  this  industry  within  the 
course  of  four  years.  The  symptoms  ob- 
served are  the  usual  ones;  treatment  consisted 


in  removal  from  the  work,  administration  of 
a  mild  cathartic,  venesection,  lavage  of  the 
stomach,  and  oxygen  inhalation.  The  author 
seems  not  to  have  had  access  to  the  most  re- 
cent German  literature  on  the  subject." — M. 
C.  Shorley. 


DUST  HAZARDS  AND  THEIR  EFFECTS 


Dtst  Rfj>uction  by  Wet  Stopers.  D. 
Harrington.  U.  S.  Bur.  Mines,  Reports  of 
Investigations,  Serial  No.  2291,  Nov.,  1921. — 
Samples  were  taken  from  two  mining  dis- 
tricts in  the  western  part  of  the  United  States 
in  order  to  compare  dust  content  in  the  air 
of  mines  using  wet  and  dry  methods  of  drill- 
ing both  with  and  without  external  spraying. 
While  methods  of  dust  determination  are  not 
described,  the  figures  siiow  tlie  air  dustiness 
to  be  markedly  less  for  the  wet  drilling  than 
for  the  dry,  although  both  exceed  the  per- 
missible dustiness  allowed  by  the  South  Afri- 
can st^Tudards.  Tlie  author  favors  the  elimina- 
tion of  dry  drilling  and  the  use  of  wet  stopers 
because  of  greater  speed,  probably  lower  cost 
of  operation,  anil  a  greatly  reduced  dust  eon- 
tent  in  the  air  breathed  by  the  minei-s. — Thilip 
Drinker. 

Annual  Report  op  the  Miners'  Phthisis 

BOARll   KOR   THE   PeRIOD   ExDIXO    MaRCH,    1M"J0. 

Union  of  So.  Africa,  1921. — Dr.  Watkins- 
Pitchford,  in  the  medical  section  of  this  re- 
port, adds  a  further  chapter  to  the  fascinat- 
ing story  of  the  fight  which  is  being  .so  al)ly 
waged  to  eliminate  tuberculous  silicosis  from 
the  gold  mines  of  South  Africa.  He  has  been 
faced  during  the  past  two  years  with  influ- 
ences which  make  difficult  the  preparation  of 
statistics  comparable  to  those  of  preceding 
years.  Thus,  the  return  to  the  mines  of  many 
men  wlio  during  the  war  joined  the  colors  has 
been  an  important  factor.  ;\Iaiiy  of  these 
men,  who  showed  no  Signs  of  silicosis  at  the 
time  they  entered  military  service,  on  their 
return  have  been  found  during  the  interim  to 
have  passed  into  what  is  known  as  the  pri- 
mary stage.  The  deduction  is  drawn  from 
such  occurrences  that  there  must  exist  a  pre- 
liminary, latent  and  unrecognizable  condi- 
tion from  which  silicosis  may  evolve  even 
though  the  individual  be  completely  removed 
from  risk  of  inhaling  silica  dust.     Another 


influence  affecting  the  statistics  has  been  the 
recognition  of  a  new  group  entitled  the  ante- 
primary  stage,  which  is  made  up  of  men  show- 
ing the  earliest  detectable  specific  physical 
signs  of  the  disease.  The  recognition  of  this 
'.rroni>,  which  leads  not  infrecpiently  to  elimin- 
ation from  employment,  naturally  reacts 
upon  the  next  group  known  as  the  primary 
stage,  and  the  yet  further  group  known  as 
the  secondary  stage.  Several  years  must  elapse 
before  the  records  of  the  Miners'  Phthisis 
Medical  Bureau  recover  from  the  effect  of 
these  influences.  Nevertheless,  reviewing  the 
position.  Dr.  Watkins-Pitehford  considers 
that  he  may  reasonably  hold  that  the  health 
of  the  whole  body  of  miners  has  improved. 

All  men  seeking  emplo.vment  in  the  mines 
have  to  pass  a  severe  initial  examination; 
since  this  examination  was  instituted  in 
1016,  3.592  men  who  have  passed  the  doc- 
tors have  obtained  luiderground  employment. 
The  effect  of  this  severe  entrance  exam- 
ination is  to  be  found  in  the  statement 
that  only  two  of  this  large  number  of  men 
have,  up  to  the  present  time,  developed 
ordinary  pulmonary  tuberculosis,  while  no 
case  of  silicosis  has  developed  among  them. 
Silicosis,  however,  continues  to  make  its  ap- 
pearance among  those  who  have  been  em- 
ployed for  a  longer  time  in  the  mines,  but 
the  length  of  emplojinent  previous  to  its  ap- 
pearance is  steadily  increasing,  and  the  type 
of  disease  encountered  is  becoming  for  vari- 
ous reasons  less  severe.  A  claim  has  been 
made  that  coal  dust  has  some  influence  in 
preventing  the  incidence  of  tuberculosis;  this 
adds  interest  to  the  statement  that  no  evi- 
dence is  found  that  previous  work  in  coal 
mines  had  any  effect  in  retarding  the  develop- 
ment of  silicosis.  On  the  other  hand,  a  curi- 
oiis  phenomenon  is  reported;  men  who  had 
previously  been  tin  miners  in  Cornwall  and 
so  exposed  to  silica  dust,  when  employed  in 
the  gold  mines  of  South  Africa,  actually  took 


272 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


longer  to  develop  silicosis  than  other  new  men, 
the  mean  length  of  time  for  the  tin  miners 
being  eleven  years  and  five  months  as  con- 
trasted with  nine  years  and  eight  months  for 
men  coming  from  other  forms  of  emplojTnent. 
Dr.  Watkius-Pitchford  suggests  that  possi- 
bly the  Cornish  miner  of  today  springs  from 
a  stock  which  has  been  subjected  to  risk  for 
many  generations,  and  so  represents  the  sur- 
vivor of  a  form  of  natural  selection.  Further 
evidence  is  given  in  support  of  the  contention 
made  in  previous  years  that  the  onset  of  tu- 
berculosis causes  a  condition  of  latent  sili- 
cosis to  become  manifest. 


Reference  is  made  in  the  report  to  an  in- 
vestigation carried  out  in  industries  apart 
from  the  Reef,  in  which  there  is  exposure  to 
dust  inhalation.  This  inquiry  gives  further 
support  to  the  law  that  unless  the  dust  in 
question  contains  silica,  there  is  but  Little 
danger  of  pulmonary  fibrosis  developing,  or 
of  dust  phthisis  supervening.  The  case  of 
the  Bon  Accord  Quarry  is  of  particular  inter- 
est. Here  the  dust  conditions  could  hardly 
be  worse,  but  the  rock  dealt  with,  norite,  was 
found  to  contain  no  free  silica,  and  no  defi- 
nite case  of  silicosis  was  brought  to  light 
among  men  employed. — E.  L.  CoUis. 


OCCUPATIONAL  INFECTIOUS  DISEASES:   OCCURRENCE, 
TREATMENT  AND  PREVENTION 


Contagion  in  Industrial  Establishments. 
D.  L.  Richardson.  Nation's  Health,  Jan.  15, 
1922,  4j  No.  1,  34. — This  article  summarizes 
briefly  the  measures  which  should  be  em- 
ployed to  detect  contagious  disease  in  indus- 
trial establishments  and  to  prevent  the  spread 
of  contagion  from  one  employee  to  his  fellow 
workers. 

Among  the  various  sanitary  devices  which 
aid  in  relieving  the  spread  of  contagious  dis- 
eases are  mentioned  safe  drinking  water, 
drinking  fountains  or  individual  cups,  ade- 
quate toilet  facilities,  suitably  constructed 
lavatories,  liquid  soap,  individual  or  paper 
towels,  moisteners  for  stamps,  envelopes,  etc. 

Ideally  all  employees  should  be  examined 
for  infectious  disease  before  entering  upon 
their  duties,  especially  for  tuberculosis  and 
venereal  disease.  Cooks,  waiters,  bakers,  and 
those  who  dispense  drinks  should  all  be  li- 
censed and  examined  by  the  health  depart- 
ment at  least  twice  a  year.  Widal  and 
Wassermann  should  be  done  in  suspicious 
cases;  in  some  places  Widal  should  be  made 
on  all  persons  ajiijlying  for  licenses. 

An  employee  sick  with  an  infectious  disease 
should  be  excluded  until  he  is  well  or  until 
the  physician  thinks  it  safe  for  him  to  return 
to  work.  The  factory  doctor  should  inspect 
daily,  during  the  period  of  incubation,  em- 
ployees who  were  in  intimate  contact  with 
the  sick  individual. — Katherine  R.  Drinker. 

The  Local  and  General  Serum  Treat- 
ment OF  Cutaneous  Anthrax.  Joseph  C. 
Regan.    Jour.  Am.  Med.  Assn.,  Dec.  17,  1921, 


77,  No.  25,  1944-1948. — "1.  The  measures  of 
local  therapy  of  malignant  pustule  that  have 
been  in  common  use  for  many  years  possess 
too  many  disadvantages  to  be  considered  lo- 
cally effective.  These  disadvantages  include 
pain,  scarring,  danger  of  introducing  second- 
ary infection  into  the  lesion,  liability  of  dis- 
seminating the  infecting  micro-organism  both 
locally  and  into  the  circulation,  prolongation 
of  convalescence,  lack  of  specific  action,  and 
high  mortality  rates. 

"2.  As  anthrax  in  man  is  primarily  a  local 
infection  with  a  decided  tendency  to  remain 
as  such  in  a  high  proportion  of  eases,  no 
method  of  treatment  is  warranted  which  tends 
to  break  down  the  barrier  zone  of  the  inflam- 
matory process  which  Nature  has  so  carefully 
and  characteristically  constructed  in  this  dis- 
ease. 

"3.  Since  we  have  available  an  extremely 
potent  therapeutic  agent  in  antianthrax 
serum,  these  measures  should  be  omitted  from 
the  therapy  of  the  disease.  The  serum 
.should  be  administered  both  locally  around 
the  lesion  and  generally  into  the  circula- 
tion by  the  subcutaneous,  intramuscular 
or  intravenous  routes.  The  dosage,  fre- 
quency of  injection  and  route  used  necessar- 
ily depend  on  the  location  and  severity  of 
the  lesions,  the  presence  or  absence  of  an 
anthrax  septicemia  and,  to  a  lesser  extent,  on 
the  degree  of  the  constitutional  symptoms. 
An  outline  of  dosage  in  the  various  forms  of 
the  disease  has  been  given  above. 

"4.  The  local  injection  of  serum  around 
the  lesion  every  twelve  to  twenty-four  hours 


ABSTRACTS 


273 


is  a  most  desirable  method  to  replace  the  local 
measures  until  lately  in  common  use.  It  pos- 
sesses none  of  the  disadvantap^es  or  dangers 
of  the  previous  methods.  On  the  contrary, 
it  is  an  additional  safeguard  against  an  an- 
thrax septicemia,  and  appears  to  exert  a  very 
beneficial  action  in  bringing  about  a  rapid 
subsidence  of  the  malignant  pustule  itself. 
The  theoretical  basis  for  the  method  is  dis- 
cussed in  the  preceding  text. 

"5.  There  have  been  eight  cases  of  anthrax 
successfully  treated  in  the  last  two  years  at 
the  Kingston  Avenue  Hospital  by  the  employ- 


ment of  Eichorn  antianthrax  serum,  given  by 
local  injection  around  the  lesion  and  general 
injection  into  the  circulation,  without  any  fa- 
talities. The  acute  inflammation  disappeared 
from  the  second  to  the  sixth  day  of  treatment, 
the  eschar  separated  from  the  twelfth  to  the 
twenty-first  day,  and  the  wound  healed  from 
the  twentieth  to  the  thirty-second  day.  No 
sequels  were  noted  in  any  instance,  and  the 
scar  left  was  so  minute  as  to  pass  unnoticed. 
The  acute  stage  was  over  within  a  week." — 
C.  K.  Drinker. 


OCCUPATIONAL 


AFFECTIONS    OF  THE 
SENSES 


SKIN   AND    SPECIAL 


Crvde  Co.\l  Tar  in  Dermatology.     C.  J. 
Whife.     Abstracted    as    follows    from    Arch. 
Dermat.  and  Syph.,  Dec.  1921,  4,  No.  6.  796, 
in  Jour.  Am.  Med.  As.sn.,  Dec.  17,  1921,  77, 
No.  25,  1997.— "White  is  impressed  with  the 
eflBcacy  of  crude  coal  tar  in  certain  skin  dis- 
eases.    He  uses  5   i)er  cent,   incorporated   in 
zinc  paste.    His  formula  is  as  follows:  Crude 
coal  tar,  2;  zinc  oxid,  2;  cornstarch,  16;  pe- 
trolatum, 1().     Mix  thoroughly  the  cornstarch 
and  the  petrolatum;  second,  rub  together  the 
coal  tar  and  the  zinc  oxid ;  third,  combine  the 
first  product  with  the  second.     This  method 
produces    a    nearly    black,    perfectly    smooth 
paste,  which  smells  strongly  of  coal  gas  and 
tar.    These  two  injunctions  are  absolutely  es- 
sential to  success.     Proper  methods  of  ajipli- 
cation  and  removal  of  this  paste  are  to  be  ob- 
served.    Always  cut  all  involved  hair  short 
when  possible.    Never  bandage  crude  coal  tar, 
pustulation  is  the  result  if  this  injunction  is 
disobeyed.     Smear  on   a  medium   coating  of 
the   paste  with   a   wooden    throat   stick,    and 
cover  over  the  part  with  one  thickness  of  old 
cotton  or  linen.    Thin  white  cotton  gloves  may 
be  advantageously  substituted  when  we  are 
treating  the  feet  and  ankles;  and  the  footless 
legs  of  white  cotton  stockings  may  be  drawn 
over  the  arms  or  legs  of  the  patient.     All  of 
these  dressings   must   be   washed   and   boiled 
every   twenty-four   houi-s.      The   same    crude 
coal  tar  should  never  be  allowed  to  remain  on 
the  human  skin  for  more  than  twelve  hours. 
Every  vestige  of  the  previous  application  must 
be  removed  before  making  the  next  dressing 
and  this  maj'  be  accomplished   by  means  of 
sterilized  gauze,  soaked  in  the  oil  of  sweet 
almonds  or  in  olive  oil." — C.  K.  Drinker. 


AXHIPROSIS    FOLLO\VINO    ToXIC    DERMATITIS. 

W.  Paf^achc  and  li.  Plant.  Abstracted  as  fol- 
lows from  Miinchen.  med.  Wchnschr.,  Sept.  2, 
1921,  68,  No.  35,  1117,  in  Jour.  Am.  Med. 
Assn.,  Dec.  10,  1921,  77,  No.  24,  1933.— "The 
toxic  dermatitis  developed  after  working  on 
and  wearing  furs  that  had  been  treated  with 
naphthalin.  The  functioning  of  the  sweat 
glands  was  completely  abolished  thereafter, 
the  young  woman  develojjing  high  fever  at 
work,  at  the  theater,  and  in  dancing,  and  once 
she  attempted  suicide  in  her  despair.  This 
generalized  anhidrosis  was  stationary  for  a 
year,  and  then  daily  treatment  to  stimulate 
the  sweat  glands  was  begun.  After  .subcu- 
taneous injection  of  0.006,  0.003  or  0.001  gm. 
of  pilocarpin,  she  was  given  an  arc  light  bath 
for  forty  minutes.  Under  this  combined 
treatment  improvement  was  rapidly  realized 
and  has  persisted  to  date.  These  minute  doses 
of  pilocarpin  had  no  effect  on  the  normal." — 
r.  K.  Drinker. 

Care  op  the  Eye  Following  Removal  of 
Small  Foreign  Bodies  from  the  Cornea. 
WiUiam  C.  Bane.  Am.  Jour.  Ophth.,  Dec. 
1921,  4.  No.  12.  917-918.— The  author  empha- 
sizes the  importance  of  sealing  the  eye  for 
twenty-four  hours  or  more  after  the  removal 
of  a  foreign  body.  His  reasons  for  this  meas- 
ure are:  (1)  The  corneal  tissue  normally  does 
not  have  any  blood  vessels,  but  receives  its 
nourishment  by  imbibition;  (2)  the  closing 
of  the  eye  prevents  the  admittance  of  infec- 
tion through  dust  coming  in  contact  with  the. 
open  wound;  and  (3)  by  the  application  of  a 
compress  bandage,  it  is  possible  to  reduce  to  a 
minimum    the   irritation    and   the   discomfort 


274 


TliE   [OURNAL  OF  INDUSTRIAL  HYGIENE 


which  woukl  be  caused  by  the  movement  of 
the  eyelid. 

Immediately  after  the  removal  of  the  for- 
eign body  it  is  Dr.  Bane's  practice  to  "apply 
some  sterile  vaseline  in  the  palpebral  aper- 
ture, then  a  small  triangular  pad  of  gauze 
with  cotton  between  its  layers,  and  adhesive 
strips  retain  the  pad  on  the  closed  eyelids. 
The  patient  is  ad^ased  to  leave  the 
pad  luidisturbed  for  twenty-four  hours  and  to 
return  for  further  attention  if  the  eye  is  not 
comfortable.  Otherwise  the  pad  can  be  re- 
moved. If  a  second  visit  is  made  fluorescein 
is  used  to  determine  whether  or  not  the  heal- 
ing is  complete.  As  a  rule  the  corneal  wound 
is  found  healed.  .  .  .  After  a  corneal 
abrasion  with  'loss  of  considerable  of  the  epi- 
thelial layer,  upon  sealing  the  eye  it  is  surpris- 
ing how  rapidly  the  destroyed  epithelium  is 
reformed.  "—M.  C.  Shorley. 


Arsenical  Conjunctivitis.  Milian.  Ab- 
stracted as  follows  from  Paris  med.,  Oct.  15, 
1921. 11,  No.  42,  303,  in  Jour.  Am.  Med.  Assn., 
Dec.  3, 1921,  77,  No.  23,  1847.— "Milian  caUed 
attention  nearly  ten  years  ago  to  congestion  of 
the  conjunctivae  as  a  premonitory  sign  of 
poisoning  from  atoxyl,  wax-ning  of  impending 
blindness.  He  now  generalizes  this  warning, 
saying  that  it  applies  to  all  arsenicals.  The 
arsenic  induces  a  paralytic  vasodilatation. 
This  may  be  the  first  and  long  the  only  symp- 
tom from  the  ai'senic  poisoning,  but  this  ai'- 
senical  conjunctivitis  warns  of  d9,nger  and 
calls  for  longer  postponing  of  the  next  injec- 
tion of  the  arsenical.  A  little  epinephrin 
morning  and  evening  may  be  useful,  but  the 
main  indication  is  to  ward  off  microbian  infec- 
tion of  the  eyes,  while  this  paralytic  vasodila- 
tation lasts."— C.  K.  Drinker. 


OCCURRENCE  AND  PREVENTION  OF  INDUSTRIAL  ACCIDENTS 


OcctTPATiON  Hazard  op  Railwat  Shopmen. 
Bur.  Reseai'ch,  Railway  Employees'  Dept., 
Am.  Fed.  Labor,  Chicago,  pp.  14. — According 
to  the  census  of  manufactures  in  1914  there 
were  339,518  men  employed  in  railroad  repair 
shops.  This  occupation  is  extremely  hazard- 
ous owing  to  the  high  accident  risk  to  which 
the  men  are  exposed.  The  report  takes  up  the 
accident  hazard  as  reported  by  the  Interstate 
Commerce  Commission,  accidents  to  locomo- 
tive builders,  the  hazard  as  shown  by  the 
Workmen's  Compensation  i-ates  ui  Pennsyl- 
vania, the  mortality  of  shopmen,  and  finally 
the  extent  of  their  occupation.  The  data  are 
presented  chiefly  in  tables. — M.  Dent. 

Precautions  to  Be  Observed  in  Entering 
Abandoned  Exploratory  Shafts  and  Pits. 
B.  0.  Pickard.  U.  S.  Bur.  Mines,  Reports  of 
Investigations,  Serial  No.  2295,  Nov.,  1921.— 
As  a  result  of  fatalities  in  abandoned  explor- 
atory shafts  the  author  describes  precautions 
which  should  be  taken  before  entering  shafts 
in  order  to  be  certain  there  is  no  poverty  in 
oxj'gen.  To  poverty  in  oxygen  the  author  at- 
tributes the  greater  part  of  such  fatalities, 
and  recommends  that  a  little  publicity  be 
given  to  the  subject  of  simple  precautions. — 
Philip  Drinkef. 

Safety  amid  Slaughter.  Lotiis  Resnick. 
Nat.  Safety  News,  Dec,  1921,  4,  No.  6,  7-12, 


34. — This  is  a  lurid  description  of  the  sur- 
roundings in  the  Chicago  stock  yards,  with  a 
reflection  as  to  the  difficidties  of  safety  work 
in  such  environment.  A  trip  through  the 
yards  reveals  some  striking  examples  of  acci- 
dent prevention  work. 

As  an  example  the  case  of  the  "dope"  room 
is  cited.  In  this  room  the  tops  and  bottoms 
of  cans  are  prepared  for  soldering.  The 
grooves  of  can  covers  are  coated  with  a  ben- 
zol composition.  The  fumes  from  this  benzol 
were  so  hea\y  that  operators  and  inspectors 
would  fall  asleep  at  their  work,  thus  allowing 
many  imperfect  can  tops  to  pass  and  at  the 
same  time  exposing  themselves  to  accidents. 
The  superintendent  devised  an  exhaust  sys- 
tem which  draws  off  these  fumes  and  work 
can  now  go  on  as  normally  in  this  room  as  in 
other  rooms  of  the  factory. 

Simple  and  convenient  guards  for  almost 
every  type  of  knife  have  been  developed; 
illustrations  of  some  of  these  are  given  in  this 
article,  and  also  descriptions  of  various  types 
of  accident  guards  that  have  been  invented. 
— M.  Dent. 

Does  Accident  Prevention  Pay?  Why 
We  Think  It  Does.  Raij  H.  Angove.  Nat. 
Safety  News,  Dec.,  1921,  4,  No.  6,  33-34.— A 
brief  description  of  the  safety  department 
(including  medical)  of  the  Cutler-Hammer 
Manufacturing  Company  is  given.    Safety  de- 


ABSTRACTS 


275 


vices  were  installed  on  machines  which  not 
only  prevented  accidents  but  also  increased 
production,  in  one  instance  as  much  as  400 
per  cent.  The  statistics  of  the  Cutler-Ham- 
mer Company  are  given  for  compensation  and 
accidents  for  the  years  1919  to  1921,  and  these 
prove  conclusively  that  accident  prevention 
pays.  In  1919  compensation  amounted  to 
$1.55  per  person,  and  in  1921  (first  six 
months)  to  53  cents  per  person. — M.  Dent. 

Twenty-Three  Thousand  Lives  Saved  by 
Safety  Work  in  1919.  Xat.  Safety  News, 
Dec,  1921,  4,  No.  6,  27.— This  short  paper 
gives  charts  .showing  the  proportion  of  de- 
crease in  accidents  from  various  causes  for 
the  years  1906  to  1919.  Automobile  acci- 
dents for  that  jieriod  have,  however,  increased 
from  0.4  to  9.4  per  100,000  of  population.— 
M.  Dent. 

A  Practical  V^iewpoint  on  Safety  and 
Production.  John  A.  Oarfrl.  Nat.  Safety 
News,  Dec,  1921,  4,  No.  fi,  Ifi.— Several  in- 
.stanees  are  given  in  which  accident  preven- 
tion devices  not  only  accomplished  their  direct 
purpose,  but  are  also  saving  money  for  the 


companies   and   expediting   the   process. — M. 
Dent. 

The  Relation  between  Safety  and  Ser- 
vice Work.  Boyd  Fisher.  Nat.  Safety  News, 
Dec,  1921,  4,  No.  6,  17.— "Experts  on  health 
tell  us  that  the  so-called  degenerative  diseases, 
diseases  of  the  heart,  liuigs,  etc..  which  are  not 
disea.ses  so  much  as  gradual  impairment  of 
those  organs,  are  on  the  increase,  and  .  . 
we  could  prove  much  of  the  increase  is  due  to 
conditions  of  work. 

"So  if  we  look  not  alone  to  safeguards  and 
accident  prevention,  but  look  also  to  the  ques- 
tion of  fatigue,  the  question  of  industrial  poi- 
soning, the  (piestion  of  monotony  and  the 
question  of  plant  hygiene,  we  are  taking  the 
legitimate  next  step  in  safety,  which  in  many 
eases  we  have  already  taken.  But  we  must 
not  forget  that,  although  accident  compensa- 
tion in.surance  does  not  extend  necessarily  to 
these  gradual  impairments,  our  moral  re- 
sponsibility is  just  the  same  towards  those 
things  as  it  has  always  been  towards  acci- 
dents." And  also,  "we  should  not  be  indif- 
ferent to  the  things  in  industry  which  eon- 
tribute  to  the  deterioration  of  the  human 
mind." 


INDUSTRTAT.     SURGERY 


Industrial  Surgical  Service — Past,  Pres- 
ent, PuTiTRE.  J.  Rollin  French.  Nation's 
Health.  Dec  15,  1921,  3,  No.  12,  671-G73.— 
This  article  is  a  plea  for  the  more  general  use 
hi  industrial  surgery  of  modern  means  of 
post-oi)erativo  therapj'  for  obtaining  func- 
tional rehabilitation  following  industrial  acci- 
dents.   The  author  calls  attention  to  the  great 


value  of  practical  exercise  and  training  and  of 
occupational  therapy  when  selected  with  re- 
gard both  to  its  usefubiess  in  reestablishing 
functional  ability  and  to  its  power  to  interest 
the  patient  and  to  stimulate  him  to  co-opera- 
tive effort  in  his  own  cure. — Katherine  R. 
Drinker. 


INDUSTRIAL    PHYSIOLOGY:     NUTRITION,    METABOLISM, 

FATIGUE,  ETC. 


Legal  Requirements  Regarding  Seats  i.n 
Industry.  Edith  Hilles.  Nation's  Health, 
Dec.  15,  1921,  3,  No.  12,  659-661.— This  arti- 
cle first  reviews  the  legal  requirements  of  the 
various  foreign  countries  in  regard  to  the 
provision  of  seats  in  work  places,  and  then  re- 
views briefly  the  laws  in  the  United  States. 
In  1920  forty-seven  states  had  laws  requiring 
seats  in  mercantile  establishments,  and  thirty- 
six  states  required  seats  in  both  mercantile 
and   manufacturing   establishments.     A   few 


other  states  now  require  seats  for  women  in 
practically  all  work  places. 

"The  laws  as  they  stand  offer  comparative- 
ly little  protection  to  health,  because  even 
when  a  sufficient  number  of  seats  is  provided, 
it  is  practically  impossible  to  see  that  em- 
ployees are  allowed  to  use  them. 
Too  often  an  understanding  exists  that  if  a 
girl  is  found  sitting  down  she  is  liable  to  dis- 
charge. In  some  work  places  the  old  idea  still 
holds, — that  to  be  seated  is  to  be  lazy. 


276 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


"The  number  of  seats  to  be  provided  is  in 
most  eases  designated  as  'suitable,'  though  in 
a  few  states  a  proportion  of  at  least  one  seat 
to  every  three  employed  women  is  reqiiired. 

"The  type  of  seat  to  be  provided  is  usually 
left  to  the  '  discretion '  of  the  Industrial  Com- 
mission or  the  inspectors." 

Recent  interest  in  industrial  fatigue  has 
brought  the  question  of  seating  to  the  fore. 
"The  reports  of  various  committees  studying 
fatigue,  of  the  British  Health  of  Munitions 
"Workers'  Committee,  and  the  Federal  as  well 
as  State  Labor  Departments,  and  of  an  in- 
finite  number  of  non-official  groups  dealing 
with  industry,  have  all  emphasized  the  im- 
portance of  posture  and  seating  at  work. 
Their  conclusions  and  recommendations  are 
much  alike  in  the  standards  suggested  and,  of 
course,  go  ahead  of  any  legal  requirements. 
Perhaps  the  best  general  summary  of  the 
points  which  they  tend  to  bring  out  can  be 
found  in  the  Bulletin  issued  as  a  flier  in  an 
executive  series  of  the  National  Safety  Coun- 
cil, which  reads  as  follows : 

"  'The  day  of  the  ordinary  wooden  chair 
and  of  stools,  without  backs,  as  a  part  of  mod- 
ern factory  equipment  is  past.  Factory  man- 
agers and  the  manufacturers  of  factory  chairs 
know  that  a  chair,  to  have  utility,  must  be 
adjustable,  so  that  it  can  be  more  nearly 
physiologically  correct.  During  the  last  few 
years,  the  manufacturers  of  factory  equip- 
ment have  given  some  consideration  to  the 
things  that  make  a  factory  chair  desirable 


from  the  standpoint  of  physical  comfort. 
Chairs  should  support  the  part  of  the  body 
receiving  the  greatest  stram  from  the  work. 
The  legs  of  the  chair  should  be  adjustable  as 
to  length,  to  suit  the  height  of  the  user.  A 
back  rest  which  can  be  raised  or  lowered  is 
generally  desirable. 

"  'For  certain  operations  the  factory  chair 
must  be  high.  Under  such  conditions  a  suit- 
able foot  rest  should  be  provided.  In  most 
eases  the  foot  rest  should  preferably  be  at- 
tached to  the  work  table,  rather  than  to  the 
chair.  It  should  be  large  enough,  and  placed 
in  such  a  way  that  the  operative  may  be 
seated  in  a  normal  position. 

"  'When  the  work  requires  constant  stand- 
ing, chairs  should  be  available  for  use  during 
lulls  in  the  day's  work,  and  the  employees 
should  be  encoiiraged  to  use  them.  Wherever 
possible,  it  is  well  to  arrange  the  work  so  that 
the  operator  may  stand  part  of  the  time  and 
sit  part  of  the  time.  Change  of  position  ap- 
pears to  decrease  fatigue  and  increase  produc- 
tion.' 

"The  encouraging  thing  is  not  what  has 
already  been  written  into  the  existing  laws  and 
standards,  but  the  fact  that  we  have  reached 
a  time  when  shop  equipment  is  recognized  as 
needing  study  and  needing  standards,  not 
only  for  the  sake  of  economy  and  efficiency  in 
production,  but  also  for  the  sake  of  the  work- 
ers who  must  be  consid'^red  as  human  beings. ' ' 
— Katherine  R.  Drinker. 


HAZARDS  OF  COMPRESSED  AIR,  DIMINISHED  PRESSURE,  GEN- 
ERATION AND  USE  OF  ELECTRICITY.  AND  ELECTRICAL 

WELDING 


Compressed  Air  Machinery  and  Equip- 
ment. Nat.  Safety  Council,  Safe  Practices 
No.  47,  Dec,  1921.  Nat.  Safety  News,  Dec. 
1921,  4,  No.  6,  43-50. — This  pamphlet  deals 
with  the  hazards  from  air  compressors  and 
air  receivers;  explosion  hazards  for  the  elim- 
ination of  which  it  is  recommended  that  spe- 
cial attention  be  given  to  compressor  lubrica- 
tion,   cleanliness   of    the    air   at    intake,    air 


cylinder  temperature,  and  cooling  the  air  be- 
tween stages  and  after  compression;  correct 
compressed  air  utilization,  under  which  head- 
ing is  included  piping,  portable  air  drills  and 
reamers,  and  pneumatic  hammers;  and  lastly, 
there  is  a  section  on  general  precautions,  such 
as  wearing  goggles  and  the  prevention  of 
horse-play  and  practical  joking. — M.  Dent. 


WOMEN  AND  CHILDREN  IN  INDUSTRY 


Child  Employment  and  Adult  Employ- 
ment. Am.  Child,  Nov.,  1921,  3,  No.  3,  199-200. 
— The  child  labor  situation  registers  the  state 
of  adult  employment,  but  in  part  the  effect  is 


opposite  to  that  which  might  be  expected; 
children  are  being  forced  to  go  to  work  be- 
cause older  members  of  the  family  cannot 
find  employment.     The  tendency  is  always, 


ABSTRACTS 


277 


when  children  become  a  part  of  the  working 
population,  for  the  children  to  lower  the 
wages  of  adults  and  even  displace  adults,  and 
it  is  partly  because  of  this  that  the  American 
Federation  of  Labor  strongly  opposes  the  em- 
ployment of  children  under  IG  years  of  age. 
Keeping  children  in  school  would  not  only 
help  the  labor  market,  but  would  benefit  the 
children  by  gi\'ing  them  opportunity  for 
further  education. — G.  E.  Partridge. 

Administration  of  Child-Labor  Laws. 
Part  4.  I']mi'loymi;nt-('i;rtikioate  Systkm. 
Wisconsin.  Ethel  E.  Hanks.  U.  S.  Dept. 
Labor,  Indust.  Series  No.  2,  Part  4,  Children's 
Bur.  Pub.  85,  Washington,  1921.  pp.  159.— 
This  is  a  very  detaih'd  study  of  the  employ- 
ment-certificate system  of  Wisconsin,  treating 
administration,  methods  of  securing  permits, 
evidence  of  age,  physical  and  educational  re- 
quirements, vocation  .schools,  the  aii|)rentice 
system  and  the  enforcement  of  regulations. 
There  is  an  appendix  containing  the  laws  of 
Wisconsin  relating  to  employment  certificates 
in  effect  April  1,  1918,  the  forms  used  in  the 
administration  of  child  labor  laws,  and  the 
Orders  and  Resolutions  of  the  Industrial  Com- 
mission relating  to  the  employment  of  chil- 
dren. 

The  ])ani])hlet  is  summarized  as  tVillows: 
"Tlie  (U'ntralization  in  the  state  industrial 
commission  of  primary  authority  and  resjion- 
sibility  over  the  administration  of  the  child- 
labor  laws  gives  that  commission  pgwer  to 
insure  enforcement  of  existing  legislation. 
The  commission,  moreover,  through  its  author- 
ity to  make  rules  and  regulations,  has  unusual 
power  to  interpret  this  legislation.  The  laws 
themselves,  however,  are  essentially  weak  in 
several  particulars,  notably  in  their  failure  to 
require  school  attendance  of  children  between 
16  and  17  years  of  age  who  must  have  permits 
and  attend  vocation  school,  in  their  low  educa- 
tional standard  for  going  to  work,  and  in  their 
failure  to  require  definitely  a  physical  exam- 
ination as  a  prerequisite  to  obtaining  a  permit. 
Moreover,  because  of  failure  of  the  industrial 
conmiission  to  exercise  fully  its  supervisdi-y 
powers,  the  laws  are  not  uniformly  enforced 
throughout  the  state.  In  part  this  failure 
is  due  to  the  fact  that  the  attention  of  the 
commission  has  been  given  to  the  administra- 
tion of  other  new  legislation,  especially  the 
workmen's  compensation  and  safety  laws;  in 


part  it  ha.s  been  due  to  the  practical  impossi- 
bility of  bringing  about  all  at  once  adequate 
enforcement  of  all  the  changes  recently  made 
in  the  labor  laws  of  the  states ;  and  in  part  it 
has  been  due  to  lack  of  fuiuls  for  the  large 
mass  of  work  assigned  to  the  commission. 

