086498 (I^arnell HntuErsity Ctbrari} 3ti;aca. Neiu fork THE LIBRARY OF EMIL KUICHLING, C. E. ROCHESTER, NEW YORK THE GIFT OF SARAH L. KUICHLING 1919 3 1924 004 977 710 Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924004977710 The fundamental purpose of labor legislation is the con- servation of the human resources of the nation. AMERICAN LABOR LEGISLATION Vol. II, No. 2 r> T7T 7TT?\Ttr Issued Quarterly Publication 17 rvJiVliiVV Price *3.00 Per Year INDUSTRIAL DISEASES Symposium on Diseases of Occupation. Investigation of Industrial Diseases. Health Problems in Modern Industry. State Promotion of Industrial Hygiene. Bibliography on Industrial Diseases. JUNE, 1912 PROCEEDINGS OF THE SECOND NATIONAL CONFERENCE ON INDUSTRIAL DISEASES ATLANTIC CITY, N. J., JUNE 3-5, I9I2 American Association for Labor Legislation Joint Session with American Medical Association AMERICAN ASSOCIATION FOR LABOR LEGISLATION 131 EAST 23d ST., NEW YORK CITY Entered as second-class matter February 20, 1911, at the post office at New York, N. Y., under the Act of July 16, 1894 PRICE ONE DOLLAR American Association for Labor Legislation 131 EAST 23d ST., NEW YORK CITY President, Henry R. Seacer, Columbia University. Vice-Presidents Jane Addams, Chicago Morton D. Hull, Chicago.; Louis D. Brandeis, Boston, Mass. J. W. Jenks, Ithaca, N. Y. Robert W. deForest, New Yorlc Frederick N. Judson, St. Louis Richard T. Ely, Madison, Wis. Paul M. Warburg, New York Samuel Gompers, Washington, D. C. Woodrow Wilson, Trenton, N. J. Secretary, John B. Andrews, 131 East 23d St., New York. Assistant Secretary, Irene Osgood Andrews, New York City. Treasurer, V. Everit Macy, New York City. EXECUTIVE COMMITTEE Charles M. Cabot, Boston Frederick L. Hoffman, Newark John Calder, Detroit, Mich. Paul U. Kellogg, New York City John R. Commons, Madison, Wis. Samuel McC. Lindsay, New York Henry W. Farnam, New Haven John Mitchell, New York City Ernst Freund, Chicago Charles P. Neill, Washington The President and the Secretary. MEMBERSHIP AND DUES Minimum individual membership fee, $3 a year. Associate members contribute annually $5 to $25. Contributing members contribute annually $25 to $100. Sustaining members contribute annually $100 or more. In addition to the American Labor Legislation Review, which is sent pre- paid to all members, the quarterly Bulletin of the International Labor Office will be sent to members paying $s or more, if specially requested. Societies and institutions pay $5 or more a year and receive all publications. Letters of inquiry and membership contributions should be sent to The American Association for Labor Legislation, John B. Andrews, Secretary, 131 East 23d St., New York City. International Association for Labor Legisiatioa BASEL, SWITZERLAND. Serves as a bond of union to all who believe in the necessity for Labor Legislation. Facilitates the study of Labor Legislation in all countries and provides in- formation on the subject. The International Labor Office publishes a periodical Bulletin in English, German and French — which contains the text of recent Labor Laws in all countries, notes on action taken in the various Legislatures, resolutions of Congresses, and an International Bibliography on Labor Legislation. NATIONAL SECTIONS ARGENTINA FINLAND ITALY AUSTRIA FRANCE NORWAY BELGIUM GERMANY SPAIN DENMARK HOLLAND SWEDEN ENGLAND HUNGARY SWITZERLAND UNITED STATES AMERICAN LABOR LEGISLATION REVIEW Vol. II, No. 2 ILLUSTRATIONS Dry Sandpapering. Wet Sanding with Pumice Stone . Facing P Arsenic Poisoning Cross Section of Caisson in Full Operation Occupational Skin Diseases Making Lead Colors. Lead Casting, Showing Lead Pot in a Smelter Dust Collectors in a Lead Plant. Emptying a Red- Lead Furnace Lead Used as a Hardening Agent. Heading up Barrels of Dry Red Lead , Chaser Room in White-Lead Factory .... Air-Lock on Top of Caisson Separating Screens in White-Lead Factory Workers in White-Lead Factory 181 188 193 208 273 276 284 288 353 360 368 AMERICAN LABOR LEGISLATION REVIEW Vol. II JUNE, 1912 No. 2 CONTENTS I. Stmposium on Industrial Diseases. page Classification of Occupational Diseases W. G. TI^oMPso^f... 185 Compressed-Air Illness Frederick L. Keays 192 Occupational Skin Diseases Tohn A. Fordyce.. 206 Occupational Nervous and Mental Diseases. .Charles L. Daxa.. 217 Occupational Eye Diseases Ellice M. Alger. . 223 Industrial Poisoning David L. Edsall ... 231 Cooperation in Promoting Industrial Hygiene Henry R. Seagee . . . 235 General Discussion 242 II. Investigation or Industrial Diseases. Intensive Investigations in Industrial Hygiene F. L. Hoffman .... 255 Compulsory Reporting by Physicians Leonard W. Hatch 264 Lead Poisoning in New York City Edward E. Pratt. . 273 General Discussion 381 III. Health Problems in Modern Industry-. The Function of Hospitals and Clinics in the Prevention of Industrial Disease Richard Cabot 293 Temperature and Humidity in Factories. .. .C.-E. A. Winslow.. 297 Air Impurities — Dusts, Fumes, and Gases. .. Charles Baskerville 305 Effects of Confined Air Upon the Health of Workers George M. Price .... 312 General Discussion 317 IV. State Promotion or Industrial Hy-giene. Education for the Prevention of Industrial Diseases M. G. Overlock 329 Notification of Occupational Diseases Cressy- L. Wilbur.. 339 Medical Inspection of Factories in Illinois. .Harold K. Gibson.. 346 Compressed-Air Illness in Caisson Work. . . .L. M. Ryan 350 Legal Protection for AVorkers in Unhealthful Trades John B. .Andrews. . 356 General Discussion 363 V. Bibliography' on Industrial Hy'giene. American Titles 369 Titles Other Than American 397 The American Lator Legislation Review is published quarterly by the American Asso- ciation for Labor Legislation, 131 East 23d St., New York, N. Y. The price is one dollar per single copy, or three dollars per year in advance. Annual subscription includes indi- vidual membership in the Association. Princeton University Press Princeton, N.J. DRY SANDPAPERING Dry Sanding of Paikt is a Frequent Cause of Lead Poisoning. The Operation Fills the Air With Tiny Particles of Lead Dust WET SANDING WITH PUMICE STONE Dust is Avoided When Sanding is Done with Wet Pumice Stone INTRODUCTION When the American Association for Labor Legislation called the First National Conference on Industrial Diseases, in Chicago in June, 1910, it was possible only to mention the appointment of the first state commission on occupational diseases and to note the completion of an investigation of one industrial poison. That practically marked the extent of serious public interest in dis- eases of occupation, and the first conference attracted attention to this as to a new problem. Since then there has been a re- markable development of interest in the subject. The Memorial on Occupational Diseases, prepared by a com- mittee of the first conference, laid the foundation for and strongly urged national investigation of industrial hygiene. One after another eight states have since then passed the Association for Labor Legislation's standard bill requiring physicians to report all cases of certain diseases of occupation. The work of the one state commission, in Illinois, led to the enactment of a special occupational disease law requiring monthly medical examinations of workmen in a few of the most hazardous employments. In April, 1912, the United States Congress agreed, by passing the Association's bill placing a prohibitive tax on poisonous phos- phorus matches, to abolish "phossy jaw", the occupational disease due to the one industrial poison which had then been thoroughly studied. In the meantime, the List of Industrial Poisons, pre- pared by the International Association for Labor Legislation and translated by the United States Bureau of Labor, gave definite direction to further investigations. Reports on industrial pois- oning from lead and mercury have already been published, and medical inspection of factories has increased in importance. The Second National Conference on Industrial Diseases, in At- lantic City, June, 1912, was attended by practicing physicians, state and federal public health officials, medical inspectors of factories, physiologists, investigators and statisticians, manu- facturers, efficiency engineers, insurance experts, labor leaders, economists, and social workers. Through an industrial hygiene exhibit, the first extensive display of the kind in America, in- I SYMPOSIUM ON INDUSTRIAL DISEASES Joint Session with the American Medical Association Presiding Officer: Rupert Blue Surgeon General, United States Public Health and Marine Hospital Service Washington, D. C. CLASSIFICATION OF OCCUPATIONAL DISEASES W. Oilman Thompson Cornell University Medical College. In order to establish a satisfactory classification of the occupa- tional diseases and the industrial hazards which give origin to them, it is necessary to agree upon a standard nomenclature which may prove not only of scientific value, but constitute a working basis for such remedial legislation as may prove desirable. The authority for such nomenclature and classification is properly vested in the United States Bureau of the Census which, being a national insti- tution, is better fitted for this work than the local municipal or state boards of health or labor bureaus. Agreement as to uniform- ity among the latter would obviously involve much time and dis- cussion, with probably less satisfactory ultimate results. The Bureau of the Census already furnishes a generally accepted classification of the causes of death from ordinary diseases and includes a number of causes of death from occupational diseases, about one hundred of which are enumerated in the Mortality Statistics Bulletin No. io8, 1909, p. 33. But this list is obviously merely tentative, else why should the making of neckties be included as hazardous and the caisson disease be omitted, of which, in the admirable report of Dr. F. L. Keays, twenty fatal cases are re- corded as occurring within a few years in New York City alone? Fortunately, the Bureau of the Census is at present cooperating with the Committee of the American Medical Association on the Nomenclature and Classification of Diseases, and it is to be hoped that they will find time to include in this work the formulaton of a complete classification of the disease hazards and deleterious sub- stances which are causatively related to the industrial diseases, — irrespective of mortality statistics. As far as these diseases are themselves concerned, they are fairly well named and classified already, but not in connection with their causation. For example, arteriosclerosis or chronic nephritis due to chronic lead poisoning do not differ materially from the same diseases originating from l86 American Labor Legislation Review syphilis, chronic alcohohsm, gout and other etiological factors. Nor does a bronchitis due to inhaling dust in a cotton mill differ essen- tially from that acquired in other ways. In fact, apart from the lesions of the caisson disease, and a few of the bone lesions, occupa- tional tics and palsies, there is little that is new in those of the diseases of hazardous industries, and little which cannot be included in existing medical nomenclature as applied to disease in general. A. Harmful Substances The injurious substances employed, however, present a somewhat more complex problem, mainly because their number is rapidly increasing, and any system of classification should be an elastic one, permitting of extension and providing for a large miscellaneous group. For example, the great majority of injurious substances may be comprised under the six general headings: (i) Metal poisons, including the metallic salts; (2) toxic gases, vapors and fumes; (3) toxic fluids (such as acids and alkalies, petroleum products, etc.); (4) toxic or irritant dusts, subdivided into: (a) insoluble inorganic dusts (irritating the respiratory passages), (b) soluble inorganic dusts (liable to be swallowed and absorbed), (c) organic dusts and fibers; (5) organic germs (such as those of glanders and anthrax) ; and (6) miscellaneous irritants. Under these major headings may be grouped practically all of the irritant substances, yet certain difficulties arise even in this elementary arrangement. For example, lead, which of course would be classed as a simple metal poison, is also, when heated, to be ranked among the toxic fumes, and again, in the form of filings, as a soluble inorganic dust. As this applies to many of the other metals, to repeat them all under each subheading would be cumber- some. Phosphorus, for instance, is a metal, yet it is as a toxic fume that it works such havoc, and it had better be classed with the latter. Furthermore, the names of many substances may convey no inti- mation of their special hazards. For example, whether ferrosili- con be classed among the metals as containing iron and traces of arsenic, or as a liquid, since by itself it is non-toxic, neither of these groups would suggest its real hazard, which consists in the acci- dental access of water, producing the combination arseniuretted hydrogen gas that has cost many lives, especially on ships in which the ferrosilicon was being transported. Classification of Occupational Diseases 187 For such reasons, it would seem best to class each substance primarily in the major group which its most common form and use suggest, and, when its common name conveys no idea of the hazard, to indicate the latter in parenthesis. Thus ferrosilicon would be grouped under toxic liquids, and a parenthesis should follow, reading "(arseniuretted hydrogen gas, on hydration)". B. Harmful Conditions of Physical Environment The above general classification refers only to the material haz- ards, so to speak, and does not provide for the injuries arising from environmental or physical conditions, such as the air compression afifecting tunnel and caisson workers and divers, the rarefied air af- fecting aviators, or the tunnel injuries to the ears. Nor does it pro- vide for the injuries arising from excessive temperature changes as afifecting smelter employees, stokers, workers in cold-storage, etc. A group, therefore, of hazardous occupations due to physical environ- ment should be established, including hazards from excessive varia- tions in (a) air pressure, (b) humidity, (c) air temperature, and (d) light (including electric light, the X-ray, etc.). C. Injuries (Medical) to Nerves, Muscles, and Bones Another general group of occupational hazards is necessary to comprise disease injuries to nerves, muscles, and bones, arising from such conditions as occupational strain, fatigue, repeated blows and vibrations, excessive pressure, repeated muscular contractions, and faulty positions assumed in working at benches, handling many forms of tools, etc. The large group of "occupational neuroses", with cramps, palsy, tremors, tics, neuralgia, neuritis, and vaso-motor disorders, should be included as subdivisions of this group. To this also may be added a subclass comprising insomnia, headache, general nervousness as from "speeding up", etc. D. Injuries of Special Organs Other primary groups of occupational diseases should include injuries of special organs: namely, (i) injuries to the skin; (2) injuries to the eyes; (3) injuries to the ears; and (4) injuries to the nose and throat. Under the foregoing general classification, with appropriate sub- divisions, may be included all the specific causes of occupational diseases, namely, the (a) material, (b) chemical, (c) physical, and (d) physiological causes. i88 ' American Labor Legislation Review Classification of Hazardous Occupations There remains to be dealt with the classification of hazardous occupations, which is, from every point of view, a far more difficult task. While it is true that some few definite occupations, like that of the caisson and tunnel workers, each produce a single definite disease from a single definite cause, very many industries are so complex as to give rise to many different hazards and as many dif- ferent diseases. A classification which fails to make this clear fails of its primary object, and is not alone useless but may prove unfair as a basis for remedial legislation or scientific deductions. But to specify all the subdivisions of labor in a complex industry is to accumulate a catalogue of many thousands of technical terms and easily to become lost in a maze of phraseology. It is precisely in this understanding of technical work that physicians as a body need education, for upon them must devolve the collection of disease data, if such data are to be confirmed by accurate diagnoses. It is not customary, as yet, to give systematic instruction in medical colleges upon occupational diseases. Most of the standard text- books on medicine refer to scarcely a half dozen of the industrial poisons, such as lead or arsenic, and the Hterature of this topic adapted for use in this country is scattered mainly in isolated monographs and a few brief journal articles. One or two illustrations will serve to emphasize the difficulties of properly classifying the occupations involving disease hazards. If a workman be classed merely as a "potter" he may be employed in glazing or polishing and acquire lead poisoning ; or, as in the Limoge works in France, he may be a grinder subject to inhalation of silica dust, and may acquire fibroid phthisis and subsequently tuberculosis ; or as a molder he may be exposed to constant humidity and may suflfer from rheumatism or chronic bronchitis. Obviously, to class him solely as a potter supplies information so incomplete as to be almost useless. Other terms are still more ambiguous. For example, a "hatter" may be engaged in the non-hazardous occupation of selling hats, may be a maker of straw hats, associated either with no hazard or with the minor one of using some bleaching substance or inhaling straw dust, or may be a man who is employed in making felt hats. This latter industry is so subdivided that the man may rank as a blocker, blower, pouncer, flanger, curler, shearer, stiffener, singer, trimmer, coner, dyer, dryer, feeder, hardener, mixer, welter, or ARSENIC POISONING 1. Putting Paris Green Into a Bolter. An Old and Daxgekols Method 2. A Comparatively Dustless Bolter. Respirators Worn as an Additional Protection Classification of Occupational Diseases 189 finisher. In about half of these labors he would be subject to no hazard whatever, as for instance if he be a curler or finisher; but if he be a fur-cutter, "maker" or sizer he is very susceptible to bron- chial irritation and liable to add to the tuberculosis mortality. If, on the other hand, he be a pouncer he is almost certain to acquire chronic mercurial poisoning and sooner or later to become wholly incapacitated for work, and he may possibly die as a result of his labor. In confirmation of the lack of information among manufacturers, or of their much worse willful neglect of the humanitarian interest which they ought to exercise, is the common observation of all who have made special investigations in lead poisoning that the manu- facturers almost universally profess ignorance as to its existence, at least in their own establishments. Yet in New York State, Dr. John B. Andrews has compiled data of sixty cases of death from this cause occurring within the two years 1909 and 1910, and I have personally collected data from only two hospitals and one dispensary in New York City of over three hundred cases of lead poisoning so serious as to demand hospital treatment, and sometimes to produce permanent disability. Before a standard classification of occupational diseases is adopted, attention should be given to the educational needs of the situation. A classification which is too elaborate may fail of its chief purpose, which is to interest physicians in this important humanitarian, scientific, and legislative work, i. e. the control and mitigation of the occupational disease hazards. It is desirable, therefore, to furnish physicians and employers with a simple general classifica- tion, after the form outlined in this article, and to supplement it with a more elaborate classification to be supplied to special investi- gators in hospitals and dispensaries, or to those who have access to the study of large groups of cases. It is clearly undesirable that hasty or unfair legislation, based on insufficient data, should be enacted, and it is therefore of the greatest importance that physi- cians everywhere enter into hearty cooperation with the state authorities in the collection of accurate statistics which shall be of true scientific value. A beginning has been made in eight states by the enactment of laws requiring physicians to report six of the occupational diseases, namely, those due to four metals, lead, arsenic, mercury, and phos- 190 American Labor Legislation Review phorus, to one germ, the anthrax bacillus, and the caisson disease.. This list will doubtless be extended considerably in the near future, and among the first additions should be wood-alchohol poisoning. This substance is used to dissolve the shellac for varnish which is often applied in confined spaces, such as the linings of brewery vats, where the alcohol fumes accumulate. There were two deaths and a case of permanent blindness from this cause in Buffalo recently, and three other deaths, the last one of which was diagnosed by the physician who was summoned as a case of "epilepsy", occurred in a brewer's vat in New York. As an aid to meet the educational requirements of classification in New York State, I have furnished the state labor bureau with a brief general classification of occupational hazards and harmful substances, which is printed on the backs of the notification blanks required by law to be sent to each physician. I also furnished a more elaborate classification which is printed in small booklet form and is designed for distribution to hospitals and dispensaries, social service workers, and all physicians who will take interest enough to gather special data. As far as possible this classification is arranged in four parallel columns, headed respectively "Industry", "Harmful Substance", "Mode of Entrance", "Symptoms and Diagnosis." For my own use and that of my assistants in hospital and dispen- sary work, I have designed history cards with headings calling for classified data, one set for the metal poisons, another for the dust and fiber irritants, etc. From such uniformly classified cards it is easy to compile scientific data for any particular group of diseases. Conclusion In conclusion, I would recommend (i) that the Bureau of the Census establish a uniform nomenclature and classification as com- plete as possible, to be used as a national standard; and (2) that the state labor bureaus or health boards issue a standard notification blank like the one in use in New York State, which is modeled after the national death certificate blank of the Bureau of the Census. On the back of this blank should be printed a brief working classifica- tion of the commoner occupational hazards and harmful substances, emphasizing in black letters the most important ones. And I would also recommend (3) that there should similarly be issued to all who will make use of it, a more comprehensive classification in booklet Classification of Occupational Diseases 191 form, detailing the symptoms in parallel columns with the injurious substances liable to produce them. General Classification of Occupational Diseases AND Harmful Substances A. Harmful Substances: 1. Metallic poisons. 2. Toxic gases, vapors, and fumes. 3. Toxic fluids (acids, alkalies, dyes, etc.). 4. Irritant dusts and fibers. (a) Insoluble inorganic dusts. (b) Soluble inorganic dusts. (c) Organic dusts and fibers. 5. Organic germs (anthrax, glanders, etc.). 6. Miscellaneous irritants. B. Harmful Conditions of Environment : 1. Air compression and rarefaction. 2. Excessive humidity. 3. Extreme heat and cold. 4. Excessive light (electric, X-ray, etc.). C. Occupational Injuries: (Medical) 1. Injuries to nerves, muscles and bones. (Strain, fatigue, cramp, faulty positions, "occupational neuroses", blows, vibrations, pressure, etc.j 2. Injuries to the eyes. 3. Injuries to the ears. 4. Injuries to the nose and throat. 5. Injuries to the skin. Occupational Diseases of the 1. Blood. 2. Circulatory system. 3. Respiratory system. 4. Nervous system. 5. Digestive system. 6. Muscular system. 7. Cutaneous system. 8. Urinary system. 9. Special sense organs. COMPRESSED-AIR ILLNESS Frederick L. Keays Cornell University Medical College. This paper is based largely upon a report, made by the writer in 1909^, of 3692 cases of compressed-air illness which resulted at the Pennsylvania East River Tunnels during the time that he was medi- cal director. It will present a brief general description of the subject of compressed-air illness, special attention being paid to its cause and to its prevention. Triger,^ a French engineer, who designed the first practical caisson in 1839, mentioned the occurrence of pains in the extremities of workmen employed. In 1868, Le Roy de Mericourt^ published the first medical report of illness among sponge-divers. Since Triger's report many contributions have been made to the subject of compressed-air illness. A full review of the literature of the subject may be found in Caisson Sickness by Leonard Hill, a book published this year. Etiology — Causes Various theories have been advanced to explain the symptoms occurring among compressed-air workers. The earliest theory to receive general recognition was that advocated by Pol and Wattelle* in 1854, the so-called mechanical-congestion theory. In 1878 Paul Bert" proposed the theory, supporting it by logical reason- ing and by experiments, which is now universally accepted. It is ' Keays, "Compressed-Air Illness, With a Report of 3692 Cases," Researches from the Department of Medicine, Publications of Cornell University Medi- cal College, Vol. II, pp. 1-55. ' Triger, "Compte rendus," Acad, des Sciences, 1841, tome XIII, p. 884 ° De Mericourt, Bull, de I'Academie de Med., 1868, XXXIII. Ann. d'Hygiene Publ. et de Med. Legale, 1869, second series, XXXI. * Pol and Wattelle, "Memoire sur les Effets de la Compression de I'Air." Annal. d'Hyg. Publique et de Med. Legale. Paris, 1854. ° Bert, La Pression Barometrique. Paris, 1878. CROSS sb:ction of caisson in i-ull operation W'oKKKKS ("Sand Hoes") At Bottom of Caissox ^\'oRK Uxder Atjiosphkric PkESSL'KK Sri-FICIKNT TO PkI-A'ENT WaTKR 1'"r(IM 1'"|,o\\' I xg In As Sand is Shovfllkh Up Too Rapid Dkcomprkssion. as ix Going Suijukxia- (;i-t ixtu the Xormai, Atmosrhi-ri:, Cai.-sks Compressi:|]-Ai;; Illness Compresscd-Air Illness 193 a surprising fact that Bert's explanation was practically disregarded for several years, while the mechanical-congestion theory continued to be accepted, especially by the early American writers. Briefly stated, Bert's theory is as follows : The blood of a man or of an animal, when in compressed air, takes into solution an in- creased quantity of oxygen and nitrogen from the air, the quantity of the gases absorbed being in direct proportion to the increase of pressure. The gases taken up by the blood are gradually distributed to the fluids of the various tissues. With rapid decompression the nitrogen gas bubbles off in the blood. These bubbles act as emboli, block up the capillaries in one or another part of the body and, by cutting off the blood supply or by direct mechanical violence, cause the symptoms of compressed-air illness. Symptoms of illness may be prevented by making decompression slow enough to allow the absorbed nitrogen to escape from the lungs. Further experimenta- tion by Von Schrotter," Hill and his associates,' and others, have confirmed his theory. Post-mortem findings, moreover, in many fatal cases of compressed-air illness, both in men and in animals, give conclusive proof that this theory is correct. From this theory, as well as from practical experience, the chief etiological factors have been deduced as follows: (i) In general, the higher the pressure, the greater the chances of illness; (2) the longer the time of pressure, the greater the chances of illness ; and (3) the more rapid the decompression, the greater the chances of illness. Let us now consider these three factors in brief detail. I. The degree of pressure. — Practical experience has shown that cases of compressed-air illness seldom happen at pressures up to fifteen pounds per square inch above normal." Fatal cases seldom result from pressures below thirty pounds. The lowest pressure from which death has been reported is twenty-one pounds, and there seems to be some doubt as to the authenticity of this report. Among • Heller, Mager and von Schrotter, Die Luftdruckerkrankungen, Vienna, 1900. ' Hill and Macleod, "Caisson Disease and Diver's Palsy," Journal of Hy- giene, 1903, p. 401 ; Hill and Greenwood, Proceedings Royal Society, B. Vol. 77, p. 442, 1906; Vol. 79, p. 21 and p. 284, 1907. 'The figures in regard to pressure given in this paper all refer to the number of pounds per square inch above normal atmospheric pressure, which is a little less than 15 pounds. 194 American Labor Legislation Review twenty fatal cases of compressed-air illness resulting at the Pennsyl- vania East River Tunnels, only two were caused by pressures below thirty pounds, one at twenty-eight pounds, the other at twenty-nine pounds. The following table, taken at random from the records of the Pennsylvania East River Tunnels, illustrates the influence of only slight additions of pressure upon the percentage of cases of illness, when pressures in the neighborhood of thirty pounds were being used. Tunnel A. Manhattan Site. Month Number of Man-shifts Length of Shifts AveragePres- sure Abo-ve Normal No. Cases ol Comp.-Air Illness Per Cent Jan. '07 3751 8 hours 28,5 lbs. 7 .18+ Feb. '07 4141 6 hours (2-3 hr. periods) 31 lbs. 25 .604- Mar. '07 4902 u 31.5 lbs. 33 .67-h Apr. '07 4018 (1 32 lbs. 39 .97-h It may be stated that, with other conditions the same, the number of cases of illness will depend directly upon the degree of pressure. 2. The time under pressure. — When pressures of one atmos- phere or more are being used, the time spent under pressure is an important etiological factor. It is obvious that if less time is spent in compressed air than is necessary for complete saturation of the body fluids, the chances of symptoms developing upon decompres- sion will be less than if that time is equalled or exceeded. The exact time in which complete body saturation takes place has never been determined. No doubt it varies in different individuals. It is certainly hastened by work and exercise. Some parts of the body saturate quickly and others slowly. Fat especially saturates slowly, both on account of its poor blood supply and because it has the property of absorbing about six times as much nitrogen as the other body fluids. Haldane and Boycott" estimated that half saturation of the body occurs in about twenty-five minutes, and almost full saturation in about ninety minutes. "Boycott, Damant and Haldane, "The Prevention of Compressed-Air Ill- ness," Jojirnal of Hygiene, Vol. VIII, No. 3, June, 1908. Compressed-Air Illness 195 In the Pennsylvania East River Tunnels, when pressures of 30 lbs. and more were being used, all new men, before being allowed to work, were given a preliminary test at the prevailing tunnel pres- sure which lasted 90 minutes, decompression being at the rate of two pounds per minute. In 2719 preliminary tests only three cases of compressed-air illness were encountered. Two of these were mild cases of pain, and the third was a case of paralysis of the lower extremities. After the preliminary test, those who took it satis- factorily were allowed to work 90 minutes when six-hour shifts were in progress. In 2000 men who worked for 90 minutes in pressures averaging 32 lbs., seven cases of compressed-air ill- ness resulted, all being mild cases. The small number of cases in the former group would indicate that complete saturation had not taken place in 90 minutes. The influence of work in hastening absorption would account for the increased number of cases in the latter group. The following table, made up from the records of the Pennsyl- vania East River Tunnels, throws some practical light upon the question of the time of nearly complete body saturation and of the effect of work, and also indicates the effect of fatigue, as shown by a comparison of the number of cases following the first and the second three-hour periods of six-hour daily shifts : Average Pressure (estimated) Time under Pressure Number of Men Ca Cot U No. ses oi np.-Air Iness Per cent. Eemarks 31 lbs. \)4 hours 2719 Preliminarj' test, not working 3 0.18-f- 2 cases ordinary pain. 1 case paralysis legs. 32 lbs. 1>^ hours 2000 (estim- ated) Working 7 0.35-1- All ordinary cases (pain, vertigo, etc.) 29 lbs. 2 hours 6000 (estim- ated) Working 13 0.21 + 1 case pain and prostra- tion, not severe. Rest, ordinary cases. 33 lbs. 3 hours 1st half 6-hr. shift 43,680 (est.) Working B.& D. Tunnels, Manhattan 152 0.35-f- 4 fatal. 2 pain and prostration. 3 partial paralysis. Rest, ordinary cases. 33 lbs. 3 hours 2nd half 6-hr. shift K 317 0.72+ 2 fatal. 1 pain and prostration. 1 partial paralysis. Rest, ordinary cases. 196 American Labor Legislation Review The decreased percentage of cases of illness from two hours work, as compared with that from one and one-half hours work, is accounted for by the lower pressures in the former case. At the same pressure, other factors being equal, two hours work would probably be followed by more cases than one and one-half hours work. In comparing results from three-hour shifts with those from one and one-half and two-hour shifts, it should be noted that in the former case the percentages were based chiefly upon old workmen ; but in the latter the percentages were based entirely upon new men. 3. The time of decompression. — All authorities agree that the rate of decompression is a most important factor in determining the number of cases of compressed-air illness, as well as in de- termining their severity. During decompression the absorbed gases are liberated from the body fluids and blood in the form of bubbles, and are excreted through the lungs. The rapidity with which these gases are set free, and the size of the gas bubbles, depend directly upon the rate at which the pressure is removed. Consequently rapid decompression increases the chances of illness and slow decom- pression diminishes them. It is not known how long it takes for complete desaturation ; like saturation it probably differs in indi- viduals. The practical problem is to find, if possible, a safe rate of decompression. From practical experience it has been learned that with pressures up to 15 or 20 lbs. rapid decompression seldom gives rise to any symptoms, and probably never, even after long exposures of six to eight hours, to those due to large quantities of free gas in the circulatory system. An explanation of this, which appears logical, is that at these pressures not enough gases can be absorbed to embarrass the circulation even when suddenly liberated. That rapid decompression from pressures of four or more atmos- pheres is more dangerous than slow decompression has been re- peatedly demonstrated in animal experimentation. Bert concluded, from experiments with animals, that all trouble could be avoided by allowing thirty minutes for decompression from pressures between two and three atmospheres and sixty minutes for decompression from pressures between three and four atmospheres. Von Schrotter considers an allowance of twenty minutes per atmos- phere safe; and Hill and his associates found twenty minutes per atmosphere safe for a large number of animals exposed to satur- Compressed-Air Illness 197 ation. Haldane,^" on the other hand, advocates the interrupted or stage method of decompression. Starting from the fact that rapid decompression from 19 lbs. to normal atmospheric pressure is com- paratively safe, he argued that it would be correspondingly safe to decompress rapidly from four to two atmospheres, or from six to three atmospheres, and he found this true in a series of experi- ments with animals. He proposes the following rate of decompres- sion for caisson and tunnel work: Working Pressure in Pounds per Square Incli Number of Minutes for each Pound of Decompression after the First Eapid Stage. After first 3 hours' exposure After second or third 3 hours' ex- posure following an interval for a meal. After 6 hours or more of continuous exposure 18-20 21-24 25-29 30-34 35-39 40-45 2 3 5 6 7 7 3 5 7 7 8 8 5 7 8 9 9 9 His first rapid stage of decompression reduces the pressure in about three minutes to a point equal to one-half the actual pressure. To illustrate, if the working pressure is 40 lbs., the actual pressure equals 55 lbs. One-half of 55 or 27.5 equals the actual pressure, or 12.5 lbs. equals the gage pressure. Applying this table to decom- pression from 40 lbs., one would reduce the pressure in about three minutes to 12.5 lbs. and then allow 87.5 minutes for decompression after the first three hours' exposure. Haldane presents strong theoretical reasons in proof of the advan- tages of the stage method of decompression. In his own experiments with goats, however, the beneficial results of stage decompression, as compared with the uniform decompression of equal time, are less ap- parent than the theory would lead one to expect. Hill and Green- wood^^ tested the effects of uniform and stage decompression on pigs without showing any decided advantage for the latter method. Hill says : "The conclusion to be drawn, then, from experiments on ani- mals is that there is evidence in favor of stage decompression after- "Haldane, 'The Hygiene of Work in Compressed Air," Journal of the Society of Arts. Vol. XVI, p. 214. Jan. 1908. "flill, Caisson Sickness, Longmans, N. Y., 1912. igS American Labor Legislation Review short exposures, but no decisive evidence of its superiority after long exposures. The theory is a captivating one, but experiment has not brought that conclusive support which wd,s to be expected." In this statement by short exposures is meant periods of one hundred and twenty minutes or less. Bornstein compared the effects of stage and uniform methods at the Elbe Tunnel Works, Hamburg, (two atmospheres), with the following results : Days Workers Cases of Illness 20 stage 526 16 16 uniform 528 17 18 stage 529 12 16 uniform 529 14 14 stage 536 12 The percentage on the basis of man-shifts for the stage method is 0.15; and for the uniform method 0.19. These results show only a slight advantage for stage decompression, but they are not con- clusive. It would seem, then, that in the case of men working long periods in compressed air in pressures above 20 lbs., the question of the time taken for decompression is of more importance than the question of the method of decompression. Hill claims that exercise and the breathing of oxygen, both of which aid in the elimination of nitrogen gas, during decompression will safely permit of the reduction by at least one-half of the times of decompression advocated by Hal- dane. ■ ' ■ '''[ '■ JI'Wi]^, In the Pennsylvania East River Tunnels, during a period of five hundred and fifty-seven days, with about one thousand men a day working in compressed air at pressures varying from 15 lbs. to 36 lbs., and a decompression period at the rate of one minute for each two pounds of pressure, there were reported to the medical depart- ment 3692 cases of compressed-air illness with twenty deaths. About ten thousand different men in all worked during this time. On the basis of the number of men working, the percentage of illness was 36.92 and the percentage of fatal cases 0.2. On the basis of man- shifts, estimating one thousand men a day for five hundred and fifty-seven days, or 557,000 man-shifts, the percentage of illness was 0.66 and the percentage of death 0.0035. The substitution of the Compressed-Air Illness 199 rate of decompression now required by the New York State law for tunnel work, of three pounds every two minutes up to 36 lbs. and of one pound per minute for pressure above 36 lbs., would no doubt have reduced the number of cases of illness, as well as the number of serious and fatal cases, but it seems highly improbable that it would have prevented all illness and death. In considering the etiology of compressed-air illness it must be re- membered that, beside the questions of pressure, time of compression, and rate of decompression, there are many other factors to be reck- oned with, which might be called predisposing causes. Briefly stated these are as follows : Age. — Boys, on account of underdevelopment, and men past forty are generally acknowledged to be bad subjects for compressed-air work. Build. — Fat individuals are bad risks in compressed-air work and should be avoided. Organic disease. — Persons with organic disease should not be sub- jected to work in compressed air because, even if they are not more susceptible to compressed-air illness, they are certainly less able than those with normal organs to stand the effects of such illness. Alcoholism. — Alcoholics are bad risks for the same reason that those with organic disease are bad risks. Neimiess to zvork. — "Green" men are more likely to have symptoms of compressed-air illness than old workmen. Fatigue. — This appears to play a decided part in the causation of compressed-air illness. Ventilation. — C O., within reasonable limits probably has no effect. Poisonous gases, such as C O and H.S, may play a part in etiology. The personal element. — This is a factor which I believe plays a large part in the causation of compressed-air illness. I have used this term for want of something more definite. Just what conditions may exist to make certain individuals susceptible to compressed-air illness or to cause those who have apparently been immune suddenly to develop symptoms, sometimes serious, I cannot say. It has seemed to me probable that certain individuals may lack the ability to ex- crete the gases from the blood at the physiological rate during decom- pression and that such a condition may arise at any time in men who have been free from it. In my experience I have found that certain men, who from careful examination appeared especially fit subjects, 200 American Labor Legislation Review fell easy victims to the effects of compressed air. In the work on the Pennsylvania East River Tunnels several old workmen had fatal ill- nesses while working under apparently the same conditions under which they had worked safely for months. Symptoms The time is too short to allow of a detailed report in this paper of the symptoms of compressed-air illness. They are various in form and depend first upon the amount of gas set free in the blood, and second upon what organs are affected by the gas emboli. In many cases, as when soft tissues or unimportant organs are in- volved, gas emboli will give no symptoms. A small gas bubble causes pain when present in some unyielding tissue, such as nerve sheath or periosteum ; it causes vertigo when in the semicircular canal ; paralysis when in a motor area of the spinal cord ; and sud- den death when in a vital center of the medulla, or possibly in the coronary artery. Large accumulations of gas in the blood stream cause general pains and prostration, and in extreme cases collapse, coma, and sudden death. In my study of 3692 cases I made the following classification, giving the number and percentage of cases falling under each group, as follows : No. Per cent A. — Cases shozving pain in various parts of the body, "bends" 3278 88.78+ Cases with pain also having local manifes- tations 9 .26+ B. — Cases showing pain and prostration 47 1.26-)- C. — Cases showing symptoms referable to the central nervous system: 1. Brain (hemiplegia) 4 .11 + 2. Spinal cord : (a) Sensory disturbance (b) Motor disturbances (c) Sensory and motor disturbance . . Total (Spinal cord) D. — Cases shozving vertigo, "staggers" E. — Cases shozving dyspnoea and sense of con- striction of the chest, "chokes" 60 1,63 36 34 10 80 2.16+ 197 5-33+ Compressed- Air Illness 201 'P.— Cases showing partial or complete uncon- sciousness zvith collapse 17 464- Grand total 3692 99.98+ r Group B 6 Fatal Cases -j Group C 5 (_ Group F 9 20 or .54+ per cent. Pathology The results of autopsy in fatal cases have fallen largely under two classes : first, those which died after long illnesses and showed lesions of the spinal cord, such as disseminated and transverse myelitis and hemorrhage, with consequent complications, such as pneumonia, cystitis, pyonephritis, bed sores, etc. ; and second, those which died soon after decompression, many of which showed the presence in greater or less degree of free gas in the circulatory sys- tem. Von Schrotter, in an analysis of one hundred and thirty-seven fatal cases reported between the years 1854 and 1897, found twenty reported autopsies showing lesions of the spinal cord and their complications, and eighteen reported autopsies in rapidly fatal cases of which eleven showed the presence of free gas in the circulatory system. In the twenty fatal cases reported by me, five fell within the first group, and of these two came to autopsy and showed lesions of the cord and complications ; fourteen fell within the second group and of these, in twelve autopsies reported, eight showed the presence of free gas in greater or less degree in the circulatory system. In cases of sudden death, when no discoverable lesions have been found, it seems fair to suppose that death has been due to the in- volvement of vital centers by emboli too small to be detected. In several of our fatal cases no sign of organic disease could be found. Treatment Recompression is the most efficient means of treatment. This was recommended by Pol and Wattelle in 1854; Bert demonstrated its value in animal experimentation about 1871 ; and Mr. E. W. Moir made the first practical use of the medical lock at the old Hudson 202 American Labor Legislation Review River Tunnel. He there proved its efficiency, thus making it a necessary equipment in caisson and tunnel work. The medical air-lock, as used on the Pennsylvania East River Tun- nels, consisted of an air-tight steel cylinder about six feet in diameter and twelve feet in length, closed at one end. At the other end was an entrance by means of an air-tight door which opened inwards. The cylinder was divided into two compartments by means of a transverse partition, which had a door opening toward the inner compartment. Compressed-air pipes and outlet valves supplied both chambers, so that the pressure could be raised or lowered from either chamber. This arrangement enabled the physician or attendant to enter or leave the chamber in which the patient was being treated without disturbing the pressure of that chamber. Valves were also placed outside the lock so that the pressure could be regulated from without. The inner chamber was fitted with two bunks, one on either side, upon which patients could lie, and with electric lights, telephone, clock, pressure gage, thermometer, and electric heater. A means of ventilating the inner chamber was also supplied. Heavy glass win- dows were placed on a line in both doors so that one could watch from outside the patient, pressure gage, and thermometer. Recompression should be instituted as soon as possible after the appearance of symptoms, the pressure being raised quickly to the working pressure. Relief of symptoms, when afforded, usually occurs before this point is reached. Soon after reaching full tunnel pressure decompression should be begun at a rate not less than one pound per minute, and in severe cases much more slowly. At the Pennsylvania East River Tunnels we thought our results were best when decompression was made rather quickly down to lo or 15 lbs., and then continued very slowly. During decompression the patient, if able to do so, should move about and exercise the affected part. In severe cases massage and passive movements should be admin- istered by an attendant, and in unconscious cases artificial respira- tion should also be performed. If symptoms return after one recom- pression, a second recompression should be made. We sometimes had to recompress three or four times before permanent relief was obtained. In cases of simple pain, where there is a return of symp- toms after recompression, relief, frequently permanent, may be obtained by the use of counter-irritation with linaments, the vibrator, or the Faradic current, or by hot applications. A hot bath for the Compressed-Air Illness 203 return of pain after recompression is beneficial, but would hardly be indicated in cases where there is prostration. The results of treatment in 3692 cases in the Pennsylvania East River Tunnels were as follows : In 3278 cases of pain in various parts of the body about 90 per cent got relief from one or more recompressions. Recompression failed to give any relief in only about .5 per cent of the cases of this class, and in some of these the failure was undoubtedly due to improper recompression or to failure of the patient to exercise while decompressing. In forty-seven cases of pain and prostration, thirty-eight were re- lieved or cured by recompression, all ultimately recovering, but six had only temporary improvement and died. The other three refused the medical lock, and recovered after illnesses of about a week. In eighty cases with symptoms referable to the central nervous system the results were as follows : — Four cases of hemiplegia were all cleared up permanently by re- compression ; of thirty-six cases of sensory disturbance, thirty-four were relieved by recompression, two refused the medical lock and were improved by medical treatment ; of thirty-four cases of motor disturbance, partial or complete paralysis of the legs, twenty- three were benefited by recompression and either cleared up at once or recovered later, in eleven recompression caused no improvement and of these five ultimately died, three had permanent spastic paraplegia, and three were lost sight of ; of ten cases of sensory and motor disturbance, nine were permanently relieved, and one was improved, but the final result was not learned. In one hundred and ninety-seven cases showing vertigo, with or without vomiting, pain, prostration and dyspnoea, one hundred and eight had complete relief from recompression, eighty-two had par- tial relief from recompression, and seven refused the medical lock. In sixty cases of dyspnoea and sense of constriction of the chest, all cleared up with one recompression except two which required a second recompression. In seventeen cases of partial or complete unconsciousness and collapse eight were cured or relieved by one or more recompressions, but nine had little or no relief and died. Oxygen given to several of these severe cases during decompression afforded no appreciable benefit, 204 American Labor Legislation Review Prevention of Com pressed- Air Illness How to prevent compressed-air illness is a most important ques- tion. Modern demands in engineering require the use of compressed air. Recompression, while an efficient means of treatment in mild cases, often fails to prevent disability and death in severe ones. If high pressures are to be used, all means should be employed to prevent illness. These should consist of thorough medical examin- ations of workmen and especially of new candidates. In cases where "green" men must work in high pressures, 25 lbs. or over, preliminary tests should be given and, if satisfactorily passed, a short working shift should first be tried. Careful supervision of the workmen should be exercised, and occasional reexaminations made, especially after any absence from work. The men should be instruct- ed as to the dangers of rapid decompression, should be made to move about during and after decompression, and should be warned that neglect to seek medical advice at once upon the appearance of any symptoms may result disastrously. They should also be in- formed of the bad effects of excesses of all kinds, of improper hy- giene, and of intercurrent illness. The following table indicates briefly what can be done by medical examination and proper supervision to eliminate the predisposing causes mentioned under the subject of etiology : Predisposing factors Can be prevented Age (improper) Yes Build (fat) Yes Organic disease To a large extent Alcoholism To a large extent Newness to work Partly Fatigue No Ventilation (bad) To a large extent Personal element No, not with our present knowl- edge. The chief means of preventing illness must be found in the ar- rangement of shifts and decompression periods to suit the pressures. In this connection we find the old conflict between labor and capital. The workman is willing to reduce the shift but rebels at what seems to him an unnecessary time for decompression. The contractor, on the other hand, desires to offset long shifts by long decompressions. Laws have already been passed in different countries regulating Conipressed-Air Illness 205 the length of shifts and decompression periods. Such a law has been passed, however, in but one state (New York) in this country. As time goes on further legislation will no doubt be needed and this could be made much more efficient if full information in regard to all cases of compressed-air illness could be reported to the state and reviewed by some competent person or board, who should recom- mend the necessary changes in the laws. What is now most needed is an exhaustive study of the practical application of theories which have been well worked out. In studying the causes of compressed- air illness, one should not forget that many factors play a part, and that, since the human organism is concerned, it is not a purely phy- sical question. The results of comparatively few experiments with animals should not be looked upon as final. In the same way, the results, under certain conditions, with a comparatively few men should not be considered conclusive. While much may be done by proper regulations to diminish cases of illness and death in com- pressed-air work, I believe that, when pressures of two or more at- mospheres are being used, it should be classed as a dangerous occu- pation on account of individual conditions, not now understood, which I have called the personal element. OCCUPATIONAL SKIN DISEASES John A. Fordyce University and Bellevue Hospital Medical College. With the exception of certain well-defined types, occupational der- matoses as a class have not, in this country at least, received the attention they merit. While every dermatological clinic numbers among its applicants each year many patients in whom occupation has a direct or indirect bearing on the causation of their eruption, it is difficult, owing to lack of systematic investigation, to give a definite idea as to the prevalence of skin afifections in the various trades. At my own clinic at the University and Bellevue Hospital Medical College about 2 per cent of the total number of new cases for 191 1 constituted occupational dermatoses. The great majority of these were of the type known as trade eczemas and, while many cases yield readily to treatment and proper preventive measures, others constitute a serious inconvenience from an economic stand- point, sometimes necessitating a complete cessation from work or a change of occupation. Cutaneous vulnerability is more or less an individual peculiarity, for while persons are met with who are so sensitive to an irritant, physical, chemical, thermal, or actinic, that they react after a short exposure or contact by an acute dermatitis, other people remain en- tirely unaffected. Occasionally such individuals exhibit so high a degree of sensitiveness that, instead of acquiring an immunity, an increasing susceptibility is established. Fortunately these cases are not very common and it is more usual to see workers, though sub- jected to continuous injury, only after a considerable time develop lesions, either from the summation effects of the irritant or because the resistance of the skin has been gradually undermined. After such a cutaneous outbreak there is frequently a tendency to acute exacerbations at regular intervals or when the occupation is resumed. These eruptions may then persist for years. While the skin, both anatomically and physiologically, is en- dowed with a relative amount of protection against the action of irri- Occupational Skin Diseases 207 tant substances, by reason of its exposure it is subjected to injuries of every description and these may lay the foundation for a subse- quent eruption. In addition there are other contributing factors, such as a special susceptibility, a delicate skin or one presenting some congenital anomaly, as excessive dryness or ichthyosis, impaired gastro-intestinal, hepatic or renal function, a depressed state of health, neglected hygiene of the skin, or its lowered resistance due to a preexisting eruption. We often find the same etiologic factor operative in both allied and unrelated trades, owing to similar conditions under which the work is done ; for example, where men or women are exposed to ex- cessively dry or moist heat. Such an atmosphere leads to congestion and interference with the normal activity of the skin, which is fol- lowed by various inflammatory processes and sweat eruptions like prickly heat. These affections are met with in cooks, stokers, fire- men, foundry workers, etc. A warm, moist medium, such as laun- dresses work in, sometimes produces a cystic condition of the sweat ducts of the middle third of the face, known as hydrocystoma. Cold, by favoring the development of chilblains, causes much suffering among people who are obliged to carry on their work outdoors or in poorly heated places. In factories where drastic measures are employed for the removal of dirt or stains, cleansing agents like chlorid of lime or benzine used on the hands, by divesting the skin of its natural secretions, supply the base for an eczema. Oil, which is used wherever machinery is installed, is the causative agent of acneiform and eczematous lesions in employees who operate or are otherwise engaged about such apparatus. In occupations which necessitate standing, people who have a tendency to varicose veins not infrequently exhibit this condition, with a secondary eczema and ulceration. Slight traumatisms lead to erosions of the skin, which often become infected in patients who, owing to venous congestion, have slight resistance. Young women who are obliged to stand at their work sometimes develop erythema induratum or Bazin's disease, which is characterized by nodules be- neath the skin that may break down and produce ulcers. Some of these forms of Bazin's disease have been proved to be tuberculous. The infection is usually of benign type and readily yields to rest in bed, improved nutrition, and a change to better hygienic surround- ings. 2o8 American Labor Legislation Review Many occupations, without being pathological in the strict sense of the word, bring about changes in the skin which are so characteristic that Blaschko^ has given them the name of trade stigmata. These include localized thickenings of the horny layer in shoemakers, tai- lors, musicians, etc. ; bronzing of the skin in gardeners, farmers, and other people who follow outdoor occupations ; staining of the hands in dyers, chimney-sweeps, etc. ; pigmentation in workers in silver from a deposit of the latter metal and in millers from iron par- ticles, etc. The skin responds to the most diverse irritants, on the one hand by the production of a catarrhal inflammation, and on the other by the development of diiiferent types of eruption from the action of the same agent. Of the former we have an example in the trade eczemas and of the latter in the effects of working with tar, where eczema, acne, warty and epitheliomatous lesions may exist alone or intermingled. The commonest type of occupational disease is an eczematoid dermatitis. In a recent article Herxheimer- enumerates seventy- four trades provocative of this form of disease. It may vary in grade and intensity from an erythematous and scaling dermatitis to a vesicular and bullous eruption. As the condition becomes chronic, infiltration of the skin takes place, with desquamation and fissuring. With the cutaneous defenses lowered, pus infection is frequently superadded. The excessive use of soap and water, by extracting the fat and macerating the horny cells, reduces the resistance of the skin. These agents may then act as direct excitants or prepare the way for some ether irritant, as washing powders, etc. Severe eczemas of the hands and forearms are seen in those whose occupations require them to have their hands continually in water, as in the case of washerwomen, housemaids, barkeepers, etc. In my clinic nearly one-third of the occupational diseases during the past year were seen in persons whose vocations necessitated the frequent employ- ment of soap and water, and in some cases of the various cleansing alkalis. ' Blaschko, "Gewerblichen Hautkrankheiten." Handhuch der Arbeiter- krankheiten, Th. Weyl-Gustav Fischer, 1908. ' Herxheimer, "Ueber die gewerblichen Erkrankungen der Haut." Deutsch. Med. Wochenschr., 1912, Nr. i. OCCUPATIOXAL SKIX DISEASES 1. Papilloma of Palm of the Hand or Ax Iron-Wokker. Three Years' Duration-. Lesion is due to Friction from the tools of the trade 2. CcMMON Type of Chronic Eczema of Hands and Forearms Following Prolonged Contact with Irritants. In this case the iriitant WAS wood-alcohol used in the preparation of V-ASNISH Occupational Skin Diseases 209 In bakers a form of dermatitis of the hands and forearms is known as baker's itch. The exciting causes are the heat, the moist dough, and the saccharine solutions. A mite said to Uve in flour has also been incriminated. Candy-makers suffer from a similar eruption, as well as from impetiginous lesions. Confectioners, bak- ers, and preservers of fruit frequently show an eczema of the fingers and peri-ungual tissues from the action of fruit acids. In a personal communication, Winfield describes a dermatitis in sugar-refiners, which involves the hands, forearms, and legs, and re- sembles an impetiginous scabies. It has been claimed that a mite found in raw sugar is responsible, but this lacks verification. Oliver^' states that in sugar factories a condition known as "lymphangitis of sugar-makers" is sometimes found among the sugar-refiners and molasses stirrers. It is accompanied by a slight constitutional dis- turbance and a crop of boils is not an unusual sequel. According to Gaillot the lymphangitis is a Staphylococcus pyogenes aureus infec- tion. This organism is said to be found, not in the freshly made molasses, but in the residue, and the temperature of the factory and the condition of the skin favor its development. Builders and masons develop an eczematous affection of the ex- posed parts of the body from the irritating effects of lime and cement. In stonecutters an analogous condition is caused by the stone dust. A palmar dermatitis is also seen in brickmakers. Metal workers, whether from the constant irritation of the dust or filings, their direct cauterant action, or that of acids or turpentine used in the various processes, suffer from all grades of inflammation to in- tractable ulceration. Printers and machinists, from contact with chemicals and oil, often develop a chronic eczema of hands and fore- arms. Electroplaters are also liable to an inflammation of the hands and forearms from the use of a mixture of lime dust and olive oil in "finishing" and of sour beer in the process known as "scratch brush- ing." Workers who handle the chromates in the arts and trades suft'er from an eczematoid eruption, as well as from ulceration of the skin and mucous membrane, which shows little tendency to heal. Hydro- fluoric acid, employed in the manufacture of glass, the bleaching of cane, the washing of manure, etc., produces sores of the nasal ori- fice and gums and painful blisters and ulcers of the skin. ' Oliver, Diseases of Occupation. E. P. Button & Co., 190S. Occupational Skin Diseases 211 caused by pulling threads the people who engage in this part of the work present callosities on their index fingers. Callosities of the palms are also met with in laborers, engine drivers, etc. Among miners they form a special dermatosis called "beat hand." Painful thickenings develop over the regions where the handle of the pick makes greatest pressure, along the bases of the fingers, over the ball of the thumb, and on the outer side of the hand. The subjacent tissue becomes inflamed, and not infrequently is further complicated by suppuration. To this condition the term "keens" is applied. Warts sometimes form very troublesome lesions on the palms of people engaged in manual work. In some cases they are purely epi- dermic growths ; in others, where the epidermis has been removed, the underlying tissue, as the result of irritation, becomes the seat of exuberant granulations with papillomatous formation. Dyers and workers in anilin colors are apt to develop eczematoid and pustular eruptions on different portions of the body. The bad effects are not limited to those in this trade, but the wearers of clothing prepared with certain of the dyes may ultimately be the victims of a severe dermatitis. The black, red, and orange-yellow pigments are particularly irritating, marked inflammatory reactions having been cavised by socks, gloves, underwear, and shoes so colored. I have also seen unusually severe forms of eczematoid dermatitis in barbers who had employed proprietary anilin hair dyes on their patrons. It is not an uncommon experience in dermatological prac- tice to be consulted for a dermatitis of the face, neck, and ears which had followed the application of various of these hair dyes. In sus- ceptible subjects the use of hair tonics may produce similar trouble. Another dermatological condition met with in anilin workers is a hyperidrosis of the palms due to washing the hands with chlorid of lime for the removal of dyes. According to Blaschko it may be so intense as to amount to a flux. The afifection is also seen in chlorid of lime and soda workers. The manufacture of chlorid of calcium and chlorid of sodium and potassium by electrolysis is sometimes attended by an erythema- tous and edematous inflammation of the face of the workmen resem- bling erysipelas. This is attributed to the hypochlorite of soda that is formed. With the subsidence of the acute process an acneiform eruption is left behind, the so-called chloracne. This is the com- 212 American Labor Legislation Review monest cutaneous malady met with in this occupation and is char- acterized by the early development of blackheads on the face, trunk, and extremities, followed by a grayish discoloration of the face. With inflammation and suppuration of the follicular glands, nodules, pustules, boils, and disfiguring scars are a not uncommon sequel. Tar and paraffin workers develop a similar eruption which may last several months and then change to the so-called "tar itch." This is accompanied by hyperkeratosis and increased activity of the seba- ceous glands, forming plaques and crusts, with the further develop- ment of multiple warts, one or more of which degenerate into malignant growths. The disease affects chiefly the hands, forearms, and scrotum. It progresses slowly and in many instances no recur- rence takes place after removal of the epithelioma. Oliver cites the case of a man aged 58 who had worked among coal-oil and tar products for thirty years. He presented numerous indurated patches,- some of which had ulcerated, as well as multiple black warts and scars, the remains of old ulcers. On the other hand, his son, 27 years old, following the same employment, developed a malignant growth of the forearm which necessitated amputation. Metastases of the axillary and cervical lymph nodes took place and the patient succumbed to secondary carcinosis. Cancer in chimney-sweeps has been reported chiefly from England. The soot produces a chronic irritation of the skin, and when retained in such regions as the folds of the scrotum causes warty growths which become epitheliomatous. In some instances the hands, arms, and thighs have been involved. With the advent of machinery for cleaning chimneys the incidence of scrotal cancer has been markedly reduced. It is reported that gardeners who employ soot for the pro- tection of plants from slugs show in a like manner the effects of this irritant in the development of mahgnant growths of the hands. Gardeners and florists frequently suffer from some form of in- flammation of the hands and arms occasioned by contact with certain plants. It is estimated that some sixty or seventy plants possess this irritant action and the power to induce a dermatitis. The more familiar ones are poison-ivy, poison-sumac, primrose, chrysanthe- mum, and eucalyptus, the eruption varying from a simple erythema to marked swelling, with the formation of vesicles and bullae. Not only are the exposed parts involved, but the affection may be carried by the hands or clothing to other portions of the body. It is probable that Occupational Skin Diseases 213 the active principle in the majority of these plants, as in the case of Rhus toxicodendron, is an essential oil. Lacquer which is obtained from a tree belonging to the genus Rhus produces a dermatitis either by direct contact or through the fumes from evaporation.* The symptoms appear in a few hours, and consist of fever and edema of the skin of the face, limbs, and generative organs, nasal and conjunctival catarrh, and a papular eruption of the legs and fore- arms. The resinous dust of certain hardwoods, like teak, ebony, satin- wood, rosewood and others, will occasionally set up a dermatitis in carpenters and joiners. In teak the exciting agent is beheved to be an essential oil derived from the central part of the tree and present in the dust. The symptoms are sometimes very severe, the eruption becoming generalized and accompanied by vomiting. It may last for several months and is quite apt to recur on resumption of work. The so-called "polisher's itch" of the forearms and hands, met with in furniture polishers, is attributed to the methyl or impure alcohols present in varnishes and polishes. Impure benzine and turpentine used for cleansing purposes likewise provoke an eczema of the hands. In individuals who follow an outdoor occupation the uncovered portions of the skin sometimes undergo peculiar degenerative changes. Under the name of "sailor's skin" Unna has described an affection which he observed chiefly in seafaring men. A diffuse cyanotic redness not unlike chilblain develops at first on the ears, on adjacent parts of the cheeks and temples, on the backs of the hands, and on the fingers. The skin then becomes mottled, pigmented, rough, and hard, and in places papillomatous. These warts may last for years and slowly undergo a malignant change. A similar condition is met with on the face, neck, and hands of people who follow agricultural pursuits. The cause is sought in the actinic rays. The effect of light on the skin is illustrated in X-ray workers, in whom, unless protected, the hands become the seat of a mild erythem- ato-squamous eruption, more or less persisent, which is succeeded by pigmentation, telangiectases, and atrophic wrinkling. This con- dition may remain unchanged, or keratoses may be added, which develop into epitheliomata. Drivers and coachmen exposed to the rigors of the weather are * Castellani and Chambers, "Lacquer Poisoning." Manual of Tropical Med- icine, 191 o, p. 118. 