' '  Two  unique  features  of  the  Wisconsin  plan 
of  regulating  child  labor,  not  yet  touched 
upon  in  the  conclusions  of  this  report,  deserve 
special  praise.  The  first  is  the  system  of 
vocational  continuation  schools,  the  most  com- 
plete existing  in  any  state  in  this  country. 
These  .schools  have  become  such  an  integral 
part  of  the  regulations  of  child  labor  in  Wis- 
consin that,  though  in  their  methods  they  are 
still  frankly  experimental,  the  desirability 
of  their  existence  is  no  longer  in  (fuestion. 
The  second  is  the  apprenticeship  .system  over 
which,  as  over  the  permit  system,  the  indus- 
trial commission  has  absolute  and  complete 
control.  Wisconsin  is  the  only  state  in  the 
Union  which  has  created  by  law  a  modern 
apprenticeship  system,  and,  though  many  dif- 
ficulties have  to  be  overcome,  the  ultimate 
idea  of  a  combination  of  shop  and  vocational 
school  training  may  prove  the  solution  of  the 
problem  of  adjusting  young  persons  to  useful 
|)laces  in  the  industrial  sy.stem." — G.  E. 
Partridge. 

Child  Labor  in  Agriculture.  Gertrude  H. 
Folks.  Am.  Child,  Nov.,  1921,  3,  No.  3,  267- 
273. — In  seventeen  states  agriculture  is  spe- 
cifically exempted  from  the  provisions  of  the 
child  labor  law  regulating  the  age  at  which 
children  may  work  and  the  number  of  hours 
during  which  they  may  work.  There  are  two 
reasons  for  this :  It  has  been  believed  that 
employment  in  agriculture  is  not  injurious 
to  children,  and  that  such  work  cannot  readily 
be  regulated. 

Gathany,  in  1920,  made  a  study  of  farm 
conditions  in  the  North  Atlantic  States,  and 
has  empliasized  the  necessity  of  eliminating 
rural  child  labor;  and  the  Massachusetts  So- 
ciety for  the  Prevention  of  Cruelty  to  Chil- 
dren has  reported  that  boys  and  girls  from 
10  years  of  age  upwards  are  being  employed 
in  the  tobacco  fields  of  the  Connecticut  Valley 
under  conditions  which  are  injurious,  boys 
working  from  nine  and  one-half  to  ten  hours 
a  day  under  canvas  covering — an  evil  which 
was  recognized  as  earlj'  as  1906  at  a  conven- 
tion of  tobacco  growers  in  Kentucky. 


278 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


An  investigator  of  the  National  Child  Labor 
Committee  went  through  the  agricultural  sec- 
tion of  Ohio  in  1917,  and,  although  compar- 
atively few  children  were  found  employed  in 
general  farming  or  truck-gardening,  "where 
found  they  were  working  for  about  ten  hours 
a  day,  and  were  paid  on  the  average  $1  a 
day."  Similar  conditions  were  found  on  the 
onion  and  celery  farms  in  Ohio  and  on  the 
Pacific  Coast  where  children  are  employed 
picking  fruit,  cotton  and  asparagus  under  bad 
conditions.  "These  are  but  a  few  instances 
of  a  situation  that  reaches  from  New  England 
to  the  Pacific  Coast,  and  eveiywhere  is  marked 
by  overworked,  under-educated  children." 

There  are  three  types  of  farm  work  in  which 
children  are  engaged:  (1)  that  performed  for 
parents  at  home;  (2)  that  done  for  wages; 
(3)  that  which  children  perform  with  their 
parents  but  under  contract.  These  must  all 
be  treated  separately.  Unless  hours  are  ex- 
cessive and  the  work  injurioas,  the  parent's 
right  to  permit  or  require  his  child  to  work 
at  home  cannot  be  interfered  with,  and  chil- 
dren so  engaged  can  be  reached  only  indi- 
rectly through  compulsory  scliool  attendance 
laws,  and  by  the  education  of  parents.  But 
children  employed  for  wages  can  be  protected 
by  direct  legislation.  They  should  be  sub- 
jected to  the  same  regulations  as  those  which 
apply  to  other  gainful  occupations. 

The  third  type  of  child  labor  is  the  most 
difficult  to  regulate.  It  has  been  suggested 
that  families  with  children  should  not  be  em- 
ployed in  such  work,  but  this  is  not  easily 
made  a  matter  of  compulsion.  Probably  the 
best  means  is  to  make  emjjloyers  responsible 
for  the  observance  of  certain  standards  for 
the  children  of  families  hired  by  them  under 
contract.  The  children  should  be  permitted  to 
work  for  only  a  limited  number  of  hours  a  day. 
depending  on  age  and  physical  condition,  and 
the  employer  must  be  held  responsible  for  ob- 
servance of  regulations,  and  for  providing 
suitable  quarters  subject  to  the  approval  of 
the  state  department  enforcing  the  child  labor 
act. — G.  E.  Partridge. 

Industrial  Accidents  to  Youxg  Wage- 
Earners.'  Am.  Child,  Nov.,  1921.  3,  No.  3, 
200-203. — From  two  to  three  times  as  many 
children  as  adults,  in  proportion  to  the  num- 
ber employed,  are  killed  or  injured  in  indus- 
try. The  accident  rate  in  Southern  cotton 
mills  (although  children  are  employed  in  the 


less  hazardous  occupations)  was  48  per  cent, 
higher  for  persons  of  14  and  1.5  years  than 
for  those  1(3  years  and  over  (1910).  In  a 
textile  mill  in  Connecticut,  during  the  year 
1920,  there  were  37.1  accidents  per  hundred 
among  workers  under  15  years,  and  42.9  for 
those  between  15  and  20  years,  while  for  all 
others  the  average  was  21.6.  Similar  reports 
have  been  obtained  in  other  places.  Despite 
safety  devices  and  safety  campaigns,  the  high 
rate  of  injuries  sustained  by  boj-s  and  girls  as 
compared  with  older  workers  continues. 

It  has  been  siiggested  that  the  cause  of  this 
greater  proneness  to  accident  on  the  part  of 
the  young  is  to  be  found  in  carelessness,  ad- 
venturoiLS  disposition,  and  the  awkwardness 
of  adolescence,  but  it  does  not  follow  that 
because  accidents  are  due  to  carelessness  they 
can  be  prevented.  The  only  possible  remedy 
is  to  keep  children  from  working  in  occupa- 
tions which  may  cause  injury,  until  they  are 
of  an  age  when  they  can  reasonably  be  ex- 
pected to  withstand  fatigue  and  to  take  proper 
eare.  Thirty-five  states  now  recognize  the 
need  of  prohibiting  emplojmient  in  dangerous 
occupations  to  persons  under  16  years,  but 
the  laws  should  be  strengthened  by  specifying 
and  increasing  the  list  of  occupations,  and  by 
raising  the  age  at  which  children  may  be  al- 
lowed to  enter  industry,  or  at  least  factory 
work. — G.  E.  Partridge. 

He.\lth  Protection  for  Young  Workers. 
//.  H.  Miichcll.  Am.  Child,  Nov.,  1921,  3,  No.  3, 
236-246.— This  is  the  report  of  a  health  study 
made  of  1,200  children  working  in  various 
occupations  in  Newark  and  attending  contin- 
uation school  three  hours  per  week.  Case 
histories  were  carefully  taken  preceding  the 
examination,  the  results  of  which,  as  regards 
vision  and  mouth  conditions,  are  here  re- 
corded. Children  having  20/30ths  or  better 
were  regarded  as  normal.  Of  616  boys,  60 
had  visual  acuity  of  20/40ths  or  less;  and 
among  614  girls,  88  had  visual  acuity  of 
20/40ths  or  less. 

Comparison  with  records  of  examination  of 
vision  made  at  the  time  of  entrance  into  em- 
ployment was  possible  in  127  defective  cases, 
and  it  wa.s  found  that  68.6  per  cent,  of  the 
boys  and  57  per  cent,  of  the  girls  in  that 
group  had  less  visual  acuity  when  examined 
the  second  time.  The  conclusion  is  reached 
that  there  is  a  distinct  tendency  for  cases  of 
defective  vision  at  the  time  of  entrance  into 


ABSTRACTS 


279 


employment  to  grow  worse.  A  large  percent- 
age of  defective  children  were  found  who 
either  did  not  own  glasses,  or  did  not  wear 
them. 

Relative  to  the  condition  of  the  teeth,  sim- 
ilar results  were  obtained.  "If  an  examina- 
tion at  the  time  of  obtaining  working  papers 
is  adequate  protection  to  the  health  of  the 
working  child  during  the  period  of  his  employ- 
ment, we  should  expect  to  find  no  dental 
defects  in  our  examination  among  those  cases 
that  had  had  no  defects  when  starting  work." 
It  was  found  that  of  3^2  girls  who  were  reg- 
istered when  obtaining  working  papers  as 
having  no  defects,  and  who  had  worked  six 
months  or  longer,  fil  per  cent,  had  dental  de- 
fects at  the  time  of  the  examination.  Prac- 
tically the  same  proportion  of  281  boys  were 
found  defective.  So  far  as  dental  conditions 
are  concerned;  therefore,  these  data  indicate 
the  inadequacy  of  the  present  Newark  jilan 
for  health  protection  of  working  children  and 
the  need  for  continued  health  service. 

It  is  shown  also  that,  altliough  the  correction 
of  dental  defects  at  tin'  time  of  going  to  work 
is  of  some  value,  periodic  examinations  are 
necessary  in  order  to  call  the  attention  of  the 
children  to  those  defects  which  occur  after 
beginning  work,  and  to  insure  such  corrections 
as  may  be  necessary  for  their  future  general 
health.  The  condition  might  be  remedied  to 
some  extent  by  stricter  reciuirements  for  the 
correction  of  all  defective  teeth  before  grant- 
ing woi'k  permits,  but  this  would  not  cover  the 
whole  ground,  as  is  obvious.  There  is  reason 
for  concluding  that  all  children  with  serious 
dental  caries  in  even  one  tooth  should  be 
treated  either  before  they  go  to  work  or  soon 
after.  Those  with  tartar  or  beginning  gin- 
givitis should  likewise  have  attention.  Those 
having  less  serious  conditions  at  the  time  of 
examiiuition  for  working  i)apers  might  be 
urged  to  have  prompt  dental  treatment,  and 
through  follow-up  work  in  the  continuation 
seliools  compliance  could  be  assured. — G.  E. 
Partridge. 


Seventeenth  Annual  Report  of  the  Na- 
tional Child  Labor  Committee  for  the 
Fiscal  Year  Ending  Sept.  30,  1921.  Owen 
R.  Lovejoy.  Am.  Child,  Nov.,  1921,  3,  No.  3, 
216-235. — Investigations  of  the  field  staff  in 
regard  to  the  conditions  of  child  labor  and  the 
enforcement  of  tlie  laws  in  West  X'irginia  are 
reported  briefly;  also  a  survey  of  Alabama 
child  welfare  laws,  a  studj'  of  children's  insti- 
tutions in  Kentucky,  a  similar  study  in  De- 
troit, and  a  study  of  the  health  conditions 
among  pupils  in  continuation  schools  in  New- 
ark. There  is  a  brief  summary  of  work  done 
in  procuring  legislation,  and  of  the  new  enact- 
ments in  seventeen  states.  The  publicity  work 
of  the  committee  is  described.  During  1021 
this  was  confined  mainly  to  "specialized  pub- 
licity," such  as  following  up  the  publication 
of  reports,  etc.  Efforts  were  made  to  obtain 
the  widest  possible  notice  of  Child  Labor  Day 
(the  fourth  Sunday  in  January),  and  two 
general  announcements  of  it  were  sent  out 
to  about  1,500  newspapei-s.  Four  new  pamph- 
lets were  published.  A  special  department 
of  information  was  organized.  There  are 
notes  on  natui'al  conferences  on  child  labor 
and  on  social  work  and  on  co-operation  of  the 
Committee  with  other  agencies,  such  as  the 
National  Council  of  Rural  Agencies  and  the 
United  States  Children's  Bureau. 

New  measures  are  recommended :  Twenty- 
one  states  are  still  below  the  standards  of  the 
Federal  Tax  Law;  dangerous  trade  laws  for 
children  are  in  need  of  further  study  and 
revision ;  studies  of  the  effect  of  child  labor 
on  health  must  be  continued,  with  special 
attention  to  phj'sieal  examinations;  admin- 
istration of  child  labor  and  child  welfare  laws 
must  be  intelligent  and  free  from  politics.  It 
is  stated  that  the  field  work  for  1922  will 
be  chiefly  devoted  to  rural  child  life,  with 
emphasis  on  education  and  recreation.  The 
report  closes  with  the  financial  statement  for 
the  year. — G.  E.  Partridge. 


INDUSTRIAL  SANITATION:    FACTORY  CONSTRUCTION,   ILLU- 
MINATION, VENTILATION,  HEATING,    WATER    SUPPLY,    SEW- 
AGE DISPOSAL 


Oil-Camp  Sanitation.  C.  P.  Botvie.  U.  S.  viduals  have  written  much  on  sanitation  in 
Bur.  Mines,  Tech.  Paper  261,  1921,  pp.  32.—  rural  districts  in  the  United  States,  the  author 
"Although  federal  and  state  bureaus  and  indi-     has  repeatedly  observed,  during  visits  to  min- 


280 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


ing  camps,  oil  fields  (espeeiallj'  those  of  the 
'boom'  variety),  fruit  districts  during  the  har- 
vest season,  and  other  places  of  temporary  or 
semitemporary  habitation,  that  the  advice 
given  by  these  writers  is  for  the  most  part 
disregarded,  and  that  much  remains  to  be 
done  in  an  educational  way  before  the  plane 
of  sanitation  in  such  districts  becomes  rela- 
tively as  high  as  that  in  cities. ' '  The  responsi- 
bility of  betterment  of  insanitary  conditions 
belongs  to  the  states'  governments  but,  though 
they  all  have  adequate  sanitation  laws,  they 
have  inadequate  enforcement  of  those  laws. 

The  author  takes  up  in  detail  the  questions 
of  the  fl}'  nuisance,  mosquitoes,  the  location  of 
camps,  spacing  of  buildings,  houses,  water 
supply,  disposal  of  garbage,  stable  refuse  and 
sewage. 

A  bibliography  of  recent  publications  on 
camp  sanitation  and  kindred  subjects  is  ap- 
pended.— M.  Dent. 

Bath  House,  Hospital  and  Heating  Ar- 
rangements Provided  for  the  Employees  op 
THE  Lynch  Mines  in  Kentuoky.  Howard  N. 
Evanson.  Abstracted  as  follows  from  Coal 
Age,  Oct.  27, 1921,  pp.  676-678,  in  The  Digest, 
Nov.-Dec,  1921,  3,  Nos.  11-12.— "Plans  of  the 
bath  houses  and  the  heating  systems  at  the 
mines  of  the  United  States  Coal  and  Coke 
Company  are  given  in  this  article.  The  bath 
houses  are  located  at  the  mine  entrances  and 
the  lockers  are  suspended  from  the  ceilings. 
The  hangers  are  drawn  by  galvanized  steel 
sash  cord  and  rest  under  steel  hoods  attached 
to  the  ceiling.  In  this  way,  the  clothes  are 
kept  out  of  the  way  and  it  is  possible  to  util- 
ize more  floor  space. 

"A  brief  description  of  the  hospital  is  given, 
but  perhaps  the  heating  plan  is  a  more  un- 
usual feature.  The  buildings  of  this  company 
are  heated  by  hot  water  from  a  central  heat- 
ing plant.  This  water  is  conducted  by  pipes 
under  ground.  And  in  order  to  prevent  cor- 
rosion, a  special  deactivating  plant  has  been 
set  up.  This  plant  consists  of  a  tank  filled 
with  loose  thin  steel  sheets,  upon  which  the 


oxj'gen  acts,  and  a  sand  filter  to  remove  any 
foreign  material  from  the  water." 

Good  Lighting  Increases  Production.  J. 
M.  Hickerson.  Indust.  Management,  Dec, 
1921,  62,  No.  6,  325-328.— Adequate  light  has 
an  important  part  in  modern  manufacturing, 
but  it  was  the  emergency  of  the  late  War  that 
gave  it  its  great  opportunity.  It  has  been 
shown  that  proper  industrial  lighting  in- 
creases production  with  the  same  labor  cost; 
increases  the  accuracy  of  workmanship ;  les- 
sens the  number  of  accidents;  lessens  eye- 
strain, and  improves  the  morale  of  workers. 
An  example  is  given  of  high  intensity  illumi- 
nation installed  in  a  Chicago  factory  making 
iron  pulleys,  by  which  there  was  effected  a  20 
per  cent,  increase  of  production  at  a  cost 
amounting  to  5.-1  per  cent,  of  the  i)ayroll. 

Glare  is  light  out  of  place.  Its  degree  is 
determined  by  several  factors .-  by  the  total 
candle-power  emitted  by  the  light  source  in 
the  direction  of  the  eye;  by  the  distance  from 
the  light  source  to  the  eye ;  by  the  intrinsic 
brilliancy  of  the  source;  by  the  contrast  in 
brightness  between  the  light  source  and  the 
working  surface  and  surroundings ;  by  near- 
ness of  the  light  source  to  the  line  of  vision  ;  by 
the  total  length  of  time  during  which  the 
source  of  glare  is  present  within  the  field  of 
vision. 

An  investigation,  made  hj  a  concern  selling 
a  lighting  specialty,  in  which  about  500  indus- 
trial plants  in  157  towns  and  cities  were  vis- 
ited, showed  that  while  25  per  cent,  of  the 
work  done  in  factories  is  under  artificial  light, 
only  17.5  per  cent,  of  the  manufactured  goods 
are  produced  under  artificial  light;  that  85  per 
cent,  of  the  manufacturers  are  more  or  less 
satisfied  with  their  present  lighting,  but  only 
40  per  cent,  of  the  plants  are  adequately 
lighted ;  that  the  lighting  units  are  inefficient- 
ly spaced  in  40.6  per  cent,  of  the  plants ;  that 
more  plants  ai-e  liurning  bare  lamps  than  there 
are  plants  with  lamps  entirely  equipped  with 
reflectors ;  and  that  only  22.4  per  cent,  of  the 
plants  clean  their  lighting  equipment  regu- 
larly.—G.  E.  Partridge. 


INDU.STRIAL  MEDICAL  SERVICE:  MEDICAL  DISPENSARIES  AND 
HOSPITALS  IN  INDUSTRIAL  PLANTS 

Partnership  between  Industrial  Phy-  long  as  the  workman  retains  his  right  to  choose 
siciAN  and  Practitioner.  C.  C.  Burlingame.  the  physician  ho  wishes,  it  is  to  the  interest 
Nat.  Safotv  News.  Dec,  1921,  4.  No.  6,  39.— So     of  the  industrial  physician  to  form  a  partner- 


ABSTRACTS 


281 


shin  with  the  community  physician  and  make 
his  problems  community  ones. 

"To  be  a  little  more  concrete,  could  we  not 
assign  to  the  industrial  physician  the  duties  of 
inspection  of  health  hazards  within  the  plant, 
the  care  of  conditions  arising  out  of  or  in  the 
course  of  employment,  studies  into  occupa- 
tional research,  the  giving  of  first  aid,  medi- 
cal, and  surgical  treatment,  caring  for  the  rou- 
tine minor  illnesses  which  would  not  ordinar- 
ily go  to  a  doctor  but  the  treatment  of  which 
would  keep  the  employee  on  the  job,  aiul  act- 
ing as  a  general  clearing  house  to  direct  em- 
ployees into  the  hands  of  other  physicians  and 
specialists?  To  this  could  not  the  industrial 
physician  add  the  position  of  consultant  with 
any  physician  who  was  caring  for  the  em- 
ployees of  his  concern  T" 

And,  too,  the  private  practitioner  "owes  it 
to  his  patients  to  know  the  etiology  of  the 
diseases  which  he  may  be  called  upon  to  treat, 
and  without  some  knowledge  of  industrial 
conditions  he  is  not  in  a  position  to  pass  upon 
the  question  of  the  etiology  of  all  diseases." — 
M.  Dent. 

Five  Points  in  Employe  ITeai.th  Work. 
Robert  S.  Quinby.  Hosp.  Management,  Nov., 
1921,  12,  No.  5,  60.  62,  64,  66.— The  five  points 
elaborated  on  in  this  article  are  as  follows : 

"Physical  examination  and  necessary  re-ex- 
amination of  applicants  and  those  already  em- 
ployed. 

"Dispensary  treatment  of  sickness,  acci- 
dental injuries,  and  in  many  cases  dental,  ocu- 
lar, and  other  conditions. 

"Supervision  of  factory  sanitation  and 
elimination  of  disease  hazards. 

"Home  nursing  and  medical  supervision  of 
such  cases  as  may  seem  advisable. 

"Education  in  matters  of  health  and  per- 
sonal hygiene." 

A  plant  employing  900  or  more  persons 
should  have  one  full-time  physician,  and  an 
additional  physician  for  each  l,.iOO  workmen. 
The  ratio  of  nurses  to  employees  should  be  one 
to  each  1,000.  Dental  defects  comprise  40  per 
cent,  of  the  total  defects  found  in  employees. 
A  dental  dispensary  is,  therefore,  very  im- 
portant. Dr.  Quinby  believes  that  a  necessary 
function  of  the  industrial  nurse  is  to  raise  the 
standards  of  home  life  of  the  workmen. — M. 
Dent. 


Results  op  the  Physical  Examination  of 
THE  Employees  op  the  New  York  City  De- 
partment OF  Health.  Maud  Glasgow.  N.  Y. 
City  Dept.  Health,  Month.  Bull.,  Nov.,  1921, 
11,  No.  11,  269-284.— Since  1917  all  employees 
entering  the  New  York  City  Department  of 
Health  have  been  required  to  undergo  a  physi- 
cal examination,  the  general  character  of 
which  is  herein  outlined.  The  value  of  the 
examination  is  further  enhanced  by  follow-up 
work.  A  special  effort  has  been  made  to  give 
hygienic  instruction  and  advice  when  needed. 
Leaflets  dealing  with  some  of  the  more  com- 
mon sources  of  ill  health  have  been  used  ex- 
tensively. The  necessary  knowledge  can  be 
imparted  to  the  patient  without  causing  undue 
alarm,  if  judicious  measures  are  employed. 

It  must  be  remembered  that  departures 
from  the  normal  are  not  necessarily  due  to 
occupation;  heredity,  psychic  conditions,  home 
environment,  including  eating,  ventilation, 
etc.,  must  all  be  taken  into  consideration  in 
assigning  disabilities  to  their  proper  causes. 

The  disabilities  which  are  most  commonly 
met  with  are  here  mentioned,  together  with 
the  benefits  derived  from  advice  and  treat- 
ment in  several  specific  instances. 

The  author  is  emphatic  in  his  demand  that 
equal  opportunity  and  equal  pay  for  equal 
work  should  obtain  everywhere,  and  a  square 
deal  for  everyone,  regardless  of  sex.  The 
greater  morbidity  found  among  women  than 
among  men  is  without  doubt  due  to  the  fact 
that  women  are  much  oftener  overworked  and 
underpaid  than  men.  Men  receiving  a  low 
wage  suffer  in  exactly  the  same  way. — L.  A. 
Shaw. 

Life  Saving  Makes  a  Popular  Appeal. 
Otto  P.  Gfier.  Nation's  Health,  Dec.  15,  1921, 
3,  No.  12,  663-670.— This  article  is  an  account 
of  the  industrial  physicians'  exhibit  at  the 
Cincinnati  Health  Exposition — an  exhibit 
which  undertook  to  demonstrate  "that  medi- 
cal supervision  in  industry  is  a  vital  factor 
in  any  health  program,  community  or  person- 
al ;  that  it  is  doing  for  the  adult  not  only  what 
medical  supervision  is  doing  for  the  school 
child,  but  that  it  is  a  great  social  and  educa- 
tional force  for  the  employer,  the  employee,  as 
well  as  engineering,  medical,  nursing,  and 
dental  professions. ' ' 

An  interesting  feature  of  the  exhibit  was 


282 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


the  demonstration  of  two  contrasting  minia- 
ture workshops — one,  dark,  unclean,  unhealth- 
ful  and  unsafe  and  in  charge  of  a  dissatisfied 
workman ;  the  other,  clean,  well-lighted,  well- 
ventilated,  with  machinery  properly  guarded 
and  in  charge  of  a  contented  and  efficient 
workman.  The  men  in  the  two  shops  greatly 
interested  the  visitors  by  their  constant  com- 
ments on  the  disadvantages  and  advantages 
of  their  respective  working  conditions. 

The  general  plan  of  the  exhibit  was  to  give 
the  public  a  composite  view  of  industrial  medi- 
cine as  it  is  practised  in  the  ten  plants  repre- 
sented at  the  exposition  "presenting  the  aver- 
age conditions  rather  than  the  advanced  work 
done  in  any  one  or  more  of  the  plants.  It  was 
interesting,  for  instance,  to  note  that  11,800 
physical  examinations  were  made  in  all  in 
1920 ;  that  the  average  percentage  of  rejection 
was  5.7  per  cent.;  and  that  rejections  varied 
from  1.2  per  cent,  to  8  per  cent.  It  was  im- 
pressive to  note  that  among  11,800  employed, 
70,000  medical  cases  and  35,000  surgical  cases 
visited  eight  industrial  dispensaries,  making 
a  total  of  250,000  visits  and  revisits  for  all 
causes."  During  this  same  period,  the  out- 
patient department  of  the  Cincinn'ati  General 
Hospital  afforded  but  10,000  patients  facilities 
for  30,000  visits. 

Some  of  the  industries  "reported  that  as 
high  as  7  per  cent,  of  the  working  force  daily 
sought  the  physician's  aid  for  one  reason  or 
another.  The  average  ratio  of  medical  to 
surgical  cases  was  as  7  to  3.5.  The  collected 
data  showed,  on  the  other  hand,  that  almost 
invariably  the  sickness  rate  and  absence  be- 
cause of  sickness  was  materially  reduced,  in 
some  instances  being  cut  in  half ;  that  lost  time 
from  infected  woimds  after  installation  of 
medical  service,  with  its  prompt  and  proper 
treatment,  rediiced  infection  cases  to  the  neg- 
ligible point." 

Statistics  of  this  sort  suggest  that  "indus- 
trial medicine  is  preventive  medicine  prac- 
tised on  the  firing  line;  that  the  daily  super- 
vision, the  accessibility  of  the  service  to  the 
patient,   the   frequency    of    observation,   the 


early  diagnosis  and  prompt  treatment  is  the 
sanest  and  most  economical  way  of  preventing 
human  wastage ;  that  it  keeps  the  front  line  of 
industrial  attack  and  maximum  production 
intact ;  that  this  is  the  best  means  yet  devised 
for  keeping  the  old  time  'evacuation  stations' 
free  from  overflow  of  chronically  incapaci- 
tated dependents ;  that  to  reduce  the  size  of 
the  human  scrap  heap  most  systematically  we 
must  move  more  of  our  scientifically  trained 
medical  men  up  to  and  on  the  industrial  firing 
line." 

The  author  goes  on  to  discuss  in  some  detail 
the  value  of  industrial  medical  service  as  dem- 
onstrated in  the  health  exhibit,  not  only  to 
the  worker  in  better  working  conditions,  sta- 
bility of  health,  and  the  reduction  of  suffering 
and  loss  from  disease  and  accidents,  but  also 
to  the  employer  in  lessened  absences  fi'om  ill- 
ness, higher  output  per  man  at  a  lower  cost, 
and  better  morale  of  the  working  force. — 
Katherine  K.  Drinker. 

Has  Clinic  for  Employes'  Children. 
Hosp.  Management,  Nov.,  1921,  12,  No.  5,  56, 
58. — The  Gilbert  and  Barker  Manufacturing 
Company  of  Springfield,  Mass.,  has  main- 
tained for  several  years  an  efficient  medical 
department  consisting  of  a  physician  and  two 
industrial  nurses.  A  thorough  physical  ex- 
amination is  given  to  every  applicant  for 
work,  and,  contrary  to  common  belief,  little 
objection  has  been  made  to  this  examination. 

Employees  are  encouraged  to  come  to  the 
factory  hospital  for  all  slight  ailments.  Health 
and  sanitation  talks  are  given  by  the  medical 
division  and  through  the  medium  of  the  com- 
pany's monthly  magazine.  A  clinic  for  em- 
ploj'ees'  children  is  kept  up  with  great  en- 
thusiasm. "Sanitation  as  a  foundation  for 
better  health  is  rigorously  maintained" 
throughout  the  plant.  Supplonionting  all 
these  benefits  the  company  provides  athletic 
recreation  and  two  types  of  financial  assist- 
ance— ^'The  Employes'  Mutual  Benefit  Asso- 
ciation" and  "The  Annuities  and  Benefits 
Plan.'"— M.  Dent. 


INDUSTRIAL  NURSING 


A  Talk  on  He.vlth  Talks  for  IxnrsxRiAL 
NuBSEs.  Amia  Mayhee  Staebler.  Pub.  Health 
Nurse^  Dec.,  1921,  13,  No.  12,  647-648.— The 
following  hints  for  health  talks  are  given: 


the  noon  hour  is  usually  necessary;  select  a 
quiet  room ;  talk  to  not  more  than  thirty-five 
persons  at  one  time ;  begin  promptly  and  stop 
in  time;  do  not  talk  for  more  than  fifteen 


ABSTRACTS 


283 


minutes;  do  not  talk  to  mixed  frronps;  if  there 
are  minors  employed  talk  to  them  separately; 
«mphasize  only  three  or  four  important  points 
at  one  talk;  illustrate  by  posters;  demonstrate 
when  it  is  possible;  have  notices  posted  con- 


cerning the  talks ;  and,  finally,  distribute  leaf- 
lets at  the  close  of  the  talk  (these  may  be  ob- 
tained free  from  federal  and  state  depart- 
ments of  health). — M.  Dent. 


INDUSTRIAL   INVESTIGATIONS  AND  SURVEYS 


The  Hide.  Hair,  axd  Horsehair  Ixdus- 
TKiES.  D.Olibert.  Ministere  belgicjue  de  1 'In- 
dustrie, du  Travail  et  du  Ravitaillement,  Ser- 
vice Medical  du  Travail,  1921.  A.  Lesigne, 
Brussels,  1921,  pp.  448.— The  1921  report 
which  Dr.  Gilbert,  head  of  the  medical  depart- 
ment of  industry,  has  presented  to  the  Bel- 
gium frovernment,  is  a  valuable  monograph 
of  448  pages.  The  inquiry  therein  described 
was  restricted  to  seven  trades  connected  with 
the  manufacture  and  preparation  of  the  skin 
and  hair  of  animals.  The  .slaughterer,  the 
taxidermist  and  certain  dyeing  operations  are 
outside  the  investigations. 

According  to  a  prearranged  and  uniform 
method,  each  of  the  9,317  workers  in  the  se- 
lected industries  was  personall.v  exaininod  by 
the  medical  inspector.  The  state  of  health  of 
every  individual  was  recorded  under  the 
heading  of  good,  fair,  or  indifferent.  The  re- 
sults obtained  were  summarized  into  elaborate 
tables.  Further  tables  show  under  these  .same 
three  divisions  of  health  how  each  worker 
was  influenced  .by  place  of  residence  (town, 
country,  or  mixed) ;  by  age  at  date  of  exami- 
nation ;  by  age  at  which  he  started  work ;  by 
heredity  as  shown  by  the  physical  condition 
of  the  parents;  and  by  the  healthfulncss  or 
otherwise  of  the  progeny  of  the  employees. 
These  figures  worked  out  in  percentages  con- 
stituted the  basis  for  comparative  purposes. 
Under  the  same  headings  each  department  of 
each  trade  was  analyzed  in  a  similar  manner, 
and  compared  with  the  above  total  figure. 
The  trades  reviewed  are  tanning,  currying, 
unhairing,  wool  washing,  pelt  dyeing,  felting 
and  brush  making.  In  some  of  the  sub- 
branches  of  these  trades  the  number  of  em- 
ployees is  very  small.  This  source  of  weak- 
ness for  comparative  statistics  is  pointed  out 
by  Dr.  Glibert.  He  also  notes  that  perma- 
nence in  an  occupation  is  largely  influenced 
by  the  nature  of  the  work,  wliether  casual 
labor,  or  one  requiring  special  aptitude  and 
training.  Unhairers  constantly  change, 
Tvhereas  tanners  and  curriers  remain  with  the 


same  firm  for  years.  Matrimony  and  ma- 
ternity largel}'  restrict  the  industrial  life  of 
women. 

The  technical  details  of  all  the  above  in- 
dustries are  fully  described,  and  special  at- 
tention is  drawn  to  any  operation  where  in- 
jurious chemicals  are  likely  to  be  handled;  or 
where  exposure  to  heat,  strain,  moisture,  etc., 
may  cause  ill  health. 

The  general  average  of  well-being  was 
poorer  in  those  who  had  started  in  the  tan- 
yards  between  the  ages  of  12  and  14,  than  in 
those  who  had  commenced  their  employment 
later,  between  the  ages  of  14  and  16.  Among 
1,7G0  tanners  examined,  165  cases  of  dermato- 
sis were  discovered.  The  sore  known  as 
"pigeoneau,"  characteristic  of  this  occupa- 
tion, is  fully  described.  Glibert  associates  it 
with  the  length  of  occupation,  the  arsenic  and 
chrome  used.  He  mentions  that  on  one  occa- 
sion where  stronger  solutions  of  arsenic  had 
been  employed,  some  portions  were  carried  by 
the  hands  of  the  operatives  to  the  penis,  there 
causing  excoriations.  These  sores  led  to  the 
belief  that  the  men  suffered  from  venereal 
disease. 

The  health  of  leather  curriers  is  below  the 
general  standard  found  in  the  combined  in- 
dustries covered  by  this  inquiry.  Of  838 
leather  dressers  inspected,  twenty-one  showed 
affections  of  the  skin.  Unhairing,  washing 
wool,  dyeing,  and  preparing  bristles  for 
brushes,  do  not  appear  to  be  particularly  in- 
imical to  soundness  of  body,  whether  these 
operations  are  done  by  hand,  or  by  machinery. 
In  the  haireutting  and  plucking  rooms  con- 
junctivitis is  very  prevalent.  Fifty-four  cases 
were  seen  in  men,  and  sixty-five  in  women. 
Septic  sores  on  the  fingers  are  common  in  some 
of  these  workrooms.  Dr.  Gilbert  draws  at- 
tention to  a  slow  spreading  form  of  inflam- 
mation on  the  digits,  which  he  has  previously 
reported,  peculiar  to  men  who  split  rabbit 
skins.  In  one  department,  where  the  hairs 
are  extracted  by  hand,  the  atmosphere  be- 
comes very  unpleasant  and  impregnated  with 


284 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


dust  and  fluff.  This  work  is  regai'ded  by  the 
inspectors  as  being  more  disagreeable  than  in- 
jurious, as  chest  affections  are  not  luiduly 
common.  Skin  diseases,  conjunctivitis,  and 
ulcers  of  the  mucous  membrane  of  the  nose  are 
frequent.  This  work  is  done  only  by  women. 
The  constant  use  of  the  right  forearm  causes 
the  muscles  to  hypertrophy  and  the  tendons 
to  thicken,  and  this  is  sometimes  associated 
with  neuralgic  pains.  The  constrained  po- 
sition assumed,  bending  forward  while  sitting 
on  the  right-buttock  for  long  consecutive  peri- 
ods, leads  to  spinal  curvature.  Seventeen  in- 
stances of  left  lateral  curvature  were  noted. 

In  the  carrotting  room  nitrate  of  mercury 
is  brushed  over  the  hair  either  by  hand  or  by 
machine.  The  ill  effects  of  this  salt  are  easily 
seen  on  the  health  of  the  men  and  women  in 
this  and  the  subsequent  processes  of  brushing, 
stoving,  finishing,  etc.  All  the  operatives  look 
anemic,  and  the  viability  of  the  offsprmg  of 
these  workers  is  imperiled.  The  hands  of  the 
Garrotters  are  always  fissured  and  eczematous. 
Glibert  does  not  think  that  the  mercury  is 
volatilized  by  any  of  the  above  operations, 
neither  does  he  believe  that  it  is  absorbed 
through  the  skin.  He  suggests  that  it  is 
sometimes  carried  to  the  mouth  with  food  by 
soiled  fiiigers;  but  the  greatest  risk  is  in  the 
constant  inhalation  of  bits  of  hair  and  parti- 
cles of  dust  saturated  with  the  salt.  The  type 
of  mei'curialism  observed  is  chronic,  and  very 
rarely  acute.  The  gums  are  swollen  and 
ulcerated,  salivation  is  unusual.  The  teeth 
are  markedly  blackened,  and,  as  in  saturnine 
poisonnig,  dark  blotches  occasionally  appear 
on  the  inside  of  the  lips.  Dr.  Glibert  says  that 
the  mercury  line  is  grayer  and  broader  than 


that  due  to  lead,  but  is  easily  mistaken  for  it. 
The  nervous  symptoms  include  tremors  of  the 
lips  and  tongue,  and  of  the  arms  and  legs  on 
movement.  The  blood  picture  is  but  little  al- 
tered from  the  normal.  He  regards  chronic 
mercurial  poisoning  as  much  less  grave  than 
that  caused  by  lead,  since  the  evil  effects  dis- 
appear much  more  rapidly. 

Between  the  years  1899  and  1920  only  fifty- 
five  cases  of  anthrax  were  reported :  thirty- 
five  among  brush-makers,  and  sixteen  among- 
tanners.  Sixty  pages  of  the  report  are  taken 
up  with  a  general  discussion  on  the  subject  of 
anthrax. 

Improvements  are  being  gradually  intro- 
duced into  the  different  trades  in  Belgium,  as 
in  other  countries.  In  the  tanneries,  hand 
labor  is  being  replaced  by  machines.  By  this 
means  the  chances  of  exposure  to  noxious 
agents  are  greatly  lessened,  the  work  is  light- 
ened, and  the  irritation  from  chrome,  in  the 
two  bath  method,  is  largely  obviated.  Local 
regulations  have  almost  prohibited  the  use  of 
sulphurous  acid  for  bleaching  fleeces,  which 
was  always  attended  with  a  certain  amoimt  of 
danger.  Recent  procedures  are  gradually  de- 
creasing the  opportunity  of  absorbing  poison- 
ous doses  of  mercury.  Though  much  has  been 
done  in  this  direction.  Dr.  Glibert  more  than 
hints  that  in  the  near  future  the  salt  of  mer- 
cury will  be  found  unnecessary.  One  excel- 
lent colored  plate  shows  the  effects  of  mer- 
cury on  the  teeth  and  lips,  and  others  in 
black  and  white  illustrate  the  volume. 

This  report  will  remain  a  useful  .source  of 
information  on  these  branches  of  iiulustry  for 
some  time  to  come. — R.  Prosser  White. 


SUBJECT  INDEX  TO  VOLUME  III 

This  is  a  subject  iiulex  to  all  the  reading  matter  in  the  Abstract  of  the  Literatlre  of 
Industrial  IIyGiE>E,  and  one  should,  therefore,  look  for  the  subject  word.  The  name  of  the 
author    follows    the   subject   entry    in    parentheses. 

For  author  index,  see  page  304. 


Absentehjism    and    attendance   of    workers   in 

Moscow    factories 92 

industrial,  study  of    (Quinby) 239 

Acciuk.nts,  xco  also  under  Safety,  specific  oe- 

cui)ations,  and  specitic  parts  of  the  body. 

AcciDB.NTs,    accident    fretiueiicy    and    sc%-erity 

rates  for  tlie  iron  and  steel   industry  and 

Its    principal    departments,    1907    to    I!i2l» 

( Chaney )     'I'M 

accident   fre<iueiicy   rates   iti   iron   and   steel 

industry,  liy  causes,  litl.'i  to  lOl'O  (i-'haney)   2,34 
accident-preventing  education    ( Ilerdiiian) . .   130 
analysis  of,  as  cau.ses  of  fatalities    (Cruni)   2.S2 
campaign   asjainst  careless   handling  of  ma- 
terials   ( Uos.s<dand )    233 

circular   saw,   prevention   of    (Farra) 162 

classitications  of  .■idministrative  methods 
for  teclinical  sup(>rvision  of  pa.i)er  work- 
ing unions    ( Iliitt  I 217 

coal  mine  fatalities  in   l.  S..  1920  (Adams)   21<! 

coal  mine,  in  state  of  Wasliington 72 

coke  oven,  in  V.  S.  during  1920  (Adams)  ..  .  25S 
discussion     of     American     accident      table 

(Ilookstadt)    161 

does  accident  prevention  pay?  (Angove)...  274 
Eastiiiiin  Kod.ik  Coniii.iny  cuts  severity  and 

fre<iueiicy   i  ates  of 12 

electric.il.  statistical  study  of   (.laeger) 191 

fatal    accident    in    low    voltage    installation 

(lleydricli)    14 

fatal  industrial  accidents  in  Canada  in- 
crease during  1920 161 

five  months  without  an  accident,  record  of 

sheepskin  workers 55 

from   liiind  tools,  prevention  of 57 

from    machine   shop   machinery,   prevention 

of   57 

getting  rid  of  ladder  accidents  (Keefer)...  56 
hazards  of  logging  industry,  mechanical  vs. 

human    (Cole) 57 

h(rars  most  prolific  of  accidents  (Van  Ant- 
werp)       233 

how  an  electrical  company  cut  accidents  7S 

per  cent.    ( Strickland) 104 

in  mines  and  on  railroads  in  United  King- 

dcmi  in   1919 26 

in   mines  and  quarries  of  T'ntted   Kingdom 

in    1920 216 

industrial  accident  fre<inencv  in  Wisconsin, 

1in.->    to    1920    (Altmeyer)" 191 

industrial,  caused  by  defective  illumination 

(Simpson)    1,3 

industrial.  French  court  decisions  regard- 
ing   iiica]tncities   from .38 

industrial,     occurrence    and    prevention    of 

(Alexander)    54 

industrial,  record  of.  for  1919   (Hoffman)..     12 

industrial,  reducinsr  cost  of  (Lott) 104 

industrial,   to   young   wage-earners 27S 

industrial,   tuberculosis   after    (Broca) 209 

metal  mine,  in  T'.  S,  during  1919  (.\dams)  216 
nucleus  for  accident  iirevention  library....  54 
obscure  hut  most  prolific  hazard  (Mowery)  72 
occupation  hazard  of  railway  shuinnen 274 


.\cctde.\ts.  one  thonsand   industrial  accidents 

suffered  by  Massachusetts  children  (Kaves)     60 

IMint   as  accident  reducer    (Tillinghast) . . .  220 

prevention  and  first-aid  work  in  telephone 
field    ( Downey )     257 

prevention  of,  in  foumlry  of  Locomotive 
Stoker  Company  of  I'ittsburgh,  I'a. 
( Steele)     104 

prevention  of,  in  mines  of  Butte,  Montana 
(Harringt(m)    26 

prevention  of,  on  power  transmission  ma- 
chinery   t  Keefor )    102 

prevention  of,  u.se  of  stenches  as  warning 
in  mines    (Katz,  Allison,  and  Egy) 26 

prevention,  safety  and    ( Lange) ■.   103 

(juarry,  in  V.  S.  during  1919  (Adams) 72 

question  of  increased  protection  against,  for 
industrial  workers  injured  in  war  (Zieg- 
]er )     5o 

reduction  of,  in  oil  refinery    ( EstiCrly ) 215 

reduction  of,  through  visual  acuity  (Porter)     13 

remarkable  record  made  in  building  con- 
crete ships    ( Woedtke) 161 

report   of,   for   1920 12 

report  of  medical  advisory  committee  of 
Massachusetts  Industrial  Accident  Board 
to    medical    profession 175 

safety  hook  prevents  mine  car  grade  acci- 
dents     216 

sources  of  danger  from,  in  building  indus- 
tries    (Quarg) 233 

standard  schedule  as  aid  to  uniformity  in 
accident    reporting    ( Hatch ) 54 

state  industrial  accident  insurance  officially 
acclaimc<l    (Chubb) 88 

statistics,  industrial,  in  state  reports,  inad- 
e<iuacy   of    ( Gadsby ) 72 

statistics  of  trades  unions,  definition  of 
term  poison   in    ( Rheinfels) 191 

status  of  labor  union  accident  prevention 
( Rothe)    73 

1.100  steel  workers  make  sixty  days  no  acci- 
dent record 162 

suggestion  .systems  for  elimination  of 57 

tanks  and  pipe  lines  as  causes  of  (  Hoffman)      14 

T'nited  States  Steel  Conwration  analyzes 
causes   of   2no.(l<IO    accidents 72 

what  are  dangerous  jobs?    (Tobey) 21.'; 

who  is  to  blame  for  accidents? 72 

why  shoidd  we  not  prevent  accidents? 
(Hubbard)    190 

work,   among   women    (Swartz) 27,  167 

Acetic   acid,   studies   of  effects   of,  on   albino 

rats    (Sollmann) 49 

Acetoxuria    of    fatigue    during    alimentation 

(Azzo)     15 

Acettijsne    generator    precautions 193 

poisoning   from    (Pontopiddan) 347 

Acid,  itre  alio  under  names  of  specific  acids. 
Acid  and  all<ali  burns,  treatment  of   (Smith)   134 


285 


286 


THE   JOURNAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

Agbjcvlture,  eliikl  labor  in   (Folks) 277 

control    of    employmeut    of   children    in,    in 

Europe    2C3 

.\JR  compressors,  explosions   in 1!)3 

deterioration  of,  in  closed  rooms  ou  naval 
vessels,   with  especial  reference  to  battle 

conditions     (Bathe) 28 

dustiness,  experiments  in  eontnil  of  (Spen- 
cer)        50,     98 

expired,    dust    in 98 

of  granite-working  plants,  dust  in.  (Katz)..   15S 
Alcohol  and  precision  in  work   ( Jotterniann)   109 
effects  of,  during  normal  and  fatigued  con- 
ditions      109 

influence  of  dilution  on  toxic  action  of  alco- 
holic   licjuids     ( Vernon ) 77 

influence    of,    on    function    of    heart    (Pan- 

tania )    259 

Alkali  and  acid  burns,  treatment  of  (Smith)   1S4 
Aluminium  poisoning,  case  of   ( Spoff orth ) . . .   185 

Ambulance  and   first  aid    (Bridge) 75 

Amido  Compounds,  aromatic,  detection  of,   in 
urine,   and  change  they   undergo  in  bod.v 

( Kuclienbecker )    7 

Ammonia  bums   of   cornea 103 

Anaerobes  in  hair  dust    (Buchanan) 101 

Anesthetics,   local,    reix)rt    of   committee    on 

use  of,  in  ophthalmic  work 255 

Aniline,  in.iury  of  cornea  by   (Bachstez)  ....     12 
ipeculiar    injury    due    to    thread    dyed    with 

"ice-black"     ( Sachs ) 57 

poisoning     ( Ka wamura ) 270 

workers,  tumors  of  bladder  among 70 

ANKYLOSTOMIA.SIS,  See  HookwoiTn. 

Anthracene     factor.v,     carcinoma      cutis     in 

(O'Donovan)     187 

Anthrax,  advantage  of  .serum  therapy  in.  as 
shown  l)y  comparison  of  various  methods 

of    treatment    (Regan) 253 

clinical    picture   of    (Graham) 2.3.3 

cutaneous,  local  and  general  serum  treat- 
ment of    ( Regan ) 272 

cutaneous,  treatment  of  (Ogilvie  and  Hall)   1.59 
human,  case  of.  in  Buganda  Kingdom   (Pea- 
cock   and    Duke) 187 

in  animal    (horse)   hair    (Hubbard) 10 

malignant     pustule    with     multiple    lesions 

(Grant)     187 

normal  beef  serum  in  treatment  of   (Kraus 

flud    fReltrami ) 253 

prevention  of.  am(mg  industrial  workers: 
memorandum  on  disinfecting  station  es- 
tablislied    in    Great    Britain    for   disinfe<-- 

tion   of  wool   and   hair 211 

Arsentc.  afftvtions  of  retina   and  optic  nerve 

caused  by  arsenical  .poisoning   (de  Haas)      .53 

arsenical    con.1unctivitis    (Milian) 274 

fatal  intoxications  by,  in  viticultural  dis- 
tricts    (razeneuve) 250 

Is    industrial    di.sease   of    briquette    makers 

chronic  arsenical  noisoning?   (Rurkhardt)     47 
is  proohylaxis   feasible  in   arsenous  dust?.  .   209 

poisonimr.   <-bronic    (Stockman) 150 

poisoning,  niiignesium  sulphate  in   (Hansen')   185 
question  of  resistance  of  various  animals  to 
(Willberg)     47 


Arseniuretted  hydrogen,   personal  experience 

of  iX)isoning   by   arslne    (Kunz-Krause)  . .   207 

Absenous  Oxide,  perforations  of  nasal  sep- 
tum due  to  inhalation  of  (Dunlaii) 47 

Absine,  see  ArseniiU'etted  hydrogen. 

Arterial    pressure    among    workers    in     high 

temperatures    ( Tedeschi) 112 

Arterioscijcrosis     localized     in     arteries     of 

shoulder    ( Torraca ) 181 

Asthma,  anaphylactic  bronchial,  among  work- 
ers in  furs,  clinical  and  experimental  ob- 
servations  on    ( Curschmann ) 95 

anaphylactic  bronchial,  from  para-phenyl- 
enediamiue  dyes,  observations  and  inves- 
tigations  on    ( <4erdon) 4,  4,  5 

experimental,      investigations      on      calcium 

therapy  in  ursol  asthma   ( Mehl ) 182 

pneumokoniosis  and  asthmatic  attacks  in 
woodworkers    (Pincberle)     251 

Atmospheric  conditions  in  boot  and  shoe  fac- 
tories, preliminary  notes  on  (Hambly  and 

Bedford )     ." 11.3 

effect  of  cooling  power  of  atmosphere  on 
body     metalmlism     (Campbell,     Hargood- 

Ash.     and    Hill ) 259 

environment,  relation  of  health  to  (Hill  and 

Greenwood )     105 

impurities,    determination    of    (Monnett)...     28 
pressure,    diseases    of    ear    in    railway    em- 
ployees working  at  high  altitudes   (Clam- 
.polini )     189 

AuTosroBiLE  industry,  occupations  in,  as  em- 
ployment  obje<'tives    for   disabled 201 

Ax  factory,  tuberculosis  among  polishers  and 

grinders   in    ( nrury ) 52 

Back    injuries,    diagnosis    and    treatment    of 

( Sever )     75 

Bakebtes,   inspection   of    (Wibaux) 147 

sanitation    in    (Barnard ) 81 

Batteries,  dry.  tar  melanosis  in  manufacture 

of     (Arnstein) 11 

Benzene,  xrc  Benzol. 

Benzol,  benzene  poiscming  in  rulilier  manu- 
facturing   ( (Juiidiy  ) 157 

intoxication,  blood  and  blood-forming  organs 

in     (Fontana) 1.83 

purpura    hemorrhagirfl   caused   by   fumes   of     23 
Benzyl  Benzoate.  effect  of,  on  leukocytes  of 

rabbit    ( Emge    and    .Tensen ) 184 

BijVDDEb.  tumors  of.  among  aniline  v.  orkers..      70 
tumors    <if.    in    workers    in    clieniical    indus- 
tries    (Schwcrin) 7 

Bla.st  Furnace  gas.  injurious  action  of  (Der- 

dack^     1.83 

gas    ijoisoninsr     (.T<diannsen> 240 

Bi.oon  and  bloodforming  organs  in  benzol  in- 
toxication    (  Font.'ina  t 183 

cells,  red.  resistance  of.  to  hemolytic  action 

of  sapotoxin    (Xeilson   and  W'heelon)  . . . .    125 
condition    of   radium   wiu'kers.   effect   of   in- 
creased   i>rotection    from    radiation    upon 

(Mottram)     205 

effect  of   benzyl   benzoate   on   leukoc.vtes   of 

rabbit    (Kmge   and    .Ten.'^en) 184 

Boiler.   steanL   safetv   features  of  accessori'-s 

(Hilleary)     107.  107 


SUBJECT  INDEX 


287 


Boils,  sec  Furunculosis. 
Boot,  see  Shoe. 

BUAi-N    injui-.e.s,   e.ve    findings    in    (lilack  )  .  ,  .  .   257 
lesions,  contrast  between   l>raiu  lesions  i>ro- 
flnceil  l>.v  lead  and  other  inorfianic  poisons 
and    those    eansert    by    epidemic   encepha- 
litis    (Hassin) 15C 

Bmqvette    maliers.    is    Industrial    disease    of, 

chronic   arsenical    ixiisoning    (I'urkliardt)     47 
makers,    skin    lesions    In,    and    relation    of 

lesions  to   war  melanoses    (Schlirerl 214 

Broken     Hill    mines,    health    conditions    at 

(P.irks)     91 

RKo^(I.^I•;,  histolofrie  changes  in  lungs  follow- 
ing   inspiration    of S 

Bboom    M.x.'Kjais,    <Useas»s   'and.    stigmata!    of 

( I'iccinini )     3 

Bin.ra.Mi    industries,   sources  of  danger    from 

accidents    in     ( Quarg) 233 

regul.'itions  of  I'ru.ssian  State  Coniinissioner 
of  Housing  of  April  2.".,  1!>1!)   (Tittler)   32,     32 
Btuxs,  acid  and  alkali,  treatment  of  (Smith)   131 

ammonia,  of  cornea 103 

electric   current,    patliolog.v    of    (,Jellinek  I  . .   237 
electrical,    paral.vsis    of    radial     nerve    and 

trophic  disturliances  following   t.lcllineki   112 
of  stei'l   workers  redu<'ed   by  safe  <4otbing..    10.") 

prevention    of 1<>3 

prevention    of    ( VounRt 163 

zinc  chloride,  among  workers  in  wood  i)re- 
servinR  industry    (McC'ord  and  Kilker)..     48 

Calcium    ("VANAMinE    fertilizers,    impairment 

of   health    from    (Schliert 11 

Caijfobma,  iiroiM)sed  death  benefit  schedule  of  lOS 
Canada,    workmen's   compensation    legislation 

in     ,S5 

workni<>n's  coin,i)ensation  legislation  of  I',  S, 

and     (Clark    and    Frincke) .SO 

Canckh,  ]iarnflinoma  and  wax  oineer   (Davis)      2'> 
Cannkbik,'^,  fruit  and   vegetable,  sanitation  of 

(Miller)     264 

Carbon  dioxide  excretion  of  man  in  wrestling 
and  fencing  (fiuUichsen  and  Soisnlon- 
SoiniiKMi)    2.'')0 

disulphide,  hygienic  prec-autions  in  manu- 
facture an(l   industrial  use  of   (Blain)...     61 

monoxide,  accidental  deatli  by  illuminating 
gas  under  ordinary  conditions  of  work 
(P'.Messio)     183 

monoxide  asphyxia,  behavior  of  lieart  in 
(Haggard)     157 

monoxide  asphyxia,  respiration  and  blood 
alliali   during    (Haggard   and    Henderson)    120 

monoxide,   asjihyxiation    in    garages 40 

monoxide,    detection    of    (Hoover) 182 

monoxide,  early  apiiearance  of  secondary 
pneumonia  after  poisoning  with  (Strass- 
mann)    8 

monoxide,  gas  mask  for  protection  against..   102 

monoxide  poisoning,   acute    (Xicloux) 207 

monoxide  poisoning,  immediate  and  subse- 
quent  manifestations  of    (Lnden)..,     69.     69 

monoxide  poisoning  in  factories,  memoran- 
dum   on 229 

monoxide  poisoning  in  foundry  (Gros  and 
Kocbman )     157 

monoxide  poisoning,  spinal  fluid  in  (T.egry 
and    Lermo.vez) 46 


PAGE 

Cabbon     monoxide     poisoning,     treatment     of 

(  Haggard  and   Henderson  ) 206 

monoxide   poisoning,   treatment   of    (Sayers 

and   ()"Brieu  ) 270 

monoxide,  respiratory  apparatus  for  protec- 
tion  against    (Desgrez,   Guillemard,   Hem- 

merdinger   and   Labat ) 248 

monoxide  resulting  from  use  of  explosives 

in  confined  places    (Colburn) 183 

monoxide,  toxic  effects  of   (Wilmert 4.3 

oxychloride,   .tec  Phosgene. 
Cuk.mical  industries,  bladder  tumors  in  work- 
ers in    ( Schwerin )    7 

industries,     safeguarding     of     workers     in, 
against  occupational  disea.ses   (Danuerth)   153 

plant,    tuberculosis    in    (  H.ichfeld  i IMi 

workers,   safe  clothing   for    ( Kepner  I 105 

Children,  administration  of  child-labor  laws. 
Part    4.      Em,plo\-ment-Certilicate    s.vstem, 

Wisconsin     (Hanks  I 277 

at  what  age  should  children  enter  industry? 

(.Milchell)     137 

chilli   employment  and  adult  employment..   276 

child    labor 262 

child  l.-ibor  and   mental   hygiene    (Fuller)..   115 

child  lMl>or  in  agriculture     (Folks) 277 

child  lalxir  in  Imperial    \'alle.v 116 

child   labor  problem     (Mitchell) 60 

child  labor  versus  children's  work   (Fuller)   203 
conserving  children  in  industries  of'Massa- 

ehusetts    60 

control  of  employment  of,  in  agriculture  in 

Europe    263 

cost  of  adolescent  to  communit.v   (Collis) . .  264 
enfi>rcenu'nt    of    child    labor    laws    in    AYest 

Virginia     (Van     Bu.skirk) 220 

examination    of.    for   industries 20 

health   and   working  child    (Mitchell) 19 

health       protection      for      young      workers 

(  Mitchell )     278 

industrial   accidents  to  young   wage-earners  278 
International    Labour   Ollice   and   protection 

of    children 219 

.iuvenile  court  and  child  labor  (Ellis) 19 

new  British   legislation   affecting  admission 

of.    to    industry 114 

night  employment  of   ( Beard) 116 

one   thousand    industrial   accidents  suffered 

by   Massachusetts   children    (Kaves) 60 

orders     affecting     employment    of.    in    lead 

processes    262 

physical      standards      for     child      laborers 

(Baker)    167 

Iisychological  approach  to  child  labor  prob- 
lem   (l^dler)     l'< 

relation     of    child     labor     to    child     health 

(Chandler)     219 

seventeenth  annual  report  of  National  Child 
Labor  Committee   for   fi.scal    .vear   ending 

Sept.   30,    1921    ( Lovejoy ) 279 

trend  of  child   labor  in   C.   S.,   191.'!  to  1920 

( McOill)     115 

what  is  health  protection  for  working  chil- 
dren?   (Mitchell) 20 

working,     effect     of    war    on,    in    Germany 

( Kalet)     168 

working,   health    needs   of 115 

working,  physical  standards  for 79 


288 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

Chorea,  case  of:  new  occupational  paiu  from 

handling  compressed   air   motor    (Moren)     60 
Chromate     poisoning,     acute,     symptoms     of 

(Brieger)    98 

Clinic  for  employees'  children  maintained  by 

(Jilbert  &  Barker  Manufacturing  Company  282 
industrial,    Framingham   demonstration   No. 

25     ( Murray ) 141 

industrial,  in  general  hospitals    (Wright)..     64 
industrial,    in    general    hospitals,    functions 

and    scope    of    (Linenthal) 14] 

occupational,    work    of.    in    preventing   pre- 
ventable    diseases     in     New     York     City 

(Harris)     251 

Coal     dust     hazards     in     industrial     plants 

(Tracy)     158 

heaver,    case    of    .secondary    infection    with 

parasitic    mold    in    (Pezzali) 206 

mine,  see  Mine,  coal, 
miner,  sec  Miner,  coal. 

pulverized,    dangers    from 131 

Coal  Tar,   crude,    in   dermatology    (White)..  273 
derivatives,   skin  lesions   from    (Koelsch)..     11 
dyes,  see  specific  dyes. 
CoKK-OvEN    accidents    in    U.    S.    during    1920 

(Adams)     258 

Cold,  dermatosis  of  lower  limbs  from  chilling    12 

effect  of.  on  kidneys    (Ciceonardi) 217 

experimental     researches     on     "autocolloid- 
oclasie"    from    chilling     (Widal,    Abrami, 

and    Brissaud ) 237 

Colds,  common,  effect  of  ventilation  and  tem- 
perature   on    (Talmer) 265 

Colleges.  ,pre\entive  medicine  and  hygiene  in 

relation   to    ( Lee) 3 

Community,  cost  of  adolescent  to  (Collis)...  264 
importance      of      industrial      medicine      to 

(Collis)     205 

industrial,  practical  hospital  probleni.s  en- 
countered  in    ( Stanton ) 84 

Companies 

Aluminum  Manufacturers  of  (Cleveland,  in- 
dustrial      dispensary      of      (Davis      and 

George)     140 

American      Bosch      Magneto      Corporation, 

dental  disiionsary  of    ( Rood) 141 

American  Smelting  and  Refining  Company 
helps  community  through  industrial  nurse 

(Adams)     1"1 

American    Steel   and   Wire   Company,   sixty 

days  no  accident  record  of 162 

Ashland  Iron  and  Mining  Company,  accident 

experience    of    (Van    Antwerp) 233 

Baltimore  and  Ohio  Railroad,  safety  work 

of    ( Resnick ) 233 

Bell    Teleplinne   Coniiiany.    accident   preven- 
tion and   first-aid  work  of   (Downey)  ....   257 
Bell   Telephone   Company   of  Pennsylvania. 

first-aid  work  of   (Brintnnll) 234 

Bethlehem  SIiii>huihling  Corporation  pro- 
vides cafeterias  for  employees 197 

Bethlehem  Steel  Company,  safety  and  medi- 
cal work  of.  saving  men  and  money  (Res- 
nick)    55 

Brill  (.T.  G.)  Company.  dental-o<:ulist  ser- 
vice for   employees  of   (Hastings) 224 

Brown-Lipe-Chapin  Ccmipnny.  plant  dispen- 
sary   of    (Broughton) 22 

Bnda  Compan.v.  medical  service  of  (Tup- 
per)     83 


PAGE 

Companies 

Calitornia  Associated  Raisin  Company,  den- 
tal   service    of    (Brownell) 141 

Cambria  Steel  Company,  reduction  of  burns 
in,  by  use  of  safe  clothing 105 

Campbell  (Joseph)  Company,  defects  in 
employees    of    ( Buzby ) 266 

Cananea  Consolidated  Copper  Company, 
hospital   service   of    (Hogeland) 143 

Champion  Coated  Paper  Company,  health 
service   of 238 

Clark  Equiiiment  Company,  prorision  for 
recreational  activities  of  employees  of 
( Altman)     242 

Continental  Motors  Corporation,  welfare 
work    of 171 

Curtis  Publishing  Company,  aim  of  medical 
division  of   (Morgan  and  Repplier) 170 

Cutler-Hammer  Manufacturing  Company, 
hospital    of    2(J.5 

Cutler-Hammer  Manufacturing  Company, 
safety   work   of    { Augove) 274 

Detroit  Stove  Works,  medical  service  of 
(Barbour)    224 

Dominion  Forge  and  Stamping  Company  of 
Ontario.  Canada,  solves  goggle  problem 
(Kuechenmeister)     257 

Du  Pont  Company,  safety  work  of  (Res- 
nick)    74 

Eastman  Kodak  Company  cuts  accident 
severity    and    frequency    rates 12 

Eastman  Kodak  Company,  success  of  medi- 
cal department  of   (Robertson) 222 

Fairbanks.  Morse  and  Compan.v,  treatment 
of  injuries  at  shop  hospital  of   (Schram)     74 

Fairbanks.  Morse  and  Company,  work  of 
hospital    department    of 141 

Faulkner  and  Colony  Manufacturing  Com- 
pany solves  problem  of  excessive  humidi- 
ty  in   dye   houses 82 

Ford  Motor  Plant.  9..500  partially  disabled 
employees   working  in 89 

Fulton  Bag  and  Cotton  Mills,  medical  de- 
partment   of    (Heyser) 29 

General  Electric  Company,  methods  adopted 
by.  for  prevention  of  burns   (Young)....   163 

General  Motors  Corporation,  activities  of. 
in  providintr  homes  for  workers    (Smith)     33 

Gilbert  and  Barker  Alanufacturing  Com- 
pany, clinic  of.  for  employees'  children..   282 

Gillette  Company,  medical  service  of 30 

Hood  Rubber  Company,  study  of  absentee- 
ism   in     (Quinby) 239 

Illinois  Bell  Telephone  Company,  health 
service   of    (Crosley) 1"^ 

Inland  Colliers  Company,  safety  Improve- 
ments of   (Resnick) 161 

International  Harvester  Company,  place  of 
women   in    (TarbelU 5!> 

Interstate  Iron  and  Steel  Company,  safety 
work    of     (Salisbury) 2.34 

Keystone  lyoatber  Company,  defects  in  em- 
ployees   of     (Buzby) 266 

Lawrence  (  \.  C.1  Leather  Company,  safety 
work  of.  five  months  without  an  accident     55 

lyeRlond  (R.  K.)  Machine  Tool  Company, 
eye  room  of.  saves  workers'  siglit  and 
increases    output    (DoHart) 83 

I^Bloiid  (R.  K.)  "SXiyrhuw  Tool  Company, 
hospital  d(Miartment  of.  supervises  safety 
work    (Dellart) 142 


SUBJFXT   INDEX 


289 


PAGE 

Companies 

LeBlond  (R.  K.)  Machine  Tool  ('uinpany, 
industrial  dental  disi»ensary  of   (DeHart)     31 

I^eUlond  (K.  K.)  Maeliiue  Tool  Company, 
nose  and  throat  room  of   (DeHart) 224 

LeBlond  (K.  K.)  Machine  Tool  Company, 
plant  lunchroom  of    (DeHart) 148,  14S 

Liocomotive  Stoker  Company  of  Pittsburgh, 
prevention  of  accidents  in  foundry  of 
(Steele)    1(M 

Ludlow  Manufticturing  Associates,  medical 
department  of   (Andrews) i.  221 

Lynn  General  Klectric  Company,  education 
in  safety  engineering  as  given  at  engi- 
neering and  apprentice  school  of  ( Du 
Chemln )    214 

Maryland  Casualty  Company,  medical  de- 
partment of.  diri'its  lilirary    (Fort) 139 

Metropolitan  Lifo  Insunince  Comimny,  per- 
sonnel  maiingomonl   of   (Washington)....   172 

Michigan  Mutual  Liability  Company  service 
(Torrey)     142 

Midvale  Steel  and  Ordnance  Company,  an- 
alysis of  accidents  in,  from  point  of  view 
of    responsibility 72 

Milwaukop  Kloctric  Raihva.v  and  Light 
Comiiany.  coniprchcnsivo  medical  service 
for  employees,  of   ( I,pinon) 30 

Morris  and  Comi>any,  pliysical  examination 
system    of    ( Bureau) 139 

Moi-sc  I>ry  Dock  and  Repair  Company, 
shipyard    c.Tfptorin    of 268 

Natioii.il  Miilloable  Castings  Coinpany,  pro- 
cedure of.  in  medical  examinations  of 
employees     63 

New  Ijigland  Telephone  Conipnny.  cafeteria 
of     (Ansell) 241 

New  York  and  Queens  Klectric  Light  and 
Power  ComiMny.  safety  work  of  ( Strick- 
land >    104 

New  York  Shipbuilding  <"oriH)ration.  hospi- 
tal organization   of    (I/Mipold) 143 

New.port  Compan.v  of  Milwaukee,  twenty- 
four-hour  medical   sprrice  of 143 

Pennsylvania  Railroad  Compan.v.  first-aid 
work  of.  132.013  sick  and  injury  cases 
treated    in   a    year    (Rower) 30 

Picknnds.  Mather.  nii;l  Company,  polic.v  of. 
in  selecting  industrial  nurse   (Martinson)   144 

PuUmiin  <'ompauy.  policy  of,  in  reporting 
slight    in.iuries    (Matthys) 141 

Rue  (Thomas  dp  In)  and  Company,  medical 
department   of    (T'ndorwoodl 23S 

Saginaw  Products  Company,  employees  of. 
protected   by   hip   leiigtb   lecrgings 106 

St.  l/ouis  Southwestern  Railway,  medical 
service    of    (Chacp) ' 222 

Shppard  Electric  Crane  .-ind  TToist  Com- 
pany's   pmnlo'-pes    plfin    hosnitnl 142 

Standard  Oil  Company,  health  service  of 
( Adnms^     170 

Thompson  Starrett  Cnnmnny.  success  of 
snfety  nrosrrnm  of   (Davis  and  Clpnrse)  .  .     73 

PnitPd  St.ntps  Coal  and  Cokp  Company, 
plans  of  bath  bouses,  hospital  and  beat- 
ing .irran^ements  provided  for  employees 
of    (Rvanson) 2S0 

T'nited  States  Steel  Corporation  analyzes 
pauses  of  200.(X)0  accidents 72 

T''nitpd  States  Steel  Corporation,  safety 
work    of    (Resnick) 190 


PAUG 
COMI'A.MES 

Western  Electric  Company,  housing  project 
of  employees  of    (Jamieson) 172 

Westiughouse  Electric  and  Manufacturing 
Company,    industrial    cafeteria    of 148 

Westiughouse  Electric  and  Manufacturing 
Company,  Victory  Garden  Association  of 
(Barth)     268 

White  Motor  Company,  restaurant  facilities 
of    (Hobart)     242 

Winchester  Repeating  Arms  Company,  ma- 
tron service  for  plant  hospital  of  (AVes- 
tervelt)!    142 

Winchester  Repeating  Arms  Company,  med- 
ical department   of    (Westervelt) 169 

Compensation,    see    also    under     Workmen's 

Compensation. 
Compensation,   accident,   for   maritime   work- 
ers,  legislative  program   of    (Andrews)..   197 

corrections  versus  compensation  of  physical 
defects   ( Lee  and  Brown ) 41 

for  incapacities  from  industrial  accidents. 
LFrench  court  decisions  regarding 38 

for  industrial   disease 149 

for  maritime  workers,  conflict  of  jurisdic- 
tion  in    (Chaml>prlain) 197 

for  severely  but  not  totally  disabled  in  in- 
dustr.v,  with  siwcial  reference  to  one- 
arme<l     (Eloesser) 201 

late  traumatic  detachment  of  retina,  its 
prophylaxis  and  importance  from  dis- 
ability comiiensation  standiioint  (Giffordl   256 

liability  for  concurrent  compensation  (Sher- 
lock )     41 

plea  for  more  adequate  compensation  rates 
(.Stewart)     39 

principle  governing  estimates  of  visual  loss 
(Mehl)    174 

proposed  death  benefit  schedule  of  Califor- 
nia      198 

to  longshoremen,  legislation  needed  for  res- 
toration  of    (Chamberlain) 86 

Compressed  air  macliinery  and  equipment....  270 

air  motor,  new  occupational  pain  from 
handling    ( Moren) 69 

air.  rupture  of  large  intestine  from   (.lean)   21S 

air  workers,   rules  for  protection   of    (Ley- 

mann  >   78 

Construction  work,  safet.v  in  (Davidson)...  .56 
Cooper,  ca.se  of  industrial  injury  in  (Smital)  .57 
Cripples,  rehabilitation  of.  mc  Reliabilitation. 