214 American Labor Legislation Review often the subjects of the severer forms of rosacea. The use of alcohol, however, to which many of these people are addicted, cannot be wholly ignored as a contributing etiological factor. Certain callings, notably those dealing with dead or live animals or their products, favor the development of infectious diseases. Owing to the prevalence of pyogenic organisms, local pus infections, as boils, carbuncles, impetigo contagiosa, or cellulitis are not infre- quently met with in butchers, slaughter-house men, and other indi- viduals who handle dead animal matter. A generalized bullous dermatitis, with severe constitutional symptoms and a high mortality, has also been observed. The starting point is usually an infected wound. Several years ago Bowen'' pointed to a possible relationship between these cases of so-called "acute infectious pemphigus" and foot and mouth disease of cattle, as he had observed such instances during an epizootic of the latter disease in New England. Foot and mouth disease takes place by inoculation of the skin or mucous mem- brane in butchers, dairymen, stableboys, and drivers. Herxheimer records having seen a case in a horsedealer. The parasitic diseases which are more definitely identified with particular avocations are tuberculosis, anthrax, glanders and actin- omycosis. Inoculation tuberculosis occurs in its simplest form as verruca necrogenica or anatomical tubercle. It is encountered chiefly among medical students, physicians, hospital ward attendants, and butchers as a localized papillomatous formation usually about the knuckles or other parts of the hand or forearm. Anthrax is very uncommon in this country, but it is very preva- lent in animals, especially cattle and sheep, in certain parts of Europe and Asia. In man the disease occurs as the result of direct infection from such animals or their products, via the skin, the intestines, or more rarely the lungs. It is met with in the wool-sorting, wool- combing and spinning industries, in horse-hair and brush factories, in stevedores, wharf-laborers, carters, farmers, shepherds, butchers, meat inspectors, and cattle salesmen. The internal form is known as "wool-sorter's disease." Of the external, which is also the more usual, there are two varieties, the malignant pustule and malignant anthrax edema, the latter of which is the more fatal of the two. ' Bowen, "Acute Infectious Pemphigus in a Butcher During an Epizootic of Foot and Mouth Disease with a Consideration of the Possible Relation- ship of the Two Affections." Journ. Ctitaneous Diseases, 1904, vol. xxii, p. 253- Occupational Skin Diseases 215 Glanders, usually contracted from horses, is seen almost exclu- sively in hostlers or those who have to do with these animals. It is rare in this country. The bacillus may gain entrance through the mucous membrane of the eye, nose, mouth, or respiratory tract, or the site of inoculation may be a lesion of the skin. Clinically the disease is divided into glanders and farcy, according to whether the lesions of the mucous membrane or skin predominate. Both types present an acute and a chronic form. Actinomycosis is endemic in cattle and more rarely affects horses, hogs, and other animals. In man the disease is seen in those who come in contact with such animals or who handle fodder or grain, as farmers, coachmen, dairymen, millers, etc. Infection in man takes place through a carious tooth or a lesion in the mouth, and less often through the skin. The ray fungus is believed to flourish on corn, hay, and cereal grains, as the latter has frequently formed the nucleus of an actinomycotic lesion. Erysipeloid, an infection of the skin caused by poisoning from meats, fish, poultry, cheese, and similar animal products, is seen chiefly in butchers, fishmongers, poultry dealers, cooks and scullions. From Gilchrist's* observations, crab bites and injury by crabs are a frequent cause. The disease is believed by Rosenbach to be due to a micro-organism of the order Cladothrix. It is characterized by one or more areas of slowly spreading inflammation, clearing up at the part originally afifected and progressing slowly to new areas, the advancing border being festooned or scalloped. Burning, pricking, or itching sensations accompany the affection, which involves chiefly the fingers and hands. Among the minor infections may be mentioned ringworm trans- mitted from horses, dogs, and other domestic animals to men and boys employed about stables or engaged in the care of such diseased animals. Ringworm of equine origin is characterized by the forma- tion of irregular and projecting nodular lesions studded with pus- tules involving the beard region, neck, wrist, or hands. In certain grain regions infested by a mite, Pediculoides ventn- cosus, an intensely itching urticarioid eruption is epidemic among the farmers and laborers who handle sacks of wheat, barley, and other • Gilchrist "Erysipeloid, with a Record of 329 Cases, of Which 323 were Caused by Crab Bites or Lesions Produced by Crabs." Journ. Cutaneous Diseases, Vol. xxii, 1904, p. 507. 2i6 American Labor Legislation Review grains or straw harboring this parasite. Small epidemics have also appeared at different times from the use of mattresses made from straw on which the organism had made its habitat. To Dr. Jay F. Schamberg' belongs the credit of priority in describing the affection in this country. In conclusion, while many of the industrial dermatoses lead to little inconvenience, some forms of dermatitis may become so severe that they absolutely prevent a man from carrying on his occupation. In certain susceptible individuals the action of the irritant is not con- fined to the parts exposed, but may spread over the entire body. Where patients develop such an idiosyncrasy they should be guarded against these forms of dermatitis becorriing permanent, and should be advised as to the best means of prevention. Such measures cannot be discussed at length in a paper of this scope, as they must neces- sarily fit individual cases. If the nature of the work permits, the wearing of masks and gloves to protect the exposed parts, as prac- tised by Chinese lacquerers, is advisable, but obviously this is not feasible in all forms of occupation. The use of soap and water is to be recommended in some trades in order to remove the noxious sub- stances ; while in those instances where they prove the irritants they are positively injurious and should be sparingly used. In any case, after washing, the hands should always be very carefully dried and, if practicable, covered with a protective ointment, or a salve or cold cream should be thoroughly rubbed into the skin at night. People whose vocations bring them in contact with live or dead animals or their products should be instructed as to the mode of inoculation of infections from these sources, and all wounds or breaks in the con- tinuity of the skin should be sealed with collodion, plaster, or some other protective dressing. ' Schamberg, "Grain Itch (Acaro-Dermatitis Urticarioides) : A Study of a New Disease in this Country." Journ. Cutaneous Diseases^ 1910, Vol. xxviii, p. 67. OCCUPATIONAL NERVOUS AND MENTAL DISEASES Charles L. Dana Cornell University Medical College. The nervous and mental diseases which may be called occupa- tional are brought about by one or more of three agencies: (i) The occupation itself may be such as directly to cause damage to the nervous tissues, as when a cigarmaker gets a cramp or neuritis, or a painter or worker in a lead factory gets an arm paraly- sis. This is a direct occupational disease. (2) The occupation may be such that exposure and the mode of work or life almost necessarily involve risks, temptations, or accidents which lead to disease. Thus cab-drivers suffer from occupational alcoholism, and soldiers in time of war and millworkers on very long hours suffer from occupational insanities of various kinds. These may be called indirect occupational neuroses or psychoses. (3) Nervous diseases may develop when work is carried on under such depressing conditions of meager wages or insanitary and unwholesome fac- tory and home life that ill health necessarily follows. These may be called industrial neuroses and psychoses. With this broad view of the nervous diseases of occupations one can see that the subject is not easily exhausted. Direct Occupational Nervous Diseases The direct occupational nervous diseases are quite numerous. They take the form of paralysis, atrophy, inflammation of the nerves of the arm or leg, neuralgia, paresthesia, and dysesthesia (disagreeable numbness, prickling, tingling, etc.). In most skilled workers, and in all kinds of workers who do one skilful act over and over again for long periods of time, we have the occupational cramps; writer's, telegrapher's, musician's, pianist's, etc. Though about ninety per cent of these troubles affect the arms and hands, the legs are also affected, and we have paralysis and pains in tailors, gardeners, and potato diggers, besides the more serious paralysis of the legs in caisson disease. The occupations which involve long 2i8 American Labor Legislation Review periods of standing also cause various foot-pains, due usually more strictly to mechanical disturbances of the ligaments, bones, and mus- cles than to nerves. Policemen, soldiers, and letter-carriers have podalgia, sciatica, and other painful troubles. The nerves of the head are least often involved, but miners suffer from nystagmus, boilermakers and rivetters from deafness, and workers with strong arc-lights from paralysis of the accommodation or light reflex muscles. The general facts about these troubles were set forth by Dr. Starr and myself in papers read before the Academy of Medicine and published in the Medical Record of February 3, 1912. It was shown that among occupational nervous diseases, the most serious and frequent were those due to lead poisoning; and it has been shown by Dr. Alice Hamilton that lead is used and lead poisoning may occur in one hundred and eleven different trades. Arsenic, which is used in the furrier's trade and twenty-six others, is much less often a cause of nervous disease, but it has been in the past an important source of danger in the manufacture of wall-papers and in beer making. Mercury and brass occasionally cause symptoms of nervousness, tremors, and asthenic and anemic states. The number of occupations in which, by reason of mistake or overuse of the hands and arms, we find neuritis, neuralgia, and cramps, is very large. I gave a list of twenty such occupations in my previous paper. In a Paris thesis, 1901, under the title Occupational Neuritis, Dr. Helene R. Baraks gives a list of one hundred and nineteen different occupations in which inflammation of some nerves, mainly those of the arm and shoulder, was due to the work in which the persons were employed. She reports over two hundred cases illustrating the different conditions. Bruising and pressure on the parts and overwork are the immediate causes. In New York the occupations which contribute most often to these troubles are those of tailors, cutters, ironers, pressers, laundry workers, musicians (pianists and violinists), porters and other car- riers of heavy weights, stenographers, telegraphers, and bookkeep- ers. The occupational nervous troubles, aside from those due to the caisson disease and to lead, and aside from the cramps, are not very serious. They are curable as a rule in a few months. In rare cases, however, they pass on to serious and progressive organic disease Occupational Nervous and Mental Diseases 219 (atrophy or sclerosis). These troubles are caused partly by care- lessness and uncleanliness and perhaps more often by prolonged and excessive woi-k. If I were to single out any one point for special attention and action, I should advise that short pamphlets be written to be cir- culated among ironers, pressers, tailors and especially cutters, cigar- makers, masons, and boilermakers, whose work involves heavy, reg- ular manual movements; and also among workers in compressed air and those who have to handle arc-lights, cautioning them against the dangers and showing how they may be avoided. The dangers of lead, mercury, arsenic, phosphorus and caisson work have already been fully explained. The remedies have only to be applied. Summing up, one may say that the principal occupational ner- vous diseases are : 1. Toxic: Lead palsies, neuralgias, psychoses. Arsenical palsies. Mercurial tremors, etc. 2. Mechanical: Paralyses, neuritic and atrophic. Atrophies. Parasthesias. Neuralgias. Spasmodic disorders. Caisson paraplegia (the "bends"). 3. Environmental: Exhaustion (auto-toxaemia). (Neurasthenia, psychasthenia, insanity). Mental Disturbances Due to Occupations The occupational psychoses, or mental disturbances due to occupa- tions, furnish practically an unexplored field and perhaps not a fruitful one. That is to say, occupation is essentially a healthful thing, much more so than recreation or rest ; and I would urge that the aim of the social and industrial reformer be not to lessen oc- cupation, but to make it easier and more agreeable, or at least more interesting. There is nothing so mentally healthful as work. There are, consequently, very few occupations which directly, by 220 American Labor Legislation Review reason of the kind of work, cause insanity. Nevertheless, there is a lead insanity, an alcoholic insanity, and an insanity caused by sulfid of carbon and by sulf ureted hydrogen ; also perhaps a mental deteri- oration, especially of memory, in those exposed to CO2. Then there are certain occupations which are in their nature exciting or one-sided in their demands on the mental life, and Dr. T. H. Kel- logg enumerates soldiers (and sailors), poets, prostitutes, and poli- ticians as being especially liable to insanity. To this list others have added the occupations of cab-driver, stoker, and bartender. Millworkers who tend machines for long hours are said by Spoult- ing to contribute unduly to the state hospitals for the insane. The insanities due indirectly to occupation and industrial condi- tions are, moreover, very numerous and important. Forel says: "Other causes, such as the herding together of the proletariat in great cities, in bad rooms or tenements with insufficient food and unhealthy employment, undoubtedly weaken the nervous system." And Dr. Kaplan, in enumerating the causes of that devastating form of mental degeneration, dementia praecox, says : Most, if not all, of my patients came from the congested districts of Greater New York; they lived in tenement houses; they were deprived of light, proper sanitation, fresh air, and good food; they worked in sweatshops for means of getting their livelihood ; they were in constant struggle and strife for the maintenance of their existence. Some of the married women were compelled to work in shops, in addition to their housework, in order to support the family. Seventy-two patients did housework; thirty-three were employed in shops; three had positions in stores; eight were dressmakers; two were bookkeepers ; three stenographers ; one a governess ; one an attend- ant in a hospital for the insane; two clerks; one a student; four had no oc- cupation. Influence of General Industrial Conditions All this, however, is in a way only incident to industrial progress and more intense social activity. The occupation of becoming high- ly civilized leads to increase of insanity. In the north of Italy, among the active industrial population, says Tanzi, the percentage of insanity is 25.3 per 10,000. In southern Italy it is 1.3 to 6.6 per cent. Crowd people together and there surely will be more insane. Occupations compelling life to be lived under congested conditions are thus indirectly the cause of insanity. If we wish to improve industrial conditions with a view to improving mental Occupational Nervous and Mental Diseases 221 health, we should discourage urban industries, especially urban fac- tories. This is not because of the industries or the factories, so much as it is because of the mode of living. What is the use of high wages and short hours if life away from work is unhealthful? The occupation of making shirtwaists may keep one well or drive one insane, according to the nature of the home and the kind of rest and amusements which are taken. But we should also discourage industrial isolation. Man needs social life as much as he does fresh air and good food. Men are like certain trees which do best when they are planted just so far apart; not too close, for then the roots encroach and rob each other of nourishment ; and not so far apart that there is no support and protection from the sun and winds. The active money-earning occupations of life, then, have really little in themselves to do wnth causing the great mass of nervous and mental disorders. It is what is done between times, what kind of rest is taken, and what kind of home life is lived. It is this which does the harm. Women have many more nervous troubles than men, but they have fewer occupations and the fewer they have the more they get nervous. It is, then, I repeat, not occupations themselves, but the industrial and domestic con- ditions to which working people are subjected which cause the mass of nervous and mental diseases. Take a man or a woman and make him or her do a dexterous piece of work over and over again during long hours and under a nervous strain. Underfeed a little, shorten or disturb the sleep, and you can produce neuralgia or neuritis or a cramp within from two to three months. Take a person who has not a very stable nervous system and put him at work for long hours, at tasks of concentration or skill. Let him have no real recreation and not quite enough restful sleep and you can produce a mental trouble of at least a minor type. Those who work on a certain tension, like mill operatives in charge of machinery, engineers, etc., and those who work always with a strain and efifort to finish a certain fixed amount in a fixed time, get nervous or mental troubles unless they have periods of real recreation. Real play is needed for hard, tense work. For the ordinary worker it is not so important. Scientific manage- 222 American Labor Legislation Review merit, therefore, which speeds up the human machine, must give it longer rest and an absolute change of nervous and mental in- terest. The direct occupational causes of mental diseases are, then, of small importance. The industrial causes, however, which lead to bad home conditions, bad forms of recreation and rest, bad social and moral conditions, are of immense and fundamental impor- tance. We could lessen insanity more by razing tenement-houses than by shortening hours of labor. Occupation is mentally health- ful; play may be exhausting and dangerous. Give the hard- working man knowledge and opportunity to spend his leisure well, just as seriously and just as quickly as you give him more leisure. Some legislation, but much more ordinary good sense and sanitary rules should be preached. I would say, then, in conclusion, that occupational and industrial nervous diseases call for special atten- tion on the part of the sanitarian and of the legislator. OCCUPATIONAL EYE DISEASES Ellice M. Alger Nezv York Postgraduate Medical School. If we are to judge from the relative space assigned to them in our books, the importance of occupational diseases of the eyes has not been properly estimated. There are many industries which regularly cause serious organic diseases of the eyes while, in the wider sense, there are few skilled occupations in which the eyes are not used far beyond nature's intentions, with corresponding discom- fort and disability. I have no intention of giving you a catalogue of the rare diseases which have been observed from time to time in connection with our modern highly specialized industries, but I do wish to call your attention to several distinct types of occupa- tional disease and to assure you that of each variety there are numerous subvarieties. Exposure to Injurious Substances Trade accidents should not, of course, be classed as trade dis- eases, whether of the eye or of other organs. It is very difficult, however, to draw any hard and fast line between the occasional injuries which must be classed as accidents, and those which, like injuries from dust, are due to constant exposure to injurious sub- stances and must, therefore, be assumed as conditions of the in- dustry. To lose an eye from the impact of a popping cork is doubtless an accident, though not by any means so rare a one as you might suppose. But, in the bottling industries, accidents of this sort happen so regularly that they have to be considered as inci- dents of the trade and guarded against accordingly. The same may be said of the bursting of unprotected water gages and of other similar accidents which so often destroy the eyes of engi- neers and machinists. The daily total of more or less dangerous injuries to the eyes of workmen is something enormous. 224 American Labor Legislation Review Consider the men employed in the various grinding trades. In working over an emery wheel, for instance, there is a constant stream of small particles thrown off at great speed. The experi- enced man has learned to save his eyes as much as possible, but the beginner is always in trouble. When these particles are small they are removed from the eye by a fellow workman with the corner of a dirty handkerchief, the soft end of a chewed toothpick, or the point of a penknife. Every large shop has some man who is par- ticularly expert at removing these foreign bodies, and it is only when they are too deeply embedded for the amateur operator's skill that they are referred to the physician. The writer often sees half a dozen or more cases in a single afternoon in his dispensary ser- vice, most of them showing signs of previous manipulation. Considering the chances for infection, bad results are astonishingly rare. Nevertheless, there are many cases in which infection does occur, resulting in extreme pain, loss of time, more or less perma- nent disability, and most infrequently in the loss of the eye itself. It must not be forgotten that every one of these foreign bodies, except the most superficial, produces a minute but permanent opac- ity of the cornea, which if rightly situated interferes seriously with sight. I have seen many men with numerous scars in each eye as the result of repeated injuries of this kind, and yet they seem to learn nothing, the same ones coming back time after time in spite of warning and advice. The various safeguards that have been devised do not seem to be practical, for opposition to their use seems to come from the men rather than from their employers. Then there is the less frequent but much more serious list of injuries caused by the larger bits of metal and stone in foundries, quarries, and mines. These chips fly through the air with tremen- dous velocity and not infrequently pass clear through an eye. These are, of course, accidents and are therefore rather outside the limits of this paper, but they are for the most part preventable and they should be prevented. There are many other trades each of which has its own peculiar type of injury, like the lime burn and the solder burn. Practically all the so-called dusty trades cause chronic inflammation of the eyes, which not only makes trouble in itself but predisposes to various infections. Masons and plasterers not only suffer from lime burns but commonly have chronic conjunctivitis, as do flour-mill Occupational Eye Diseases 225 employees. Hop pickers suffer from an acute inflammation of tlie conjunctiva during the season, and farmers and other outdoor la- borers who are exposed to wind and dust very often develop ptery- gium. Trade Poisoning There are also many trades in which the workmen suffer more or less permanent loss of sight through the absorption of drugs of one sort or another, and the number of these is constantly increas- ing as th° complexity of our manufacturing processes increases. I have no intention of giving you a list of all the chemicals which are on record as having produced blindness. The list is a long one and many of them are important simply as suggesting profitable di- rections for future investigation. Among them are tobacco ; alcohol ; lead, used in so many different industries ; bisulfid of carbon, used in the manufacture of rubber; nitrobenzol, used in the manufacture of explosives; and some of the anilin dyes. The one to which I wish particularly to draw attention is methyl or wood-alcohol. Owing to its low price it has very largely displaced grain alcohol in manufacturing processes. It was never intended for internal use, but has long been consumed by the ignorant and benighted as furnishing a cheap and very potent source of intoxica- tion. Such sprees often end in death and more often in a specific type of blindness. Since attention has been devoted to this subject, it has been found that in susceptible individuals a very small dose of wood-alcohol may produce permanent total blindness. Ten drops have produced this effect in one case. Furthermore, instances are accumulating in which the same result has followed its use as a sub- stitute for grain alcohol in bathing and rubbing. But the fact that compels us to class wood-alcohol blindness with the occupational diseases is the increasing number of cases in which it has followed mere inhalation of the vapor for a comparatively short period. It is used in many of the trades as a solvent of shel- lac, as, for instance, by painters and hat makers. Many typical cases are now on record of blindness in painters, who have used it in re- moving varnish in close rooms or in applying shellac to the inside of beer vats and the like. There are probably many cases of wood-alcohol poisoning which are entirely unrecognized. Tyson reports a whole room of girls in 226 American Labor Legislation Review a pencil factory who suffered from ill-defined disturbances of vision, among other symptoms. It was finally discovered, almost by acci- dent, that the pencils were varnished with wood-alcohol, and with suitable ventilation the trouble disappeared. Apparently there is no valid excuse for the manufacture of wood- alcohol. Its actual cost is much greater than that of grain alcohol, and its manufacture results in the denudation of mile after mile of growing timber. To facilitate the use of grain alcohol in the arts the government permits the sale of the so-called denatured alcohol tax free; but unfortunately one of the processes of denaturing con- sists of adding ten per cent of wood-alcohol, which is sufficient to make even denatured alcohol dangerous to the susceptible. It is, perhaps, beyond the scope of this paper, but Holden has recently called attention to the fact that many retail druggists sell wood-alco- hol over the counter under various names, not only without any indication of its poisonous nature, but with the phrase on the label "guaranteed under the food and drug act", which many people understand, not as a guarantee of purity, but of harmlessness. We have much to learn about the subject before we can legislate intelligently. The manufacturers claim that the pure wood-alcohol is harmless, the poisonous brands being those incompletely refined, while even the latter are safe enough if sufficient ventilation is se- cured. Disabilities Due to Exposure to Light There is another long list of more or less serious disabilities which result from exposure of the eyes to artificial light, made necessary by our modern factory conditions. Electricians are dazzled and sometimes blinded by sudden exposure to the intense light caused by blow-outs and short circuits. Too intense light, like that of the arc lamp, decomposes the visual purple faster than it can be regen- erated and causes a condition of retinal exhaustion. It also causes, in the effort to exclude the light, a constant extreme contraction of the pupil, which is both painful and fatiguing. This accounts for the asthenopia which is so common in many trades which, like those of gilders, metal polishers, and glass workers, compel a close attention to polished surfaces which reflect light. The modern methods of industrial lighting have made the com- position as well as the intensity of light a subject of great practical Occupational Eye Diseases 227 importance. Incandescent gas and electric lights contain many of the violet and ultra-violet rays, which are not only useless for illumina- ting purposes, but are capable of causing effects on the eye not un- like a modified snow-blindness. The worker who is exposed to them day after day often develops annoying inflammations of the lids and conjunctiva, and also often suffers from asthenopic symp- toms which vastly diminish his efficiency. Furthermore, their ef- fect on the deeper structures of the eye is suspected of being still more serious. The refractive media of the eye absorb most, if not all, of these ultra-violet rays, so that the retina suffers little harm, but it is quite possible that the continued process of absorption may be one of the causes of cataract. It is certain that stokers, bottle makers, glass-blowers, and others who are continually ex- posed to very intense light and heat have an enormously increased liability to cataract. One foreign observer found that as many as 40 per cent of the bottle makers in one establishment showed evidences of cataract, though the great majority of them were under forty years of age. The left eye, which is nearest the fire, was invariably affected more than the right. Diseases Due to Occupational Strain There is also a very large group of diseases, organic or functional, which are due to prolonged use or excessive strain of the eyes. The eye is one of the most complicated organs in the body. Perfect single vision requires not only two good eyes but their complete co- ordination, which is accomplished by the joint action of fourteen separate muscles. Four of the twelve great cranial nerves are de- voted exclusively to vision. When one stops to think that most people use their eyes almost constantly and that many tasks involve a continuous strain for hours at a time, one begins to understand why vision necessitates expenditures of nerve and muscle energy beyond almost any other function. There are at least three distinct types of eye fatigue which show themselves in different trades. We have already alluded to the retinal fatigue resulting from the constant watching of polished or reflecting surfaces, resulting in the asthenopia of gilders and polishers. Next comes the muscular fatigue which we see in the trades that compel the constant use of the eyes for close, fine work. The perfectly normal -eye sees things close at hand only by a process 228 American Labor Legislation Review of accommodation or focusing, which is a muscular effort and which produces a normal fatigue. It is, therefore, perfectly possi- ble to strain healthy, normal eyes by overwork. In most of the so- called errors of refraction, hyperopia, astigmatism, and the like, distinct vision is only possible by overaccommodation, and the individual who has to accommodate too much naturally becomes tired sooner than he otherwise would. Holden, in a very interest- ing paper, calls attention to the fact that one of the first occupa- tional diseases of which we have any record was the scholar's dis- ease; his headache, his eye pains, his indigestion, and his pessimism were ascribed to his sedentary life and his brain work. Many of the ills which the scholar endured were due to overuse of his eyes and are to-day relieved by the use of suitable glasses. But the scholar no longer has any monopoly of either the symptoms or the life. To-day there are many trades in which the workman sits hour after hour chiefly engaged in watching intently — a task which eventually tires even the normal, healthy eye. And among the factory workers, badly housed, ill fed for generations, diseased, refractive errors, which are for the most part congenital, are not only practically universal, but often so great that they cannot be compensated for by any amount of strain. Consider the garment workers, for instance. They all sufifer from errors of refraction, large or small. They have less than the nor- mal compensatory powers because their muscles are overworked and badly fed. They work long hours in close, badly ventilated, badly lighted rooms, driven to the utmost. The least muscular re- laxation means indistinct vision and mistakes in their work, and for every mistake there is a regular tariff of fines and deductions. The constant strain to see distinctly results in a whole series of eye symptoms. The muscular fatigue causes headache, which most operatives seem to consider an inevitable incident of life. The eye, like the hand,, has its muscle cramps from over- stimulation, and its pareses from exhaustion, but, while the cramp of writers and telegraphers is regularly included in the list of oc- cupational diseases, nothing is said of the far more common ciliary spasm or the convergence insufficiency of the eye worker. The nervous exhaustion which follows the effort to stimulate tired ocu- lar muscles day after day is certainly one at least of the causes of lowered vitality and depression. Neurasthenia and the other Occupational Eye Diseases 229 fatigue and attention neuroses are said to be practically universal among the garment workers, and no small part of it can be ascribed to eyestrain. Miner's nystagmus has always been described as the type of oc- cupational disease resulting from eyestrain of a definite sort. Pro- gressive myopia is no less so. Practically unknown in infancy, it first appears occasionally in the early years of school, and be- comes more and more common as the children advance from grade to grade. In the various social classes it is found to be in direct proportion to the amount of close work which they have to do. Among the German lithographers Cohn found that 45 per cent were myopic and among the typesetters 51 per cent. The same practical conclusions are true the world over. The myopic eye is a diseased eye and progressive myopia means a gradual failure of vision, constant liability to ocular inflammation, and in many cases final blindness. It is a true occupational disease which in Germany accounts for approximately ten per cent of blindness. Conclusion I have given a very brief resume of certain types of disability which may affect the eyes as the result of certain occupations. Be- fore we can possibly have wise legislation we must have far more exact knowledge of many of them. Accidents and injuries are, even to-day, passably taken care of. They are interesting to the physician, and their cause, their treatment, and their prevention are often so obvious that much progress has already been made in reducing their frequency. The study of the trade poisonings which affect the eyes is still, however, in its infancy in this country, and is not likely to progress much till a change is made in the method of investigation. The hospital physician is in no position to study them. They come to him as isolated cases, often in patients who speak little or no Eng- lish and who work at trades the details of which are unknown to him. Most of them have no pathognomonic symptoms to distin- guish them from similar conditions which are not occupational. I am sceptical of the scientific value of the compulsory reporting of such cases. It will doubtless reveal occasional extreme typical cases and be worth while from an educational standpoint and from the standpoint of punishing legal infractions, but that it will add 230 American Labor Legislation Review much of scientific value to the specialist's knowledge of occupa- tional diseases I doubt. The place to study these conditions is not in the hospital or the clinic but in the factory. What we need is an intensive study, once for all, of each of the important trades by a group of trained observers. Personally I believe that the eye diseases due to fatigue are far more important than we commonly suppose. More people are blind from malignant myopia and retinal detachment than from all the trade poisonings. More inefficiency and more misery are caused by defective eyes than by diseased ones. There is no field in which it would be easier to enlist the enlightened self-interest of employers. Any intelligent shop management must consider the eyes of em- ployees. There may be a place in our modern factory system for the lame and the halt, but not for the blind or the partly blind. Pro- fessor Munsterberg can tell by psychological tests whether it will be worth while to train a girl as a telephone operator. The oculist, in his turn, can not only do a good deal to convert unprofitable into profitable employees ; he can pick out employee after employee whom no intelligent man could afiford to hire. More than this he can form a pretty good estimate of those who are fit to-day but will be unfit to-morrow. There has been so much exaggeration on the subject of eyestrain that the medical profession has dis- gustedly refused its attention, and yet I know of no one factor that afi^ects the earning capacity of the laboring classes to such an extent. I know of no medical field to-day in which the poor and the ignorant have been so entirely abandoned to the care of the incompetent and the dishonest. Here again intensive study is needed. INDUSTRIAL POISONING David h. Edsall Harvard Medical School. There has been a great deal said in the past few years about the general problem of industrial hygiene, but until very recently there has been a deplorable lack in this country of precise information in regard to industrial intoxication. Even yet, in spite of the investiga- tions made by Dr. Alice Hamilton, Dr. John B. Andrews, and others for the Labor Bureau, the Illinois Industrial Disease Commission, and the American Association for Labor Legislation, we do not have anything like the detailed information which is available in Europe. I have been able to get more information in two or three days from an official introduction in a foreign country than I can get in this country in two or three months. The only difficulty there is that the manufacturers are often afraid you are looking into trade se- crets ; they don't care how much you look into trade health. Yet we know that conditions in this country are certainly as bad as conditions abroad. There used to be claims that, owing to our great national ingenuity and inventiveness, or to other causes, there was not so much industrial disease here and that, therefore, we did not need the rigid legal control which they exercise in other coun- tries. But the recent investigations of phosphorus and lead and mercury poisoning show that we are dealing with conditions that need attention here just as much as abroad. Dr. Thompson has mentioned his experience in New York with regard to lead poison- ing, and I have had some experience in Philadelphia. From my own records I could produce more cases of lead poisoning from each of two white-lead works there than from any similar works in Great Britain. I have gone over the records of some of the latter and know what they are. The work I have done, however, has been purely individual. Official information and investigation is much better. The expe- rience we gain from unofficial investigations is very vague and frag- mentary and brings to light only a fraction of what exists. As good 232 American Labor Legislation Review evidence as I have ever had of this fact was in connection with two large plants, both of which used carbon bisulfid and lead. One manu- facturer told me they had so little trouble they did not pay any attention to it at all. The other plant, carrying on the same processes, told me with the greatest openness that they had considerable trouble with carbon bisulfid and lead in spite of great precautions. It is essential to get precise and definite studies on the subject from an official standpoint. Such studies are particularly necessary, I believe, by reason of the fact that a great many processes in this country differ from the processes abroad. It is an interesting fact that Great Britain has had a different problem to deal with from that in Germany. As we know, Germany's vast commercial importance is the development of the last half century or less and it has been possible, therefore, to put into effect there almost any law affecting the health of employees without greatly disturbing the manufacturer. In England many per- sons carried on trades in very old localities and old shops and if they had enacted drastic laws immediately they would have destroyed their industries. They had different conditions. We are only mak- ing a beginning at regulation and are far behind both Germany and Great Britain. But we must know our own conditions, and not go too much on observations in other countries, if we are going to deal justly with our industries. From the United States Bureau of Labor and other such sources we must get the information we need. No one need feel, because we have acquired some valuable knowledge of conditions in the last two or three years, that we have approached a fraction of what is really important. In getting this information and in drawing up regulations based upon it, the first thing we need is uniformity, — uniformity between investigating agencies and between states. If we cannot have uni- formity in the first place we will have trouble in classification. More- over, it is extremely important in legislation, for any regulation of these things in one state, when there is no regulation in surround- ing states, may do such harm to industries that they will move to an- other state or new industries will not develop there. Uniformity is the first step in regulation. The reporting of industrial diseases, and the reporting of a larger number than now required in the eight states that demand such reports, furnishes the most important source of information. The Industrial Poisoning 233 importance of this is at once recognizable by anyone who knows even vaguely the effect of the reporting of infectious diseases, though very few except those interested know the profound eiTect of the report- ing of industrial diseases. As a striking example of this, I was talk- ing with Dr. Legge, the head of the medical inspection of factories in England, in regard to their regulations concerning industrial in- toxication. His long experience under the British reporting law has made him famiHar with almost all the plants in Great Britain, and particularly with all the diiTerent operations of these plants. He told me, if I wanted to see a curious difficulty which they had not been able to remedy, to go to a certain pottery. Then he pointed out various plants elsewhere that exhibited simple or more complex means of overcoming particular dangers. This detailed information gave him precise knowledge as to where any company needed to be corrected and where they did not need to be corrected. There is other important information that cannot be gained in any way except by the reporting of diseases. In particular it gives a definite idea as to whether or not regulations are doing the right amount of good. Another fact that the reporting of industrial diseases opens out is the occasional necessity for rather drastic special regulations in re- gard to matters of this kind, such as the French laws concerning the use of lead paint. In England they have had little improvement, owing to their regulations, in lead poisoning among painters. It may be that they will be forced into drastic prohibitory laws like those in France. The medical inspection of working people exposed to conditions of this kind will unquestionably, I am sure, lead to improvements of conditions equal to those from reporting diseases. The manufac- turers abroad that I have talked with about this, and I talked with a number in England, were actually enthusiastic then, though they opposed it at first. Some told me that, although required by law to have an inspection once a month, they had voluntarily introduced it once a week because it had the value of detecting any trouble at once. The manufacturer has been rather condemned this morning by one or two speakers. My experience has been that very frequently he is quite as willing to cooperate as anyone else. Manufacturers may be divided into three classes : those who are educated as to the value of these matters, those who are willing to be educated, and 234 American Labor Legislation Review those who are uneducated and unwilHng. But many of them are wilHng to do what they can if the matter is once made clear to them. An essential thing that, it seems to me, needs to be done in over- coming the conditions we are facing is to establish some definite standards. That is true of anything relating to industrial condi- tions or anything else. You cannot make improvements unless you know the standard of improvements. Most of our laws in regard to industrial hygiene throw the whole burden on the medical inspector. If he is an honest and capable man he may do it well. If he tends to be a grafter, he can use his position for that purpose. If he is uninstructed he does nothing. In England the regulations in regard to potteries fill a large pamphlet, going precisely into every detail. This is fair to the manufacturer, because he knows what he must do ; but it holds him up if he does not do it. Standards should be given in every instance when possible, so that the manufacturer may come up to the standard and not just vaguely try to do the right thing. Even then inspectors should be trained. Another important thing is that the regulations shall not be de- pendent upon the occasional meeting of a state legislature, that there shall be some provision similar to that in the English law, which practically gives the Secretary of State power to modify these regu- lations as may seem to him wise if he submits the changes to the action of Parliament as soon as possible ; but in the meantime he can protect working people from changes in processes, or other things that might be dangerous, and not wait for indefinite periods. There is only one thing more I should like to say, and that is that I think we have been and still are altogether too prone to consider occupational poisoning of various kinds merely as showing certain picturesque results. We tend to look on colic, palsy, and encephalo- pathy, foT example, as being all of the important effects of lead poisoning, but the main effects of lead poisoning are other things ; much more ill health is caused by the general effects on the health, the arteries, the kidneys, and digestion. I think we have no more right to speak of lead colic and such things as the main effects of lead poisoning than we have to speak of drowsiness as the main effect of the morphine habit. Any statistics that we can get only show a minor fraction of the results of these intoxications. They undoubtedly cause many times the bad results that appear from these definite, discoverable consequences. COOPERATION IN PROMOTING INDUSTRIAL HYGIENE Henry R. Seager President, American Association for Labor Legislation. Nothing could better illustrate the advantages of cooperation in our efforts to promote industrial hygiene than the papers that have been presented at this Conference, or indeed than this Conference itself. The greatest present need in this field in the United States is undoubtedly fuller knowledge. We need to know more accurately what are the occupational diseases to which American wage-earners are exposed. We need to know the conditions which give rise to these diseases in the occupations in which they are found. Finally, we need to know the easiest and most effective means of changing conditions so that these diseases may be prevented. The fact that this is only the Second National Conference on Industrial Diseases is evidence of the tardy attention we are giving to occupational dis- eases in this country. For some time to come careful, intensive studies, like that described by Mr. Hoffman, must precede the intro- duction of remedial measures. '^ If fuller knowledge is what we most need, the group to which we must look for light is obviously that of the trained physicians who have taken to heart the old adage that an ounce of prevention is worth a pound of cure, and who are deliberately turning aside from the work of curing the sick to the more important, if less appreciated, work of searching out the causes of sickness and devising measures that will narrow the field over which these causes operate. But in connection with occupational diseases physicians require, perhaps more than in any other department of preventive medicine, the cooperation of other groups. This is because occu- pational diseases must be studied not merely in the symptoms of * The results of one such study have been published in a monograph by Mrs. Lindon Bates on Mercury Poisoning in the Industries of New York City and Vicinity, by the Women's Welfare Department of the National Civic Feder- ation. Copies may be secured by application to the American Association for Labor Legislation, Metropolitan Tower, New York City. 236 American Labor Legislation Review their victims, but in direct connection with the occupations that give rise to them. It is not enough that employees who have con- tracted occupational diseases submit themselves to examination and treatment; other employees in the same trades who have not yet contracted the diseases must be examined, and all must be induced to furnish full information, not only in regard to the places and conditions under which they work, but also in regard to their homes and habits of life. It is not enough for employers to send employees who require treatment to company physicians ; they must also grant free access to their plants and permit periodical phy- sical examinations to be made of all their employees, both well and ill. Finally, to bring physicians, employees, and employers together in a united effort to lessen the ravages of occupational diseases, the zeal and enthusiasm of social workers are required. As in the case of tuberculosis, itself to some extent an occupational disease, so for occupational diseases generally, the road to reform lies through a vigorous campaign of public education. Social workers must be counted upon to organize this campaign and to press it on to a successful issue. A comparison of conditions in the United States with conditions in Germany and in the United Kingdom indicates how far we are behind those countries from the point of view of public appreciation of the importance of industrial hygiene. In introducing the sys- tem of obligatory illness insurance for wage-earners in 1883 and requiring employers to contribute one-third of the necessary prem- iums, Germany made industrial hygiene thenceforth a matter of supreme concern to her industrial classes. Preventing occupational diseases was changed from the interest of a few unusually humane or unusually far-sighted employers to a pursuit in which the most mercenary and penny-wise were almost equally zealous. Reducing the number of employees to fall ill and the number of days of illness for those who could not be kept well, now meant reducing sick-insurance premiums and thus adding directly to the year's profits. Whatever may be thought of incidental effects of the compulsory insurance system, there can be no doubt that the won- derful progress that Germany has made in the last thirty years in the field of preventive medicine has been largely due to this bold policy of the Iron Chancellor. The United Kingdom, in adding in 1906 to industrial accidents Cooperation in Promoting Industrial Hygiene 237 certain specified industrial diseases as grounds on whicli wage- earners suffering a loss of earning power might demand compen- sation from their employers, went even further than Germany. Under this plan the employer had to pay, not merely one-third of the premiums out of which indemnities should go to wage-earners, but the whole indemnity prescribed by the law. The list of occu- pational diseases has been steadily expanded since the law was first passed, until now more than a score are included; and as regards these diseases, it will readily be believed, the British employer has become the eager coworker with the sanitarian in trying to lessen in every possible way the risk to which his employees are exposed. The National Illness and Unemployment Insurance Law, which comes into operation next month, gives the British employer an interest equal to that of his German colleague in reducing all forms of illness. It is no doubt unfair, as well as unkind, to British physicians to ascribe their opposition to certain features of this law to a fear that it will put them out of business ; but it is certain that in England, as in Germany, the new policy will give a tremendous impetus to preventive medicine. In the United States illness insurance, even through sick-benefit societies, is as yet little developed. Even without it, it is probably true that on strict financial grounds it is vi'orth while for the American employer to give greater attention than is customary to keeping his employees well and strong; but for employers in our big cities, with large reserve forces of labor to draw on, the proposition is debatable. It is, therefore, essential that social wOrk-' ers cooperate with physicians in trying to induce employers, on grounds of humanity, or self-interest, or both, to do their indis- pensable part in furthering the cause of industrial hygiene. Social workers must also rouse employees to an appreciation of the risks they run in unhealthful occupations and induce them, not only to demand safer conditions, but to give the attention to personal hygiene that is now so commonly lacking. In preference to elaborating further on the subject in general terms, I prefer to illustrate the need of cooperation in promoting industrial hygiene by describing some of the work in which the American Association for Labor Legislation has been concerned since its organization six years ago. Its founders early recognized that industrial hygiene W9S one of our great national needs. How 238 American Labor Legislation Review to impress this view on a busy and inditiferent public was the prob- lem. It happened that the European sections of the Association had recently been giving much attention to the prohibition of the use of poisonous phosphorus in the manufacture of matches, and that European governments had even made treaties for their mutual protection on this subject. Poisonous phosphorus thus seemed a promising industrial poison with which to begin our campaign. When Dr. Andrews, the secretary of the Association, began his investigation of the match industry for the federal Bureau of Labor, phosphorus necrosis, "phossy-jaw", was a disease of which it is safe to say few laymen in the United States outside of match factories had ever heard, and which few physicians had ever had occasion to diagnose. His first task was to satisfy himself that this disease was one of the necessary by-products of the manufacture of poisonous matches in the United States, as it was acknowledged to be in Europe ; his second, to convince an influential body of pub- lic opinion that such a dangerous, loathsome, and unnecessary dis- ease ought to be stamped out here by prohibitive legislation, as it had been stamped out by the other civilized nations of the world. Without the cooperation of employers, employees, and physicians, his investigation must have proved a failure. I need not now detail the steps by which it was made a success, nor the two years' cam- paign waged by the American Association for Labor Legislation which culminated last April in the enactment of the Hughes-Esch Law imposing a prohibitive tax on poisonous phosphorus matches manufactured in the United States after July i, 1913. Suffice to say that but for the cooperation of the majority of the match manu- facturers in agreeing not to oppose the bill, on condition that it should apply to all of them alike and that it should include the prohibition of the importation of poisonous phosphorus matches, the act probably would not have been passed. Further, but for the cooperation of physicians and hospital authorities in supplying evi- dence of cases of phosphorus necrosis and of the ineffectiveness of preventive measures falling short of outright prohibition, the public could not have been aroused as it was against this evil. Finally, but for the aid of match workers, one of whom went to Washing- ton to display his cruelly disfigured face to the members of the Ways and Means Committee for the sake of his fellow workers exposed to a similar fate, those gentlemen would not have reported out the bill, which had so long been held in committee. Cooperation in Pronioting Industrial Hygiene 239 The issue presented by the use of poisonous phosphorus in the American match industry was simpler and more clear-cut than that found in connection with any other industrial poison. Usually pre- ventive measures, not outright prohibition, are the remedies to be sought, and usually there is great difference of opinion as to what preventive measures are best and how they may best be made effective. Appreciating the need of further information about occupational diseases, the Association has been responsible for the introduction and enactment by eight states in the last two years of bills requiring physicians to report certain specified industrial diseases to desig- nated state authorities, usually the state commissioner of labor. Legislatures are only too ready to pass bills imposing duties upon physicians ! It was another matter to devise machinery to insure that reports of value would be sent in and that the statistics so secured would be turned to useful account. Partly for this purpose and partly to promote industrial hygiene in other ways, the New York Association for Labor Legislation, on the initiative of its secretary, Mr. Paul Kennaday, organized last October, in conjunction with the New York Academy of Medicine, a joint committee on industrial diseases. Dr. W. Oilman Thomp- son has been from the first the guiding spirit of this committee, and its frequent evening meetings at his house have already resulted in achievements which promise much for its future usefulness. It was felt by all that the first work of the committee should be to try to make the law requiring the reporting of industrial diseases more effective. Dr. Hatch, statistician of the department of labor, was asked to be a member of the committee. He gladly accepted the offer of the committee to cooperate with him in drawing up a more satisfactory form for the reporting of occupational diseases than the department had been using. A much improved reporting blank was finally agreed upon, and this blank is now not only in use in New York, but is likely to be adopted by other states which require occupational disease reports. To impress upon physicians the importance of cooperating with the state authorities in the efforts to collect adequate statistics of occupational diseases, the committee next undertook the compilation of a pamphlet on the nomenclature of occupational diseases, which is to be printed and circulated by the department of labor to all of the physicians in the state. 240 American Labor Legislation Review The services of Dr. E. E. Pratt were then secured to make a re- port on all the investigations of occupational diseases that had up to that time been undertaken in New York State. With this report as a guide, the committee advised the special Factory Investigating Commission of this state as to the occupational diseases most likely to repay further investigation. The other work undertaken by the commission is so broad that the attention it can devote to occu- pational diseases has proved to be disappointingly slight, but it has asked the cooperation of the committee in framing recommendations to the state legislature for the creation of a permanent bureau for the study of occupational diseases, and with the constantly growing interest in the subject there is strong likelihood that such a recom- mendation will be acted upon favorably. Besides these more important activities, the committee has served as a clearing-house of information for numerous other groups in- terested from other points of view in the general subject of in- dustrial hygiene. For example, it has met with the committee on in- dustrial poisons of the Chemists' Club of New York City and dis- cussed possible lines of cooperation during the coming winter. It is the purpose of this committee, so soon as the necessary funds are se- cured, to prosecute investigations of the numerous occupational dis- eases that have not thus far received adequate attention. Its mem- bers, through articles and addresses to all sorts of audiences, are constantly urging the importance of greater attention to industrial hygiene. Also through its members it hopes to induce some em- ployers voluntarily to introduce the precautionary measures that its investigations and the investigations of others prove to be de- sirable. So soon as the practicability and efficacy of these measures shall have been demonstrated, the Association for Labor Legislation will seek to have their introduction made mandatory through labor laws, so that the lives and health of all employees may be protected. Our experience in New York has convinced us that the organiza- tion of a committee of physicians, sanitarians, and interested lay- men, such as I have described, is an important, if not a necessary, aid to effective work for industrial hygiene. Physicians and sanitari- ans must supply the expert knowledge, but for the most part they are too busy to direct the work of educating public opinion or of shaping the legislation which this knowledge proves to be necessary. This Cooperation in Promoting Industrial Hygiene 241 part of the task must devolve mainly on social workers. In addition, industrial chemists, representatives of life insurance companies, and officials of the appropriate departments of the city and state govern- ments, may be drawn in to form a group which is representative of enlightened and progressive public opinion touching this problem. Through such a group tasks can easily be accomplished that would be impossible for men working in isolation, or even for the associated miembers of any single profession. We recommend the organization of similar committees in other states as an efficient means of advancing the cause which we all have at heart. GENERAL DISCUSSION Dr. Warren Coleman, Bellevue Hospital, Nezv York City: In view of the importance of the subject of industrial diseases, may I be permitted to suggest that a petition be presented from this section to the House of Delegates of the American Medical Association re- questing the appointment of a committee to cooperate with the American Association for Labor Legislation to promote the study of industrial diseases. This motion was duly seconded and unanimously carried. Dr. Rosalie Slaughter Morton, New York City: I have been especially interested in this joint session. It seems a great evidence of progress that the laity and the profession of medicine should get together to work for the public good. The work done by the Asso- ciation for Labor Legislation has gone so far that I, as vice-president of the Medical Section, feel it an honor to cooperate with you. Dr. C. F. Stokes, Surgeon General, United States Navy, Wash- ington, D. C: We have been looking after occupational diseases in the Navy, but entirely on the basis of military efficiency. There is no humanitarian factor in it. Sanitation generally has reached a satisfactory condition. But in a battleship we find grouped together a more varied set of activities than will be found elsewhere in the same space. Respecting the eye troubles, the men who adjust arc-lights have severe troubles caused by the sudden glare. In our turrets, too, we have our gun pointer, the man who points the guns ; the range is so long that he must use a telescope, and we have found that these men, who started in with normal vision, have dropped down to eight and ten below. That is something which is very important to the Navy. Then there are the toxic gases. We find in almost all these great ships a type of gas which has caused death in many instances, hap- pily in foreign navies. The element at work seems to be a diminu- tion of oxygen. After two or three rounds at battle practice, the carbon dioxid runs up to forty. We have powder gas at work there which gives us a carbon monoxid poison. Men who have at the General Discussion 243 beginning of iiring a pulse rate of seventy-two, have at the end of ten minutes a pulse rate of one hundred and twenty. And in the fire rooms the heat prostrations are due largely to gas contamination, carbon monoxid. The same thing applies to submarines. We have been working at this gas problem. I was interested in what Dr. Dana had to say. It is now known that there were some two thousand men at Port Arthur during the Russian-Japanese War who were invalided home by reason of insan- ity. In other words, they were not temperamentally fit for that hazardous work. We find that some men get along very well during peace times but, when it comes to battle practice, or possibly to some great hazard, they break down. They are temperamentally unfit. These are all military considerations bearing on occupational hygiene. Dr. Mark D. Stevenson, Akron, Ohio: Occupational eye dis- eases may be caused by exposure to excessive light or heat, to poison- ous gases or fumes, and by prolonged and peculiar strain. First are diseases due to excessive light or heat, e. g., in electric welders, steel smelters, and in those who melt or anneal glass. Metal polishers and buffers, brightening surfaces which they must closely watch, often suffer with hyperesthesia of the retina. This can be relieved by proper lenses or colored glasses. Excessive heat and light are met with in iron and steel works. Men can watch a fur- nace until the temperature is up to 2000° F., but before it gets to 3000° colored glasses should be worn. If some of these hot furnaces are looked into without lenses it is several minutes before the eye can see ordinary objects again. Some men seem to have surprising immunity from bad results in dealing with these white-hot furnaces ; others cannot endure them and must change their work. Herbert Parsons and Marcus Gunn, who visited some of the important glass works in England in 1908 to gather statistics of industrial diseases for the framing of the Workmen's Compensation Act, state that bottle workers have a characteristic form of cataract, — typi- cally, a dense, well-defined disk of opacity in the center of the poste- rior cortex. Excessive heat and bright light are said to be the causes, but the Germans claim that heat is the most important cause. Weyl mentions, besides glass-blowers, fire workers, puddlers, blacksmiths, bakers, and cooks. Great care is required to avoid very strong light 244 American Labor Legislation Review flashes before the eyes, as in short circuits and electric welding. In the latter large shields are worn, in the center of which are four al- ternate layers of blue and red glass. Helmets and screens, with four or six layers of red and green glass, are often used. The tempera- ture in electric welding goes as high as 7000° F., but the question of whether it is the heat or the chemical rays that act so harm- fully has not been settled. If the eyes catch the light they are affected at once, but usually the effect appears some hours afterwards. The eyes feel swollen as if filled with burning sand and the pain is usually severe; the lids are swollen and there is much lacrimation. Other diseases are due to working in certain poisonous gases, fumes, dusts, or substances, such as bisulfids of carbon, lead, etc. Dinitrobenzol is largely employed in making explosives. During the various processes of its manufacture fumes are given off which affect vision. These can be lessened by properly covering the mix-' tures and by the use of fans and exhaust apparatus. Respira- tors and glasses should be used. Bisulfid of carbon, formerly much used in vulcanizing rubber, caused impaired eyesight, but this pro- cess has been so greatly modified that it is now of little impor- tance in causing ocular lesions. Toxic amblyopias, due to tobacco, ethyl alcohol and wood-alcohol, are too well known to require consideration. The eye affections formerly attending the manu- facture of iodoform have by care been eliminated. A few cases of eye involvement have been reported in dye factories from handling the various coal-tar preparations. Arsenic and paris green from wall-paper, artificial flowers, paper hangings and paintings, have caused various visual disturbances. Painters, plumbers, electro- typers, file-cutters and many others, through handling lead, are like- ly to get chronic lead poisoning, causing central and peripheral affections of sight, various paralyses, retrobulbar neuritis, etc. Poisonous gases and fumes are also formed in certain lead processes, and in shoe cement, japanned or patent leather, and rubber manu- facturing, where the mixtures containing naphtha are sometimes al- lowed to remain in uncovered containers and proper ventilation is not insisted upon. Eye diseases may also be due to occupations requiring prolonged and peculiar use of the eyes, e. g., nystagmus in miners, which is due to their peculiar way of looking at their work. Treatment consists in changing the kind of work. After relief the miner can General Discussion 245 return to his work if the head can be kept straight and the eyes are not often turned upward. SneU mentions several other occupations which he has thought might cause nystagmus, because the eyes were turned directly or obliquely upward. Dr. Walter F. Button, Carnegie, Pa.: The occupational dis- ease which results from the manufacture of vanadium is not as yet well known. There are two reduction plants in the United States, in which there are a number of employees. The products are being used more and more in the manufacture of steel, in photography, and in manufacturing plants where mordants are used. The mon- oxid is used in photography ; the dioxid in printing calicoes, and the trioxids in the manufacture of steel. This disease will become more and more well known as the use of vanadium products in- creases. I should like to call your attention to an article in the Journal of the American Medical Association of June 3, 1911. Mr. E. C. Curtis, New York City: Speaking for the men who work in compressed air, I think we need very much the cooperation of physicians and of the American Association for Labor Legislation to better our condition. Up to the present time the doctors have not attended to this industry as they should. There were 3692 cases of compressed-air illness in one small job, the East River Tunnel. I have known personally of men who have entered these air-locks without the doctor ever looking at them ; there were small boys who acted as doctors and passed the men to go into the caissons. We had one case in particular where we ought to get a conviction ; we went before the doctor proving that the man was sent down with an abscess on his neck, and was dead before he got half way down. That is one of the conditions under which the men I represent are compelled to suffer, and I claim there is carelessness among the doc- tors. We had another case only recently, where a man was put into the medical air-lock while a new invention was being tried on him. They put him into cold air. The man was frozen to death in the medical air, taken out of there and laid for three solid hours on a plank, and then brought home dead. The physicians do not seem to value human life at all. Here was a man with six children brought home dead for experimental purposes. But if the physicians are going to be sincere in this matter, and the American Association for Labor Legislation and the American Medical Association Avill 246 American Labor Legislation Review work together, it is going to be a great help to the men in the industry I repreicnt. Mrs. Henson : With regard to the point just brought out, the workmen ought to know, and they do know if they stop to think about it, that physicians are better paid by the corporations. They should take this point close to heart and get after the remedy. Until the workmen own the industries, and therefore are the employers of the physicians, they will never be certain of the best service. Lest some may not have read enough of Socialism to know what I mean, they must establish the cooperative commonwealth. Dr. Allen Starr, New York City: I wish to say a word about a matter which does not seem to have been brought out in the dis- cussion, — the necessity for informing the individual laborer of his dangers and of the means for their avoidance. It seems to me that the American Federation of Labor can do a great work by insist- ing in its labor unions upon certain definite information being given to each laborer, in his own department, as to the methods of avoid- ing these dangers, and so preserving his health. If a painter, for example, will take an ordinary piece of newspaper and place it be- tween his sandwich and his fingers, he will not get the lead from his fingers into his mouth. Yet in a large clinic in New York last year I questioned thirty individuals suffering from lead poisoning in regard to whether any instructions had been given them, by their employers through notices posted in the factories, or in their labor unions, as to methods of avoiding lead poisoning, and found that they had never heard even of a simple device of that kind. Many of these cases of disease, too, are the result of careless- ness. I have had some experience with the caisson disease, which the gentleman from New York has alluded to. One of the most compe- tent engineers in the employ of the Pennsylvania Railroad Com- pany insisted on disregarding the precautions he should have known and was careless enough to come out from a tunnel without spend- ing enough time in the various