Defects  affecting  fifteen  hundred  men  (Buzby)  266 
DEFORNtiTiEs.   Occupational,  of  band    (Pichler^   134 

Deiiyoratton  equipment  as  safety  field 131 

Dkntai.  dispensary   in   magneto  plant    (Rood)   141 

dispensary,    industrial     (Dellart) 31 

di-;ppnsary.   imlustrinl.   how   factory   dentist 

earns   his   salary    (Bowers) 31 

service,  do  workers  prefer  to  pay?  (Mor- 
rison )     265 

service     of     California     Associated     Raisin 

Company     (Browncll) 141 

work     as     production     factor     in     industry 

(Crocker)     l^l 

Dentist,   occupational    dermatitis   in   dentists 

caused   b.v   proenin    (Lane) il 


290 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

DEKiiATiTis,  sec  Skill  diseases. 
Dermatoconiosis,  see   Skin  diseases. 
Diet,    role   of.    in   etiolog.v    mid    treatment    of 
migraine    and    other    ty.pes    of    headache 

( Brown)    235 

DiMETHYLSULPHATE,    local    effect    of    ( Boden- 

stein)    207 

DixiTROBENZE.xE     poisoniu;,'.     degeneration     of 

liver  following    (Curschmanu) 150 

Diphtheria,   nianagemout   of  outbreak  of,   iu 

private  school    (Fleischuer  and    Shaw)..   2.!»2 
Disability,    false    standards    of,    iu    industry 

(Clark)     26T 

funds    for     (Mills) 147 

ill  upper  extremity  resulting  from  indus- 
trial injuries,  flexion  power  as  index  to 
functional   efflcieuoy    in    appraisement   of 

(Barnes)     226 

in    workmen's    circle,    statistical   review    of 

( Rubin    and    Baskin ) 87 

Disabled,   copipeusation   for   severely  but   not 
totally  -disabled,  with  special  reference  to 

one-armed    (  Eloesser) 201 

industrial   training  of,   in   United   Kingdom  177 
9,500  partially  disabled   employees  working 

in   Ford  motor  plant 89 

question  of  Increased  protection  against  ac- 
cidents for  industrial  workers  injured  in 

war     (Ziegler) 55 

rehabilitation  of,   see  Rehabilitation. 
Disease,     diseases     prevalent     among     steel 

workers  iu  Pennsylvania  city   (Brundage)     90 
prevalence  among  wage  earners  during  first 

half  of  1920 " 34 

respiratory   efficiency   iu   relation   to   health 

and    disease    (Flack) 236,2.36,236 

Dispexsary.   dental-oculist   service   for   work- 
ers    (Hastings) 224 

dental,  of  American  Bosch  Magneto  Corpo- 
ration    (Rood) 141 

equipment  and  personnel  for  care  of  inju- 
ries    (Lan/ya) 140 

industrial   dental    (Dellart) 31 

industr'al  dental,  bow  factory  dentist  earns 

his  salary    ( Bowers) 31 

industrial,  plan  for   (Davis  and  Oeorge)...   140 
modern    industrial,   location    and   equipment 

of     (Danza) 140 

plant  nose  and  throat   room    (Dellart) 224 

plant,  saves  employees'  time   (Broughton)  . .     22 
DrsT,    arsenous.    is    prophylaxis    feasible    in 

arsenous    dnst? 209 

dividends    from   collecting 99 

expiM-iiuents    in    control     of     air    dustiness 

( Spencer)    50,     9S 

exjdosion   prevention,   engineei-ing   problems 

in     (Price) 57 

hair,  anaerobes  in   (Buchanan) 101 

hard     rubber,     explosion     of      (Price     and 

Brown )    216 

harnifulness    of.   in    workslioi>    (Smyth)....        9 

how  to  catch  and  ship  dust   (Radford) 1.5S 

in  air  of  granite-working  plants,  investiga- 
tion   of    (Kat7,)    15S 

in  bootinaking  industry   (Sardi) 100 

in    expired   air 9R 

indu'-^trial     (Tveitch) 50 

inhjilation    in    granite     industry.    Roentgen 

study    of    (.Tarvis) 100 

inspired   in  mines,  action  of  (.Tunghans)  ...      10 


PAGE 

DrsT.  lung  iutlamniation  among  workers  with 

Thomas  slag  dust    (Opitz) 51 

recently   developed   dust  explosion  aud   tire 

haziird    (Price   and   Brown) 216 

reduction    by    wet    stopers    (Jriarriiigton)  .  .  .   271 
removal  of,   from   rag-tearing  and   rag-beat- 
ing   machines     ( Morgner) 99 

removal,  pneumatic  systems  for   (Allen)...  127 

rock,    inhalation    of 100 

toliacco.  pneumokoniosis  from  inhalation  of 

( Palitzsch  1     251 

wood,  pneumokoniosis  and  asthmatic  at- 
tacks   in    woodworkers,    from    inhalation 

of     ( Pincherle  ) 251 

Dyes,  .sec  also  under  Aniline,  Para-I'benylene- 

diamine,    and   Ursol. 
Dyes,  .poisoning  from  shoe  dye   (Xeuhoff )  . . .     70 

Ears,     diseases     of,     in     railway     employees 

working   at    high    altitudes    (Ciamiwlini)   1S9 
EurcATiON    of   adult   working  class   in   Great 

Britain   and   1.   S.    (Sweeney) 4 

health,  see  Health   etlucation. 
Effktency  and  fatigue  in  iron  and  steel  in- 
dustry   ( Vernon  t 110 

industrial,   and   fatigue    (CoUis) 136 

mental  and  motor,  effect  of  smoking  on 
(Froeberg)     IDS 

necessity  for  greater  attention  iu  industry 
to  maintenance  of  efficiency  and  preven- 
tion of  ill  health   (Collis) 152 

physical,  application  of  certain  physical 
efficiency  tests   ( Scott) 7.S 

physical,  effects  of  short  spells  of  rest  on, 
as  measured  by  bic.icle  ergometer  (Wall- 
rich   and  Dawson) 165 

physical,   spells  of  rest   and    (Dawson    and 

Wallrich )    HI 

EiGHT-HorR  (Jay,  sanction  of 270 

Ei.Bow.  treatment  of  injuries  to  (Cohn) 217 

Er.EiTRHiTY.    fatal     accident    iu    low    voltage 

installation     (Heydrich) 14 

lessons  lc;irncd  from  forty  electrical  fatali- 
ties   (Whituig) 112 

lethal   power   of    (D'Halluin) 236 

paralysis  of  radial  nerve  and  trophic  dis- 
turiwinces  following  burn  by   (Jellinek)..   112 

pathologv  of  electric  current  burns  (.Jelli- 
nek)   .' 2.37 

safeguarding  of  electrical  hazards  (Balliet)   194 

safety  features  iu  high  tension  generating 
stations   aud    substations    (Samuels) 21S 

safety  features  on  high  voltage  transmis- 
sion lines    (von  Dannenberg) 19t 

safety  in  relation  to  eleeti-ical  appliances 
(Pierce)    131 

statistical     study     of     electrical     accidents 

(.Jaeger) ;  •   Wl 

ELECTRorARniocRAPiiY   and   its   significance   in 

insurance    medicine     (Sachs) 6f 

Extpi  ovEi-s.     industrial,     sickness     frequency 

among    -"  '- 

physical  examination   of    fColcord) 139 

present  altitude  of.  to  industrial  psycholo 

gy     (Brierlcy ) ^t 

Ejfpi.oYMKNT     and     sickness,    application     of 

statistics  to  study   if   (Thiele) 6,"i 

manager,  relation  of  industrial  nurse  to 
(Ross)    3t 

scientific  method   in   job   analysis    (Kitsnn)  22.T 


SUBJECT   INDEX 


291 


PACK 

Enercy  C'.\peu(liture  in  household  rusks  (Laug- 

worthy   and    Barott) Ill 

Exercise,   muscular,   effect   of.   upon   coniinon 

blood  constituents    (UaUestraw) 10.5 

ExpLOSio.NS,     dust,    engineering    prohlems    in 

prexention    of    ( I'rice I "iT 

jras,    in     anthracite    mines,    prevention    of 

( Walsh  )    72 

jras.    in    liituminous   ccuil    mines,    i.revention 

of    (Walter) 2(i 

hazard  and  prevention    (Shadgeni 2.5S 

in   air  coiniiressors 1!);; 

of  sas  tanks   ( llelwig) IC.l 

Of  hard  rubber  dust   (Trice  and  I'.rown)...  210 
recently   di'vel(i]K>d   dusl    explosion   and    fire 

hazard    (I'rice  and    Brown) 21t; 

lOxiM.osivKs.  dimmer  of  usiu'-'  explosives  in  con- 
fined   places    ( ( "olburn  i IS-T 

Eyes,    aft'ections    of    relina    and    o|)tic     nerve 

ciiused   l>y  arsenical   poisoning   (de  Haas)     53 

ammonia   burns  of  cornea 103 

arsenical    conjunctivitis     (Miliaiil 274 

care  of.  followiii;;  rcnioviil  of  small   fnrcii.'n 

bodies    from     (  Hane  t 273 

cataract    in   iron   workers IGO 

economic    asjiect    in    eye    injuries,    plea    for 

early    Ireatnu-nt     (  Llewellyn) 1.3P 

etiology     and     iircvenlion     of     injuries     to 

( Wiirdemann  \     1(i3 

eye  lindings  in  lir:iin  injuries   (Black) 2.'57 

factory  e.ve  room  saves  workers'  sight  and 

increases  output    (Dellart) S3 

fluoroscopy  for  ocular  foreign  bodies  (Frank- 
lin, Cordes.  and   Horner) 103 

foreign   body   spud   Illuminator    (Lowell)...   250 
goggles    for    locomotive    enginemen     ( .''oder- 

berg) 100 

goggles  save  eyes  every  day 14 

indiistri.'il    myopia    anil    selection    of    trade 

(Schneider)     .'')4 

infection     of    cornea     among    reapers    and 

winnowers     (Olierardi) 103 

injuries     to.     with     report     of     1.051     cases 

( ("'ampbell    and    Carter) 100 

injur.v  of  cornea  b.v  aniline   (Bnchstez)  .  .  . .     12 
late    tranmatic    detacbment    of    retina,    its 
T>rophylaxis     and     importance     from     dis- 
ability ciimpens.ntio'i  standpoint   fOilTord)   250 
Xatioiiiil     Safety    Cooncil    code    for    protec- 
tion   of    heads    and    eyes    of     industrial 

workers  100 

new    test   card    (Thoringtcm) 2.50 

ocular  factor  in  hend.'iche   (Kearney) 255 

o<-uI>ir    menace    of    wood    alcohol    i)oisoning 

( Ziegler)     185 

ocular   nystagmus    and    railroad   nvstagmus 

(Bilrrtny)    '..'. 214 

preventable  vocational  e.ve  injuries  (Wliitel  214 
proi'cilure     for     eve     protection     campiiign 

(Rosseland )     ..'. 233 

protection    of % 191 

reduction  of  accidents  through  visual  acuity 

(Porter)    13 

report  of  committee  on  local  anesthetics  in 

ophthalmic    work 2.55 

solution  of  goggle  problem  in  Plant  of  Do- 
niiiiion   Force  .nnd  Stamping  Company,  of 

Ontario.  Canada    (Kuechenmeister) 257 

sujierficial   injuries  to.   in  industry   (lloyerl   120 


PAGE 

Eyes,  value  of  good  ligliting  au<l  iiaintiug   in 

relieving   eyestrain    (Reid ) 220 

visual  fatigue   ( Jackson ) 71 

what  constitutes  fair  estimate  of  loss  of 
use  of  eye  in  workmen's  compensation 
eases?    (Mehl) 174 

what  constitutes  industrial  blindness? 
( Stieren)     129 

what  principle  must  govern  estimates  of 
visual  lo.ss  in  compensation  cases?  (Mehl)   174 

worknien's  compensation  for  loss  of  one 
eye    (Siegrist) 243 

workmen's  compensation  with  especial  ref- 
erence to  loss  of  vision    (.\Uport) 40 

F.\CT0i{v    and     workshops,     welfare    work     in 

( Anderson )     44 

cnnstruction.  model  building  regulations  of 
Prussian   Slate  Commissioner  of  Housing 

of  April  25,  1919   (Tittler ) 32, 32 

medical  unit    (Happ) 29 

workers  in  Xew  Y(n-k  State,  sickness  among  202 
i".\n.\iKHs,  syphilis  in  (  Stokes  and  Brehmer*..  232 
F.VTioiB.    acelonuria    of.    during    alimentation 

(Azzo)     15 

and    efficiency    in    iron    and    steel    industry 

(  Vernon  I    110 

and  shop  standards   (Newman) 70 

charts    (Oausset   and   Boigey) Ill 

<'heniical  fa<-tors  in:  effect  of  muscular  exer- 
cise njiDU  certain  common  blood  constitu- 
ents  ( Rakestraw)    105 

industrial  efficiency   and    (Collis) 1.30 

is  fatigue  test    possilile?    (Muscio) 130 

physiologic'al  basis  for  sliorter  working  day 

for   women    ( Webster) 79 

pliysiology  of:  physico-chemical  manifesta- 
tions of  fatigue  in  blood   (Hastings) 261 

practical    mcllimls    for   elimin:it  ion    of    ((!il- 

lircth  I      21.S 

Iiractical  methods  of  reducing  (Gilbreth  and 

(iilbreth)     .5S 

preventable  causes   of 110 

study  and  safety  work  co-ordinate  (Oilbretli 

and  Cilhrcth )    257 

study  of  niovements  (Binet) 202 

tests  at  Purdue  University    (Shepnrd) 261 

therapy  of   (Preti) 110 

working    capacity    and,    during    pregnancy 

(Carlini)    195 

Feerlemixiied,  expc'rinv^nt  to  determine  possi- 
bilities   of    subnormal    girls     in    factory 

work    (Bigelow)    125 

Fettv.  (latfoot  as  problem  of  industrial  surgery 

( Bettman)     164 

injuries  of  (Portmann  and  Warnshuis)  , . . .     75 
musculature  of  foot,  and  treatment  by  elec- 
tricity (Levick)    134 

three  frequent  causes  of  weak  and  flat  feet 

(Rugh)     108 

Ferbosii.icon  ,     sickness     and     dcnrli     due     to 

(Thiele)     158 

FEUTn.izER.s,    calcium    cyanamide,    impairment 

of  health  from   ( Schlier) 11 


292 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


PifiE 

B^EE  preveution.   industrial   trend   of    (Malla- 

lieu)     233 

FIRST   Aid   and   accident    prevention    work   of 

Bell  Telephone  Coini)au}'  (Downey) 237 

and  ambulance    ( Bridge) T5 

in  industrial   plants    (Brintnall) 234 

work  of  I'ennsylvania  Railroad  Company, 
132,913  sick  and  injury  cases  treated  in  a 

year    ( Bower )    30 

Fishermen,  diseases  of  ( Evans) tio 

Fluorine  compounds,  intoxication  with  (Koekel 

and  Zimmermann )    "0 

Fluoroscopy  for  ocular  foreign  bodies  (Frank- 
lin, Cordes,  and  Horner) 103 

Folliculitis  caused  by  sodium  borate 255 

Food,  economic  importance  of  sanitary  control 

in  manufacture  of  foods   (Grindrod) 261 

handlers,   examination   of,    from   standpoint 

of   tuberculosis    ( Fine) 100 

Formic  aei<l,   studies   of  effects  of,   on  albino 

rats    (Sollmann)    -l'^ 

Foundry,  carbon  monoxide  poisoning  in  (Oros 

and   Kochman )     157 

fever    (Rost)     •    tJ"-' 

workers  protected  by  hip  lenjith  leggings...  100 
Fr.\ctui!es  incident  to  occui>ation  (Moorhead)   108 
of  long  bones,  influence  of  physical  therapy 
in    reducing    disability    time    in     (Wain- 

■wright)     268 

Framingham  community  health  and  tubercu- 
losis   deiiionstration.    medical    results    of 

( Armstrong    and    Bartlett) 172 

demonstration,  industrial  clinic   (Murray)..   141 
Fltrs    and    skins,    calcium    therapy    in    ursol 

asthma  among  workers  iu   (Mehl) 182 

chemicnl  and  experimental  oliservations  on 
anaphylactic     bronchial     astlima     among 

worljers    in    (Curschmaun) 05 

harmful  eifects   of  ursol   among  workers  in 

(Ritter)    1S2 

F^runculosis,  treatment  of   (.Mien) 128 

Garages,  asphyxiation  in 40 

Gas.  blast  furnace,  src  Blast  Furnace  gas. 

exhaust.  as)ihyxiation  in  garages 46 

exhaust.  Bureau  of  Mines  experimental  tun- 
nel for  studying  removal  of  automotive 
exhaust   gas    (Fioldiior   and   Paul) 248 

exhaust,   poisoning   by     (Kraus) 247 

explosions  in  anthracite  mines,  prevention 
of    (Walsh)     72 

explosions  in  liituminous  coal  mines,  pre- 
vention  of    (Walter) 26 

formation  of  poisonous  gases  by  gas-fired 
water  heaters    (Schochi 120 

illuminating,  accident.'il  death  by.  under  or- 
dinary  conditions   of  work    (D'Alessio)  .  .   183 

illuminating,  early  appearawe  of  secondary 
pneuiiionin  after  poisoning  with  (Strass- 
mann)    ^ 

illuminating,  extensive  Intravital  clotting  In 
(Hedincer)     40 

illuminating,  gangrene  from  poisoning  by 
(I.aignel-T.avastine    and    Alajonanine)  . . .     07 

ma.sks.  ace  Gas  Masks. 

permeation  of  oxygen  lu-eatliing  apparatus 
by  gases  and  vapors  (Fieldner.  Katz.  and 
Kinney)    "C 

tanks,  explosion  of   (Helwig) l*"'l 

Gas  Masks  for  carbon  monoxide  perfected..  102 


PAGE 

Gas    M.\sks,    new     tubular    breathing    mask 

(Smith)      90 

Georgia,  working   conditions   of  women   wage 

earners  in    237 

Glanders,   human,   case  of    (Jacob,   Turnbull, 

Arkwright,   aud    Dobrashian) 52 

Glass  blowers,  syphilis  in   (Bajla) 186 

industry,  lead  poisoning  in 7 

Gold  and  silver  plating,  poisoning  with  hydro- 
cyanic acid   gas   in    (Holtzmann) 70 

Granite  industry.  Roentgen  study  of  dust  in- 
halation  in    (.Jarvis) 100 

working  plants,  investigation  of  dust  in  air 
of    (Katz)     158 

Giunders  and  polishers  in   ax  factory,  tuber- 
culosis among  (Drury) 52 

Hair  dust,  anaerol)es  in    (Buchanan) 101 

Hand,  occupational   deformity   of    (I'ichler)..   134 
Head.  National   Safety  Council  code  for  pro- 
tection  of   lieads   and    eyes   of  industrial 

workers  106 

Headache,  ocular  factor  in  (Kearney) 255 

role  of  diet  in  etiology  and  treatment  of 
migraine    and    other    types    of    headache 

(Brown )    235 

Health   and   welfare  of  postal  employees....   124 

care  at  Hotel  McAlpin,  liigh  standards  in 
(MacFarlane)    30 

conditions  at  Broken  Hill  mines   (Birks)...     01 

education  in   industry    (Ford) 94 

five  points  in  employee  health  work  (Quin- 
^liy)    281 

hazards  of  pottery  workers    (La   Forge)  ...      10 

in  industry  and  efficient  production  (Hub- 
bard i    .  .' 170 

industrial,  production  manager's  interest  in 
( Speuce)     221 

industrial,  value  of.  in  public  health  ser- 
vice   (Collis)     123 

insurance,  xpc  Insurance,  health. 

legislati(ni.  regulations  of  Jan.  27.  1920,  of 
imperial  minister  of  lalior  for  establish- 
ment and  management  of  works  for  prep- 
aration of  lead  colors  and  other  lead 
compounds   37 

necessit,v  for  greater  attention  in  industry 
to  maintenance  of  efliciency  and  preven- 
tion of  ill  healtli   (Collis") 152 

of  pni.ployees.  adv.antages  of  proper  bath- 
ing   (Mason)     144 

of  employees,  how  sliowers  improve  morale    32 

of  employees  promoted  by  providing  good 
food   107 

officers,  measures  for  increasing  supply  of 
comlietent  health   olficers    (Ferrell) 124 

of  seamen,   safeguarding  of    (Mackeown)..   228 

of  workers,  inlluence  of  night  work  on 
(Bruckner)    228 

of  workers  in  millinery  industry,  conditions 
affecting   (Ilubliard   and  Kefauver) 35 

jtrolilems  of  women  iu  industiT   (Anderson)   114 

Iiublic.   and   occupation    (Gottstein) 3 

pulilic.  effect  of  industrial  sanitation  on 
(Hubbard)     168 

public,  problems  of  industrial  hygiene  in 
relation    to    (Oliver) 245 

,pul>lic.  relation  of  industrial  medicine  to 
(T/egge)     43 

relation  of  posture  to   (Hilles) 110.  135 


SUBJECT  INDEX 


293 


PAGB 

Health,   relation  of,   to  atmospheric  environ- 
ment   (  Hill   and   Greenwood ) 165 

res|»iratorv   etfieieney   in   relation   to   health 

and   disease    ( Flacl£) 2.3t),  236,  236 

service  in  industr.v 118 

service  in  industry,  cost  of 120 

service  of  Chainiiion  Coated  I'aper  Com- 
pany    238 

service  of   Illinois   Hell  Conii)any    (Crosley)   170 
service  of  Standard  Oil  ("oniiiany    (Adams)    170 
service  sideof  i)er.sonnel  manaj^enient  (Mor- 
gan and  ilepplier) 170 

work  iu  live  industrial  plants   (Shipley)...   133 
Heart,    behavior  of,   in   carbon  monoxide   as- 
phyxia   ( llaf,'J,'ard)    157 

disea.se,  aminilator.v  patient  with  cardiac 
disease,  with  special  reference  to  disjitalis 

therapy    ( I'ellini )     (i.S 

disease,     etiuivalent    of    ordinary    exertion 

(Wilson)     6S 

disease,  exercl.se  tolerance  of  children  with, 
as  delerniined  by  standardi!ce<l  test  exer- 
cises  ( Wilson  )    95 

durinK  physical  exercise   (lioijjey) 217 

elfort  syndrome,  together  with  a  considera- 
tion   of    llu'   siffiiilicance   of   certain    niur 

nnirs    iCohn)    01 

intUii'iice   of   ah'oliol    on    function    of    il'an- 

tJini;i »    250 

size  of,  before,  dwrini;  and  after  .short  peri- 
ods of  heavy  physical  labor  (Hruns) 2(iO 

HEATiNfi  and  vontilatin;;  paper  machine  rooms. 

suKficstions  on    (  Kyan) t-.l 

Home    work,    tenement,    in    New     York     City 

( Scbonhersr)     ".     27 

HooKwort.M,    clinic.'il    aspects    of    ankylostomi- 
asis  I  rti  (liovanni) 2.">2 

in  California  fiold   mines    (Nauss) 101 

HoRSEiiAiii.   anthrax  in    (Hubbard) Id 

hide  !ind  hair  industries,  survey  of  condi- 
tions in,  in  r.eliriiim    (Gilbert) 2S,3 

lIosi'iTAr,   department   of   industrial   plant   su- 

porvi.ses   safety   work    (Hellart) 142 

field,    ill    construction   work    ((^lear.v) 143 

how    to    induce   workmen    to   come    to   shop 

hospital    (Schrnm)    74 

of  Cutler-IIiimmer  Manufacturinfr  (^ompany  2('>.'> 
of  employees  of  Shepard  Klectric  Crane  and 

Hoist  Company    142 

orira nidation  of  Now  York  Shipbuildins  Cor- 
poration   (Leupold)     143 

plant.   (>ssenti!ils    of    (Dye) 142 

plant,   faults   of 2.3.>* 

plant,   function  of 141 

plant,   matron  service   for    ( Wesfervelt)  .  .  .  .   142 
prol)Ieiiis  encountered   in  industrial  commu- 
nity    (St.'inton)     ,<54 

service,    liish    standards    in    health    care    at 

Hotel    Mc.Mpin    (JfacFarlane) 30 

.service  of  Cananea  Copper  Companv  (Hoge- 

land)      ■ !..   143 

TIOTEi..  Iii^b  st.indards  In  Iiealth  care  at  Hotel 

AfcMpin     (JlacFarlnne)     30 

-social-hysienic  conditions  of  hotel  personnel 

in  Ttome   02 

HorRs   of   work    (Williams) 67 

of  work,  does  the  lonir  day  pay? 4.') 

of  work  for  women.  ofTects  of  leffislation 
limitincr  137 


PAGE 

HoLBs  of  work,  a  manufacturer  on  the  short 

day    ( Collins )     67 

of  work  iu  relation  to  quality  of  output 
(Ityau   and  Florence) 92 

of  work  of  women  in  restaurants  and  tele- 
phone  exchanges   in    Minnesota 137 

of  work,  physiological  basis  for  shorter 
working  day  for  women   (Webster) 79 

of  work,  practical  experience  with  work 
■week  of  forty-eight  hours  or  less 93 

of  work,  sanction  of  eight-hour  day 270 

of  work,  snorter,  effect  of,  on  output  and 
health    16 

of  work,  three  shifts  in  steel  (Shaw) 16 

IloisiXG,  employees  and  homes   (Jamieson)..   172 

home  and  industry    (Mc<Juilkin) 144 

how  eleven  nianufaclnrers  combined  for 
better  housing   ( I  )e  Tree ) . .    32 

how  munii'ii)alities,  corporations  and  com- 
munities are  solving  housing  problem 
(Astle)     145 

methods  of  selling  houses  to  employees 
(Allen)    145 

miners'    146 

model  building  regulations  of  Prussian 
State  ConiTi'issioner  of  Housing  of  April 
2.-).    1010    (Tittlerl 32,     32 

providing  homes    for    \Vorkers    (Smith)....     33 
Hr.\rn>iTV.   preliminary  study  of  physiological 
el1'(H-ts    of   high    temperatures     and     high 
humidities    in    metal    mines    (Sa.vers   and 

Harrington)     5.S 

HviiitocYAXic  acid  gas.  indii.strial  i)oisoning 
with,  in  gold  and  silver  plating  (Holtz- 
mann )    70 

acid,    inspired,    action    and    intoxication    of 

(Flury  and  Henlmer) S 

HvmtoKi.i'osii.icir    ;icid,     monlanin     poisoning 

(Kransso)     1S5 

Hv(;iF.NE.  department  store   (Eninious) 3 

hygienic  precautions  in  manufacture  and 
industrial  u.sc  of  carbon  disidphide 
(Hlain)    61 

industrial.  Kre  Industrial  hygiene. 

mental,  arc  Mental  hygiene. 

preventive  medicine  and.  in  relation  to  col- 
leges ( Ijoe)    3 

social,  srr  Social  hygiene. 

Illumination,  nee  Lighting. 

Immunity,  industrial  disease  and   (Goadby)..   12] 
IxnusTBiAL   accidents,  xrr  Accidents,  industrial, 
clinic.  Ker  Clinic,  industrial. 

code  of  New   York   State 84 

court.    British     (Mackenzie) 242 

disease   and   imninnit.v    (Goadby) 121 

disease.   comi>ensation    for 140 

dise:ises    ( Legge)     1 

diseases  during  the  v.w    (Teleky) 203 

(lisi)ensarv.  xcr  Plspensary.  industrial. 
Fatigue   Research    Hoard    report   on   atmos- 
pheric  conditions    iu    boot   and    shoe   fac- 
tories   (Ilanvbly  and  Bedford) 113 

Fatigue  Ue.search  Board  report  on  boot  and 

shoe  industry    (T/Ovoday  and   Jlnnro)  .  . .  .     33 
Fatigue  Research   Board   report  on  fatigue 
and   efficiency   in   iron   and  steel   industry 
(Vernon)    . ." 110 


294 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

I.XDUSTRiAL  Fatigue  Keseiircli  Board  reiiort  on 
statistk-al  study  of  labor  turnover  in 
munition   and  otlier  fai-tories   (Broughton 

and   Xewlxild )     172 

hygiene    (Cliamberlain )     12.3 

liygiene  (Oliver)    91 

hygiene  as  factor  in  production    (Xewman)       2 
hygiene,  experiences  with,  in  Bavarian  mu- 
nitions industry    ( Koelsch) 7 

hygiene  in   Toronto,   survey  of  general  con- 
ditions  of.    with    results   of    investigation 

into  lost  time  due  to  sickness 14G 

hygiene,    its    rise,   progress,   and    opportuni- 
ties   (Oliver)    151 

hygiene,    problem    of.    and    co-operation    of 
physicians      in      industrial      suijervision 

(Rasch)    205 

hygiene,   problems   of,   in   relation   to  public 

'  health   ( Oliver  i    245 

management,     human     fai-tor     in     industry 

I  XortUcol  1 1      240 

medical  service,  gee  Medical  service,  indus- 
trial, 
medicine,  see  Medicine,  industrial, 
nurse,   sec  Xurse.   industrial, 
nursing,   see  Xursiug.   industrial, 
physician,  see  Physician,  Industrial, 
poisoning,  xce  under  specific  .poison, 
poisoning,    medical    opinions    on    cases    of 

( Cur.schmann )    24,  GO,  96,  15G 

poisonings  and   their  prevention    (Brezina)   240 
psychiatry,  see  Psychiatry,   industrial, 
psychology,  see  Psychology,  industrial, 
relations,  tive  ways  to  gain  better  co-opera- 
tion    ( Hain     200 

supervision  and  lalior  agreement  laws  (Ben- 
der)      .' 197 

supervision   and  Taylorism    (Bender) 14" 

supervision,    co-operation    of    physicians    in 

(Kasch)    -05 

surgeon,  see  Surgeon,  industrial, 
surgery,   see   Surgery,   industrial, 
training   of   disabled   men    in   Tnited    King- 
dom     177 

wastes,  see  Wastes,  industrial. 

Industry,  health  education  in    (Ford) 94 

mental   hygiene  of    (.Tarrett) 1 

necessity  for  greater  attention  in.  to  main- 
tenance of  efficiency  and  proveution  of  ill 

health    ( Collis)    152 

new  application   of  psychology   to    (Link)..     '■'<(< 
IxFEcno.N.  focal  infections  as  affecting  trivial 

injuries    (Selby)     132 

preventing  spread  of  contagion  in  industrial 

establishments   (Richardson)    272 

wound    (I>nnglas.   Fleming,   and   Colebrook)   132 
Ix.HRiF.s,  see  also  under  specific  parts  of  the 

body. 
INJI'RIKS.  case  of  industrial   injury   in  coopr-r 

(.'^mital)     57 

equipment     and     personnel     for     care     of 

(Lanza)    HO 

focal  infections  as  affecting  trivial  injuries 

(Selby)    132 

French   court   decisions   regarding   incapaci- 
ties from  industrial  accidents 3S 


Injuries,  industrial,  flexion  power  as  index 
to  functional,  efficiency  in  appraisement 
of  disability  in  upper  extremity,  resulting 
from    industrial    injuries     (Barnes) 220 

peculiar  injury  due  to  black  Italian  thread 
( Sachs )     57 

policy  of  I'ullman  Company  in  reporting 
slight    injuries    (Matthys) 141 

severe,  l>y  blunt  force,  early  appearance  of 
secondary  pneumonia  after   (Strassmann)        S 

transportation   of  injured    (Sayers) 235 

IxsuRAxcB.  accident,  results  of  meniscus  op- 
erations after  industrial  accidents,  from 
point  of  view  of  accident  insurance 
(Dubs)    17.5 

casualty,  preventable  losses  in    (Gerster) . .     S7 

German  workmen's  and  emp!,oyees',  social- 
hygienic  results  of.  during  war.  and  prol)- 
lems  of,  in  future    (Hauauer) ST 

health   ( Lynch )    140 

health.  Britisli  Xational  Health  Insurance 
Act  of  Mjiy  20.  1020   (Harris) 41 

health,  fact  .'uid  ojiinion  as  to  Briti.sh 
Xational   Health  Insurance  Act    (Toad)..   150 

health,  report  of  investigations  into  oi)era- 
tion  of  British  Health  Insurance  Act 
( Ramsey   and  Tead  ) 243' 

medicine,  electrocardiography  and  its  sig- 
nificance  in    (  Sachs) 69 

obligatory  sickness    (Borne) 41 

old  age.  legislation  for.  now  up  to  states 
(MacKenzie )     SS 

social,  comparison  of  compensation  insur- 
ance systems  as  to  cost,  service,  and 
security    ( Hookstadt)     .SO 

social,  systems  in  Portugal 199 

state  industrial  accident,  officially  acclaimed 

(Chubb)    •'W 

IxTELLiGExcj;  tests,  see  Mental  tests. 
IxTERXATioxAi.  Association  of  Industrial  Acci- 
dent   Boards    and    Commissions,    seventh 

annual   meeting  of    (Hookstadt) 12 

IROX  and  steel  industry,  accident  frefiuency 
and  severity  rates  in,  1907  to  1?)20  (Clia- 
ney)     234 

and  steel  industry,  accident  frequency  rates 
in.  by  causes.  1913  to  1920  (Chaney) 234 

and  steel  industry,  fatigue  and  efficiency  in 
( Vernon )     H" 

workers,   cataract   in 160 

.TopLix      district,      industrial      conditions      in 

(Mills)     fif- 

KiDXET.    histologic    changes    in,    produced    by 

chilling    (Cicconardi)     217 

Labor  agreement  laws  and  industrial  super- 
vision   (Bender)     ^^~ 

departments  of.  see  under  individual  states. 

laws,  enforcement  of  child  labor  laws  in 
West  Virginia   (Van  Buskirk ) 220 

laws  of  New  York  enacted  in  1921   (Rayer)   174 

laws  of  New  York  with  amendments  to 
August    1.    1921 197 

leL'islation.  Kuropean.  tendencies  of.  since 
the  war    149 

legislation  in  Fr.-ince  during  and  after  the 
war    (Pi.-ard)     225 

legislation   of   1919    (Clark) 149" 


SUBJECT  INDEX 


295 


PAUE 

Labor  le^'isliitioii.  (iiic  day  <if  it'^t  in  sfvoii  for 

Distiict  of  Columbia   workers 10 

maternity   and    (Fraschetti) 28 

policy,     iilaie     of     industrial     medicine     in 

(Geierj    3G 

turnover  in  niunilidii  :ni(l  other  factories, 
statistical  study  of  l  Brouglitou  and  New- 
bold  I 172 

Laddehs,   essentials    of   National    Safety    Code 

for    (Oonnelley )     258 

getting  rid  of  ladder  accidents  (Keefer)...     .")C 

need  of  safety  code  for   (Davidson) 2.")S 

Laws,  labor,  see  Labor  laws. 

Le.\u  absorption,  earliest  positive  sign  of. .  . .  1.^.") 
colors  and  otlii'r  lead  compounds,  reiiula- 
tious  of  Jan.  27,  ]'J2t).  of  imperial  minis- 
ter of  labor  for  establishment  and  man- 
agement of  works  for  iireparation  of.  ...  o7 
contrast  between  l>rain  lesions  produced  by 
lead  and  other  inorganic  poisons  and 
those    caused     by    epidemic    eueeplialitis 

(Ilassin)     15(j 

compounds,   regulations  for  nnmufacture  of  24!1 
pharmacologic    action    of,    in    organic    com- 
bination   ( Mason )     2."><l 

poisoning,  blood  exaniinalion  by  thick  drop 

nietliod  hi  sus|K!ctcd  cases  of  (Schwarz)  20s 
poisoiiiiig,   clironic.    effects   of.    with    spiM'ial 

ref<icnc('   to   arterios<'lerosis    (I'agel l.'id 

.poisoning,    clinical    and    pathological    niani- 

fcslatious    of     I  I'inclierle) 2.'!1 

jioisoning.  comparison  of  mnm|vs  and  iliron- 
ic     load     poisoning     from     standpoint     of 

totalit.v   of  .symiitoms    ( WesselhiH'ft  i 2.'!1 

poisoning,  earl.v  diagnosis  of   (Hottrich)  . . .   is,') 
poisoning,  early  diagnosis  of   (Schoenfeld  (  .     71 

poisoning  in  glass  industry 7 

]>oisoning    in    I'tah.    relation    of.    to    mining 

(Murray)      21!l 

l)olsonini:,    iiulnstrial    (Sliie) !'7 

lioisoning,    induslrial.    early    recognition    of. 

uilh  aid  of  blood  examination  (Welwarii  <! 
IiiiisiPuiMg.  industri.-il.  Micmiirandnm  on.  l."i.  '2'M 
poisoiiiug.   industrial,   nature  of.  in  light  of 

miMlicfil    investigation     (Kiirner) (> 

poisoning,    occupational    (Itandi '^' 

IHiisnning.   pica   fin-  comjilete  suppression  of 

industrial    .saturnism     (Devoto) 20S 

poisoning,    pos.siblo    sonrce    of     (("adenhond 

and    .Tac(iues )     210 

lioisoning.    rare    manifestations    of    (Pa.ssa- 

nellot     (> 

poisoning',   report  of  first  course  on  proph.v- 
laxis  of.  for  iil;int   physicians   of  (German 

lead   color   industries    (Orolict 0.<? 

poisoning;,    simpler   method    of   blood    exam- 

inatiiin  in  suspected  cases  of  (Schwarzl  20S 
Itroci'sscs.    (u-ders    affecting   emplo.vraent    of 

women   and   children    in 202 

white,  prohibition  of  use  of.  in  painting  2()S.  231 

white,  use  of    in  painting 240 

Legislation^.     Austrian,     for     protection     of 
workers,   from   11113  to  1020    (.\d1er-Herz- 

raark) 94.     S5 

for     protection      of     worlcers      in     Holland 

(Seholtel     S.^i 

for    protection    of    workers,    objectives    and 
results  in    (Koplsch') .37 


I'AOE 

IjKgislatio.x.    heaUh.    .tec    Health    legislation. 

insurance,  xee  Insurance  legislation. 

labor,  .see   Labor  legislation. 

now    needed     to     restore     compensation     to 

longshoremen    (Chamlierlain)     SO 

Lioiiri.xo.    advantage    of.     in     relieving    eye- 
strain   ( Keid  I     220 

defective  illumination  as  cause  of  indus- 
trial  accidents    (  Simpson  I IS 

elTe<-tivi'   iiriiiting-plant    illiunination    (Belli      28 

elements  of  good  industrial  lighting   (I)oane)     21 

live  tests  for  good  lisrhting  (Norman) IIS 

good  lighting  increises  production  (Hick- 
erson  ) 2^0 

illumination  as  factor  favoring  production 
I  Harrington  )     2.37 

industrial,  in  relation  to  health  and  safety 
(Caster)     21 

industrial,   year's  developments  in 195 

light  much  neglected  in  efflciency  promo- 
tion   (Doanc)     Itlii 

painting  profits  into  factory 117 

recent  advances  in  mine  illumination  (Miil- 
lerl 82 

selling  better  lighting  as  aid  to  safety,  con- 
servation of  vision  and  increased  produc- 
tion   (Iloevpler)     21 

solvim;  everyday  lighting  problems  (Hib- 
ben )     82 

solving  lighting  difficulties    (Vorch) IIS 

value  of  industrial  painting  from  standpoint 
of    illnmin.'ition    SI 

what  one  i)lant  has  learned  about  lighting 
( McLaughlin  1     21 

where  light  is  wasted 82 

Loio.MoTiM'.    enginomen,    goggles    for    (Soder- 

berg(      10(5 

Lo(;(;i.xo  .-lud  lumbering,  inspections  for  haz- 
ards   in     (  lleroi 57 

industry,  liazards  of,  meclmnical  vs.  human 

( <  'ole  I    57 

r>fiU!KA.NTs.  prevention  of  skin  troubles  from 

cutting  oils   and   omulsiotis 128 

Ireatment   of  skin  afl'eitions  due  to   (Allen)   128 
Lt  Nos.   histologic  changes   in.  following  inha- 
lation  of  bromine 8 

iiillnmnKiti(Ui  of.  among  workers  with 
'riicimas   slag  dust    (Opitz) 51 

iiitlaiuination  of.  case  of  secondary  infec- 
tion with  parasitic  mold  in  coal  heaver 
(I'ezzali)     200 

>L\ONESifM     sulphate     in     arsenic      poisoning 

(Hanson)      .^ 185 

Manoanese  dioxide,  quantitative  distribution 
of  particulate  material  (nianiranese  diox- 
ide)    administered     intravenously    to    cat 

(I)riid<er   and    Shaw) IfS 

ingi>sted  as  oxides  and  siliciites.  absorption 
and   elimination   of    (Reiman   and   Minot)     40 

^lAKviANt)  state  board  of  labor  and  .statistics. 

report    of,   for    1020 225 

Masox.s.   mortality    of    (Oherardi) 244 

Massachttsetts  Industrial  .Vceident  Board, 
report  of  medical   advisor.v  committee  of, 

to   medical   profession 175 

workmen's  oomnensation  act,  medical  ser- 
vice  under    (Ponnahue') .30 

JiATEENiTY   and  labor    (Fraschetti) 28 


296 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


May-Weed,   bullous   eruplion   caused   by    (Se- 

quelra )    213 

Mebical  department  directs  library    (Fort)..   139 

department  helps  cafeteria    (Ansell) 241 

department  in  industry    (Westervelt) 169 

department,  industrial,  of  future   (Chace)..   223 
department  of  Fulton  Bag  and  Cotton  Mills 

( Heyser)     29 

department,     practices     and     functions     of 

( Andrews )   221 

department  proves  its  value   (Robertson)..  222 
Research    Council,    annual    report    of,    for 

1920-1921    289 

Research  Council  report  on  effects  of  alco- 
hol and  some  other  drugs  during  normal 

and    fatigued    conditions 109 

Research  Council  report  on  studies  in  wound 
infection     (Douglas,    Fleming,    and    Cole- 

ibrook)     132 

Research   Council   report   on   T.N.T.   poison- 
ing and  fate  of  T.N.T.  in  animal  body...   127 
service     as     affecting     industrial     relations 

(Cheney)     223 

service,    factory    eye    room    saves    workers' 

sight  and  increases  output   (Dellart) S3 

service   for   employees   of    Milwaukee   Elec- 
tric Railway  and  Light  Company  (Lemon)      30 
service,   fundamental   requirements  for  suc- 
cessful  medical   work   in   industry    (Saw- 
yer)          62 

service,    how    can    medical     service   be    im- 
proved ?    ( Thompson )    31 

service,  industrial,  consultant  in   (Wright).   221 
service,  life  saving  makes  a  popular  appeal 

(Geier)    281 

service,    Michigan    Mutual    Liability    Com- 

jiany   service    (Torrey ) 142 

service,  need  for.  in  industry   (Cumming)..      22 
service,  nose  and  throat  room  of  R.  K.  Le 

Blond   Company    (Dellart) 224 

service  of  Buda  Company    (Tupper) S3 

service  of  Detroit   Stove  Works    (Barbour)   224 

service  of  Gillette  Company 30 

ser^^ce  of  Newport  Company  of  Milwaukee  143 
service  of  St.  Louis  Southwestern  Railway 

(Chace)     222 

service  of  Thomas  de  la  Rue  and  Company 

(TTnderwoodl     238 

service.    Oregon    system   of    (Thompson)...      .'^'I 

service,  systems  of   (MowelH 39 

service     tuider     Massachusetts     workmen's 

compensation   act    (Donoglme) 39 

treatment,   proper,  economy  of    (^lagnuson")      62 
unit,  routine  work  of.   in   factories    (Kapp)      29 
welfare  work  in  small  factories  (Burnham)     83 
Medicine  as  related   to  workers  and  produc- 
tion    ' Andrews)     ll'f' 

industrial,  educative  potential  in   (Geiert..   T'O 
industrial.      from      physician's      viewpoint 

(Geier^      ISO 

induslri.'il.  future  of.  as  labor  policy  (Geiprl     4.*? 
industrial,    lioalth    service    establishes    foot- 
ing   (Selliy)    firi 

industrial,     im.portancc     of,     to     community 

(Collis)     20f; 

induRtri.il.  place  of.  in  labor  policy   (Geier)      3fi 
industrial,     relation    of.    to    public    health 

(Tx'gs'e)     43 

preventive,  and  hygiene,  in   relation  to  col- 
leges   (TjOo)     3 


PAGE 

Meniscus     operation     after     industrial     acci- 
dents, results  of    (Dubs) 175 

JIental  and  motor  efficiency,  effect  of  smoking 

on    ( Froeberg)    lOS 

hygiene  and  child  labia*   (Fuller) 115 

hygiene  in  industry    (Campbell ) 154 

hygiene  of  industry    ( Jarrett) 4 

hygiene,  place  of  occupational  therapy  in 
(Burnette)     229 

hygiene,  practical  application  of,  in  indus- 
try   ( Fisher)     196 

science,  importance  of,  to  industries  and 
commerce    147 

tests,  critical  survey  of  intelligence  testing 
( Sandiford)     240 

tests,  note  on  intelligence  tests  (Johnson)  ITS 
MERC.4NTIU3  health  work,  field  of  (Emmons)  3 
Mercury,  action  of   (Salant  and  Kleitman)..   250 

poisoning,   industrial 1S4 

Metal  mine,  sec  Mine,  metal. 

working     machinery,      safe     practices     on 

(Keefer)     193 

Methyt.  Alcohol  poisoning,  ocular  menace  of 

(Ziegler)     185 

Metol  dermatitis    ("photographers'   eczema")     53 

Migraine,   see  Headache. 

iMiLLiNERY      industry,      conditions      affecting 

health  in   (Hubbard  and  Kefauver) 35 

Mine,  accident  prevention  in  mines  of  Butte, 

Montana    (Harrington)    26 

accidents  in  mines  in  United  Kingdom  in 
1910     26 

action  of  dust  inspired  in  mines  (.Tunghans)     10 

and  quarries  of  United  Kingdom,  accidents 
in,  in  1920 216 

bath  houses,  hospital,  and  heating  arrange- 
ments provided  for  employees  of  Lynch 
mines  in   Kentucky    (Fvanson) 280 

coal,  accidents  in.  in  state  of  Washington. .     72 

coal,  car-pushing  in   ( Hapgood) 124 

coal,  fatalities  in,  in  U.  S.,  1920  (Adams)  ..   216 

coal  (anthracite),  prevention  of  gas  explo- 
sions in    (  Walsh ) 72 

coal  (bituminous),  prevention  of  gas  explo- 
sions   in    (Walter) 26 

dust  reduction  in.  l)y  use  of  wet  stopers 
(Harrington)     271 

hookw<uni  in  California  gold  mines  (Nauss)    101 

metal,  accidents  in.  in  U.  S.  during  1910 
(Adams)     216 

metal,  preliminary  study  of  physiological 
effects  of  high  temperatures  and  high 
humidities  in  metal  mines  (Sayers  and 
Harrington )     58 

metal,  ventil.'ilion  in   (Harrington) 82 

recent  advances  in  illumination  of  mines 
(Miiller)    S2 

use  of  stenches  as  warning  in  mines  (Katz. 

Allison,  and  Egj-) 26 

Miner,  coal,  physiologic^il  cost  of  work  of  col- 
liers  (Waller  and  De  Decker) HI 

consumption  in  minos  of  'Butte.  Montana 
(Harrington  and  Lanza) 101 

flame  safety  lamps,  relative  safety  of  brass, 
copix^r,  and  steel  gauzes  in  (Ilsley  and 
(Hooker)     lt>2 


SUBJECT  INDEX 


297 


Miner,     flame     safety     lamps,     tests     of,     in 
gaseous,  coal-dust-laclen  atmospheres   (Ils- 

ley    and    Hooker) 132 

housing    of    ]4<i 

medical  impressions  of  miners'  strike 154 

Miners'    Phthisis    Board,    annual    report   of, 

for  period  ending  March,  IDliO 271 

MiNl.NG,  coal,  accident  prevention  in 258 

relation     of     lead     poisoning     to,     in     t'tuh 

(Murray)      24!) 

Minnesota  department  of  lal)or  and  industries, 

seventoentli  biennial  reiMirt  of Hi) 

Mortauty  of  masons  (Gherardi) 244 

sickness    and    death    rates    among    German 

printers     244 

MoToit  and  mental  eHiciancy,  effect  of  smoking 

on    ( l'"roeberg )    108 

control    and    ritlc   shooting,    correlation    be- 
tween  ( Spaetli  and  I  >unliain  ( 104 

MuMi's.  comparison  of  mumps  and  chronic  lead 
poisoning   from   standpoint  of  totality   of 

synii)tonis    (AVesselhoeft)    2.'!1 

Munition  factories,  statistical  study  of  lal)or 

turnover  in   (Uroughton  and  Newlnild  I  .  .  .    172 
industry.  Bavarian,  fxperiences  with  indus- 
trial  hygiene   in    (KoclschI 7 

Musci.K,     progresshe     amyotrophy     resulting 

from  labor    (  Vincen/.o ) ISl 

MuscxTLAR    exercise,    ncc    Exevci.se,    muscular. 

work,  .ire  Work,  muscular. 
Myopia,    industrial,    and    selei-tion    of    trade 

( Schneider)     54 

Naphtha     derivatives,     skin      lesions      from 

(Ivoelsch)     11 

Nasai,  septum,  perforation  of.  due  to  inluila- 

tion    of   arsenous   oxide    (Dunlapl 47 

National  Industrial  Conference  Board  report 

on  cost  of  licalth  service  in  industry 120 

Industrial     f'onference     Board     report     on 

liealtli  service  in  industry US 

Industrial  ("onference  Board  report  on  i>rac- 
tical     experience     with     work     week     of 

forty-eiglit  hours  or  less 93 

Nerve,    radial,   paralysis   of.  and   tropliic   dis- 
turbances  following  electrical   burn    (.Tel- 

linek)     112 

Neuroses  in  business  life   (Casamajor) 20-") 

NKw  York  labor  laws  enacted  in  1921  (Sayer)   174 

state  industrial   code 84 

state  laltor  law  wirii  amendments,  additions 

and   annotations   to   Augiist   1.   1921 107 

state    workmen's    compensation    law.    with 
amendments,    additions    and    annotations 

to  Septenilier  1.  1921 225 

Night  emi>loynient  of  yomig  .jiersons   (Beard)   116 
work,    influence   of,    on    health    of   workers 

(Briiekner)    228 

NiTB.\TE  plants,  provisional  regulations  regard- 
ing policing,  safety,  and  beiilth  in 197 

NiTROBENzor.  poisoning,  blood  in   (Loeb.  Bock. 

and  Fitz)    127 

poisoning  from  wearing  dyed  shoe.s  (Neuhoff)     70 
Nitrous  fumes,  acute  poisoning  from   (.Tacou- 

let)     46 

Nurse  in  guise  of  industrial  physician   (Saw- 
yer)      " 2.39 

industrial,    in     metal     mining    communities 
(Martinson)     144 


Nurse,  industrial,  relation  of,  to  employment 

manager    ( Boss)     31 

industrial,  suggestions  for   (Kofauveri 32 

industrial,  talk  on  health  talics  for(Staebler)   2S2 
industrial,  what  industrial  nurse  can  do  for 

community    (Adams)    171 

industrial,  wliat  industrial   nurse  does 14rl 

why  nurses  fail  in  industrial  work    (Scott)     31 

XuKsi.Ni;.   industrial,  in   South    (Dodd) 144 

NvsTAo.Mis.    ocular    nystagmus    and    railroad 

nystagmus   ( Barflny  i    214 

Oak,   dermatitis    venenata    caused    liy    i,Spill- 

maun)    213 

OccupATio.N   and  public  health   (Gottstein) . . .       3 

fractures   incident   to    (Moorliead) 108 

Occupational  clinic,  see  Clinic,  occupational, 
disease,   new   occupational    pain    from    han- 
dling compressed  air  motor    (Moren)....     69 
disease    of    reapers    and    winnowers    (Ghe- 
rardi)       103 

diseases,  cost  of,  under  workmen's  compen- 
sation acts  in  V.  S.  (Ilookstadt) 86 

diseases   in   chemical   industries,   how  work- 
ers   in    cliemical    plants    are    safeguarded 

(Dannerth)     153 

therapy     ( Thompson )     150 

therapy,  place  of,  in  mental  hygiene   (Bur- 

nette)    229 

tlierapy.  vocational  training  versus  (Brown)   200 
Ohio    Industrial     Commission,    work    of,    for 

promotion  of  safety  education    (Lange)..      12 

Oil  camp  sanitation    (Bowie) 279 

refinery,  reduction  of  accidents  in  (Esterly)   215 
Oils,  sec  Lubricants. 

Orange,  bitter,  dermatitis  caused  bv  (Mur- 
ray)       188 

Oregon,  industrial  reluibilitation  in   (Kirk)..     89 
system  of  medical  service    (Tliompson)  . . . .     89 
OuTPiT  and  health,  effect  of  shorter  hours  of 

work  on   10 

quality    of.    hours    of    work    in    relation    to 

(  Kyan   and   Florence) 92 

Oxygen  breathing  api>ai'atiis.  iiermeation  of. 
by  ga.ses  and  vapors  (Fieldner.  Katz.  and 
Kinney)    96 

Paint  as  accident  reducer   (Tillinghast> 220 

as  aid  to  better  management   (Dexter) 138 

how  imint  affects  waste   (O'Shea) 169 

painting  profits  into  .vnur  factory 117 

value  of.  from   stand|M)int  of  illumination..     81 

value  of.  in  redticiuL'  eyestrain   (Reid) 220 

Painter,    causes    of    disease    among    painters 

(Goadliy ) 230 

Painting,    prohibition    of   u.se    of   white   lead 

in   208,  -2.31 

u.se  of  white  lead  in 249 

P.\PER  machine  rooms,  suggestions  on  heating 

and   ventilation   of    (Ryan) 61 

Para-Dichlorrenzene.  properties  and  uses  of 

(Witt)     247 

PaRvVPfin.      paraffinoma      and       wax      cancer 

(Davis)     25 

PARA-PHEN^TENEDiAnnNE    dyes.     anaphylactic 

bronchial  astlima  from    (Gerdon) 4.  4.  5 

Pennsyt.vania.  safety  progi-am  of  (Connelley)     73 

I*ENSiONS.  old  age.  legislation  in  France 198 

Personnel    management,    health    service    side 

of    (Morgan  and  Repplier) 170 


298 


THE  TOURXAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

Person>'El,  management  of  Metroixilitau  Life 

Insurance    Ccimiiany     (\\  asliinylou  ) 172 

Phagocytosis  of  sulid   particles :   carbon   and 

quartz    (Kenn)     125 

Phenol  resins,  dermatitis  among  workers  in 

(Sachs)     213 

Phosgene,    blood    in    poisoning    by     (Achard, 

Lebanc,  and   BInet) 49 

occupational  poisonini;  with   (Gerber) S 

Phosphate,  increase  in  capacity  for  work  due 
to  administration  of  (Embden,  Grafe,  and 

^^chmitz )     250 

Phosphorus    poisoning,    anatomical   diagnosis 

and  histology  of    ( Petri ) 250 

sesiiuisulphide,  match  box  dermatitis  (Frei)   254 
sesquisulpliide.    match    box    dermatitis    and 

conjunctivitis     (Rasch)     212 

I'HOTOtiKAPHERs'  eczema.  see  Metol  dermatitis. 
Phthisis,  see  Tuberculosis. 
Physical  defects,  corrections  versus  compen- 
sation for   (Lee  and  Brown) 41 

efHciencv,   spells  of  rest  and    (Dawson  and 

Wallrich)     Ill 

efficiency  tests,  application  of  ( Scott ) 78 

examination,  advantages  of   (Austin) 63 

examination,    false    standards    of   disability 

in    industry    (Clark) 267 

examination  for  employees   (Douthitt) 22 

examination   of  employees    (t'oleord) 139 

examination  of  employees  of  New  York  City 
Department  of  Health,  results  of  (Glas- 
gow)      281 

examination   of  workers    (Ervin) 170 

examination   of   workers    (Rector) 63 

examination,  .procedure  of  National  Malle- 
able Castings   Company   to   keep  workers 

well    63 

examination,  why  we  have  physical  exam- 
inations at  our  plant  (Bureau) 139 

examination,  winning  employees  to  physical 

tests    (Curtin )    . . , 147 

exercise,  effect  of,  on  heart   (Boigey) 217 

fitness,  tests  for   (Heald  and  Thomson)...,     15 

physique  of  German  workers 266 

standards  for  cliild  laborers   (Baker) 167 

therapy,  influence  of,  in  reducing  disability 
tinio   in    fractures   of  Ions   bones    (Wain- 

wright)     26S 

Piivsic'HN    contracting    witli    industry,    types 

of   (Geier)    44 

co-operation    of.    in    industrial     supervision 

( Rasch )     205 

industrial,     and     general     hospital     (Llnen- 

thnl)    22T 

industrial,  and  practitioner   (Moninn) 22.S 

industrial,  nurse  in  suise  of   (Sawyer) 230 

industriiil.  partnersliiii  between  industrial 
jihysician   and   jtractitioner    (Burlingame)   28(1 

PNEmroKONiosis    155 

and     asthmatic     attacks     in     woodworkers 

(Pinchorle)     2.51 

case    of    (Grahn) 200 

from  inspiration  of  tol>acco  dust  (Palitzsch)   251 

in    guinea-pigs    (Willis) 128 

PxEixroM.v.  secondar.v.  early  apTX^arance  of. 
after  severe  in.iuries  by  blunt  force  and 
after    poisoning     wTth     illuminating     gas 

(Strassmnnn)      ^ 

PoiRONi>r,.  acute,  electrocnrdiographic  studies 

in    (Schott)    45 


PAGE 

Poisoxs.  combined,  experience  witli,  in  indus- 
try  (MuUer)    24 

Polishers  and  grinders  in  ax  factory,  tuber- 
culosis   among    ( Drury ) 52 

Porcelain  and  earthenware  industries  from 
standpoint  of  protection  of  workers  and 
neighborhood,  and  measures  for  fighting 
danger    (Thieme)    153 

Postal  employees,  health  and  welfare  of . . . .  124 

Posture,   industrial,  and  seating    (Hilles   and 

Conger)     135 

relation  otto  industrial  health  (Hilles)  110,  135 

Pottery     workers,     health     hazards     of     (La 

Forge)     10 

Printer,  industrial  dermatosis  among  print- 
ers   ( McConuell )     102 

sickness  and  death  rates  among  German 
printers     244 

Printing,  conditions  in  typographical  indus- 
try  in  Rome   ( Ranelletti) 35 

plant,  effective  illumination  for    (Bell)....     28 
press,  protective  device  for   (Scholte) 162 

Psychiatry,  application  of.  to  industry,  report 

on  (Stedman  and  JIaePherson) 35 

industrial    (Wright)     .181 

Psychology,    industrial,    present    attitude    of 

employees    to    (Brierley) 35 

new  application  of,  to  industry   (Link)....     36 

Psychopathic    employee,    industrial    cost    of 

( Powers )    95 

PsYCHOTECHxics.  industrial,  laboratory  for, 
at  technical  training-school  in  Charlotten- 
burg   (Woede)    68 

Purpura    hemorrhagica,    rare    disease    caused 

by  fumes  of  benzol 23 

Pyrbtthrum  industry,  occupational  dermatoses 
among  workers  in  (McCord.  Kilker,  and 
Minster)    120 

QT7ARRY      accidents      in      T'.S,      during      1011) 

(Adams)     72 

R.'U)iu.M  and   X-ray   workers,  protection  of...  154 

in  safet.v  movement 13 

treatment    of    roentgen    dermatitis    (Bergo- 

ni6)    18S 

workers,  effect  of  increased  protection  from 
radiation  ui)on  blood  condition  of  ( Mot- 
tram)     . 205 

Rag-Be.\ting   and   tearing   machines,    removal 

of  ilust   from    ( Morgner) 00 

RAiLROAt)s.  accidents  on,  in   United  Kingdom 

in  1010   26 

occupation   hazard  of  railway  shopmen....   274 
Railways,    diseases    of    ear    in    railwa.v    em- 
ployees working  at  high  altitudes   (Ciam- 

polini )     189 

employment  of  women  on.  as  conductors  and 

ticket    agents    H"* 

Reapers  and   winnowers,  m'cupational  disease 

of    (Gherardi)    103 

Recreation     activities    of    Clark     Equipment 

C^ompany    ( .\ltnian)    -"*- 

Rehabilitation,  bill  proposed  for  co-operation 
by  all  stales  under  new  federal  law  for 
rehabilitation  of  industrial  cripples   (Mac- 

I-        •    1  4'' 

Nenzie)     ^- 

Chicago  service  league  restores  handicapped 

to  industry    200 


SUBJECT   INDEX 


299 


liEHAMMTATioN,    functioiis    of    special    school 
at   Niiuvoo  fur  inactive  tulx-rculuus  cases 

( Tiiruei)      15(1 

industrial,  in  Oregon    (Kirk) S!l 

iiiiliislrial.  in   I'.   S ITU 

industrial,    status    of 17(; 

occuiuilional   tliorapy    (Thompson ) loO 

occupations   in    automoliilc   iiKlustry   as  em- 
ployment objectives  for  disabled 1201 

of  injured   employees:    I  lie   industrial   cpies- 

tion     (Cotton)     !Kl 

of  tuherculous  in  District  12  (  Hartlett )  .  . .  4li 
report   of  activities  of  l)iirean  of  relialiilita- 

tion   to  .lanuary   1,   liVJl ITS 

salvairiiiK      humanity      a      social      necessity 

( Munroe)    17") 

taUin;.'  care  of  industrial  <'ripple  (Bryant)  26>< 
traininj;  of  disabled  nt  Iowa  Slate  College..  ><il 
vocational,   of  jK-rsons  disabled    in    industry 

or  otherwise   41 

vocational,     .problems     of     maintenaiu'c     in 

( Kratz)     201 

Re.spibation.    artificial,   aiivertise    prone    iire.s- 

sure    resuscitation     (T,auft'er) 21.T 

resjiiratory   efliciency    in    reI;ition    to    health 

and    disease    (Vlnrk  I 230.  Sin.  2.^0 

Rkspiratiihs.   Industrial    (Levy  and  West)....   217 
respiratory  ;ipparat\is  for  prote<'lion  nsninst 
carlxui     monoxide     (Desgrez.    rJuillemard. 

ITemmerdinKer  and   T,nt>at) 24S 

H'KSt    .ind    plivsical    etficiencv    (Dawson    and 

WallriclO      Ill 

effect  of  short  spells  of,  on  ph.vsical  ellicien- 
<-y     :is     nu^asured     by     bicycle    ersonieter 

( Wallrich    and    Daw.son) Hi." 

Restai'bant.  hours  of  women  workers  in.   in 

Minnesota     VM 

indiistrial.  as  service  nucleus  (DeTTarl)...  14* 
iu<Iustrial,    larfiest    industrial     cafeteria     in 

world     ll.** 

industri.'il.   plant    lunch    room    health    factor 

(Dellart)    14'« 

iMi'dical    depMrtnieiit   of  New  England   Tele- 
phone  Company   he1t)s   cafeteria    (.\nsein   241 
of  .Morse  Dry   Dock   and   Uejiair  Company..    2()S 

serving  meals  at   a  loss    (Ilol)art) 242 

"UESU.SPITATION .  proue  pressure  (Lauflfer) 215 

EocK   dust,  inhalation  of KVr 

RuniiER   manufacturing,   benzene   i>oi.soning   in 

(Quinliy)    l.'iT 

■Safktv.  xcc  also  uiuler  .\ccidents. 

SAFirrY,  acetylene  g(>nerator  precautions 10.'! 

amid    slaughter     ( Uesnick) 274 

and  ac<'i(l(Mit   prevention    (1/nnge) 103 

appli.-inces.  legal  responsiliilitv  for  provision 

of    (Hirsing)     " 14 

brakes   for   elevators    (Dorn) 1!14 

campaign    against    defective    and    iiii.proix^r 

hand    tools    1(17 

Cleveland    company    makes    toggle    ]iresses 

safe    14 

closing  devices  for  carboys "•> 

code  for  ladders,  need  of  (Davidson) 25S 

courts     and     accomplishment     of     worlcers' 

safety    (Schilling)     '. ST 

dehydration  fMiuipment  as  safety  field 131 

devices  for  automatic  barrel  washers  (Rehr)  104 
disadvantages    of    wooden    machine    guards 

(Benedict)    T'S 


PAGE 

Safety,    disconnecting   hangers   as    safeguard 

( Thompson )     15 

disijensary  on  construction  job   (Davis  and 

(Jeorge )     73 

do  safely  drives  pay?   ( Bahcock ) 189 

educati(Ui,  what  Ohio  State  Industrial  Com- 
mission     has      done     for     promotion     of 

(Lange)    12 

engineer,  duties  of    (Beyer) 257 

engineering,  education  in,  as  given  at  I.ynn 
(Jeueral  Klectric  Kngineering  and  Appren- 
tice  School    (DuChemin) 214 

engineering  factor  in    (Forster) 257 

engineering     revision,     engineer's     part     in 

safety   (Tolman )    liU 

essentials  of  National  Safety  Code  for  lad- 
ders   ( Connelley  )     25S 

fi-atures  in  high  tension  generating  stations 

and   substations    (Samuels) 218 

features   of   steam    boiler   aeces.sories    (liil- 

leary »    107,  107 

features  on   high  voltage  transmission  lines 

(  von   I  >annenberg)    194 

linger    guard    for    iK-centric    presses     (Kck- 

slein )     194 

from    accident    and    lire    in    wood    working 

Industries     iCreiniK^)     194 

goggles    for    locomotive   enginemen    (Sixler- 

berg)    lOfi 

goggles  save  eyes  every  day 11 

hip  length  leggings  protect  pourers  in  foun- 
dry        106 

hook  prevents  mine  car  grade  accidents. . . .   210 
how  Canadian  company  solved  goggle  prob- 
lem   ( Kuechcnmclster)     257 

how  to  make  tloors  safe 162 

in    construction    industry    (Davidson) 56 

in    factory     ( I'ranklin  I 214 

In  relation  to  electrical  a|«i)liances   (I'ieri-e)    131 

in    steel    making    (Salisbury) 234 

Industrial  lighting  in  relation  to  ((Jaster)..     21 

imlustrial   safety    organization 1.30 

inspiH'tions    for    hazards   in    lumhering   and 

logging    ( Hero)    57 

lamps,  relative  safety  of  brass,  copper,  ami 
steel  gauzes  in  miners"  tlame  safety  lamps 

(  llsley  and   Hooker) 192 

lamps,   tests  of,   in   ga.seous,  coal-dust-laden 

atmospln-res    (llsley   and   Hooker) 132 

methods  .as  applied  in  loading  and  unload- 
ing of  steamships   (Welch) 107 

movement,    radium    in 13 

National  Safety  code  for  protection  of  heads 

and   eyes   of  industrial   workers 106 

organization    (Costigane)    13 

practical  gimrd  for  contact  points  of  sheave- 
wheels   and    cables    (Osgood) 14 

practical  viewpoint  of  safety  and  produc- 
tion   (OarteD    275 

precautions  to  he  observed  in  entering  al)nn- 
doned   exploratory  shafts  and  pits    (Pick- 

nrd)     274 

problems   of  today 130 

procedure     for     eye     protecti<m     campaign 

(  Rosseland )     2.3.3 

railroad   safety   work    (Resnick) 2.3.3 

relation    between    safety    and    service   work 

(Fisher)    275 

reiiuirements  of  woodworking  shops  (Keefer)    162 


300 


THE  JOURNAL  OF  INDUSTRIAL  HYGJENE 


•  TAGF, 

SAiETY,   1-ult.s   and   regulatious   for  safeguard- 
ing   woudwurliiug    maeuiuerj' ]4 

safe  elotlimg  fur  cuemicjal  workers  (Kepuer)  105 
sate  clotliiug  for  factory  workers  (Lamb)  105 
safe  elotliing  for  womeu  workers  (.Edwards)  106 
safe  (.•lutiiiug  reduces  burus  of  steel  workers 

50  iJer  ceut 105 

safe  practices  on  metal  working  macMuery 

( Keefer)     19"^ 

safeguarding  of  electrical  hazards  (Balliet)  194 
safeguarding  woodworking  machinery  (I<ov- 

ett)    1-i 

saving  men  and  money   (Resnick) 55 

saving  meu  and  money   at  du  I'ont  plants 

(Resnick)     'i'J 

selling  better  lighting  as  aid  to  (Hoeveler)  21 
standards  for  trench  construction    (Browu- 

ell )     19a 

steam  boiler  or  steam  pressure  apparatus? 