compartments. I should like to know if these men are not instructed about the necessity of remaining in the compartments a certain length of time, and whether their in- juries have not resulted from carelessness. I should also like to make one other point in defense of the manu- General Discussion 247 facturer. I have a large acquaintance with important manufactur- ers in New York State, but I have yet to find one, of a reasonable degree of intelligence, who is not as much interested, from his stand- point, as the laborer is from his. I will cite one company in Jersey City which put up a factory in which incidentally there is a large amount of dust discharged into the air. This company spent $40,000, under the direction of an incompetent engineer or archi- tect, for a system of ventilation by which the dust was taken up to the top of the room, passing on its way the mouths of the operatives. One intelligent operative came to the head of the firm, a personal friend of mine, and said : "That is a defect ; if you would put your exhaust apparatus in the side of the floor, gravitation would take the dust down and we would not breathe it in." That gentleman had the good sense and the philanthropic instinct developed, and he changed the whole system and spent $20,000 more in installing a new apparatus. I believe there is great hope along these lines of disseminating in- formation, — first, information to the employer as to what is the necessary thing for him to do, and secondly information to the em- ployee as to personal methods of protection. And that, it seems to me, devolves more upon the Association for Labor Legislation than it does upon us physicians. De. Geier, Cincinnati: I wish to disagree with the last speaker when he states that you must approach the employer from the hu- manitarian standpoint. I have had some experience with employers in Cincinnati in the tuberculosis problem. You don't need to use the cry of humanity at all. They prefer to have you come in with a business proposition. It is perfectly possible to go to them and say : "You are doing this and that and the other thing and you are losing this and that, so many hours loss and so much inefficiency; put in this device for sanitation and ventilation and you will make from one to twenty per cent in the increased efficiency of your em- ployees." That is the thing that is bound to appeal to the business man. As a trimming on the side we may speak of the humanitarian work; but we must approach the business man with a business proposition. In Cincinnati there is a factory which is ready to pay $2500 to $3000 a year to a physician to come in and advise them and examine 248 American Labor Legislation Review their operatives, etc. I have been asked to find such a man. As a matter of fact I do not know one man in Cincinnati, who is not earning $5,000, $6,000, or $10,000, who has the proper socio- logical view to fill that position. Dr. Charles E. Brest, W at erf or d, N. Y.: For some twelve years I pointed my practice to preventive medicine. It naturally brought me into the shops and into contact with employers, and I barked up the humanitarian tree for four or five years. I looked up sta- tistics in regard to the mortality among employees in certain rooms where the air vifas the same air as when the walls of the building were put up, and presented them to the employers. But up to the good times of a few years ago, when it was difficult to get trained em- ployees, they derided me, and there is nothing more difficult to stand than ridicule. At that time, however, I demonstrated that it is an expensive proposition to develop skilled employees and then lose them absolutely, and that it is good policy to care for them. Employers close down for a week every year to fix up the machin- ery; they never think of doing that for the employee. But when I put it as a business proposition the employers were willing to see the point, and they came to me, not only in cotton mills, but in laundries. I thoroughly agree with the gentleman from Cincinnati. If you present the proposition to any manufacturer who is trying to make good with his work he will cooperate with you. Professor Henry R. Seager, President, American Association for Labor Legislation, New York City: Some one has said that the first work of science is classification. From that point of view it would be impossible to exaggerate the importance of Dr. Thomp- son's paper. The other papers give point to the suggestions which he has made, since they deal, most of them, with specific occupa- tional diseases. We are especially glad to have evidence from the men who must know what the occupational hazards really are. As a business proposition to employers, as a line of least resist- ance, I am afraid, when we consider the employer in a large city and his mass of unskilled labor, that those of us who are conscientious would not have the face to go before an employer and tell him that it would be profitable to look after the health of this man who is taken ill and turned ofif, for some one else can be taken on in his General Discussion 249 place without much expense and with httle trouble. But by all means let us, wherever possible, approach the problem from the point of view of business. I do not regard that as optimistic. It seems to me those who approach the problem from the humanitarian point of view are the more optimistic. Dr. a. M. Harvey, Chicago: As one of the chief duties of the physician is to prevent disease and preserve health, it is indeed gratifying to attend a joint meeting of physicians and members of an Association which is interested in proposing legislation for the pro- tection of the health of workers. We need a great deal more knowl- edge of the subject of occupational diseases before proper laws can be proposed and enacted. Nothing should be done hastily, for we undoubtedly have too many laws now on our books that are not enforced. I believe that one of the chief things that can be done to prevent occupational disease is to limit the age at which children may go to work, and another is to limit the hours of work so that the worker may recover from the fatigue incident to his labor. My experience with workers during the past sixteen years has shown me that many diseases may be prevented by proper elimination of dusts and noxious gases and by proper ventilation and lighting of workshops. As all speakers have said, a great deal can be done by cooperation, but I think we have left out one class of organizations with which we should cooperate, the manufacturers' associations of the various states. In Illinois we have an influential manufacturers' associa- tion, and I think it would be very easy to induce it and other similar associations to take up the work as outlined in this symposium. I know that many of the larger manufacturers in Illinois have main- tained health departments for years, have a great deal of data for which you have been asking, and would do a good deal toward pre- venting disease. Many of our manufacturers have taken an interest both from the humanitarian standpoint and from the economic standpoint, because they know it is hard to get skilled workers and that it is cheaper to prevent than to cure. Mrs. Florence Kelley, National Consumers' League, Nezv York City: As a layman I have listened to the papers of the morning with the' very greatest interest and I should not venture to criticize the 250 American Labor Legislation Review medical statements. But Dr. Edsall ventured into my own field when he suggested that we should not be hasty or drastic in drafting bills for the protection of working people lest the manufacturer move from one state to another. Manufacturers do not move from one state to another to escape legislation for the protection of working people. Our legislation is very halting and faulty compared with that of Europe, and its enactment is always accompanied by threats of removal from manufacturers. Since May, 1889, I have been looking for the manufacturer who actually moves to escape such laws. For four years I was head of the state factory inspection of Illinois. The Illinois Glass Company of Alton made the most ominous threats in order to escape the en- forcement of the child labor law enacted in 1893. We found two hundred and ninety-six violations of that law and made it clear that children under fourteen must be dismissed, that children under six- teen must not work at night, and that all children must have the certificates required by law. The threat has been renewed by that company at every amendment to the statute. But the company has not moved. It has stayed where it was and has multiplied its staff and plant by three in the intervening years. I did once appear to have come upon a case in which a textile mill had moved from Massachusetts to Rhode Island in consequence of an amendment which made the laws for the protection of women and children more drastic. When I hunted it up I found that the company was desirous of establishing new and entirely modem, up-to-date plants simultaneously in one of the southern states and in New England. It received from the village to which it went in Rhode Island the gift of right to the land and valuable concessions in regard to water power. Its removal has been used as an argument against improved legislation in Rhode Island and Massachusetts ; but no one, not even the manufacturers themselves, could clearly disentangle the influence of a slightly increased rigidity in the laws regulating the employment of children from the gift of land and lasting concessions of water power. We want uniformity, but we don't want to let uniformity become such a bugaboo that we are afraid to do anything for fear a state may cease to be uniformly bad with the other states. I challenge anyone here, and I have been challenging anyone from whom I had any hopes of enlightenment for twenty-three years, to produce an General Discussion 251 authentic case of the removal of a manufacturer from one state to another because of the protection of the workingman. Mr. Miles M. Dawson, New York City: I feel as if I were taking the position Scipio Af ricanus is said to have taken before the Roman Senate, "Carthage must be destro3'ed", when I arise to speak concerning the intimate and necessary relations between the various branches of the work we are unfolding and starting in the United States. We can never accomplish what we wish in the matter of industrial hygiene and the prevention of industrial diseases until we have throughout the United States a system of compulsory sick insurance. The statement made by the lady who spoke of the neces- sity for the workman being interested in the employment of the physician, whatever we may think about her general conclusion, is justifiable. The physicians have not given the caisson sickness proper attention. We need in the United States something which will take care of our people and we shall not be able to do it effec- tively until they are obliged to have sickness insurance. Professor Samuel McCune Lindsay, Cohimhia Universi%, New York City: In view of the fact that every speaker has con- fessed that our ignorance of occupational diseases is so great that any legislation at present would be hasty, we are likely to have hasty and ill-considered legislation. But there are some kinds of legislation we are now ready for, and it is important that, at this joint meeting of the Medical and Labor Legislation Associations, we should turn our thought to the kind of legislation for which we are ready. I shall pass over the sort of legislation that has resulted so satis- factorily in the prevention of phosphorus poisoning, where our knowledge was a little further advanced than in regard to other kinds of industrial poisoning. We need authoritative information and, as has been suggested by several speakers, we are all agreed that such information can be had, in the last analysis, only with the co- operation and support of the state. In other words, we must se- cure legislation in several states that will set to work the machinery we need to get that information. I have just returned from Wash- ington, where I have been in connection with the work of the com- mittee which has undertaken to urge the passage of a bill providing 252 American Labor Legislation Review for an impartial national commission to inquire into all the relations between employers and employees. Such a commission, I take it, would properly bring within the scope of its inquiry the subject we are discussing. That measure should have the support of all here present. Reference was made by one of the speakers to the disagreeable feature of reporting cases of industrial disease, the burden on the physician. I think the gentleman suggested that he had a little doubt about the advantage of these laws. But it ought to be pointed out that the use of such a schedule as that of the bureau of labor of New York will have a good effect. It will call the physician's atten- tion to the industrial side of the health problem and will have a value in his work which will make the burden not without its re- ward. At any rate, it seems to me that this is a type of legislation for which we are ready, and that the American Association for Labor Legislation is justified in pushing its campaign to have re- porting laws passed in all the great states. II INVESTIGATION OF INDUSTRIAL DISEASES Presiding Officer: Henry R. Seager President, American Association for Labor Legislation New York City INTENSIVE INVESTIGATIONS IN INDUSTRIAL HYGIENE Frederick L. Hoffman Statistician, Prudential Insurance Company. Industrial hygiene is gradually assuming the position of an applied science in its relation to government and the public at large. The nation-wide agitation for effective workmen's compensation legisla- tion and the establishment of state insurance for this purpose in Washington, Ohio, and Massachusetts, emphasizes the necessity for trustworthy information, statistical or otherwise, with regard to the whole question of health and safety in American industry. It is not going too far to say that most of the published information on the subject of industrial hygiene and industrial accidents is of very limited practical value, and much of it is decidedly misleading. There have been very few intensive studies of the actual condi- tions under which American industry is carried on at the present time. In the memorial to the President on the appointment of a national commission for the investigation of industrial diseases, practically all the conclusive evidence was derived from foreign sources or intensive and more or less conclusive investigations made in foreign countries. It is most encouraging, however, that within recent years the necessity for such investigations should have been recognized, and mention only requires to be made of what has been done in this respect by the states of Massachusetts, New York, Illi- nois, etc. The honor belongs to the state of Illinois for having been the first to appoint a special commission to investigate and report upon the subject of industrial diseases, and the report of that com- mission constitutes a valuable contribution to the literature of industrial hygiene. The publications of the Massachusetts State Board of Health, and of the New York State Department of Labor require also to be mentioned as helpful indications of the direction which in years to come investigations of this kind are bound to take to an increasing extent. The monograph by Dr. Andrews on phos- phorus poisoning and the reports by Dr. Hamilton on lead poisoning 2S6 American Labor Legislation Review are epoch-making documents which separate precisely the field of guesswork opinion from the field of impartially ascertained facts. The principles which underlie all investigations of this kind are not as yet fully defined. It may be said at the outset, however, that every industry should be inquired into with reference to the health and safety of persons employed therein, but with a due regard to the essential conditions under which such industries can be econom- ically, profitably, and efficiently carried on. It is important in all investigations of this kind that the investigator first make him- self thoroughly familiar with the technique of the industry or trade about to be investigated, since whatsoever conclusions may be arrived at, they must be more or less conditioned by the elements of the industry itself. A clear understanding of the technical details of any given industry or trade often requires much patient study and research, but without such an understanding of the methods by which a particular industry or trade is carried on most of the conclusions as to health and safety must be more or less wanting in the essential requirements of absolute accuracy and impartiality. It is unfortunate for research in the field of American industrial hygiene that most of the textbooks descriptive of industrial or manufacturing processes should be by foreign authorities, just as is the case with regard to textbooks on occupational diseases and the prevention of accidents. Some notable exceptions are the standard works of reference on metallurgical processes and industrial chem- istry. The treatise on Industrial Organic Chemistry by Sadtler, and the Outlines of Industrial Chemistry by Thorp, are indispensable to research work in a large number of industries chiefly or partly in- clusive of chemical processes of manufacture. The earlier Diction- ary of Arts, Manufactures, and Mines by Ure, in three volumes, and the still earlier Cyclopedia of Useful Arts by Tomlinson, and Cham- bers' Information for the People, published in 1847, ^re useful for the purpose of illustrating the methods and processes of manufacture in the past. Some of the descriptive accounts of industrial processes published by the Census Office from time to time since 1880 are of considerable practical value in investigations of this kind, but it is much to be regretted that there should not be a popular treatise on the technology of trades and industries giving, at least in brief out- line, an intelligent account of modern methods of manufacture, with particular reference to the safety and health of the employees, and including the smaller, but frequently more important trades. Intensive Investigations in Industrial Hygiene 257 As illustrations of the textbooks useful for the purpose of obtain- ing a sound preliminary understanding of the essential factors in industry, I may refer to the treatise on The Manufacture and Prop- erties of Iron and Steel, by Campbell ; Modern Copper Smelting, by Peters ; The Textbook of Ore-Dressing, by Richards ; and Lead and Zinc Pigments, by Holley. For many of the industries excellent monographs have been published by corporations which, by their illustrations alone, render substantial aid to the students of industrial processes in their relation to health and life. I may refer to a short treatise on The Destructive Distillation of Bituminous Coal, with ref- erence to the United-Otto system of by-product coke ovens, which practically constitutes a guide to that rather intricate process which has made the utilization of valuable waste products a commercial possibility. The federal and state geological surveys publish reports which frequently contain interesting observations and suggestive illustrations, but I can only refer to the report of the geological survey of the State of New York on the lime and cement industries of that state, and to the report on the manufacture of roofing tiles, published by the geological survey of Ohio. Next to a sound technical foundation it is of some importance that the historical facts of any given industry be taken into account, and while the history of American manufactures has not been brought down to date. Bishop's classical work is still of value, mono- graphs are occasionally printed by institutions of learning, and the report on manufacturing industries by the Census Office also contains much useful information. I can only refer to the excellent monograph on The Printers, by Professor Barnett, published by the American Economic Association, and to the historical account of the English tin miners, by Lewis, published in the series of Harvard Economic Studies. The most useful sources of information with regard to industrial processes are the technical trade journals, which for practically all of the industries extend over a considerable period of time. These publications, to an increasing extent, take into account the economic and social conditions of labor, and with special regard to wages, hours of labor, etc. The reports and bulletins of the federal Bureau of Labor and of the state departments of labor, moreover, make an immense amount of more or less trustworthy information conven- iently available. Such reports of the federal Bureau of Labor as 258 American Labor Legislation Review have recently been published on the steel industry, and the series of reports on the condition of women and children, emphasize im- portant elements of inquiry which require to be taken into account. It is the disregard of this necessity for preliminary education which usually accounts for failure to secure the best possible results. Intensive industrial investigations are a burden upon industry and they should be made only by those qualified for the task, and by men or women thoroughly trained in advance with regard to all the facts and conditions which they can ascertain from existing sources of information. Industry does not exist for the purpose of providing material for the writing of books or descriptive monographs, but solely for purposes of production at a rate of profit consistent with safe and economical management. The large majority of manufac- turers throughout the United States are deserving of unstinted praise for the manner in which their establishments are conducted and made to conform to legal and moral requirements with regard to the safety, health, and comfort of employees. The difficulty is not so much in what is obvious as in what is not obvious. Immense progress has been made and the tendency practically everywhere is decidedly toward betterment consistent with the conditions under which industry can be profitably carried on. The problem is one of ignorance rather than of neglect. Most of the factors which condition health and safety in industry are as yet very imperfectly understood, at least in the United States. It is true that within the last quarter of a century immense progress has been made in Germany, but largely because of the requirements of compulsory accident insurance institutions established to replace an antiquated system of employers' liability law. We have not as yet developed in this country the function of the safety engineer, who has attained to such high professional standing throughout the German Empire because of the practical utility of his services. Manufacturers or employers of labor generally are not blamable for their reluctance to install expensive safety devices, or ventilating devices, or other methods or means by which health, safety, and comfort can be improved, unless the evidence is conclusive that the investment will be productive of the desired results. The function of the ventilating engineer in his relation to industrial requirements is practically new, and almost the same may be said of the function of the illuminating engineer. All of these questions require to be Intensive Investigations in Industrial Hygiene 259 taken into account by the critic of industrial conditions in so far as they have relation to the safety, health, and comfort of the employees. A manufacturing plant is private property and admission thereto obtained by visitors or investigators is a matter of courtesy on the part of the corporation or firm. All manufacturing establishments are subject to the visitorial powers and duties of state labor bureaus, or state factory inspection bureaus, and to a certain extent of state boards of health. The inspectors of these respective governmental departments are free to make their investigations without let or hindrance, and their conclusions, so far as practicable, should be made public as a matter of record. Until, however, the status of the factory inspector, or the health inspector, is raised to the dignity and far-reaching responsibility inherent in the position, it is self- evident that radical conclusions must be accepted with caution, and exceedingly favorable reports must be looked upon with more or less distrust. It is not going too far to say that most of the published reports of factory inspectors in this country are of very limited practical utility for research work in the field of industrial hygiene; while, in marked contrast, the annual reports of the chief factory inspectors of England, Germany, Austria, France, Switzerland, Bel- gium, etc., are models of their kind and trustworthy sources of information with regard to conditions more or less detrimental to health and life in industry. The investigator, having obtained permission, as a matter of courtesy, to visit an industrial establishment, should refrain from any conversation with the employees except by the specific perrrtis- sion of the employer. A labor force, under the best conditions, is easily disturbed by the visits of strangers, and most of all by men or women who are supposed to be in search of information or facts more or less detrimental to the industry investigated. There are everywhere employees with grievances, whose evidence may be given in good faith, but who cannot be relied upon in matters of fact. The investigator should be a trained observer and should take notes at the time of inspection of everything seen or heard which has any possible bearing upon the purpose of the investigation— that is, whether conditions exist which are a menace to the safety and health of the employee. The investigator must keep in mind that employers of labor who 26o American Labor Legislation Review have given years to the operation of a particular plant, possibly representative of extremely complex methods of manufacture, are not likely to be indififerent to the desirability that the best possible conditions of work be maintained. At the same time it quite fre- quently happens that the most obvious need escapes attention, since the mind of the employer is preoccupied with matters of more immediate personal concern. Every manufacturer or em- ployer of labor welcomes intelligent, concrete suggestions as to methods and means by which the conditions afifecting the health and safety of his employees can be materially improved. The investi- gator may safely take it for granted that, broadly speaking, the man- ufacturer or employer is as much interested in the ascertainment of the truth regarding actual conditions as the outside public or the investigator himself. He is fully assured of the most hearty co- operation in the large majority of cases in which intensive investiga- tions are made under proper conditions and by thoroughly qualified persons fit to go into delicate matters of this kind. The information obtained may be considered confidential or not, according to the previous understanding with the manufacturer or employer whose particular plant has been made the subject of an inquiry. As a rule, there should be a precise agreement on this point, and if a written report is made a copy thereof should be sent to the manufacturer or employer for verification or for such com- ments as misstatements or errors in matters of fact may require. It is hardly possible, on an occasion of this kind, to enumerate all of the factors which should be taken into account. It requires no discussion to prove that such problems as air conditioning in textile mills, the mechanical properties of industrial dust or the effective removal of such dust by ventilating devices, the alleged pathogenic properties of mine air, or the injurious effect of intense light in electro-metallurgical processes, all demand special and highly techni- cal qualifications for the rendering of a judgment or opinion that may be relied upon as sound. But with regard to most of the con- ditions which injuriously affect the health of employees, or which have a relation to the employees' safety as conditioned by safety devices, ordinary intelligence, plus the power of intelligent observa- tion, is sufficient. But granting this, an intensive industrial investi- gation is a difficult task, than which perhaps no public function requires to be approached with miore genuine humility and diffidence. Intensive Investigations in Industrial Hygiene 261 It is not a difficult matter to conceive of ideal conditions of work, and most of all is it easy to condemn the employer and relieve the employee of all responsibility. But it requires a trained mind to ascertain the necessary facts and to draw conclusions which can be practically applied to the more or less apparent needs for drastic reform. Investigations of this kind are laborious and should not be undertaken by those who are easily fatigued or confused. The sole object in view is to ascertain the truth and to ameliorate, as far as possible, the conditions of labor, so that those who are the real producers of the nation may not pay the price of industry in an excessive amount of disease or premature invalidity and death. There is no more useful function in society than that of the earnest seeker after truth in matters of tliis kind, and there is nothing more credit- able to any nation than actual progress in industrial hygiene and the prevention of needless industrial accidents. On a very conservative basis, twenty-five thousand lives are annually lost in the United States as the result of industrial accidents, which is the tribute paid in lives by some thirty million toilers who carry on the nation's work. What the tribute is in ill health and invalidity no one is at present in a position to estimate even with approximate accuracy upon the slender basis of data available. But granting that the relative occur- rence of industrial disease is greater in Germany than in this country, and taking only half the calculated amount of sickness on the GeiTnan basis, the figures are as startling as they are suggestive of the im- perative need for the most patient, the most disinterested, but at the same time the best qualified methods of research in industrial hygiene. It requires no argument, therefore, to emphasize the need for a thorough understanding of the essential facts of industrial hygiene as a preliminary requisite for intensive investigations into the con- ditions inimical to health and life in industry. The historical method has obvious advantages in that it brings out with reasonable accuracy the progress which has been made by the complete elimination of some of the worst conditions injurious to the health of wage-earners in the past. The treatise by Ramazzini, published for the first time in English in 1705, is a textbook which may still be consulted to practical advantage, and it is to be hoped that some time this exceed- ingly rare work will be reprinted. Tissot's Essay on the Disorders of the People of Fashion, and the Diseases Incident to Literary and 262 American Labor Legislation Review Sedentary Persons, published in 1772, is also quite suggestive; and the same may be said of Thackrah's treatise on The Effects of Arts and Professions on Longevity, published in 1832. There is much valuable information in Gaskell's book on Artisans and Machinery, and the Moral and Physical Condition of the Manufacturing Popula- tion ; but one of the most suggestive works on occupational diseases is The Vital Statistics of Sheffield, by Holland, published in 1843. There could be no more serious error than to assume that the health- injurious consequences of occupations are limited to the mechanical industries, and it only requires to be pointed out that the propor- tionate mortality from tuberculosis of the lungs at ages from twenty- five to thirty-four among salesmen is 46.7 per cent. In 1884 Thomas Sutherst, a barrister-at-law, published a very suggestive work, with numerous cases, on Death and Disease Behind the Counter, intended as a protest against the more or less unnatural conditions of shop labor. These are the earlier works of reference, which have since been partly replaced by the Handbook on Occupational Diseases, by Ar- lidge, followed by the standard work of reference on Dangerous Trades, prepared under the editorial supervision of Sir Thomas Oliver, who about two years ago published a compact textbook on Diseases of Occupation, which can be consulted to great practical advantage on the group of occupations to which the work is limited. There are a number of German and French textbooks on industrial hygiene which have not their counterpart in English. Foremost among these is the great work prepared under the editorial super- vision of Weyl, including observations on the "General Principles of Industrial Hygiene and Factory Legislation" which have for their specific object improvements in conditions affecting safety and health in industry. An excellent manual in German is a treatise on Indus- trial Hygiene, by Holitscher, and there is a book by the same title published in 1906 by Dr. Bender, a medical factory inspector of large experience. Special reference should be made to two small manuals of advice to German boys and girls about to enter a trade, which have particular regard to the physical requirements and the mental adaptation to particular industrial processes. Manuals of this kind, obtainable at a cost of a few cents, convey the required information in the most effective manner, but the suggestions contained therein are also of practical value to the student of industrial hygiene. Intensive Investigations in Industrial Hygiene 263 Research work on a larger scale is much facihtated by the Index Catalogue of the Army Medical Museum and Library, for some of the most useful and instructive discussions of special phases of industrial hygiene and the medical consequences of industrial acci- dents are the occasional contributions by practicing physicians to the medical periodical press. A thorough study of the available medical literature relating to occupational diseases and occupational neuroses is imperative, for even the most earnest seeker after in- formation may fail of his or her purpose on account of lack of the required preliminary training. As has been previously pointed out, the recent legislation on workmen's compensation and the tendency in the direction of drastic and far-reaching laws make investigations into the field of industrial hygiene and accidents of great practical importance. Those who have had to do with the settlement of Claims Arising from, the Results of Personal Injuries appreciate the value of a work with this title by Magruder, and of the larger treatise on the Causes of Disability, by Harbaugh. A most useful handbook in this connection is Saunders' Medical Hand Atlas of Diseases Caused by Accidents. In brief, the present plea is for scientific methods in intensive investigations in the field of industrial hygiene as a first requirement for the attainment of really useful and conclusive results. Probably no other field of systematic research offers such exceptional oppor- tunities to the earnest seeker after truth, and certainly none is more likely to prove of great benefit to the mass of mankind. In justice to employers, whose every effort to improve conditions inimical to health deserves encouragement, and in equal justice to employees, whose health and well-being are menaced at the present time by conditions more or less unsatisfactory, it is of the utmost importance that so difficult a task should be approached with a due consideration of the seriousness of the problem, the need of a scientific method, and the duty of absolute impartiality. The object of all investiga- tions of this kind is not to prove or sustain any particular conclusion arrived at in advance, but to determine the truth and the facts as they actually exist and as they condition at the present time the health and well-being of the men, women, and young persons em- ployed in productive industries. COMPULSORY REPORTING BY PHYSICIANS Leonard W. Hatch Nczv York State Department of Labor. Compulsory reporting of industrial diseases by physicians consti- tutes the first step in the campaign for prevention, if the latter is to be comprehensive and scientific. It is a case of an extensive evil known to exist in various forms, in divers places, and from a variety of causes, but also known to be in large measure eradicable if only we can discover its various forms, their location, and their causes. If, therefore, preventive efforts are to be directed so that they may be at once comprehensive in scope and intelligently effective in detail, knowledge of the frequency, incidence, and sources of the evil are of prime importance. Furthermore, it is safe to say that the prevention campaign only awaits the necessary knowledge of the evil to be assured of success. The propriety of the exercise of the police power of the govern- ment in the interests of public health, which means the health, not only of all the public, but of any particular portion which may be subject to peculiar health hazards, has long been recognized, and public sentiment was never more quick than now to back laws for such a purpose, while private initiative, stimulated by public senti- ment or moved by humanitarian motives, has never inspired greater activity than now along these lines. If, then, prevention waits only for adequate information, where shall this information be secured ? Obviously for information con- cerning diseases the principal source technically equipped to serve as a reliable informant is the medical profession. Further, it is not essentially a case of calling upon physicians to go out of their particular field of work, because practically all cases of occupa- tional disease, serious enough to be important, come to physicians automatically, so to speak, in the course of their regular professional practise. In this aspect, compulsory reporting of occupational diseases is precisely like compulsory registration of deaths. It is simply the necessary requirement for bringing together by registra- Compulsory Reporting by Physicians 265 tion at one place scattered tlata which come under the eye of dif- ferent physicians in their regular work. That this registration of industrial diseases is usually to be made with a different depart- ment of government than registration of deaths, is due simply to the fact that special government agencies, in the shape of labor departments, have been developed for the safeguarding of the health of workers, just as health boards or departments have been developed for the conservation of the general health of the com- munity. Registration of deaths, being significant for all phases of the public health, goes naturally to the department of government with the broader function. Registration of the diseases of industry goes, likewise naturally, to the department whose special field is health in industry. But more important than analysis of the fundamental reason for laying upon physicians the obligation of registration of industrial diseases, is consideration of just what kind of information should be asked of them in connection with such registration. It almost goes without saying, of course, that the first thing to be required in a registration certificate is the strictly professional matter of the physician's diagnosis of the disease. But if registra- tion is to furnish all that is necessaiy, the physician must be asked to go beyond the narrowly professional function of diagnosis to consideration of antecedent causes of the patient's condition. The importance of the physician's taking this point of view can hardly be overemphasized. It is necessary because, to a large extent, it is the only means by which the physician can discover that diseases are occupational. When we speak of industrial diseases we are not dealing with a class all of which are clearly distinguished from other diseases by peculiarities of their own, so that identification alone affords, or necessarily suggests, their occupational character. On the contrary, we are dealing in large measure — probably when the full truth is known it will be found to be in largest measure — with ordinary diseases found elsewhere but which may be due to occupation and which can be identified as occupational only by inquiry as to the circumstances of the patient's calling. In a word, many occupational diseases are distinguished from others primarily by their causes, so that only by their causes can they be identified. To put this matter in the concrete, there is one industrial disease, compressed-air illness or caisson disease, which is practically always 266 American Labor Legislation Review due to circumstances of occupation. And there are a few poison- ings, the most notable example of which is — or rather we may now say, fortunately, has been — phosphorus necrosis, which are known to be due so frequently to occupation that they have acquired the name of industrial poisonings. There are also one or two infectious diseases^ the leading example of which is anthrax, which likewise are so commonly associated with an occupation that they imme- diately suggest occupational causes. Even in these fairly well- recognized industrial diseases, however, the physician must go back of diagnosis to identify them as occupational in character, as witness instances lately reported in New York State of lead poison- ing in the case of a schoolboy, of phosphorus and mercury poison- ings in cases of children, and of anthrax in the case of a stock broker. A more striking illustration of this point is another New York case in which only the accidental discovery of occupational causes prevented an absolutely incorrect diagnosis of a case of industrial poisoning. In a brewery in the state two men were employed last year in varnishing the inside of closed wooden vats with alcohol and shellac. After a day of such work one of them became violently ill and died during the night without medical attendance. The coroner's physician, on examination, found the cause of death obscure, but, on the strength of what he could discover by inquiry concerning the patient's illness, certified the cause of death as apoplexy. On the day of the funeral the physician heard that the other workman had become blind, and for (he first time learned what kind of work the two men had been doing. Thereupon he procured a sample of the alcohol and shellac, had it analyzed, and found that the alcohol was wood-alcohol, with the result that both the nature of the disease and its occupational cause were revealed, and his certificate as medical examiner was accordingly altered to make the cause of death wood-alcohol poisoning. This is, of course, an extreme case, but experience in connection with the registration of deaths aflfords evidence that such errors are frequent enough to sustain the point here emphasized, namely, that even in the case of the more exclusively occupational diseases the physician must probe for causes back of his diagnosis if registration is to realize what is needed. This extra-professional information which the physician must Compulsory Reporting by Physicians 267 be asked for, in order that the identity of the disease as occupational in character may be evident, at least presumably, comprises two items. First, and rather obviously, but none the less of most im- portance, is a careful statement of the patient's occupation and the industry in which it is pursued. Upon this, of course, all accurate statistical study of the whole subject depends. It is, likewise, the first necessary inquiry of the physician in determining the occupa- tional character of the disease. Had the physician, in the case of wood-alcohol poisoning above referred to, looked at once for this item, which he accidently noticed later, doubtless his first certificate of the cause of death would not have gone so wide of the mark. But, as already noted, comparatively few industrial diseases are caused exclusively by occupation. Many may, or may not, be occupational in character. Furthermore, even in the case of an exclusively occupational disease, other factors may also be present. Hence, in the second place, if we are to read correctly the responsi- bility of circumstances of occupation for disease, the physician must be asked to look for the other possible causes, and to report any factors other than occupation, such as complicating diseases or personal circumstances, which may be contributing or accompanying causes. Now it is precisely in connection with this extra-professional information that the principal difficulties arise with physicians' reports, — that is, of course, after the primary task of bringing and keeping before physicians the necessity of reporting at all is accom- plished. The reasons for this are natural enough, since all the neces- sary information as to occupational or other causes lies beyond the strictly professional interest and point of view of the average physi- cian, and he must secure it by special inquiry outside of his purely technical duties. For example, when the New York law requires that all cases of occupational lead poisoning shall be reported, it means that every physician who may treat a case of the disease, after his professional work of diagnosis and prescription is attended to, must first of all remember that lead poisoning is to be reported, and that then he must make inquiry as to the patient's occupation, must ascertain whether any other factors enter into the case as causes, and must record this information with the necessary details, along with a number of other items as to sex, age, etc., all outside of his natural professional interest except as general obligation toward the public welfare may appeal to him, 268 American Labor Legislation Review To a large extent the difficulties referred to are those long familiar in connection with the registration of deaths by physi- cians, and simply argue that without doubt a long period of educa- tion will be necessary to secure general and accurate observance of a reporting law for industrial diseases. Indeed, so far as the report of diagnosis and the statement of occupation alone are concerned, the problem is precisely the same in both forms of registration. But when we come to that element in the reporting of diseases which virtually requires the physician specially to weigh the causative influence of occupation, as compared with other possible causes, there is a fundamental difference between the two. Regis- tration of deaths requires a statement of occupation only as a simple addendum to diagnosis, and requires no consideration what- ever of occupation as the cause of death. But such consideration is essential, as pointed out above, in the registration of industrial diseases. It is specifically implied, moreover, by the very terms of the New York reporting law which, like all but one of those in other states having such a law, follows the British act, and which requires a report from the physician for each patient "whom he believes to be suffering from (the specified diseases) contracted as the result of the nature of the patient's employment." The most significant aspect of this peculiar source of difficulty connected with the reporting of industrial diseases is that it in- creases in importance as compulsory reporting may be extended from diseases known to be exclusively or mainly occupational to those whose sources may be either in occupation or in other circum- stances, or in both combined. For, as we proceed in this direction, the causes of the disease become more and more uncertain and com- plex, with consequently increased difficulty for the physician who is called upon to determine, or at least to express his belief as to, the influence of occupation. Compare, for example, caisson disease and tuberculosis as to the relative difficulty of determining whether occupation or other factors were responsible for the disease. This aspect of the reporting problem naturally suggests the question of how general the reporting should be made. As a matter of fact, reporting laws enacted in this country so far, here again in accordance with the British act, have limited compulsory reporting to a small number of easily identifiable industrial dis- Compulsory Reporting by Physicians 269 eases, namely, as in the New York law, poisoning by lead, phos- phorus, arsenic or mercury or their compounds, anthrax, and com- pressed-air illness. All of the American laws are of very recent date and the wisdom, at the outset, of such limitation of reporting would seem to be clear from what has here been said. Neverthe- less, if the problem of industrial diseases is to be treated broadly, and if the prevention campaign is to be planned on comprehensive lines, nothing less than an extension of registration to all recogniz- able industrial diseases must be considered as the ultimate goal. This may appear, at first sight, to be only an ideal whose con- sideration may well be postponed for the present. But a rather interesting experience in New York State has brought it forward for immediate consideration. The New York reporting law took effect in September of last year. Prior to that time notices of the law were sent to medical journals, and shortly thereafter a circular notice and sample forms for reports were mailed to each of the 13,700 physicians, hospitals, and dispensaries in the state. The form adopted for reports was patterned after that used in Great Britain, was kept as simple as possible, and was limited to the few items specifically mentioned in the law, without taking advantage of a blanket clause permitting the inclusion of other items of informa- tion. The form was made thus simple with the express idea of encouraging reporting by making it as easy for the physician as possible. (It may be remarked, parenthetically, that the nine months' experience so far makes it very evident that something besides making it easy will be required to make reporting general, even with a very limited list of diseases). But the law had not been in force three months before we were met by the suggestion, from members of the medical profession itself, that we were not calling for enough information in our report form and that reporting ought not to be confined to the diseases mentioned in the act, some of which were not so common or serious as others not included. This was, indeed, far from being a general clamor from the profession as a whole, but it was an earnest expression of opinion from a few prominent members in New York City, who are interested in the subject. The question of the extension of reporting to all industrial diseases thus raised, it must be confessed, in an unexpected quarter, but in the very one to make it the more to be regarded, became then an 270 American Labor Legislation Review immediately practical one in New York. To come at once to the result of the matter, the New York Department of Labor proposes to ask the cooperation of physicians to the extent of reporting all industrial diseases, and is just completing the work of inaugurating such extension. The reporting law has not been amended for this purpose, but it is proposed, for the field outside of that specified in the law, to rely for the present, at least, upon the voluntary cooperation of physicians. While New York, relying upon a cue from members of the medical profession itself, thus proposes to start at once definitely toward the ultimate goal, it will be evident from what has been said in this paper that the difficulties of this larger program cannot be overlooked, and a word or two as to practical means of meeting these difficulties is in order. Government offices to which reports are to be made have two chief means of overcoming the difficulties referred to. The first of these is a carefully prepared form for reports, which shall clearly indicate the information needed. For this there may be commended one worked out by the committee on industrial diseases of the New York Association for Labor Legislation, and recently adopted with some modification by the New York Department of Labor in con- nection with the extension of reporting above alluded to. This form is indorsed by the committee on uniform schedules of the national Association for Labor Legislation, which recommends it as a standard schedule for use in all states. But, as repeatedly suggested in the foregoing analysis of the reporting problem, ulti- mate success must finally rest to a large extent upon the active interest of physicians. A second aid to reporting, therefore, may be found in the circulation among physicians, for their assistance and to stimulate their interest, of information concerning industrial diseases. For an example of this, reference may be made to a book- let recently issued by the New York department, containing brief descriptive matter and a general classification of industrial-disease hazards, with a list of the more important harmful substances and their effect upon workers. Reference to this may be made by the writer with all modesty because, for the material, the department is largely indebted to representatives of the New York Academy of Medicine, especially to Dr. W. Oilman Thompson of the Cornell University Medical College. Compulsory Reporting by Physicians 271 In the foregoing, compulsory reporting of industrial diseases by physicians has been considered only in its general aspects and chiefly from the statistical point of view. From that point of view the problem of accuracy and completeness of reporting are matters of foremost importance. It has been made clear, perhaps, that the solution of these problems will be a matter of considerable time and education, a conclusion which is supported, not only by analysis of the problems, but by consideration of the number and character of the reports produced by nine months' experience in New York. But, lest a wrong impression as to the value of reporting should be given by this technical view of the matter, two practical results, already clear in New York experience, may be mentioned in con- clusion. In the first place may be noted the very active interest among a number of influential members of the medical profession which the reporting law almost immediately aroused, or at least crystallized into activity. This has already been alluded to in connection with the assistance it has lent the department of labor with reference to reporting. The most significant fruit of it, however, has been the formation of a permanent committee on industrial diseases under the auspices of the New York branch of the Association for Labor Legislation, six members of which committee are physicians con- nected with medical colleges and leading hospitals in New York City. The value of such active cooperation of the medical pro- fession in the campaign for industrial hygiene, going far beyond mere reporting of diseases, can hardly, of course, be overestimated. If the reporting laws of the seven other states in which such laws have been enacted, have revealed possibilities of this kind such as have appeared in New York within the first few months under its law, the work of the American Association for Labor Legislation, in securing the enactment of these laws during 191 1 and 1912, must be regarded as marking the beginning of a very important forward movement. In the second place is to be noted the practical value of reports of industrial diseases as indices of points of danger, for the guid- ance of factory or medical inspectors. This is a value which may be realized practically from the very moment that reports begin to come in, without regard to the statistical problems of reporting. Each individual report at once invites attention to an establish- 272 American Labor Legislation Review ment or an industry for investigation with a view to preventive measures, and as reports multiply the field demanding attention becomes more and more clearly indicated for the inspector. To illustrate, the medical inspector of factories in New York State is just beginning a special investigation of lead poisoning. As a result of only six months' returns under the reporting law, the medical inspector may begin his work with definite knowledge at the very outset of fourteen different manufacturing industries and of one or more particular establishments in each of those industries, in which conditions positively known to have caused lead poisoning are offered for immediate application, or study, of preventive measures. Here again, therefore, the enactment of reporting laws in eight states must be regarded as marking a very important step forward in the practical preventive work of the factory and medical inspector, and prevention is, of course, the ultimate goal in the whole matter. MAKING LEAD COLORS Pouring Pigments Into Gmnding Machine and Sprinkling Color Solu- tion With Lead Litharge LEAD CASTING, SHOWING LEAD POT IN A SMELTEK Danger of Poisoning is from Breathing Lead Oxide, Fumes and Dust. The Worker in this Picture Now Loses on an Average One Day a Week on Account of Chronic Lead Poisoning LEAD POISONING IN NEW YORK CITY^ Edward Ewing Pratt Nciv York State Factory Investigating Commission. It has often been said. that, compared with foreign countries, there has been and is very httle lead poisoning in the United States. Recent investigations, however, throw considerable doubt upon these conclusions. The Illinois commission, during the years 1908, 1909, and 1910, found iive hundred and seventy-eight cases of lead poisoning in that state alone. Last fall a hasty study of lead poisoning in New York City revealed three hundred and seventy- six cases which had occurred during the years 1909, 1910, and 191 1. And during the year 191 1 alone there were found one hundred and twenty-one cases. This study was based largely upon hospital records, and therefore includes only the more serious cases ; a vast number of less serious ones must have been treated in dispensaries and by private physicians. These facts are startling when we think that in England during 1910 there were only five hundred and five cases. In a single year New York City had one hundred and twenty-one cases, — all England five hundred and five. These cases of lead poisoning were not confined to any one trade or industry, but were scattered through a considerable number. The industries represented, in which the victims had been employed, were the following; white-lead, lead-acetate, lead-oxid, dry colors, use of lead as a hardening agent, scaling paint on battleships, ship- calking, diamond-polishing, printing, carpentering, plumbing, tin- smithing, and painting. A canvass of the hospitals in New York City was made, and all the cases of lead poisoning or plumbism which they had treated during the last three years were selected. Names and addresses of the per- sons and any other available facts were taken from the hospital rec- ords. These records were lamentably lacking in everything that 'The facts given herewith are taken from a study made last fall and win- ter, by the writer, with the cooperation of a number of his students, and submitted to the N. Y. State Factory Investigating Commission. 274 American Labor Legislation Review would interest anyone who wished to make a study of lead poison- ing and its causes. In only two hospitals in Greater New York were occupations specified more accurately than "laborer", or "painter", and in these two exceptional instances the information was not more detailed than the statement, "lead worker", "molder", "carriage painter", etc. No hospital recorded where the victims had worked, or under what conditions. However, with these names and addres- ses, and a few which were furnished by the New York State Depart- ment of Labor, the labor unions, the board of health, and several employers, the men themselves who had been leaded were visited. It was not always easy to find the people we wanted, for, in addi- tion to the difficulties due to false addresses, which are habitually given at hospitals, we found it difficult to locate Poles, Slavs, Rus- sians, Lithuanians, Italians, and others of our recent immigrants. I remember searching for a man named John Sichosk, whose name had been sent in by the department of labor. At the address given, only the blankest faces answered my inquiry for John Sichosk. In broken English one of the men explained that he knew no one by that name. As a last resort I showed the record card with the typewritten name. The man's face lighted up at once, "Oh ! John Sichosky ! Sure, he live upstairs." He was there all right, and before the afternoon was over John had taken me to five others who had been leaded in the same factory. A careful study was made of each case. The facts, not only about the man's last job, but concerning others as far back as he could remember, were ascertained. As far as possible the maternal history of the wife was obtained, the personal habits of the work- er, and the precautions or lack of precautions in the factory. One hundred and nine cases, in all, were intensively studied in this way. The results are interesting, even if the small number of cases some- what detracts from their value. In general, these results are similar to the results of studies made abroad. Practically all the various forms of lead poisoning were found, ranging from light attacks of colic to death. Among these cases were several of wrist-drop and paralysis. Many of the workers had had recurring attacks and had been disabled for considerable periods, varying from a few days to almost a year. About half of the men were comparatively young; in fact, fifty of the one hun- dred and nine were actually less than thirty-five years of age, and Lead Poisoning in Neiv York City 275 almost one hundred were less than fifty-five years of age when they became leaded. Economists of the old school have always held that men's wages increase with the dangers and risks of their employment. This is certainly not true of lead workers. Over half of the workers studied (fifty-eight) were earning less than $16.00 per week; a quar- ter (twenty -three) were earning less than $12.00; and over a tenth (thirteen) were actually earning less than $10.00. Strangely enough, the most dangerous of all the industries paid the lowest wages. In the white-lead industry not a single man was earning over $14.00 per week, and many of them were earning less than $10.00. At these low rates one would imagine that the total loss of wages due to lead poisoning would be comparatively small. It is not surprising, therefore, that most of the losses were of small amounts, and that fifty-nine of the one hundred and nine men lost less than $150 each. But it is a surprising fact that some of these workers lost larger sums, seven men actually losing over $1,000 each. Some very interesting facts were brought out in the analysis of conditions in the factories and workshops. Sixty-two of the one hundred and nine workers ate in the same room where they worked ; twenty-two never washed before eating and forty-five washed only in cold water ; seventy-three, or almost three-fourths, were never given oral instructions of any kind as to the dangers of their work or as to methods of preventing lead poisoning; seventy-six men never saw any posted instructions where they worked. It is usually admitted that men addicted to alcohol are more liable to contract lead poison- ing, as they are to succumb to most other diseases. Employers delight to say that it is only the "hard drinkers" who are ever troubled by lead. But only six of the one hundred and nine men were found to use alcohol to excess ; sixty-five were moderate drink- ers; and thirty-one were teetotalers. These facts point out and emphasize the importance of the problem, right here and now in this country, and the need of prevention, the first steps in which have evidently not been taken by the majority of employers. Of the one hundred and nine cases studied, seventy-nine persons were married, among them forty men whose wives had been preg- nant while their husbands were employed at lead work. In all there had been one hundred and fifty-seven conceptions among these forty 276 American Labor Legislation RcviezV wives. There were born to the persons one hundred and forty-four children, thirty-nine of whom died in the first year, and two in the second. The cause of death in many cases was malnutrition and convulsions. In addition, there were four still-births and eight miscarriages ; and the latter figures understate the facts, as our in- formation on this point is not full nor very accurate. The effect upon reproduction has long been noted. Some in- teresting cases have come to my attention : 1. A young Hungarian came to this country in 1904. He worked in a wire mill, where the wire is tempered and hardened by being passed through a bath of molten lead. The lead is uncovered, and vapors and oxids fill the air. He married in 1909. In the same year his wife miscarried at the end of seven months. Early in 1910 a second child was born but died of con- vulsions within two weeks. About this time the husband had a severe at- tack of lead poisoning and was given another job. In January of this year the wife gave birth at full term to a normal child. 2. A Barbadoes negro came to the United States in 1908. He was married and had a little daughter, at that time two years of age. He found work in a lead factory handling and packing sugar of lead, or lead acetate. The following year his wife miscarried at the end of seven months. A year later a child was born at full term, but died in convulsions when six months old. The curious part of this case is that the worker himself was unaffected until a few months ago and until after the birth last referred to. 3. James Scott was a printer for over forty years and died of lead poison- ing. He was married in 1868. Of twelve births six children survived, four died from various causes during their first year, there was one still-birth and one miscarriage. 4. Alexander Joronsky, a Pole, came to this country in 1891. After hav- ing various unskilled jobs, he found employment as a stripper in a big white-lead factory. During his period of employment as a stripper his wife gave birth to four children ; one of these was still-born, and the others lived four days, three days, and one day respectively. 5. A Hungarian painter, who came to this country in 1893, presents an interesting case. Five of his ten children died within a year of their birth and his wife has had two miscarriages. The man himself, however, had his first attack very recently. The investigation of hospital cases at once opened up numerous others, and also gave us clues to factories where there were lead processes of which we did not know. The next step in the investi- gation, therefore, was the inspection of factories. One of the first cases which came to our attention was a pathetic case of double wrist-drop. The victim, a man of middle age, had worked in a magneto factory. It was a big place, with many hun- DUST COLLECTORS IN A LEAD PLANT Cloth Bags Permit Air from Exhausts to Pass Through While Retain- ing Lead Dust Which Falls Into Bins and is Saved. In Up-To- Date Plants the Bags Are Shaken by a Mechanical Device Operated from Outside of Dust House EMPTYING RED-LEAD FURNACE When Oxidized in Furnaces the Lead is Raked Out Into Cars. In Spite of Powerful Exhausts and Hoods Some Dust Floats in the Air and is Breathed by the Workers Lead Poisoning in New York City 277 dreds of employees, but the lead process was carried on exclusive- ly in one small room, a sort of lean-to at the rear of the factory and a little below the level of the ground. Here were located five lead pots, the temperature of which varied from 800 to 1500 de- grees. These pots, when inspected, were covered by hoods leading to a chimney, btit were not provided with any blower at- tachment. The roof was raised slightly and a fan at one end gave a fairly good air circulation. In the process preceding the so-called "hardening", bars of steel are bent into the horseshoe shape of a magnet. They are then brought into the hardening room and im- mersed in a bath of molten lead. There they remain for a specified length of time, when they are removed and suddenly immersed in water. After cooling they are stacked up, one above the other, and are rubbed down with sandpaper to remove any particles of lead that remain. This process, at the time when the inspection was made, had been in operation for less than a year and nine men were employed at it. I found seven cases of lead poisoning; one had resulted in death, and one in double wrist-drop; others had necessitated long periods of unemployment. A wire mill carried on a similar process. Here the tempering and hardening is done by passing the wire slowly through a bath of molten lead. The wire is wound on huge spools revolving slowly, and is then wound onto another reel. The room is habitually full of smoke, gas, and fumes, and the men work intolerable hours, — two shifts of twelve hours each, with no time for meals. They have to snatch what they eat, — because the lead positively cannot be cooled off. In both of these processes the danger comes, I believe, not from the fumes of molten lead, but rather from the particles of lead oxid which probably fill the air. In both cases the skimmings from the lead pots are brushed carelessly aside and allowed to fall upon the floor, or to accumulate in piles beside the pots. Some of you will wonder how a girl working in an embroidery factory can be poisoned by lead. You will doubtless scoff at the possibility of a worker on embroidery contracting lead poisoning. But I have found two such cases. The designs to be embroider- ed are stenciled on cloth. This is usually done with a mixture of chalk and talcum powder. One resourceful employer, however, ob- serving the way in which the chalk rubbed off, substituted dry 278 American Labor Legislation Review white lead, which chngs more tenaciously. The girls who used it were ignorant of its poisonous character and handled it as care- lessly as they had handled the chalk. They pounded it into the stencils and the dust rose in their faces and the lead covered their hands. Little wonder they got lead poisoning. The use of lead for this purpose is common. Another case, which is individually the most pathetic I have seen, is that of William O'Connell. O'Connell has now been out of work for about eleven months and is likely to remain so, as he is to- tally incapacitated. The interesting and exasperating thing about it is that he is our employee, — speaking collectively, — because O'Con- nell was in the employ of the United States government, immediate- ly under the Navy Department and a worker in the Brooklyn Navy Yard, where his job was that of "scaling" in the double bottoms. Battleships are provided nowadays with double bottoms, a shell which envelops the entire keel of the ship ; between these bottoms is a space of about two and one-half feet, which is divided into compartments of from four to six feet square. In order to prevent rust these double bottoms are painted with red oxid of lead, sometimes to a thickness of one-fourth of an inch. The pro- cess of scaling consists of scraping ofif the red oxid paint with an automatic compressed-air chisel called a "hammer". When in op- eration this hammer throws a spurt of dust up into the faces of the workmen, who wear goggles but no respirators. Sometimes several men work in one small compartment, and they tell me that it is al- most impossible to see the electric bulbs at their elbows. "And then when the air hose breaks, you ought to see the place !" one of the men remarked. Think of working in such a place for eight hours a day ! It is any wonder that, out of a squad which averaged about fifty men, we found twenty cases of severe lead poisoning, in- cluding two deaths and O'Connell, who is totally incapacitated? And these men have no washing facilities, they wear no respirators, there is no exhaust, there are no accessible eating facilities, there is no medical inspection, and they get no compensation. The government gives no compensation for lead poisoning because, technically, it is not an accident, — which is true, for under the circumstances it is a dead certainty. Yet the surgeon of the post asked me, — a lay- man, — ^"Why! is that work dangerous?" Other industries contributed their quotas of lead poisoning cases. Lead Poisoning in New York City 279 One firm, manufacturing white and red lead, reported through its physicians twenty-four cases from October, 1910, to October, 191 1. We dug around a bit and found a dozen more. About two hundred men were exposed. In another white-lead works, where the factory had been running with about two dozen men, we found eight cases diagnosed by the factory physician. In another white-lead fac- tory the superintendent claimed that no case of lead poisoning had ever occurred during his ten or a dozen years there; for, said he, "We send a man off when he shows the first signs of being leaded." The next Sunday I saw five men who had been leaded in that plant, and who had been out of work for periods varying from a week to almost a year. One poor fellow had had four separate attacks and had gone doggedly back to the same job. Just the week before, when he was sufifering severely from colic, this same superintendent had on two occasions sent a messenger to him asking him to come back to work. Of all the industries which I have studied, painting, especially interior decorating, yields more lead poisoning than any other, not proportionately but in the total number of victims. ]\'Ian after man had the same tale to tell, — a long job, close interior work, sand- papering, stipple, painting, more sandpapering and more painting, a sudden overpowering attack, and a period of sickness and idleness, leaving him just at the end of the busy season when it is impossible to find work. It does not occur to many of us that in New York, at any rate, a building in course of construction is absolutely (with one or two possible exceptions) without the pale of the law. And yet any new building in course of construction in New York City has constantly working in it from two hundred to six hundred, or even more, men. These men are usually working under almost intolerable conditions, with a complete lack of sanitary conveniences, no washing facilities, no provision for eating, and no attention to health or hygiene. Many a painter has related to me how impossible it is for him to wash his hands for lunch, and how he is forced to hold his sand- wich between two pieces of paper in order to keep his lead-covered hands from coming in contact with his food. It is not a difficult matter for a builder to safeguard his painters. He can use zinc white, which is better in some ways than white lead and is but slightly more expensive. In fact, one of the biggest so-called speculative builders in New York City now specifies white zinc and wet sandpapering. 