(Schlippe)    234 

steam  boiler  safety  and  oiieration   (Snyder)   234 
strength  of  hoisting  cables  needs  more  at- 
tention        lt)2 

to  life  in  ship  construction    (Brandensteiu)   106 

trip  for  punch  presses  (Wildouer) 217 

twenty-tliree  thousand  lives  saved  by  safety 

work   in   1919 : 275 

two   new    protective   devices   from    Amster- 
dam Safety  Museum    ( Scholte) 162 

what  Pennsylvania  is  doing  for  safety  and 

safety  codes    (Connelley) 73 

where   a    hell-hole    might    have   been    (Res- 
nick)      161 

work,    co-ordination    o£'  fatigue    study    and 

( Oillireth    and    Gilbreth ) 257 

work   in  shipbuilding  Industry,  i>rogress   of 

( Walsh )    14 

work    of    federal    government     (Rosa    and 

Oakes)     189 

work    of    I'nited    States    Steel    Corporation 

(Itesnickl      190 

Sanitation    (Wright  and  Slocock'* SO 

In  bakeries    (Barnard) SI 

in    oil   camps    (Bowie) 279 

industrial    (Fitch)     20 

industrial,  affects  public  health    (Hubbard)    16S 

labor  camp  sanitation    (Miller) 195 

of  fruit  and  vesetable  canneries   (Miller)..   2^)4 
outline  of  health  first  campaign  for  Indus- 
tries   ( Soderberg)    CI 

sanitary   control   in   manufacture   of   foods. 

economic   importance   of    (Orindrort) 264 

Saturnism,  see  Lead  poisoning. 

Saw.   circtilar.    prevention    of   accidents   from 

(Farra)    162 

Scientific    5IANAGE^tENT,    Taylor    system    in 

Europe    266 

Taylorism  and  industrial  supervision   (Ben- 
der)      147 

Scij;uoDACTixi-\,  -tee  Skin  diseases. 

Seamen,  suggestions  for   safeguarding  health 

of    (Mackeown)     22S 

Seating  in  industry,  practical  experiments  In 

(Ilillps)    166 

industrial  posture  and   (llilles  and  Conger)   135 
legal    requirements    regawling   seats    in    in- 
dustry   (Hilles)    275 

seats    for   workers    in   factories    and    work- 
shops       136 


SHiPBUiLWNG     industry,     progress     of    safety 

work  in    ( Walsh) 14 

satety  to  life  in   (Brandensteiu) 106- 

Shoe  and  boot  factories,  prelimmary  notes  on 
atmospheric   conditions   in    (Hambly   and 

Bedford;     ll^i 

and    boot    iudustry,    preliminary    notes    ou 

(Loveday   and   Munro) 33 

dust  in  bootmakiug  industry    (Sardi) 100 

dye,  iJoisoning  from    (Xeuuoff ) 70 

Shouluek,  sclerosis   in   arteries   of    (Torraca)   Ifjl 
Sickness     among     New     York    State    factory 

workers   in   1919 202 

among  telephone  employees  in  Italy 243 

and   death   rates   among   Uerman  printers.  .   244 

and  employment,  application  of  statistics  to 
study    of    (Thiele) 05 

frequency  among  industrial  employees..  90,  202 

frequency  among  industrial  employees ;  dis- 
ease prevalence  among  wage  earners  dur- 
ing first  half  of  1920 34 

insurance,  see   Insurance,  sickness. 

plan  for  sick  leave  with  i>ay    (ilachol) . . . .   148 
Silk     mill     village,     tuberculosis     survey     of 

(McBra.ver)     84 

SiL\-ER  and  gold  plating,  poisoning  with  hydro- 
cyanic acid  gas  in   (Holtzmann) 70 

Skin  affections,  treatment  of   (Allen) 128 

carcinoma  cutis  in  anthracene  fa(!tory 
( O'Donovan  (     187 

diseases,  anhidrosis  following  toxic  derma- 
titis   ( I'atzsche  and   Plant ) '. 273 

diseases,  case  of  bullous  eruption  caused 
by  Jlay-wced    (Sequeira) 21c5 

diseases,  case  of  dermatitis  due  to  aspara- 
gus   ( Brenuing)    129 

diseases,  crude  coal  tar  in  dermatology 
(White)    273 

diseases,  dermatitis  among  workers  in  cane  103 

diseases,  dennatitis  among  workers  in  phe- 
nol  resins   ( Sachs) 213 

diseases,  dermatitis  caused  by  bitter  orange 
(Murray)     188 

diseases,  dermatitis  due  to  carpogly.phus 
passularnm    (O'Donovanl     71 

diseases,  dermatitis  venenata  caused  by 
oak     ( Spilliiiann )     213 

diseases,  dcrmntdsis  dy.strophic-a trophic  of 
lower  limbs   from   chilling 12 

diseases,  folliculitis  caused  by  sodium  bo- 
rate   255 

diseases,  industrial  dermatosis  among  .print- 
ers   (McConnell)    102 

diseases,  matcli  box  dermatitis   (Frei) 254 

diseases,  malch  box  dermatitis  and  con- 
.iunctivitis    (Rasch)    212 

diseases,  metol  dermatitis  (photographers' 
eczema )     ^3 

diseases,  occupational  dermatitis  in  den- 
tists, caused  by  procain    (TjJine) 71 

diseases,  occupational  dermatoconiosis 
among  zinc   oxide   workers    (Turner)  ....   212 

diseases,  prevent  ion  of  skin  troubles  from 
cutting  oils   and   emulsions 128 

disen.sps.  pyrethrum  dermatitis  (McCnrd, 
Kilker.   and    Minster) 129 

diseases,  rndiiun  treatment  of  roentgen  der- 
matitis   (P.erizanif^)     188 

diseases,    sclerodactylia    (SenHeirn) 213 

diseases,   trauma    as  factor  in    (Alevolii...   102 


SUBJECT   INDEX 


301 


I'AOE 

Ski^  lusious  frum  coui  tar  ami  uaphtbu  deriv- 
i.tives    auU    their    pliotodyuamiu    aspects 

(Koelsch)     11 

lesions  iu  briquette  makers  uud  their  rela- 

tiou  to  war  melauoses   (Schiirerj 1114 

Slaughteb-Houses,  safety  work  iu   (Uesnick)   274 
Smoiuing    aud    meutul    aud    motor    efficieucy 

(Froubergj 108 

Soci^vL   hygieue,   soeial-liygienie   conditions   of 

hotel  personnel  iu   Home 92 

hygiene,  sucial-hygieuic  results  of  German 
workmen's  aud  employees'  insurance  dur- 
ing    war,    and     its     probleuis     iu     future 

(llauauer)     S7 

Sodium  borate,  folliculitis  due  to 255 

Spumks,    wrist,    patliology    of     (Cyriax    aud 

Melville)     108 

Stkki.   and   iron   industry,   accident   frequency 
and  severity  rates  iu,  1907  to  1920   (Cha- 

ney)     ■ 234 

and  iron  industry,  accident  frequency  rates 

in,  by  causes,  1913  to  1920  (Clianey) 234 

and  iron  industry,  fatigue  and  ediciency  in 

(Vernon)     110 

industry,  three  shifts   in    (Shaw) 16 

w-orkers  iu  I'onnsylvania  city,  diseases  prev- 
alent   among    ( Hrundage) 90 

workers,  reduction  of  l)urns  among,  hy  nse 

of   safe    clothing 105 

workers,   sixty   days  no  accident   record   of 

1,3(111   steel    workers 162 

Ste\'ei)oiiixc.    safety    methods    as    applied    in 

(Welch)    107 

Sur.pin'u  industry  of  Catania,  hygienic  condi- 

tious   in    (Snngiorgl) 23 

StiRGEON,     industrial,     and     individualization 

(Bettm.an)     LIS 

SuR(!Ei!Y.  industrial,  as  specialty  (Shernian)  15 
industrial,  tlatfoot  as  probloni  of  (nettman)  164 
Industrial    surgical    service — past,    present. 

future    (French )    275 

traumatic,   problems  of   (Moorhcad) lOS 

SvpiiiLts.  HOC  nlan  under  Venereal  Disease. 

SYriiiris   iu   glass  blowers    (Rajla) 1S6 

nieniornndiim  on  occupational  study  of,  with 
special  rcforence  to  farmers  (  Stoke-:  ;ind 
Brehmer) 232 

T.\n    melanosis     iu    making    of    dry-batteries 

(Ariistein)     11 

sarcoma  in  rabbit  (Yamaglwn.  Suzuki,  and 

iMurayama ) 156 

Teijspitone.    bacterial    content    of    telephones. 
^        with     special     reference     to     respiratory 

pathoL'ens    ( Saelhof )    100 

employees,  sickness  among,  in  Italy....'...  243 
exchanges,  hours  of  women   workers  in.  in 

>i'innesota     il-^" 

field,  accident  prevention  and  first-aid  work 

in    cnowney'i    2?i~ 

industry,    investigation    of il7 

TEi.i.TTiirNr.    toxicology    of 6 

TEMPFnATTTiE.   arterial   pressure  among  work- 
ers in  high   temporatnrps    (TedeschI) . . . .   112 
keeping     factory    temperatures    where    you 

want    them     (TTubhard) 138 

preliminary  study  of  physiological  effects 
of  hiuh  temperatures  and  high  humidi- 
ties in  metal  mines  (Sayers  and  TTar- 
rington ) 58 


PAOE 

Tests,      physical     ethciency,     application     of 

(Scott)     78 

trade,  see  Trade  tests. 
Tetr.^xitrometuaxe    vapors,     pulmonary    tu- 
berculosis   resulting    from    inspiration    of 

( Curschnumn  )     8 

Textile   mills,   night-working   mothers   in.    in 

Passaic.  N.  J.   ide  Lima ) 59 

Time  Stuwes,  making  time  studies  pay   (May- 

nard)     94 

Tobacco    pneuniolconiosis    (Palitzsch) 251 

Toronto,  survey  of  general  conditions  of  in- 
dustrial   liygiene   in 14G 

Tr.\de  tests,  use  of.  iu  building  a  better  force 

of   workers    ( lienge ) 37 

Transmission     nmchiuery,     preventing     acci- 
dents on    (Keefer) I<i2 

Tbichlorethyi-exe.  death  as  sequel  to  respira- 
tion  of    (Curschmaun) 156 

Trinitrotoluexe  poisoning    (Lewin) 250 

poisoning  and  fate  of  trinitrotoluene  iu  ani- 
mal   body     127 

poisoning,    industrial    (Ilubiuo) 48 

Trinitrotoi.voi,   death    following   employment 
with,     caused     by    poisoning    or    by    pre- 
existing liver  disease?   (Curschmann)  . . . .   156 
Tlbeucvi.osis       after       industrial       accidents 

(Broca)    209 

among  polishers  and  grinders  in  ax  factory 

( I  )rury )      52 

annual  report  of  Miners'  Phthisis  Boitrd  for 

Iieriod  ending  March,  1920 271 

employment  of  tuberculous    (Rogers). 211 

examination   of   food   handlers  from   stand- 
point of    (Fine) 100 

exiierimental.  effect  of  nitrous  oxide,  natu- 
ral gas  and  formaldehyde  on  (Rogers)...  254 
funcli(ms   of  special   school   at   Naiivoo  for 

inactive  tuberculous  cases    (Turner) 150 

in  a  chemical   plant    (P.achfeld) 186 

in   Xew   York   Citv   attacks   men   especially 

(Droleti 209 

medical  results  of  Framingham  comnniuity 
health     and     tuberculosis     demonstration 

(Armstrong  and  Bartlett) '. 172 

miners'  phthisis  in  mines  of  Butte  (Har- 
rington   and    Lanza) 101 

of  husband  and  wife   (Barnes) 254 

jirevention  of.  keeping  workers  well ,     11 

problem  of  tuberculous  employee  in  industry 

( Mock  and  Kllis) 253 

pulmonary,    as    result   of   inspiring   tetrani- 

tromethane  vapors  (Curschmann) 8 

pulmonary,    presence,    absence   .and   location 

of  rales  in  prognosis  of  (Trudeau) 210 

rehabilitation   of  tuberculous  in  District  12 

(Bartlett) .., .......     42 

studies  on  .  tuliorcidous  infection:  spontan- 
eous pneumokoniosis  in  guinea-pigs  (Wil- 
lis)        128 

survey  of  silk  mill  village  (McBrayer) 84 

Tumors  of  bladder  among  aniline  workers...     70 
of  bladder  in  workers  in  chemical  industries 

(Schwerin) 7 

tar  sarcoma  in  rabbit  (Tamaglwa,  Suzuki, 
and   Murayama )     .••;?■'>  156 


302 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


United  States  luteiilepaitmental  Social  Hy- 
giene Board,  report  of,  for  fisoal  year 
ended   June  30,   I'JL'l '25H 

Ursol  asthma,  experimental  investigations  on 

calcium  tlierapy  in   ( Jlelil) 182 

clinical    and    exiieriniental    observations    ou 
anaphylactic     bronchial     asthma     among 
workers  in  furs  dyed  with   (Curschmann)     95 
liarmful  effects  of,  among  workers  in  furs 
(Ritter)    1S2 

Venereal  Disease,  industrial  application  of 
army  and  navy  venereal  disease  records 

(Everett  and  Clark) 187 

report    of    U.    S.    Intertlepartmental    Social 
Hygiene  Board  for  fiscal  year  ended  June 

30,   1921    253 

Ventilation    ( Sherlock)    118 

in   metal  mines    (Harrington) 82 

making  the  factory  a  better  place  to  work  in     82 

monitor  system  of    (Griffin) 265 

suggestions     for     heating     and     ventilating 

paper  machine  rooms    (Ryan) CI 

weather,  and  common  cold    (Palmer) 265 

Vibration,  elimination  of   (Hubbard) 11" 

Visceroptosis,   normal   incidence  of    (Bryant)   246 
Vocational  rehabilitation,  see  Rehabilitation, 
vocational, 
selection   for  specialized   tasks :   a   study   of 
selective  tests  for  Ilollerith-macirine  oiier- 

atives    ^6 

training       versus       occupational       therapy 
(Brown)     200 

Wage    Kauners.     disease    prevalence    among, 

during  first  half  of  1920 34 

Washington,  coal  mining  accidents  in 72 

workmen's    compensation    act,    systems    of 
medical   service   provided    by   amendment 

to   (Mowell)    39 

Wastes,    industrial    243 

industrial,    in    relation    to    water    supplies 

(Donaldson)    ^2 

Water,    pure    drinking    water    for    industrial 

plants    (Buswell)     -9 

supplies,    industrial    wastes    in    relation    to 

(Donaldson)    82 

WBa,Dixo.    autogenous,    dangers    to    health    in 

( Adler-Herzmark)     157 

Wra.FARE  in  factories  and  workshops    (.\nder- 

son)     44 

provisions  that  help    (Thompson) 173 

Victory  Garden  .Association  of  Westinghouse 
Electric     and     INIanufacturiiig     Company 

(Earth)    268 

work,  does  welfare  work  pay?  (Peacock)..   147 
work  of  Continental  Motors  Corporation...   171 
West    Virginia,    enforcement    of    child    labor 

laws  in    (Van  Buskirk) 220 

Wisconsin,   industrial   accident   frequency   in. 

1915  to  1020   ( .\ltmeypr) 191 

Women  and  young  persons,  emiiloyment  of,  in 

lead   processes    262 

and  young  persons,  new  British  legislation 

affecting   114 

causes  of  work  accidents  among  (Swartz) . .   167 
effects  of  legislation  limiting  hours  of  work 

for    137 

employment  of.  in  Five  and  Ten  Cent  Stores  218 


TAGE 

Women,  hours  of  work  of,  in  restaurants  and 

tcleplione   exciianges   m   Minnesota 137 

in  industry,  health  piolilems  of   (Anderson)   114 

in  industry,  new  place  of — new  industrial 
professions     ( Tarbell) 167 

in  industry,  new  place  of,  women  of  Inter- 
national  Harvester  Company    (Tarbell)..     59 

in  industry,  standards  for  employment  of..   262 

listing   work   of    ( Sluibert) 167 

a  new  force   in   industry    (Tarbell) 262 

new  position  of,  in  American  industry 17 

uiglit-working  mothers  in  textile  mills,  Pas- 
saic,  N.   J.    (de   Lima) 59 

physiological  liasis  for  shorter  working  day 
for    ( Webster )    79 

street  ear  conductors  and  ticket  agents....   114 

wage  earners  in  Georgia,  working  conditions 
of     237 

work  accidents  among  (Swartz) 27 

work  and  fatigue  in  puerperal  state  (Car- 
lini)     195 

workers,  safe  clothing  for  (Edwards) KKi 

Wood  Alcohol,  see  Methyl  Alcohol. 
Wood    preserving   industry,    outbreak    of   zinc 
chloride     poisoning     among     workers     in 
( McCord    and    Kilker) 48 

workers,  pneumokoniosis  and  asthmatic  at- 
tacks   in     (Pincherle ) 251 

working  industry,  safety  from  accident  and 
fire  in  (Orempe) 194 

working  macliincry.  rules  and  regulations 
for  safeguarding   14 

working  machinery,  safeguarding  of  (Lov- 
ett)     14 

working     shops,     safety     requirements     of 

(Keefer)     162 

Wool  and  hair,  memorandum  on  disinfecting 
station   establislied    in    Great   Britain    for 

disliifection  of   211 

Work,  collier's,  .physiological  cost  of   (Waller 

and  De  Decker) HI 

household,  energy  exi>enditure  in  (Lang- 
worthy    and    I'.arott) HI 

increase  in  c'liKicity  for,  due  to  administra- 
tion of  plio.spliate  (Embden,  Grafe,  and 
Schmitz)     2.'i9 

muscular,  carbon  dioxide  excretion  of  man 
in  wrestling  and  fencing  (Gullichsen  and 
Soisalon-Soinincn)     259 

muscular.  lUiysiological  cost  of  (Hill  and 
Campbell)     K^l 

muscular,  physiological  cost  of.  reply  to  ob- 
jections   (Waller  and   De  Decker) 260 

muscular.  physioloL-ical  cost  of:  significance 
of  rcsjiiratory  iimitient  in  indirect  calori- 
metry     (Orr   .ind    Kinloch) 164 

physical,   size  of  licart.  blood   nrcsiire  "nd 
pulse,     before,     during     and     after     short 
periods  of  hoavv   physical   labor    (Bruns)   260 
tenement    bonio    work    in    New    York    Cit.v 

( Schonherg)     27 

Workmen's     Comim-nsation.     are    aNo     under 

Compensation. 
Workmen's   Co^tfENSATiON   Act  of  Massachu- 
setts,  medical   service   under    (Donoghue)      39 

Act  of  Washington,  systems  of  medical  ser- 
vice provided  by  amendment  to  (Mowell)     39 
Acts  in  T'.  S..  cost  of  occupational  diseases 
under  (Hook.stadt)    §6 


SUBJECT  INDEX 


303 


PAGE 

WOBKUEN's  CoMPE-NSATiox  and  social  iusur- 
auce,  comparison  of  compensation  insur- 
ance   systems    as    to    cost,    service,    and 

security    (Hookstadt)     S6 

flexion  power  as  index  to  functional  effi- 
ciency in  appraisement  of  disability  in 
upper  extremity,  resulting  from  indus- 
trial   injuries    (Barnes) 22(3 

for  loss  of  one  eye   (Siegrist)    243 

law,  court  decisions  on  constitutionality  and 
coverage,    .January,    1920,    to    June,    3921 

(Mcf'onachie)     j74 

law  of  New  York   State,  with  amendments 

to   September   1,    1921 025 

legislation  in  Canada ,  ] ,  ~85 

legislation  of  V.  S.  and  Canada   (Clark  and 

Princke)     gf. 

trend  of   (French ) 85 

what  constitutes  fair  estimate  of  loss  of  use 
of  eye  in  workmen's  compensation  cases' 

(Mehn    ;;  174 


PAQE 

Workmen's  Compensation,  with  esix>cial,  ref- 
erence to  loss  of  vision    ( Allport) 40 

Wound  infection,  studies  in  (Douglas,  Flem- 
ing,   and    Colebrook) 132 

Wkist  sprains,  pathology  of  (Cyriax  and  Mel- 
^le)     10s 

X-Ray  and  radium  protection 154 

Zinc  chloride  poisoning,  report  of  outbreak 
among  workers  in  wood  preserving  in- 
dustry  ( McCord  and  Kilker) 48 

foundry  fever    (Rost) 69 

industrial  conditions  in  .Toplin  district 
(-aril's)     ■. : 66 

occurrence  of— biochemical  studies  on  ma- 
rine  organisms    (Bodansky) 15 

oxide,  occupational  derma toconiosis  among 
workers  in   (Turner) 212 


AUTHOR  INDEX  TO  VOLUME  III 


PASE 

Abrami,  P.,   see  Widal,  F. 

Ac-hard,    Lebanc,    aiul    Binet :    The    Blood    in 

Poisoning  by  Carbon  Oxj-cbloride  (Phosgene)     49 
Adams,  B.  W. :  "What  an  Industrial  Nurse  Can 

Do  for  a  Community 171 

Adams,  J.  M. :  Standard  Oil  Company  Health 

Service    170 

Adams,  W.  W. :   Coal-Mine  Fatalities  in   the 

United  States,   1920 21C 

Adams,   W.   W. :   Coke-Oven   Accidents   in   the 

United  States  during  the  Calendar  Year  1920  258 
Adams,   W.  W. :    Metal-Mine  Accidents  in  the 

United  States  durmg  the  Calendar  Year  1919  216 
Adams,    W.    W. :    Quarry    Accidents    in    the 

United  States  during  the  Calendar  Year  1919     72 
Adler-Herzmark,  J.:  Austrian  Legislation  for 

Protection  of  Workers  from  1913  to  1920.  .84,  So 
Adler-Herzmark,    J. :    Dangers    to    Health    in 

Autogenous  Welding 157 

Aievoli,  E. :  Trauma  as  Factor  in  Skin  Disease  102 
Alajouauine,   sec  Laignel-Lavastine. 
Alexander,   J. :   Occurrence  and  Prevention  of 

Industrial  Accidents 54 

Allen,  F.  C,  Jr.:  Pneumatic  Systems  for  Re- 
moval of  Dust 127 

Allen,   L.   H. :   Methods  of   Selling  Houses   to 

Employees     145 

Allen,  "0'.  C. :  How  to  Trent  Skin  Affections  of 

Employees 12S 

Allison.  V.  C,  see  Katz,  S.  H. 

AUport,    F. :    '^^'orknien's    Compensation,    with 

Especial  Reference  to  Loss  of  Vision 40 

Altman,  T.  W. :  This  Provides  Recreation 242 

Altmeyer,    A.    J. :    Industrial    Accident    Fre- 
quency in  Wisconsin,  1915  to  1920 191 

Anderson.   A.   M. :   Welfare   in   Factories    and 

Workshops     44 

Anderson.  M. :  Health  Problems  of  Women  in 

Industry     114 

Andrews.  C.  A. :  Medicine  as  Related  to  \\''ork- 

ers   and   Production 179 

Andrews.  J.  B. :  Legislative  Program  of  Acci- 
dent Compensation  for  "Maritime"  Workers  197 
Andrews,  R.  E. :   Practices  and  Functions  of 

the   Medical   Department 221 

Angove,    IT.    H. :    Does    Accident    Pi-evention 

Pay?    Why  We  Think  It  Does 274 

Ansell.    E.    H. :     Medical    Department    Helps 

Cafeteria    241 

Arkwright,  .T.  A.,  xce  .Tacob.  F.  H. 
Armstrong.  D.  B..  and  Bartlett.  P.  C. :  Frani- 
ingham  Community  Health  and  Tuberculosis 
Demonstration.     Certain   Medical   Results..   172 
Arnstein.  A.:  Tar  Melanosis  in  the  Making  of 

Dry-Batteries    11 

Astlo.   W.    C. :    How    Municipalities.    Corpora- 
tions   and    Communities    Are    Solving    the 

Housing   Problem    145 

Austin.  .1.  P.:   Why   Pliysical   Examination?..     63 
Azzo,   A. :   Acetonuria   of  Fatigue  during  Ali- 
mentation          15 

Bnbcock.  K.  P. :  Do  Safety  Drives  Pay? 189 

Bachfeld.  R. :  Tuberculosis  in  a  Chemical  Plant  186 
Bacbstez:  Tn.iury  of  the  Cornea  by  Aniline...  12 
Bajla:   Syphilis   in   01a«s  Blowers 186 


PAGE 

Baker,   S.    J. :    I'hysical   Standards   for   Child 

Laborers     167 

Balliet,   H.   S. ;   Electrical  Hazards  and  their 

Safeguarding    194 

Bane,  W.  C. :  Care  of  the  Eye  Following  Re- 
moval  of   Small    Foreign    Bodies    from    the 

Cornea    273 

Biirauy,  R. :   Ocular  JNystagmus  and  Railroad 

Nystagmus     214 

Barbour,  W.  T. :  Personal  Call  on  Employees. .   224 

Barnard,  11.  E. :  Sanitation  in  Bakeries 81 

Barnes,  F.  L. :  Flexion  Power  as  an  Index  to 
Functional  EUicieucy  in  the  Appraisement 
of  Disability  in  the  Upper  Extremity,  Re- 
sulting from  Industrial  Injuries 226 

Barnes,  II.  L. :  Tuberculosis  of  Husband  and 

Wife    254 

Barott,  H.  G.,  see  Langworthy,  C.  F. 

Barth,  O.  R, :  An  Association  that  Pays 268 

Bartlett,  L.  W. :  Rehabilitation  of  the  Tuber- 
culous in  District  12 42 

Bartlett,  P.  C,  see  Armstrong,  D.  B. 
Baskin,  .7.,  see  Rubin,  G. 

Bathe:  Deterioration  of  the  Air  in  Closed 
Rooms  ou  Naval  Vessels  with  Especial  Ref- 
erence to  Battle  Conditions 28 

Beard,   W.   K. :   Night   Employment  of  Young  ■ 

Persons     116 

Bedford,   T.,   .see  Hambly,   W.   D. 

Behr:    Safety   Devices   for   Automatic   Barrel 

Washers    194 

Bell,  A.  D. :  Effective  Printing-Plant  Illumi- 
nation          28 

Beltrami,  P.,  see  Kraus,  R. 
Bender:    Lalior   Agreement   Laws   and   Indus- 
trial Supervision  19" 

Bender,  A.:  Taylorism  and  Industrial  Super- 
vision       147 

Benedict,  F.  "S. :  Wooden  Machine  Guards 73 

Benge.    E.    S. :    Building    a    Better    Force    of 

Workers 37 

Bergonie.  .T. :  Radium  Treatment  of  Roentgen 

Dermatitis    ^^^ 

Bettman.   R.  B. :   Flat  Foot  as  a  Problem  of 

Industrial    Surgery     164 

Bettman.  R.  B, :  The  Industrial  Surgeon  and 

Individualization     153 

Beyer.  D.  S. :  The  Day  of  the  Safety  Engineer  257 
Bigelow,  E.  B.:  Experiment  to  Determine  the 
Possibilities  of  Sirbnormal  Girls  in  Factory 

Work    125 

Binet,  see  Achnrd. 

Binet.  I/. :   Study  of  Movements 262 

Birks.  M. :  Health  Conditions  at  Broken  Hill 

Mines     ?1 

Black.  N.M.:  Eye  Findings  in  Brain  Injuries  257 
Plain.    .T. :    Hygienic    Precautions    to    be    Ob- 
served  in   the   Mnnufncture   and   Industrial 

I'sc   of   Carbon   Disulfide 61 

Bock.  A.  v..  srr  Lnpb,  R.  F. 

Bodanskv.  M. :  Biochemical  Studies  on  Marine 

Oriranisms.     IT.  The  Ocrurroncp  of  Zinc.  ...     15 
Bodensteiu.  .T. :  Tlie  Ijocal  Effect  of  Dimethyl- 
sulphate    20T 

Boigey  :  TJie  Heart  during  Physical  Exercise. .  217 

Boigev.  see  Dausset.  IT. 

Borne:  Obligatory  Sickness  Insurance 41 

304 


AUTHOR   INDEX 


305 


PAGE 

Bottricli :  Observations  on  the  Early  Diagno- 
sis of  Lead  Poisoning 185 

Bower,  J.  L. :  132,913  Sick  and  Injury  Cases 
in  a  liear 30 

Bowers,  E.  F. :  How  the  Factory  Dentist  Earns 
his  Salary   .' 31 

Bowie,  C.  r. :  Oil-Camp  Sanitation 279 

Brandenstein,  S.  C :  Safety  to  Life  in  Ship 
Construction    106 

Brehmer,  H.  E.,  see  Stokes,  J.   II. 

Brenning,  C. :  A  Case  of  Dermatitis  Due  to 
Asparagus    129 

Brezina,  E. :  Industrial  Poisonings  aud  tlieir 
Prevention    240 

Bridge,  J.  C. :  Ambulance  and  First  Aid 75 

Brieger,  II. :  Tlie  Symptoms  of  Acute  Cliro- 
mate   Poisoning    98 

Brierley,  S.  S. :  The  Pre.sent  Attitude  of  Em- 
ployees  to   Industrial  Psychology 35 

Brintnall,  R.  A. :  Standardized  First  Aid  in 
Industrial    Plants    2'M 

Brissaud.   E.,   see  Widal,   F. 

Broca,  A. :  Tuberculosis  after  Industrial  Ac- 
cidents       209 

Brougliton,  D. :  Plant  Dispensary  Saves  Em- 
ployees'   Time    22 

Broughton,  G.  M.,  and  Newbold,  E.  M. :  A 
Statistical  Study  of  I-abour  Turnover  in 
Munition    and    Otlier    Kartories 172 

Brown,  II.  R.,  see  Price,  I).  J.    (2). 

Brown,  L.  T.,  see  Lee.  K.  I. 

Brown,  P.  K. :  Vocational  Training  vs.  Occu- 
pational  Tlierapy    2(K) 

Brown,  T.  R. :  RtMe  of  Diet  in  Etiology  and 
Treatment  of  Migraine  and  Other  Types  of 
Headache    23.". 

Brownel!.  H.  L. :  California  Associated  Raisin 
Company  Dental   Service 141 

Brownell.  .T.  H. :  Safety  Standards  for  Trench 
Construction    193 

Brilokner.  H. :  The  Influence  of  Night  Work 
on  the  Health  of  Workers 22S 

Bi-uudage,  D.  K. :  Disea.ses  Prevalent  among 
Steel   Workers   in   a   Pennsylvania    City....     90 

Bruns.  O. :  On  the  Size  of  tlie  Heart.  Blood 
Pressure  and  Pulse,  liel'dre.  during,'  and  after 
Short  Periods  of  Heavy  Physical   Lalior...  200 

Bryant,  J. :  Visceroptosis :  Normal  Incidence : 
A    Preliminary    Ileport 246 

Bryant.  L.  T. :  Taking  Care  of  the  Industrial 
Cripple    26S 

Buchanan,  E.  M. :  Anaerobes  in  Hair  Dust...   101 

Bureau,  A.  A  :  Why  We  Have  Physical  Ex- 
aminations at  our  Plant 139 

Burkhardt:  Is  the  Industrial  Disease  of  Bri- 
quette Makers  Chronic  Arsenical  Poisoning?     47 

Burlinsame.  C.  C. :  Partnerslii])  lietween  In- 
dustrial   Physician    and   Practitioner 2S0 

Burnette.  N.  I,. :  The  Place  of  Occupational 
Therapy  in  Mental  Hygiene 229 

Burnliam.  A.  C. :  Medical  Welfare  Work  in 
Small    Factories    ?3 

Buswell,  A.  M. :  Pure  Drinking  Water  for 
Industrial   Plants ^ 29 

Buzby,  B.  F. :  Defects  Affecting  Fifteen  Hun-    ■ 
dred  Men   266 

Cadenliead.  A.  F.  C.  and  .Tacques.  A.  O. : 
A  Possible  Source  of  I,ead  Poisoning 249 


PAOl 

Campbell,  C.  M. :  Mental  Hygiene  in  Industry  154 

Campbell,  D.  M.,  and  Carter,  J.  M. :  Injuries 
to  the  Eye  with  Report  of  1,051  Cases 160 

Campbell,  J.  A.,  Hargood-Ash,  D.,  and  Hill,  L. : 
The  KiTect  of  Cooling  Power  of  the  Atmos- 
phere on   Body   Metabolism 259 

Campbell,  J.  A.  C,  see  Hill,  L. 

Carlini,  P. :  Work  and  Fatigue  in  the  Puer- 
peral State 195 

Carter,  .J.  M.,  see  Campbell,  D.  M. 

Casamajor,  L. :   Neuroses  in  Business  Life...  205 

Cassanollo,  R. :  Rare  Manifestations  of  Lead 
Poisoning    8 

Cazeneuve,  P. :  Fatal  Intoxications  by  Arsenic 
in    Viticultural    Districts 250 

Chace.  A.  E. :  The  Industrial  Medical,  Depart- 
ment of  the  Future 223 

Chace,  A.  E. :  St.  Louis  Southwestern  Railway 
Medical  Service  222 

Chamberlain.  J.  P.:  The  Conflict  of  Jurisdic- 
tion in  Comiien.sation  for  Maritime  Workers  197 

Chamlx'rlain.  .1.  P.:  I^egislation  Now  Needed 
to   Itoslore   Compensation   to  Longshoremen     86 

Clianilierlain,   N. :   Industrial   Hygiene 123 

Chandler.  A.  B. :  The  Relation  of  Child 
Labour   to   Child   Health 219 

Chancy.  L.  W. :  Accident  Freiiupncy  and  Sever- 
ity Rates  for  the  Iron  and  Steel  Industry 
and  its  Principal  Departments.  1907  to  1920  234 

Clianey.  L.  \V. :  .\ccidcnt  Frequency  Rates  in 
the  Iron  and  Steel  Industry,  bv  Causes, 
1913   to   1920 .' 234 

Cheney,  H. :  Medical  Service  as  Affecting  In- 
dustrial   Relations    223 

Chubb.  I.  S. :  St.-ite  Industrial  Accident  In- 
surance   Otiicially    AcelaiuKHl 88 

Ciampolini,  .\. :  Diseases  of  the  Ear  In  Rail- 
way Employees  Working  at  a  High  Alti- 
tude       189 

Cicconardi:  Histologic  Changes  in  the  Kidney 
Produced    by   Chilling 217 

Clark.  L.  D. :  Review  of  Labor  Legislation  of 

.  1919 149 

Clark.  L.  D..  and  Frincke.  M.  C.  .Tr. :  Work- 
men''! Compensation  Legislation  of  the 
I'nitnd   States  and  Canada 86 

Clark,  M.  A.,  see  Everett,  R.  II. 