28o American Labor Legislation Review We have now acquired in this country, I beheve, a body of evi- dence whicli demonstrates the prevalence of lead poisoning and other industrial diseases. They may not be as prevalent as abroad, but I doubt it. The industries in which these diseases are found employ unskilled, non-English speaking workers, who pass quickly from one industry to another, and who seldom come under the ob- servation of the authorities. In preventing industrial disease, especially lead poisoning, an ed- ucational campaign is, it seems to me, the thing of prime impor- tance, — education of the worker and education of the employer. The first step in the education of the employee is a knowledge of the rudiments of English, then the simple rules for the care of health and self which are so effective in preventing lead poisoning. The employer, on the other hand, should be told that there is such a thing as lead poisoning, and then how to prevent it and how to treat it. There are many employers who are willing and anxious to safeguard their workers. One white-lead manufacturer is spending $20,000 on prevention. He may not be doing it in the right way, but he has got the right spirit and will doubtless do more, — more in fact than he could be forced to do. Then, let us bring on the legislation and force the recalcitrant employers into line. GENERAL DISCUSSION I. Lead Poisoning Mr. F. V. Ham MAR, President of Hammar Brothers White-Lead Co., East St. Louis, Illinois: I think the pictures shown by Mr. Pratt demonstrate one fact, and that is that all lead poisoning comes from lead dust. Factories can be made sanitary by the elimination of dust. This statement relates, not to industrial poisoning as a whole, but to white lead, and is based on experience in my own fac- tory. We are not appalled by the lead menace. Our record of twelve years is not one death, either in our lead smelter or in our white-lead works, and in the past eleven months we have had but four reportable cases under the Illinois law, and the loss of labor was not to exceed fifteen to twenty days. The experience of those who have been reasonably successful in controlling lead poisoning, with a view to minimizing the laborer's loss of wages and preventing any danger to his future health, should be of interest. No consideration of the sanitation of lead works is valuable until the avenue of entrance of various poisons, dusts, fumes, or gases into the human body is satisfactorily settled. If you do not know how toxins get into the body, you have little hope of knowing how to keep them out. Lead poisoning seems to be particularly pro- ductive of theories as to causes of inoculation. But, as a practical fact, lead is non-poisonous until brought into contact with the fluids of the alimentary tract, chiefly hydrochloric acid in the stomach. Undissolved lead is no menace, and only when dissolved by the or- ganic fluids is it absorbed into the vascular system. Such solvents are lacking in all organs except the alimentary tract. Therefore the skin, abrasions of the skin, the scalp, under the finger nails, and even the lungs, are not avenues of entrance of toxins. If they were, they have little if any power of converting sufficient lead salt into soluble poisons and absorbable solutions to be a serious menace to health. There is no doubt but that mild plumbism may result from lead hair dyes and lead face powders, and that lethal quantities may be forced into the pulmonary organs of a cat, but the menace of 282 American Labor Legislation Rcviezv such special conditions is so rare and so slight that, for general pur- poses of sanitation, we may assume that the only avenues of entrance are the nose and the mouth, and that the only place of conversion into absorbable liquids is the alimentary canal. The cardinal principle of lead-works hygiene, therefore, is to pre- vent the lead salt, in any form, from entering the nose or mouth. The first necessity is to inform all workmen of the danger of lead poison- ing, — that it comes from working in lead dusts ; that the first symp- toms of intoxication are constipation and colic; and, of great im- portance, that as soon as they notice alimentary disturbances, they are to report at once to the foreman and to the factory physician for treatment. That men may work in a minimum of dust, forced drafts, hoods, and artificial ventilation are necessary. It is generally recommended by authorities that floors should be of such material that they may be flushed daily, and this is most desirable. If all lead works could be rebuilt, for this and other economical reasons, they would have concrete floors. But we believe forced drafts are more efficacious than flushed floors because, while it is most desirable that floors should be clean, the first truck or barrel that passes over them drops some lead salts, and the quantity on the previously clean floor ac- cumulates in proportion to the work done during the day. Lead salt is, as a rule, of high specific gravity and only a small proportion of the siftings are carried into the air. As a result, while the floors may not be immaculate, the ventilators soon remove floating parti- cles, and leave the air cleaner and more sanitary than where the floors are flushed daily without the forced draft and ventilation. There is no doubt in our minds that under all circumstances and conditions, no matter how perfect the ventilation and cleanliness, wherever lead dust is in the air the workman must wear a protec- tion over the nose and mouth. We have to some satisfactory extent perfected a "mask" that is inexpensive, afl^ords a maximum area for air filtration, and, once it becomes damp from the laborer's breath, is an excellent protection against dust. The workmen wear these masks without objection, and the results are very encouraging. There are places in all American factories where fans, drafts, or flushed floors are impossible. In these departments the workmen are forced to wear masks, the circulation of air is as free as possible, the hours of labor are reduced to a minimum, and the physician General Discussion 283 gives his especial attention to the men employed. Our records show that, by these means, the menace is reduced to a minimum. We find it essential to separate the dusty departments from those where no dust originates, for the men who handle lead in oil never suffer from plumbism, and in the latter department the liberal use of ordi- nary floor oil is quite satisfactory. It fixes in place such dust as may blow in and assists in sanitation. All of these suggestions are only coordinate with shower-baths, washing facilities, places for eating outside the factory, frequent sweeping, and above all constant vigilance to see that the laborer realizes the danger and uses the precautions furnished. But all these items are precautionary. The active and effective agency in the conservation of our workmen's health is an excellent phy- sician. No system of prevention can be devised that will be so perfect as entirely to prevent plumbism among men of the small intelligence of the average day-laborer. The tendency is always to minimize the danger and to disregard positive orders regard- ing wearing the mask and proper cleanliness in eating. There- fore men do get lead colic, and they often neglect to report it until it becomes severe. In fact, such serious cases as we have had have almost invariably arisen among strong, vigorous young white men who, in the egotistical belief that nothing can hurt them, neg- lect, as far as they dare, our regulations for their protection, espe- cially in emergencies. That we may treat cases in their incipiency, our physician personally sees all the workmen every Friday. The men whom he suspects of intoxication are held for personal exami- nation. His experience enables him to spot a suspect at sight and a few words completes the diagnosis. There is a great advantage in reaching the case in its incipiency, when a spoonful of Epsom Salts will effect a cure. There is no doubt that white lead is a menace. But there is also no doubt that this menace can be controlled. For such control regu- lation and law are necessary. We believe in legislation for danger- ous trades. The necessity for it comes, however, from ignorance rather than from essential danger. We believe that every man working in lead should realize how and why he may become intoxi- cated and, equally important, how he can avoid serious results. Legis- lation is necessary that this information shall be disseminated ; and legislation helps the manufacturer by assisting him to enforce regu- 284 American Labor Legislation Review " ; lations. That plumbism can be controlled to a satisfactory degree I know beyond a question of doubt, and if your Association can suggest any practical methods or regulations that will assist in re- moving the menace to labor, all white-lead makers will give you hearty cooperation. Dr. James P. Waebasse, New York City: I have listened with interest to this apology for the lead industries. But I think there is one point to bring out, that the lead industry is practised for the profit there is in it. There are satisfactory measures for protecting the lead worker, but I do not agree with the previous speaker that adequate means of protection are now used in any factory in the United States. The question of profit is the important side and it behooves us, as students of industrial diseases, to bear this fact in mind. Dr. J. W. Foss, Arizona: The statement has been made that the only way a person can become poisoned from lead is through the intestines, and not through the skin. Only last evening Dr. Ander- son of the Navy told me they had been making investigations of the poisoning of the men who chip off paint scales in the Brooklyn Navy Yard. They made tests and it was thoroughly demonstrated that in seven days you could get poisoning by rubbing lead on the skin. The investigations made by the Navy show that it is a great error to believe that you cannot be poisoned except through the intestinal tract, and that we ought not to allow this idea to go out. Mr. Hammar: The men who work in the Navy wear goggles instead of respirators. I contend, very reasonably, that if they keep the dust out of their mouths they will keep it out of their systems. But I was speaking of white-lead works, and ninety per cent of lead poisoning comes from sandpapering and not from lead works. Dr. C. T. Graham -Rogers, Medical Inspector of Factories, Neu) York: The fact that lead is absorbed through the skin and pro- duces toxic effects is brought out by Rambousek of Austria and Roth of Germany, in works published within a year. The method of poisoning indicated by Mr. Hammar is the more usual, but most of the cases of lead poisoning occur among painters who are work- LEAD USED AS A HARDENING AGENT Steel Magnets Are Dipped Into Molten Lead Until Red Hot^ Then Plunged Into Water, and When Cooled, Polished with Sand Paper. Workers Endangered by Fumes and Dust HEADING UP BARRELS OF DRY RED LEAD Deaths Due to Lead Poisoning from Breathing Dust in this Work. Have Sometimes Been Reported by Physicians with the Occupa- tion Given Merely as "Cooper" A More Specific State- ment OF Occupation is Needed to Reveal True Cause of Death General Discussion 285 ing with lead paints. When they are employed in sandpapering paint and the application of oil is neglected, the poison is absorbed through the skin. Mr. John Vogt, Nezv York Department of Labor: I had the good fortune to accompany Mr. Pratt during his investigation, and from the many tests I made of the various oxids came to the conclusion that, where the dust was eliminated as much as practicable, the num- ber of cases of lead poisoning was reduced. Professor C.-E. A. Winslovv, A^civ York City: The great pos- sibility of lead poisoning is getting lead into the mouth. It is an ordinary problem of sanitation. Dr. Harold K. Gibson, Illinois Factory Inspection Department: Mr. Hammar's remarks are interesting. I believe he is, like others, making an effort to eliminate lead poisoning from his plant. It can be eliminated, but all the dust collectors and improved methods of sanitation and exhaust devices and washing facilities will not do it by themselves. After all, I think the decisive factors are strict personal supervision by foremen and the education of the men in personal hygiene. We have what we call two classes of manu- facturers, those who comply with the letter of the law and those who comply with the letter and with the spirit. Mr. Hammar I know to be one of the latter class. All these measures, including sanitation, will not avail unless the manufacturer complies with the spirit of the law. Dr. John B. Andrews, Secretary, American Association for Labor Legislation, New York City: A year and a half ago Mr. Hammar treated this subject at our annual meeting in St. Louis. I have often cited his work as an illustration of what can be done. There is need of labor legislation to bring other manufacturers up to his standard. Mr. Hammar is also correct in his contention that the amount of industrial lead poisoning due to absorption through the skm is comparatively insignificant. Practically all industrial lead poison- ing, leading authorities agree, is caused by the inhalation or the swallowing of lead vapor or dust. 286 American Labor Legislation Review Mrs. Florence Kelley, National Consumers' League, New York City: What is the use of teaching a man to shovel lead and then telling him it is harmful, yet paying him to keep it up. Is there any apparatus on the market to prevent that phase of the business? Mr. Thompson, Chemist, National Lead Company, New York: I came here on account of our interest in this work. I want to say a word or two in supplement to what Mr. Hammar has said about dust. In our experience the dust is the dangerous element. In re- gard to mechanical handling, not much has been done on that ques- tion, but we are making progress. There is a phase in the manu- facture of white lead not yet touched on, however, which illustrates one direction in which a saving of dust can be accomplished. From the time when you put the white lead in the factory, it may be handled in enclosed machinery and no dry lead dust produced until it is put in pans ; and even that can be avoided by mixing it with oil. However, the trade requirements are such that this cannot always be done. Some painters will not accept such paint. We need an educational movement, to be followed by such legis- lation as is necessary, and I am almost inclined to think, by the time the legislation is accomplished, the manufacturers will have done everything that will be required of them. We sympathize heartily with this work and want to help it along in every way possible. We are spending a great deal of money, from an economic standpoint, in washrooms and in new machinery. The policy of our company, and I speak authoritatively, is not to hold back the expenditure of money in any way which will assist in the prevention of lead poisoning. II. Investigation and Reporting of Industrial Diseases Dr. George M. Kober, Georgetoivn University, Washington, D. C: The papers presented this morning are particularly valuable. Very naturally we inquire why there is such a paucity in American literature upon this subject. The reason we have so little litera- ture is that we have had few original investigations, and I think it is exceedingly encouraging that the United States Labor Bureau is recently paying more attention to the question of industrial dis- eases. I consider that one of the most important duties the bureau can perform is to have expert investigations made into the conditions General Discussion 287 affecting the workers' health. This example should be followed by our states. More money should be spent on original investigation, so that we may come into possession of facts to form a literature on the subject. Then we need the training of men and women to this work. I believe the reason the Germans lead in literature of that kind is that they have a large number of medical olTicers connected with in- dustrial insurance companies, whose business it is to prevent dis- ease and who naturally give special attention to the investigation of factors which affect the welfare of workers. We may benefit the American laborer to a great extent by encouraging the employment of men whose business it is to give their entire attention to the health of the laborer. The ordinary workman often hesitates until he is really compelled to give up work before asking for medical advice. If he were in the hands of a physician whose duty it was to give attention at any hour of the day, he would ask advice at the earliest possible and most opportune moment. I wish to make a strong plea for the reporting of all industrial diseases in every state in the union. Until we do this many dis- eases may be due to industrial causes but not be recognized as such. We should also train up medical men to be perfectly conversant with what constitutes industrial disease. Dr. J. W. Foss, Ari::ona: I have had some experience in the re- porting of diseases, and the question of what should be reported and what compensation should be paid. It would seem right to ask the labor organizations to cooperate, as they have recently done ni Arizona in regard to the union label. They sent out letters to all the people who use printed matter asking them to use that label. If the physician is receiving his living from these people he will pay attention to their request. Dr. William F. Snow, Calif ornia State Board of Health: The California legislature of 191 1 passed a law, recommended by this Association, requiring the reporting of six occupational diseases. The bill was essentially that formulated by this Association but with one minor change, that reports should be made to the state board of health instead of to the bureau of labor statistics. The state board of health then makes a transcript of the report and immediately forwards it to the bureau of labor statistics. 288 American Labor Legislation Rcviezv I think it possible that, when a careful survey has been made, we shall find that California does not have, under present industrial and limited manufacturing conditions, a large problem of industrial disease. We are doing some things, however, which may interest you. The labor bureau is in touch with the labor associations of the state and I have given them a list of all the occupations which we thought might be productive of industrial diseases. We have tried to get the names of the secretaries of all the painters' unions and of all the printers' unions. We are also trying, in the principal cities, to obtain information in regard to diseases which are not reported. That is joint work of the health and statistical boards. The physicians are the biggest factor in reporting. If we could get all the physicians to be active and interested and to study the problem and see the importance of reporting, it would be a great assistance. Professor Henry R. Seager, Chairman: I am sure we have all listened with the greatest interest to Mr. Hoffman's stimulating and salutary paper. It is just the sort of doctrine we need as social workers to keep us alive and aware of our weakness. But I think most of us would wish to put in a caveat against his description of the manufacturer. He has had in mind the large-scale, high-minded, far-seeing employer. There are many of that type, but I think we must not forget that there are manufacturers of the other type and that the presence of such manufacturers in the community is the justification for public interference, by legislation or otherwise, to remind them that, while tariff protection is to them the all-important thing, to the community at large protection of the lives and health of their employees is even more important. Mr. Hoffman has called attention to the paucity of literature on the subject of industrial hygiene and the difficulty of obtaining readily the literature that is available. We hope our bibliography of industrial hygiene will serve a useful purpose by giving access to this literature. One of the achievements of this Association has been the enact- ment by some eight states of a law requiring the reporting of certain industrial diseases. Dr. Hatch's paper brings out very clearly the fact that in this work we have passed the stage of talking about what we ought to do and are really beginning to do things of value. I wish •■CHASER ROOM" IN WHITE-LEAD FACTORY MECHANICAL MIXING OF DRY LEAD AND OIL Dry White Lead Is Shovelled From the Trucks Into the Openings Under THE Exhaust Pipes Which Carry Away Much of the Dangerous Dust In One Modern Factory the Chasers Are Entirely Enclosed, Filled by Machinery Lighted by Electricity, and Inspected Through Glass ^^■INDO\vs Genera! Discussion 289 to reenforce what he has said in regard to the cordial cooperation that this Association has had, in connection with its efiforts to make the reporting law a success, from leading physicians in New York City. It must be admitted that, at the outset, most of the physicians we communicated with were not enthusiastic about this additional burden. But as soon as it was explained to them, their attitude changed and we have had their cordial cooperation. I hope that the plan worked out in New York State may serve as a model for the other seven states which have laws requiring the reporting of industrial diseases. Ill HEALTH PROBLEMS IN MODERN INDUSTRY Presiding Officer: Warren Coleman Bellcvue and Allied Hospitals New York City THE FUNCTION OF HOSPITALS AND CLINICS IN THE PREVENTION OF INDUSTRIAL DISEASE Richard C. Cabot Massachusetts General Hospital, Boston. What are the hospitals doing to prevent industrial disease ? Little or nothing. What ought they to be doing? Much. Why? Were hospitals organized to do preventive work and to follow back into the community all the medical problems that the community shoots into the clinics? No; the charters and constitutions of hospitals contain no distinct evidence of any such provision. But public sentiment is beginning to demand that the hospital shall advance, as the country has advanced, beyond the thought of its founders. Public opinion is beginning to demand that hospitals and doctors alike shall do something to abolish the need of their own existence — shall make, at any rate, a sincere and strenuous effort in that direc- tion. There are those of us who doubt the success of that effort and are inclined to believe that the prevention of industrial disease is largely a moral problem with which the hospital is not organized or temperamentally fitted to deal. But there can be no doubt that the public is putting it up to the hospitals to deal in some way with the many-spreading branches and with the single deep root of industrial disease. Industrial diseases, such as lead poisoning and "heat cramps", pass through the hospital and out again Like threads in a loom. They represent but one of many such threads of human sutTering which, from the hospital point of view, suddenly appear out of the wild jungle of the modern industrial world, are visible for a moment in the cleared and lighted space which science has established in the clinic, and disappear again into the tangled outside world. It is precisely because there are so many such threads, besides that leading to industry, that no one notices or follows up any one of them. The doctor's mind is distraught with a dim awareness, "out of the corner of his mind's eye", of this mesh of threads. He sees not only occupational diseases but recreational diseases (poi- 294 American Labor Legislation Review soned recreations) and educational maladies due, like caisson disease, to the crushing pressure of many atmospheres on sensitive minds, or to rarefication of the educational atmosphere, or to poi- sonous elements introduced in education. He cannot be altogether oblivious of the strands which bad housing, bad cooking, alcohol, morphine, racial misadaptation, and disillusionment weave into the many-colored fabric of misery as it passes through his clinic. If he had been challenged only by the disgrace of industrial disease, he might have long since picked up the gauntlet and gone into the fight. But he is dimly aware that industrial disease is now in the limelight chiefly because Mr. John B. Andrews and a few other intelligent people have recognized the horror and shame that it is and are focusing public opinion upon it. He knows that poi- soned recreation and poisoned education are disease-breeding factors as serious as poisoned air, and that the housing problem, the immigration problem, and the drink problem do as much as industrial risks to keep the public sick and the hospitals busy. But he also knows that he cannot fight all of the giants at once and unaided, and that to recognize them clearly and do nothing about them would render his medical right arm powerless. Hence, with a judicious instinct of self-protective adaptation, he turns his attention elsewhere. This explains why our hospitals, though called upon to do so much, are actually doing so little to prevent industrial disease. Hospital doctors see no advantage and no heroism in biting off more than they can chew. But the reorganization of the hospital has begun. Its forces will soon be arranged so that the doctor can call for the help he needs with some confidence that an answer will come. As soon as doctors realize this, they will begin calling for the following: I. Trained investigators. — The human results of industrial disease should be followed up to their source. Was it the patient's ignorance, the employer's negligence, the law's delay, or the predis- posing influence of heredity and other conditions outside the field of industry? Whenever one case of industrial disease appears at a hospital there must be many more that didn't. These others must be found. The investigator should represent the hospital and not an outside agency, because the hospital occupies a position of judicial fairness Hospitals and Clinics in Industrial Disease 295 and impartiality. It is quite unconcerned with the special viewpoint or class consciousness of the employer or of the employed. It cannot justly incur the suspicion of either, for the hospital doesn't care a button whose fault is represented in industrial sickness. 2. Educational zveapons. — As a result of the efforts of these investigators, excellent illustrative material will be amassed for the prosecution of campaigns of education among employers, employed, menders of legislative bodies, and the general public. The recent success of the campaign against phosphorus in industry would have been impossible if the agitation had not had some excel- lent pictures of the effects of phosphorus necrosis on the jaw. The hospitals are very promising fields in which to search for awful examples of this kind, and the examples will be all the more telling and persuasive if they are found by the hospitals' own agents and not by outside agencies exposed to suspicion of prejudice. Pictures illustrating the effects of diseases and the devices for preventing them should be on the walls and screens of every clinic. They accomplish little by themselves, but if you lead a patient up to one of them and explain the picture and your advice, each by means of the other, you produce a far deeper effect on the patient's mind than you can by talk alone. A clinic thus furnished is a permanent exhibit of industrial hygiene and one likely to produce all the more effect because of its connection with the hospital. Hospitals will probably be slow to set up such exhibits by them- selves, but they might be given sets of pictures on trial by an organization interested in industrial hygiene. 3. Research in industrial hygiene. — Such research will naturally become a part of any hospital associated with a medical school which maintains an active department of preventive medicine. It wdl concern the modes by which industrial disease is produced and those by which it may be prevented. At the beginning of this article I indicated my conviction that it is the hospital's business to look into education, recreation, housing, and alcoholism as causes of disease for the same reason that it is its business to look into industry. Each of the factors just mentioned is as important as industry in causing illness and disability. In closing I wish to say that just because the hospital physician sees the interweaving and interlocking of all these factors as no one else 296 American Labor Legislation Review does, he is pointed out by the finger of common sense as the man most responsible for the difficult task of disentangling them and de- ciding which is dominant and most deserving of remedial effort. Tu- berculosis, for example, is sometimes referred to as an industrial disease and doubtless in occasional cases it is so, but in the vast majority of cases the influence of other factors, such as nutrition, contagion, and housing, is, I believe, more important. The hospital physician, with his eye on all these factors, can take a more impar- tial and discriminating view of the tangled problem than anyone else. He is therefore the king-pin in the whole situation. Let us try to make him realize the honor and responsibility thus thrust upon him! TEMPERATURE AND HUMIDITY IN FACTORIES C.-E. A. WiNSLOw College of the City of New York. Discussion of certain moot points in the theory and practice of ven- tilation has become so general and sometimes so disputatious that we are in danger of losing sight of the underlying facts upon which experts are in substantial agreement. Yet there is a solid basis of accepted principles and efficient methods ; and this basis is amply sufficient for practical application on the part of individual factory owners, even if it is not yet so concretely defined as to be easily em- bodied in the form of legislative enactments. In the first place, it is quite clear that the principal thing which makes the air of confined spaces harmful, aside from the special problems presented by dust and fumes, is overheating, especially when combined with excessive moisture. Any temperature over 70° F. puts a strain upon the heat-regulating mechanism of the body, keeps the blood in the skin away from the vital organs, and produces far-reaching impairments of the efficiency of the nervous system, the digestive system, and the body as a whole. Changes in metabolism and blood pressure, to which attention has recently been called by Dr. Oilman Thompson, are similar well-known physiological reac- tions to temperature change. This general effect of heat and humidity is familiar to everyone who contrasts his own ability to do either brain work or muscular work in the dog-days and in brisk autumn weather. It is established by the exhaustive studies of physiologists in Germany, in England, and in the United States; while the same studies have as yet failed to reveal any definite bad effects due to the chemical constituents of the air. Other atmos- pheric conditions are still in doubt. The best lower Hmit of tem- perature is uncertain. The action of hot, dry air is debatable. The physiological eflfect of odors in air has not been demonstrated. It is beyond question, however, that the workers in a factory where the temperature is over 70° are injured by a lowering of their vitality that may lead to tuberculosis and other serious diseases ; and 2g8 American Labor Legislation Review that they are working below their normal standard of efficiency, so that both they and their employer are the losers. The New York State Department of Labor is the only official body in this country, so far as I am aware, which regularly carries out examinations of factory air and publishes the results. From the reports of this department for 1908, 1909, and 1910, it ap- pears that two hundred and fifteen workrooms were examined at seasons when the outdoor temperature was 70° or less. Of these workrooms one hundred and fifty-six, or 73 per cent, had tem- peratures of 73° or over and sixty-three, or 29 per cent, had temper- atures of 80° or more. In a recent study of a mill village carried out by the Rhode Island Anti-Tuberculosis Society, temperature and hu- midity readings were taken three times a day inside and outside of a weaving room. The outdoor temperature for the month (Septem- ber) averaged 65.5°. The temperature in the weaving room aver- aged 75.8°, 10° higher. Is it not clear that, aside from all debatable questions, there is a simple and obvious condition here which di- rectly menaces the health of the workers and impairs the efficiency of industry? The first clear problem of air conditioning in the factory is the prevention of overheating. The practical method of attaining this end is air change or ventilation. With only a few people in a room, heat may be transferred through cracks and through the substance of walls and ceiling with sufficient rapidity, without any special provision for the purpose. Where many workers are crowded together, however, this is impossible. The average human being at work produces about two hundred and fifty calories of heat per hour, equivalent to the heat liberated by the burn- ing of two candles. In many factories this heating effect is sup- plemented by the friction of machinery and the combustion of illuminants, and often by furnaces, mangles, steam jackets, press- ing irons, solder pots, and other direct sources of heat. The most convenient method of removing this excess heat is by air change; and the primary need in factory ventilation is to provide for the removal of the heated air and its replacement by cooler air from without. The latter must usually be first tempered by raising it to a point a little below that which is normally felt to be com- fortable. Whatever may be the case in hospitals and schools, it 13 fairly certain that incoming air much below 60° would not be Temperature and Humidity in Factories 299 endured by factory operatives; and it would certainly not be compatible with efficiency in the majority of trades which call for manual dexterity. I am speaking in this connection of the maintenance of ordinary normal atmospheric conditions in the factory. The possibility of occasional variations from this normal is a separate question. It is maintained by many sanitarians that changes in temperature are stimulating and beneficial. There is little exact evidence for this view, but it is in harmony with general experience and is probably correct. In many schools it is the practice to open windows and flush out the room with cold air every two hours or so, and the effect upon the spirit and efficiency of the pupils is said to be excellent. Such a procedure might be well worth the temporai-y interruption of work in many industrial processes. It is merelj^ a modification of a general system of air conditioning, however, not a separate system by itself. The fundamental problem is the exhaustion of the hot air of the workroom and the supply of cool but tempered air to take its place. I shall not dwell upon the methods by whidi this end can be attained, since they differ in each individual case. In general, I believe the hot air should be taken out near the top of the room and the cool air admitted near the bottom. The hot air may escape by its own tendency to rise or may be sucked out by fans. The cool air may be ad- mitted at window openings in the room, equipped with tempering coils ; or it may be forced from a central point through special ducts. The system of ventilation may or may not be supplemented by a direct system of heating. The essential principle remains unchanged. When we pass, however, to the question of embodying desirable conditions in statutory form, which is the primary object of your Association, the matter is not so simple. At present there are only two types of laws on the statute books of American states, with the exception of the 1909 law of Illinois. Eight or ten states provide for a minimum cubic space per occupant, usually two hundred and fifty or four hundred cubic feet. Some twenty states require that factories shall be "ventilated" or "well venti- lated" or "sufficiently ventilated". The cubic space requirement by no means insures good air conditions. It merely prohibits such a state of overcrowding that proper air conditions are im- 300 American Labor Legislation Review possible. Whether a factory with ample air space is comfortable or not depends on the further provision for air change. In the studies made by the English departmental committees it was found that the air was no better on the average in factories with over five thousand cubic feet of air space per occupant than in those with an air space under three hundred cubic feet. As to the provisions that factories must be "ventilated" or "well ventilated", they are unenforceable and meaningless in the hands of the present de- partments charged with factory inspection in this country. The Illinois law is the only real ventilation law in the United States. It provides that a definite amount of air, 1500 to 1800 cubic feet per occupant, according to specified conditions, shall be supplied, unless the cubic space in the workroom be over 2000 cubic feet per occupant and the outside window and door space be equal to one-eighth of the floor space. In formulating a standard for factory ventilation one is met at the outset by the question whether the standard should be a mechanical or an analytical one. Ventilating engineers prefer to have the amount of air supply fixed as in the Illinois law. Sani- tarians argue that the proper standard is the actual condition maintained in the workroom, however it may be reached. In a proposed law drafted in conference with members of this Asso- ciation in New York a year ago and introduced in the state leg- islature as Senate Bill No. 1019, on March 31, 191 1, an attempt was made to combine these two viewpoints on an alternative basis. This bill provided that "a workroom shall be deemed to be prop- erly and sufficiently ventilated if the air in the working parts thereof does not contain more than nine parts of carbon dioxid in 10,000 volumes of air in excess of the number of parts of car- bon dioxid in 10,000 volumes of the exterior air, or if there is constantly supplied throughout the interior of the room at least 1200 cubic feet of air per hour for each person therein present and employed and in addition thereto at least 1000 cubic feet of air per hour for each cubic foot of gas burned per hour". Such a law, which demands a reasonable rate of air change, to be demon- strated either by analysis or on a mechanical basis, seems eminently fair to the manufacturer and probably safeguards sufficiently the health of the worker so far as the extent of air change is concerned. Any ventilation standard must, however, deal with the quality as Temperature and Humidity in Factories 301 well as with the quantity of the air. The most important things are the temperature and humidity of the air. These qualities are measured very simply by the use of an instrument known as the sling-psychrometer, which consists of a pair of thermometers, one of the ordinary type and the other having its bulb covered by a wet cloth. Moisture evaporates from the wet cloth at a rate determined by the amount of moisture in the air and this evaporation cools the wet-bulb thermometer and lowers the temperature recorded. From the temperature of the dry-bulb thermometer and the difference between the dry and wet bulb, the moisture in the air may be readily calculated. A high wet-bulb reading means a combination of tem- perature and humidity, precisely the condition most harmful to the human organism, and Haldane has shown that in general a given wet-bulb reading has about the same physiological effect, whether it be the result of a very high temperature with low humidity or of a moderately high temperature combined with high humidity. The proposed New York law, to which reference has been made, pro- vided that "the temperature in any factory workroom except a boiler room, shall not exceed 72° F. as determined by the wet-bulb thermometer, unless the temperature of the exterior air exceeds 70° F. as determined by the same process, in which case the wet-bulb temperature shall not exceed that of the exterior air by more than 5°." A wet-bulb temperature of 72° would correspond to a dry- bulb temperature ranging from 72° with completely saturated air to 93° with air containing only 30 per cent relative humidity. It is just here that the difficulty comes in formulating a standard for factory ventilation. Either the Illinois law or the proposed New York law would serve pretty well to regulate the amount of air to be supplied. I do not believe, however, that we have ade- quate data for fixing a maximum figure for temperature and hu- midity. The limit of 72° wet bulb written into the proposed New York law was taken as a maximum which would probably not be onerous to the manufacturer, but it is possible that even this limit might be difficult of attainment in certain industries, while in most factories it is probable that a much more stringent regulation could well be adopted. Industrial processes are very diverse and any rigid statutory standard is likely to work hardship on the one hand and to give inadequate protection to the worker on the other. As Socrates long ago taught his ardent pupil Glauco in the Mem- 302 American Labor Legislation Review crabilia, it is no light matter to make laws governing industrial conditions. Standards for factories can only be wisely formulated after a careful study of existing conditions in the light of physio- logical ideals and by striking a fair balance between what we should like and what the factory owner can reasonably provide. In our own homes we maintain, not a wet-bulb maximum of 72°, but a dry-bulb maximum of 70°, a very different thing. How near this desirable ideal the legal limit should be placed can only be de- termined by a careful study of present conditions and practical possibilities in specific trades. The old English law governing conditions in cotton-weaving sheds provided that in sheds in which there was artificial humidi- fication the limit for carbon dioxid should be nine parts per 10,- 000, and fixed a definite relation between wet and dry-bulb tem- peratures for each dry-bulb temperature over a wide range, but set practically no upper limit for either. With the advance of modern ideas as to the supreme importance of temperature in air conditioning the whole question was reopened by the creation of a departmental committee which heard ninety-six witnesses, including physiologists, factory inspectors, mill owners and operatives, made seventy-six inspections and numerous air examinations, published the results in two hundred and fifty closely printed pages and formulated a new standard raising the carbon dioxid limit to eight parts in excess of that in the outside air and adding a temperature limit of 75° wet bulb. All this was done for one branch of one industry ; precisely this sort of investigation is urgently needed in the United States. In view of the difficulty of formulating legal standards, Wis- consin has adopted an entirely different plan, abandoning entirely the attempt to fix the details of factory regulation in the form of law and creating instead an industrial commission with power to fix specific standards whose reasonableness can be reviewed only by the supreme court of the state. The regulations of such a com- mission could be made far more responsive to the varied and chang- ing conditions of science and industry, and would offer the most promising method of securing a maximum of protection for the worker with a minimum burden on the business itself. It is quite as essential, however, for the work of such a commis- sion as for the formulation of specific laws, if that method of pro- Temperature and Humidity in factories 303 cedure be preferred, that a thorough study of existing factory con- ditions by properly quahfied experts should be made. There have recently been valuable studies of certain industrial poisonings in this country, notably by the Illinois Commission on Occupational Diseases and by Dr. Andrews, the secretary of this Association. General sanitary conditions, and particularly air conditioning, are far more important in the aggregate than these specific poisonings. The latter are obvious and spectacular, but they only affect a com- paratively small fraction of the working class. Even in the pottery industry, one of the trades most subject to lead poisoning, it was shown in England by the departmental committee on this industry that the excess death rate due to plumbism was only .8 per 1000 while the excess death rate due to tuberculosis was 7.0. Industrial tuberculosis pervades not only the dusty trades, but in less degree every industry from the largest to the smallest. Yet as to air con- ditioning in our factories we know pitiably nothing and we have no machinery for finding out anything. New York has a good medical and laboratory expert in Dr. Graham-Rogers. Illinois has recently appointed a medical expert from whom we are to hear to-morrow. Massachusetts has a force of fifteen medical inspectors devoting some or all of their time to the work. This is all that we have in the way of scientific factory inspection in the whole United States. For progress in air conditioning it is essential to have air exami- nations and intelligent inspection of ventilating appliances in fac- tories of various types. Only on the basis of such studies can legal standards be enacted or specific rules laid down by a factory com- mission. Yet we have in the whole United States, except for Dr. Graham-Rogers in New York, not one single chemist or engineer regularly employed by any state to study factory air conditioning. Would it not be well for this Association to take up seriously at this time the problem of expert organization of the state bureaus which are supposed to deal with industrial hygiene and sanitation? It is less standards that we need than experts to formulate new standards and enforce the old ones. There should be medical experts and chemical experts and engineering experts,— not just doctors and engineers, but doctors and engineers who have spe- cialized in public health,— on the staff of the body which enforces heahh laws in factories in every large industrial state; and we shall not get much farther with the problems on hand until this comes to pass. 304 American Labor Legislation Review Meanwhile, however, there is an excellent opportunity for the individual factory owner to benefit his employees and increase their output by attention to the problem of air conditioning as regards temperature and humidity. There should be a thermometer in every workroom and the foreman should be made to understand that every time the temperature passes 70° he is failing to secure the best work from his hands. In any large factory, observations of ordinary temperatures should be supplemented by the use of the sling-psychrometer. Only by such observations can window venti- lation in small shops and ventilation systems in large factories be intelligently controlled. Direct practical results in diminishing ab- sences and decreasing damaged and imperfect work have been obtained in many a factory by improved air conditioning. Efficien- cy methods have been applied to a hundred mechanical details of shop administration. That delicate mechanism the human body is, however, the underlying factor which is after all of most impor- tance. Yet in many a workshop, perhaps in most workshops, the human body is being operated under conditions which preclude its maximum effectiveness, and the work suffers while the sanitariums fill up with cases of industrial tuberculosis. AIR IMPURITIES— DUSTS, FUMES, AND GASES Charles Baskerville College of the City of New York. The nature and extent of air impurities discussed in this paper are dependent upon local conditions. For our purposes these air im- purities may be classitied under three heads: namely, (i) dusts, (2) fumes, and (3) gases. These divisions are not exclusive, as fumes in abundance may become dusts ; for example, a sudden escape of white arsenic fumes results in a cloud of dust. Again, smelter fumes (mainly sulfur dioxid), much diluted, may be classed as gaseous. The classification, therefore, is neither specific nor de- pendent upon inherent properties of the materials. It is merely a convenience and must admit of a broad and liberal interpretation. A technical discussion as to proper lines of differentiation would be of little profit and less interest. Industrial Dusts It is well known that various industrial dusts cause irritation of the respiratory passages and of the eyes and skin of workmen. Such dusts may be considered in three classes : namely, — I. Insoluble inorganic dusts. — This class includes metals (anti- mony, arsenic, type-metal, brass, bronze, copper, aluminum, iron, steel, lead, mangapese, vanadium and ferro-vanadium, silver, tin, zinc, and solder) in a state of fine division (dusts, atomized metals, metallic powders); flue dusts; various ore dusts (iron ore, etc.); silica, sand, emery, flint, glass powder; carbon, graphite, diamond, coal, soot; brick dust, marble, granite, cement, terra-cotta; lime, gypsum, plaster, meerschaum; phosphates, guano, etc. Fibrosis of the lungs may result from the inhalation of silicious or metallic particles ; for example, we have "potter's asthma" and "grincJer's phthisis" (chronic catarrhal bronchitis among knife- grinders). Pneumonia has been reported as frequent among work- men in blast-furnaces, in part owing, directly or indirectly, to the 3o6 American Labor Legislation Rcviciv inhalation of slag dust; cardiac dilation is said to occur among work- men in slate quarries ; ankylostomiasis among brickmakers, miners, etc. ; and recurrent inflammation of bone with hypertrophy among pearl-dust workers. Hellthaler^ has shown the high rate of death among various classes of metal workers in America who are apparently in ignorance of the peculiar dangers of their occupations ; and Prinzing^ has demon- strated the high death rate from phthisis among steel grinders and other workmen at Solingen, Germany, for the years 1885 to 1895. It is certain that the inhalation of iron dust may diminish in time the respiratory efficiency of the lungs through a loss in their elastic property ; or may reduce the resistance of the organs to invasion by harmful bacteria ; or may infect the lungs through a transportation of disease germs to places favorable for their inoculation. The disease known as siderosis exists commonly among metal polishers, knife-grinders, and others engaged in metal working. The earliest symptoms of this disease are, according to Soper,-'' catarrh and bron- chitis, but shortness of breath is pronounced by all authorities to be the most characteristic symptom. Eventually there follows what appears to be phthisis without the presence of tubercle bacilli, yet genuine infective phthisis is the most common cause of death. The effects may be delayed for years, but metal working is indeed a dan- gerous occupation ; undoubtedly many die from infectious pulmo- nary diseases who do not know that the breathing of dusty air has led to their infection. With the development of rapid transit systems in modern cities, it may be well to direct attention to a new and specific form of city dust investigated by Dr. Soper,* who found that the average weight of dust in subway air was 61.6 mg. per 1,000 cubic feet of air, or 2.25 mg. per cubic meter. The figures for the streets were 1.83 mg. per cubic meter. The subway dust was found to consist chiefly of angular particles of iron, but no case of siderosis seemed to have been reported. 2. Soluble inorganic dusts. — This class comprises such substances ' Hellthaler, "The Death Claims." Tlie Independent, December 27, 1906, v. 61 :i56o. ' Prinzing, Handbuch der Medizimschen Statistil!. 1906, p. 489. 'Soper, The Air and P^entilation of Sutrways, 1908, p. 205. ' Ibid., p. 200. Air Impurities — Dusts, Fumes, and Gases 307 as are likely to be swallowed and absorbed, and includes : metal particles (lead, brass, copper, zinc, arsenic, mercury, and silver) and soluble inorganic salts. Many dusts of this class are dangerous, not only because of their irritating or poisonous properties, but also because of their inflammability, — e. g., potassium chlorate. 3. Organic dusts. — This class comprises sawdust, fur, skins, feathers, broom and straw, grain and flour, jute, flax, hemp, cotton, wool, carpet dust, street sweepings, tobacco and tobacco-box dust, hides and leather, felts, rags, paper, horsehair, etc. As representative diseases caused by organic dusts we have : "flax- dresser's disease", a kind of pneumonia due to the inhalation of par- ticles of flax ; pneumokoniosis due to the inhalation of dust by gannis- ter workers ; alkaloidal poisoning from African boxwood by workmen engaged in shuttle making ; and malignant pustule and a febrile disease among rag-sorters. As in the other classes, the components of this class of dusts are all irritating to the respiratory tract and to the eyes, and especially are they capable of forming inflammable, and even explosive mixtures with air. In addition, there are various trade eczemas, and anthrax has been frequently reported among wool-sorters. The solution of the industrial dust problem presents many diffi- culties. Undoubtedly, however, disease from dust may be much re- duced by the following procedures : (a) Those engaged in the following occupations should wear "workmen-respirators" : sorting rags in paper factories ; workmen on threshing machines ; millers ; batch-mixers in glass factories ; stone- cutters and sculptors ; and all those working in factories where the air is contaminated with irritating or poisonous dust. (b) Those employed in the manufacture of oxidizing agents and lead workers should be compelled to change their clothes before leaving the factory. This is done now in some works in this country. (c) Glasses for the protection of the eyes of workmen should be looked upon as necessary in plants where irritating dusts are unavoidable. (d) The dust on the floors of printing, type-castmg, metal- working, and other establishments may be laid by means of certain useful preparations. Heise' considers those consisting entirely of non-drying (mineral) oils to be the best for the purpose. "Heise, Arb. Kais. Gesundh.—Amt, 1909, v. 30; 93- 3o8 American Labor Legislation Review Where vapors are likely to occasion industrial poisoning, ventila- tion will serve to prevent their accumulation ; but in the case of dusts, economic considerations often render such a procedure difficult except, of course, as the maintenance of normal ventilation assists in their elimination. NOXIOUS FUMES, GASES, AND VAPORS The air of cities and towns where chemical manufactories exist is often contaminated with noxious gases of industrial origin which are dangerous to the health of the workmen employed in the in- dustries. The usual gases which give rise to complaint in manu- facturing localities are the following : chlorin, which is emitted by pottery kilns and ceramic-products manufactories, and from plants for the electrolysis of halides ; hydrogen chlorid, which is produced by the combustion of coal, and by pottery kilns, ceramic- products manufactories (partly from the coal and partly from the clay), nickel and cobalt smelting, platinum refining, glass manufac- tories, fertilizer manufactories, the chlorid of lime industry, and alkali manufactories ; sulfur dioxid and sulfuric acid, which result from the combustion of coal, coke, petroleum, and gas, copper smelt- ing, bleaching operations, etc. ; fluorides and hydrofluoric acid, which are emitted from acid phosphate and heavy chemical plants ; hydro- gen sulfid, from chemical works, especially those which produce ammonia; carbon monoxid, which is emitted from iron furnaces and from copper smelters ; organic vapors, from, for example, glue refineries, bone burners, slaughter and packing houses ; zinc fumes from zinc smelters and from brass foundries ; arsenical fumes from copper smelters ; phosphoric fumes from match manufactories ; and carbon disulfid and sulfur chlorid from some rubber works. Lehmann" compiled the accompanying table from the reports of many investigators, to show at what concentrations the various com- mon industrial gases are capable of producing immediate and observ- able efTects upon health. The destructive action of fumes in the vicinity of chemical plants is generally due, however, to the presence of sulfurous acid, sulfuric acid, or hydrochloric acid; and this table is given on account of the occupational hazards on the part of work- men employed in chemical manufactories and smelters. ' Lehraann, Methoden der Praktisch en Hygiene, 1901, p. 174. Air Impurities — Dusts, Fumes, and Gases 309 Bearable for „,,,_^^„_ Rapid and 30to60min. Trifling symp- NAME OJ? OAS dangerous without grave toms after action injury effects for some fiours Hydrochloric acid.... per 1000 1.5 — 2 0.05 o.oi Sulfurous acid " 1000 0.4 — 5 0.05 Carbonic acid " 1000 About 30 6 to 8 i to 2 Ammonia " 1000 2.5 — 4.5 0.3 o.i Chlorin ; Bromin " 1000 0.04 — 0.06 0.004 o.ooi Iodine " 1000 0.003 0.005 — o.ooi Hydrogen sullid .... " 1000 0.5 — 0.7 0.2 — 0.3 o.i — 0.15 Carbon disulfid " 1000 o.oi 0.002 o.ooi Carbon monoxid .... " 1000 2 to 3 0.5 — i.o 0.2 Of the gases which affect the respiratory passages and eyes the most important are the following: illuminating gas, gases from coke and coal; carbon monoxid; carbon dioxid (in brewing, baking, and the manufacture of aerated waters) ; chromic acid; chlorin; sulfuric, hydrochloric and nitric acids, and nitrogen oxids (in acid factories, heavy chemical works, engraving, etching, lithographing, etc.) ; mer- cury cyanid ; heated lead ; ammonia ; naphtha and Iienzine (petroleum refineries and dry-cleaning establishments) ; arscniuretted hydrogen (copper refineries) ; sulfur, hydrogen sulfid, sulfur dioxid, and car- bon disulfid, sulfur chlorid, nitrous gases, hydrocyanic acid; smoke (fire extinguishing) ; and the vapors of various organic coinpounds and substances (tar, creosote, carbolic acid, petroleum and its pro- ducts, methyl alcohol, fusel-oil, varnish solvents, dinitrobenzol, nitro- glycerine, formaldehyde and formic acid, pyridin, etc.). In addition to irritating the respiratory tract and eyes, such substances as the halogens, mineral acids, formic acid, alkalies, creosote and carbohe acid, various dyes, etc., cause injuries to the skin, giving rise to burns, eczema, fissures, ulcers, etc. It has been said that workmen in by-product coke plants, coal-tar color works, and in the roofing and paving industries are troubled with epitheliomatous cancer or ulceration of the skin or of the corneal surface of the eye, owing to constant exposure to pitch and tar compounds ; that workers with chromates, tanners, and dyers have "chrome ulceration" of the skm ; and that there are various trade eczemas, often of a troublesome nature. . Virtually no accidents have been recorded with hydrogen chlond gas, and accidents with hydrocyanic acid gas and arsenwretted 310 American Labor Legislation Review hydrogen are not of frequent occurrence in American plants. Car- bon monoxid occurs in colliery workings after explosions, in gas producers, blast-furnace gases, and in the manufacture of calcium carbid and phosphorus ; hydrogen sulfid occurs in gas-liquor storage tanks, gas purifiers, sulfate stills and saturators, and in sewers ; chlorin is found in and about bleaching-powder chambers, mangan- ese stills, and Deacon and other chlorid plants ; and nitrous and nitric acid fumes, which are very insidious in their action, are met with in vitriol chambers, especially in Gay-Lussac towers, during repacking and cleaning, in the manufacture of nitrate of iron and nitric acid, and in all breakages of vessels containing nitric acid. The prevention of accidents and diseases among workmen in chemical and metallurgical plants is a subject which has received much consideration in England and Germany. From the experience in those countries we may conclude that the following preventive measures may be taken: — 1. In petroleum refineries, extraction rooms, ether manufactories, plants where inflammable liquids and vapors are likely to be present in the air, flour mills, and all other mills where inflammable dusts are likely to be wafted about or suspended in the air, the belts on all machinery should be treated with a suitable compound to pre- vent or minimize the possibility of static discharges. The other measures necessary for minimizing the fire risks are well known. 2. Workmen in plants wherein the air is contaminated with halo- gen, mineral acid, metal or other irritating vapor, should be re- quired to wear "workmen-respirators". 3. Instructions should be given as to the use of oxygen and the methods of effecting artificial respiration. A very good description of such procedures is given in the Chemical Trade Journal, 1896, v. 19: 260. 4. Glasses for the protection of the eyes of workmen should be required in plants where acids or caustic liquids are used or made. 5. The plants should be well ventilated, in order to prevent the accumulation of gases and vapors. A number of safety devices have been invented in Europe for workmen in chemical plants, and many of them have been found to be of great value. These cannot be considered here. It has also been statistically shown that a great many of the accidents in chemi- cal plants happen on Mondays, Air Impurities — Dusts, Fumes, and Case 3ii While we have not given as much attention in this country as we might to the subject of dusts, fumes, and gases in industrial establish- ments, the writer knows of earnest efforts on the part of certain large corporations to provide every precaution. One of the most difficuh phases of the problem here is to secure the cooperation of the non-English speaking laborers. The American's appraisal of the value of a Dago's life, however, is associated not only with questions of financial economy, but also with the problem of how best to pre- serve the economic efficiency (health) of the individual. Preven- tion, reduction, and recovery are, therefore, of great importance as public health problems. Legislation is needed, but laws do not either enact or execute themselves and we must have sufficient ap- propriations for the determination of facts and the enlightenment of the public mind as to the effects of noxious industrial emanations. EFFECTS OF CONFINED AIR UPON THE HEALTH OF WORKERS George M. Price New York State Factory Investigating Cotnvtission. The air conditions in industrial establishments, which have an effect upon the health of the workers, may be classified in three divisions: (i) extreme variations in pressure, humidity and tempera- ture; (2) dusts, poisons, gases, fumes, and infective bacteria; and (3) ordinary confined air. Of these three divisions the first two may be regarded as accidental to industries. The third division, or- dinary confined air, is practically incidental to all indoor industries. The relative number of industries in which there is considerable variation in pressure, humidity, and temperature, or in which there is considerable danger from dust, poisons, gases, and fumes, is small in comparison with the industries in the establishments of which confined air prevails. By the term "confined air" is meant air which is confined and vitiated by many impurities due to respiration, combustion, illumi- nation, and overcrowding. In an examination of 4,850 establish- ments in New York State no means of ventilation, except by win- dows, was found in 88 per cent of the shops. The air in all these shops was confined and vitiated. There is as yet a diflference of opinion as to the exact nature of the toxicity of confined air. There is, however, no difference of opin- ion as to the dangers to health of a continuous and constant inhala- tion of such air. It is not difficult to study the effects of extreme variations of pressure, temperature, and humidity of the air upon the health of workers in factories. Nor is it very difficult to trace the effects of specific poisons, gases, or fumes in the air, or to study the results of constant inhalation of certain kinds of dusts. The etiological re- lations between the accidental air impurities and the health of workers may be studied experimentally as well as clinically. The pathological lesions produced by most of these accidental impurities Effects of Confined Air Upon Health of Workers 313 are distinct and certain, and the diseases produced by them are either acute or chronic. Not so with the effect of ordinary air impurities, which are under- stood by the term "confined air". The effects of confined air are less distinct, more difficuh to prove, less direct, and more insidious, although not less deadly. Mortality statistics show that the death rate of workers in indoor occupations is much higher than that of workers in outdoor occupations. There is no doubt that the chief cause of this higher rate of mortality among indoor workers is the confined air of shops and factories. Aside from this, however, we have hardly any evidence in mortality statistics as to the effects of confined air upon workers. Confined air does not produce distinct pathological lesions, nor does it directly cause any diseased condi- tions; and therefore its influence on the death rate is difficult to prove. The best method for studying the effects of confined air upon the health of workers is to study the comparative morbidity rates of workers in different occupations who habitually breathe stale air in the course of their several employments. The effects of constant and continuous inhalation by workers of the vitiated atmosphere of shop or factory will undoubtedly manifest themselves upon the general health of the workers, but more imme- diately and directly in the organs of respiration and digestion. Lassitude, fatigue, headaches, anorexia, anemia, indigestion, defec- tive oxygenation, lack of vital resistance, and a predisposition to catarrhal affections of the air passages, are the inevitable results of a chronic intoxication by vitiated air. The diseases, therefore, which we would expect to find among workers in vitiated atmospheres are bronchitis, anemia, and indi- gestion. Pulmonary tuberculosis and diseases of metabolism would probably be the sequelae. In the effort to determine the effects of confined air upon workers it would be valuable to have a comparative table of the prevalence of anemia, bronchitis, and digestive diseases among workers in vari- ous indoor occupations. Unfortunately such data are unavailable in this country. The only way by which the facts may be gathered is by a physical examination of a large number of workers in different trades. It has, therefore, occurred to me that it may be of value to present some results of a physical examination of workers in 314 American Labor Legislation Review two different industries, which it was my privilege to conduct during the last year. The medical examination of eight hundred bakers was made dur- ing last October by the New York State Factory Investigating Com- mission. The medical examination of six hundred cloak and suit makers was made by the Joint Board of Sanitary Control in the Cloak, Suit and Skirt Industry during the month of March. The bakers examined were those found in cellar bakeries in New York City; the tailors examined were those found in some of the best shops in the same city. We have also examined six hundred tailors in the worst shops in the East Side of New York City, but data for these are still unavailable. The accompanying table is very incom- plete and no classification has been made according to age and sex. The nativity and personnel of the bakers and tailors examined differed very little ; their hours of labor were but slightly different though somewhat to the advantage of the tailors ; night work is, of course, customary in bread making although a negligible factor in tailoring. Dust was found in bakeries as well as in tailor shops. With the present methods of baking, however, the effect of the flour dust is unimportant as very little is allowed to escape. The vegetable and animal dust found in cloak shops was not sufficient in quantity to cause serious injuries. In the bakeries the temperatures near the ovens were rather high, but this affected only a comparatively small number of workers. The amount of CO^ in bakeries and cloak shops does not differ very much. According to Dr. C. T. Graham- Rogers, who has made examinations in the shops of both industries, the amount of COj in the air ranges from 6 to 25 per 10,000 vol- umes, and does not differ very much in the two industries. The sanitary conditions of the cloak shops in which workers have been examined were exceptionally good, as these belonged to certificated shops in the industry. All the cloak shops examined were ventilated, however, by means of ordinary windows and, although not overcrowded, the ventilation of all the rooms was de- fective because the windows were closed and no special provision was made for introducing fresh air. The bakeries examined were all underground with no provision for ventilation except through small windows or gratings, but owing to the heated ovens the change of air was probably not less than in the tailor shops. Effects of Confined Air Upon Health of Workers 315 RESULTS OF THE PHYSICAL EXAMINATION OF 1413 WORKERS CELLAR BAKERIES AND IN SOME OF THE BEST TAILOR SHOPS IN NEW YORK CITY Total examined Free from disease Had the following diseases : Anemia Asthma IN Bronchitis Laryngitis Pleurisy Acute Chronic Tuberculosis Positive Suspected Diseases of the digestive system 76 Bakers Tailors No. Per ■ cent No. Per cent 800 1 00.0 613 lOO.O 347 43-4 115 18.8 183 22.9 158^ 25-8 21 2.6 9'- 1-5 177 22.1 ig-' 36* 5' 31 5-9 0.8 2 0-3 4" 0.7 19 2.4 4 7' 0.7 1.2 176 9-5 186 30.3 'Of the 158 who had anemia only 31 had no other disease; of the 186 who had diseases of the digestive system only 36 had no other disease; the others had one, or more than one, other disease. ' Five of these had chronic bronchitis and are included in that list. ^One of these had tonsilitis and is included under diseases of the diges- tive system. 'One of these had pharyngitis and is included under diseases of the digestive system. "One of these had chronic bronchitis and is included in that list. 'Two of these had chronic bronchitis and are included in that list. 'All of these had chronic bronchitis and are included in that list. Total number of diseases among the tailors, about 950. Total number of tailors, 613. Ratio of diseases to tailors, 15.^:10. 3i6 American Labor Legislation Review We have no statistics in this country with which to compare the results obtained by our physical examination. We thus have no standard by which to judge the variations in the morbidity rate. Nor can a comparison be made with the morbidity statistics of Sommerfeld and others gathered from the German sick funds (Krankenkassen), for the reason that these morbidity rates are giv- en mostly for those members of the sick-fund societies who are unable to work. Dr. Sidney I. Schwab's figures of the preval- ence of neurasthenia among tailors, * and Dr. Waters' claim of the large percentage of tuberculosis among tailors, may be referred to here as the only figures available on the morbidity of tailors. The standard mentioned by Hoffman of the incidence of 15.5 dis- eases to ten persons, being the German rate, can be compared to the 950 diseases for the 613 tailors examined, which makes a ratio of 15.5 to 10. The large number of bakers suffering from bronchitis, in com- parison with the number of tailors suffering from that disease, seems to indicate the better sanitary conditions of the tailor shops, which, as has been noted above, belong to those that have received sanitary certiiicates from the Joint Board of Sanitary Control. On the other hand, the comparatively large number of digestive diseases among tailors may perhaps be due to their stooping pos- ture and to their lesser muscular activity as compared with bakers, who are always on their feet and who change the character of their work a number of times during the day, while tailors sit at a machine for nine hours a day with only a single interval for relaxation. It seems to me that the comparatively high percentage of anemia, bronchitis, and digestive diseases noted among both the bakers and the tailors is at least suggestive of the defective ventilation of the shops in these industries, and that the confined air which bak- ers and tailors are compelled to breathe habitually has a strong etio- logical relation to these diseases. Much more intensive and exten- sive study of the subject is necessary, however, before the relation of confined air to the health of the workers can be definitely deter- mined. 'Publication No. 12, Ameiiran Association for Labor Legislation. GENERAL DISCUSSION Mr. J. T. AiNSLiE Walker, New York City: I have listened with great interest to the papers read this afternoon. Speaking as an Englishman, having been in this country but a few months, there is one phase of this problem which you do not consider as fully as I had hoped. We have heard of the precautions to secure proper ventilation, but the last speaker has dashed our hopes by stating that in many instances among tailors and bakers confined air is al- most essential. To consider ventilation alone is not enough ; we must deal with the presence of dust on all workroom floors. This problem has received attention at home and I hope soon to see it properly handled in this country. I know of no finer institution to take up such work than this Association. I think we all agree, also, that if this problem is to receive proper attention we must have the assistance of the manufacturers. There is no use in trying to force them to do what we want, but we must try to persuade them. If the moral argument is not sufficient, the best inducement is the one that appeals to the pocketbook. The best that a man can do in a day is one hundred units of work. Sup- pose a manufacturer is employing one hundred workmen. If you represent to him that, by neglecting certain precautions which you can show him how to handle successfully and economically, the loss of work and fall in efficiency is ten per cent, you have a direct ar- gument to place before him. He sees that among one hundred workers a lowering of ten per cent in efficiency means that he is losing the work of ten able-bodied men every day. If this argu- ment is put before the American manufacturer, as it has been suc- cessfully put before the English manufacturer, I think he will listen to you. You are more likely to achieve success this way than if you appeal from a moral point of view. A year or two ago an English doctor, bearing the famous name of Lister, called attention to the high death rate among printers. The attention of the federation of printers and allied trades was called to it by myself, and they decided to investigate the question first-hand. A certain area of floor space in one of the largest es- tablishments in London was chalked off. One-half was sprinkled with a disinfection solution; the other half was sprinkled with 3i8 American Labor Legislation Review water. Swabs were taken over each of these spaces and the con- tents examined. On the plate which was from the section sprinkled with water only there were crowds of bacteria ; the other plate showed no colony of bacteria. Thus the disinfection was shown to be satisfactory. The publication of this result in the textile papers and trade journals had a marked effect on the minds of manufac- turers in England. Mr. Mehren, New York City: We are engaged in efficiency en- gineering work, the improvement of factory conditions in order that the output may be the maximum and that the manufacturer may have the least possible cost and the worker the highest wage. From that standpoint the efficiency of the men is a very important con- sideration. We go to the manufacturer and say, "Betterment works of all sorts are not philanthropies ; they are profitable investments." We have not gone into chemical factories and consequently much said this morning about the lead industry went over my head, but we have been able to make valuable use of efficiency tests. We found a short time ago a large establishment with fifteen hundred em- ployees in which the manufacturers knew they had not full effi- ciency, although they had not been able to put their finger on the cause. We found that the ventilation was bad and that the common drinking cup had propagated colds in winter. Why not call in to aid the campaign for industrial hygiene the efficiency engineer, who is directly studying factory conditions with the idea of improving them? Legislation, strict enforcement of law, will produce much good. But the greatest result will be accomplished when you take advantage of all possible methods, one of which is to enlist the cooperation of the consultant in the engineering world. Dr. Leonard W. Hatch, New York Department of Labor: This point has come to my attention as bearing out what was said of the value to the manufacturer of medical care of his employees. A certain small New York plant employing two hundred and fifty people is quite a model establishment so far as ventilation goes. The firm established a benefit system and in connection with that a plan for giving the employees medical attention. It was arranged that a physician, employed by the firm, should be at the plant every day at five o'clock, and anyone who was employed there could con- General Discussion 319 suit the physician by mal<:ing his desire known to the watchman or porter. At iive o'clock all who could be attended to that day were notified by the watchman. After a year's experience the head of the firm stated that, though they had never kept records of the time lost in previous years, he was sure that, even in that period, without any special hazards, they had saved enough of the workers' time to more than pay the cost. Mr. Paul Kennaday, Secretary, New York Association for Labor Legislation, New York City: We have heard that it pays to keep the workmen well. In this Association we want to take the view that it is just to keep the workmen well. We should go to the labor unions, get out on the stump, use the newspapers, and teach the industrial population that they should keep themselves well for their own benefit and not to increase any dividends. And then, having aroused that feeling among them and a certain amount of enthusiasm, we should get after our state labor departments and get them to do their duty. Many are doing excellent work and many are not doing anything at all. They should make investigations into continuous processes, and give us the facts in regard to the number of men who are working seven days a week and the efifect of such work on their health. At present we have no such facts. As one member of the Association I say, let us emphasize a little more strongly the fact that it is justice we are after and not the payment of higher dividends. Dr. Lee K. Frankel, New York City: I have been reminded of an old story about barking dogs that never bite. I suppose you know the story of the man who was running away from a dog. His friends told him, "Barking dogs never bite." But the man re- plied, "You know it and I know it, but the dog doesn't know it." The discussion here has centered largely around what might be done in the direction of preventing disease through efficient legis- lation and by the employer of labor, but nothing has been said about what can be done by the workman toward safeguarding his own health. I want to mention what has been done in the city of Vienna, where there is a federation of sick clubs, under the Austrian govern- ment, which records every disease that occurs among its members, and these clubs practically comprise every workman earning a cer- 320 American Labor Legislation Review tain income. Every member realizes that it is for his distinct ad- vantage to report the conditions that exist in the factory where he works, particularly with reference to accidents. The result is that in the central bureau there is a careful record of every industrial establishment in the city of Vienna reported under the very best form of factory inspection known, namely by the employee himself, and by moral suasion without the necessity of legislation. These clubs have gone to the employer who has not introduced proper safeguards against accidents, or who has not put his mill or factory in good sanitary order, and have shown him that his establishment is below the standard, or proved to him that more accidents occur in his establishment than in those of his competitors. By this method they have been able to raise the standard exceedingly. Lacking compulsory industrial insurance it seems to me that, if this problem were taken up by our labor organizations, they could institute a sys- tem similar to that in vogue in Vienna and bring home to their employers the need for putting their factories in proper condition. Mr. Miles M. Dawson, Neiv York City: There is no question in my mind but that wherever there is a system of insurance, con- tributed to by both employer and employee, in addition to the col- lection of reliable information, there is the further result that at- tention is given to the subject by both sides. The benefits of sick- ness insurance in guarding the health of employees in Germany are doubtless great. This has reference quite as much to accidents as to illness. It is, therefore, unfortunate that so far, during the brief development we have had of workmen's compensation in this country, there has been no extension of such insurance. We would not only have done better work in connection with workmen's com- pensation, but would have indirectly had means of determining what the facts are concerning industrial diseases and industrial accidents, if we had adopted the plan in force in many countries of sickness insurance societies. Mr. John Martin, New York City: Professor Winslow said, and so far as I have been able to read the literature on the subject it seems to be agreed, that practically the only factor in ventilation about which we are positive is that overheating is detrimental to health and vigor. He went on to argue that that was a sufficient General Discussion 321 reason for declaring in favor of an artificial system of ventilation ; because, he said, if your factory or schoolroom is overheated, evi- dently the thing to do is to force in air, but it must not be below 60° F. when it enters. That logic, which I think is commonly enun- ciated by ventilating engineers, seems to me defective. If the fac- tory or schoolroom is overheated, the common-sense, obvious remedy is to turn off the steam and reduce the heating surfaces. As a matter of fact in this country we have for some years been convinced of the desirability of having rooms occupied by human beings, particularly hotels, trains, factories, and schools, kept at something above the outside temperature in winter and, with a na- tional tendency to overemphasis and exaggeration, we have gone to the length of making about 75° or 80° F. the standard indoor tem- perature in wintertime. Manufacturers and school authorities are literally killing with kindness. We have installed elaborate heating apparatus, and we use up coal in the most lavish manner, with the result that we are creating greater loss than we are avoiding. Now the remedy for that, it would appear, is not to discard heating apparatus but to install another apparatus to offset the one you have already installed. Surely the manufacturer might more rea- sonably be told, "You can save your earlier expense; you need not install so many radiators ; you are damaging your employees, as we are damaging our school children, by this mistaken kindness." To my mind, the thing to do is to teach the employees to throw the windows open. Mrs. Irene Osgood Andrews, New York City: I want to say a word as to the relative value of protection from bad ventilation and protection from disease. Ventilation is a much bigger problem and covers a larger number of persons, and we should be delighted to know what to do about it. We knew, after some study, what was an effective remedy for phosphorus poisoning; we knew after a while about compressed-air illness, about lead poisoning, and some- thing about blindness from wood-alcohol ; but we don't know what to do about ventilation. Illinois passed in 1909 perhaps the most effective law, yet I am told that it is only indifferently enforced. The occupational disease law passed last year has met with greater success. Massachusetts has had medical inspection of factories for six years, but Massachusetts has no standard for ventilation. New 322 American Labor Legislation Review York has had medical inspection for four j'cars, but has no standard for ventilation. Those of you who are familiar with New York conditions know that for three years we have been having confer- ences on ventilation. Last year a bill was proposed and this year the experts disagreed entirely and the bill was cast out. Anyone who can give us information on how to handle effectively and en- forcibly this subject of ventilation awaits a place in the hall of fame. We hoped that might be one outcome of the meeting here. Dr. Frankel has told us what the workman can do. Austria has been behind other foreign countries. But, as an illustration of its recent progress, although fourteen countries have prohibited the night work of women, the period of rest being between ten at night and five in the morning, Austria has now taken the advanced stand that the rest period is to come between eight at night and five in the morning. Before we can expect much of the workman we must have a strong body of labor law back of what we expect him to do. I see no reason why the conditions which Mr. Pratt showed us this morning in his pictures of lead poisoning should not be removed before we ask the workman to protect himself. I think that must be the line of progress in this country. Dr. C. T. Graham-Rogers, Medical htspcctor of Factories, New York: I think the subject of ventilation has been pretty well covered by those who have discussed it, and I do not feel that I can add much. It is true that experts on ventilation, instead of agreeing, have disagreed, and that the whole subject is in rather a chaotic state, probably because there has not been strong enough cooperation on the part of engineers, physiologists, medical men, and factory work- ers to get results. There are so many factors entering into the question that I doubt if six months or a year will give us much of a clue to its solution. It will take several years of intensive investiga- tion. But we cannot have any standard ventilation for all indus- tries; each industry stands by itself and in each intensive research must be pursued. We shall get results, not now, but in the future. Professor C.-E. A. Winslow, New York City: I hope very much that this Association will take up specifically the problem of venti- lation. If the Association could get experts, men qualified to take up these problems, it would mean a great deal of work and time, but the results would be of great value. General Discussion 323 I face the logical conclusion: If the only problem is overheating we can do without ventilation. But aside from the heat question we have to change the air in order to remove the odors, the dust, and the fumes. Whether they hurt or not they have to be removed. And we have to have tempered air. In a hospital you can do what you want with patients, but in a factory you cannot have the people making complaints, so the windows have to be shut, and I doubt if it would conduce to the efficiency of the industrial worker to do other- wise. Mrs. Florence Kelley, National Consumers' League, New York City: One point has not been clearly brought out in tiie discus- sion of poisonous trades and occupations. We were shown this morning pictures of common laborers shoveling lead, filling the air with dust in its most poisonous forms, for themselves and for every- body else to breathe, and to my lay mind it was a most horrifying spectacle. I do not know much about it, but I had not had a con- ception that there were men who would do such work, especially when it is not necessary in this or any other country. Would it not be possible to have the officials of a state where the lead industry is carried on publish the pictures and an explanation of apparatus in use by standard concerns, which eliminates the poisonous process, so the workman could be intelligent in his choice of occupations? Could not that knowledge be spread among the people so that where there is in actual use a successful mechanical method for the elim- ination of poison there need no longer be any excuse for the primi- tive process? Dr. David L. Edsall, Harvard Medical School, Cambridge: There is one thing I should like to say in relation to a subject of which Dr. Cabot spoke. It is important that hospitals keep records and that physicians be trained. The hospital records, if available, would be the best thing we could have. At present it is impossible to get any satisfactory facts which are precise enough to amount to anything. Except a careless name like "laborer" to describe a dozen different occupations, we find nothing to indicate what a man is doing. Hospital physicians need to be urged to contribute their share to the solution of the problem of industrial diseases. Hospitals should also have exhibits which they could use to teach 324 American Labor Legislation Review the patients themselves what they should do. Undoubtedly one of the best effects of the German insurance laws has been their effect on health, and one of the most important ways in which they have affected health has been through the graphic education they have given. The education that has spread among the people as to right methods of living has been one of the most advantageous things the country has had. The hospital must be looked upon as one of the centers for spread- ing information in regard to hygiene. I do not see any reason why our hospitals should not spread a great deal more information than they do on health matters. Dr. Warren Coleman, Chairman: In Bellevue and no doubt in the larger hospitals of the country, the physicians themselves take little or no part in acquiring sociological data concerning the patient. At Bellevue we have our bedside card, one side giving the sociolog- ical data and the other the bedside data. The sociological data is filled out in the lower office by an untrained person. That could be corrected, but they are not disposed to pay salaries to trained per- sons for that character of work. Again, there is no nomenclature to which we can turn to deter- mine what a man's occupation is. A committee has been appointed for the purpose of getting up such a nomenclature. It will be a heavy task, but in the course of perhaps a year of two years we shall probably have some such thing. Not long ago a young man came into my ward as a patient. He was sixteen and gave his occu- pation as lithographer. I thought I would cross-question him and find out just what he did. I found he swept the floor in the litho- graphing room and in winter swept the snow off the sidewalk; yet he had gone down on our records as a lithographer. There are many other similar points to which I could refer. Dr. John B. Andrews, Secretary, American Association for Labor Legislation, New York City: The medical profession can furnish us with information which we can spread broadcast in the form of leaflets among the workers and employers. Professor Thompson of New York has prepared a leaflet on lead poisoning which he has been using in his hospital work and from which he is getting interesting results. Why cannot that plan be worked out in every hospital? General Discussion 325 There was a second point that I hoped Dr. Cabot would empha- size, — the estabhshment of special clinics for the prevention and cure of occupational diseases. We have such a splendid illustration in Milan, where they have three buildings with hospital wards, lab- oratories, clinics, etc., especially devoted to this subject. I hope that within the next ten years we shall have in this country half a dozen of these institutions. It may be necessary to begin the work with general hospitals and I think Dr. Cabot and Dr. Edsall will be among the first men to superintend such plans. We must have medical men with the tools at hand working all the time supplying information for the prevention of these industrial diseases. IV STATE PROMOTION OF INDUSTRIAL HYGIENE Presiding Officer: Henry W. Farnam Yale University New Haven, Connecticut EDUCATION FOR THE PREVENTION OF INDUSTRIAL DISEASES M. G. OVERLOCK State Inspector of Health, Massachusetts. Standing to-day at the very portals of a vast field of opportunity, I can see stretched before me a decade of achievement in human efficiency unparalleled in the history of the world. Your organiza- tion has tilled the bare edges of this field, and the fruits of its labor has attracted the attention of every student of human events. The mighty stride of our industrial and commercial America is the wonder of all the nations of the earth. And the superior skill of our American workmen is attested by the fact that, although the machines of the American Shoe and Machinery Company are scat- tered throughout Europe, shoes made upon the same machines by American workmen are still eagerly sought, because of their supe- rior finish and workmanship, by Europeans. The maintenance of human eflSciency at its highest standard must be the watchword in the next decade. And, if kept at high-water mark, it will rebound to the credit, satisfaction, and glory of those who have to do with and who bring about the application of tried and found-true principles of personal hygiene for the avoidance of industrial accident and industrial disease. The prevention of such diseases must be brought about by.a systematic course of edu- cation, with the cooperation of the numerous agencies at our com- mand. These agencies, taken in the order in which in my judg- ment they belong, should be : first, medical colleges ; second, industrial clinics; third, industrial hygiene exhibits, both traveling exhibits and museums ; and fourth, publicity by means of lectures, leaflets, and posted warnings. Laws drawn up for the protection of working people from disease are themselves, moreover, educa- tional, and employers can do much to assist the movement. 330 American Labor Legislation Review I. Medical Colleges At the present time an opportunity presents itself to the medical colleges of this country which is most opportune. If these institu- tions of learning will add to their curriculum a department for the diagnosis and treatment of industrial diseases, they may be, by their cooperation with boards of health and bureaus of factory inspection in the various states in which they are located, a potent factor in impressing upon the different legislative bodies the need for proper health legislation and for proper appropriations to carry out this work. Medical men thus trained, reporting all industrial diseases to the central body and keeping in close touch with the boards of health and bureaus of factory inspection in different states, may hy this cooperation be of immense value to that great army of work- ers whose occupations make them susceptible to industrial diseases. What is the legislation necessary to bring this about? To my mind the system under which we are working in the state of Massachusetts should be in vogue in every state in the union. Every state should have medical men as state inspectors of health, working under the direction of a state board of health or bureau of factory inspection, and reporting their findings to the central health author- ity. It is my candid opinion, and I feel that it is also the opinion of the physicians generally throughout Massachusetts, that the act creating the state inspectors of health and setting forth their duties was a most important legislative action. For it is well to remember that they are the only large body of physicians on this continent who, acting in the capacity of state health officials, study the health, in- cluding the moral, social, and physical habits of the people, within and without the factory. Their investigations include, among other things, an inquiry into cleanliness, ventilation, the condition of the air, eyestrain, temperature, artificial moisture, the proper removal of dust, a proper system of lighting to avoid injury to the eye, pure drinking water, receptacles for expectoration, excessive humidity in textile industries, exposure to extreme heat in laundries and foundries, and exposure to lead and other industrial poisons, — in fact, a scientific study with a view to the elimination of all causes which lead to industrial disease. Those of us in the field feel that we are working under the direction and careful scrutiny of those who have made the prevention of disease their life study and who are ever willing and anxious, so far as the means at their Education for the Prevention of Industrial Diseases 331 command will allow, to make scientific application of every health principle. I believe that the emulation by every state in the union of the methods now in vogue in the state of Massachusetts will, within a decade, produce results of which this nation may be justly proud. Then, as I said in the beginning, the medical colleges, by their co- operation with the state boards of health and bureaus of factory inspection, could with profit to themselves and to the community and the state, turn out men whose training would aid greatly in the reduction of industrial diseases. Because it is plain that these colleges, using the deductions made from the experience of the state health officers in the field, would be working on facts and not on theories. II. Industrial Clinics The results and experience at Milan, Italy, and the opinion of medical men who have followed this clinic and its workings show, I believe, that we should have an industrial clinic in each of the large industrial centers of the United States. This seems to me an excellent opportunity for our philanthropists, but it could also, in my judgment, be taken up with benefit and propriety by the United States government. The money thus spent would make for effi- ciency in our industrial life, would be conducive to a greater de- gree of health among the industrial classes, and would be of ines- timable value to the millions yet unborn. I therefore suggest that the Association for Labor Legislation, by the appointment of a proper committee, take this matter under advisement. III. Industrial Hygiene Exhibits As I said in the beginning, this campaign for the betterment of the condition of the man or woman who works, to be efficient and far-reaching, must necessarily be a campaign of education. I feel sure that you will agree with me that the traveling exhibits, particu- larly those which have been sent out by the Boston Association for the Prevention of Tuberculosis, as well as those from other cities and states, have been of immense educational value and have left a strong impression upon the lay mind, as well as upon the minds of members of the medical profession and of social workers,— in fact of all who visited these different exhibits. It would seem to me that >ve might establish an industrial hygiene exhibit which could be 332 American Labor Legislation Review sent from city to city and which would have a stimulating influence upon those at the head of industrial establishments, who have an opportunity to provide sanitary conditions in modern up-to-date factories. It would also bring to the laboring man the realization that, after all, the scientific application of the principles of sanitation and hygiene are being worked out for the betterment of the working class. Such an exhibit would have another effect. It would ask a question of the landlord who is renting insanitary and ill-kept dwell- ings to the working classes. This question in substance is: If the manufacturer furnishes excellent sanitary surroundings for working men and women ten hours a day, why should I not furnish tene- ments with equally healthful conditions and surroundings for these people during the remainder of the twenty-four hours? In fact, in Massachusetts, with its rigid enforcement of factory laws calling for proper light, cleanliness, removal of dust, pure drinking water, re- ceptacles for expectoration, and numerous other health measures, the question is often asked : "Why have we not a tenement-house law that will place the conditions of the home on a par with those of the factory and shop?" Such industrial hygiene exhibits might be brought together at some central place, thereby forming a museum which could be visited by those anxious to learn just what is being done for the man and for the woman who works. IV. Publicity Through Lectures, Leaflets, and Posted Warnings In 1908, in the eleventh health district in my state, I began a series of noon-day talks in the different large manufacturing estab- lishments, particularly those located in the city of Worcester. If I may speak without egotism, I believe that these talks were of im- mense educational value. They were given in lay language on ques- tions of personal hygiene and sanitation, including the use of pure air and the importance of proper exercise, diet, and rest. These lectures were largely attended. I have in mind at this moment one establishment employing at that time twelve hundred women where, when a notice was posted a few days in advance that this talk was to be given, nine hundred remained at the factory during the noon hour to listen to what they must have considered a question pertinent to Education for the Prevention of Industrial Diseases 333 their welfare and well-being. In a number of instances manufac- turers shut down at half past eleven o'clock to allow their employees to attend my lecture without its interfering with their noon hour. During these lectures I usually distributed a little circular on "Don't", setting forth briefly, and recommending the avoidance of certain habits detrimental to health. These little leaflets were eager- ly sought for ; I believe they were carried home ; and perhaps the suggestions were followed. At any rate, I had the satisfaction of knowing that I had set the people to thinking. Since that time I have been pleased to learn that these lectures have been delivered in several other states. It is my opinion that the posting of warnings, whenever this can be brought about in large industrial establishments, will be prolific of much good, as they readily attract the attention of all the employees and at least set them to thinking as to their meaning. I also feel that an excellent means of educating the industrial worker is by the distribution of leaflets through the different trade-union organiza- tions. A great deal of good can be brought about in this way, and especially effective work may be done by calling the attention of the employee to the ordinary care needed in the handling of articles or chemicals which might in numerous instances be conducive to the production of poisoning. For example, attention may be called to the need of ordinary care in preventing lead poisoning. These leaflets, gotten up in a plain, readable manner, and printed in the several languages used by the employees in the different industries, might be made of great educational value. V. Ventilation and Eyestrain Laws In Massachusetts the law covering the ventilation of factories and the installation of mechanical ventilating apparatus (Chapter 106, Sees. 51 and 52) has, I believe, brought into play factors which tend in many instances to the maintenance of bodily resistance, as well as to the prevention of many industrial diseases. This law provides that "a factory in which five or more persons and a work- shop in which five or more women or young persons are employed shall, while work is carried on therein, be so ventilated that the air shall' not become so impure as to be injurious to the health of the persons employed therein and so that all gases, vapors, dust or other impurities, injurious to health, which are generated in the course of the manufacturing process or handicraft carried on therein shall, so 334 American Labor Legislation Review far as practicable, be rendered harmless." Should elements detrimen- tal to the health of the employees be found in any of these factories or workshops, the state inspector of health may require the installa- tion of mechanical ventilating apparatus. In any instance where much dust is generated, if it appears to the state inspector of health that the inhalation of such dust would be substantially diminished without unreasonable expense by the use of a fan or other mechani- cal means, such fan, if he so directs, must be provided, maintained, and used. In all of the dusty trades, as well as in rooms which are close and poorly ventilated, the installation of fans and blowers has had its effect upon the health of the employees. The enforcement of this statute does away with vitiated and foul air, to which otherwise the employees must be subject. Numerous examples of the practical working of the law might be given if space permitted, but in passing I will mention two. In the basement of a large manufacturing establishment, where about forty men were employed, the air, which appeared damp, was heavy and charged with carbon dioxid, and the men were continually suffer- ing from colds. The installation of two small fans and the covering of several emery wheels, which were provided with suction pipes, clarified the atmosphere to such an extent that the men told me they felt as if they were working in the open air as compared with the conditions under which they had worked before this apparatus was installed. They said that they had fewer colds, that they felt more like working, and that they could do better work without getting tired. In other words their physical condition underwent a change almost immediately after the installment of the apparatus mentioned and the removal of the foul and heavy air. In another instance, in the weave room of a large cotton mill where about forty girls were employed, the air was close and heavy, the girls went about their work in a listless manner, and hardly a day elapsed during certain seasons of the year but several of them were out on account of not feeling well. After the installation of a large fan, which removed the dust as well as the overheated atmos- phere and allowed fresh air to take its place, a change was immedi- ately brought about which was at once noticeable to the eye of the inspector. There was less absence from work, denoting, of course, less sickness among the employees, and the manner in which they applied themselves to their work showed that a higher degree of Education for the Prevention of Industrial Diseases 335 efficiency was being maintained, and that tlieir general heallli was much better. Massachusetts, I beheve, is the only state in the union which has passed any act relative to injuries to the eyes of those employed in industrial establishments. This, I believe, is an excellent law and will do away with many cases of eyestrain, of headache, and of nervousness, which arise from improper lighting of the rooms in which people are employed. In going into this question, we look first to the natural light and attempt to bring about, by a careful study of the different establishmients, the best condition obtainable from natural light. The question of artificial lighting, the kind of light and its effect upon the eyes, is next gone over, and the best light which our experience and judgment dictates is ordered in- stalled. In many instances simple washing of windows and orders as to their care have wrought a wonderful change. In others, the placing of more windows in such a position as to give the best pos- sible light has proved beneficial. Then again, the whitewashing or painting white of the walls and ceilings of many rooms has made a change in the condition of the eyes of the employees. On entering one of these establishments, we first determine the kind of work, whether it needs close application of the eyes or not, whether many of the employees are wearing glasses and, if so, why they are worn, and then we determine the effect of the artificial light or the rays of light admitted to the room upon the eyes of the employees. Ques- tions are asked as to the length of time employed in the present occupation, the condition of the eyes previous to this employment, and the difficulties, if any, under which the employees are working. As this law is new, and as many changes in the lighting of estab- lishments are being made throughout the state, we are as yet unable to judge of the beneficial results which we hope to obtain. From my personal observation, however, I believe this to be an important step which the state has taken, and I believe that eyestrain and kindred industrial diseases, which heretofore were caused by inade- quate and improperly lighted rooms, will be done away with to a large extent. There is no doubt in my mind that many internal dis- turbances, particularly what is known as dyspepsia or nervous indi- gestion, which is in many instances the result of eyestrain and which has become distinctly an industrial disease, will be done away with. If this be true, it is plain that the general condition of the 336 American Labor Legislation Review worker must be bettered. Physicians, of course, have for a long while realized that much malnutrition and consequent general weak- ness has been brought about by eyestrain. And no one whose occu- pation requires close application to fine work can escape its deleterious effects and its consequent influence over the general nervous system. This, of course, leads up to the whole question of industrial disease as related to the eye. In comparing notes with the several inspectors of health throughout the state, we can arrive at but one conclusion and that is, that the judicious application of this statute will be rich in beneficial results to the industrial worker. VI. Employers' Tuberculosis Agreement It is said that all medical men have hobbies. I believe once in a while, however, the laity credit us with entertaining practical ideas. Appointed state inspector of health in 1907, with instructions to inspect and examine minors in various industries throughout my district, I knew I should find tuberculosis. I reasoned that in the vast majority of cases, when I found this disease in a boy or girl, I should also find that they did not have the four dollars a week re- quired of all who would enter a sanitarium, even if such opportunity was open to them. I have since found it to be a fact that more than ninety per cent of the workers, when stricken with this disease, have not saved for the so-called rainy day. After one of my noon-day talks a young girl approached me saying that she had listened to the hope which I held out to those having tuberculosis that they might be cured if sent early to a sanitarium. She told me that she had tuberculosis but that she had an invalid mother whom she must support, and that she had no money. I took up this case with the president of the company for whom she worked, and he not only assured me that he would pay for this girl, but that he would pay for any other of his employees who might be so stricken. I asked him if he would give me a letter to this effect. He did, and I then saw a vast field opened before me. I went to other manufacturers, ask- ing for the same pledge, and in a short time I obtained more than a hundred similar pledges. This was the starting of what the Survey, in April, 1910, saw fit to call the "Overlock Tuberculosis Agreement". This movement quickly spread throughout the city of Worcester and the surrounding towns. It attracted the attention of the Boston Chamber of Com- merce, which body, by accepting a year later a recommendation of Education for the Prevention of Industrial Diseases 337 their committee on the prevention of disease, adopted it without a dissenting voice. Boards of trade and merchants' associations throughout New England took up the matter as bodies. The move- ment has spread from city to city and from state to state, until I find, by conferring with my coworkers in difterent states, that this agreement at the present time protects more than a million people. In a year's time, moreover, the work which I had done began to bear fruit in a different direction, which I had not anticipated in the beginning. Young men and women were sent to sanitariums, into the country, and to their homes across the sea, and were then sent back as arrested cases to become teachers in sanitation and health mat- ters. At the present moment I think I can say that there are in different parts of New England and the eastern states more than five hundred cases under treatment, the expenses of which are paid by their employers. My hope now is that this movement may spread throughout the United States. This movement, outside of its humanitarian and economic fea- tures, has set the manufacturers to thinking. They began at once to reason, first, as to why they should have tuberculosis among then- employees; second, as to whether, if it did occur, it was because of the surroundings under which they were working; and third, what were the steps necessary to place their different establishments under a sanitary regime and to remove as fast as possible all causes which lead up to the lowering of vitality and resistance in their employees. They soon learned, also, that by placing their establishments in the best possible hygienic condition the efficiency of their employees was increased. I have been much gratified in the past three years by the whole-souled cooperation of the manufacturers in this movement. They at once began to extend the welfare work, in their several establishments, so that at the present time not only do many of the large establishments provide recreation halls, but they are serving the noon-day meal at its bare cost. This sentiment existing among the business men of a community must necessarily have its effect upon the whole community. The local health authorities, who in too many instances in the past have been sadly remiss and dilatory in the manner in which they enforced laws, have had it pointed out to them that they must cooperate in matters pertinent to the health of the community. The steps taken for the eradication of tuberculosis from industry 338 American Labor Legislation Reviezi) are the very steps which must be taken for the prevention of indus- trial diseases in general. This movement, in the localities in which it has been applied, unites, we find, all sects, all creeds, all schools of medicine, in one common brotherhood. Your organization, acting in conjunction with the organized forces which I have mentioned, may be a most potent factor in bringing about the cooperation of the various agencies needed in the campaign of education for the pre- vention of industrial diseases. NOTIFICATION OF OCCUPATIONAL DISEASES Cressy L. Wilbur United States Bureau of the Census. The notification of occupational diseases has a somewhat similar relation to the registration of deaths from occupational diseases that the notification of births has to the registration of births. Notification in each case — and to be entitled to be considered real notification it must be immediate — is for the purpose of giving the earliest possible information to the authorities charged with the supervision or control of the class of events. Immediate notifica- tion of births is chiefly for the purpose of enabling the sanitary au- thorities to insist upon the necessary precautions for the preven- tion of ophthalmia neonatorum and of infant sickness and mortal- ity. It is not intended to replace the registration of births, for which a reasonable interval must be allowed, at least in rural dis- tricts; but it may serve as an important aid in securing complete registration, while the birth registration law may in return help to secure the thorough enforcement of notification. The purposes of such laws may be combined, as in the recent Massachusetts statute, which provides that physicians and midwives shall, within forty- eight hours after the birth of a child, mail a notice thereof to the local registrar (notification), and within fifteen days file a cer- tificate of birth (registration), but that the notification shall not be required if the birth is registered within forty-eight hours. In like manner the notification of sickness from occupational dis- ease will be followed, in a certain proportion of cases, by the regis- tration of death. The notification of all cases of occupational or industrial diseases ought to be a most valuable aid for the com- plete and satisfactory registration of all deaths from such diseases ; and likewise the registration of the deaths should be a most im- portant check on the completeness and promptness of the notifica- tion. It is, therefore, desirable that the notification and registra- tion of occupational sickness and mortality should be thoroughly 340 American Labor Legislation Review correlated, and for this reason it will probably be found necessary to administer them under the same general direction. The notification of occupational diseases may properly be con- sidered a part of the general subject of the notification or regis- tration of sickness in general. The reporting of sickness is a very difficult matter to deal with, and morbidity statistics are, as a rule, far less complete than statistics of mortality. Even with respect to some of the most important infectious diseases, such as typhoid fever, diphtheria, and tuberculosis, it will be found that in some locaHties many cases fail to be reported. This is readily shown by comparison of the reported cases of sickness with the deaths registered, according to which a most absurd ratio of fatality will not infrequently be shown. Such indications prove that physicians fail to a considerable extent to report the occurrence of notifiable diseases ; and knowledge of this fact by the sanitary authorities should lead to rigorous enforcement of the law, with prosecution and the collection of fines when it is disregarded. It is likely that the same condition will be found to exist in the administration of laws requiring the notification of occupational diseases ; and the whole experience of general registration points to the necessity of rigid and thorough enforcement of law from the very beginning, if fully dependable results are to be obtained and the true value of such legislation is to be demonstrated. It is far easier to enforce a reasonable law from the start than to restore the efficiency of a law that has become more or less of a dead letter. The registration of sickness does not come in the scope of the Bureau of the Census, which receives and compiles the returns of deaths from the registration area of the United States. I shall, therefore, deal chiefly with the relation of the notification of oc- cupational diseases to the registration of deaths from occupational diseases. It may be proper to point out, however, that the re- ported mortality from occupational diseases is as yet relatively insignificant, and the true measure of the loss of health and ef- fective working power can only be learned from well-kept mor- bidity returns. For example, during the year 1910 there were, in the registration area of the United States, comprising an esti- mated population of 53,843,896, or 58.3 per cent of the total population of continental United States, and including practically all of the chief industrial states of the north and west, only one Notification of Occupational Diseases 341 hundred and thirty-six deaths reported from chronic lead poison- ing and six deaths from other chronic occupational poisonings out of a total of 805,412 deaths from all causes. All the deaths from chronic lead poisoning were not occupational in character. The very small number of deaths (six) from other chronic occupa- tional poisonings includes all deaths reported from phosphorus necrosis (whether specified as industrial or not), from chronic industrial arsenical and mercurial poisonings, etc. It is likely, however, that some deaths that should have been classified under this title were omitted because the certificates of death bore no evidence as to the industrial character of the poisonings, and some may have been reported under terms relating to mere symptoms or conditions, such as "paralysis," "necrosis," etc., that afforded no clue to the true nature of the cause of death. The returns were compiled in strict accordance with the international classification; and it is impracticable for the Bureau of the Census to investigate all doubtful statements of cause of death, although this is done to a certain limited extent. The responsibility for indefinite reports rests, primarily, upon the recording physician, and, secondarily, upon the local registrar of vital statistics who accepts a doubtful certi- ficate and issues a burial permit thereon. It may be noted in the above statement in regard to "occupational diseases" that the term is used in the very limited sense of occupa- tional poisonings, and not in the broader sense of all diseases af- fected by occupations. Thus the draft of the "Certificate of Indus- trial Diseases" issued by the New York State Department of Labor provides for the reporting of "poison by lead, phosphorus, arsenic, or mercury or their compounds, or from anthrax, or from com- pressed-air illness." The schedules of California, Wisconsin, Con- necticut, New Jersey, Maryland, and Michigan are the same as that of New York, while Ilhnois requires the reporting of "disease or illness due or incident to" a few specified dangerous occupa- tions. The very recent introduction of such legislation is indicated by the fact that these eight states are the only ones having such laws. The report of the Illinois Commission on Occupational Dis- eases (January, 191 1) related chiefly to industrial poisonings, al- though the scope of a more comprehensive investigation was fully pointed out. It may be asked, for example, whether the reporting of tuberculosis caused by, or aggravated by, occupation is contem- 342 American Labor Legislation Review plated as a regular procedure by means of any of the special noti- fication blanks? It is difficult to define those diseases that may or may not be affected, to some extent, by conditions incident to employment. The general study of occupational mortality is dependent upon comparison of the deaths from various causes of persons engaged in specified occupations with the corresponding populations or lives at risk, and it is hardly necessary to say that regard must be had to the age and sex distribution, as well as to the factors of race and color, in order to obtain comparable results. It is absolutely neces- sary that there should be a uniform classification of causes of death, that physicians should report the causes of death by means of pre- cise and definite terms that can be readily compiled thereunder, and also that there should be an identical classification of occupations in use for both the population and mortality returns. In order to make the latter of the greatest service, physicians and others must be in- structed in regard to the correct statement of occupations. It is, therefore, very gratifying that a standard form of certifi- cate of death has come into general use in the United States dur- ing the last ten years, prior to which time there was very little uni- formity in this respect. This blank was originally prepared in 1902 and was revised in 1909 by the organized registration officials of the country (Section on Vital Statistics of the American Public Health Association). I desire to call attention especially to the form of statement of occupation on the present blank, with specification of the "(a) Trade, profession, or particular kind of work", and "(b) General nature of industry, business or establishment in which em- ployed", and to the instructions on the back of the certificate rela- tive to the statement of occupation and cause of death. Although not as detailed as the information sought on the New York certifi- cate of industrial diseases, it was the general consensus of opinion among registration officials that the statement was as complete as it would be practicable to require in the general mortality returns. The necessity for full information in regard to the length of time employed, the previous employment, previous illnesses due to occu- pation, etc., can best be met by including such inquiries on the no- tification blank, thus avoiding incumbering the death certifi- cate with many questions in addition to those already required for the general purposes of vital statistics. Thus the two blanks to a Notification of Occupational Diseases 343 large extent supplement each other, and may be used together as a basis for many important statistical purposes and intensive investi- gations. It would seriously interfere with the conduct of death registration, the extension of which to cover the entire United States is one of the most important tasks in which the Bureau of the Census is cooperating with state authorities and national asso- ciations, to add a single additional question to the schedules, which are already regarded as cumbrous by legislatures and those not fa- miliar with the requirements of registration laws. But a state of high industrial development can readily obtain, by means of such blanks as are provided for notification of industrial diseases, all supplemental data required to make its occupational statistics of the greatest practical value. A very beneficial means of building up complete and correct statistics of occupational mortality for the United States lies in the education of physicians, undertakers, and others in regard to the proper statement of occupation upon certificates of death, and in training physicians to report the causes of death under precise designations. For the latter purpose a booklet entitled the Phy- sicians' Pocket Reference to the International List of Causes of Death has been distributed by the Bureau of the Census to all the physicians of the United States. It contains lists of indefinite and unsatisfactory terms, and also points out the importance of examin- ing the statement of occupation (not usually filled in by the phy- sician) so that full data may be available concerning the occupa- tional influences afifecting causes of death. Similar instructions are used by state and local authorities; and it is only necessary, with the growing knowledge of the importance of the statement of occu- pational diseases, to make such instructions just as precise as may be necessary. I believe that it might be useful for a committee of this Association to consider the subject and to cooperate with the registration officials and with the Bureau of the Census in obtain- ing more complete returns. Objections not infrequently arise when a local or state registrar questions the completeness of a return of death, that would be removed if a great national organization had pronounced clearly in regard to the necessity for full details. In this connection I may say that the reporting of the causes of occupational mortality has sufifered, in common with all reports of causes of death, from the entire absence in this country of an ac- 344 American Labor Legislation Review cepted nomenclature of diseases. I do not mean by this that we do not have a standard classification, or preferably statistical list, of causes of death and illness. The latter necessity was met by the general adoption of the International List in 1900, since revised at Paris in 1909. But this list is solely for statistical purposes and does not answer the purpose of a nomenclature, or authoritative guide for the selection of medical terms for the designation of dis- eases and conditions, such, for example, as the "Nomenclature of Diseases of the Royal College of Physicians of London", which has been the accepted authority in England for the past forty years. I am glad to say that the American Medical Association has un- dertaken to supply this deficiency, and that its Committee on the Nomenclature and Classification of Diseases has held several ses- sions during the present meeting of that association and will sub- mit a report calling for the publication of a nomenclature for im- mediate practical use. In this nomenclature, which must neces- sarily be regarded as somewhat provisional or tentative in charac- ter — although the committee has labored upon the subject for sev- eral years — precise directions will be given for the reporting of industrial poisonings, and the importance of such reports will be emphasized as earnestly as possible. It is hoped that any sugges- tions on the subject from members of this Association, and also any action which may be taken by the Association on the basis of the papers presented by Dr. Thompson and others, may be promptly sent in to the committee, a statement and report by which may be found in recent issues of the Journal of the American Medical Association. The nomenclature will be arranged in the order of the Interna- tional List, in accordance with the original resolution of the House of Delegates adopted in 1907. This is for the purpose of compara- bility with the statistical lists employed for the compilation of mor- bidity and mortality statistics. For the essential use of the nomencla- ture the question of classification is of minor importance. One ar- rangement may be as good as another for the presentation of indus- trial diseases, but as a matter of convenience it is desirable that tables should present causes of death as far as possible in the interna- tional order. Of course, the titles of the International List can be subdivided to any extent found necessary, but when this is done the aggregates should be comparable with the causes shown under Notification of Occupational Diseases 345 the corresponding titles in general morbidity and mortality statis- tics. The Bureau of the Census and the Registrar-General of Eng- land have recently published manuals for the assignment of terms to the International List, so that a convenient guide will be available for all offices compiling statistics of occupational causes of death. Thus the general comparability of all classes of mortality and morbidity statistics will be assured. MEDICAL INSPECTION OF FACTORIES IN ILLINOIS Harold K. Gibson Medical Inspector of Factories in Illinois. Is the Occupational Disease Act of Illinois in its application practical ? To this question, although appreciating the fact that our experience is all too brief, I must answer most emphatically in the affirmative. There have been reported, in the period from August I, 191 1, to April I, 1912, two hundred and forty-seven cases of occu- pational or industrial disease, which were divided as follows : Lead 240 Arsenic 6 Phosphorus necrosis i Total 247 When it is taken into consideration that in this period not to exceed thirty-one manufacturing establishments were reporting, the importance of this legislation, particularly as it concerns the reporting of occupational disease, may be grasped. Personal experience has taught me that the Occupational Disease Act, as applied in our state, must fall far short of its mission unless we keep continually before us the idea of education, not only of employee, but of employer. I have with me now, indeed, the mental picture of two large manufacturers of paints whom we will desig- nate as X and Z. Both plants are new and well equipped with modern devices for collecting dust ; both have shower-baths, abun- dant facilities for washing, dining rooms, compartment lockers, working clothes, and regular medical examinations by well-qualified physicians. X reported eight cases of industrial lead poisoning for the month of October. Z reported seven. From this period until April I, the monthly reports of X have failed to show a single case of lead poisoning; while Z, on the contrary, has reported on an average of four cases monthly since October. Why this great discrepancy in two large industrial concerns using a practically identi- Medical Inspection of Factories in Illinois 347 cal process, having the same number of employees, both of modern building construction and sanitation, and both complying with our occupational disease law? Because X is complying with the spirit as well as the letter of the law, while Z is complying only with the letter. Being present in X's plant recently when the noon whistle blew for lunch, I was surprised to find that X not only allowed sufficient time for thorough scrubbing of the hands and face, but that the firm provided a man whose duty it was to see that all hands were clean before the food was taken from the locker. It is merely a difference in superintendents, foremen, and shop discipline. An employee in the plant of X knows that the creation of an unnecessary amount of dust, as, for example, in opening a container of white lead, or the failure to wear his respirator where there is dry grinding, means a reprimand from the foreman or, if he is a chronic offender, dismissal. On the other hand, the superintendent at Z plant is a lead man of thirty years' experience, who boasts he has never been leaded, and who believes that chewing tobacco is the greatest of all prophylactic measures in the prevention of lead poisoning. It was interesting to note, however, that this man, although not a user of alcohol, had a blood pressure of one hundred and sixty and peripheral blood-vessels of the consistency of whipcords. Z will not get results in his plant, with all of his modern sanitary apparatus, fans, and dust collectors, until he gets foremen who will personally supervise the hygiene of his men. I grant you that this is not a simple matter. Quite recently, in the inspection of the linotyping room of one ■of our largest daihes, equipped with a splendid exhaust system, the men complained bitterly that the exhaust and fans caused colds and sore throats. These are purely matters of education. Then there is the employer who tells you that the men prefer the saloon to the dining room and will not use a shower-bath, and that the men will not wear respirators ; he is as badly in need of education as his employees. Demonstrate to him what an intelligent foreman can accomplish. Will you allow me to tell you of our experience with the Pullman Car Company which, by the way, was the first corporation to comply with the occupational disease law in Illinois? Their first report made after our prehminary inspection showed seventy-three cases of lead poisoning. Bear in mind that they employ between three 348 American Labor Legislation Review hundred and six hundred painters and interior finishers, and that these people are engaged in an occupation, pecuHar to the finishing of Pullman cars, which is, I believe from personal experience, the most fraught with danger of any of the occupations in which lead is handled. I refer to the dry sander of lead inside the Pullman car. Here a group of men is confined in a relatively small place devoid of artificial ventilation, rubbing down dry lead paint with emery paper. They told us in the beginning that men could not be made to wear respirators in such a case ; that they would want to temporize with a strip of gauze or a handkerchief tied over nose and mouth. I wish to emphasize the point that in this, the most dan- gerous of the lead trades, the gauze or handkerchief will not do. Only an approved respirator, constantly worn when at work, and the most scrupulous personal hygiene, will save the dry sander of lead. His work admits of no compromise. To recapitulate, the Pullman company had seventy-three cases in August ; they have not had a case for the past four months. They have a perfect equipment of baths, washing facilities, lockers, clothes, and dining rooms ; but more than that they have a safety department with a man at its head who is an enthusiast in his work and who believes that lead poisoning in employees can be practically elimi- nated by personal supervision. Remember, too, that these men, of all classes of lead workers, are doing the character of work which furnishes the greatest number of cases of lead poisoning. That is to say, they are painters and sanders. Permit me, also, to say a few words upon the importance of what our German colleagues call the symptom complex in making a diag- nosis of industrial disease. I will refer to lead, as it is easily the most frequent and has the most disastrous final results of any of our industrial poisons. The blue line is by no means pathognomonic of lead poison, nor is a basophilic degeneration unless a previous malaria can be excluded, and it must be borne in mind that many of our lead workers, at least in Illinois, come from the malarial belt of southern Europe. Muscular weakness in any group of muscles with anemia I regard as most suggestive, even without colic or blue line. You must not ask a man if he has abdominal pain, but if he has pain and where, giving importance to the group of symptoms rather than to any one symptom, unless, of course, it be a wrist-drop or a typi- cal colic. I have found what I considered a well-marked case of Medical Inspection of Factories in Illinois 349 lead poisoning where there was no history of pain, muscular weak- ness or paralysis, and no blue line, but a moderate anemia, albumin- uria, and a blood pressure of one hundred and eighty, with a baso- phiHc degeneration. Of course, in estimating the value of blood pres- sure, one must exclude alcoholism and evidence of venerial disease. Just a word in regard to the importance of basophilic degeneration as a sign of lead poisoning. In a series of twenty-six cases, all of which presented a certain degree of anemia, I found this sign present in twenty-one cases. If I have dwelt upon lead to the seeming exclusion of other poisons, it is because of its commercial importance. I am sure that we in Illinois owe a debt of everlasting gratitude to this Asso- ciation and to your honorable secretary, in particular, for his efforts in the matter of white phosphorus legislation. The Esch-Hughes Act will eliminate one plague spot from our industrial disease map in Illinois, and one which was particularly offensive, as 70 per cent of the employees exposed to the fumes of phosphorus were girls under the age of twenty. But consider, I beg of you, that while phosphorus necrosis is a loathsome disease, yet it is strictly a local disease, and where it numbers its victims in tens, lead numbers its victims in thousands. I wonder how many lead workers of all grades could obtain a standard life insurance policy at the age of thirty-five. Re- member, too, that the atheromatous changes produced in the vessel walls by lead, as also the kidney changes, are permanent. COMPRESSED-AIR ILLNESS IN CAISSON WORK L. M. Ryan Medical Examiner, New York Foundation Company. Under conditions as they exist in New York at present employ- ment in compressed air is not such a dangerous occupation as it was a few years ago. As improvements have been made in equip- ment for lessening the laborious part of the work and for over- coming the difficult problems of engineering, so has there been a great advance toward bettering the conditions under which the men are working. Chief among the altered conditions which have less- ened the dangers of loss of life from caisson disease are: (i) phy- sical examination of all employees; (2) shortening the hours of labor; (3) hospital locks, in charge of qualified attendants, where victims of the "bends" can be immediately recompressed ; (4) lengthening the time of decompression in coming from work; (5) substitution of electricity for candlelight; and (6) a greater ten- dency on the part of the men to sobriety. I am speaking now with reference to the work of sinking cais- sons for foundations of buildings, and particularly of the compressed- air work during the last five years in connection with many of the large buildings in lower Manhattan. Caissons or large vertical boxes are sunk to rock or hardpan, as necessity may demand. As the earth is excavated from underneath and inside the boxes the caisson settles, so that when rock or hardpan is reached we have a hollow vertical cylinder, or a miniature tunnel, leading from the surface of the ground to a solid support. For a building which extends over a large area a great many of these caissons have to be sunk. In the case of the municipal building of New York, for example, one hundred and six caissons were sunk to a depth of one hundred and twelve feet below water level and one hundred and thirty-five feet below the street level. These boxes or caissons are sunk in groups of three, four, five, or six, so that a force of from one hundred to one hundred and fifty men, or even as many as five hundred men, are employed at one time. The air is pumped from air compressors to the caissons and the pressure varies ac- Compressed-Air Illness in Caisson Work 351 cording to the depth of sinking, so that at the same moment we may have one caisson, which is nearing its destination, having a pressure of as much as forty-five or forty-six pounds and another one, just being begun, having a pressure of only two or three pounds. In caisson work we have a few difficuhies to be dealt with that are not met in tunnel work, but in the main the problem is the same. The percentage of cases of compressed-air disease in my experience has been lower on foundation work than in tunnel work, in spite of the fact that under most circumstances employees in caissons are working under more disadvantageous conditions than tunnel workers. The reason for this is, I think, that in tunnel work, up to the present time, for the same pressure the men have worked longer hours. In caisson work our main difficulty in the past has been in lengthening the time of decompression on exit from work. One reason for this is that, on account of the comparatively small size of the lock used in this work and through which all em- ployees must pass, it is a much greater mechanical problem to di- minish the pressure gradually. I mean that, comparing two locks, one large and the other small, with an equal pressure of air on them, if you release the same amount of air from each through the same sized valve, the pressure in the small lock will drop much more quickly than in the large one. Another reason is that the lock used on the caisson, in contrast with tunnel work, is not permanently placed, as it must be lowered with the caisson. The necessity for the frequent removal of locks leaves a greater mar- gin of chances for leaks to occur from time to time, and from a leaky lock it is almost impossible to release the air slowly. In addition, the cramped position that the air worker must assume while sitting in the bucket during decompression differs from the comparative comfort with which he issues from a tunnel lock. Another feature of caisson work that has to be reckoned with is the environment of a busy city, as compared with the location of a tunnel plant which is usually in a more secluded section. In the