Cl.-irk.  W.  I.:  Our  False  Standards  of  Dis- 
ability In  Industry 267 

Cleary.  .7.  P. :  Field  Hospitals  in  Construc- 
tion Work   143 

Cohn.  .\.  E. :  The  Effort  Syndrome  together 
witli  a  Consideration  of  the  Significance  of 
Certain   Murnnu's    94 

Cohn.  I.:  Observations  Based  on  a  Study  of 
Injuries    to    Elbow 217 

Colburii.  C.  ly. :  Danger  of  Using  Explosives 
in  Conflned   Places 183 

Colcord.  A.  W. :  Physical  Examination  of 
Employees    139 

Cole.  W.  (i. :  The  Hazards  of  the  I..ogging  In- 
dustry— Meclianical   vs.  Human 57 

Colebrook.  L..  see  Douglas,  S.  R. 

Collins.  H.  H.,  .Tr. :  A  Manufacturer  on  the 
Short  Day 67 

Collis.  E.  L. :  The  Adolescent  and  the  Com- 
munity   .1 264 

Collis.  E.  T/  :  Discussion  of  the  Importance 
of  Industrial  Medicine  to  tlie  Community..   205 

Collis.  B.  L. :  Industrial  Emciency  and  Fatigue' 136 


306 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Cullis,  E.  L. :  Industrial  Health :  Its  Value  in 
Public    Health    Service 123 

Collis,  E.  L. :  The  Necessity  for  Greater  At- 
tention in  Industry  to  the  Maintenance  of 
Efficiency  and  the  Prevention  of  Ill-Health  152 

Conger,  W.,  see  Hilles,  E. 

Counelley,  C.  B. :  The  Essentials  of  a  Xational 
Safety"  Code  for  Ladders 258 

Conuelley,  C.  B. :  What  Pennsylvania  Is  Do- 
ing for  Safety  and   Safety  Codes 73 

Cordes,  F.   C,  see  Franklin,  W.   S. 

Costigane,  A.  P.:   Safety  Organization 13 

Cotton,  F.  J. :  The.  Industrial  Question :  A 
Proposal  and  Announcement 90 

Crocker,  A.  A. :  Dentistry  as  a  Production 
Factor    in    Industry 171 

Crosley.  W.  E. :  Health  Service  of  Illinois 
Bell"  Co 170 

Crum,  F.  S. :  How  We  Die  from  Accidents  in 
Careless   America    232 

Cumming.  11.  S. :  Industry  Xeeds  an  Adequate 
Jledical    Servios 22 

Cursehmann :  Medical  Discretion  in  Industrial 
Poisonings     24 

Cursehmann:  Pulmonary  Tuberculosis  as  a 
Result  of  Inspiring  Tetranitromethane 
Vapors  ?    8 

Cursehmann,  F. :  Medical  Decisions  in  Cases 
of   Industrial   Poisoning 96 

Cursehmann,  F. :  Medical  Decisions  on  Cases 
of   Industrial   Poisoning 69 

Cursehmann.  F. :  Medical  Opinions  on  Indus- 
trial   Poisonings    156 

Cursehmann,  H. :  Clinieai  and  Experimental 
Observations  on  the  Anaphylactic  Bronchial 
Asthma  of  Workers   in  Furs 95 

Curtin,  A.  L. :  Winning  Employees  to  Physi- 
cal Tests    1^7 

Cyrias,  E.  P.,  and  Melville,  S. :  The  Path- 
ology of  So-Called  Sprains  of  the  Wrist. 
With  a  Note  on  Skiagrams  in  these  Con- 
ditions       108 

D'Alessio:  Accidental  Deatli  by  Illuminating 
fias  under  Ordinary  Conditions  of  Work..   183 

Dannerth.  F.  :  Occupational  Diseases  in  Chem- 
ical Industries.  How  the  Workers  in  Chem- 
ical Plants  Are   Safeguarded 153 

Dausset.   H..   and   Boigey :   Fatigue   Charts...   Ill 

Davidson.  F.  A.:  The  Need  of  a  Safety  Code 
for   Ladders    25S 

Davidson.  F.  A. :  Safety  in  the  Construction 
Industry    ^^ 

Davis.  B.  F. :  Paraffinoma  and  Wax  Cancer..     25 

Davis.  H.  Li.,  and  George,  T.  H. :  Dispensary 
on    Construction    Jobs 73 

Davis.  IT.  L..  and  George.  T.  II.:  Planning 
the  Industrial   Dispensary 140 

Dawson.  P.  >!..  and  Wallrich,  L.  A. :  Spells  of 
Best  and  Physical   Efficiency Ill 

Dawson.  P.  M..  xec  Wallrich.  L.  A. 

De  Decker.  G.,  see  Waller,  A.  D.  (2). 

De  Haas.  H.  K. :  Affections  of  the  Retina  and 
Optic  Nerve  Caused  by  Arsenical  Poisoning     53 

DeHart.  S. :  Factory  Eye  Room  Saves  Work- 
ers' .Sight  and  Increases  Output 83 

DeHart.  S.  :.The  Factory  Restaurant  as  a 
Service   Nucleus    14.': 

DeHart.  S. :  Hospital  Department  of  Indus- 
trial Plant  Supervises  Safety  Work 142 


PAGE 

DeHart,  S. :  Industrial  Dental  Dispensaries..     31 

DeHart,  S. :  Plant  Lunch  Room  Health  Factor  148 

DeHart,  S. :  A  Room  that  Stops  Sneezing....  224 

De  Lima,  A. :  Night-Working  Mothers  in  Tex- 
tile Mills,  Passaic,  New  Jersey 59 

De  Pree,  C. :  How  Eleven  Manufacturers  Com- 
bined for   Better   Housing 32 

Derdack :  The  Injurious  Action  of  Blast  Fur- 
nace Gas   183 

Desgrez,  A.,  Guillemard.  H.,  Ilemmerdinger, 
A.,  and  Labat,  A.:  Respiratory  Apparatus 
for  Protection  against  Carbon  Monoxide...  248 

Devoto,  L. :  For  the  Complete  Suppression  of 
Industrial  Saturnism   20S 

Dexter,  J.:  I'aint  as  an  Aid  to  Better  Man- 
agement       138 

D'Halluin,  M. :  The  Lethal  Power  of  Elec- 
•     tricity    230 

Di  Giovanni,  I. :  Clinical  -\speets  of  Ankylos- 
tomiasis      252 

Doane,  S.  E. :  Elements  of  Good  Industrial 
Lighting    21 

Doane,  S.  E. :  Light  Much  Neglected  in  Effi- 
ciency  Promotion    19tt 

Dobrashian,  G.  M..  sec  Jacob,  F.  H. 

Dodd,  R.  A. :  Industrial  Nursing  in  the  South  144 

Donaldson,  W. :  Industrial  Wastes  in  Rela- 
tion .  to   Water   Supplies 82 

Donoghue,  F.  D. :  Medical  Service  under  the 
Massachusetts  Workmen's  Compensation  Act    39 

Dom,  E. :  The  Question  of  the  Fall  of  Eleva- 
tors, with  Sjjecial  Reference  to  Safety 
Brakes    194 

Doiigl.is,  S.  R-  Fleming.  A.,  and  Colebrook,  L. : 
Studies  in  Wound  Infection 132 

Douthitt.  C.  M. :  Physical  Examination  for 
Employees    22 

Downey.  F.  M. :  .Vccident  Prevention  and  First 
Aid  Work  in  the  Telephone  Field 257 

Drinker.  C.  K.,  and  Shaw.  L.  A. :  Quantita- 
tive Distribution  of  Particulate  Material 
(Manganese  Dioxide)  Admini.stered  Intra- 
venously  to   the   Cat 78 

Drolet,  G.  J. :  Tuberculosis  in  New  York  City 
Attacks   Men   Especially 209 

Drur.v.  W.  II.:  Tuberculosis  among  Polishers 
and  Grinders  in  an  .\x  Factory 52 

Dubs.  J.:  Results  of  ^leniscus  Operations 
after   Industrial    Accidents 175 

DuChemin.  N.  M. :  Education  in  Safety  Engi- 
neering as  Given  at  the  Lynn  General  Elec- 
tric Engineering  and  Apprentice  School....  214 

Duke.  H.  T,..  arc  Peacock.  W.  L. 

Dunham.  G.  C.  scr  Spaeth.  R.  A. 

Dunlnp.  L.  G. :  Perforations  of  the  Nasal 
Septum  Due  to  Inhalation  of  Arsenous  Oxid     47 

D.ve.  J.  S. :  Plant  Hospital  Essentials 142 

Eaves.  L  :  One  Thousand  Industrial  Accidents 

Suffered  by  Massachusetts  Children GO 

Eckstein,    M. :     Finger    Guard    for    Eccentric 

Presses   194 

Edwards,     N. :     Safe     Clotbins     for     Women 

Workers    lOR 

Eey.  W.  L..  see  Katz.  S.  H. 
Ellis.  .1  D..  srr  Mock.  IT.  E. 
Ellis.   M.  B. :   The  Juvenile  Court  and   (!hl!d 

I,abor    19 


,    AUTHOR    INDEX 


307 


PAGE 

Eloesser,  L. :  On  the  Severely  but  not  Totally 
Disabled  in  Industry,  with  Special  Refer- 
ence to  the   One-Armed . .-. 201 

Enibdeu,  G.,  Grafe.  E.,  and  Schmitz.  E. :  In- 
crease in  Capacity  for  Work  Due  to  Admin- 
istration  of   Phosphate 259 

Emge.  L.  A.,  and  Jensen,  J.  P. :  Effect  of  Ben- 
zyl Benzoate  on  Leiikot-ytes  of  Rabbit 1S4 

Emmons,  A.  B.,  2d :  Department  Store  Hygiene      3 

Erviu.  C.  K. :  The  Routine  Physical  Exam- 
ination of  the  Worker 170 

Esterly,  E.  C. :  How  Accidents  Are  Reduced 
in    an    Oil    Refinery 215 

EA-aus,  H.  M. :  Fishermen's  Diseases 65 

Eviinson.  11.  X.:  Bath  House.  Hospital  and 
Heating  Arrangements  Provided  for  the 
Employees  of  the  Lynch  Mines  in  Kentucky  280 

Everett.  K.  II..  and  Clark,  M.  A.:  Industrial 
Application  of  Army  and  Navy  Venereal 
I  lisease   Records    1^7 

Farra.    E.    R. :     Circular    Saws — Keep    Them 

Sharp.  Safe,  and  Efficient 162 

Fenn,  W.  (>. :  The  Phagocytosis  of  Solid  Par- 
ticles.    III.  Carbon  and  (Juartz 12r> 

Ferrell.    J.    A. :    Measures   for    Increasing   the 

Supply  of  Competent  Health  Oflicers 124 

Fieldner.  A.  C,  Katz.  S.  H..  and  Kinney,  S.  P. : 
Permeation  of  Oxygen  Breatliing  .\pparatus 

by   Gases  and   Vapore 96 

Fieldner.  A.   ('..  and  Paul,  .1.  W. :   Bureau  of 
Mines    F-xpcrinieiitnl    Tunnel    for    Studying 
the  Removal  of  Automotive  Exhaust  Gas...   24.S 
Fine,   M.  J. :   Examination  of   Food   Handlers 

from   Standpoint   of   Tuberculosis 100 

Fisher,   B. :   Has  Mental  Hygiene  a   Practical 

T'sc   in    Industry? 196 

Fisher.  B. :  The  Relation  between  Safety  and 

Service    Work    275 

Fitch.   \V.   \. :    Indvi-trinl  Sanitation 20 

"Fltz.  R.,  sec  Loeb,  R.  F. 

Flack,  M. :  Re.<piratory  Efliciency  in  Relation 

to    Health    and    Disease i;:!i!.    2:!fi.  2.^C. 

Fleischner.  E.  C.  and  Shaw.  E.  B. :  The  Man- 
agement   of    a    Diphtheria    Outbreak    in    a 

Private  School    ■. 252 

Fleming.  A.,  sec  Douglas.  S.  R. 
Florence,  P.  S.,  see  Ryan,  A.  H. 
Flury.  v..  and  ITeubner.  W. :   The  Action  and 
Intoxication   of   Inspired   Hydrocynnie  Acid       8 

Folks,  G.  H. :  Child  Labor  in  Agriculture 277 

Fontana.  G. :  New  Researches  on  the  Blood 
nnd   the   BIood-Forming   Organs    in    Benzol 

Intoxication   183 

Ford,  C.  E. :  Ile.nltli  Education  in  Industry..  94 
Forster,  W.  H. :  The  Enaineering  Factor....  257 
Fort,     H.     ,T. :     Medical    Department    Directs 

Library 139 

Frnnkl'n.  E.  L.  M. :  Safety  in  the  Factory...   214 
Franklin.   W.   S.,  Cordes.  F.  C.   and   Horner. 
W.    D. :     Fluoroscopy    for    Ocular     Foreign 

Bodies     103 

Frnschetti.   V.:   Maternity  and  T.abor 28 

Frei.  M. :  Matchbox  Dermatitis: 254 

French.   J.  R. :   Industrial   Surgical   Service — 

Past.   Present.  Future 275 

French.  W.  ,T. :  The  Trend  of  Workmen's  Com- 
pensation         85 


TAGK 

Frincke.  M.  C,  Jr..  sec  Clark,  L.  D. 
Froeberg,  S. :  Smoking  and  Mental  and  Motor 

Efficiency    108 

I'^iller.     R.     G. :     Child     Labor     and     Mental 

Hygiene    115 

Fuller.   R.  G. :  Child  Labor  versus  Children's 

Work     263 

Fuller.  R.  G. :  The  Psychological  Approach  to 
the  Child   Labor   Problem 18 

<;adsby.  M. :  Inadequacy  of  Industrial  Acci- 
dent Statistics  Published  in  State  Refwrts..     72 

<!aster.  L. :  Industrial  Lighting  in  Relation  to 
Health  and  Safety 21 

Geier.  O.  P.:  The  Educative  Potential  in  In- 
dustrial  Medicine    ISO 

Geier,  O.  P.:  The  Future  of  Industrial  Medi- 
cine  as  a  Labor  Policy 43 

Geier,  O.  P.:  Life  Saving  Makes  a  Popular 
Appeal  2S1 

Geier.  O.  P.:  The  Place  Industrial  Medicine 
Has  in  a  Labor  Policy 36 

Geier,  O.  I*.:  The  Physician's  Viewpoint 180 

Geier.  O.  P. :  Types  of  Physicians  Contracting 
with   Industry  44 

George.  T.  II.,  see  Davis,  II.  L.    (21. 

Gerber,  1. :  Occupational  Poisoning  with 
Phosgen    8 

Gerdon,  C. :  Observations  and  Investigations 
on  the  Anaphylactic  Bronchial  Asthma  from 
Para-Phenylenediamine   Dyes    4,4,5 

Gerster.  J.  C.  A.:  Preventable  I.,osses  in  Cas- 
ualty Insurance   87 

Gherardi.  G.:  Concerning  the  Occupational 
Disease  of  Reapers  and  Winnowers 103 

•  Jherardi.  G. :  The  .Mortality  of  Masons 244 

GilTord.  IL:  Late  Traumatic  Detachment  of 
Retina.  Its  Prophyl.-ixis  and  Importance 
from  a  Disability  Compensation  Standpoint  256 

(Jilbreth.  F.  B  :  I'ractical  Methods  of  Fatigue 
Elimination    218 

Gilbreth.  F.  B.,  and  Gilbreth,  L.  M. :  Fatigue 
Study  and   Safety  Work  Co-ordinate 257 

Gilbreth.  F.  B..  and  Gilbreth.  L.  M. :  Practical  . 
Methods  of  Reducing  Fatigue 58 

Gilbreth.  L.  M..  srr  Gilbreth.   F.  B.   (2). 

Glasgow.  M. :  Results  of  the  Physical  Exam- 
ination of  the  Employees  of  the  New  York 
City  Department  of   Health 281 

Glibert.  D. :  The  Hide.  Hair  and  Horsehair 
Industries    283 

Goadby.  K. :  Importance  of  Industrial  Medi- 
cine  to   the  Community 250 

Goadby,  K. :  Industrial  Disease  and  Immu- 
nity       121 

Gottstein,  A. :   Occupation  and   Public  Health       3 

Grafe.  E..  see  Embden.   G. 

Graham.  J.  R. :  A  Clinical  Picture  of  Anthrax  253 

Grahn.  E. :   Case  of  Pneumoconiosis 209 

Grant.  R.  T. :  Malignant  Pustule  with  Mul- 
tiple  Lesions    187 

Greenwood.  M..  see  Hill.  L. 

Grem.pe.  P.  M. :  Increasing  the  Safety  from 
Accident  and  Fire  in  the  Woodworking 
Industries    194 


308 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

Gi-illiii,   \V.  A.:   Monitui-   \entilatiou 265 

Grindrod,  G. :  .Siinitary  Control  iu  the  Mauu- 
faetuie  of  Foods  and  its  Economic  Im- 
portance     264 

Grobe,  h. :  Report  of  the  First  Course  on  Pro- 
•phylasis  of  Lead  Poisoning  for  the  Plant 
Physicians  of  the  German  Lead  Color  In- 
dustries         98 

Gros,  O.,  and  Kochman,  M. :  On  Carbon  Mon- 
oxide I'olsonlng  in  a  Foundry 157 

GulUemard,  H.,  see  Desgrez,  A.' 

Gullichsen,  K.,  and  Soisalon-Solulnen,  J.  L. : 
On  the  Carbon  Excretion  of  Man  in  Wrest- 
ling and   in   Fencing 259 

Haggard,  H.  W. :  Studies  in  Carbon  Monox- 
ide Asphyxia.    I.  The  Behavior  of  the  Heart  157 

Haggard.  H.  W.,  and  Henderson,  Y. :  Hemato- 
Respiratory  Functions.  XII.  Respiration 
and  Blood  Alkali  during  Carbon  Monoxld 
Asphyxia    126 

Haggard,  H.  W.,  and  Henderson.  Y. :  The 
Treatment  of  Carbon   Monoxld   Poisoning..   206 

Hall,  A.  W.,  sec  Ogilvle,  W.  H. 

Hall,  E.  K. :  Five  Ways  to  Gain  Better  Co- 
operation      266 

Hambly,  W.  B.,  and  Bedford,  T. :  Preliminary 
Notes  on  Atmospheric  Conditions  in  Boot 
and   Shoe   Factories 113 

Hanauer,  W. :  The  Social  Hygienic  Results 
of  the  German  Workmen's  and  Employees' 
Insurance  in  the  War  and  its  Problems  in 
the   Future    87 

Hanks,  E.  E. :  Administration  of  Child-Labor 
Laws.  Part  4.  Employment-Certificate  Sys- 
tem,   Wisconsin    -7" 

Hansen,  O.  S. :  Magnesium  Sulfate  in  Arsenic 
Poisoning   185 

Hapgood,  P.:   Car-Pushing  in  Coal  Mines 124 

Hargood-Ash,  D.,  see  Campbell,  .7.  A. 

Harrington,  D. :  Accident  Prevention  in  the 
Mines   of  Butte,   Montana 26 

Harrington,  D. :  Dust  Reduction  by  Wet  Sto- 
pers   -'^ 

Harrington,  D. :  Ventilation  in  Metal  Mines..     82 

Harrington.  D.,  and  Lanza.  A.  .7. :  Miners' 
Consumption  In  the  Mines  of  Butte,  Mon- 
taha.  Preliminary  Report  of  an  Investiga- 
tion Made  in   the  Years  1916-1919 101 

Harrington.  T>..  see  Sayers,   R.   R. 

Harrington,  R.  K. :  Illumination  as  a  Factor 
Favoring  Production    237 

Harris,  H.  J.:  British  National  Health  In- 
surance Act  of  May  20,  1920 41 

Harris,  L.  I.:  Preventing  Preventable  Dis- 
eases in  New  York  City.  Occupational 
Clinic    251 

Hass;n.  G.  6.:  The  Contrast  between  the 
Brain  Lesions  Produced  by  Lead  and  Other 
Inorganic  Poisons  and  Those  Caused  by 
Epidemic    Encephalitis    156 

Hastings,  A.  B. :  Tlio  Physiology  of  Fatigue. 
Physico-Cliemical  Manifestations  of  Fatigue 
in  "the  Blood 261 

Hastings.  L.  E. :  Dental-Oculist  Service  for 
Workers    224 

Hatch.  L.W.:  A  Standard  Schedule  as  an  Aid 
to  Fnlformity  m  Accident  Reporting 54 

Heald,  C.  B.,  and  Thomson.  B. :  Tests  for 
Phvsical  Fitness   15 


PAGI 

Hedlnger,  E. :  Extensive  Intravital  Clotting  in 
Illuminating-Gas  Poisoning   46 

Helwig :  Explosion  of  Gas  Tanks 161 

Hemmeidinger.  A.,  .sec   Desgrez,   A. 

Henderson,  Y.,  see  Haggard,  II.  W.   (2). 

Herdman,  H.  H. :  Accident-Preventing  Educa- 
tion       130 

Hero,  C.  O. :  Inspections  for  Hazards  in  Lum- 
bering and  Logging 57 

lieubner,  W.,  see  Flury,  F. 

Heydrich,  C. :  A  Fatal  Accident  }n  a  Low 
Voltage  Installation   14 

Heyser,  D.  T. :  The  Medical  Department  of 
the  Fulton  Bag  and  Cotton  Mills 29 

Hlbben.  S.  G. :  How  17  Everyday  Lighting 
Problems  Have  Been  Solved S2 

Illckerson,  J.  M. :  Good  Lighting  Increases 
I'roduction    280 

Hill,  L.,  and  Campbell,  .1.  A.  C. :  The  Physio- 
logical Cost  of  ^Nluscular  Work 164 

Hill.  L.,  and  Greenwood,  M. :  The  Relation  of 
Health  to  Atmospheric  Environment 165 

Hill,  L.,  see  Campbell,  J.  A. 

IliPeary.  W. :  Safety  Features  of  Steam  Boil- 
er   Accessories    107,  107 

Hilles.  E. :  Legal  Requirements  Regarding 
Seats  in  Industry 275 

Hilles,  E. :  Practical  Experiments  in  Seating 
In    Industry     166 

Hilles,  E. :  The  Relation  of  Posture  to  Indi- 
vidual Health  110 

Hilles.  E. :  Relation  of  Posture  to  Industrial 
Health  135 

Hilles,  E.,  and  Conger,  W. :  Industrial  Posture 
and   Seating    1.35 

Hlrsing :  Can  the  Producers  of  and  Contrac- 
tors for  Machines  Be  Made  Legally  Respon- 
sible in  General  for  the  Provision  of  Safety 

Appliances?   14 

.  Hobart.  E. :   Serving  Meals  at  a  Loss 242 

Hoeveler,  .1.  A. :  Selling  Better  Lighting  as 
an  Aid  to  Safety.  Con.servatlon  of  Vision 
and  Increased   Pr(iduption 21 

Hoffman.  F.  L. :  Industrial  Accident  Record 
of  1919   12 

Hoffman,  H.  A. :  Tanks  and  Pipe  Lines  as 
Causes   of   Accidents 14 

Hoiieland.  F.  T. :  Copper  Company  Has  56- 
Bed   IIosi)ital    143 

Holtzmann  :  Industrial  Poisoning  with  Ilydro- 
cvanic  Acid  Gas  in  Gold  and  Silver  Plating     70 

rr.inkor,    A.   P...   .-.•(•(■    Ilslov.   L.   C.    (2"». 

Hookstadt,  C. :  Cost  of  Occupational  Diseases 
under  Workmen's  Compensation  Acts  in  the 
Tnited  States   86 

Hookstadt,  C. :  Diseiission  of  an  American 
Aocidont   Table 161 

Hookstiidt.  r. :  Seventh  .\nnual  Meeting  of 
the  International  Association  of  Industrial 
Accident    Boards    and    Commissions 12 

Hookstadt.  C. :  Workmen's  Compensation  and 
Social  Insurance.  Comparison  of  Compen- 
sati<m  Insurance  Systems  as  to  Cost,  Ser- 
vice,  and   Security 80 

Hoover.  C.  R. :  The  Detection  of  Carbon  Mon- 
oxide       1^ 

Horner.  W.  D..  sec  Franklin.  W.   S. 

Hover.  E.  F. :  Superficial  Injuries  to  the  Kye 
in  Industry   129 


AUTHOR    INDEX 


309 


PAGE 

Hubbard,  C.  L. :  Elimiuatiug  Vibratiou,  an 
Kuemy    of    Pi-oductiou 117 

Hubbard,  O.  h. :  Keepiug  Factory  Tempera- 
tures Where  You  \\  uut  Tliem 138 

Hubbard,  S.  D. :  Authrax  iu  Animal  (Horse) 
Uair :  Tbe  Modern  Industrial  and  Tublic 
Healtli   Menace    10 

Hubbard,  S.  i>. :  Health  in  Industry  and  Effi- 
cient  rroductiou    179 

Hubbard,  S.  D. :  Industrial  Sanitation  Affects 
I'ublic    Health    168 

Hubbard,  S.  D. :  Why  Should  We  Not  I'reveut 
Accidents?    190 

Hubbard,  S.  D.,  and  Kefauver,  C.  U. :  Condi- 
tions Affecting  Health  in  the  Millinery  In- 
dustry        35 

Hiitt,  U.:  Administrative  Methods  for  Tech- 
nical Supervision  of  the  Taper  Worlving 
Unions     217 

Ilsley,  U  C  and  Hooker,  A.  B. :  The  Relative 
Safety  of  Brass,  Copper,  and  Steel  Gauzes 
in   Miners'   Flame  Safety-Lamps 192 

Ilsley,  L.  C,  and  Hooker,  A.  H. :  Tests  of 
Miners'  Flame  Safety-Lamps  in  Gaseous, 
Coal-Uust-Laden  Atmospheres 132 

Jackson,  E. :  Visual  Fatigue 71 

Jacob,  P.  IT.,  TurnbuU,  11.  M.,  Arkwright. 
J.  A.,  and  Hobrashian,  G.  M. :  A  Case  of 
Human    (Jlanders    52 

Jacoulet,  F. :  Acute  I'oisonhig  from  Nitrous 
Fumes   ■16 

Jacques,   A.   G..  see  Cadenhead,   A.  F.  G. 

Jaeger,  H. :  Statistical  Study  of  Electrical 
Accidents    191 

Jamieson.  R.  E. :  Employees  and  Homes 172 

Jarrctt.  M.  C. :  The  Mental  Hygiene  of  In- 
dustry           4 

Jarvis.  D.  C. :  A  Roentgen  Study  of  Dust 
Inbalation  in  the  Granite  Industry ....  I .. .   100 

Jean,  G. :  Rupture  of  Large  Intestine  from 
Compressed  Air   218 

Jelliuek:  I'aralysis  of  the  Radial  Nerve  and 
Trophic  Disturbances  Following  an  Electri- 
cal  Burn    112 

Jellinek.  S. :  The  Pathology  of  Electric  Cur- 
rent  Burns    2H7 

Jensen.  J.  P..  kcc  Emgo.  L.  .\. 

Joliannsen.  O. :  Blast  Furnace  Gas  Poisoning.  246 

Johnson,  W. :  A  N'ot<>  (m  Intelligence  Tests...   173 

Jnftovniiinn.  T". :  Alcohol  and  Precision  in 
Work    109 

Jungl^ans:  The  .\ction  of  l'\isf  Inspired  in 
Mines    10 

Kalet.  .X.:  Effect  of  the  War  on  Working 
Children  iu  Germany 1<>? 

TTatz.  S.  H. :  Investigation  of  Dust  in  the  .\ir 
of  Granite-Working  Plants 15S 

Katz,  S.  H,.  Allison.  V.  C.  and  Egy.  W.  L, : 
Fse  of  Stenches  as  a  Warning  in  Mines...     26 

Katz.  R.  H..  xee  Fieldner.  A.  C, 

Kawamura.   J,:    Aniline   Poisoning 270 

Kearney.  J.  A. :  The  Ocular  Factor  In  Head- 
ache      255 

Keefer.  W.  D. :  Getting  Rid  of  Ladder  Acci- 
dents         56 

Keefer,  W.  D. :  Preventing  Accidents  on  Pow- 
er   Tran.smission    Machinery 162 


Keefer,  W.  D. :  Safe  Practices  on  Metal  Work- 
ing Machinery    193 

Keeler,  W.  D. :  Safety  Requirements  of  Wood- 
working Shops  162 

Kefau\  er,  C.  K. :  Suggestions  for  the  Indus- 
trial  Nurse   32 

Kefauver,  C.  R.,  see  Hubbard,  S.  I). 

Kepner,  I.  \'. :  Safe  Clothing  for  Chemical 
AVorkers   105 

Kilker,  C.  IL,  see  McCord,  C.  P.   (2J. 

Kiuloch,  J.  P.,  sec  Orr,  J.  B. 

Kinney,  S.  P.,  see  Fieldner,  A.  C. 

Kirk,  W.  T. :  Industrial  Rehabilitation  in 
Oregon    89 

Kitsou,  H.  D. :  Scientific  Method  iu  Job  Anal- 
ysis       225 

Kleitman,  N.,  see  Salant,  W. 

Kcichnian,   M.,   xcc   Gros.   O. 

Ki>ckel  and  Zinimermauu :  Intoxication  with 
Fluorine   Compounds    70 

Koelsch :  Objectives  and  Results  in  Legisla- 
tion for  the  ProtL>ction  of  Workers 37 

Koelsch,  F. :  Experiences  with  Industrial  Hy- 
giene in  the  Bavaran  Munitions  Industry..        7 

Koelsch.  F. :  Skin  I>esions  from  Coal  Tar  and 
Naphtha  Derivatives  and  their  Pliolody- 
namic  .\spects    U 

Korner:  Tlie  Nature  of  Industrial  l^ead  Poi- 
soning in  the  Liglit  of  Medical  Investiga- 
tion        6 

Kratz,  J.  A. :  Problems  of  Maintenance  in 
Vocational  Rehabilitation   201 

Kraus.  R..  aiul  Beltrami,  P.:  Normal  Beef 
Serum   in  Treatment  of  Antlirax 253 

Kraus,  W.  M. :  Case  of  Gasoline  or  Gas  Poi- 
soning      247 

Krausse :    "Montanin"   Poisoning 185 

Kucheiihecker.  A, :  Tlie  Detection  of  Aromatic 
Amido  Compounds  in  the  T'riue  and  the 
Change  They  I'ndergo  in  the  Body 7 

Kuechcnmeister.  G.  A.:  How  We  Licked  the 
Goggle  Problem  in  our  Plant 257 

Knnz-Krause.  H. :  Personal  Experience  of 
Poisoning  hy  Arsiue 207 

Laliat.   A.,   spc   Desgrez,   A. 

La  Forge.  7,. :  Health  Hazards  of  Pottery 
Workers    10 

Laignel-Lavastine  and  Alajouanine:  Gangrene 
from  Gas  Poisonin'..' 97 

Laml).  J.  J. :  What  Is  Safe  Clothing  for  Fac- 
tory   Workers?    105 

Lane,  C.  (J, :  Occupational  Dermatitis  in  Den- 
tists :   Susceptibility  to  Procain 71 

Lange,  F.  G. :  Safety  and  Accident  Prevention  103 

Lange.  F.  G. :  What  the  Ohio  State  Indus- 
trial Commission  Has  Done  to  Promote 
Safety   Education    12 

LangMortby.  C.  P..  and  Barott.  H.  G. :  Ener- 
gy Expenditure  in  Household  Tasks Ill 

Laiiza.  A.  J. :  Equipment  and  Personnel  for 
Care  of  Injuries 140 

Lanza.  A,  J. ;  The  Location  and  Equipment  of 
:Modern    Industrial    Dispensaries 140 

Lanza,   A.  J.,  ifee  Harrington,  D. 

Lauffer.  C.  H. :  Advertise  Prone  Pressure  Re- 
suscitation     ......-..,.■...  —  ..   215 

Lebanc,   see  .\chard. 

Lee,  R.  I. :  Preventive  Medicine  and  Hygiene 
in  Relation   to   Colleges 3 


310 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

Lee.  R.  I.,  and  Bro\ra.  L.  T. :  Correctious 
versus  Compensation  of  Physical  Defects . .     -1] 

Legge,  R.  T. :  Relation  of  Industrial  Medi- 
cine to  Public  Healtli ^3 

Legge,  T.  M. :  Industrial  Diseases J 

Legry  and  Lermoyez:  The  Spinal  Fluid  in 
Carbon  Monoxide  Poisoning -16 

Leitch,  A.  S. :  Industrial  Dust 50 

Lemon,  C.  H. :  Comprehensive  Service  for  Em- 
ployees         ^ 

Lermoyez,  «ee  Legry. 

Leupold.  F.  C. :  Ship  Xard  Has  3  Hospitals..   143 

Levick.  G.  M. :  Musculature  of  Foot  and  its 
Treatment  by  Electricity 134 

Levy,  L.,  and  West,  D.  W.:  Industrial  Respi- 
rators       -■^^ 

Lewin.  L. :   Trinitrotoluene  Poisoning 250 

Leymann:  The  Ruling  of  June  i^i^.  1920,  for 
the  Protection  of  Workers  in  Compressed 
Air    "S 

Linenthal.  H. :  The  Functions  and  Scope  of  an 
Industrial  Clinic  in  a  General  Hospital 141 

Linenthal.  H. :  The  Industrial  Physician  and  ^ 
the  Hospital   ^27 

Link.  H.  C. :  A  New  Application  of  Psychol- 
ogy  to   Industry 36 

LleweUvu.  T.  L. :  The  Economic  Aspect  in 
Eve  injuries:  A  Plea  for  Early  Treatment  130 

Loei).  R.  F..  Bock,  A.  V.,  and  Fitz.  R. :  Acute 
Xitrobenzol  Poisoning:  Studies  on  Blood  in 
Two  Cases  ^^ 

Lolt.  M.  R.:  Reducing  the  Cost  of  Industrial 
Accidents   ^^ 

Lovedav,  J.,  and  Munro.  S.  H.:  Preliminary 
Notes  on  the  Boot  and  Shoe  Industry 33 

Lovejov.  O.  R. :  Seventeenth  Annual  Report 
of  tlie  National  Child  Lalx>r  Committee  for 
the  Fiscal  Tear  Ending  Sept.  30.  1921 2T9 

Lovett.  F.  G.:  Safeguarding  Woodworking 
Machinery    ^'^ 

Lowell.  W.  H. :  Foreign  Body  Spud  Illumina- 
tor   256 

Luden.  G.:  Chronic  Carbon  Monoxid  Poison- 
ins — Its  Immediate  and  Subsequent  Mani- 
festations       <"•■'*•     ^ 

Lynch.  J.  M. :  Health  Insurance 1-19 

ilacFarlane.  S.  H. :  High  Standards  in  Health 
Care  at  Hotel   McAlpin 30 

Machol  M.  R. :  A  Plan  for  Sick  Leave  with 
Par    1^ 

MacKenzie.  F. :  Bill  Prop^^ed  for  Co-opera tioii 
hv  all  States  under  the  New  Federal  Law 
for  the  Rehabilitation  of  Industrial  Cripples    42 

MacKenzie.  F. :  Old  Age  Insurance  legisla- 
tion Now  up  to  the  StJtes 8S 

Mackenzie.  W. :  The  British  Industrial  Court .  242 

Mackeown.  E.  J. :  The  Health  of  Seamen  and 
How  to  Safeguard  It 228 

MapPher.Kon.  D.  J-.  «ee  Stedman.  H.  R. 