former case the force of men, like the pressure of the air, is con- stantly changing; in the latter the tendency is more for the force to be a steady one, for the men have a pressure to work in that is pretty nearly constant and is not accompanied with the same degree of uncertainty. In considering the problem of how to care for the men, the 352 American Labor Legislation Review two factors that are of the utmost importance are: (i) the rejec- tion for work of all physically unfit; and (2) slow decompression in coming from work. The only death that has occurred in any of the work of which I have had charge during the last five years was due to a pressure of only twelve pounds of air where a man had gone to work without having been examined. Post-mortem examination showed that he had had a dilated heart which ruptured from the strain of a fairly rapid decompression. Very few cases of caisson disease occur in a pressure less than twenty pounds. In the examination of the men it should be borne in mind that it is an extraordinary occupation in an extraordinary atmosphere, and only extraordinary men should be employed. They should be physically above the average, between the ages of twenty-one and forty, of slender build, non-alcoholic, and with absolutely sound heart and lungs. Any variation from normal, even in rate or regularity of the heart, should be enough to reject a man. No man with symptoms of any organic disease should be passed. The fight for slower decompression has not been with the con- tractors so much as with the employees themselves, and I do not believe that the reason is so much the desire on the part of the men to get away from their work quickly as it is a spirit of bravado that prevails with nearly all. There is a certain con- tempt developed for the air, the result of familiarity. As they say, they can "eat air". Reason and a few painful lessons, however, have diminished this spirit to a great extent and, by the placing of responsible men in the position of lock-tender, we have been able to regulate the time to much better advantage. Nearly all cases are caused by too rapid decompression, and my experience has been that where the decompression has been slow no serious case has ever resulted. It is my belief that if a suffi- ciently long time were taken for decompression we would never have a fatal case in an otherwise healthy man. The time that should be taken for proper and scientific de- compression depends directly on the amount of air that is dis- solved by the blood under pressure. And the amount of air dis- solved by the blood is determined by (i) the length of time spent in the air, (2) the number of pounds of pressure, and (3) the amount of exercise undertaken in the air. A lock-tender may go rapidly in and out of very high pressure with no ill effects, %™l}Mi''yz AIR-LOCK ON TOP OF CAISSON In SiNKiXG Foundations For Skyscraping Buildings Men Go Down Beneath the Water Level and Work In Compressed- AiR Chambers Or Caissons The Air Pressure is Frequently More Than .Three Times the Normal Fifteen Pounds Per Square Inch. Workers, If Released Grad- ually During Decompression in the Air Lock, Avoid the "Bends", or Compressed-Air Illness Compressed-Air Illness in Caisson Work 353 as his stay in the air is short. Superintendents and engineers, whose stay is shorter than that of a regular shift and who do no manual labor in the air, do not suffer from the "bends" as fre- quently as do the diggers. In addition to the purely mechanical problem as a causative fac- tor, we have to take into account the individual susceptibility to caisson disease. Five men of apparently the same physical condition come out of a caisson under absolutely the same conditions. One of the five is attacked by the affliction and the other four are unaf- fected. What determines this susceptibility? The blood of each undoubtedly dissolves the same amount of air under pressure, and when the pressure is reduced the air comes out of solution in pre- cisely the same length of time. Authorities differ as to the change in pressure in the vessels, but to my mind this is a real and impor- tant factor. If the pressure within the vessels were not increased, the blood could not dissolve the air or hold it in solution. Conse- quently, in rapid decompression we have not only to deal with air in the form of small emboli in the blood stream, but we have exerted against the vessel walls an abnormal pressure which has not had time to diminish at the same rate as the air in the air-lock. The ves- sel walls of the man in good condition, or rather the man who is the good risk, are able to counteract this pressure and carry the air to the lungs where it is expelled. The man whose vessel walls dilate under this pressure is not able to get rid of his air so quickly, and the small emboli collect in sacculations at the weaker points and remain until recompression is carried out so that the air is again taken up in solution in the blood. For my own convenience I have classified the different types of the disease as follows: (i) spinal type; (2) cerebral type; and (3) pulmonary type. Each of these is again subdivided into (A) mild variety, and (B) severe variety. Of the spinal type the mild variety is characterized by aching pains in the extremities ; and the severe variety by paraplegia and general weakness but no pain. Of the cerebral type the mild variety is characterized by vertigo, nausea and some prostration ; and the severe variety by coma, usually hemi- plegia, and great prostration, with pulse and respiration barely per- ceptible. The main symptom of the pulmonary type, which is seen less frequently, is dyspnoea. The mild variety of the spinal type never results fatally, but in rare cases it causes a wasting of the 354 American Labor Legislation Review muscles of the thigh by a gradual process which involves the hip- joint as well. The severe variety, with paralysis of the legs, never terminates fatally except from the secondary results of a myelitis, where treatment has been of no avail. The milder variety of the cerebral type is due probably to a disturbance of the internal ear and terminates favorably; but the severe variety of the cerebral type, characterized by coma, is fatal in many cases in spite of any treat- ment that may be instituted. In regard to the treatment of the severe cases, everything de- pends on proper and skilful recompression in the hospital lock. The greatest mistake in the past has been in recompression to the number of pounds in which the patient was working. This is abso- lutely unnecessary and is highly dangerous. Uniformly good results are obtained by recompressing to two-thirds what the pres- sure was in the working chamber. This corresponds in some meas- ure to Dr. Haldane's theory of rapid decompression for the first stage. When the desired pressure is attained it is wise to leave it stationary for some time, according to the merits of the case and the improvement of the patient. In all cases of the severe type the medical attendant should be recompressed with the patient and it is his duty to use artificial respiration if necessary, to massage over the heart with movements of the extremities, and in many cases to force the mouth open and promote respiration. When consciousness returns it is wise to encourage the patient to execute voluntary movements and to get up and walk in the lock, allowing him to rest at intervals. Decompression in patients afflicted with the milder va- riety of the disease can be carried out at the rate of about one pound in four minutes, taking one hour where the recompression has been to 15 lbs. In the severe cases, decompression should be much slower, at the rate of ten to twelve minutes for a single pound, — that is, where the recompression has been to 15 lbs. taking as long as two and one-half or three hours, and where the recompression has been to 20 lbs. taking as long as three and one-half or four hours. The following is the history of an interesting case followed by recovery : Name, J ■ M . Age 28. Ht. 5 ft. 6 in. Wt, 160 lbs. History : — On December loth, 1909, started to work in 37 lbs. pressure without ever having been examined. He had been quite ill for about two Compressed-Air Illness in Caisson Work 355 weeks previously, suffering from a severe cold. Worked for two hours, al- though he had never been employed in compressed air before. On coming out of the lock was decompressed very rapidly, in about one minute's time, with the rest of the gang. He fell unconscious and was carried to the lock for recompression. Treatment: — Was at once recompressed with an attendant to 20 lbs., and after the air had been maintained at this level for about ten minutes re- covered consciousness and was able to get up and walk about in the lock. He was gradually decompressed, taking a period of two hours. On exit from the lock he felt pretty well, but at the end of fifteen minutes again fell over unconscious and seemed to be quite lifeless. He was again recom- pressed with myself to 20 lbs. and under the same treatment recovered con- sciousness in the air. His pulse was weak and rapid, pupils dilated, and body covered with a profuse perspiration. I encouraged him to sit up, after administering strychnine to him hypodermically. Passive movements were carried out with massage and two and one-half hours were taken for de- compression. When he made his exit from the lock he felt fairly well, but was noticeably weaker than he was on coming out the first time. He was allowed to rest in the recovery room and restoratives were administered to him. Five hours later he said he felt well enough to get up and walk around, but complained of some dizziness. He was standing up near the hospital lock and was speaking to me when he was seized with a violent convulsion and fell over in my arms. He was again recompressed with me to a pressure of 22 lbs. and the pressure was maintained at that level for an hour before he fully regained consciousness. During that time I was using artificial respiration on him, his jaws held open with a mouth gag and his tongue drawn forward. It was almost a quarter of an hour before he breathed at all satisfactorily. At the end of an hour he could answer ques- tions but only in an indefinite way, and he had a well-marked paresis of his left side. This gradually improved, but he was so very weak that he was in clined to lie down. He wanted to sleep continually. We released him very slowly until at the end of five hours decompression was complete. This was at the rate of one pound in fourteen minutes. He was carried to the re- covery room and by that time had recovered entirely from the coma and paresis. He was given some broth and was allowed to sleep for three hours. He rested for two hours more and at the end of that time was so improved that I allowed him to go home. He never had any recurrence and was able to come around for his pay three days later. Two weeks later he was in apparently good health, but I advised him never to enter even the slightest pressure again. Neverthe- less, within three weeks of his illness, he did go to work in light pressure in another part of the city, but only worked a few days. About four months later he had an attack of pneumonia and died. LEGAL PROTECTION FOR WORKERS IN UNHEALTHFUL TRADES John B. Andrews Secretary, American Association for Labor Legislation. The need of labor legislation for the protection of workers in unhealthful trades is so apparent to anyone at all familiar with the facts that argument upon the subject is unnecessary. "Factory legislation", to use the earlier English term, has aimed particularly at the protection of workers from insanitary conditions of employ- ment. Long before any considerable number of people admitted that legal regulation of working hours and of wages was justifiable, there was very general recognition of the fact that the worker was entitled to a decently safe place in which to labor. The reasonable- ness of sanitary regulations as a legitimate interference with work conditions prescribed by the employer and suffered by the employee, has also been more uniformly upheld by the courts than any other kind of labor legislation. In general, certain trades are unhealthful and require regulation principally because the workrooms under ordinary conditions are likely to be poorly ventilated. More specifically, the harmful condi- tions of employment are frequently due to the presence of dusts, gases, vapors, and fumes ; to extremes of temperature, humidity, or density of the atmosphere ; and to improper lighting and overstrain. The evil results of unhealthful conditions have long been recog- nized, and in every industry there are humane and intelligent em- ployers who devote much time and money to the elimination of un- necessary hazards. Whether prompted by humanitarian or commer- cial considerations, these advanced employers frequently provide model establishments. By their commendable efforts they also help to establish reasonable standards of comfort and safety which, when drafted into labor law, constitute uniform minimum requirements for all employers in the same industry. But only through the uni- formity of regulation which legal enactments alone can secure, can these more progressive and humane employers be themselves pro- Legal Protection for Workers in Unhealthful Trades 357 tected from less scrupulous competitors who would otherwise often fail to go to the expense of providing adequate safeguards, and only through such compulsory uniformity can the health of the em- ployees of these competitors be protected. It frequently happens, moreover, that even a vast majority of the manufacturers in a given industry claim that they are unable to bring about reforms, which they freely admit are desirable, without the aid of uniform legal regulations to force the recalcitrant mi- nority into line. A striking example of this, the condition which culminated successfully in the poisonous phosphorus match pro- hibition act, is still fresh in the public mind. Match manufacturers, representing ninety-five per cent of the total product, testified before Congress that they could not substitute a harmless compound for the slightly cheaper poison without a uniform law compelling all manufacturers in that industry simultaneously to abandon the poi- son. Match manufacturers representing the remaining five per cent of the product stood out stoutly until the last, declaring that they would close their factories before they would submit to this sanitary regulation already in compulsory operation in practically all the civilized countries of the world. It required labor legislation to prohibit the use of this unnecessary deadly poison before "phossy jaw", the most loathsome of all industrial diseases, could be abol- ished. For other industrial poisons there are harmless but more ex- pensive substitutes. Automatic mechanical processes can be sub- stituted for dangerous methods still conducted by hand labor. Scores of operations in the present list of particularly insanitary trades can be made safe by the use of scientific apparatus for the removal of dangerous dusts and fumes. The unhealthful trades demanding legal regulation may be con- veniently classified according to the nature of the principal hazards : (i) Trades menaced by specific industrial dusts, fumes, gases, vapors and acids (poisonous and non-poisonous) ; (2) Trades menaced by compressed or rarified atmospheres; (3) Trades menaced by improper light; (4) Trades menaced by extremes of temperature and humidity; (5) Trades menaced by excessive strain. Hundreds of peculiar injuries, caused by these unhealthful con- ditions of employment, are now beginning to receive serious atten- 3s8 American Labor Legislation Review tion in America as special diseases of occupation. This new line of study is most encouraging to those interested in securing effective legal regulation of unhealthful trades, because it has long been recog- nized by the people most familiar with the facts that specific studies, leading to the establishment of more definite standards of safety, are necessary before much even of the now existing legislation can be effectively enforced. While such researches are under way, we should emphasize at every opportunity the following considerations : ( i ) All preventable occupational diseases must be prevented; (2) those occupational diseases which we do not yet know how to prevent must be reduced to a minimum; and (3) the victims of occupational disease must be compensated for their injuries by some just system of insurance. Efforts to carry out this program lead naturally to three principal methods : (i) Absolute prohibition. — Through the successful outcome of the efforts to secure a prohibitory tax upon matches made with poisonous phosphorus, an avenue of tremendous possi- bilities, if carefully followed and not abused, is opened up for the further conservation of human life. (2) Regulation. — There may be specific or general regulations: A. — Specific regulation. — For the sake of clearness we may recall, as an illustration of specific regulation, the earlier his- tory of the match industry, when several countries, before harmless substitutes for poisonous phosphorus were dis- covered, attempted to prevent "phossy jaw" by requiring, (a) that match paste should contain not more than seven per cent of the deadly poison; (b) that no one should be permitted to work in the poisoned atmosphere of a match factory more than eight hours in any one day, and (c) that children should not be so exposed. There were, then, in this intermediary pe- riod of specific regulation, three definite limitations, (i) upon the hazardous material, (2) upon the period of exposure, and (3) upon the persons exposed. By this method of specific regulation also there are extensive possibilities for legal regu- lation in the interest of human health. B. — General regulation. — This method is, unfortunately, the most common. If, again, for the sake of clearness, we make final use of the match-factory illustration, we recall that be- Legal Protection for Workers in Unhealthfitl Trades 359 fore prohibition was thought of and before specific regulation had been tested, most countries had made vague elTorts, through general regulations, to provide education, ventilation,' and cleanliness for the promotion of the comfort and health of workers in match factories. This general method lends itself most readily to that large group of trades in which the occupational causes of industrial maladies are least clearly defined. It marks the earliest stage of regulation where, on account of complex conditions of employment, we are still feeling our way in partial darkness without definite standards for our guidance. (3) Insurance. — It is now recognized that the campaign for work- men's compensation or insurance for industrial accidents, both in Europe and in America, has been the greatest practical force in the prevention of such injuries. No intelligent per- son can go far in the study of insurance against industrial accidents without realizing that a logical consideration of the facts must lead likewise to insurance against industrial dis- eases. A workman, incapacitated by disease contracted in his trade and due to his employment, is as much entitled to compensation as if he had been disabled by an accident. In many European countries this principle is already established. In all attempts to control dangerous trades, the method of general regulation has naturally preceded specific regulation and absolute prohibition as well as insurance. On paper it is by far the easiest, and unfortunately it creates a temporary impression of accomplish- ment which is quite fascinating to the occasional-day reformer. It is probably a necessary first step in most industries where definite, en- forceable, scientific standards must wait upon investigation and prac- tical experiment. In attempting to deal intelligently with these problems, our bill drafters are hopelessly baffled by the lack of scientific standards. And nothing is more clear to serious students of the subject than the unavoidable conclusion that eflfective laws for the regulation of unhealthful trades cannot be properly drafted by busy and harassed legislators in the midst of legislative sessions. In the field of in- dustrial hygiene, no greater contribution could be made at the present time than the establishment, by a commission of experts, of such standards. 360 American Labor Legislation Review The existing laws in this country for the regulation of factory labor in the interest of the comfort and health of the workers are for the most part formulated on general lines, — confused, indefinite, and full of loopholes. In the fifteen states which even pretend to protect workers from the effects of poisonous gases, fumes, and vapors, the laws seldom give more definite directions than that such dangerous gases, fumes, and vapors must be removed or rendered harmless "when injurious to the health of employees", or "so far as practicable", or "if necessary". In one state the law sweepingly provides for all health protection by stating that the factory inspect- or "shall also examine into the sanitary conditions of factories, workshops, mines and quarries, and when any condition or thing is found that in his opinion endangers the health or lives of the em- ployees, he shall notify and direct the employer to rectify the same." This class of statute law, which is quite common, places no duty upon the employer to provide proper protection until he is ordered to do so by the inspector. When one considers the area to be covered in our large industrial states, and the number of workplaces to be inspected, it can easily be seen that workers depending for their safety upon the specific orders of a limited number of inspectors are likely to receive entirely insufficient protection from laws of this character. Although work in compressed air has become an important element in the building trades of this country, New York is still the only state which has a scientific law relating to work of this character. There are only twelve states that make any mention of the sub- ject of light in their general factory or labor laws. And "in not one of these", says a well-known efficiency engineer, "are the pro- visions sufficiently specific to render them of practical value." Laws intended to protect the workers from injurious dusts in fac- tories have been enacted in twenty states, but they are generally very crude and in practice more or less ineffective. "Drastic legal re- quirements alone", says the leading American authority on this sub- ject, "are certain to bring about the required degree of comfort and health." One reason that many safe methods are not in operation at the present time is simply that many employers, busy with the making of profits, have had no sufficient incentive to turn their attention to factory sanitation ; and another reason is that state factory inspect- "SEP.^ RATING SCREEXS" I\ WHITE-LEAD FACTORY A Once Dusty Process Is Here Made Practically Free From Lead Dust By the Use of Enclosed Churn-Like Machines Which Sift THE Metal from the Corroded White Lead Legal Protection for Workers in Unhealthful Trades 361 ors have not always been fully aware of their opportunities and responsibilities. The motive which leads some intelligent employers properly to equip their plants with safeguards is undoubtedly the conviction that it increases the efficiency of their workmen. There is abundant testimony to that effect from the rapidly rising profes- sion of efficiency engineers and from their patrons. But even the most enthusiastic "boosters for safety" among the thoughtful effi- ciency experts recognize the absolute necessity for the establishment of uniform legal standards of safety if the health of the great majority of factory workers is to be conserved. Recently a few of the less though ful enthusiasts in the popular agitation for efficiency have failed to get the true perspective and have clamored for protection for the workers solely upon the ground that "it pays" the employer. Let us congratulate ourselves that those who are in danger of losing their health and their lives in their daily toil have in some instances at least that incidental advantage. But let us have less of this everlasting dinning in our ears that, be- fore we ask for decent protection for the workers, we must first demonstrate that each advance toward health and safety will actually put additional dollars in the pockets of employers. Let no one for- get, meanwhile, that the philosophy of mercenary profit, when carried to its logical conclusion, may result in some instances, where it is not clear that profits will respond immediately to the expense of safety, in less than decent protection. No man in this Republic should be permitted for a moment to forget that, no matter how urgent is the duty to protect the property of citizens, society has a much higher responsibility, the protection of human life. In our efforts to secure the necessai-y information upon which to base intelligent legislation, we must draw more and more upon the expert service of the physician. Eight states have already enacted laws requiring medical reports on the most easily recognizable dis- eases of occupation. These reports will indicate special danger points for intensive study within industrial establishments. Periodical physical examination of workers in particularly hazard- ous trades is now required in one state, and the regular medical in- spection of factories, now unhappily limited to three states, will undoubtedly be extended rapidly within the near future. Medical colleges might vi'cll include regular courses on industrial hygiene; hospitals, too, will be expected to improve their system of records ; 362 American Labor Legislation Rcviezv and in the leading industrial centers we shall eventually have special clinics and wards for the study and prevention of industrial dis- eases. Recent developments indicate that the medical profession will not evade its opportunity and responsibility. For many years it has been our shame that in this field we have lagged far behind some of the countries of Europe. Our scandalous disregard for the safety and health of workers is widely known. But in this country true reform waits not so much upon sentiment as upon facts. We are just beginning to utilize the materials at hand, and our machinery for scientific cooperation in promoting in- dustrial hygiene is but fairly set in motion. We move rapidly when once under way. Let us press on in the hope that another generation may see America leading the nations of the world. GENERAL DISCUSSION Dr. C. T. Graham-Rogers, Medical Inspector of Factories New York: Any discussion of the question of state promotion of indus- trial hygiene would comprise four points, first the reporting of industrial diseases, second the recording of the reports, third in- tensive study of the means of prevention, and fourth 'education. The departments of state which would naturally be responsible would be the health department, the labor department, and the educa- tional department. Dr. Wilbur has spoken of how the question of reporting corre- sponds to the registration of births. The notification of industrial diseases gives us some idea of how to make an investigation and then of how to prevent further trouble. The morbidity returns are more important than the mortality returns. Last year I went over the reports of New York State and I noticed that the mortality from pulmonary tuberculosis in a locality known for steel grinding ap- peared to be low, while in an essentially country district it appeared to be very high. I have visited every factory in the state and, from the known facts that I have of the steel district, these statistics are no indication whatever of the real conditions. In foreign coun- tries the records are more complete. In New York State the reports of occupational diseases are sent to the bureau of labor statistics. Dr. Hatch of that bureau then sends me a copy of every report that is made. These cases are followed up and when they run up to a certain number in an indus- try we start an intensive investigation. We try to find the cause of the occupational disease, whether it is due to dust, to fumes, to gases, or to atmospheric conditions. We try to find the exact point in the industry that is to blame. We have in New York an engineering inspector who takes up the matter with the medical in- spector whenever it is a question of mechanical means for the re- moval of dust, fumes, and gases. The state labor department can also take up the question of the home worker and of the child worker. In the promotion of indus- trial hygiene it is an important thing to know whether or not a child is fit to go into an industry. If a child is not fit to go into 364 American Labor Legislation Review a certain industry we should keep him out. The educational de- partment can help in this work by vocational schools, by finding out what the children are fit for, and by teaching them that there are certain means to protect their health and lives and how to use these means. Dr. Overlock, in taking up the question of education, has em- phasized the instruction of physicians in medical colleges to under- stand and know industrial diseases when they see them. I think that is most important. I myself had an example of the need for such instruction. I went into a factory where they made storage batteries and one of the workers there had a typical case of lead poisoning and wrist-drop. I asked the foreman if he had known anything of lead poisoning. He said no, that the individual just hung around there, suffering from rheumatism and one thing and another, and that it was a matter of charity to let him do little jobs. I asked the worker if he had been to a physician and found that he was being treated for rheumatism. He was in the vicinity of the Vanderbilt Clinic, so I gave him a card and sent him over there. It was a well-marked case of lead poisoning and not rheumatism. So the statement made by Dr. Overlock is true. Some of the medical men are not instructed and do not see enough cases to be able to recognize these diseases. Mr. Paul Kennaday, Secretary, New York Association for Labor Legislation, New York City: I liked particularly Dr. Over- lock's suggestion with regard to tuberculosis. A tuberculosis cam- paign furnishes us with a standard for the whole question of indus- trial disease. What the people who are fighting tuberculosis have done it seems to me we should do with industrial diseases in general. The exhibition, the lecture, the printed leaflet, and the newspaper have all been used with great success in that campaign, and we should use the same means in the matter of industrial diseases. We must get this thing over to the public. We must make them realize that there is a relation between occupation and disease, and we must not be overnice in the way we go about it. In Massachu- setts they say that at one time there was a sign in Boston which stated that the public was requested not to deposit sputum upon the pavements. We said in New York, a more vulgar lot, "Don't spit", and I think the message carried over rather better. General Discussion 365 It is the same with regard to industrial diseases. We are dealing with people many of whom are not very intelligent, who are rushed with their occupations, and who have no time for study, and we must make this message to them just as brief and just as vivid as possible. We must use the picture to a large extent and we must use the ex- hibition. We ought to have in every large city in this country a permanent industrial exhibition open day and night, especially on Sundays and holidays, for the education of the worker as well as the manufacturer. Then we should make use, it seems to me, of the motion picture. There are infinite possibilities there for driving home this lesson of prevention. We must remember, too, that we must educate not only the indus- trial worker but the physician. If we are to believe the physicians themselves, this latter job is probably more difficult than the former. The physician looks rather askance on anything new and he is fear- ful of reformers. We must gain his confidence and we must not be overstrenuous in our desire to force this registration law. In New York City the law compelling registration of tuberculosis was first put on the books, then physicians were notified of it, then lec- tures were given ; and the thing was worked up gradually among the people until it came finally to actual enforcement. By that time the law had the good-will of the majority of the medical profession. The same method should be applied to the reporting of occupa- tional diseases in general. But, finally, the whole thing is up to the state labor departments and not to reformers or welfare workers or employees. Our public officials are put there to do the job for us. They are our representatives, the representatives of the great body of the public, of the trade unionists and also of the men who are not organized but who are still part of the people. It is up to all of us to see that our public officials do their work honestly and with a cer- tain amount of vision, that they do not just stick to the strict letter of the law but go out and do the thing in a whole-hearted, splendid way. In order that they may do that, it is up to us to see that they get suf- ficient appropriations, that they are able to pay sufficient salaries so that they can get and retain the right sort of men, and that they in- sist upon efficiency and do not countenance the retention in office of men who simply want to hang on to good political jobs. Professor Henry W. Farnam, Chairman: I think that the form 366 American Labor Legislation Reviezv in which the topic "State Promotion of Industrial Hygiene", is put, is calculated to awaken in the minds of many people a certain pre- sumption against the proposition. When we talk of the state I think we are very apt to have in mind the old police state. "The state, I'm the state." We sometimes forget that we are the state, that the state is all of us in a democracy. The only question is whether this matter of industrial hygiene is sufficiently important for all of us to get together to try and put something through or whether it is a matter which can be safely left to the individual. We have in our country a very good precedent for the action of the government in these matters. In the first decade after the adop- tion of the Constitution the government established a sick insurance and benefit fund for seamen. It was one of the first systems of the kind in the world. Here was a case where the government singled out a single profession or occupation, known to be particu- larly hazardous, and took extraordinary measures to provide for sickness. The remarkable thing is that in those early and simpler days apparently no one ever thought to contest the constitutionality of that measure, and the consequence was that it went on and wc have developed a great medical system, the United States Public Health and Marine-Hospital Service, out of that small beginning which was an effort by the government to provide for the health of one particular occupation. In connection with the very valuable suggestion thrown out by Dr. Overlock with reference to the establishment of hospitals for industrial diseases, it may be well to state that Dr. Devoto of Milan is expected to be in this country in September in attendance at the International Congress on Hygiene and Demography and I am sure I voice the sentiments of the Association in saying that we second heartily Dr. Overlock's suggestion and hope that someone who has money to give away wisely will establish such a hospital. V BIBLIOGRAPHY ON INDUSTRIAL HYGIENE Trial List of References ON Occupational Diseases and Industrial Hygiene Prepared by the American Association for Labor Legislation United States Bureau of Labor Library of Congress WORKERS IN WHITE-LEAD FACTORY Removing Corroded White Lead From Jars in Which it has been Trans- formed FROM Metallic Plates by the Action of Acetic Acid. Improvised Rag Muzzles the only Protection from Death Dealing Dust BIBLIOGRAPHY ON INDUSTRIAL HYGIENE This preliminary list of titles is here printed in the hope that it may be found immediately useful to the rapidly growing group of Ameri- cans intelligently interested in industrial hygiene. Additions will be made to this list during the year. Copies of all publications on the subject are therefore urgently solicited in order that from this beginning there may be prepared a comprehensive bibliography, conveniently ar- ranged and classified and fully annotated, for the guidance of all who wish to make future work still more effective. AMERICAN TITLES Addams, Jane, Hamilton, Alice. The "piece-work" system as a factor in . the tuberculosis of wage-workers. (Transactions of the Sixth interna- tional congress on tuberculosis, Washington, igo8, v. 3: 139-140.) The effect of fatigue from "speeding up". Adler, L. H., Jr. Report of a case of chronic ariercurial poisoning. (American lancet, Detroit, 1890, n. s. V. 14: 161.) General discussion of mercurial tremor and account of a case in a hatter. A report of five cases of chronic mercurial poisoning. (Med- ical news, Philadelphia, 1891, v. 59: 186-188. Also reprint.) All in hat factory workers. Agnew, C. R. A preliminary analysis of 1,060 cases of asthenopia. New York, 1877. 12 p. With occupation tables for men and wo- men afflicted with this eye disease. Alcohol. Hearings on free alcohol be- fore the Committee on ways and means of the House of representa- tives, February-March, 1906, ist ses- sion, 59th Congress. Washington, government printing office. 1906. 439 P- Testimony upon the effects of wood-alco- liol on the health of workmen. See Index, "Health", p. 436. Aldrich, Charles J. Trap-drummer s neurosis: a hitherto undescribed oc- cupational disease. (Medical news, N. Y., Feb. T, 1903, v. 82:257-258.) Single case due to overstrain of certain muscles. Caisson disease; illustrated with pen drawings of caisson, tunnel, shaft and drift, air-locks, etc. (Cleveland medical gazette, March 1899, V. 14:279-287. Discussion, p. 287-295.) General discussion of symptoms, causes, theories, etc., with account of cases in Ar- kansas. Compressed-air illness, or cais- son disease. (Medical news, N. Y., 1904, V. 85: 1020-1024. Illustrated.) Based on study of 50 cases of caisson disease occurring in the water tunnel under Lake Erie at Cleveland, with description of a caisson, and review of experience else- where. Alger, EUice M. Occupational eye diseases. (American labor legisla- tion review, June 1912, v. 2, no. 2: 223-230.) Allen, J. W. On the need of a pro- gressive study of industrial diseases. (Chicago magazine times, 1907, v. 40: 641-649.) American Association for Labor Leg- islation. First national conference on industrial diseases. Chicago, June 10, 1910. American association for labor legislation. New York, 1910, S2 p. (Publication no. 10. American association for labor leg- islation.) (See Farnam, Favill, An- drews, Henderson, Hamilton, and Hoffman.) Second national conference on industrial diseases, Atlantic City, June 3-5, 1912. American Labor leg- 3/0 Aincyican Labor Legislation Rcviczv islation review, v. 2, no. 2. p. 179-417. (See Thompson, Keays, Fordyce, Dana, Alger, Edsall, Seager, Hoff- man, Hatch, Prait, Cabot, Winslow, Baskerville, Price, Overlock, Wilbur, Gibson, Ryan, and Andrews.) American labor legislation re- view, V. I, no. I (see Hamilton, Schwab, Hoffman, and Memorial on occupational diseases). (Discussion of reporting of diseases by employ- ers, medical inspection of factories, clinic for industrial diseases, mer- curial poisoning in New York and New Jersey, etc., p. 73-95.) V. I, no. 2 (see Hoff- man, Winslow, Elliott, Graham- Rogers, and Laws.) V. I, no. 3 (see Laws). V. I, no. 4 (see An- drews). (Discussion of occupational disease reports, p. 111-137.) V. 2, no. I (see Hotch- kiss.) Leaflets, nos. 1-6. American museum of safety, N.teV York. Safety manual no. 3. Foun- dry practice. Dangers to health in the molding industry. 1912. 44 p. Ames, Azel, Jr. Sex in industry: a plea for the working girl. Boston. Os- good and company. 1875. 158 p. A popular treatment of the results of the investigation into special effects of certain forms of employment upon female health, published in the Sixth Annual Report of the ("Mass.) Bureau of Statistics of Labor (q. v.) by the physician who made the investiga- tion. Andrews, John B. Phosphorus poi- soning in the match industry in the United States. (U. S. Bureau of labor. Bulletin no, 86, Jan. 1910, p. 31-144.) Based on thorough, original investigation of 15 out of the 16 match factories in the United States. Deaths from industrial lead poisoning (actually reported) in New York state in 1909 and lOio. (U. S. Bureau of labor, Bulletin no. 95, July 191 1, p. 260-283.) A personal investigation of 60 deaths re- ported by physicians as due to lead poison- ing. Phosphorus poisoning in the manufacture of matches. (American association for labor legislation, 1910. Publication no. 10: 11-19.) Brief general discussion based on report for United Stales Labor Bureau (q. v.). The beginning of occupational disease reports. (American labor legislation review, Dec. 191 1, v. I, no. 4: 107-113. Discussion, p. Iil- 137.) Reasons for and mam provisions of laws passed in six states in 1911. Legal protection for workers in unhealthful trades. (American labor legislation review, June 1912, V. 2, no. 2: 356-362.) Industrial diseases and occu- pational standards. (Proceedings of the National conference of chari- ties and corrections, 37th session. May 1910, p. 440-449. Reprinted as pamphlet.) Protection against occupation- al diseases. (Academy of political science, New York, v. 2, no. 2: l8- Industrial diseases and physi- cians. (Journal of American medical association, April 15, 191 1, v. 56: 1132-1134.) Beginning of occupational disease reports. (Journal of Ameri- can medical association, Dec. 16, 1911, V. 57: 1984-1986.) Diseases of occupation. (The physician, Aug. 1911, p. 9-15. Ameri- can federationist, June 1911, p. 45S- 457-) Industrial diseases problem. (Proceedings of the National con- ference of charities and corrections, 39th session, June 1912.) Clinic for industrial diseases. (Survey, Nov. 12, 1910, v. 25, p. 268- 270. Illustrated.) A description of the Milan clinic. A match worker. (Survey, Dec. 2, 1911, V. 27, p. 1275. Illus- trated.) Case of phosphorus necrosis. Bard, C. L. Malignant pustule, and insanity due to bisulphide of carbon. (Southern California practitioner, Los Angeles, 1892, v. 7:481-485.) Case of anthrax and discussion of dangers to which shepherds are exposed. Three cases of insanity from bisu'phide of carbon, one in a manufacturer of the substance, and dis- cussion of its uses and ellects on workmen. Bartlett, Elisha. Vindication of the character and condition of the fe- males employed in the Lowell mills. Lowell, 1841, 23 p. Results of personal investigations of health of operatives in 1835 and 1841 (p. 10-14). Bibliography (American) 371 Baskerville, Charles. Air impurities — dust, fumes and gases. (American labor legislation review, June 1912, V. 2, no. 2:305-311.) Bassoe, Peter. Compressed-air dis- ease. (Report of Illinois commis- sion on occupational diseases, Jan. 1911, p. 99-150.) Thorough, up-to-date discussion, with tahle of 161 cases personally investigated, ahstract of work conducted hy Britisli Ad- miralty, abstract of Henry Japp's article (q. v.), text of the New York law, summary of laws in other countries, and suggestions for legislation. Bates, Josephine (White) "Mrs. L. W. Bates." Mercury poisoning in the industries of New York city and vicinity, by Mrs. Lindon W. Bates (New York) National civic federation. New York and New Jersey section (Women's welfare de- partment), 1911, 132 p. Illustrated. Results of an investigation made by the Woman's Welfare Department of the Na- tional Civic Federation, with statistics, des- criptions of processes, and cases. Bauer, Louis. Pathological efl:ects up- on the brain and spinal cord of men exposed to the action of a largely increased atmospheric pressure. (St. Louis medical and surgical journal, May 10, 1870, n. s. v. 7:234-245.) Historically interesting e-xperiencc with caisson disease among workmen on St. Louis bridge. Beard, Geo. M. Our home physician. New York, 1869. "Influence of the occupation on health," p. 332-373. Illustrated. Historically interesting description, pic- tures and statistics of especially danger- ous occupations, Bennett, W. H. Dust as an exciting- cause of disease of the air passages. (Medical record, N. Y., 1872, v. 7: 388-389.) Brief article on dusty occupations. Bergey, D. H. Principles of hygiene. 3rd ed. Philadelphia, 1909. Ch. XI. "Industrial hygiene", p. 268-286. On effects of anilin dyes and nitroben- zine, influence of length of working day on health of laborers, and lighting of industrial establishments. Betts, W, W, Ch.alicosis pulmonum, or interstitial pneumonia induced by stone-dust. (Denver medical times, 1899-1900, V. 19:354-361. Discussion, p. 361-366.) Eased on practice among workers in a cyanide mill, showing great mortality from effects of dust. Billings, John S. Diseases of occupa- tion. (Progress of the world, Aug. 1896, V. 2:248-252.) Good, brief, general treatment in lecture before Pratt Institute. Based on experi- ence in the Philadelphia Hospital, with special descrij-ition of 9 cases. Blumer, G., Young, H. H. A case of anthrax septicaemia in a human be- ing, associated with acute anthrax endocarditis and peritonitis. (Johns Hopkins hospital bulletin, Baltimore, 1895, V. 6: 127-132. Also reprint.) In a hair factory laborer, resulting in death, with report of autopsy. Boston, L. N. Leukocystosis in lead- workers. (Philadelphia medical journal, 1902, v. 10:441-443. Also Proceedings of the Philadelphia county medical society, 1902-3, v. 23: 246-250.) Bowen, John T. Acute infectious pem- phigus in a butcher, during an epi- zootic of foot and imouth disease, with a consideration of the possi- ble relationship of the two affec- tions. (Journal of cutaneous dis- eases, 1904, v. 22, p. 253-265. Illus- trated.) Braymer, O. W. The sanitary inspec- tion of factories. (Journal of the American medical association, Chi- cago, 1896, V. 26:320-323.) Urging importance of proper legislation and factory inspection. Brigham, Charles H. Influence of oc- cupations upon health. (Michigan State board of health report, 1875, p. 41-54.) General descriptions of effects of dust, bad air, noise, eyestrain, etc., and possible safe- guards. Brooks, Harlow. Caisson disease; the pathological anatomy and patho- genesis, with an experimental study. (Long Island medical journal, April 1907. V. i: 149-158.) Thorough discussion of the history, theo- ries, etc., with medical history of cases and autopsies. A study of blood pressure in compressed-air workers. (Medical record, N. Y., 1907, v. 71:855-857.) Observations in 75 cases occurring in employees of the Belmont Tunnel. Brose, L. D. Amaurosis following the entrance of a well after the use of dynamite. (Archives of ophthalmol- ogy. N. Y.. 1899, V. 28:402-406.) T:\o capes of iir-scration and temporary blindness in a farmer and his rescuer. Broughton, M. The "bends." [Cais- 372 American Labor Legislation Review son disease.] (Medical tribune, N. Y., 1882, V. 4: 185-195.) General discussion based largely on Dr. Smith's pamphlet (q. v.) with description of case in employee of Hudson River Tunnel. Burr, C. W. Occupation spasms. (In A text-book on nervous diseases by American authors. Ed. by Francis X. Dercum, 1895, p. 276-279.) Brief discussion of various occupational cramps. Burrell, H. L. The report of a case of anthrax. (Transactions of the American surgical association, Phila., 1893, V. 11:309-328. Also Annals of surgery, Phila., 1893, v. 18:605-622. Illustrated. Bibliography.) Thorough discussion of the disease as manifested in a longshoreman who had been handling hides. Butler, Elizabeth. Women and the trades: Pittsburgh, 1907-1908. The Pittsburgh survey. Charities pub- lication committee, N. Y., 1909. "Health," p. 358-367. Summary of health conditions among women workers in Pittsburgh. Cabot, Richard. The function of hos- pitals and clinics in the prevention of industrial diseases. (American labor legislation revievi^, June 1912, v. 2, no. 2: 293-296.) Caisson disease and a safety apparatus for pneumatic caisson locks. (En- gineering record, N. Y., 1904, v. 49: 112-113.) Brief description of disease, and descrip- tion and pictures of a device for reducing pressure gradually, invented by Mr. W. I. Aims, engineer of the New York Tunnel Co. Caisson disease. Cases of. (Medical and surgical reports, Presbyterian hospital. New York, 1896.) Callan, L. W. Double choked discs associated with compressed-air dis- ease. (Archives of ophthalmology. N. Y., July 1907, v. 36:509-512.) Case in a tunnel worker, and general dis- cussion of effects of compressed air on the eyes. Camac, C. N. Bancker. Chromic acid poisoning, (Cornell university med- ical college bulletin, Jan. 1905.) Cancer mortality in the United States, by occupations, (In Tenth census, vital statistics, v. 2: S76-577.) Canfield, W. B. Relation of dusty oc- cupations to pulmonary phthisis. (Transactions of the medical and chirurgical faculty, Maryland. Balti- more, 1889, Report of the section of practice of medicine, p, 106-110, Also reprint,) Describes case of a slate miner. Carpenter, J. T. Mining, considered with regard to its effects upon health and life. (Transactions, Medical society of Pennsylvania, Phila., 1869, 5. s. pt. 2:487-491.) General discussion of effect of coal min- ing on the health of miners. Chace, D, E. Diseases of shop-girls in notes of private practice, (Med- ical society of the County of Kings, Brooklyn, Proceedings, June 1881, v, 6:83-89, Discussion, p, 89-91,) Record of 150 cases, argijing that lack of seats is not particularly injurious, Chadbourne, A. P. The gastric and respiratory symptoms caused by the dust of curled hair, (Boston medi- cal and surgical journal, 1894, v, 130: 439-) Case of a man who had worked 20 years in a mattress factory Chancellor, C. W. Impure air and un- healthy occupations as predisposing causes of pulmonary consumption, (American public health association report, 1885, Concord, N, H,, 1886, v, II : 67-72,) General discussion of indoor and dusty occupations, Chaney, Lucian W, Employment of women in the metal trades, (Report on condition of woman and child wage-earners in the United States. 6ist Cong,, 2d sess,, Senate doc, 645, v, II, "Legal provisions against industrial dangers and diseases," p, i6-t8; "Light and ventilation, dust and fumes," etc. p, 22-26,) General results of extensive, official in- vestigations, Chapin, J. B. Insanity following ex- posure to fumes of mercury. (Amer- ican journal of insanity, Utica, N, Y., 1863-4, v, 20:335-338,) General discussion and description of a single case in a blacksmith who had been engaged for two years in "retorting gold," or driving off the mercury by means of high temperature, Chenery, Wm. Ludlow, Occupational diseases, (Independent, Feb, 9, 1911, V, 70: 306-309,) Popular article based on Dr, Hamilton's report for the Illinois Commission on In- dustrial Diseasps and Dr, Andrews' report for the U, S, Labor Bureau fq, v,), Cheney, Horace B,, La Rue, Omer, Report of factory conditions in Con- necticut as related to tuberculosis. Bibliography (American) 373 (Connecticut public document, spe- cial. Hartford, 1908. 8 p.) Part of report of special committee to in- vestigate tuberculosis, with special reference to the future enactment of laws to prevent its spread. Church, John A. Accidents in the Comstock mines and their relation to deep mining (Transactions of the American institute of mining engineers, 1879-1880. v. 8:84-97. Abstract in Scientific American, Nov. I, 1879, V. 55:272-273.) On the effects of excessive heat on min- ers, — fainting, insanity, prostration, and death. Clark, E. A. Effects of increased at- mospheric pressure upon the human body with a report of thirty-five cases brought to city hospital from the caisson of the St. Louis and Il- linois bridge. (Medical archives, St. Louis, Sept. 1870, V. 5: 1-30.) Valuable historically, not theoretically. Clark, J. F. Mercurial tremor. (Med- ical record, N. Y., 1893, v. 43: 13.) Single case in a hatter, with description of his work. Clark, L. P. Occupation neurosis or ironer's cramp. (Medical record, N. Y., 1896, V. 50:642.) Single case in a laundress. Clendening, L. Muscular spasms due to heat in cooks on Pullman diners. (Journal of American medical asso- ciation, Chicago, 1910, V. 54: 1517.) Brief account of single case. Clothing, Men's ready-made. (Report on condition of woman and child wage-earners in the United States, 6ist Cong., 2d sess.. Senate doc. 645. "Health and hygienic conditions" (home work), v. 295-298; "Ventila- tion of workrooms," v. 2:321-322.) General results of a thorough ofRcial in- vestigation in New York and other cities. Coleman, J. W., Jerome, A. T. Some pathological conditions to which the miner is peculiarly liable. (Colora- do medical journal, Denver, 1902, v. 8:99-101. Also Medical dial, Minne- apolis, 1902, V. 4: 183-184.) Effects of powder smoke, heat, dust, etc., especially on metal miners. Cook, J. C. Physical effect of child labor upon the individual. (Illinois medical journal, Springfield, 1902-3, n. s. V. 4:509-510.) Brief, general article. Cooseman, E. The hearing-power of beetlers; contribution to the study of occupation deafness. (Archives of otology, N. Y., 1899, V. 28: 413-) Linen-workers in Belgium. Coplin, W. M. L., and others. The ef- fects of heat as manifested in work- men in sugar-refineries. (Medical news, Sept. 3, 1892, v. 61:262-266.) E-xperience with over 200 cases in a single refinery in Philadelphia during period of eight days. Corning, J. L. Observations on the caisson or tunnel disease, with notes on nine cases which occurred at the engineering works known as the Hudson river tunnel. (Medical record, N. Y., 1890, v. 37:513-521. Illustrated. Bibliography.) Corporations and operatives. Lowell, 1843, 72 p. (Jn health conditions among factory oper- atives in Lowell, p. 35-40. Cotton textile industry. (Report on condition of woman and child wage- earners in the United States, 6ist Cong., 2d sess., Senate doc. 645. Pre- pared under the direction of Chas. P. Neill, commissioner of labor. "Hygienic conditions of mills," v. 1:3,58-367.) Kesults of extensive investigations, in the ^orth and the South, of lighting, venti- lation and humidity, dust and lint, and spit- ting on floors. Cotton and woolen operatives. Dis- eases and disease tendencies of oc- cupations. (New Jersey bureau of statistics of labor and industries, twenty-fifth annual report, 1902, p. 377-382.) General description and statistics of sick- ness and death. Cov/gill, J. E. Occupation as affecting the death rate. (Medical examiner and practitioner, N. Y., July 1901, V. 11:339-341-) General discussion from actuarial point of view, with classification of occupations and census and life insurance company statistics. Mortality of the United States: diagrams of tlie mortality by occupation. Indianapolis, 1901. Crabtree, J. H. The methods of dust extraction on cotton-carding en- gines: safeguarding the working- man's health. (Scientific American, Dec. 30, 1911, V. 105:592-593. Illus- trated.) Practical. Crawford, H. M. Medical appliances for health and safety in the weaving industry. (Cassier, Dec. 1910, v. 39: 117-134. Illustrated.) Mainly on accidents, but describes and gives pictures of safe methods of thread- ing shuttles. 374 American Labor Legislation Review Mechanical appliances for dust extraction in cotton mills. (Gas- sier, Nov. 191 1, V. 40: 579-596. Illus- trated.) With 21 illustrations of respirators, dust extractors and exhaust fans. Crum, Frederick S. Health and imor- tality of the cotton mill operatives of Blackburn, England. 23 p. (Med- ical record, Aug. 11, 1906, v. 70:207- 213. Also reprint.) Occupation mortality statis- tics of Sheffield, England. 1890- 1907. (Publications of the American statistical association, Dec. 1908, v. 11:309-318.) Two reviews of English reports. Statis- tics. The mortality from consump- tion in small cities. (Quarterly pub- lications American statistical asso- ciation, Boston, Dec. 1907, v. 10:448- 479-) Influence of occjpations, with statistics, p. 463-466. Curtis, Josiah. Public hj'giene of Mas- sachusetts; but more particularly of the cities of Boston and Lowell. ^Transactions of American medical association, 1849, v. 2:487-554. Sum- mary quoted in Documentary his- tory of American industrial society, V. 8: 187.) On lack of ventilation in mills and board- ing houses of Lowell (p. 513-519). Dana, Charles Loomis. Text-book of nervous diseases and psychiatry, for the use of students and prac- titioners of medicine. 7th ed. New York, W. Wood and company, 1908, xii, 782 p. "Professional neuroses, occupation neuroses": p. 609-617. Excellent treatment of occupational cramps. Occupational nervous and mental diseases. (American labor legislation review, June 1912, v. 2, no. 2: 217-222.) Occupational neuroses. (Med- ical record, Feb. 3, 1912, v. 81, no. 10:451-459. Illustrated.) Elaborate clinical study of 100 cases, giv- ing occupations of patients. Darlington, T. The effect of the pro- ducts of high explosives, dynamite, and nitro-glycerine, on the human system. (Medical record, N. Y., 1890, v. 38:661-662. Also reprint.) Based on experience as surgeon of the Croton Aqueduct and of Arizona mining and railroad companies. Darwall, J. Diseases of artisans. (In Ziemssen's Cyclopedia of practi- cal medicine, Phila., 1845, v. 1:17a- 182.) Davis, I. P. Diseases occurring in 'manufacture of rubber boots and shoes. (Tenth annual report of the board of health of New Jersey, 1886, Trenton, 1887, p. 195-200.) Describes processes of manufacture, con- ditions of work and danger of lead poison- ing, etc. Dennis, L. Hatting as affecting the health of operatives. (Report of the New Jersey State board of health. 1878, p. 67-85. Also Report of the Connecticut board of health, 1882, Hartford, 1883, p. 41-59.) Description of processes and statistics of 168 cases of mercury poisoning among 1546 hatters. Detmold, W. The physiological effect of highly condensed air on the hu- man body. (New York journal of medicine, 1843, v. 1:185-189.) Description of the use of compressed air in mining and its effect on the miners, based on German article. Interesting as the first American article on caisson disease. Dickey, John L. "Nailers' consump- tion" and other diseases peculiar to workers in iron and glass. (West Virginia State board of health re- ports, 1881-1884. p. 149-154.) ^ Describes briefly work and its dangers, with typical case of "nailers' consumption". Diseases of occupation. (Report of the Chicago industrial exhibit, March, 1908.) Diseases and disease tendencies of oc- cupations. (New Jersey bureau of statistics of labor and industries, twenty-fourth annual report, 1901, P- 347-354-) General discussion. Dock, George, Bass, Charles C. Hook- worm disease. St. Louis, 1910. 250 p. Describes briefly .St. Gothard Tunnel epi- demic, the anemia of brick workers, miners, etc. p. 22-23, 33-37. Hookworm disease in the United States, p. 37-45, etc. Doehring, C. F. W. Factory sanita- tion and labor protection. (U. S. Bureau of labor, Bulletin no. 44, Jan. 1903, p. 1-131.) Extended treatise on factory conditions and industrial processes injurious to health, with lists of injurious dusts and poisons and descriptions of the lead manufacturing and using industries, and of dangerous processes in the manufacture of oilcloth and linoleum, linseed oil, tallow, and fertilizers. Describes Bibliography (^■Imcricaii) 375 methods of safeguarding workmen. Based mainly on European experienee and inves- tigations in a few faetories in the United States. Donaldson, Frank. The influence of city life and occupation in devel- oping ^ pulmonary consumption. (American public health association. Reports and papers, v. 2:95-114. New York, 1876.) Mainly on general influence of city life, but shows briefly influence of sedentary and indoor occupations (p. 106-7J. Drake, Daniel. The principal diseases of the interior valley of North America. "Cotton ginning," v. 2: 799-801. Draper, Frank W. Arsenic in certain green colors. (Massachusetts State board of health report, 1872, p. 18- 57.) Effects on workmen, with specific in- stances, p. 52-56. Dudley, P. The metal worker's occu- pation and his health. (Report of the board of health, etc., of Penn- sylvania, 1888-9, fifth annual. Har- risburg, 1891, p. 374.-377.) Brief general discussion of the effects of dust, especially as a cause of consumption. Dust and its relation to disease. (Iowa State board of health report, 1906, p. 105. Illustrated.) Pictures of lungs of coal miners, lead miners, steel grinders, etc. Dusty occupations and the dust prob- lem. (See reports of state factory inspection departments and of state labor bureaus.) Dusty trades in Massachusetts. (Monthly bulletin of the Massachu- setts State board of health, Aug. 1910, v. 5:316-379. Illustrated.) Mainly illustrations, with brief descrip- tions. List of processes declared injurious to the health of minors by State Board of Health, July 7, 1910, p. 378-9. Dutton, Walton Forest. Vanadium-, ism. (Journal of American medical association, June 3, 191 1, v. 56: 164S.) Brief description of the poisoning to which employees are subject in establish- ments where vanadium is produced. Eads, James B. Report to the presi- dent and directors of the Illinois and St. Louis bridge co., 1870. On compressed-air illness in employees. Edsall, David L. Diseases due to chemical agents. (In Osier's Mod- ern medicine, 1907, v. 1:83-155.) Authoritative treatise on chronic poison- ings, with special reference to occupational causes. Industrial poisoning. (Amer- ican labor legislation review, June 1912, V. 2, no. 2:231-234.) Some of the relations of occu- pations to medicine. (Journal of American medical association, Dec. 4, 1909, V. 53: 1873-81. Wisconsin medical journal, Jan. 1910, v. 8:425- 447.) (.jood general discussion of the disease tendencies of occupations. Elliott, E. Leavenworth. Factory lighting: topical criticism of exist- ing laws. (American labor le,gisla- tion review, June 1911, v. i, no. 2: 110-112.) Brief criticism of existing laws, with su.g- gestions for improvements. Elliott, W. C. Measures to protect workers in factories and elsewhere from noxious dust and fumes. (Transactions of the Medical society of Wisconsin, Madison, 1896, v. 30: 360-362.) Brief plea for the protection of the mclal polislier. Emerson, Nathaniel B., Tracy, Roger 5. On the manufacture of ci.gars in tenement houses. (New York city board "of health report, 1874-7S, p. 649-656.) Ivcsults of personal investigation of air, light, ventilation, etc., with spi^cial reference to the effects on the healtli of workers and their families. Endemann, H. The operations of cleansing hair and manufacturing felt. (New York city board of health report, 1872, p. 305.) Brief account of dust conditions, advo- cating use of respirators by working people. Erdman, Seward. Aeropathy or com- pressed-air illness among tunnel workers. (Journal nf American medical association, Nov. 16, 1907, V. 49: 1665-1670.) General review of history, theories, etc. Exline, J. W. The sanitation of mines. (Transactions of the Colorado med- ical society, Denver, 1S96, p. 235-242. Also Medical age, Detroit, 1897, v. 15:99-102.) General discussion, with special reference to the prevention of disease in Colorado mines. Fantus, B. The diagnosis and treat- ment of plumbism. (Illinois medical journal, Springfield, 1910, v. 17:616- 621.) Mainly technical, but names trades which are most likely to produce plumbism, and gives special attention to symptoms. 376 American Labor Legislation Review Farrar, J. N. Importance of direct sunlight in the workroom; useful- ness in art, and its bearing upon the general health. (In American dental association. Transactions, 1877. Elgin, 1878, V. 17:77-85.) General argument applied mainly to health of dentists, but using as illustrations Wa\- tham and Elgin watch factories (p. 83-84). Favill, Henry Baird. Importance of industrial hygiene. (American asso- ciation for labor legislation, 1910. Publication no. 10:9-11.) Brief remarks as presiding officer at First National Conference on Industrial Diseases. Industrial hygiene and the police power. A reprint of a paper, prepared for the American associa- tion for labor legislation, on the Legitimate exercise of the police power for the protection of health. (From the Thirteenth biennial re- port of the Wisconsin bureau of labor and industrial statistics. Mad- ison, Wisconsin, 1908, p. 479-486. Also in Transactions of the Sixth international congress on tubercu- losis, Washington, 1908.) Shows the necessity for extensive regula- tion of unhealthful trades, based on scien- tific research. The toxin of fatigue. (Pro- ceedings, Thirty-seventh annual ses- sion of the National conference of charities and corrections, p. 405-414.) On f«atigue as a factor in standardizing hours of labor. Female health. Special effects of cer- tain forms of employment upon. (Sixth annual report of the Massa- chusetts bureau of statistics of labor, 1875, part II, p. 67-112.) Describes especially the manufacture of textile fabrics, typesetting, telegraphy, and sewing machine labor. Fisher, Irving. Industrial hygiene as a factor in human conservation. (Academy of political science, New York, V. 2, no. 2: 1-9.) Relates primarily to women and children. Fitch, John A. The steel workers. The Pittsburgh survey. Charities publication committee, N. Y., 1911, "Health and accidents in steel mak- ing", p. 57-75. Effects of heat, dust, noise, nervous strain, and long hours. Foley, J. L. The influence of occupa- tion in skin diseases. (Journal of cutaneous and genito-urinary dis- eases, N. Y., 1889, V. 7:170-178.) General discussion and classification of occupational skin diseases by a London (Eng. J physician. Fordyce, John A. Occupational skin diseases. (American labor legisla- tion review, June 1912, v. 2, no. 2: 206-216.) Occupational diseases of the skin. (Medical record, N. Y., Feb. 3, 1912, V. 81:207-210.) Practically same as article in American Labor Legislation Review, v. 2, No. 2 (q. v.). Freeman, J. Addison. Mercurial dis- eases among hatters. (Transactions New Jersey state medical society, i860, p. 61-64.) One hundred cases in Orange and cases in other New Jersey cities. French, John Marshall. Occupation in relation to longevity. (Medical examiner and practitioner, N. Y., Jan. 1904, V. 14:26-28.) Statistical study based on Massachusetts registration report for 1886. Occupation and longevity. (x^nnals of hygiene, Phila., 1896, v. 11:80-82.) Brief, general discussion. Freudenthal, Wolil. In what relation does occupation stand to tubercu- losis? (Medical news, Philadelphia, Sept. 15, 1900, V. 77:402-404.) Results of investigation of 1,576 cases, with statistics of occupations and special discussion of tuberculosis among tailors. Furey, G. W. Obesity among loco- motive engineers. (Medical bulle- tin, Philadelphia, 1889, v. 11:211- 212.) With table showing weight of 19 men on becoming engineers and "present weight." Gallivan, J. V. The etiology of cais- son disease; theories based on clin- ical observations of the disease. (Long Island medical journal, April 1907, V. i: 181-183.) Account of a case, and theories of causes of the disease. Gardner, A. K. Hygiene of the sew- ing machine. (American medical times, Dec. 15, 22, i860, v. 1:420- 421, 435-437. Also Bulletin of the New York academy of medicine, 1860-62, V. i: 100-108.) Argument that use of sewing machines is not injurious to health of women. Garvin, L. F. C. Sanitary require- ments in factories: injurious effects of cotton factories upon the health of operatives. (Transactions of the American public health association, N. Y., 1877, V. 3:69-78.) Bibliography (American) 377 An argument, based on several years' med- ical practice in a Rhode Island factory vil- lage, for child labor legislation, regulation of hours, and medical factory inspection. George, H. The poisons of the man- ufactory. (Popular science monthly, N. Y., 1882, V. 21:663-667.) Brief general article on industrial poisons, lead, mercury, phosphorus, etc. Getchell, Albert C. The relation of the industries of Worcester to tuber- culosis. (In Tuberculosis in Massa- chusetts, ed. by Edwin A. Locke, p. 187-192.) Based on personal observation of 1000 cases. Gibson, Harold K. Medical inspec- tion of factories in Illinois. (Amer- ican labor legislation review, June 1912, V. 2, no. 2:346-349.) Gilbert, G. R. Effects of gases and powder smoke upon coal miners' eyes, and the treatment to be used. (Therapeutical gazette, Detroit, 1903, 3. s. V. 19:529-532.) Based on experience as surgeon of a coal mining company in Wyoming. Gilchrist, T. C. Erysipeloid, with a record of 329 cases, of which 323 were caused by crab bites or les- ions produced by crabs. (Journal of cutaneous diseases, 1904, v. 22: 507-519-) Description of disease and cases, some of them due to occupational causes. Gilliam, D. T. Miner's wrist. (Ohio imedical recorder, Columbus, 1878, v. 2:542-543.) Based on personal observations. Glass industry. (Report on condition of woman and child wage-earners in the United States, 6ist Cong., 2d sess., Senate doc. 645. Prepared un- der the direction of Chas. P. Neill, commissioner of labor, v. 3. "Dif- ficulty and physical strain of the work", p. 47-59; "Dust and fumes" and "Heat conditions", p. 65-80; "Causes of death of glass blowers and diseases of glass workers", p. 237-277; "Light, ventilation, and overcrowding", p. 341, 342; "Rela- tion of the work to health", p. 433- 447; "Special features of the work" of making incandescent electric lamps, and "Ventilation", p. 477-487, 500, 501.) Results of extensive, official investigations. Diseases incident to the glass industry. Diseases and disease ten- dencies of occupations. (New Jer- sey bureau of statistics of labor and industries, twenty-fourth annual re- port, Trenton, 1902, p. 35S-363; 373" 39I-) Description of unhealthful occupations, statistics of sickness and death, and sched- ules from 24 establishments, filled in by employers. Goldmark, Josephine. Fatigue and ef- ficiency: a study in industry. Char- ities publication committee for the Russell Sage foundation. New York, 1912, 890 p. Thorough, scientific, and authoritative study based on European and American ex- periments and experience, and on European authorities. Part II consists of material used in four briefs for the regulation of the hours of women. Goltman, A. A case of occupation neurosis. (New York medical jour- nal, 1898, V. 68:625-626.) In a cigarette roller. Gonley, John W. S. Excision and dis- articulation of the entire inferior maxillary bone for phosphorus ne- crosis. Philadelphia, 1877, 6 p. History of interesting case and operation in 1864. Gordon, John A. Tuberculosis among the granite workers of Quincy. (In Tuberculosis in Massachusetts, ed. by Edwin A. Locke, p. 193-200.) Based on analysis of death records of Quincy, Mass. Graham-Rogers, C. T. Protection from gases, fumes and vapors: top- ical criticism of existing laws. (American labor legislation review, June 1911, V. I, no. 2: 110-112.) Medical inspection of indus- trial plants. (Proceedings of the eighth annual conference of sani- tary officers of the state of New- York, Albany, Dec. 1-3, 1908. Twen- ty-ninth annual report of the N. Y. state department of health, Albany, 1909, p. 726-736. Discussion, p. 736- 742. Also North American journal of homoeopathy, 3, s. v. 24: 386-39S-) General description of the work of the sanitary inspector of factories, with remarks on physical condition of the working child. Report of medical inspector of factories. New York. (Eighth annual report of the commissioner of labor, for the year ended Sept. 30, 1908. Appendix II, p. 65-94, Albany, 1909.) (Ninth annual report of the commissioner of labor for the year ended Sept. 30, 1909. Appendix i?