Ma^nuson.  P.  B. :  Economy  of  Proper  Medical 
Treatment    ^^ 

Mallalieu.  W.  E.:  Trends  in  Mannsement- 
The  Direction  Industrial  Fire  Prevention 
Is  Taking    233 

Martinson.  G. :  Industrial  Nurses  in  Metal 
Minins  Communities    144 

Mason.  E.  C. :  The  Pharmacologic  Action  of 
I^ead  in   Oi^anic  Combination 2.50 


Mason,  J.  L. :  Advantages  of  Proi)er  Bathiug 
for  Workers   

Matthys,  R.  P.:  Reporting  Slight  Injuries... 

Maynard,  B.  M. :  Making  Time  Studies  Pay . . 

McBrayer.  L.  B. :  Tuberculosis  Survey  of  a 
Silk  Mill  VUlage 

MeConachie.  L.  G. :  Court  I'ecisious  im  Work- 
men's Compensation  Law  January,  1920- 
Juue,  1921.     Constitutionality  and  Coverage 

McConnell,  W.  J.:  Industrial  Dermatosis 
among  Printers    

McConl.  C,  and  Kilker.  C.  H. :  Zinc  Chlorid 
Poisoning.  Report  of  Outbreak  among 
Workers  in  a  Wood  Preserving  Industry... 

McCord,  C.  P.,  Kilker.  C.  H.,  and  Minster, 
D.  K. :  Pyrethrmu  Dermatitis.  A  Record  of 
the  Occurrence  of  Occupational  Dermatoses 
among  Workers  in  the  Pyrethrum  Industry 

McGill,  N.  P.:  Trend  of  Child  Labor  in  the 
United  States.  1913  to  1920 

McLaughlin.  J.  J.:  What  One  Plant  Has 
Learned  about  Lighting 

Mcguilkiu,  A.  H. :  The  Home  and  the  Indus- 
try     

Mehl.  O. :  Expprimeutal  Investigations  on 
Calcium  Therapy  in  Frsol  Asthma 

Mehl,  W. :  What  Constitutes  a  Fair  Estimate 
of  Loss  of  Ise  of  Eye  in  Workmen's  Com- 
pensation Cases?   

Mehl.  W.:  Whnt  Principle  Must  Govern  Esti- 
mates of  Visual  Loss  in  Compensation 
Cases?  

Melville,  S..  gee  C.vriax,  E.  F. 

Milian  :  Arsenical  Conjimctivitis 

Miller.  H.  M. :  Sanitation  of  Fruit  and  Vege- 
table Canneries   

Miller.  R.  J.:  Labor  Camp  Sanitation — A 
Basis  for  Education  and  Citizenship 

Mills,  C.  M. :  Joplin  Zinc:  Industrial  Condi- 
tions in  the  Worlds  Greatest  Zinc  Center. . 

Mills.  C.  M. :  Plant  Disability  Funds 

Minot,  A.  S..  see  Reinian.  C.  K. 

Minster.  D.  K..  see  McCord.  C.  P. 

Mitchell.  H.  H. :  "At  What  Age  Should  Chil- 
dren Enter  Industry  ?" 

Mitchell.  H.  H. :  The  Child  Labor  Problem... 

Mitchell.  H.  H. :  He.ilth  and  the  Working 
Child    

Mitchell.  H.  H. :  Health  Protection  for  Young 
Workers     

Mitchell.  H.  H. ;  What  Is  Health  Protection 
for  Working  Children? 

Mock.  II.  E..  and  Ellis.  J.  D. :  The  Problem 
of  the  Tuberculous  Employee  in  Industry . . 

Mongan.  C.  E. :  The  Practitioner  and  the  In- 
dustrial   Physician    

Monnett.  O. :  Determination  of  .\tmospheric 
Impurities    

Moorhead.  J.  .T. :  Fractures  Incident  to  Occu- 
pation     

Moorheao.  -T.  J.:  Traumatic  Sursery  Problems 

Moron.  J.  J.:  New  Occupational  Pain:  Casse 
of  Chorea    

Morgan.  E.  B..  and  R'^pplier.  S.  .1. :  The  Health 
Service  Side  of  Personnel  Management.... 

Morgner;  The  Removal  of  Dust  from  Rae- 
Tearing  and   Rag-Beatins   Mnchines 

Morrison^  M.  F. :  Do  Workers  Prefer  to  Pay? 


144 

141 

94 

Si 

174 
102 

4S 

129 
115 
21 
144 
182 

174 

174 

274 

264 

195 

66 
147 

137 

60 

19 
278 

20 
253 
22S 

lOS 
lOS 

69 

170 

99 

2«> 


AUTHOR   INDEX 


311 


I'AGt: 

Mottiiim,  J.  ('. :  Tlie  Effect  of  Increased  I'ro- 
teetidu  from  Kadiiitioii  uijon  the  Blood  Con- 
dition of  Uadium   Worliers 205 

Moweil,  J.  W. :  Systems  of  Medical  Service..     39 

Mowery,  II.  W. :  Tlie  Obscure  but  Most  Pro- 
lific  Hazard    72 

Miiller :  Experience  with  Combined  Poisons 
in  Industry   24 

Miiller,  ii.:  Ueceiil  Advances  in  Mine  Illumin- 
ation         t>2 

Munro,  S.  11.,  see  Loveday,  J. 

Munroe,  J.  1". :  Salvaging  Humanity  a  Social 
Necessity    175 

Murayama,   Iv.,  see  Yamagiwa,  K. 

Murray,  A.  L.:  Relation  of  Lead  Poisoning 
in  Utah  to  Mining 249 

Murray,  1\  A. :  Dermatitis  Caused  by  Bitter 
Orange    188 

Murray,  II.  G. :  The  Framingliam  I'emonstra- 
tion.     No.  25:  The  Industrial  Clinic 141 

Muscio,  B. :  Is  a  Fatigue  Test  Possible? I'M 

Nauss.  It.  W. :  Hookworm  in  California  (Jold 
Mines    101 

Neilsoii.  C.  II.,  and  Wheelon.  II.:  Studies  on 
the  Resistance  of  the  Red  Blood  Cells.  Re- 
sistance of  the  Red  Blood  OUs  in  Health 
to  the   Hemolytic   Action  of   Sapotoxin 125 

Neuhoff,  F. :  I'olsoning  from  AVearing  Dyed 
Shoes     70 

.Xowbold.    i:.   M.,   .«'■(■   Broughton.   G.   M. 

Newman,  B.  .T. :  Industrial  Hygiene  as  a  Fac- 
tor in   Production 2 

Newman,  B.  J.:   Shop  Standards  and  Fatigue    711 

Nicloux,  M. :  Acute  Carbon  Monoxide  Poison- 
ing      207 

Norman.  F.  C:  Five  Tests  for  Good  Lighting.   118 

Northcott,  O.  IT.:  The  Human  Factor  in  In- 
dustry        210 

Oakes,  C.  E.,  see  Rosa,  R.  B. 

Oartel,  .T.  .\. :  A  Practical  Viewpoint  on  Safe- 
ty  and   Production 27.'") 

O'Brien.    H.   R..   trr   Sjiyprs.   R.   R. 

O'Donovan,  W.  .T,  :  Carcinoma  Cutis  in  an 
.Vnthracone  Fn<'tory    187 

O'Donovan.  W.  .T. :  Dermatitis  Due  to  Carpo- 
glyphus    P'lssularum    71 

Ogil'vie,  W.  11..  an<l  Hall.  A.  'W. :  The  Treat- 
ment of  Cutanoons  .\nllira\' 159 

Oliver,  T. :  Tndustri.nl  TTygiene 91 

Oliver.  T. :  Tnrlnstrial  Hygiene:  Its  Rise,  Prog- 
ress  and  Opiiortunities 151 

Oliver.  T. :  Problems  of  Industrial  Hygiene 
in  Relation  to  Pidilic  IToaltb 245 

Opit?;.  K. :  Lung  Iiiflainmntion  among  tlio 
Workers  with  Thomas   Slag  Du<t 51 

Orr.  .T.  B..  and  Kinlocli,  .T.  P. :  On  the  Esti- 
mation of  the  Physiological  Cost  of  Muscu- 
lar Work  :  The  SicTiificance  of  the  Respira- 
tory Quotient  in  Indirect  Calorimetry Ifi4 

Osgood.  T.  W. :  A  Practical  Guard  for  Con- 
tact Points  of  Sheave-Wheels  and  Cables..     14 

O'Shea.  P.  F. :  How  Paint  Affects  Waste Iffil 

Page,  G  B. :  Some  of  tho  Effects  of  Chronic 
T,ead  Poisoning,  with  Special  Reference  to 
Arteriosclerosis     15t^ 

Palit7«sch.   F. :   Tobacco  Pneumokoniosis 251 


i'almer,  G.  T. :  Ventilation,  Weatiier,  and  the 
Common   Cold    265 

Pautauia,  G. :  Influence  of  Alcohol  on  the 
I'^unction  of  tue  Heart 259 

Patzsche,  W.,  and  Plant,  R. :  Anhidrosis  Fol- 
lowing Toxic  Dermatitis 273 

Paul,  J.  W.,  see  Fieldner,  A.  C. 

Peacock,  D.  W.  K. :  Does  Welfare  Work  I'ay'.'  147 

I'eucock,  W.  L.,  and  Duke,  H.  L. :  Case  of 
Human  Anthrax  in  Buganda  Kingdom 187 

Pellini,  E.  J. :  The  Ambulatory  Patient  with 
Cardiac  Disease,  with  Special  Reference  to 
Digitalis  Therapy    gg 

Petri,  E. :  The  Anatomical  Diagnosis  and  His- 
tology  of   I'hosphorus   Poisoning 250 

Pezzali:  A  Case  of  Secondary  Infection  with 
a  Parasitic  Mold  in  a  Coal  Heaver 206 

Picard,  R.:  Labour  Legislation  in  France  dur- 
ing and   after   the   War 225 

Piceinini,  P. :  Diseases  and  Stigmata  of  Broom 
Makers    3 

Pichler,  K. :  Occupational  I>eformity  of  Hand  l.'M 

Pickard,  H.  O. :  Precautions  to  Be  Observed 
in  Entering  Abandoned  Exploratory  Shafts 
and   Pits    , 274 

Pierce.  D. :  Safety  in  Relation  to  Electrical 
Appliances    131 

Pinchcrle.  P.:  The  Clinical  and  Pathological 
Manifestations   of   Lead   Poisoning 231 

Pincherle,  P. :  Pneumokoniosis  and  Asthmatic 
.\t tacks   in   Woodworkers 251 

Plant.   R.,  see  Patzsche,  W. 

Pontopiddan,   S. :   Poisoning  from  Acetylene..   247 

Porter.  H.  F.  ,T. :  Reduction  of  Accidents 
through    Visual   Acuity 13 

Portmann,  !'._  V..  and  Warnshuis,  F.  C. :  In- 
juries of  the  Feet 7.'5 

Powers.  >L  .1.:  The  Industrial  Cost  of  the 
Psychopathic    Employee    95 

Preti.   L. :  Tlie  Therapy  of  Fatigue 110 

Price.  I>.  .T. :  Engineering  Problems  in  Dust 
Explosion    Prevent  ion    57 

Price.  D  .L.  and  Brown.  H.  R. :  An  Explo- 
sion of  Hard  Unbbi'r  Dust 216 

Price,  D.  .L,  and  Brown.  II.  R. :  A  Recently 
Developed  Dust  Explosion  and  Fire  Hazard  216 

Quarg.  R. :  The  Sources  of  Danger  from  Acci- 
dents in  Building  Industries 233 

Quinby.  R.  S. :  Benzene  Poisoning  in  Rubber 
Manufacturing    157 

Qninbv.  R.  S. :  Five  Points  in  Employee  Health 
Work    281 

Quinby.  R.  S.  :  .V  Study  of  Industrial  Absen- 
teeism       239 

Radford.  M.  R. :  How  to  Catch  and  Ship  Dust  158 

RnUestraw.   N.  W. :   Chemical   Factors   in   Fa- 

tiL'ue.     I.   The  Effect  of  Muscular   Kxcrci.se 

upon  Certain  Common  Blood  Constituents..   165 

Ramsev.  W.  T.,  and  Tead.  o. :   Report   of  Tn- 

vestisntion  into  the  Operation  of  the  British 

Health   Insurance  Act 243 

Rand.  W.  H. :  Occupational  Lead  Poisoning.  .     97 
Ranelletti.    A. :    The    Typographical    Industry 

in    Rome    35 

Rapp.  R. :  The  Medical  Hnit  of  a  Factory...     29 
Rasch.  r  ■    Match   Box   Dermatitis   and   Con- 
luneHvitls    212 


312 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


PAGE 

Rasch,  H. :  The  rrobleiii  of  Industrial  Hygiene 
and  tlie  Co-opeiatiou  of  Pliysiclaus  iu  In- 
dustrial   Supervision    205 

Kector,  F.  L. :  Physical  Examinations  of  In- 
dustrial  Workers    63 

Eegau,  J.  C. :  The  Advantage  of  Serum  Ther- 
apy as  Shoviu  by  a  Coiiiparison  of  Various 
Methods   of  Treatment  of  Anthrax 253 

Kegan,  J.  C. :  The  Local  and  General  Serum 
Treatment  of  Cutaneous  Anthrax 272 

Keid,  A.  C. :  The  Eye  Is  Mightier  than  the 
Hand     220 

Keiman,  C.  K.,  and  Minot,  A.  S. :  Absorption 
and  Elimination  of  Manganese  Ingested  as 
Oxides  and  Silicates 49 

Repplier,  S.  J.,  see  Morgan,  E.  B. 

Resnick,  L. :  A  Peek  behind  the  Scenes  at 
Railroad   Safety 233 

Resnick,  L. :   Safety  amid   Slaughter 274 

Resnick,  L. :  Safety  Where  the  Bessemer 
Blows    19^ 

Resnick,  L. :  Saving  Men  and  Money 55 

Resnick,  L. :  Saving  Men  and  Money  at  the 
du  Pont  Plants '^ 

Resnick,  L. :  Where  a  Hell-Hole  Might  Have 
Been    1^^  ' 

Rheinfels:  The  Group  "Poisonous  Substances 
and  Gases"  in  the  Accident  Statistics  of  the 
Trades  TTnions   1^^ 

Richardson,  D.  L. :  Contagion  in  Industrial 
Establishments     -"- 

Ritter :  Some  Further  Conimnnirations  on  the 
Harmful  Effects  of  T'rsol  among  Workers 
in    Furs    1^2 

Robertson.  J.  A.:  Tlie  Jledical  Department 
Proves    its    Value 222 

Rogers.  C.  F. :  The  Employment  of  the  Tuber- 
culous       -' 

Rogers.  .T.  B. :  The  Effect  of  Nitrous  Oxide, 
Natural  Gas  and  Formaldehyde  on  Exi^eri- 
mental    Tuberculosis    254 

Rood.  A.  P. :  Dental  Dispensary  in  Magneto 
Plant     1'*'' 

Ro.sa.  E.  B..  and  O.ikes.  C.  E. :  Safety  Work 
of   the  Federal   Government 189 

Ross,  B. :  Relation  of  Industrial  Nurse  to 
Employment  Manager    ^^ 

Rosseland.  F.  M.:  GnmpaiL'n  against  "Drop- 
sy," the  Careless  Handling  of  Materials...   233 

Rosseland.  F.  M. :  "Give  Mo  Another  Pair  of 
Goggles — Just    Broke   Mine" 233 

Rost.    E  :    Foundry   Fever 69 

Rnthe.  F. :  Tlio  Status  of  Ealmr  Tni(m  .Occi- 
dent Prevention   '" 

Rubin.  G,.  and  Ba^kin.  .T. :  .\  Statistical  Re- 
view of  Disal>iPty  in  the  Workmen's  Circle     87 

Riibino     C. :    Industrial    Trinitrotoluene    Poi- 

4.S 
soning    

Uugb.  .T  T. :  Three  Frequpnt  Causes  of  Weak 
and    Flat   Feet WS 

Ryan.  A.  H. :  and  Florence  P.  S. :  The  Hours 
of  Work  in  Relation  to  Quality  of  Output.  .     02 

Ryan,  E.  A.:  Suggestions  on  Heating  and 
Ventilating  P.%ppr  Machine  Rooms 61 

Sachs.  H. :  Electrocardiography  and  its  Sig- 
nific.inco  in   Insurance  Medicine.... TO 

f!achs.  O  :  Dermatitis  among  Workers  In 
Phenol  Resins    i •  •  213 


PAGE 

Sachs,  O. :  A  Peculiar  Injury  Due  to  Black 
Italian   Thread    51 

Saelhof,  C.  C. :  Bacterial  Content  of  Tele- 
phones with  Special  Reference  to  Respira- 
tory Pathogens    100 

Salaut,  W.,  and  Kleitman.  N. :  Action  of 
Mercury    250 

Salisbury,  R.  C. :   Safety  iu  Steel  Making 234 

Samuels,  M.  M. :  Safely  Features  in  Higli 
Tension  Generating  Stations  and  Substa- 
tions      218 

Sandiford,  P. :  Critical  Survey  of  Intelligence 
Testing   240 

Sangiorgi,  G. :  The  Hygienic  Conditions  in  the 
Sulphur  Industry  of  Catania 23 

Sardi,  P. :  Dust  iu  the  Bootmaking  Industry .   100 

Sawyer,  W.  A. :  Fimdameutal  Rerjuirenients 
for  Successful  Medical  Work  in  Industry..     62 

Sawyer,  W.  A. :  Nurses  in  the  Guise  of  In- 
dustrial  Physicians    ....'. 239 

Sayer.  H.  D. :  New  York  Labor  Laws  Enacted 
iu  1921   174 

Savers,  R.  R. :  The  Transportation  of  the  In- 
jured       2,35 

Sayers,  R.  R.,  and  Harrington,  D. :  A  Prelim- 
inary Study  of  the  Physiological  Effects  of 
High  Temperatures  and  High  Humidities 
in  Metal  Mines 58 

Sa.vers.  R.  R.,  and  O'Brien.  H.  R. :  The  Treat- 
ment of  Carbon  Monoxide   Poisoning 270 

Schiirer.  R.:  Skin  Lesions  in  Briquette-Makers 
and  their  Relation  to  War  Melanoses 214 

Schilling:  Courts  and  the  Accomplishment  of 
Workers'    Safety    37 

Schlier:  Impairment  of  Health  from  Calcium 
Cyanamide   Fertilizers    H 

Schippe :  Steam  Boilers  or  Steam  Pressure  Ap- 
paratus'?     2.34 

Schmitz,  E..  see  Embden.  G. 

Sohnoidor,  R. :  Industrial  Myopia  and  Selec- 
tion of  a  Trade '54 

Schoch,  E.  P. :  Formation  of  Poisonous  Gases 
iiv  Certain  Forms  of  Gas-Fired  Water  Heat- 
ers       120 

Schoenfetd.  .T. :  Tlie  Early  Diagnosis  of  Lead 
Poisoning   71 

Scholte :  Two  New  Protective  Devices  from  tlie 
Amsterdam  Safety  Museum 162 

Scholte.  11.  .7. :  The  New  Law  for  Protection 
of  Workers  in  Holland 85 

Schonbertr.  M.  G. :  Tenement  Homework  in 
New  York   City 27 

Scliott.  E. :  Electrocardiographic  Studies  in 
Acute  Poisonings   45 

Schrani.  C.  F.  N. :  How  to  Induce  Workmen  to 
Come  to  the  Shop  Hospital 74 

Schwarz,  L. :  On  Bbiod  Examination  by  the 
Thick  Drop  Motliod  In  Suspected  Lead 
Poisoning   208 

Schwarz.  L. :  A  Simpler  Method  of  Blood 
Examination   for   Suspected   Cases   of  T>»ad 

Poisoning     208 

Scliworin  :  Bl.idder  Tumors  in  Workers  In 
Chemical    Industries    7 

Scott.  O.  F. :  Why  Nurses  Fail  in   Industrial 

Work ■• 31 

Scott,  y.  T. :  The  Application  ef  .Cert-jIn 
Physical  Efficiency  Tests,  .r.....  .'.r. ../.-.... .     78 


AUTHOR   INDEX 


313 


Selby,  C.  D. :  Focal  Infectious  as  Affecting 
Trivial  Injuries   132 

Selby,  C.  L). :  Health  Service  Establishes  Foot- 
ing         (35 

Sequeira,  J.  H. :  A  Case  of  Bullous  Eruption 
Caused  by  JIay-Weetl 213 

Sequu.ra,  J.  II. :  Sclerodactylia 213 

Sever,  J.  W. :  Diagnosis  and  TreaUuenl  of 
Disabilities  of  the  Back 75 

Sliadgeu,  J.  F. :  Esplosiuus  Hazard  and  its 
I'revention     25S 

Shaw,  A.  A. :  Three  Shifts  in  Steel.. 16 

Shaw,  10.  B.,  see  Fleischuer,  E.  C. 

Shaw,  L.  A.,  see  Drinker,  C.  K. 

Sheiard,  G.  H. :  Fatigue  Tests  at  I'urdue  Uni- 
versity      261 

Sherlock,   C.    C. :    Ventilation 118 

Sherhick,  C.  C:  Your  Lialiility  for  Concurrent 
Compensation    ^ 41 

Sherman,  W.  O. :  Industrial  Surgery  as  a 
Specialty    : 30 

Shie,  M.  D. :  Industrial  Lead  I'olsouing 97 

Shipley,  A.  E. :  Health  Work  In  Five  Industrial 
I'lants     l.~>3 

Sliubcit.  M.  E. :  Listing  the  W<irk  of  Women.  .    U'.7 

Siegrist :  AVorkmen's  Compensation  for  Loss  of 
One  Eye  243 

Sinii)Son,  R.  E. :  Defective  Illumination,  a 
Cause  of   Industrial  A'-cideiits 13 

Slocock,  see  Wright,  C.  F. 

Smital,  W.:  A  Case  of  Industrial  Ijijury  in  ii 
Cooper 57 

Smith.  A.  K. :  The  Treatment  of  Acid  and 
Alkali   Burns ;. 1.34 

Siuith.  O.  n. :  A  New  Tubular  Breathing  Mask    {)6 

Smith,  J.  S. :  rrovidiug  Home.;  for  the  Workers     33 

Smyth,  U.  F.:  The  Harmfulness  of  Dust  in 
the    Workshop !> 

Snvder,  ,1.  A. :  Steam  Boiler  Safetv  and  Oper- 
ation      234 

Soderberg,  O.  .T. :  Goggles  for  Locomotive  En- 
ginemen    IPR 

Soderberg.  G.  .T. :  "Health  First"  Campaign: 
Outline   for    Industries 61 

SoisMliin-Soiniiu^n.  .1.  L..  kip  (5\illichsen.  T!. 

Sollranii.  T. :  Studies  of  Chronic  Intoxications 
on  Albino  Rats.  III.  Acet;c  and  Formic 
Acids     40 

Spaolb.  R.  A,  and  Dunliam.  G.  C. :  The  Cor- 
relation between  Motor  Control  and  Uille 
Shooting 164 

■Speucc.  .1. :  Productionv Manager's  Interest  in 
Industrial  TToaltli • 221 

Spencer,  O.  M. :  Experiments  in  Control  of 
Air  Dustiness .'. 98 

Spencer,  O.  M. :  Recent  Experiments  in  the 
Control  of  .\ir  Dustiness .'0 

Spillnmnn.  M.  L. :  Dermatitis  Venenata 
Caused  by  .the  Oak 213 

SpofForth,  .T. :  Case  of  Aluminium  Poisoning..   185 

Stnobler,  A.  M. :  A  Talk  on  Health  Talks  for 
Industrial  Nurses   282 

Stanton.  E.  M. :  Some  Practical  Hospital  Prob- 
lems Encountered  In  an  Industrial  Com- 
munity         81 

Stedman,  H.  R..  and  MacPherson.  D.  .T. ;  Re- 
port   on    Psychiatry 35 

Steele.  W.  TT.. :  ITow  Accidents  Are  Prevented 
in  our  Foundry 104 


Stewart,  E. :  A  Plea  for  More  Ade.iu:ile  Com- 
pensation Rates  39 

Stieren,  E. :  What  Constitutes  Industrial 
Blindne-ssV    129 

Stockman,  R.  :•  Chronic  Ar>enic  Poisoning....   156 

Stokes,  J.  H.,  and  lirelimer,  II.  E. :  A  Memo- 
rMudum  on  the  Occupational  Study  of  Syph- 
ilis, with  Special  Reference  to  Farmers....   232 

Strassmann.  (i.:  Earl.v  .Vpid'aiiuui'  of  .Second- 
ary Pneumonia  after  Severe  Injuries  by 
Blunt  Force  and  after  Poisoning  with  Illu- 
minating Gas   8 

Strickland,  W.  P. :  How  an  Electrical  Com- 
pany Cut  Accidents  78  Per  Cent 104 

Suzuki.  S.,  see  Yamagiwa,  K. 

Swartz,  N. :  Causes  of  Work  Accidents  among 
Women   1''7 

Swartz,  N. :  Work  Accidents  among  Women..     27 

Sweeney,  C.  P. :  .\dult  Working-CIass  Educa- 
tion in  Great  Britain  and  the  United  States      4 

I 

Tarhell.  I.  M. :  The  New  Place  of  Women  in 
Industry.  VI.  The  New  Industrial  Profes- 
sions     * 167 

Taibell,  I.  M. :  Tlie  New  Place  of  Women  in 
Industry.  I^'-  Women  of  the  International 
Harvester  Company   59 

Tarbcll,  I.  M. :  Women,  a  New  Force  in  In- 
dustry       262 

Tead,  O. :  Fact  ;nid  Opinion  as  to  the  British 
National  HeTltli  Insurance  .'ct 150 

Toad.  O.,  see  Itaniscy.  W.  T. 

Todcschi^  Arterial  Pressure  among  Workers 
in    Higli   Tomperat\ires 112 

Toleky.  L. :   War  and  Industrial  Diseases 203 

Thielo:  The  Application  of  Statistics  to  the 
Stud.v  of  Employment  and  Sickness.-. 65 

Thielei  Sickness  and  Death  Due  to  Perro- 
silicon    ■   158 

Tliiemo:  The  Porcelain  and  Earthenware  In- 
dustries from  the  Standpoint  of  the  Protec- 
tion of  the  Workers  and  the  Neighborhood, 
and  Measures  for  Fightiiig  the  Danger....  153 

Thompson.  A.  .L  :  Safety  Disconnecting  Hang- 
ers as  a   Sa fegunrd 15 

Thompson,  B.  M. :  Welfare  Provisions  That 
Help 173 

Thompson,  F.  H. :  How  Can  Medical  Service 
Be  Improved ? ■. 31 

Thompsoii,  F.  H. :  Oregon  System  of  Medical 
Service ^^ 

Thompson.  W.  G. :  Occupation  Therapy 150 

Thomson.  B-.  see  Ueald.  C.  B. 

Thorington.  .T.  M. :  X  New  Test  Card 256 

Tillingliast.  G. :  Paint  as  an  Accident  Reducer  220 

Tittler :    Model    BuildiTig    Regulations   of    the  ■ 
State  Commissioner  of  TTousing  of  .\pril  25. 
lOin     32.     32 

Tobey.  J.  A. :  What  Are  the  Dangerous  .Tobs?  215 

Tolman.  C.  P. :  Ensineering  Revision — The 
Engineer's  Part  in  Safety 191 

Torraca  :  Arteriosclerosis  Localized  in  the 
Arteries  of  the  Shoulder 181 

Torrev.  F.  N. :  IMicIiigan  Mutual  Liability 
Company   Service    l'*2 

Tracy.  L.  D. :  Coal-Dust  Hazards  in  Indus- 
trial   Plants    158 

Trudeau.  F.  B. :  Presence.  Absence  and  Loca- 
tion of  Rilles  in  the  ProL'nosis  of  Pulmonary 
Tuberculosis    210 


314 


THE  JOURNAL  OF  INDUSTRIAL  HYGIENE 


Tupper,  II.  JI.:  Buda  Co.  Medical  Service...     83 

Tunibull,  H.  M.,  see  Jacob,  F.  H. 

Tunior,  J.  A. :  An  Occupational  Dermatoco- 
niosis  among  Zinc  Oxide  Worliers 212 

Turner,  J.  W. :  The  Nauvoo  Project.  The 
Functions  of  a  Special  School  for  Inactive 
Tuberculous  Cases    150 

Vuderwood,  K.  G. :  Liable  for  Exaniiu.ation. .   238 

I 

Van  Antwerp,  H.,  Jr. :  Hours  before  Noon  and 
Quitting  Time  Most  Prolific  of  Accidents. . .  233 

Van  Bu:skirk.  E.  H. :  Enforcement  of  Child 
Labor  Laws  in  West  Virginia 220 

Vernon,  H.  M. :  Fatigue  and  Efficiency  in  the 
Iron   and   Steel   Industry 110 

Vernon,  H.  M. :  The  Influence  of  Dilution  on 
the  Toxic  Action  of  Alcoholic  Liquids 77 

Vincenzo,  G. :  Progressive  Amyotrophy  Re- 
sulting from   Labor ". isi 

Von  Dannenberg.  C.  O. :  Safety  Features  on 
High  Voltage  Transmission  Lines 194 

Vorch,  N.  O. :  Solving  Lighting  Difficulties . . .   US 

Wainwright.  J.  M. :  The  Influence  of  Physical 
Tlierapy  in  Reducing  Disability  Time  in 
Fractures   of  the  Long  Rones..! 26S 

Waller,  A.  D..  and  De  Decker,  G. :  The  Phys- 
iological Cost  of  Collier's  Work .' . .   Ill 

Waller.  A.  D.,  and  De  Decker.  G. :  The  Phys- 
iological Cost  of  Muscular  Work:  A  Reply 
to   Objections ofiO 

Wallrich.  L.  A.,  and  Dawson.  P.  JI, :  The 
Effect  of  Short  Spells  of  Rest  on  Physical 
Efficiency  as  Measured  by  a  Bic.vcle  Er- 
goraeter    16."! 

Wallrich.  L.  A.,  see  Daw.son.   P.  M. 

Walsh.  J.  J.:  Rules  for  Prevention  of  Gas 
Explosions   in   Anthracite   Mines 72 

Walsh.  T.  A.:  The  Progress  of  Safety  Work 
in  the  Shipbuilding  Industry ." 14 

Walter.  R.  A. ;  Prevention  of  Gas  Explosions 
in    Bituminous   Coal   Mines 20 

Wanisliuis.  F.  C.   are  Portmann.  T'.  V. 

Wasliington.  L. :  Personnel  Management  of  the 
Metropolitan   Life  Insurance  Companv 172 

Webster.  G.  W. :  A  Plnsiological  Basis  for 
the  Shorter  Working  Day  for  Women 70 

Welch.  W,  E. :  Safety  IMetbods  ns  Arip'ied  In 
the  Loading  and  T'nloading  of  Steamships.   107 

We! wart.  X.:  The  Early  Recognition  of  In- 
dustrial I/ead  Poisoning  with  the  Aid  of 
Blood    Examination    6 

Wesselhoeft.  C. :  Comparison  of  Mumps  and 
Chronic  Lead  Poisoning  from  the  Stand- 
point of  the  Totality  of  Symptoms 231 


PAGE 

West,  D.  W.,  see  Levy,  L. 

Westervelt,  JI.  Z. :  Matron  Service  for  Plant 
Hospital    142 

Westervelt,  M.  Z. :  The  Medical  Department 
in  Industry   169 

Wheelon,  H.,  nee  Nellsou,  C.  H. 

White,  C.  J. :  Crude  Coal  Tar  in  Dermatology  273 

White.  W.  B. :  Preventable  Vocational  Eye 
Injuries    214 

Whiting,  S.  E. :  Lessons  Learned  from  Forty 
Electrical    Fatalities     *.   112 

Wibaux,  R. :  The  Inspection  of  Bakeries 147 

Widal.  F.,  Abrami,  P.,  and  Brissaud,  E. :  Ex- 
perimental Researches  on  "AutocolloVdocla- 
sie"  froai  Chilling 237 

Wildoner.  C.  E. :  Safety-Trip  f(u-  Punch 
Presses    217 

Willberg,  M. :  Question  of  the  Resistance  of 
\'arious  Animals  to  Arsenic 47 

Williams,  W. :  Employment:  Hours  of  Work..     67 

Willis,  H.  S. :  Studies  on  Tuberc\ilous  Infec- 
tion. VIII.  Spontaneous  Pncumokoniosis  in 
the  Guinea  Pig 12S 

Wilmer,  W.  H. :  Toxic  Effects  of  Carbon  Mon- 
oxid    45 

Wilson,  M.  G. :  The  Equivalent  of  Ordinary 
Exertion     6S 

Wilson,  M.  G. :  Exercise  Tolerance  of  Chil- 
dren with  Heart  Disease  as  Determined  by 
Standardized   Test   Exercises 95 

Witt :  Properties  and  I'ses  of  Para-Dichlor- 
benzene   247 

Woede.  W. :  The  Laboratory  for  Industrial 
Psychotechnics  at  the  Technical  Training- 
School    in    Charlottenburg 68 

Woedtke,  L.  D. :  Remarkable  Record  Made  in 
Building  Concrete  Ships 161 

Wright,  C.  P.,  and   Slocock :   Sanitation 80 

Wright,  W. :  The  Consultant  in  Industrial 
Medical    Service    221 

Wright,  W. :  Industrial  Clinics  in  General 
Hospitals    64 

Wriu'lit.  W. :   Industrial   Hygiene 1?1 

Wiirdemann.  IT.  V. :  Etiology  and  Prevention 
of  In ju lies  to  the  Eye 1(53 

Ynniagiwa,  K..  Su/.iiki.  S..  and  Mura.vama,  K. : 

Tar   Sarcoma   in   Rabbit 156 

Young.  .\.  P. :  Morn  Tips  on  Preventing  Burns  lfi.S 

Ziegler.  TI.  F. :  The  Question  of  Increased 
Protection  against  .\ccidents  for  Industrial 
Workers  Who  Wo'o  Iniured  in  the  War...     55 

Zieirler.  S.  L. :  The  Ocular  Menace  of  Wood 
.Mcohol    Poisoning   185 

Zimmermann,  kpp  Kockel. 


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