^ American Labor Legislation Reviciv II, p. 6S-91. Albany, 1910.) Includes special investigation of the calico print industry, bakeries in Manhattan bor- ough, and potteries. (Eleventh annual report of the commissioner of labor for the year ended Sept. 30, 1911. Appendix II, p. 69-133. Albany, 1912.) Includes special investigation of ventila- tion of a department store and of the cloak and suit industry in New York City. (Tenth annual report of the commissioner of labor for the year ended Sept. 30, 1910. Appendix II, p. 62-111. Albany, 1911.) Includes special investigation of the phos- phorus match industry and the pearl button industry. These reports contain valuable data con- cerning the sanitation and ventilation of fac- tories, the results of air analyses, etc. Ventilation of industrial es- tablishments. (American journal of public hygiene, Boston, June 1910, v. 20:245-251.) Brief description of the work of the Medi- cal Inspector of Factories of New York, with special reference to air analyses. Medical inspection of indus- trial plants. (North American jour- nal of homoeopathy, N. Y., 1909, v. 57:386-395-) Green, Charles Lyman. Medical ex- amination for life insurance. "Oc- cupation", Phila., 1900 ed. p. 147; 2nd ed., Phila., 1905, p. I55-I57-) Brief discussion from point of view of life insurance risks, of occupations involv- ing injurious exercise. Green, J. O. The factory system in its hygienic relations. (Medical com- munications, Massachusetts medical society, Boston, 1842-8, v. 7:217-248. Also reprint.) Extended discussion of Lowell factory system and its effects on the health of opera- tives, with mortality statistics, and brief ac- count of English factory system, especially hours and child labor. Griswold, S. Case of poisoning by ar- senic from working in Scheel's green. (New York journal of med- icine, 1858, 3. s. V. 5:64-77.) Death of a fourteen year old boy who had been woti^mg in an establishment for the manufacture of paper han.eings, with account of proceedings of the coroner's jury. Guilford, Paul. Will certain occupa- tions in time affect the cylindrical curvature of the eyeball? (Ophthal- mic record, Chicago, Sept. 1903, n. s., V. 12: 426-428.) Results of examination of 22 locomotive engineers over 50 years of age. Gulick, Luther. The effects of mental fatigue. (World's work, Sept. 1907, V. 14: 9345-9349. Also in his Mind and work, N. Y., 1908, p. 89-109.) Hackley, Chas. E., Walter, Emma E. Caisson disease. (In Reference handbook of the imedical sciences, Albert H. Buck, ed. v. 2:547-8.) Brief general discussion. Haines, Walter S., Karasek, Mathew, Apfelbach, George L. Carbon mon- oxide poisoning. (Report of Illin- ois commission on occupational dis- eases, Jan. 1911, p. 88-98.) Based on original investigations in Illinois steel and illuminating gas industries, with suggestions for prevention and treatment. Hall, H. N. Preventive medicine among the working classes. (Med- ical news, Philadelphia, 1891, v. 58: 462-465.) Based on experience as physician of the Crane Company, Chicago, and covering occu- pational and other diseases. Hall, J. N. Trainman's back. (Na- tional association of railway sur- geons. Official report of the fifth annual meeting. Chicago, 1892, p. 88-91.) Based on experience among employees of the Union Pacific Railway. Hamilton, Alice. White-lead indus- try in the United States, with an appendix on the lead-oxide indus- try. (U. S. Bureau of labor. Bul- letin no. 95, July 1911, p. 189-259.) Based on personal investigation of 22 out of 25 factories manufacturing white lead in the United States. Report on investigations of the lead troubles in Illinois from the hygienic standpoint. (Report of Illinois commission on occupational diseases, Jan. 1911, p. 21-49.) Covers some fifteen different industries. Report on arsenic (p. 47-48). Lead poisoning in Illinois. (American association for labor leg- islation, 1910. Publication no. 10; 27-35-) Brief general discussion based on pre- liminary investigations for her report to Illinois Commission on Occupational Dis- eases (q. v.). Lead poisoning in Illinois. (American labor legislation review, Jan. 1911, v. I, no. 1:17-26. Bulle- tin of the American economic asso- ciation, fourth series, no. 2:257-264.) Lead poisoning in Illinois. (Journal of the American medical association, April 29, 1911, v. 56. 1 240- 1 244.) Bibliography (American) 379 Two general discussions, with comparison of condiCions in Jiuvope and in Illinois. Occupational diseases. (Hu- man engineering, 1911, v. i;i42-i49.) Industrial diseases, with spe- cial reference to the trades in which women are employed. (Charities and the commons, Sept. 5, 1908, v. 20:655-659.) Hamilton, Allan McLane. On manu- facturing establishments where lead and arsenic are used. (New York city board of health report, 1S72, p. 312-314.) . Descriptive account of an investigation of several typefoundries, lead-smelting, and shot and lead-pipe manufactories. On the liability of car-drivers to certain forms of disease. (New York city board of health report, 1873, p. 444-S-) Diseases of circulatory and nervous sys- terns due to long hours of labor. Hamlin, A. C. Consumption as affect- ed by seafaring pursuits. (Report supervising surgeon, marine hospital service, 1875. Washington, 1876, p. 187-190.) Brief, general discussion. Hanson, W. C. Attitude of Massa- chusetts manufacturers toward the health of their employees. (U. S. Bureau of labor. Bulletin no. 96, Sept. 191 1, p. 488-500.) On health and welfare work and Worccs- ter tuberculosis movement. The work of the state inspec- tors of health. (In Tuberculosis in Massachusetts, ed. by Edwin A. Locke, Boston, 1908, p. 18-28.) Brief description of their duties in fac- tories and workshops. The effect of industry on health. Boston, 1907, 12 p. (Bos- ton medical and surgical journal, April 4, 1907, V. 156:421-425. Also reprinted as pamphlet.) Brief review of investigation conducted by Dr. Charles Harrington (q. v.) for tlie Massachusetts State Board of Health, into the sanitary condition of factories, workshops and other establishments. Protection of factory em- ployees against dust arising from certain occupations. (American journal of public hygiene, Boston, June 1910, V. 20:239-244.) Description of methods used by State Inspectors of Health in enforcing the two Massachusetts laws relating to dust. The health of young persons in Massachusetts factories. (Bos- ton medical and surgical journal, 1910, V. 162:313-314. Proceedings Sixth annual conference on child la- bor, Boston, Jan. 13-16, 1910, p. iii- 113).. Brief account of duties and opportunities of the Massachusetts State Inspectors of Health. Plard, William. Where poison haunts man's daily work. (Munsey's mag- azine, Sept. 1907, V. 37:717-721.) Popular article on occupational poisons and caisson disease. Hare, Hobart Amory. New and al- tered forms of disease, due to the ad- vance of civilization in the last half century. Philadelphia, P. Blakiston, son & CO., 1886, 71 p. Caisson disease, phosphorus necrosis, lead poisoning, etc. Harrington, Charles. A manual of practical hygiene for students, phy- sicians, and medical officers, 4th ed., revised and enlarged by Mark Wyman Richardson. Philadelphia and New York, Lea and Febiger, 1911, 13, 17-760 p. "Hygiene of oc- cupation": p. 716-742. Tliorough general treatise on the causes of industrial diseases, including classilica- tion and description of unhealthful occupa- tions, and brief discussion of employment of women and children in such occupations. Report of the Massachusetts State board of liealth upon the san- itary condition of factories, work- shops and other establishments where persons are employed. Bos- ton, Wright & Potter printing co. state printers, 1907. 144 p. Run- ning title: Dangerous occupations Senate. No. 250 Continuous report pub. in thirty- sixth Annual report of the Board 1903-04, p. xxii-xxxi. Results of a special investigation of dan gerous processes in some 65 different Indus tries, with special attention to boot and shoe and textile factories. Harris, Henry J. Workmen's insur- ance in Austria and Germany. (In Twenty-fourth annual report of the U. S. commissioner of labor, 1909, V. I. Also reprints. Statistics of sickness in Austria, 1890-1895, p. 293- 395. Statistics of sickness in Ger- many, p. 1243-1251; "Sickness sta- tistics of the Leipzig local sick fund", p. 1255-1354.) Hatch, Leonard W. Compulsory re- porting by physicians. (American 38o American Labor Legislation Review labor legislation review, June 1912, V. 2, no. 2: 264-272.) State control of occupational diseases. (Medical record, N. Y., Feb. 3, 1912, V. 81:202-205.) Explanation of need for and purpose of New York law requiring the reporting of occupational diseases. Hatters, Vital statistics of. (Semi- annual reports of the United hatters of North y\merica.) Hatting industry, Health conditions of the. Diseases and disease tenden- cies of occupations. (New Jersey bureau of statistics of labor and in- dustries, twenty-fourth annual re- port, Trenton, 1902, p. 365-371, 392- 399. Continued in twenty-fifth an- nual report, 1903, p. 361-362.) Description of processes dangerous to health. Publishes schedules filled in by em- ployers for 11 establishments. Hayes, Denis A. Length of trade life in the glass bottle industry. (An- nals of the American academy of political and social science. May 1906, V. 27, no. 3:34-41.) General discussion, without statistics, mainly of child labor. Hayhurst, Emery R. Report of the investigation of the brass manufac- turing industry, Chicago (Cook county), and the zinc smelters of La Salle county, Illinois. (Report of Illinois commission on occupa- tional diseases, Jan. 1911, p. 49-84.) Results of original investigation. Brass chills: brass moulder's secret. (Survey, Sept. 23, 1911, v. 26:879-82. Illustrated.) General discussion based on results of his investigations for Illinois Commission on Oc- cupational Diseases fq. v.). Health and duration of trade life of workmen, The effect of occupation on. (New Jersey bureau of statis- tics of labor and industries, twelfth annual report, p. 1-303; thirteenth annual report, p. 357-413; fourteenth annual report, p. 171-234; fifteenth annual report, p. 347-432; seven- teenth annual report, p. 81-135; eigh- teenth annual report, p. 63-161, 18S9- 1895.). Statistics of ages at beginning work, ages of journeymen beginning to decline, causes of decline and of incapacity, etc., by occu- pations, with descriptions of industrial pro- cesses and conditions. Health, The relation of occupation to. (New Jersey bureau of statistics of labor and industries, thirty-third annual report, Paterson, 1910, p. 167-178.) General discussion with brief description of health measures in use in certain estab- lishments. Health and its relation to occupation. (Ohio bureau of labor statistics, tenth annual report, 1886, p. 206.) Health and morals in their relation to occupation. (New York bureau of labor, first annual report, 1885, p. 85.) Health in industries. (Montana bu- reau of agriculture, labor and indus- try, first annual report, Helena, 1893, p. 18-132.) Individual reports of quartz miners, smelt- er men, engineers, and others, showing health at beginning work, health "now", and sanitary conditions of their work. Analysis of these reports by occupations. Health in industry. (Wisconsin bu- reau of statistics, third biennial re- port, 1887-88, p. 189-213. Table V. "Trade statistics, showing peculiar- ities of occupations, ailments of workmen," etc.) Compiled from reports made by workmen as to bodily ailments peculiar to their trades. Health in various industries and causes of decline. (New Jersey bureau of statistics of labor and industries, sixth annual report, Trenton, 1883, p. 80-109.) Tables, showing age at which the work- men begin to decline, age at which they be- come incapacitated for active work, and dis- eases peculiar to the trade, for glass, silk, cotton, woolen, hat, and other industries. Health of employees in various in- dustries. (California bureau of la- bor statistics, fifth biennial report, Sacramento, 1891-92, p. 245-465.) Tabulated statements of individual wage earners showing time lost by reason of sickness. Heaton, James P. World-wide fight against phosphorus poisoning. (Sur- vey, Dec. 3. 1910, v. 25:384-388.) Popular, general article. Hedger, Caroline. The relation of in- fant mortality to the occupation and long hours of work for women. (Bulletin of the American academy of medicine, Easton, Pa., 1910, v. 11:80-89. Discussion, p. 89-91.) Effect of work on health of women, with mortality statistics for Fall River, Provi- dence, Chicago, and York (Eng.). Heinemann, O. S. Necrosis of the maxillae by phosphorus poisoning. (Ohio dental journal, Toledo, 1901, v. 21 : 215-219.) Bibliography (American) 381 General discussion with special reference to lucifer-match workers. Henderson, Charles R. Occupational diseases in Illinois. (American as- sociation for labor legislation, 1910. Publication no. 10: 19-27.) On the origin, plan, and methods of the Occupational Disease Commission. Hessler, Robert. Dust; a neglected factor in ill health. (Transactions Indiana State medical society, 1904.) Hill, Leonard. Caisson sickness and compressed air. (Scientific Ameri- can supplement, Oct. 21-28, igii, v. 72:270-271, 282-283.) Excellent treatment hy leading English authority on the subject. Hinsdale, Guy. The occupation neu- roses. Illustrated. (In Wilson and Eshner, An American textbook of applied therapeutics, p. 1113-1121. Philadelphia, 1896.) On writer's and telegrapher's cramp and their treatment. Hirt, L. Tobacco dust in the lungs. The effect of the dust upon the health of workers in tobacco. (Clin- ic, Cincinnati, 1872, v. 3: 102-105.) Translated from Hirt's Krankheiten der Arbeiter, Breslau, 1871. Hobbs, W. R. Industrial lead poison- ing. (New York medical journal, 1898, V. 67:323-325.) Results of four years' experience among lead workers, with statistics. Hodgen, J. T. Effects of compressed air upon the human body. (Medical archives, St. Louis, 1870-71, v. 5: 219-226.) A criticism of Dr. Clark's article (q. v.). Hoilman, Frederick L. Mortality from consumption in dusty trades (in- cluding list of references on occupa- tion mortality). (U. S. Bureau of la- bor. Bulletin no. 79, Nov. 1908, p. 633-875.) Thorough, statistical study by classified occupations. Mortality from consumption in occupations exposing to munici- pal and general organic dust. (U. S. Bureau of labor. Bulletin no. 82, May igog, p. 471-638.) Practically a continuation of the preced- ing report, taking up a new series oi: occu- pations. Problem and extent of indtjs- trial diseases. (American associa- tion for labor legislation, 1910. Pub- lication no. 10:35-52.) General treatment, with estimate of mone- tary loss from sickness and accidents. Mor- tality statistics. •.• Industrial diseases in Amer- ica. (American labor legislation re- view, Jan. 191 1, V. I, no. 1:35-41. Bulletin of the American economic association, 4th series, no. 2:271- 276.) Brief general discussion of needs. •; Legal protection from injur- ioiis dusts: topical criticism of ex- isting laws. (American labor legis- lation review, June 191 1, v. i, no. 2: 110-112.) Intensive investigations in in- dustrial hygiene. (American labor legislation review, June 1912, v. 2, no. 2:255-263.) Physical and medical aspects of labor and industry. (Annals of the American academy of political and social science. May 1906, v. 2y, no. 3:3-28.) On efficiency as related to preventable mortality, trade diseases, industrial acci- dents, etc., with recommendations for scien- tific inquiry, Industrial accidents and in- dustrial diseases. (Quarterly pub- lications of the American statistical association, 190S-1909, Boston, v. 11: 567-603.) Plea for legislation, with statistics relat- ing mainly to accidents. Influence of trades on disease. (North American journal of homoe- opathy, N. Y., 1910, 3rd ser., V. 25: 234-250; Proceedings of ninth annual conference of sanitary officers of state of New York, Nov. loio, New York state department of health, thirtieth annual report, v. 1:421-437. Discussion, p. 437-439.) Argument for conservation of health, or- iginal research, medical factory inspection, and legislation. Relation of occupation to tu- berculosis. (Medical examiner and general practitioner, Sept. 1907, v. 17: 265-276.) Dust as a factor in occupa- tion mortality. (Medical examiner and general practitioner, Dec. 1907, V. 17:360-375-) Two papers relating primarily to consump- tion, with mortality statistics based on ex- perience of Prudential Insurance Co., simi- lar to but not as complete or recent as his reports for the U. S. Labor Bureau (q. v.). Prevention of disease by the elimination of dust. (American city magazine, May 1911, v. 4:213-216. Also in Proceedings of the first an- 382 American Labor Legislation Review nual conference of mayors of the cities of New York, June I9I0-) Brief discussion of outdoor public dusts, household dusts, and industrial dusts. Medical and social aspects of child labor. (Medical examiner and practitioner, Aug. 1903, v. 13:47°- 476.) Elaborate statistical study based on measurements of school children. Occupation mortality statis- tics of England and Wales. (Spec- tator, N. Y., Oct. 22, 1908.) Tuberculosis as an industrial disease. (Transactions of the Sixth international congress on tuberculo- sis. Washington, 1908, v. 3: I4i- 175.) Extensive statistical treatment of the dusty trades similar to his reports for the United States Labor Bureau (q. v.). Trade mortality statistics. (American journal of public hy- giene, 1910, V. 20; 126-132.) Brief paper on methods, without figures. Problems of social statistics and social research. (Quarterly publications of American statistical association, June 1908, v. 11:105- 132.) Brief discussion of the problem of prevent- able diseases, p. 116-117. Table showing mor- tality from consumption in certain occupa- tions, p. 128. The vital statistics of the cen- sus of 1900. (American statistical association, quarterly publications, Dec. 1902, V. 8: 127-202.) Theoretical discussion showing what occu- pation mortality statistics are contained m the Twelfth Census, p. 170-179, 181-185, 186, etc. Holden, E. Relative mortality of mar- iners, railroad men, and travellers. (American journal of medical science, 1876, v. 141:102-113.) Disease treated merely as accounting for deaths not due to accident, the chief sub- ject under discussion. Homan, George. The leading local productive industries, and their ef- fect on the health and lives of their operatives. (American public health association. Public health papers and reports, 1884. Concord, N. H., 1885, V. 10:327-328.) Outline of proposed inquiry into tobacco industry of St. Louis, with series of ques- tions. Hopkins, G. G. The neural disorders of writers and artisans. (Brooklyn medical journal, 1888, v. 2: 384-389.) General discussion with description of several cases. Hoppe, H. H. Occupation neurosis. (Cincinnati lancet-clinic, 1894, n. s. v. 32: 1-2.) Single case in a type-setter. Hotchkiss, S. C. Occupational dis- eases in the mining industry. (American labor legislation review, Feb. 1912, v. 2, no. l: 131-140.) Based on personal investigations in Color- ado for the U. S. Bureau of Mines and U. S. Public Health and Marine-Hospital Service. Huber, J. B. Occupations with relation to tuberculosis. (American medi- cine, Philadelphia, Jan. 21, 1905, v. 9: 112-114.) Based on diagram prepared by Miss Brandt, statistician of the Charity Organi- zation Society of New York, and considering 53 occupations. Hughes, C. H. Railway brain strain of and brain strain regulation of railway employees. (Alienist and neurologist, St. Louis, 1906, v. 27: 189-199.) Urging sanitary regulations to prevent railway accidents due to overwork of em- ployees. Hunt, Ezra M. The hygiene of occu- pations. General introduction. (Tenth annual report of the Board of health of the state of New Jersey, 1886. p. 157-166.) Gives long quotations from physicians, relating especially to diseases due to dust. Relation of trades and occu- pations to public health. (New Jer- sey State board of health, fourteenth annual report, 1890, p. 135-138.) Abstracts from lectures by Dr. Arlidge of England. Hunt, J. Ramsey. Occupation neuri- tis of the deep palmar branch of the ulnar nerve. (Cornell university medical bulletin, Oct. 1911.) Hunter, Arthur. Mortality among in- sured lives engaged in certain occu- pations involving additional hazard. (Actuarial society of America, transactions. 1907, v. 10:44-59.) Hunter, Robert. A plea for the inves- tigation of the conditions affecting the length of trade life. (Annals of the American academy of political and social science. May 1906, v. 27, no. 3:38-45-) Hutchcroft, L. W. The mortality from industrial diseases. (American journal of public hygiene, Boston, 1909, v. 19: 109-116. Also in Ameri- can public health association report, 1908, V. 34, Pt. 1:356-363.) Bibliography (American) 383 Brief plea for vital statistics that will show relation of occupation to death and for state investigation and regulation of con- ditions of employment. Hutchinson, Woods. Health of em- ployees as an investment. (Satur- day evening post, Philadelphia, Aug. 24, 1907, V. 180, no. 8: 12-13. Illus- trated.) Brief, popular discussion of hours, wages, ventilation, lead poisoning, accidents, etc. ........The hygienic aspects of the shirt-waist strike. (Survey, N. Y., Jan. 22, 1910, V. 23: 541-550.) Based on personal investigations of san- itary conditions in the shirt-waist factories of New York City. Hygiene of the sewing machine; a brief inquiry into the causes of dis- orders arising from the use of mach- ines, with suggestions as how [sic] they may be avoided. By a physi- cian. Baltimore. Turnbull. 1874. 40 p. Illustrated. ^ Argument to show that "sewing machine diseases" are due to improper posture of the body and overstrain of certain muscles, and that operatives are healthier in factories where steam power is employed, with ana- tomical causes. Hygienic conditions in American em- ployment. (Consular report 278, Nov. 1903, p. 456.) Brief review of findings of the Moselcy commission sent from England to study con- ditions in the United States. Illinois commission on occupational diseases. Report ... to Governor Charles S. Deneen. Jan. 1911. Chi- cago, 1911, 219 p. Authoritative treatise based on original in vestigations by experts (see Hamilton, Hay^ hurst, Nicholl, Haines, Karasek, Bassoe, Shambaugh, and Lane), with general des- cription of the work, discussion of prin ciples of effective legislation, text of pro posed bills, suggestions for cards of instruc tion of employees in dangerous trades, pro visions of protective laws in states of the Union and in European legislation, index of protective legislation in the United States, and extracts from Dr. Andrews' report for the U. S. Labor Bureau on phosphorus poi- soning (q. v.). Governor's special ^message, transmitting the report of the Com- mission on occupational diseases to the Forty-sixth General assembly. April, 1909. Springfield, 111., Illin- ois state journal co., state printers, 1909. 8 p. (Review of report). (U. S. Labor bureau, Bulletin no. 92, Jan. 191 1, 194-202.) Industrial diseases reported under sec- tion 58 of the labor law. (New York department of labor. Bulletin no. 50, March 1912, p. 96.) Industrial hygiene. (American public health association report, Concord, 1896, v. 21 : 367-372.) Review of report of Parliamentary Com- mittee of Great Britain on certain dangerous trades, bronzing, paper staining, india-rubber manufacture, etc. Injurious trades. Health and safety in factories and mercantile estab- lishrnents. (U. S. Industrial com- mission report, v. 19:901-904. Wash- ington, igo2.) Brief general discussion of specially in- jurious trades. International association for labor legislation and its publications. (U. S. Bureau of labor. Bulletin no. 86, Jan. 1910, p. 169-184.) Brief description of the work of the association and bibliography of its publi- cations. Resolutions of the sixth dele- gates' meeting. (U. S. Bureau of labor. Bulletin no. 92, Jan. 1911, p. 182-193) On administration of labor laws, child labor, night work, hours, home work, indus- trial poisons, work in compressed air, etc. Ireland, George H. The preventable causes of disease, injury, and death in American manufactories and workshops, and the best means and appliances for preventing and avoid- ing them. Concord, N. H., Repub- lican press association, 1886. 19 p. (American public health association. Lomb prize essay, no. 4.) (Issued also in American public health asso- ciation. Public health. Concord, N. H., 1886, p. I37-I53-) General description ot how to build and equip a factory, recommending proper ven- tilation but giving no consideration to speci- fic industrial diseases. Ivy, Robert H. Prevention of indus- trial phosphorus poisoning. (Amer- ican medical association journal, Chicago, 1911, V, 56:1018-1019.) Based on experience in supervision of health of employees in a large match fac- tory, arguing that prohibition of use of poisonous phosphorus is not necessary. Jacobi, A. The physical cost of wom- en's work. (Charities and the com- mons, 1907, V. 17:839-844.) Overwork of women and its effect on their health, with brief discussion of legislation. Jaminet, A. Physical effects of com- pressed air and causes of pathologi- cal symptoms produced on man by 384 American Labor Legislation Revieit) increased atmospheric pressure em- ployed for the sinking of piers in the construction of the Illinois and St. Louis bridge over the Mississippi river. St. Louis, 1871. 135 p. Historically interesting as first extensive treatise on tlie sul:)ject publislied in tliis country, descriliing 119 cases and 14 deaths. By the physician in charge of the employees. Japp, Henry. Caisson disease and its prevention. (American society of civil engineers, transactions. N. Y., 1909. V. 35, no. 4: 1-37.) Comprehensive, practical treatment from engineering point of view, by the engineer of the East River Tunnel, New York. Jeffries, B. Joy. Our eyes and our in- dustries. (Massachusetts State board of health report, 1882-3. Sup- plement, p. 89-117. Also in part in West Virginia State board of health reports, 1881-84, p. 178-187.) Overstrain of the eyes in industries and in schools. Jewelry industry, Health conditions of the. Diseases and disease ten- dencies of occupations. (New Jersey bureau of statistics of labor and in- dustries, twenty-fifth annual report, 1903, p. 363-369.) General description of factors producing ill health, and sickness statistics of 19 firms. Johnson, C. An unusual powder smoke fatality. (Colorado medicine, April, 1911.) Account of death from effects of nitrous fumes of nine out of a bunch of thirteen men who inhaled the smoke of a single blast in the Gunnison Tunnel. Joint board of sanitary control in the cloak, suit and skirt industry of greater New York. First annual re- port, N. Y., Oct. 1911. Contains information with regard to pres- ent conditions. Jones, J. D. Effect of occupation on health of individuals. (Ohio State board of health report, 1886-7. Col- umbus, 1888, V. 2:311-316. Also Cin- cinnati lancet-clinic, 1888, n. s. v. 21: 35,S-358.) Brief general article discussing workers in lead, file cutters, etc. Karasek, Stella. Karasek, Matthew. Preliminary report on the injurious effects of metol, platinum, chro- mates, cyanides, hydrofluoric acid and of materials used in silvering mirrors. (Report of Illinois com- mission on occupational diseases, Jan. 191 1, p. 96-98.) Results of original investigation. Keays, Frederick L. Compressed-air illness, with a report of 3,692 cases. (Cornell university medical college bulletin, Oct. 1909, v. 2: 1-55.) Authoritative article by physician in charge of the East River Tunnels, New York. Compressed-air illness. (Amer- ican labor legislation review, June 1912, V. 2, no. 2: 192-205.) Kelley, Florence. The sex problems in industrial hygiene. (American journal of public hygiene, Boston. June 1910, V. 20:252-257.) Brief plea for legal regulation of the hours of labor of women to prevent exces- sive fatigue. Kimball, D. D. Ventilation and pub- lic health. (Annals of the Ameri- can academy of political and social science, March 1911, p. 207-219.) General article, only incidentally relating to factory ventilation. King, William A. Mortality statistics of the census in relation to occupa- tions. (American journal of sociol- ogy, Sept. 1897, V. 3: 216-235.) Ten tables with discussion. Klink, Jane S. The health of women workers. (Academy of political sci- ence, New York, v. 2, no. 2: 35-40.) Based on experience as welfare manager of a Brooklyn laundry. Knapp, C. P. The caisson disease. (Lehigh valley medical magazine, Easton, Pa., 1891-2, v. 3: 1-12.) General discussion and history of 17 cases that came under his observation as surgeon during the sinking of two caissons for a coal mining company. Knapp, P. C. A case of professional neurosis of co-ordination of unus- ual origin. (Journal of nervous and mental diseases, N. Y., 1887, n. s., V. 12:41-45. Also reprint.) In a carpet maker, with general discussion of occupation neuroses. Kober, George Martin. Industrial hygiene. A report of the committee on social betterment of the Presi- dent's homes commission, 1908. Washington, D. C, iv, 8-175 p. (Also in reports of the President's homes commission, 60th Cong., 2d sess.. Senate doc. 644, p. 25-107. Washington, 1909.) Comprehensive general treatise on con- ditions in 1907 in a considerable number of trades, with discussion of measures, legal and otherwise, which would improve con- ditions. Industrial hygiene. (U. S. Bureau of labor. Bulletin no. 75, March 1908, p. 472-591.) Bibliography (American) 385 Similar to tlae above, with text of English laws for the regulation of dangerous and unhealthful industries. Korshet, M. Diseases of occupation. (New York medical journal, 191 1, v. 93: 1134-1137.) On effects of chronic fatigue, occupation dusts, industrial poisons, compressed air, woman's work, child labor, etc. Lane, Francis, Ellis, John B. Miner's nystagmus. (Report of Illinois com- mission on occupational diseases, Jan. 1911, p. 155.) Brief report on investigations in Illinois. Laundries, Employment of women in. (Report on condition of woman and child wage-earners in the United States, 6ist Cong., 2d sess.. Senate doc. 64s, V. 12. Prepared under the direction of Chas. P. Neill, commis- sioner of labor. Effect of laundry work upon health, p. 25-118.) Results of thorough investigation of this industry in Chicago, New York, Brooklyn, Philadelphia, and Rockford, 111. Law, James. Report on the malig- nant anthrax in herds, and malig- nant pustule in men, in Livingston county, N. Y., in Sept. 1875. (Amer- ican public health association. Re- ports and papers, v. 2:465-467.) Describes three cases of anthrax in the manager of a farm and two German work- men. Laws, G. C. The effects of nitro-gly- cerine upon those who manufacture it. (Journal of American medical association, Chicago, 1898, v. 31: 793- 794-) Based on experience among employees of a large nitro-glycerine factory in New Jersey. Laws relating to occupational dis- eases and industrial hygiene. (Twen- ty-second annual report of the U. S. commissioner of labor, 1903. U. S. Bureau of labor, Bulletins no. 85, 91 and 97.) Laws enacted during 191 1 re- quiring the report of occupational diseases. (U. S. Bureau of labor. Bulletin no. 95, July 1911, p. 283- 288.) Act providing for a tax on white phosphorus matches and for prohibiting their import or export. [Approved April 9, 1912.] (U. S. Bu- reau of labor, Bulletin no. 100, May 1912, p. 760-762.) Comfort, health and safety in factories. Comparative analysis of existing laws. (American labor legislation review, June 191 1, v. i, no. 2: i-ioi.) Review of labor legislation of 1911. (American labor legislation review, Oct. 1911, v. I, no. 3.) Lea, M. C. On the poisonous effects resulting fro'm the employment of arsenical preparations in the arts. (American journal of medical sci- ences, Phila., i860, n. s. v. 40: IIO- 112.) Brief, general discussion of effects on em- ployees and consumers, urging legislation to stop its use. Lead. Hearings before the Committee on interstate and foreign commerce of the House of representatives, on H. R. 2igoi. Manufacture, sale, etc., of adulterated or mislabeled white lead and mixed paint. May 31, 1910. 52 p. Contains testimony on lead poisoning. See index. Leather industry. Health conditions of the. Diseases and disease tenden- cies of occupations. (New Jersey bureau of statistics of labor and in- dustries, twenty-ninth annuall re- port, Camden, 1906, p. 209-234.) General discussion and statistics of health and accident conditions. Leupp, Constance D. Phossy jaw. (Twentieth century magazine. Mar. 1912, V. 5:28-35.) Popular article based on Dr. Andrews' in- vestigations (q. v.). Levis, R. J. Phosphor-necrosis. (Med- ical and surgical reporter, Phila., 1879, V. 41:450-451.) Brief general descrii)tion. based on ob- servation of many cases in Philadelphia and Wilmington match factories, and description of a single case in a match factory worker. Lewis, G. L. The effects of com- pressed air upon the human systein, as evinced in the sinking of bridge piers during the construction of the Atchison bridge over the Missouri river. (Transactions of the medical society of Kansas, 1860-77, Law- rence, 1884. V. 1:279-291.) History of use of com]>ressed air, de- scription of a caisson, and observations on some fifty cases which he treated as surgeon of the American Bridge Company. Lewis, Morris J. The neural disor- ders of writers and artisans. (In Pepper's American system of prac- tical medicine, Philadelphia, 1886, v. 5:504-543.) . , Extended discussion of occupational cramps. o86 American Labor Legislation Review Library of congress. Division of bibli- ography. Select list of references on occupational injuries and dis- eases. Aug. 25, 1910. Typewritten 10 p. Lincoln, David Francis. School and industrial hygiene. Philadelphia. Blakiston, 1880. American health primers. 144 p. Part II (p. 107-144) is an elementary- treatise on industrial hygiene. Linenthal, Harry. Sanitation of cloth- ing factories and tenement-house workrooms, (In Tuberculosis in Massachusetts, ed. by Edwin A. Locke, p. 28-36. Illustrated.) Brief statement of conditions in men's clothing industry in Boston. The prevention of occupation- al diseases. (Boston medical and surgical journal. May 23, 1912, v. 166:779-783. Also reprint.) Based on experience as state inspector of health in Massachusetts. Lloyd, James Hendrie. The diseases of occupations. (In Stedman, Twen- tieth century practice. New York, 1895. V. 3:309-496.) Thorough treatise covering all the common occupational diseases, with brief review of the literature and of the legal restraints on the employment of women and children in the United States. Occupation neuroses and poi- sonings in the arts and by foods. (In Modern treatment, ed. by H. A. Hare, 1910-1911, v. 2:583-619.) Including miner's nystagmus, lead, ar- senic, phosphorus and mercury poisoning, etc. Loeb, H. W. Railroad dust in rail- roaders' noses. (National associa- tion of railway surgeons. Official report of the fifth annual meeting, Chicago, 1892, p. 208-211.) Diseases resulting from such dust. Loomis, H. P. Miners' phthises. (Proceedings of the New York pathological society, 1891. N. Y., 1892, p. 52.) Brief description of a lung, said to be an example of "miner's phthisis." Lovejoy, O. R. Age probleins in in- dustrial hygiene. (American jour- nal of public hygiene, Boston, June 1910, V. 20: 233-238.) An argument for the legal regulation of cliild labor. Maclay, J. W. Prize essay on the re- lations of the different professions and vocations to longevity. N. Y., 1873. S8 p. Macleod, J. J. R. Cause, treatment and prevention of the "bends" as observed in caisson sickness. (As- sociation of engineering- societies journal, Boston, 1907, v. 39:283-302.) An excellent, comprehensive article by a former associate of Leonard Hill in ex- perimental work. M'Cready, B. W. On the influence of trades, professions and occupations in the United States in the produc- tion of disease. (In the Medical society of New York. Transac- tions, 1836-1837. Albany, 1837. v. 3:91-150.) Historically interesting as the first gen- eral treatment of the subject in American literature. Describes the unhealthful con- ditions of work of seamen, women and chil- dren in textile factories, tailors, shoemakers, sewing women, printers, butchers, smiths, gold beaters, carpenters, painters, profes- sional men, etc. "Prize Dissertation for 1837." McConnell, J. W. Case of pronator spasm in a compositor. (Philadel- phia polyclinic, April 28, 1894, v. 3: 161-162.) Description of a single case. An uncommon case of occu- pation neurosis. (Philadelphia poly- clinic, March 20, 1897, v. 6: 123-124.) In a brick sorter. McDowrell, W. J. Oyster shucker's corneitis. (Virginia medical month- ly, 1879, V. 5:883-885.) Based on experience with between forty and fifty cases of this eye disease in oyster shuckers. McKay, George A. The effect upon the health, morals, and mentality of working people employed in over- crowded workshops. (Fifth annual report of the New York state fac- tory inspector, Albany, 1891, p. 77- 90.) General discussion of results of over- crowding. McNeill, George E. Dangerous trades and occupations. (Insurance press, N. Y., July 26, 190S, p. 2-4.) Industrial diseases from the insurance point of view (9 columns). Manning, Caroline. Violations of health laws in women-employing in- dustries. (In Labor laws and their enforcernent, with special reference to Massachusetts. Susan M. Kings- bury, ed. Boston, 1911. p. 152-155.) Brief account of personal investigations in 29 factories, stores and restaurants. Manning, Wm. J. Health of em- ployees in the government printing Bibliography (American) 387 office, Washington. (U. S. Bureau of labor, Bulletin no. 75:497-508.) Mainly description of methods in use for the prevention of lead poisoning. Marriott, W. McKim. The air they breathe in New York factories. (Charities and the commons, Nov. 10, 1906, V. 17:274-276.) Results of an examination of air in a number of factories in New York City. Table and chart. Marshall, S. A. [Caisson disease.] (Long Island medical journal, April, 1907, V. i: 183-184.) Based on experience among workmen in the Pennsylvania railroad tunnel. Discus- sion of Dr. Gallivan's paper (q. v.). Martin, John. Factory legislation and tuberculosis. (Transactions of the Sixth international congress on tu- berculosis. Washington, 1908. v. 3: 179-183.) Brief discussion of dusty occupations and legislation providing for ventilation. Massachusetts. First annual report of the work of the state inspectors of health. (In Thirty-ninth annual re- port of the State iDoard of health of Massachusetts. Boston, 1907. p. 459-485.) Second annual report. (In Fortieth annual report of the State board of health of Massachusetts. Boston, 1908. p. 653-750. Illus- trated.) Third annual report. (In For- ty-first annual report of the State board of health of Massachusetts. Boston, 1909. p. 763-887.) Fourth annual report. (In Forty-second annual report of the State board of health of Massachu- setts. Boston, 1910. p. 437-556.) Fifth annual report. (In For- ty-third annual report of the State board of health of Massachusetts. Boston, 191 1.) These annual reports furnish a valuable • ource of information on factory and work- thop conditions and methods by which they may be improved, and contain discussions of specific occupational diseases and danger- ous processes. But they also cover tene- ment and schoolhouse hygiene, etc. Massachusetts House docu- ments no. 50. March, 1845; no. 153. 1850. (Reprinted in Documentary history of American industrial so- ciety, Cleveland, 1910, V. 8:133-186.) Testimony on effect of long hours of labor on health of factory operatives. Mayo, Earl. Work that kills, (Out- look, Sept. 23, 191 1, V. 99: 203-213. Illustrated.) Popular general article covering subject of industrial diseases. Mears, J. Ewing. Phosphorus necro- sis of the jaws. (Philadelphia med- ical times, Jan. 9, 1886, v. 16:264- 275. Illustrated. Also Transactions American surgical association, 1885, V. 3:357-385. Also reprint.) Elaborate paper based on European sources and on examinations of a large num- ber of employees in match factories, and the treatment of sixteen cases in this country. Meigs, Arthur V. Caisson disease. A clinical lecture. (Philadelphia medical news, Nov. 28, 1885, v. 47: 589-592.) Based mainly on Jaminet's, Smith's, Bauer's, and Clark's articles, and on Wood- ward's History of the St. Louis Bridge (q. v.). Memorial on occupational diseases. Prepared by a committee of ex- perts appointed by the American association for labor legislation, and presented to the President of the United States. (American labor legislation review, Jan. 191 1, v. i, no. 1:125-143. Also reprint.) This memorial lays the groundwork for a federal investigation. Mercury. Physiological effects of the 'mercury arc: its influence upon the eye. (Scientific American supple- ment, Oct. 7, 1911, V. 72:235-236.) Brief general article on artificial light, with only incidental reference to working people. Merk, Fred. Industrial diseases. (Or- ation, University of Wisconsin, n. p. 1911. 5 p.) Mettler, L. H. Occupation neuroses. (Clinical review, Chicago, 1904-1905, V. 21 : 43-60.) General discussion of various types of nerve disorders due to occupation. Middleton, P. Harvey. White phos- phorus horror. (Technical world magazine, April 1911, v. 15:146-155. Illustrated.) Popular article. Miles, Henry A. Lowell as it was and as it is. Lowell, 1845. 234 p. "Pro- visions for the comfort and health of the operatives", p. 116-127. Argues that the factory population, espe- cially the women, were in good health. Miller, James A. Pulmonary tuber- culosis among printers. (Transac- tions of the Sixth international con- gress on tuberculosis. Washington, 1908. V. 3: 209-216.) 388 American Labor Legislation Reviezo Results of thorough physical examinations of 20U printers in New York City, with des- cription of working conditions. Mills, Charles Karsner. Occupation neuroses; ati'ections of tlie neuro- muscular apparatus due to special occupations. (In Loomis and Thompson, A system of practical medicine, v. 4: 597-610. New York, 1898.) Good general discussion of fatigue neu- roses, occupation cramps and other forms of nervous disease due to occupation, with methods of treatment. Mental overwork and prema- ture disease among public and pro- fessional men. (Smithsonian mis- cellaneous collections, no. S94. Washington, 1885, 34 p.) Moss, R. E. Occupations. (Medical examiner and practitioner, N. Y., 1902, V. 12: 710-712.) Occupations as allecting insurance risks, giving diseases characteristic of a large num- ber of different occupations. Moyer, H. N. A rare occupation neurosis (shoe salesman's disease). (Medical news, Philadelphia, 1893, v. 62: 188-189.) Brief general discussion and description of a single case. Municipal ordinances, rules, and regu- lations pertaining to public hygiene adopted from January i, 1910, to June 30, 191 1, by cities of the United States having a population of over 25,000 in 1910. Prepared by direc- tion of the surgeon general. U. S. Public health and marine-hospital service. Washington, Gov't, print, off., 1912, 244 p. Murray, F. W. Anthrax maligna. (New York medical journal, 1889, V. 49: 144-147. Also reprint.) General discussion, with a description of four cases, a porter in a restaurant, a longshoreman, a clerk, and a groom. Myers, R. M. Cramps as affecting sto- kers. (Virginia medical semi-month- ly, Richmond, 1897-8, v. 2:552-553.) Observations as ship surgeon on one of the trans-Atlantic lines, Nearing, Scott. Social adjustment. New York, Macmillan co., 1911, 377 p. Ch. xi. "Dangerous trades", p. 211-221. Brief, popular discussion. Neer, C. S. The value of examination of the blood in the diagnosis of chronic ]ead poisoning. (Interstate medical journal, St. Louis, 1907, v. 14:838-843.) Cieneral discussion and account of three cases, all occupational in origin, Nevin, John. Occupational diseases. (Medical examiner and general prac- titioner, N. Y., Aug. 1908, v. 19:254- 256.) As affecting insurance risks. Newton, W. K. An inquiry into the causes of disease among workers in silk, flax, and jute. (Tenth annual report of the board of health of New Jersey, 1886, Trenton, 1887, p. 188-194.) Describes processes and sanitary condi- tions in workrooms. Nicholl, R. H., Flinn, T. E., Hay- hurst, E. R. Effects of turpentine upon the health of workmen. (Re- port of Illinois commission on oc- cupational diseasfes, Jan. 191 1, p. 84-88.) Results of investigations of 62 men in Chicago. Nichols, Arthur H. The effects on health of the use of sewing machines moved by foot-power. (Massachu- setts State board of health report, 1872, p. 180-221.) Based on personal investigations and re- turns from many correspondents. Norton, H. G. Dangers of the potters' trade from the life insurance stand- point. (Medical examiner and prac- titioner. New York, 1906, v. 16:242- 246.) Description of various branches of the work and their special dangers, with particu- lar reference to the Trenton, N. J., potteries; Obenauer, Marie L. Working hours, earnings and duration of employ- ment of women workers in selected industries of Maryland and of Cali- fornia. (U. S. Bureau of labor. Bul- letin 96.) Sanitary conditions in canneries, p. 359-362, 368, 401-403. Occupation mortality statistics. Cen- sus of 1890. Deaths of males in cer- tain occupations, in certain cities, and from certain causes, v. VII, Re- port on vital statistics. Part II, table 18, p. 1 130. Washington, 1896. Census of 1900. Occupations in relation to deaths. Report on vital statistics. Part I, sec. xiii, p. cclvii. Tables, p. 76. Washington, 1902. Bureau of the census. Annual reports on Mortality statistics, 1900- date. Connecticut registration re- Bibliography (American) 389 ports, 1881-1907. Deaths by occupa- tions in Connecticut for ten years, in report for 1906, Massacliusetts registration reports, 1843-1889. Deaths in Mass- achusetts by occupations for pre- ceding 20 years, in report for 1863. Elliott, E. B. Life tables of Massa- chusetts, 1858. Vermont registration reports, 1857-1889, and health reports, igoo- 1906. Rhode Island registration re- ports, 1853-1906, Rhode Island. Eighteenth an- nual report of the commissioner of industrial statistics, 1905, Mortal- ity statistics of workingmen in Rhode Island, 1899-1902. Tables, p. 53-152. New Jersey State board of health, annual reports, 1903-1907. Experience of thirty-four life companies upon ninety-eight special classes of risks. Compiled and pub- lished by the Actuarial society of America. New York, 1903, xiv, 479 p. Experience of leading life insurance com- panies with regard to specially hazardous occupations and groups of persons. Prudential insurance com- pany of America: Industrial occu- pation mortality statistics, exhibits of diagram and charts at Interna- tional exposition, Paris, 1900; In- ternational congress on tuberculosis, London, 1901; Pan American expo- sition, Buffalo, 1901; International exposition, St. Louis, 1904; James- town ter-centennial exposition, 1907; International congress on tu- berculosis, Washington, 1908. Mutual life insurance com- pany of New York, mortality exper- ience. N. Y., 1877. "Occupations", V. 2:42-43. Connecticut mutual life in- surance company, mortality exper- ience, 1846-1878. Hartford, Conn. 1884. 54 P- O'Connell, James. Manhood tribute to the modern machine: influence determining the length of the trade life among machinists. (Annals of the American academy of political and social science, May 1906, v. 27, no. .?: 20-33.) Brief argument to show that highspeed machinery has shortened the life of the operator. Oliver, Thomas. Industrial lead pois- oning, with descriptions of lead pro- cesses in certain industries in Great Britain and the western states of Europe. (U. S. Bureau of labor. Bulletin no. 95, July 191 1, p. 1-188.) Thorough treatise by the chief English authority on the suhject, based on English and European data. Oppenheimer, Seymour. Effect of cer- tain occupations on the pharynx. (Medical record, N. Y., Dec. 16, 1899, V. 56:891-893.) Results of study of 50 cases, effects of heat, e. g. a laundress and a tinsmith. Osgood, Irene. Women workers in Milwaukee tanneries. (Wisconsin Bureau of labor and industrial sta- tistics, thirteenth biennial report, igoQ, p. 1029-1172. "Health", p. 1060- 1063.) Rased on personal investigations. Overlook, Melvin George. The work- ing people; their health and how to protect it. Worcester, Mass., The Blanchard press, 1910. 293 p. Brief, popular discussion of the preven- tion of disease in certain occupations (p. 89-96); hours and fatigue (p. 106-109); and the health of factory employees fp. 166-169). Education for the prevention of industrial diseases. (American labor legislation review, June 1912, V. 2, no. 2: 329-338.) Owens, John E. Caisson disease. (Railway surgical journal, Chicago, March 1908, v. 14:254-263.) Based largely on his own experience as chief surgeon of the Illinois Central and Chi- cago and Northwestern railways. Parker, W. W. and others. Report on the effect of the use of the sewing machine on the health of women. (Transactions of the medical society of Virginia, third annual session, Richmond. 1872, p. 146-153.) Report of a committee, based mainly on Dr. Nichols' paper (q. v.). Parton, Mabel. Women's work in rub- ber factories. The work of women and children in cordage and twine factories. Plate. (In Labor laws and their enforcement, with special reference to Massachusetts. Susan M. Kingsbury, ed. Boston, 191 1. p. 135-151.) Results of personal investigations of un- healthful processes and diseases to which women workers in these industries are sub- ject, and methods by which the dangers 390 American Labor Legislation Review could be reduced. Originally published in pamphlet form. Peet, Walter. Pressing out "the bends" (caisson disease). (Harper's weekly, Feb. 17, 1912, v. 56: 12.) Brief, popular article on caisson disease and its treatment. Peirce, Paul S. Industrial diseases. (North American review, Oct. 1911, V. 194:529-540.) Good general article. Pelton, Henry H. Treatment of com- pressed-air (caisson) illness. (Amer- ican journal of medical sciences, Philadelphia, 1907, v. 133:679-685.) Precautions against, types, and treat- ment of the disease, with description of a medical lock. Perry, S. H. Brass-workers' disease. (Medical brief, St. Louis, 1907, v. 35:414-419.) Description of the disease, with special reference to its occupational origin, by a physician of Birmingham, England. Peterson, F. Three cases of acute mania from inhaling carbon bisul- phide. (Boston medical and surgi- cal journal, 1892, v. 127:325-326. Also reprint.) All three in employees of a single rubber factory near New York City. Phosphorus matches (white). Hear- ings before the Committee on ways and means of the House of repre- sentatives, 6ist Congress, 3d ses- sion, on H. R. 26540 and H. R. 29469, December 16, 1910. Wash- ington, Govt, print, off., 1910. 39 p. On bill (H. R. 29469) "A bill to provide for a tax upon white phos- phorus matches, and for other pur- poses." Hearings . . . December 16, 1910, and January 20, 1911. Wash- in.gton, Govt, print, off., 1911. iii, 277-357 p. On H. R. 26540, H. R. 29469 and H. R. 30022. 'The Hear- ing of Dec. 16, 1910, is also pub. sep- arately. ..Hearings . . . .January 10, 1912. Washington, Govt, print, off., 1912, iro p. On H. R. 2896. Hearings on bills relating to health activities of the general government, before the Committee on interstate and foreign commerce of the House of representatives. Washington, Govt, print, off., 1910, Part 6, p. 389-496. These hearings, together with Dr. An- drews' report for the U. S. Labor Bureau (q. V.) contain most of the up-to-date, pri- mary source material on phosphorus poison- ing in the United States. Poisoning, Industrial. (See Index cat- alogue of the surgeon general's li- brary and Index medicus, under Lead, Mercury, Arsenic, Phosphor- us, etc., passim.) Pietrowicz, S. R. A case of brass molder's ague, (Journal of Amer- ican medical association, Chicago, 1904, V, 43:465.) In a brass molder in Chicago. Polishing and buffing. (Fourteenth annual report of the New York state factory inspector, Albany, 1899, p. 32-35-) Relates mainly to interpretation of the law as to the employment of women and children in polishing and buffing. Pottery industry, Health conditions in the. Diseases and disease tenden- cies of occupations. (New Jersey bureau of statistics of labor and industries, twenty-eighth annual re- port, Trenton, 1905, p. 177-197.) Description of processes and statistics. Pratt, Edward Ewing. Occupational diseases. Preliminary report on lead poisoning in the city of New York, with an appendix on arsenical poi- soning. (First report of New York factory investigating commission. 1912. Appendix vi, p. 365-569.) ........ Lead poisoning in New York city. (American labor legislation review, June 1912, v. 2, no. 2:27^- 280.) Price, George M. Hygiene of occupa- tion. (In Reference handbook of the medical sciences, ed. by Albert H. Buck, 1904, V. 6:316-333.) Comprehensive discussion of the entire subject. Effects of confined air upon the health of workers. (American labor legislation review, June 1912, V. 2, no. 2: 312-315.) Medical factory inspection. (Transactions of Sixth international congress on tuberculosis. 1908. v. 4, pt. i: 307-310.) Brief outline showing the need for medi- cal inspection of factories. Sanitation and ventilation of factories. (Academy of political sci- ence. New York, v. 2, no. 2:32-34.) Brief discussion based on experience as special investigator for Joint Board of San- itary Control and New York State Factory Tnvcstip.iting Commission. Not as complete as article in Labor Legislation Review (q. v.). Bibliography (American) 391 Pritchard, J. F. Diseases of railway men caused by tlieir occupations. (American academy of railway sur- geons report, 1896. Chicago, 1897, p. 136-144. Also (abstr.) Journal of American medical association, 1S97, V. 28: 1169-1171.) Especially nervous and mental diseases from strain of responsibility over life. Ramsey, M. E. Practical life insur- ance examination. Philadelphia, 1908. "Occupation", p. 20-23. Brief treatment of occupations as affecting insurance risks. Randolph, R. L. A clinical and exper- imental study of the so-called oys- ter shucker's keratitis. (Johns Hop- kins hospital bulletin, Baltimore, 189s, V. 6: 150-154.) Description, with cases, of eye disease produced by injuries from oyster shells. Ravenel, M. P. Anthrax. (In Osier's Modern medicine, 1907, v. 3:42-51.) Complete technical discussion, with sta- tistics of occupations of persons affected with the disease. Raymond, Rossiter W. Hygiene of metal mines. (In A treatise on hygiene and public health, ed. by A. H. Buck, V. 2. Ziemsscn's Cyclo- pedia of medicine, v. 19:253-264.) Discusses ventilation, dust, temperature, etc. The hygiene of mines. (Trans- actions of the American institute of mining engineers, 1879-80, v. 8:97- 120.) Practically same as his Hygiene of Metal Mines (q. v.), with quotations from Sheafer's Hygiene of Coal Mines (q. v.). Reporting of industrial diseases. New York State department of labor. Al- bany, 1912, 25 p. Pamphlet for physicians containing the law, a statement of its purpose, and informa- tion in regard to the diseases to be reported and their symptoms. Reynolds, H. R. Caisson disease. (Railway surgical journal, Chicago, Feb. 1909, V. 15:255-59-) Rice, M. B. White lead poisoning. (Alkaloidal clinic, Chicago, 190S, v. 12:460-462.) In painters and employees of white-lead factories. Riggs, C. Eugene. Nervous disorders and paralyses from excessive use of the parts affected — vertigo, tremor, and lead poisoning. (In System of practical therapeutics, ed. by H. A. Hare, Philadelphia, 1892, v. 3:419- 45'^.) From medical standpoint, without regard to origin, but including writer's and tele- grapher's cramp and lead poisoning. Rohe, George H. The hygiene of oc- cupations. (In American public health association. Puljlic health papers and reports, 1884. Concord, N. H., 1885, V. 10: 165-173.) Brief, concrete descri]jtion of causes of disease in unhealthful trades, with general summary of American literature and Massa- chusetts mortality statistics. Royer, B. F., Holmes, E. B. Fifteen cases of anthrax treated in the Phil- adelphia municipal hospital. (The- rapeutic gazette, etc., Detroit, 1908, 3 s. V. 24:6-17. Also Pennsylvania medical journal, Athens, 1907-8, v. 11:937-949- Illustrated.) Elaborate description of cases, all of whicli were occupational in origin, from handling hair, leather, etc. Russel, C. P. Table of deaths from phthisis in New York city, showing relative mortality of various profes- sions. (Medical record, N. Y., 1873, V. 8:93-) Statistics, without discussion. Ryan, L. M. Compressed-air illness in caisson work. (American labor leg- islation reviev/, June 1912, v. 2, no. 2: 350-3SS-) Compressed-air disease from a clinical aspect. (New York medi- cal journal, July 31, 1909, v. 90: 193- 198. Also reprint.) Describes the causes, methods of preven- tion, symptoms, types, and treatment, with the clinical history of two cases. Ryland, K. Phosphorus necrosis of the maxillary bones, peculiar to lu- cifer-match makers. (St. Louis medical and surgical journal, 1854, v. 12: 28-34.) Based mainly on European exfierience, but describes conditions of work in a St. Louis match factory. Safety and security of American life. American institute of social service, New York, 1906. Sanitary conditions in factories. (See reports of factory inspection depart- ments and bureaus of labor of the various states.) Sanitary commission of Massachu- setts. Boston, 1850. Influence of occupation on health, p. 85-87, 129 and 508-510. Occupation mortality statistics, and mor- tality and conditions of work of shoemakers in Lvnn. Schamberg, F. J. Grain itch (acaro- dermatitis urticarioides) : a study of 392 American Labor Legislation Rcviezv a new disease in this country. (Jour- nal of cutaneous diseases, 1910, v. 28:67-89. Illustrated.) Scientilic description of the disease with- out special regard to its origin. Schwab, Sidney I. Neurasthenia in garment workers. (American labor legislation review, New York, Jan. 19H, V. 1:27-33. Bulletin of the American economic association, 4th series, no. 2: 265-271.) General results of study of 7000 garment ^vo^kers in St. Louis dispensary during ten years. Schwartz, G. J., Royer, B. F., Keen, W. W. Anthrax. (Annals of sur- gery, 1905, V. 42:286-296.) General discussion of the disease and des- cription of case in a farmer who had skinned a cow. Schwartz, H. J., Sincard, M. H. Brass founder's ague. (Cornell university medical college bulletin, Jan. 1905.) Scott, A. L. Report on "hatting". (Report of the Board of health of Connecticut, 1887-8, New Haven, i88g, V. II : 299-300.) Brief description of processes, arguing that the making of hats is a healtliful occupation. Scott, W. J. Hygiene of the laboring classes. (Ohio medical journal, 1881, V. i: 17-22.) Brief, general discussion of dangers to health of lead workers, stonecutters, cigar- makers, etc. Hygiene of the working class- es. (Cleveland medical gazette, 1885-86, V. 1:383-387.) Plea for public baths as method of pre- venting occupational diseases. Seager, Henry R. Cooperation in pro- moting industrial hygiene. (Amer- ican labor legislation review, June 1912, V. 2, no. 2:235-241.) Sewall, Hannah R. Child labor in the United States. (U. S. Bureau of la- bor, Bulletin 52. "Conditions affect- ing children", p. 506-516; "Health of working children", p. 528-532.) Sanitary and other conditions in factories, and facts obtained by questioning the chil- dren and their parents. Sexton, Samuel. The ear and its dis- eases. "The effect of high atmos- pheric pressure on the ear in tun- nels, caissons, etc. The effects of submarine diving on the ear." p. 428-434. With description of a number of cases of deafness occurring among employees of the Hudson River Tunnel. In part practically the same as in Medical Record, 1887 (q. v.). On the effect of high atmospheric pressure on the ear, (Medical record, N. Y., 1887, v. 32: 732-734-) ^ ^, ^ Based on treatment for ear trouble of a number of employees working in the Hud- son River Tunnel. Shambaugh, Geo. E., Boot, G. W. Reports on occupation deafness. (Report of Illinois commission on occupational diseases, Jan. 1911, p. 150-15S) Discussion of occupations which may lead to deafness and of boilermaker's deafness, based mainly on Ein'opean sources. Sharpies, C. W. A contribution to the pathology of the spinal cord in diver's palsy. (Journal of nervous and imental diseases, N. Y., 1894, v. 21, n. s. V. 19: 636-640.) Report of a single case and autopsy. Sheafer, H. C. Hygiene of coal mines. (In Treatise on hygiene and public health, ed. by A. H. Buck, v. 2. Ziemssen's Cyclopedia of medicine, v. 19:229-250.) Describes character of work, danger from gases, lack of ventilation, etc. Shoe factory operatives. Diseases and disease tendencies of occupations. (New Jersey bureau of statistics of labor and industries, twenty-fifth an- nual report, 1903, p. 37I-375-) General description and sickness statis- tics of seven factories employing 1,000 hands. Silk industry. (Report on condition of woman and child wage-earners in the United States, 6ist Cong., 2d sess., Senate doc. 645, v. 4. Pre- pared under the direction of Chas. P. Neill, commissioner of labor. "Light and ventilation", p. 179-181.) General results of official investigation in New .Jersey and Pennsylvania. Skeel, S. Lead colic, or mine sickness. (St. Louis medical and surgical jour- nal, 1848, v. 6: 125-129.) Based on experience with over a hundred cases among lead miners, with histories of a number of cases. Smith, A. H. Effects of high atmos- pheric pressure, including the cais- son disease. College of physicians and surgeons alumni association prize essay, Brooklyn, 1873, S3 p. Pub. also by New York and Brook- lyn bridge co. Extensive treatise giving his experience as surgeon of the New York Bridge Co., but based on theory which has now been abandoned, Bibliography (American) 393 Caisson disease. (Medical record, N. Y., 1894, v. 45: 130-133.) Based on experience as pliysician to tlic Presbyterian Hospital, New York City, with employees of the East River Tunnel. The caisson disease. ( In Pep- per, American system of practical medicine, v. 3:854-860.) Brief treatment based on his Effects of High Atmospheric Pressure (q. v.). Physiologic, pathologic and therapeutic effects of compressed air, Detroit, 1886. New edition of his Effects of High Atmos- pheric Pressure, with addition of a chapter on therapeutic uses of compressed air. Snow, Walter B. Dust removal in a brass foundry. (Heating and venti- lating magazine, N. Y., Oct. 1907, v. 4:30-35- Illustrated.) Scientiiic, practical. Sommerfeld, Th., Oliver, Thomas, Putzeys, Felix. List of industrial poisons. Prepared for the Interna- tional association for labor legisla- tion. (U. S. Bureau of labor. Bulle- tin no. 86, Jan. 1910, p. 147-169) Sommerfeld, Th., Fischer, R. List of industrial poisons and other sub- stances injurious to health found in industrial processes. Prepared un- der the auspices of the International association for labor legislation. (U. S. Bureau of labor. Bulletin no. 100, May 1912, p. 733-759-) This is a revision of the list in Bulletin ^6, with an outline of the work along this line of the International Association for Labor Legislation and an otitline by Dr. Fischer of measures for the protection of workers against danger of poison. Soper, George A. The air and venti- lation of subways. N. Y. Wiley and sons, 1909. 244 p. Health of employees in European subways, p. 77, 98. "Health of New York sub- way employees", p. 195-229. (Also Technology quarterly, Boston, 1907, V. 20: 218-245.) Results of original investigations into the effects of metallic dust on health of em- ployees. Practically identical with report made in 1907 to the" Board of Rapid Transit Commissioners of the City of New York. Special regulations for dangerous and unhealthy industries enforced by the factory inspectors in England. (New York State bureau of labor statistics, twenty-fourth annual re- port, Albany, 1006, p. 833-879-) Text of English laws. Spratling, W. P. Report of fifty- seven cases of insanity occurring in six years among silk-mill employees in a manufacturing city in New Jer- sey. (New York medical journal, 1894, V. 59: 614-616.) Gives cause as "prolonged and excessive overtax of mind and body" in the course of their occni'ation. T,-ililes. Stainsby, William. Diseases and dis- ease tendencies of occupation. The glass industry and the hatting in- dustry. Trenton, N. J. 1901. 55 p. (From the Twenty-fourth annual report of the Bureau of statistics of New Jersey.) (See Glass industry and Hatting industry.) Standen, Wrn. T. The effect of occu- pation and habits on life insurance risks. Pub. by N. Y. Life insur- ance CO. (Also in his Ideal pro- tection, N. Y., 1897, p. 100-118.) (iives classification of occupations, with number of insurance companies which re- ject persons in each, number which discrim- inate against the specibcd occupations, and number which accept persons engaged in them without restriction. Starr, M. Allen. Industrial diseases due to the use of metallic poisons and the measures needed for their prevention. (Medical record, N. Y., Feb. 3, 1912, V. 81:205-207.) Discusses briefly lead, arsenic, mercury and phosphorus. Stevens, George A. The health of printers: a study in industrial hy- giene. (Twenty-fourth annual re- port of the New York bureau of la- bor statistics for the year ended Sept. 30, 1906. Albany, 1907, p. 71- 152.) Mortality statistics for England and the I'nited States, and descriptions of health conditions. Stewart, D. D. Lead convulsions; a study of sixteen cases. (American journal of medical sciences, Philadel- phia, 1895, n. s. V. 109:288-306.) Four of these cases were of occupational origin, in persons wlio liandled dyes and paints. Stickler, J. W. Hatters' consumption. (New York medical journal. May 29, 1886, V. 43: 598-602. Also reprint.) Description of processes and effects, with abstracts of letters from hatters' societies, records of ]7 cases, and mortality statistics. Diseases of hatters. (Report of the Board of health of New Jer- -scv, 18S5-6, Trenton, 1887, v. 10: 166- 188.) Describes processes and sanitary condi- tii)ns of vnrl.-ronms rimi gives statistics of physical condition of 240 employees in hat 394 American Labor Legislation Review factories and mortality statistics of hatters in Newark and Orange. Stickler, J. W., Lane, F, B., Stubbart, J. B. Diseases of workers in textile goods. (New Jersey board of health, twelfth annual report, 1888, p. 159- 178.) Describes processes, and gives table show- ing results of inquiry into diseases acquired since entering mill. Sullivan, J. W. The printer's health. (Typographical journal, 1903, v. 23, no. 5, p. 425-429; no. 6, p. 527-532- Reprinted, condensed, in Commons, Trade unionism and labor oroli- lems, p. 435-454.) Based on mortality statistics of the Inter- national Typographical Union and of local union no. 6 (New York Citv;, with des- criptions of unhealthful conditions. Sumner, Helen L. History of women in industry in the United States. (Report on condition of wo'man and child wage-earners in the United States, 6ist Cong., 2d sess., Senate doc. 645, V. 9. Health in textile factories, p. 100-108.) Mainly on health of Lowell factory women before 18,80. Taylor, G. R. The Chicago industrial exhibit. (Charities and the com- mons, N. Y., 1907, V. 18:38-45. Il- lustrations.) Popular account, with reference to san- itary conditions in factories. Thayer, Gordon. Matches or men. (Everybody's magazine, April 1912, V. 26: 490-498.) Popular article on phosphorus poisoning. Thompson, T. Kennard. Pneumatic caissons. (Scientific American sup- plement, Oct. 17, 1908, V. 66:244- 247-) Mainly technical description of caissons, but contains also brief account of caisson disease. Thompson, W. Gilman. Classifica- tion of occupational diseases. (American labor legislation review, June 1912, V. 2, no. 2: 185-191.) Occupational diseases of mod- ern life. (Journal of the Maine state medical association, March 1912. Also pamphlet.) Occupational poisoning. (Journal of industrial and engineer- ing chemistry, June 1912, v. 4:454- 457.) On the prevalence, nature, and means of mitigation of occupational poisoning. Resume of the importance and prevalence of the occupational diseases. (Medical record, N. Y., Feb. 3, 1912, V, 81:201-202.) Introductory outline of the subject. Reporting of occupational dis- eases by physicians. (Academy of political science. New York, v. 2, no. 2:24-31.) Practical article with sample schedules and history cards. Notes on the caisson disease. (Medical record, N. Y., 1894, v. 45: 133-134) Brief discussion with description of sev- eral cases. Tracy, Roger S. Hygiene of occupa- tion. (In Ziemssen, Hugo von., ed. Cyclopaedia of the practice of medi- cine. New York, 1874-1881. v. 19: 3-78.) Comprehensive treatise (1879) with clas- sification of occupations, descriptions of dangerous processes, effects of poisons, dusts, constrained attitudes, etc. Bibliography. Report on tobacco and cigar manufactories. (New York city board of health report, 1872, p. 308- 311) General discussion of results of sanitary inspection to determine effects on health of workers. Dusty occupations. (New York State factory inspector, sec- ond annual report, 1888, Albany, 1889, p. 68-94.) General discussion of all kinds of dust, w'ith tuberculosis statistics of dusty occupa- tions. Trask, John W. A digest of the laws and regulations of the various states relating to the reporting of cases of sickness. U. S. Public health and marine-hospital service. Public health bulletin no. 45. Washington, Govt, print, off., 1911. 191 p. Abstracts of laws by states, and tables of notifiable diseases, including occupational diseases. Tuberculosis. American federation of labor. Movement inaugurated and plan adopted by the American fed- eration of labor to war on con- sumption. 2d ed., 1909. Washing- ton, American federation of labor, 1909. Influence of occupation in tu- berculosis. (Thirty-seventh annual report of the Michigan State board of health, Lansing, 1909, p. 93-100.) Statistics of occupations of 19,642 tuber- culous persons in Michigan, 1895-1908, and mortality statistics of various occupations. Tuberculosis in the industries of Massachusetts. (Massachusetts Bibliography (American) 395 Labor bulletin, July igog, v, 14:81- 104. Whole no. 65.) Brief descriptions of various industries whicii produce tuberculosis, and methods of relief and prevention in use. Relation of occupation to tu- berculosis. (Monthly bulletin of the New York State department of health, Sept. 1908, n. s. v. 3, no. 9; 238-239.) Occupation statistics of patients at the Henry Phipps Institute, Philadelphia. Tyson, James. On chronic interstitial nephritis. A clinical lecture. (Phil- adelphia medical times, Jan. 9, 1886, V. 16: 261-264.) Account of results of lead poisoning in a house painter. United States Bureau of labor. Bulle- tins 44 (see Doehring), 52 (see Se- wall), 75 (see Kober), 79 (see Hoff- man), 82 (see Hoffman), 86 (see Andrews, Sommerfeld, and Interna- tional association for labor legisla- tion), 92 (see International associa- tion for labor legislation), 95 (see Oliver, Hamilton, Andrews, and Laws), 96 (see Hanson and Obenau- er), 100 (see Laws and Sommerfeld), 85, 91 and 97 (see Laws). Report on condition of wom- an and child wage-earners in the LTnited States, 6ist Cong., 2d sess.. Senate doc. 64S, 1910-1912 (see Cot- ton textile industry. Clothing, Glass industry, Silk industry. Laundries, Chaney, and Sumner). Report on conditions of eim- ployment in the iron and steel in- dustry of the United States, 1912, v. 3. A study of working conditions in American steel mills. Treats of the various factors affecting the health and efficiency of the working force, e. g. the 7-day week, the 12-hour day, tem- perature, etc. Fourth annual report (see Working women). Twenty-second annual report (see Laws). Twenty-fourth annual report (see Harris). Van Kleeck, Mary. Working hours of women in factories. (Charities, N. Y., 1906-7, V. 17: 13-21.) Describes actual conditions, non-enforce- ment of ten-hour law, and results in physical condition of working women. Van Rensselaer, H. The pathology of the caisson disease. (Medical record, N. Y., 1891, v. 40:141-150; 178-182. Also Transactions of the medical society of New York, 1891, p. 408-444. I pi. Bibliography.) Thorough treatise, with reports of cases and post-mortem examinations, results of ex- periments with animals, and history of theor- ies, upholding the mechanical congestion theory. Veasey, C. A. Central amblyopia in a dye-worker, probably produced by inhalation of the aniline dyes. (American journal of ophthalmol- ogy, St. Louis, 1898, V. 15:149-152. Also reprint.) Single case. Wainwright, J. 1V[., Nichols, H. T. Two phases of anthracite mine hygiene. (Transactions of the Luzerne county medical society, Wilkesbarre, 1905, V. 13: 100-116. Discussion, p. 116- 117.) On hookworm disease and the relation between pulmonary tuberculosis and anthra- cosis, with occupation mortality statistics. Wald, Lillian D. The doctor and the nurse in industrial establishments. (Academy of political science. New York, V. 2, no. 2:41-47.) rtesults of experience of various estab- lishments. Walling, William English. The dan- gerous trades. (Fourteenth annual convention of the International as- sociation of factory inspectors of America, p. 35-42.) Walton, G. L., Carter, C. F. Metal- turners' paralysis. (American jour- nal of medical sciences, Phila., 1892, n. s. V. 104: 61-63.) General discussion and account of two cases in brass workers. Warman, D. The diseases of potters, their causes and prevention. (Elev- enth annual report of the Board of health of New Jersey, Trenton, 1887, p. 97-116.) Describes nature of the occupation, its in- fluence on health, and sanitary conditions in potteries of New Jersey. Warthin, A. S. A preliminary report on some occupational diseases oc- curring in Michigan. (Public health, published quarterly by the State de- partment of health, Michigan, Jan.- March, 1912, v. 7, no. i, p. 67-77.) On miner's cramp, compressed-air dis- ease, miner's nystagmus, etc., with cases. Washburn, E. Practical studies in oc- cupational hygiene. (Monthly bul- letin. State board of health, Massa- chusetts. Boston, 1911, V. 6:74-77.) Weidner, Carl. Occupational diseases. 396 American Labor Legislation Review (Kentucky medical journal, Feb. IS, ipil, V. 9: 171-175. Discussion, 175- I77-) Brief, concrete treatment of a large num- ber of different diseases. Wheatley, F. G. Factory inspection. (Medical communications, Massa- chusetts medical society, Boston, 1907, V. 20: 501-506. Discussion, p. 506-509.) With special reference to Massachusetts and to the campaign against tuberculosis. Wilbur, Cressy L. Notification of oc- cupational diseases. (American la- bor legislation review, June 1912, v. 2, no. 2:339-345.) Better statistics of industrial mortality for the United States. (Publications of the American sta- tistical association, June igog, v. 11: 5os-5og.) Plea for more definite statements of oc- cupations on death certificates. Wile, Ira S. Laundry hygiene. (Med- ical news, N. Y., 1904, v. 85:1065- 1068.) On health of employees, giving results of investigations in Rochester, N. Y., London, Paris, and New York City. Williams, Henry Smith. Poisonous matches. (The world to-day, Feb. 1912, V. 21:1798-1800.) Brief, popular article. Wilson, G. B. Air-conditioning: being a short treatise on the humidifica- tion, ventilation, cooling, and the hy- giene of textile factories, especially with relation to those in the U. S. A. New York, 1908. 138 p. An effort to show how methods used abroad can be applied to American condi- tions. Mainly technical, dealing incidentally with hygiene. Wilson, James C. Chronic lead poi- soning. (In Pepper's System of practical medicine by American au- thors. Philadelphia, 1886. v. 5:678- 6g2.) Brief history and medical discussion with reference to origin in trades and arts. Wilson, J. F. Diseases incident to some occupations. ("The Transac- tions". Youngstown, Ohio, 1879-80, V. 1:89-93.) Winslow, Charles Edward Amory, Occupational disease and economic waste. (Atlantic monthly, May ipog, V. 103: 679-684.) General argument for investigation, legis- lation, factory inspection, etc. Ventilation, air space, humid- ity and temperature: topical criti- cism of existing laws. (American labor legislation review, June 191 1, V. I, no. 2: 110-112.) Urging investigations to establish stand- ards. Temperature and humidity in factories. (American labor legisla- tion review, June 1912, v. 2, no. 2: 297-304.) Sanitary dangers of certain occupations. (Journal of the Mass- achusetts association of boards of health. May 1904, v. 14:92-106, Also reprint.) Factory sanitation and effi- ciency. (In Technology and indus- trial efficiency, a series of papers pre- sented at the Congress of technol- ogy. Boston, igii. McGraw-Hill book company, N. Y., 191 1, p. 442- 448. Also abstract in Journal of in- dustrial and engineering chemistry, Easton, Pa., 1911, v. 3:508-511.) On ventilation, with table showing tem- perature and humidity in New York fac- tories. Industrial hygiene. Boston, igii. 40 p. (Health-education se- ries, no. 24.) The cash value of factory ven- tilation. (Transactions of the Sixth international congress on tu- berculosis, Washington, 1908. v. 3: 184-189.) Discussion, tables and chart showing de- crease in absences from work among tele- phone and telegraph operators when work- room was ventilated. Witmer, A. F. Clinical aspects of the occupation neuroses. (Proceedings, Philadelphia county medical society, Phila., 1898, V. 19:1-5. Also Phila- delphia polyclinic, 1898, v. 7:44-48.) General article from physician's stand- point. Wood, H. B. The influence of factory inspectors upon public health. (Pennsylvania medical journal, Ath- ens, igog-io. v. 13:17-23. Also Vir- ginia medical semi-monthly, Rich- mond, igog-io, V. 14:313-317.) With special reference to Pennsylvania, ttrging additional factory legislation. Wood, James R. Removal of the en- tire lower jaw for necrosis caused by phosphoric acid gas. New York, 1856. Pm. (Also in New York jour- nal of medicine, 1856, [2] s. v. 16: 301-316.) TTistory of nine serious cases of phos- phorus poisoning in match factories in New York City, during 1855 and 1856, Bibliography (Oilier Than American) 397 Woodward, C. M. History of the St. Louis bridge, St. Louis, 1881. The physiological effects of compressed air. (Also in Van Nostrand's en- gineering magazine, N. Y., 1882, v. 26: 29-42.) Experience with caisson disease in build- nig the bridge, with statistics of cases and deaths. Working women in large cities. (Fourth annual report of the United States commissioner of labor, 1888. "Condition of health". Tables xviii, xix, and xx, p. 369-394.) Health at age of beginning work during previous occupations and "now", by indus- tries and by cities. Wright, Carroll D. "Effect of work on health." The working girls of Bos- ton, p. 69-75. (From the Fifteenth. annual report of the Massachusetts Bureau of statistics of labor.) Bos- ton, Wright & Potter printing co., 1884. Brie£ descriptive treatment based on tes- timony of girls employed in various indus- tries. Effect of factory employments on health. (Report on the factory system of the United States. Tenth census, 1882, v. 2: 558-562.) Tables giving amount of air space per operative in 2,140 rooms in textile factories in Massachusetts, and occupation mortality statistics for manufacturing cities in Eng- land. Wright, Edward W. Readers' cramp. an analogy. (New York medical journal, 1897, v. 66:347-349.) Nerve ahettion in persons whose occupa- tions necessitate overstrain of the eyes. Wurdcmann, H. V. Economic limi- tations of the visual acuity in var- ious trades and professions. (Jour- nal of American medical associa- tion, Feb. 8, 1902, V. 38:380-382.) Scientific discussion of keenness of sight as related to specilic occupations. Phosphor-necrosis of the tem- poral bone. Milwaukee, 1898. Pam- phlet, reprint. Description of unusual case of phosphorus poisoning. Wyman, Walter. ]\iver exposure and its effects upon the lungs. (Annual report of supervising surgeon-gen- eral, United States marine-hospital service. 1876-77, p. 157-164.) Describes conditions of work which result in "river phthisis". Wynne, James. Report on vital statis- tics of the United States made to the Mutual life insurance company of New York, 1857. "Occupations", p. 205-210. Mortality statistics for England and for Massachusetts. Zenner, P. Auctioneer's cramp. (Jour- nal of nervous and mental diseases, N. Y., 1886, V. 13:616-622. Cincin- nati lancet-clinic, 1886, n. s. v. 17: 207-209.) Description of a single case. TITLES OTHER TEIAN AMERICAN Abel, F. Des proprietes dangereuses des poussieres. Revue Internation- ale de science biologique, Paris, 1882, V. 10: 351, 462. Ackerman, V. J. B. Des maladies speciales aux ouvriers employes dans les fabriques de sulfate de quinine. Paris, 1880. Action populaire, Reims. Extraits des discours prononces au Senat sur: Interdiction de la ceruse a I'in- ^ Many additional titles will be found in the list of references on occupational diseases and industrial hygiene in the quarterly bibli- ography on labor topics published as a sup- plement to the Bulletin of the International Labor Office by tke Association for Labor Legislation. terieur des batiments. Reims; Par- is, V. Lecoffre [1908.] 34 p. (Actes sociaux; publication documentaire periodique de I'Action populaire, no. 15) Adelmann, G. L'eber die Krankheiten der Kiinstler und Handwerker nach den Tabellen des Instituts fiir kranke Gesellen der Kunstler und Handwerker in Wiirzburg von den Jahren 1786 bis 1802. Wiirzburg, 1803. Alfassa, Georges. Les poisons indus- triels. Rapport presente a I'Asso- ciation Internationale pour la pro- tection legale des travailleurs . . . Paris, 1006. 34 p. 398 American Labor Legislation Review Allan, J. W. Lectures on trade dis- eases. Glasgow medical journal, 1900, V. 53: 332-338. Allevi, Giovanni. Le malattie dei la- voratorie. L'igiene industriale. Mi- lano, U. Hoepli, 1908. 415 P- Alliance d'hygiene sociale. 2""° Con- gres, Montpelier, 1905. 2"° Con- gres d'hygiene sociale tenu a Mont- pelier 19-21 mai 1905. [Bordeaux, 1905] 491 p. Amado, J. J. Hygiene des professions, cultures, et metiers insalubres. Con- gres international de medicine des colonies, 1883, Amsterdam, 1884, p. 95-101. Angey, C. Les risques professionels; les accidents et les maladies du tra- vail. Paris, A. Rousseau, 1907. 207 P- Annaratone, C. A. Contributo alle malattie professionali dell' orec- chio. Giornale medico del r° esercito e della r" marina, 1905, v. S3: 739- 742. Arlidge, John Thomas. The hygiene, diseases and mortality of occupa- tions. London, Percival & co., 1892, XX, 568 p. On occupations in their re- lation to health and life. British medical journal, 1878, v. 2: 239-244. On the position of the study of industrial diseases; its past neglect and its scope. Sanitary in- stitute (London). Journal, Jan. 1895, v. 15: 517-520. The state of sickness among laborers. (In international congress of hygiene and demography. 8th, Budapest. Comptes-rendus et memoires. Budapest, 1896. v. 8, pt. 3: 37-40-) Arnould, J. La fabrication du bleu d'outremer, hygiene industrielle et hygiene administrative. Annales d'hygiene (Paris), 1884, 3. ser., v. 12: 404-423. Association des industriels de France centre les accidents du travail. Bul- letin. . . No. 22-23. Paris, 1910- (Annual) Bulletin bimestriel. . . 1910. Paris, 1910. Association nationale franijaise pour la protection legale des travailleurs, Paris. Les maladies profession- nelles; rapport de M. L.-J. Breton. Paris, F. Alcan, [etc.] igil. 107 p. [Its Publications] 6" ser,, no. 5) La reforme de la proce- dure de la mise en demeure, organi- see par la loi du 12 juin 1893-11 juil- let 1903 sur I'hygiene et la securite des travailleurs. Rapport de M. E. Briat. Paris, Felix Alcan, editeur, 1910. 150 p. (Its Publications] 6" ser. no. 2) Association ouvriere de I'hygiene et de la securite des travailleurs et des ateliers. 3d congress, Paris, 1907. Troisieme congres de I'hy- giene et de la securite des travail- leurs et des ateliers. 1907. • • Par- is, L'fimancipatrice, impr. com- muniste, 1907. 123 p., 2 i. 4th congress, Paris, 1909. Quatrieme congres de I'hygiene et de la securite des travailleurs et des ateliers, 1909. . Paris, L'fiman- cipatrice, 1909. 169 p., I_ I. Associazione degli industriali d'ltalia per prevenire gli infortuni del la- voro, Milan. [Avvisi a stampa. Mi- lan, n. d.] 18 broadsides. (Post- ers containing directions for the prevention of accidents and instruc- tions pertaining to industrial hy- giene.) Esercizio. . . 1898. Mi- lano, [etc., etc.] 1899. Le misure preventive por proteggero gli operai delle Indus- trie contro la malattie del carbon- chio. Note deir Ing. F. Massarel- li. Milano, 1909. 56 p. Astegiano, G. Contributo alio studio delle malattie professionali. Gior- nale medico del r° esericito e della r" marina, 1886, v. 34: 1025-1048. Austria. Arbeitsstatistisches Amt. Bleivergiftungen in hiittenmannis- chen und gewerblichen Betrieben, . . . Wien. Alfred Holder, 1905- 1907. 7 v. in 5. Baraks, Helene R. Les nevrites pro- fessionnelles. Paris, 1901. Barnett, Henry Norman. .Accidental injuries to workmen with reference to Workmen's compensation act, 1906. With article on injuries to the organs of special sense, by Ce- cil E. Shaw . . . and legal intro- duction by Thomas J. Campbell . . . London, Rebman limited, 1909. vii, 376 p. Appendices; a. Text of the act. b. List of industrial diseases. Bibliography (Other Than American) 399 c. Report of Departmental com- mittee, etc. Barth, C. G. De mobis ex vitae gen- ere. Lipsiae, [1764], Baum, Marie. Der Einfluss der ge- werblichen Arbeit auf das person- liche Leben der Frau. Der Ein- fluss der gewerblichen Gifte auf den Organimus der Frau, von. Agnes Bluhm . . . Jena, Fischer, 1910. 69 p. (Schriften des standigen Aus- schuss zur Fordering der Arbeiter- inneninteressen. Hft. 3) Beaumont, William Harden. Injuries of the eyes of the employed and the Workmen's compensation act; problems in prognosis. London, H. K. Lewis, 1907. viii, 160 p. Beauvais, de. Rapport sur un cas d'osteo-periostite, aigue, multiple, tres-etendue, chez un apprenti ajus- teur-mecanicien. Annales d'hygie- ne (Paris), 1878, 2. ser., v. I: 362- 384. Becker, Hans. Die Erkranks- und Sterblichkeitsverhaltnisse, (In Aus- tria. Statistische Zentralkommis- sion. Statistische Monatschrift. Wien, 1905. n. f., 10. Jahrg. [Nr.] 4, p. [2051-343) Behrend, F. J. Ueber die Einfluss der Beschaftigung auf die Gesundheit Und Sterblichkeit. Zeitschrift fiir die Staatsarzneikunde, i860, v. 70: i; 1861, V. 71: 78. Belgium. Ministere de I'interieur. Enquete sur la condition des classes ouvrieres et sur le travail des en- fants. Bruxelles, 1846-48. 3 v. Office du travail. Les fila- tures de lin. Etude d'hygiene pro- fessionnelle. . . Bruxelles, 1902 463 P- Bender, — . Industrial hygiene. 1906. Bender, W. Ueber die Lebens-und Gesundheitsverhaltnisse der Textil- arbeiter der Stadt Bocholt. Zeit- schrift fiir Gewerbe- Hygiene [etc.], 1904, V. II: 285-309; 334; 360. Benoit, F. Reglementation du tra- vail; manual d'hygiene et de ime- canique industrielles. Paris, 1893. Bericht fiber die 21. und letzte Gen- eralversammlung des Vereins zur Pflege des Gewerbehygienischen Museums in Wien am 18. Janner 1910. Mitteilungen des Gewerbe- hygienischen Museums, Wien, no. 335. Bertillon, J. Sur la morbidite et spec- ialement sur la morbidite profes- sionnelle. Revue d'hygiene et de police sanitaire (Paris), 1890. v. 12: 1105-U32. De la morbidite et de la mortalite par profession. Journal de la societe de statistique de Paris, 1892, V. zr. 341, 382. Morbidity and occupation. Journal of the royal statistical so- ciety, London, Dec. 1892, p. 559. Bertin, G. Essai sur I'hygiene de i'ouvrier au point de vue de I'hab- itation, de I'alimentation et du tra- vail. Paris, 1864. Berufskrankheiten. Zeitschrift fiir Gewerbe-Hygiene [etc.] 1899, v. 6: 344; 357. Betta, Enrico de. SuUe professioni considerate come causa di Malattia. Pavia, 1849. Beyer, E. Die Fabrik-Industrie des Regierungsbezirkes Diisseldorf vom Standpunkt der Gesundheitspflege. [Berlin?]. 1876. Bielefeldt, A. Der Einfluss der deutschen Arbeiterversicherung auf die Verhiitung und Bekampfung von Volkskrankheiten. Kranken- flege (Berlin), 1902, v. 2: 67-71. Bierbaum, J. Arbeit und ihr gesund- heitlicher Schutz. Deutsche Zeit- schrift fiir die Staatsarzneikunde, 1867, n. s., V. 25; 3-66. Biondi, C. La valutazione medico- legale delle infezioni nel campo del- la patologia del lavoro. Clinica moderna (Firenze), 1906, v. 12: 301- 305. Blackburn, Eng. Special committee appointed to enquire into the sub- ject of steaming in weaving sheds. Report of the Special committee appointed to inquire into the sub- ject of steaming in weaving sheds. [Blackburn, 1888] 232 p. Blaise, E., Napias, H. Note sur les poussieres industrielles, modifica- tions a apporter a la legislation en matiere d'hygiene industrielle. Re- vue d'hygiene, Paris, 1883, v. 5: 940- 9SI- Blandet. Maladies des professions insalubres. Paris, 1845. Blaschko,. A. Zur Aetiologie und Pathogenese des Gewerbeekzems. Deutsche medicinische Wochen- schrift, 1892, V. 18: 144-146. 400 American Labor Legislation Review Blum F. Medizinischcs uber die tawa, Printed by C. H. Parmelee, Bleivergiftung. [Leipzig, G. Tliieme, 1910-11J 3, [i] P- (Parliament, 1912] 16 p. Kjio-ii. 11. of C, Bill no. ID) Boobyer, Philip. Abstract of report Carozzi, Luigi. L'assimilazione delle upon tbe health of lace dressing nialattie professionali agli infor- operatives. [Nottingham, 1907] 48 tuni del lavoro in Francia . . . Fi- p. (With Nottingliam, Eng. Health renze, Tip. L. Niccolai, 1910. 11 p. dept. Annual health report for Avvelenamenti e infezioni 1906) professionali esposti per ordine al- The health of lace-dressing fabetico... Milano, 1909. no p. operatives,. Royal sanitary ;insti- Bibliography, p. no. tute. Journal, 1907, v. 28: 480-482. Contributo alio studio delle Boulin, M. Les fonderies de plomb. condizioni igienico-sanitarie nel- Paris, Imprimerie nationale, 1907. la trattura della seta. Firenze, 107 p. "Extrait du Bulletin de Tin- 1910. 12 p. (Estratta dal "Ram- spection du travail, 1906, nos. 5 et azzini" giornale italiano di medicina 6." sociale, anno IV, Fasc. 11-12...) Bourdin, C. E. Association philo- Inchiesta igienica-sanitaria technique. Section de Choisy-le- nell' industria poligrafica in Italia. Roi (Seine). Du progres considere fFirenze, Tip. Luigi Niccolai, 1911] particulierement au point de vue do 4 pts. (Associazione internazionale bienetre hygienique des classes la- per la protezione legale dei lavora- borieuses. Paris, 1865. tori. Sezione italiana. Pubblicaz- Eoycott, A. E., Damant, G. C. C, ioni, n. s., n. 2, 4, 6) Haldane, J. S. Prevention of com- I lavoratori del libro di pressed-air illness. Journal of hy- fronte ai problemi dell' ingiene del giene, 1908, v. 8: 342. lavoro e dell' assiscurazione malat- Braye, F. J. Quelques reflexions sur tia... IVIilano, 1910. 22 p. (Estrat- I'iniluence exercee par diverses pro- to dal giornale 'II Lavoratore del fessions sur I'economie animale. libro', anno XXXVI, n. 17.) Paris, 1836. Linee per una statistica di Breton, J. L. L'interdiction de la ce- morbilita delle classi lavoratrici. . . ruse dans I'industrie de la peinture. Firenze, 1910. 10 p. French section. International asso- Organizzazione e funzion- ciation for labor legislation. Third amente delle consultazioni fdal] series, no. i. dott. L. Carozzi... Estratto deg- Les maladies profession- li Atti della Societa medico-biolo- elles. Encyclopedie parlementaire gica, vol. IV° fasc. 3, 1909. Milano, des sciences politiques et sociales. 1910. 8 p. Paris, Dunod and Pinat. 1911. Reperti ematologici e loro Bristowe, J. S. Industrial diseases valore statistico nel saturnismo (in London. International health professionale [dal] dott. Luigi Car- exhibition. Conference, 1884. Lon- rozzi... Milano, Tip. ditta F. Fos- don, 1884. no. 2, p. 99-139-) sati, 1909. 28 p. (Estratto dal Cor- Broca, A. Osteite des nacriers. Ga- riere sanitario, n. 5-6, 1909, anno zette des hopitaux, May i, 1904, v. XX...) 77: 611-617. Ricerche sperimentali sul Bunge, Augusto. Las conquistas de carbonchio da inalazione. . . fl-II] la higiene social . . . t. 1. Buenos 1909-10. 2v. Pt. I "Estratto dal Aires, Talleres graficos de la Pen- Milano, Societa editrice libraria, ■itenciaria nacional. 1910. periodico Tl Morgagni'. n. 10, Caltnettes, .Emile. Le staturnisme. 1909". Pt. II "Estratto dal Cor- Prophylaxie, legislation comparee, riere sanitario. n. 21, 1910, anno Paris, Giard et Briere, 1910. 156 p. XXI". Bibliography in footnotes. Canada. Laws, statutes, etc. 1910- Le malattie professionali II. An act to prohibit the manu- alia sezione petto e cuore dell' Am- facture and importation of matches bulatorio policlinico. Tribuna med- made with white phosphorus. fOt- ica (Milano), 1905, v. II: 97-106. Bibliography (Other Than American) 401 II servizio delle consult- azioni della clinica del lavoro. Mi- lano, igii. Castellani and Chambers. Manual of tropical medicine. 1910. "Lacquer poisoning": p. 118. Castelnau, B. de. Note sur I'influence de la detention, des diverses indus- tries, et du nouveau regime des mai- sons centrales, sur les setenus de la maisons de Nimes, pour I'annee 1839, Annales d'hygiene, 1842, v. 27: 198-215. Central- Verein fiir das Wohl der ar- beitenden Klassen. Bericht iiber seine Entwickelung und Tatigkeit von 1844 bis 188:!, vorgelegt der all- gemeinen deutschen Austellung fiir Hygiene und Rettungswesen. Berlin, 1883. Chatelain, L. La protection Interna- tionale ouvriere. Paris, A. Rous- seau, 1908, X, 243, fi] p. "Biblio- graphie": p. fviil-x. Chevallier, A. De la fabrication des amorces; des dangers qu'elle pent causer, de la responsabilite du fabri- cant. Annales d'hygiene, 1875, 2. ser., V. 43: 330-335- Christie, J. On the hygiene of trades. Sanitary journal (Glas- gow), 1882-83, n. s., V. 6: 193-207. Chyzer, Bela. Des intoxications par le plomb se presentant dans la ce- ramique en Hongrie. Budapest, Impr. A. Schmidl, 1908. 36 p. (As- sociation Internationale pour la protection des ouvriers. Edition de la section hongroise, no. l) Az akkumulatorokkal ka- posolatosan elofordulo ipari beteg- segekrol. Gyogyaszat, 1905, v. 45: 784; 803. Gewerbekrankheiten. Zeit- schrift fiir Gewerbe-Hygiene, 1907, V. 14: 475.;. 503- Uber die im ungarischen Tonwarengewerbe vorkommenden Bleivergiftungen. . . Jena, 1908. 32 p. (Schriften der Ungarischen Vereinigung fiir gesetzlichen Ar- beiterschutz. Heft, i) Clinica delle malattie professionali di Milano. Patologia ed igicne del la- voro. Serie I, 1912. F. Fossati, Mi- lano. Istituti clinici di perfez- ionamento di Milano. Programma (legli nisegnamenti del 1911-1912, Milano, 1911. • ■. ■ • ■ Istituti clinici di perfe- zionamento di Milano. Regola- mento della clinica delle malattie professionali. Milano, 1910. Congres international d'hygiene, de sauvetage et d'economie sociale, Bruxelles, 1876. I>;apport sur I'hy- giene en Suede, redige, par ordre du Comite suedois, par. O. Printz- skold. Stockholm, 1876. Congresso internazionale per le mal- attie del lavoro, 1st, Milan, 1906. Atti del I." Congresso internazion- ale per le malattie del lavoro, Mi- lano 9-14 Giugno 1906. Milano, 1906. 784 p. 2d, Brussels, 1910. [Pro- ceedings] 1911. Congresso nazionale per le malattie del lavoro. ist, Palermo, 1907. Atti del I Congresso nazionale per le malattie del lavoro (malattie pro- fessionali ) Palermo, 19-21 ottobre 1907. Palermo, Stab. tip. Virzi, 1908. xxiii, 342 p., I I, Contini, C. Igiene dell' operaio. Ro- ma, 1881, Coreil, Francois. Les industries in- salubres; etablissements classes.... par Francois Coreil... et Leon Nicolas... Paris, H, Dunod & E. Pinat, 1908. 778 p. Coronel, S. S. De gezondheidslecr toegepast op de fabrieknijverheid. Amsterdam, 1863. Criegern, von. Ueber eine gewerb- liche Vergiftung beobachtet bei der Rauchwaarenfarbung mit Paraphe- nylendiaminpriiparaten, welche un- ter dem klinischen Bilde eines Bronchialasthmas verlauft. Ver- handlungen des Congresses fiir in- nere Medicin (Wiesbaden), 1902, v. 20: 457-464. Cutts, William Henry. On the injur- ious effects of close confinement and overwork. Australasian medi- cal gazette, Jan. 1885, v. 4: 90-95. Dammer, Otto. Han'dbuch der Ar- beiterwohlfalirt. Bearb. von dr. As- cher, prof. Biising, privatdocent stabsarzt dr. Dieudonne [etc.] Stuttgart, F. Enke, 1902-03. 2 v. illus., diagrs. Darwall, J. De morbis artificum prae- 4' .Oi American Labor Legislation Revie-W cipue eorum qui Birminghamiae hab- bitant. Edin1)urgi, 1821. De I'influence des professions sur la duree de la vie. Annales de demog- raphie Internationale, Paris, 1880, v. 4: 213-221. Delperier, Louis. La protection de la sante des travailleurs du com- merce. Paris, A. Rousseau, 1910. vii, 230 p. "Bibliographie": p. fv]- Vii. Desbouis, J. £tude sur les maladies professionnelles considerees comme accidents du travail. Paris, I904- Devoto, L. La clinica delle malattie professionali di Milano, sua azione scientifica e sociale. Clinica medi- ca italia (Milano), 1908, v. 47: 173- 176. Le malattie del lavoro. La- voro (Pavia), 1903, v. 2: 34: 49. La clinica delle 'malattie proiessionali di Milano. Corriere sanitorio (Milano), 1908, v. 19: 255- 235- La clinica del lavoro di Milano nelle sue origini. Genova. 1911. 18 Mesi di clinica dei verniciatori di Milano. Conferenza popolare. Milano, 1911. Le alterazioni dei vasi, dei reni e delle articolazioni nel sat- urnismo cronico. 191 1, F. Fossati, Milano. Devoto, L. and Carozzi, L. Rapport sur la protection hygienique des travailleurs dans i'industrie typogra- pliique, Roma, igi2. Association In- ternationale pour la protection legale des travailleurs. Dictionaire des sciences medicales, par une societe de medecins et de chi- rurgiens: MM. Adelon, Alard, Ali- bert... [et autres] Paris, C. L, F. Panckoucke, 1812-22. 60 v. plates (partly fold.) tables (partly fold.) "Maladies des artisans": v. 30, p. 209-236. Didot, A. Diseases of artisans. San- itary record (London), 1875, 109-111. Discussion on the diseases of occu- pation. British medical journal, 1901, v. 2: 401-412. Disque, — . Ueber den Einfluss der Fabrikarbeit auf die Gesundheits- verhaltnisse der Arbeiter in Thann im Ober-Elsass. Archiv fur offent- liche Gesundheits-Pflege m El- sass-Lothringen, 1882, v. 7: 99-II3- Drouineau, G. Note sur I'industrie des buandiers et la legislation^ ac- tuelle concernant les etablisse- ments insalubres; avec discussion. Revue d'hygiene, 1879, v. I: 647- 658. Sur les conditions sani- taires des ouvriers des grands chan- tiers. Revue d'hygiene, 1881, v. 3: 498-500. Duchesne, Laurent. Reponses aux questionnaires de I'Office interna- tional du travail. 1902. Publication no. IV. Belgian section of the In- ternational association for labor leg- islation. Duckering, G. Elmhirst. Cause of lead poisoning in the tinning of metals. Journal of hygiene, 1908, v. 8: 474-503- Ducrot, M. Le saturnisme dans la typographic. France. Direction du travail. Bulletin de I'inspection du travail, 1906, no. 5 and 6. Dullin, Albert. L'hygiene et la se- curite des travailleurs dans la leg- islation franqaise. Paris, A. Rous- seau, 1903. xi, 350 p. "Bibliograph- ie": p. [vii]-xi. fidition contenant les dispositions recentes de la loi generale du 19 fevrier 1902 et les reglements nouveaux concernant: 1° Les industries manufacturieres. 2° Les industries minieres. 3° L'in- dustrie agricole. Edis, A. W. Counter seats for shop- women. The standing evil. Lon- don, 1878. Ehrenfeld, Richard. Die Aktion der osterreichischen Regierung zur Be- kjimpfung der Bleivergiftungen in hiittenmannischen und gewerblichen Betrieben. Wien, F. Deuticke, igio. 97 p. (Schriften der osterr. Gesellschaft ftir Arbeiterschutz. xiv. Hft.) Eingabe des Vorortes an die Kantons- re,gierungen und Gemeindeverwal- tungen vora. 10. Marz 1905, betref. Ersetzung des Bleiweisses im Mal- ergewerbe durch bleifreie Farben. 1905. Publication no. 10, Swiss sec- tion. International association for labor legislation. Eisenstadt, H. L. Beitrage zu den Krankheiten der Postbeamten. Berlin, 1911. Bibliograpliy (Other Than American) 403 Enfermendades profesionales. (In Congreso medico internacional de accidentes del trabajo de Lieja de 1905. Apuntes y consideraciones. Barcelona, 1905. p. 37-42.) Erismann, F. Gigiena fabrichnikh rabochikh, remeslennikov i po- denshchikov. Sbornik sochinenii po sudebnoi mcditsinie, 1877, v. i; 798; 976. Eulenberg, H. Handbuch der Ge- werbe-Hygiene auf experimenteller Grundlage. Berlin, 1876. Ferrero, L. O. Contribuzioni e studi igienici sur lavoro nelle campagne e in parecchie arti e Industrie in provincia terra di lavoro. Caserta, 1884. Fischer, R. Der Entwurf einer Liste der gewerblichen Gifte. Bericht an die Internationale Vereinigung fiir gesetzlichen Arbeiterschutz erstat- tet. Frankfurt a. M., 1910. 48 p. Die industrielle Herstel- lung und Verwendung der Chrom- verbindungen. Berlin, igii. 171 p. (Schriften des Instituts fiir Ge- werbehygiene zu Frankfurt a. M. [v. I]) Die Krankheits- und Un- fallverhiitung im Gewerbetrieb Gewerbehygiene, Arbeiterschutz, Frankfurt a. M., E. Griesser, [19- ] 40 p. (Aufwarts, Bijcherei zur Be- lehrung und Erholung... Nr. 5.) [Flegel, Charles.] The abuse of the scaphander in the sponge fisheries. From Bulletin of the Bureau of fisheries, volume xxviii, 1908. Pro- ceedings of the Fourth Internation- al fishery congress, Washington, 1908. Washington, Govt, print, off., 1910. I p. 1., p. 513-543. (U. S. Bureau of fisheries. Doc. no. 668) France. Conseil d'hygiene publique et de salubrite du department de la Seine. Maladies professionnelles. (In its Rapport generale sur les travaux, 1862-1866. Paris, 1870. p. 6i-75.) Direction du travail. Hy- giene et securite des travailleurs dans les ateliers industriels. Leg- islation fran(;aise et etrangere. Par- is, Imprinierie nationale, 1895. 659 p. (Ministere du commerce, de I'in- dustrie, des postes et des tele- graphes. Office du travail) Poisons industriels. Paris Imprimerie nationale, 1901. vii p., i^ I., 449 p. "Extraits dc lois et reglements des principaux pays in- dustriels sur I'hygiene des ateliers dans les industries insalubres:" p. 265-433. Laws, statutes, etc. Lois, decretes, arretes concernant la reg- lementation du travail et nomen- clature des etablissements danger- eux, insalubres ou incommodes. (Juillet) Pans, Nancy, 1908. 149 P- 1909- , 155 P- Ministere du travail et de la prevoyance sociale. Les condi- tions du travail aux Etats-Unis, etudies specialement dans la tan- nerie au chrome pour chaussures. Mission du Ministere du travail (mai 1908) Rapports presentes a M. le ministre du travail par MM. F". Pin ... et H. Chaumartin . , . Ch. Fritz ... et F. Richard ... et Charles Barrat, enqueteur permanent au Ministere du travail, chef de la mission. Paris, £. Cornely et c"*, 1910. 2 p. 1., [vii]-xvi, 317 p., 1. 1. inch tables. Prefecture de police. Rap- port sur les operations du service d'inspection des etablissements classes... 1909. Paris, 1910. Freund, L. Die Berufskrankheiten und ihre Verhutung, mit besonder- er Beriicksichtigung der graphi- schen Gewerbe. Halle a. S., 1901. Freycinet, C. de. Hygiene industriel- le en Angleterre; rapport sur I'as- sainissement des fabriques ou des procedes d'industries insalubres en Angleterre. Annales d'hygiene, 1864, 2. ser., V. 22: 245; 1865, 2. ser., V. 23: 51-197. Traite d'assainissement in- dustriel, comprenant la description des principaux procedes employes dans les centres manufacturiers de I'Europe occidentale pour proteger la sante publique et Tagriculture contre les efifets des travaux indus- triels. Paris, Dunod, 1870. 2 p. 1., ^, 473 P- inch tables, and atlas of 21 pi. Friedrich, V. Gewerbekrankheiten und deren Erreger. Archiv fiir Un- fallheilkunde, Gewerbehygiene und 404 American Labor Legislation Review Gewerbekrankheiten, 1900, v. 4: 121-137. Orvosi haladas az 1900; evben az impari miegbetegedes ter- en. Orvosi hetilap (Budapest), 1901, V. 45: 320; 337; 353; 370; 388; 401. Friedrich, Wilhelm. Die Phosphor- nekrose in Ungarn. Jena, 1910. 69 p. (Schriften der Ungarischen Vereinigung fiir gesetzlichen Ar- beiterschutz . . . Hft. 4) Friedrich, W. Zur Frage der Lungen- krankungen unter den industriellen Arbeitern. Archiv fiir Unfallheil- kunde, Stuttgart, 1899, v. 3: 1-33. Report on grinding of metals and racing of grindstones. Parliamentary papers, London, 1909, Cd. 4913. Ventilation of factories and workshops, pt. I and 2. Cd. 3552, 3S53-) Friedrich, W. and F. Tauszk. Der Einfluss der accuten Arbeit auf das Verhalten des Herzens. Wiener medizinische Presse, 1892, v. 2Z'- 497; 544; 583. Frischmann, G. A foglalkozasi meg- bet egedesekrol. Gyogyaszat (Bud- apest), 1900, V. 40: 580. Frois, Marcel. Pratique de I'hygiene industrielle a I'usage des industriels, des ingenieurs et des architects d' usines, des conseils d'hygiene et des commissions sanitaires. . . par... Marcel Frois & Paul Razous... Paris, 1907. 215 p. Gaboriau, A. P. Contribution a I'etude des spasmes professionnels. Paris, 1887. Gallard, Frank. L'hygiene d'ouvrier aux £tats-Unis, consideree au dou- ble point de vue du milieu profes- sionnel et de I'assistance adminis- trative. Paris [etc.] Berger-Levrault & c", 1905. xvii, 200 p. incl. illus., plan, tables. At head of title: Rap- port presente a M. le ministre du commerce, de I'industrie, des postes et des telegraphes. Gaskell, P. Artisans and machinery: the moral and physical condition of the manufacturing population con- sidered with reference to mechani- cal substitutes for human labour. London, J, W. Parker, 1836. xv, 399, [i] p. Ge, A. Porajenie nosovoi polosti rabochich prigotovliajoutschich dvu- chromokisloe kali. Meditsinskii Vestnik, 1882, v. 21: 735; 749; 746; 800. Gewerbehygiene und Gewerbekrank- heiten. Rundschau des Instituts fiir Gewerbehygiene zu Frankfurt a. M. [v. l]- 1911- Berlin, 1911- monthl3^ Gilbert, W. H. Beitrage zu den neuer- en Heilverfahren in ihrer Bedeutung fiir die Behandlung der Berufs- krankheiten und Unfallsverletzun- gen. Berlin, 1903. Gine, J. Higiene del trabajo. Inde- pendencia medica (Barcelona), 1877, V. 12: 201; 213; 225; 261; 273; 289; 302. Glogner, W. Die Krankheiten, welche durch den Gewerbebetrieben verur- sacht werden, und die volksthiim- lichen Heilmittel derselben. Lieg- nitz, 1880. Godfrain, J. Sur I'hygiene des ouv- riers des manufactures. Paris, 1852. Golebiewski, Ed. Atlas and epitome of diseases caused by accidents . . . authorized translation fro^m the Ger- man, with editorial notes and addi- tions by P. Bailey. Philadelphia, W. B. Saunders & co., 1900. i p. 1., 11-549 P- illus., col. pi. (Saund- ers' medical hand-atlases). Goliner, Dr. Gewerbliche Gesundheits- pflege. Gross-Lichterfelde, 1910. 8S p. Gollmann, W. Ueber Kiinstler-Krank- heiten. Wien, 1S75. Gosse, A. L. Sur les maladies causees par I'exercice des professions. Par- is, 1816. Gt. Brit. Board of trade. Royal com- mission on labour, 1894. Papers showing the action taken by the Board of trade with regard to cer- tain recommendations of the Roy- al commission on labour respecting seamen of the mercantile marine. Presented to both houses of Par- liament by command of Her Ma- jesty. London, Printed for H. M. Stationery off., by Eyre and Spottis- woode, 1894. 7 p. ([Parliament. Papers by command] C. 7540) Consulate. Diisseldorf, Ger- many. Ankylostomiasis. Reports on the outbreak in the Westphalian Bibliography (Other Than American) 40s colliery district in Germany... Lon- don, 1903. 23 p. (Cd. 1671) Foreign office. Belgium. Report on the precautions taken to combat ^ ankylostomiasis (Miner's worm disease) in Belgium. Lon- don, 1907. 22 1. (Diplomatic and consular reports. Misc. ser. no. 656) Cd. 3284) Germany. Report on the regulations^ respecting the manufac- ture of lucifer matches in Germany and Prussia... London, 1894. S p. (Parliament. Papers by command. Cd. 6856-59) Home dept. Dangerous trades. Action taken by the Home office under the factory and work- shop acts... London, 1906. 6 p. (Cd. 3037) Factory and workshop acts. Dangerous and unhealthy industries. Regulations and special rules, in force on ist January, 1908. Lon- don, Printed for PL M. Stationery ofif., by Darling & son, ltd., 1907. 89 p. .... Factory and worshop acts. 1901 and 1907, and Notice of acci- dents act, 1906. Preliminary tables (subject to correction) of cases of industrial poisoning, fatal and non- fatal accidents, and dangerous oc- currences in factories, workshops, etc... 1910. London, 1911. ([Par- liament. Papers by command] 5548, 6472.) .... Lead compounds in pottery. Report to Her Majesty's principal secretary of state for the Home de- Ipartment on the employment of compounds of lead in the manufac- ture of pottery, their influence upon the health of the workpeople, with suggestions as to the means which might be adopted to counteract their evil effects. By Professor T. E. Thorpe... and Professor Thom- as Oliver... London, 1899. So p. (Cd. 9207) . . . . Lead smelting. Special report on dangerous or injurious processes in the smelting of mater- ials containing lead and in the man- ufacture of red and orange lead, and flaked litharge. By Edgar L. Col- lis... London, 1910. 29 p. (Cd. 5152) Manufacture of patent fuel. Special report on ulceration of the skin and epitheliomatous cancer in the manufacture of patent fuel, and of grease, by T. M. Legge, M.D. London, 1910. 10 p. Report to the Secretary of state for the Home department on the health of Cornish miners. By J. S. Haldane... London, 1904. 107 p. (Cd. 2091) .... Report upon the conditions under which bronzing is carried on in factories and workshops. By Ed- gar L. Collis... London, 1910. 32 p. (Cd. 5328)^ .... Tinning of metals. Special report on dangerous or injurious processes in the coating of metal with lead or a mixture of lead and tin. By Miss A. M. Anderson, H. M. principal lady inspector of fac- tories, and T. M. Legge, M.D., H. M. medical inspector of factories. Together with a report on an exper- imental investigation into the condi- tions of work in tinning work shops, and appendices. By G. Elmhirst Duckering, one of H. M. inspectors of factories. Presented to both houses of Parliament by command of His Majesty. London, Printed for H. M. Stationery oil., by Darl- ing & son, ltd., 1907. 42 p. diagrs. Parliament. Papers by command. (Cd. 3793) . . . . LTse of phosphorus in the manufacture of lucifer matches. Re- ports., .on the use of phosphorus in the manufacture of lucifer matches; by Professor T. E. Thorpe... Pro- fessor Thomas Oliver... and Dr. George Cunningham... London, 1899. 236 p. (Cd. 9188) .... Workmen's compensation act, 1906. Order of the Secretary of state for the Home department, dat- ed May 22. 1907, extending the pro- visions of the workmen's compensa- tion act, igo6, to certain industrial diseases. London, 1907. 4 p. (Cd. 3539) .... Workmen's co'mpensation act, 1906. Order of the secretary of state for the Home department, dat- ed December 2, 1908, extending the provisions of the workmen's com- pensation act, 1906, to certain indus- 4o6 American Labor Legislation Review trial diseases, and amending the pre- Report on grinding of metals vious order of May 22, 1907. Lon- and racing of grindstones. Parlia- don, 1908. 4 p. (Cd. 4419) mentary papers, London, 1909. (Cd. Committee on compensation 49I3-) for industrial diseases. Report of the Ventilation of factories and departmental committee on compen- workshops, pt. i and 2. (Cd. 3552, sation for industrial diseases [with 3553-) Minutes of evidence, appendices, Report of a committee of and index] London, Printed for H. the Admiralty on deep water diving. M. Stationery off., by Wyman and London, 1907. sons, limited, 1907. 2 v. in i. diagrs. Greer, William Jones. Industrial dis- ([Gt. Brit. Parliament. Papers by eases and accidents, by W. J. Greer, command] Cd. 3495-3496). ..Bristol, J. W. Arrowsmith; [etc., , . . . . Committee on lead, etc., in etc.] 1909. xiii, [i], 326 p. viii pi. 4 1. potteries. Report of the depart- "List of authors and works of ref- mental committee appointed to in- erence used in the text": p [xi] — quire into the dangers attendant on xiii. "Section on injuries and dis- the use of lead, and the danger to eases of the eye. By R. J. Coulter": health arising from dust and other p. 277-312. _ causes in the manufacture of earth- Grillet, Louis. L'hygiene du travail enware and china and in the pro- dans les etablissements industriels cesses incident thereto, including et commerciaux. Paris, [1906?] 192 the making of lithographic trans- p. fers... [with appendices and min- Gubler et Napias. Des moyens de utes of evidence] London, Printed diminuer les dangers qui resultent for H. M. Stationery off., by J. pour les travailleurs des differentes Truscott & son, ltd., 1910. 3 v. in 1. industries de I'employ des substan- plates. ([Parliament. Papers by ces minerales toxiques: mercure, command] Cd. 5219, 5278, 5385) plomb, arsenic, etc. Congres inter- .... Dangerous trades (anthrax) national d'hygiene, 1878. Paris, committee. Report of the Depart- 1880, p. 598-654. mental committee appointed to in- Guer, E. Guerlin de. Les etablisse- quire into the conditions of work in ments insalubres. L'industrie et hy- wool-sorting and other kindred giene, Paris, 1883, 43 p. 80. Berger- trades. London, 1897. 35 p. (Cd. Levrault et Cie. 8506) Guerard, A. Hygiene des ouvriers .... Dangerous trades (anthrax) charges du service des moteurs a committee. Report of the Depart- vapeur. Annales d'hygiene, 1873, 2 mental com'mittee appointed to in- ser., v. 40: 347-365. quire into the conditions of work Guy, William A. Contributions to a in wool-sorting and other kindred knowledge of the influence of em- trades. London, 1897. 35 p. (Cd. ployments upon health. Royal sta- 8506). tistical society of London. Jour- .... Dangerous trades committee. nal, Aug., Dec. 1843, v. 6: 197-211; Reports of the Departmental com- 283-304. mittee appointed to inquire into and Hahn, Martin. Die Gesundheitsver- report upon certain miscellaneous haltnisse in polygrapischen Ge- dangerous trades... London, 1898- werbe Deutschlands" mit besonderer 99- 3 V. (Cd. 8522, 9073, 9420, 9509). Beriicksichtigung der Bleivergif- .... Treaties, etc., igoi-1910. (Ed- tung. Bericht an die Internationale ward yil.) Accession of the Unit- Vereinigung fiir gesetzlichen Ar- ed Kingdom to the International beiterschutz. . . Berlin, Druck der convention signed at Berne, Sep- vaterlandischen Verlags- und tember 26, 1906, prohibiting the use Kunstanstalt [1909?] 59 p. of white (yellow) phosphorus in Der Fabrikarzt. Soziale the manufacture of matches. De- Medizin und Hygiene, 1906, v. i: cember 28, 1908 . . . London 238-242. [1909] 8 p. (Treaty series no. 4, Haldane, John Scott. Report to the 1909.) (Cd. 4530) secretary of state for the Home de- Bibliography (Other Than American) 407 partment on ankylostomiasis in Westphalian collieries, by J. S. Ilal- dane... Presented to both houses of Parliament by command of His Majesty. London, Printed for H. M. Stationery off., by Darling & son, ltd., 1903. 13, [i] p. ([Gt. Brit. Parliament, i'apers by com- mand] Cd. 1843) Effects of abnormal at- mospheric pressure and tempera- ture on the human sufjject. Lan- cet (London), 1907, v. II; 1052. Hygiene of work in com- pressed air. Engineering maga- zine, April, 190S, V. 35: 97-99. Hygiene of work in com- pressed air. Lancet (London), 1907, Halfort, A. C. L. Entstehung, Ver- lauf und Bchandlung der Krank- heiten der Kiinstler und Gewerbe- treibenden. Berlin, 1845. Handbuch der Arbeiterkrankheiten. Jena, G. Fischer, 1008. 859 p. Handbuch der LInfallerkrankungen, Einschliesslich der Invalidenbegu- tachtung. . . Bearb. von C. Thiem. . . 2. ganzlich umgearb. Aufl. Stutt- gart, F. Enke, 1909-10. 2 v. in 3. "Litteratur": vol. 1-2. Hannover, A. Haandvaerkernes Syg- domme, et Bidrag til Kundskab na- ermest om Eorholdene i Kjoben- havn. Kjobenhavn, 1861. Die Krankheiten der Hand- werker. Monatsblatt fiir medicin- ische Statistik und offentliche Ge- sundheitspflege, 1861, v. — p. 3Z', 4i; 49- Harbaugh, — . Causes of disability. (In Saunders' medical hand atlas of diseases caused by accidents.) Hauck, Karl. Die Gesundheitsver- haltnisse der Glasmacher. (In, Con- cordia, Zeitschrift der Zentralstelle fiir Volkswohlfahrt, hrsg. von H. Al- brecht. Berlin, 1910. xvii Jahrg., no. 17 [undl 18. p. 350-55, 382-87. Heijermans, L. Handleidung tot de kennisder beroepsziekten. Rotter- dam. W. L. & J. Brusse, 1908. 550 p. Heller, Mager and von Schrotter. Die Luftdruckerkrankungen. Vienna, 1900. Hellstrom, J. Om yrkessjukdomar och industriel hygien. Stockholm, 1896. Herzheimer, — . Ucbcr die gewcrb- lichen Erkrankungcn der Ifaut. Deutsche medicinische Wochen- schrift, 1912, no. 1. Hill, Leonard. Prevention of caisson sickness. Engineering magazine. May, 191 1, v. 41: 331-335. Physiology of submarine work. Nature, Oct. 26, 1911, v. 87: 5'57-573- • ■ ■ . . Caisson sickness and the physiology of work in compressed air. igi2. Hill and Macleod. Caisson disease and diver's palsy. Journal of hygiene, 1903, p. 401. Hirt, L. Die Arbeiterhygiene auf der internationalen Ausstellung in Brus- sel. Deutsche Vierteljahrsschrift fi-ir offentliche Gesundheitspilegc, 1877, V. 9: 391-396. Die Krankheiten der Ar- beiter. Breslau, 1871-1878. Hoffel, . Ueber die Gesundheits- verhaltnisse der Arbeiter in den Fa- briken von Buchsweiler. Archiv fiir ofTentliche Gesundheits-Pllege in El- sass-Lothringen, 1878, v. 3: iri-127. Hoffman, . Die Krankheiten der Arbeiter in Theer- und Paraffinfabri- ken in mcdicinisch-polizeilichcr Hinsicht. Vierteljahrsschrift fiir ge- richtliche Medicin und offentliches Sanitiitswesen, 1893, v. 5: 3i8; v. 6: 128. Hoffman, F. and B. A. Ramazzini. A dissertation on endemical diseases ...together with a treatise on the diseases of tradesmen. London, 1746. Holitscher, . Industrial hygiene. Holland, G. C. The vital statistics of Sheffield, 1843. Hungary. Kereskedelemiigj'i minister- ium. Iparifelugelok tevekenysege . . 1899-1900. Budapest, 1901. i v. Imbert, A. Ueber professionelle Krankheiten. Zeitschrift fiir Ge- werbe-Hygiene [etc], 1905, v. 12: 699-702. Influence of employments on health. Journal of the royal statistical so- ciety, London, v. 6: 197, 283: v. 12: 232. 1843. Institut fur Gewerbehygiene. Frank- furt am Main. Bleimerkblatt fiir Hiittenarbeiter. . . [Frankfurt a. M., 1910?] I 1. 4oe American Labor Legislation Review Das Institut fur Gewerbc- hygiene eu Frankfurt am Main... Frankfurt a. M., 1910. 72 p. Mitteilungen des Institutes fiir Gewerbehygiene zu F'rankfurt a. M. Beiblatt zur Sozial-technik. I. — Berlin, A. Seydel, 1910 — monthly. Issued also with Sozial- technik. Programm des Kursus fiir Unfallheilung und Gewerbekrank- heiten... Frankfurt a. M., Englert & Schlosser, 1911. [11] p. Tiitigkeitsbericht. . . 1910 — Frankfurt am Main, [1911 — International association for labor leg- islation. Deux memoires presentes aux gouvernements des etats indus- triels en vue de la convocation d'une Conference Internationale de pro- tection ouvriere. Publies par le Bu- reau de I'Association Internationale pour la protection legale des tra- vailleurs. Paris [etc.] Berger-Lev- rault & cie, 1905. 44, 32, [45];49 p, (Publications de I'Association internationale pour la protection le- gale des travailleurs, no. 4) Les industries insalubres. Rapports sur leurs dangers et les moyens de les prevenir, particu- licrement dans I'industrie des allu- mettes et celles qui fabriquent ou emploient des couleurs de plomb... Jena, G. Fischer [etc., etc.] 1903. 460 P- International conference on labor reg- ulation. 1st, Bern, 1905. Confer- ence internationale pour la protec- tion ouvriere a Berne. (Du 8 au 17 mai 1905) [n.p., 1905] 128 p. 2d, Bern, 1906. Actes de la Conference diplomatique pour la protection ouvriere reunie a Berne du 17 au 26 Septembre 1906. Berne, Impr. Staempfli & cie, 1906. 165 p. Separatbeilage zum Bundesblatt nr. 45 voni 7, November 1906. Contents. — Documents preliminaries. — Proces- verbaux des seances plenieres et des seances de commission. — Textes adoptes par la Conference: Conven- tion internationale sur I'interdiction du travail de nuit des femmes em- ployees dans I'industrie. Conven- tion internationale sur I'interdiction du phosphore blanc (jaune) dans I'industrie des allumettes. International congress of first aid and life saving. 1st, Frankfurt a. M., 1908. Bericht iiber den Internation- alen Kongress fiir das Rettungs- wesen zu F'rankfurt a. M., 10.-14. juni 1908. Hrsg. von der kongress- leitung. Redigiert vom George Meyer... Berlin, August Hirsch- wald, 1908-1909. 2 v. International congress of hygiene and demography. 13th, Brussels, 1903. Compte rendu du Congres... Brux- elles, P. Weissenbruch, 1903. 9 v. Vol. 2-8: "Premiere division. — Hy- giene"; V. 9: "Deuxieme division. — Demographie." Contents. — t. I. Compte rendu du Congres. — t. II. Section i. Bacteriologie. — t. III. Sec- tion 2. Hygiene alimentaire. — t. IV. Section 3. Technologie sanitaire. — t. V. Section 4. Hygiene industrielle et professionnelle. — t. VI. Section 5. Hygiene des transports et communi- cation — t. VII. Section 6. Hygiene administrative. — ... VIII. Section 7. Hygiene coloniale. — t. IX. Demog- raphic. 14th, Berlin, 1907; Bericht iiber den XIV. Internationalen Kongress fiir Hygiene und Demog- raphie, Berlin, 23,-29, September 1907. Redigiert vom generalsekre- tar, professor dr. Nietner... Berlin, A, Hirschwald, 1908. 4 v. illus., fold, plates, fold, diagrs. In German, French and English, Italy. Commissione incaricata di stu- diare le cause e provvedimenti pre- ventivi delle malattie degli operai nelle Industrie. Atti della Commis- sione incaricata di studiare le cause e provvedimenti preventivi delle ma- lattie degli operai nelle Industrie... I. pt, Roma, 1903. Ministero di agricoltura, in- dustria e commercio, Igiene indus- triale, Disposizioni legislative e regolamentari vigenti all'estero per la tutela della salute degli operai e per la prevenzione delle malattie professional!. Roma, Bertero, 1911. 466 p, (Its Annali del credito e della previdenza, n. 93) Ufficio del lavoro. L'indus- tria dei fiammiferi fosforici in Italia e la lotta contro il fosforismo, Roma 1905, 44 p, (Its Pubblicazioni. scr. B., n. 6) I lavoratori delle miniere... Bibliography (Other Than American) 409 Roma, 1907. I V. (Its Pubblica- zioni. ser. B, no. 17) Jacquot, A. B. Considerations hy- gieniques sur les manufactures. Paris, 1844. Jarvis, E. Connection of occupation with longevity, [n. p., n. d.] Juderias, Julian. La higiene y su in- fluencia en la legislacion; memoria premiada por la Sociedad espanola de higiene... Madrid, Imp. de la Sue. de M. Minuesa de los Rios, 1910. 86 p. (Associacion interna- cional para la proteccion legal de los trabajadores, seccion espanola, num. 19) Juraschek, F. von. Einfluss der Be- rufsverhaltnisse auf Erkrankung und Sterblichkeit. AUegemeine Wiener medizinische Zeitung, 1888, v. 23: 143; 156; 181; 209; 234. Kaup, Ignaz. Blei- und Phosphorver- giftungen in den gewerblichen be- trieben Osterreichs. Tatsachen und Aufgaben der Gesetzgebung. Be- richt erstattet der Internationalen Vereinigung fiir gesetzlichen Ar- beiterschutz. Wien, F. Deuticke, 1902. 79 p. (Schriften der Osterr. Gesellschaft fiir Arbeiterschutz. III. Hft.) Bleivergiftungen in der kera- mischen Industrie... Berlin, [igo8?] 54 p. (Deutsche Sektion, Gesell- schaft fiir soziale Reform) Kay, J. P. The moral and physical condition of the working classes em- ployed in the cotton manufacture in Manchester. 2d ed. London, Long- man, 1832. 120 p. Kerschensteiner, J. Die Fiirther In- dustrie in ihrem Einfluss auf die Gesundheit der Arbeiter. Aerzt- liches Intelligenz-Blatt, 1874, v. 21: 305; 315; 329- Klebe, H. Die gewerbliche Bleiver- giftung und ihre Verhutung. Miin- chen, Th. Ackerman, 191 1, 175 p. Koelsch, F. Zum Kampfe gegen die Tuberkulose. Fiihrer durch das K. Arbeiter-museum. [Miinchen, 1911] 31 p. (K. B. Arbeiter-museum in Miinchen. Mitteilungen Nr. 8, Nr. I, 1911) Konrich, F. Ueber den Einfluss der Beschaftigung auf den Organismus. Wiirzburg, 1864. Kummel, Hermann. Zahnarzt und Arbeiterschutz... Berlin, 1903. 131 P- Lakeman, J. B. Health in the work- shop. London, 1884. Lane^ W. A. Some changes in the form of the acetabular cavities, spi- nal column, and joints of the hand, illustrated by the anatomy of the charwoman. Guy's hospital reports, 1887, 3d. ser., v. 29: 359-567. Lawes, Edward Thornton Hill. Tin- ning of metals. Report to His Ma- jesty's secretary of state for the Home department on the draft reg- ulations proposed to be made for factories and workshops in which tinning of metal articles is carried on, by Edward Thornton Hill Lawes... London, 1909. 22 p. (Cd. 4740) Layet, A. E. Hygiene des professions et des industries. Paris, 1875. Lazarus, . Eine neue Gewerbe- krankheit. AUgemeine medicinische Central-Zeitung, 1900, v. 69: 1199. Legge, S. M. On the diseases of oc- cupations. British medical journal (London), 1901, v. 2; 401-405. Industrial lead poisoning. Journal of hygiene, 1901, v. i: 96- 108. Lemoigne, A. L'igiene dei contadini considerati nei loro rapporti col bes- tiame. Milano, 1S86. Leroye. Die Fortschritte der Indus- trie und ihr Einfluss auf die Berufs- krankheiten der Arbeiter. Deutsche Revue, Berlin, 1879, v. 3: 382-398. Lewin, L. Die Grundlagen fiir die medizinische und rechtliche Beurtei- lung des Zustandekommens und Verlaufs von Vergiftungs-und In- fektionskrankheiten im Betriebe. Berlin, C. Heimann, 1907. 36 p. Die Flilfe fiir Giftarbei- ter. Sonderabdruck aus der Deuts- chen Medizinischen Wochenschrift, 1904, no. 25. Leipzig, 1904. Lewis, W. Report on the laws and ordinances in force in France on the regulation of noxious trades and oc- cupations. London, 1855 (?). Lewy, E. Specielle Krankheiten ein- zelner Industriezweige und die Ver- hiitung derselben. (In Internation- al Congress of Hygiene and Demo- graphy. 8th Budapest. Comptes- rendus et memoires, 1894. Buda- pest, 1896. v. 8, pt. 3: 58-64. 410 American Labor Legislation Review Leymann, Dr. Die Bekampfung der Eleigefahr in der Industrie. Ergeb- nisse der Preisausschreibens der In- ternationalen Vereinigung fiir Ge- setzliclien Arbeiterschutz. Im Auf- trage des Internationalen Arbeits- amtes zu Basel . . . Jena, G. Fischer, 1908, 256 p. Louis, Paul. L'ouvrier devant I'etat; histoire comparee des lois du trav- ail dans les deux mondes. Paris, F. Alcan, 1904. 480 p. "H3'giene et securite": p. 282-302. Lundbye, J. T. Stov i industrien og dets Eekaempelse. 1908. Publica- tion no. 4. Danish association for labor legislation. Luson, Thomas. The Diseases of Workmen, by T. Luson, M. D. and R. Hyde, M. R. C. S. With an in- troduction by His Honour Judge Ruegg, K. C. London, Butterworth & CO., 1908. viii. III, [5] p. "List of references": i p. following p. in. Magruder, William Edward. Claims arising from results of personal in- juries; the relation injury bears to disease and disease to injury; a treatise showing how personal in- juries may affect various diseases, and how certain diseases may add to claims for accidents by protracting recovery. New York, Chicago, The Spectator company ["^igio] 266 p. Bibliographies at end of chapters. Mahler, . Ueber Gewerbekrank- heiten.- Aerztliche Mittheilungen aus Baden, 1905, v. 59: 167-172. Maladies professionnelles. Revue In- ternationale du commerce, de I'in- dustrie et de la banque, Dec. 1911, 13. annee: 881-883; Mar. 1912, 14 an- nee: 148-185. Mapother, E. D. The prevention of artisan's diseases. (In Lectures on public health. Dublin, 1874. p. 132- 147.) Marek, Ferdinand. Measures against phosphor-necrosis in Austria. In- ternational, June, 1909, V. 5: 209- 211. Martial, Rene. Hygiene individuelle du travailleur. . . Paris, V. Giard & E. Briere, 1907. 351 p. L'ouvrier, son hygiene, son atelier, son habitation... Paris, Oc- tave Doins et fils, 1909. 419 p. Bib- liography, [39i]-405'p. Sur I'assimilation des mal- adies professionnelles aux accidents du travail. Revue Internationale de la tuberculosis, 1909, v. 25: 245-260. Masse, Daniel. Legislation du travail et lois ouvrieres. Paris, Nancy, Berger-Levrault et cie, 1904. 874 p. "Hygiene et securite": p. 351-438. Mercanti, F. Sulle malattie che piu frequentemente colpiscono i cerni- tori di stracci. Corriere sanitario (Milano), 1906, v. 17: 688; 698. Miller, Maximilian. Die Erwerbsun- fahigkeit im Sinne des Invalidenver- sicherungsgesetzes und ihre Ursach- en... [Berlin] Arbeiterversorgung, 1908. 194 p. "Literatur" p. [vii]- viii. Monatsschrift fiir Unfallheilkunde und Invalidenwesen. Festnummer an- lasslich des 25jahrigen Bestehens der Unfallversicherungsgesetze, un- ter Mitwirkung mehrerer in der Be- gutachtung und Behandlung Unfall- verletzter, tatigen Aerzte und Heil- anstaltsleiter, hrsg. und dem deutschen Reichversicherungsamt gewidmet vom Herausgeber und Verlager der Monatsschrift fiir Un- fallheilkunde und Invalidenwesen. Leipzig, 1910. [297J-5I5 p. Monin, E. L'hygiene du travail. Guide medicale des industries et profes- sions. Paris, 1888, J. Hatzet et Cie, 300 p. Monin, F. A propos du malaise pro- fessionnel. Lyon medical, 1906, v. 106: 420-425. Mooren, A. Die Sehstorungen und Entschadigungspriiche der Arbeiter. Diisseldorf, 1891. Mori, A. Contributo alle affezioni professionali. Ramazzini (Firenze), 1908, V, 2: 78-84. Muller, Richard. Die Bekampfung der Bleigefahr in Bleihiitten. Von der Internationalen Vereinigung fiir Ge- setzlichen Arbeiterschutz preisge- kronte Arbeit... Jena, G, Fischer, 1908. 207 p. Munich, K. Bayerisches Arbeiter-mu- seum. Bestimmungen fiber das Bay- erischen. Tuberkulosewandermuse- um. Miinchen, 191 1. 8 p. ( K. B. Ar- beiter-museum in Miinchen. Mittei- lungen, Nr. 9; Nr. 2, 1911) Napias, H. L'inspection hygienique bibliography (Other Than American) 411 des fabriques et ateliers. Annales d'hygiene, 1883, 3. ser., v. 10: 412- 425- Nasmyth, T. G. Diseases of occupa- tion. Sanitary journal (Glasgow), 1895-96. n. s., V. 2: 514-525. Naudet, S. V. O. Essai sur I'hygiene du laboureur. Paris, 1861. Neison, Francis G. P. The influence of occupation upon health, as shown by the mortality experienced. In- stitute of actuaries. Journal (Lon- don), July, 1872, V. 17: 95-126. Neisser, E. J. Internationale Uber- gicht iiber Gewerbehygiene; Berlin, Verlag Gutenberg [1907] 352 p. Der erste international Kon- gres fiir die Gewerbekrankheiten zu Mailand (9. -14. Jun.) Medicinische Reform (Berlin), 1906, v. 14: 391- 394. Netherlands (Kingdom) 1815 — Cen- tral gezondheidsraad. Verslag over het voorkomen van den mijnworm boven den grond in Limburg. In opdracht van de ministers van bin- nenlandsche zaken en van landbouw, nijverheid en handel samengesteld door den Centralen gezondheids- raad en den directeur-generaal van den arbeid. ['s Gravenhage? 1909?] 97 p. inch tables. Loodwitcommissie. [Eers- ten and] Tweedc voorloopig rapport door de Loodwitcommissie, in Feb- ruari igo8 uitgebracht aan den min- ister van landbouw, nijverheid en handel. Uitg. door het Departement van landbouw, nijverheid et handel. ['s Gravenhage, Drukkerij v/h H. L, Smits, 1908. II p. Rapport der Loodwitcom- missie, benoemd bij besluit van den minister van binnenlansche zaken d. d. 12 September 1903, no. 7216, afdeeling a. (Uitg. door het De- partement van landbouw, nijverheid en handel). 's-Gravenhage, Gebrs. J. & H. van Langenhuysen [1909] 68 p. incl. tables, viii fold, diagr. Newsholme, A. Occupation and mor- tality. Transactions of the Sanitary Institute, 1893, London, 1894, v. 14: 81-101. New South Wales. Statistician's of- fice. Tuberculosis in New South Wales. A statistical analysis of the mortality from tubercular dis- eases during the last thirty-three years. By John B. Trivett ... gov- ernment statistician. Sidney, W. A. Gullick, government printer, 1909. v, 81 p. incl. tables. 4 diagr. Nikolaeff, F. Promishlennost kak prichina bolaiznei. Vrachebniya vaidomosti, 1876, v. i, no. 68: 4; no. 70: 3; no. 71: 4. Noble, Daniel. Facts and observa- tions relative to the influence of manufactures upon health and life. London, 1843. Noir, J. Une assurance en case de deces a la suite de contagion d'ori- gine professionnelle. Progres 'medi- cal (Paris), 1903, 3. ser., v. 18: 133. Norgate, R. H. Diseases of the boot and shoe trade. Journal of the Roy- al institute of public health, Lon- don, 1909, v. 17: 353-356. Nusser, J. Ueber Krankheiten bei Gewerben iiberhaupt und itber eine bei Seifensiedern vorkommende Hautwassersucht. Miinchen, 1838. Oldendorff, A. Der Einfluss der Bes- chaftigung auf die Lebensdauer des Menschen, nebst Erorterung der wesentlichsten Todesursachen. Ber- lin, 1877. Oliver, Thomas. Dangerous trades: the historical, social and legal as- pects of industrial occupations as affecting health, by a number of ex- perts; edited by Thomas Oliver... London, J. Murray, 1902. 891 p. Diseases of occupation from the legislative, social, and medical points of view. London, Methuen & CO. [1908] xix, 427, [i] p. 2 pi. (Half-title: The new library of medicine; ed. by C. W. Saleeby) Lead poisoning and the race . . . London, Eugenics education so- ciety, [1911] II P- (Reprinted from 'The Eugenics review', July, 1911). Ollive, G. and H. Le Meignen. De I'assimilation des maladies profes- sionnelles aux accidents du travail. Gazette medicale de Nantes, 1905, 2. ser., V. 23: 621 ; 646. On the influence of manufactures on health. British and foreign medico- chirurgical review, 1843, v. 15: 286- 314. Orjollet, J. B. A. De I'influence de certaines professions comme cause de maladies, et de quelques moyens preservatifs et curatifs. Paris, 1825. 412 American Labor Legislation Review Osterreichische Gesellschaft fiir Ar- beiterschutz, Vienna. Antrage der Osterreichischen Gesellschaft fiir Arbeiterschutz betreffend I. Ver- hiitung der Bleivergiftung und der Caissonkrankheit; 2. Schutz der Heimarbeiter; 3. Erhebungen iiber Arbeitszeit in Gesundheitsschad- lichen Betrieben und Arbeitsur- laube. (Eingaben an die Regie- rungen) . . Wien, Selbstverlag der osterreichischen Gesellschaft fiir Arbeiterschutz, 191 1. 16 p. Paraf, Georges G. Hygiene et secu- rite du travail industriel. Paris, V° C. Dunod, 1905. vii, 632 p. illus. Contents. — Introduction. — i. ptie. Generalities. — 2. ptie. Industries di- verses. — 3. ptie. Legislation. Parry, Leonard A. The risks and dangers of various occupations and their prevention. London, Scott, Greenwood & co., 1910. 196 p. Pecholier, G. and C. Saintpierre. fitude sur I'hygiene des ouvriers peaus- siers du departement de I'Herault. Montpellier medical, 1864, v. 12: 301- 332- , Perisse, S. Etude microscopique des poussieres industrielles. Revue d'hygiene, Paris, 1894, v. 16: 397-417. Permanent international committee for the study of industrial diseases. Bulletin de la Commission Interna- tionale permanente pour I'etude des maladies professionnelles. i. — an- nee, avril 1908 — Florence, 1908 — pam. fold. pi. quarterly. "Biblio- graphie et Fiches bibliographiques" are included in each number. Medici ispettorato del lavoro. Cusano, Tipografia A. Colombo e figli, 191 1. 176 p. (Its Pubblicaz- ione 2." della serie i.°) Bibliography, p. 173-176. Perris, G. H. Industrial disease; the quantitative aspect, London. Royal institute of public health. Journal, 1895, y- 3: 104-1-2. Perroncito. La malattia dei minatori. Torino, 1910. Pfennig, M. Ursache, Verhijtung und Behandlung der Nerven — , Lungen — , Verdauungs — und Kehlkopf- Leiden (als Berufskrankheiten der Kaufleute, Lehrer, Beamten, etc.). Stuttgart, [n.d.] Phosphorus Treaty. International convention respecting the prohibi- tion of white (yellow) phosphorus in the manufacture of matches. Text of treaty signed at Bern on Septem- ber 26, 1906 by representatives of Germany, Denmark, France, Italy, Luxemburg, Switzerland and the Netherlands. Bulletin of the Inter- national Labor Office, vol. i. p. 296. Also Bulletin of U. S. Bureau of Labor No. 86, p. 146. Pieraccini, Gaetano. Patologia del lavoro e terapia sociale... Milano, 1906. 695 p. La patologia del lavoro. Clinica moderna (Pisa), 1903, v. 9: 5SS-S58. Poincare, . Dangers de la fabri- kation des objets en carton vernis- ses et laques. Annales d'hygiene, 1881, 3. ser., V. 5: 132-138. Pol and Wattelle. Memoire sur les effets de la compression de I'air. Annales d'hygiene publique et de medicine legale, 1854. Popper, M. Beitrage zur Gewerbe- Pathologie. Vierteljahrsschrift fiir gerichtliche Medicin und offent- liches Sanitatswesen, 1879, n. s., v. 30: 98-118. Lehrbuch der Arbeitkrank- heiten und Gewerbehygiene. Stutt- gart, 1882. Poree, Henri., Livache, Ach. Traite theoretique et pratique des manu- factures et ateliers dangereux, insal- ubres, ou incomimodes, etc. Paris, 1887, Marchal et Billard. 704 p. Prendergast, W. Dowling. The potter and lead poisoning... London, Mar- shall, Russell & CO., Longton, Hughes and Harber, 1898. 54 p. Projektierte Ausdehnung des gegen- wjirtigen fraiizdsischen Arbeiterun- fallgesetzes auf Krankheiten ge- werblichen Ifrsprungs. Zeitschrift fiir Gewerbe-Hygiene [etc.], 1905, V. 12: 479; 507. Proust, A. Nouvelle maladie profes- sionnelle chez les polisseuses de camees. Annales d'hygiene, 1878, 2. ser., V. i: 193-206. • . • ■ . Professions: maladies pro- fessionnelles. International diction- naire de medecine et chirurgie pra- tique, Paris, 1880, V. 29: 509-583. PuUigny, Leclerc de. Hygiene indus- trielle, par Lijclerc de Pulligny... Bibliography (Other Than American) 413 [and others] . . . Paris, 1908. 610 p. (Traite d'hygiene; pub... par MM. Brouardel, Chantemesse et Mosny. [fasc] 7) Ramazzini, Bernardino. De morbis ar- tificum diatriba. (In liis Opera om- nia [etc]. Genevae, 1716. p. 470- 696.) Essai sur les maladies des artisans. Paris, 1777. Health preserved in two treatises. I. on the diseases of artificers, which by their particular callings they are most liable to, with the method of avoiding them and their curse. II. on those distemp- ers which arise from particular cli- mates, situations, and methods of life, with directions for the choice of a healthy air, soil and water. 2d ed. London, 1750. A treatise of the diseases of tradesmen, shewing the various in- fluence of particular trades upon the state of health; with the best meth- ods to avoid or correct it, and use- ful hints proper to be minded in reg- ulating the cure of all diseases in- cident to tradesmen. Written in Latin by Bern. Ramazzini . . . and now done in English. London, Printed for A. Bell [etc.] 1705. 6 p. I., 274 p. A treatise on the diseases of tradesmen to which they are sub- ject by their particular callings. (In Hoffman, Frederick, ed. A disserta- tion on endemial diseases, etc. Lon- don, 1746.) Ramazzini; giornale italiano di medi- cina sociale . . . Anno i — Gennaio 1907 — Firenze, L. Niccolai, 1907 — ■ V. illus., plates (partly fold.) maps (partly fold.) tables (partly fold) diagrs. (partly fold.) monthly. Rambousek, Josef. Gewerbehygiene fiir osterreichische Amtsarzte, Phy- sikatskandidaten, Verwaltungsbeam- ten und Gewerbeinspektoren. Wien, 1909. 368 p. Gewerbliche Vergiftungen, deren Vorkommen, Erscheinungen, Behandlung, Verhiitung. Leipzig, Veit & comp., 1911. xv, 431 p. illus. Bibliographical references in text. Der erste internationale Kongress fijr Arbeiterkrankheiten in Mailand. Zeitschrift ffir Gewer- be-Hygiene [etc], 1906, v. 13: 327; 359; 391- Rate of mortality. Laws of sickness, influence of trade and locality on health. Data by Neison from Friend- ly Societies. Journal of the royal statistical society, London, v. 8: 290; V. 9: 50. 1845. Razous, Paul. Reglementation du tra- vail industriel. Commentaire pra- tique, par Paul Razous [et] Armand Razous. Paris [etc.] Berger-Lev- rault & c'°, 1901. X, 328 pp. "Hy- giene et securite du travail et des travailleurs": p. 107-425. Reille, P. Les maladies profession- nelles. Annales d'hygiene, 1908, 4 ser., v. 9: 38-74. Repaci, F. Le stigmate e le modifi- cazioni e lesioni organiche delle por- tatrici di peso sul capo nelle Cala- brie. Ramazzini (Firenze), 1907, v. i: 483-496. Riadore, J. E. On the remediable evils attending the life of the peo- ple engaged in professions, com- merce, trade and labour... London, 1847. Richardson, B. W. Diseases incident to public life. Asclepiad (London), 1885, v. 2: 289-298. Rivalta, R. Malattie professionali ed infortuni del lavoro nella vita civile e nella vita militare. Rocca San Casciano, 1908. 349 p. Romanelli, L. L'influenza delle arti e dei mestiere suUa salute degli op- erai: relazione igienico-statistica. Napoli, 1879. Ronzani, E. Intorno all' influenza del- le inalazioni di gas irritanti delle In- dustrie; sui poteri di difesa dell'or- ganismo verso le malattie infettive. Annali d'igiene sper. Roma, 1909, n. s. V. 19: 139-193. Roose, R. The wear and tear of Lon- don. London, 1886. Ropke, F. Die Berufskrankheiten des Ohres und der oberen Luftwege. Ohrenheilkunde der Gegenwart und ihre Grenzgebiete, 1902, v. 2: 1-147. Die Berufskrankheiten des Ohres und der oberen Luftwege. Wiesbaden, J. F. Bergmann, 1902. 147 p. Rosenfeld, S. Gewerbekrankheiten und ihre Verhiitung in den oster- reichischen Fabriken. Wiener med- izinische Blatter, 1898, v. 21: 6; 27; 39; 59; 119; 187. Roth, Emanuel. Gewerbehygiene. Leipzig, G. J. Goschen, 1907. 156 414 American Labor Legislation Reviezv p. illus. (Sammlung Goschen. [350]) "Literatur"; p. [lSi]-i54- Kompendium der Gewerbe- krankheiten und Einfiihrung in die Gewerbehygiene. Berlin, R. Schoetz, 1904. 271 p. Royal society of arts, London. Shaw lectures on industrial hygiene. De- livered before the Royal society of arts in November and December, 1907; and February and March 1908. London, Printed by W. Trounce, 1908. London, 63 p. Rubin, J. Grundziige der internen Arbeiterversicherungsmedizin. Jena, 1909. 224 p. Sanarelli, . Discorso al Congres- so per le malattie del lavoro. Cor- riere sanitario (Milano), 1906, v. 17: 688; 698. Sandwith, F. M. Diseases of miners, wool-sorters and others. Clinical journal, London, 1908, v. 33: 133- 138. Schierbeck, N. P. Om bekaempelsen af faren ved anvendelsen af giftstof- fer i industrielle virksomheder . . . . Kobenhavn, 1907. 12 p. (Dansk forening for arbeiderbeskyttelse. [2. hfte.]) Schneider, H. Gefahren der Arbeit in der chemischen Industrie; hrsg. vom Verband der Fabrik-Arbeiter Deutschlands. Hannover, Volks- buchhandlung, 1911. Schuler, F. and F. H. Whymper. Fa- brikhygiene und Fabrikgesetzge- bung. Deutsche Vierteljahrsschrift fiir oeffentliche Gesundheitspflege, 1888, V. 20: 283-302. Schut, P. Bakker. Bericht iiber das Verbot des Gebrauches von Bleifar- ben und tiber die Versuche mit blei- freien Farben in den Niederlanden . . . Amsterdam, Drukkerij Plantijn, 1908. 21 p. (Nederlandsche ver- eeniging voor wettelijke bescherm- ing van arbeiders, section der In- ternationalen Vereinigung fiir ges- etzlichen Arbeiterschutz) Schweizerische Vereinigung zur For- derung des internationalen Arbei- terschutzes, Bern. Eingabe des Vorortes an die Kantonsregierungen und Gemeindeverwaltungen vom Mjirz 190S, betrefifend Ersetzung des Bleiweisses im Malergewerbe durch bleifreie Farben. Bern, Buchdruck- erei Beukomm & Zimmermann, [1905] 7 p. (Its [Veroffentlichun- gen] Hft. 10.) Memoire du Vorort addres- se aux gouvernements cantonaux aux administrations communales en date du 10 mars 1905 concernant la substitution dans le metier de la peinture en batiments de coleurs sans plomb a la ceruse. Berne, Impr. cooperative de I'union, [1905]. 8 p. (Association nationale pour I'avancement de la protection Inter- nationale des ouvriers. [Publica- tions] fasc. no. 10.) Scott, A. Industrial diseases. Prac- titioner, London, 1908, v. 81 : 837- 84s. Sejournet. fitudes d'hygiene profes- sionnelle. France medicale, 1885, v. 2: 1221; 1234; 1245. Shann, G. The influence of occupation and habits on health. (In National Association for the Promotion of Social Science. Transactions, 1864. London, 1865. p. 519-525.) Statistical facts intended to throw light on the influence of oc- cupation on disease. British Medi- cal Journal, 1862, v. 2: 248-253. Silberstein, P. Die Berufskrankheit der Caissonarbeiter. Oe&terreich- ische Sanitats-Beamte, 1909, v. 21: 125, 133- Smart, A. The efifects of unhealthy oc- cupations and their amelioration. Medical press and circular. Lon- don, 1883, n. s. V. 36: 505. Smith, Constance. Dangerous trades. Economic review, Oct. 1905. pp. 434-450. Sommerfeld, Th. Der Gewerbearzt. Jena, 1905. p. 194. Handbuch der Gewerbe- krankheiten. Berlin, 1898. Liste der gewerblichen Gifte. Jena, Gustav Fischer, 1912. 30 p. Die Schwindsucht der Arbei- ter, ihre Ursachen, Haufigkeit und Verhiitung. Berlin, A. Schlicke & Co., 1912. 64 p. Sozial-technik, Zeitschrift fiir tech- nische und wirtscbaftliche Fragen der Industrie, Unfallverhiitung, Ge- werbehygiene, Arbeit erwohlfahrt, Gewerberecht. Organ des Vereins deutscher Revisions-ingenieure. Ber- lin, ig — . illus., diagrs. semimonthly. Spain. Instituto de reformas sociales. Proyecto de clasificacion de indus- Bibliography (Other Than American) 415 trias insalubres y peligrosas. Mad- rid, Impr. de M. Servet, 1906. 24 p. (Institute de reformas sociales. Seccion 2.) Visita de inspeccion a la fabrica de sedas de Uygijar, por D. Florencio Porpeta y Llorente; une informe de la Seccion segunda tec- nico-administrativa Madrid, Impr. de M. Servet, 1905. 37 p. Steiner, K. Bosnische Arbeiterkrank- heiten. Medicinisch- chirurgisches Centralblatt, 1901, v. 36: 637-639. Zur Aetiologie der profession- ellen Erkrankungen im Medianus- gebiete. Miinchener medicinische ■Wochenschrift, 1903. p. 381. Steiner, Viktor. Handbuch der prak- tischen Hygiene und Unfallverhu- tung in Industrie, Gewerbe und Bergbau unter besonderer Beriick- sichtigung und Namhaftmachung der Bezugsquellen fiir samtliche zur Besprechung gelangenden Artikel . . . Wien, Im Selbstverlage, igoS. Stern, M. Zum Capitel Gewerbekrank- heiten. Miinchener medicinische Wochenschrift, 1898, v. 45: 1059. Struve, H. W. E. Die Bestimmungen der niederlandischen Gesetzge- bung gegen Ubermjissige und ge- fahrliche Arbeit jiingerer Personen und Frauen beziiglich die Heimar- beit und Plausindustrie. 1906. Dutch association for labor legislation. Sudeck, Paul. Der Arzt als Begu- tachter auf dem Gebiete der Unfall- und Invalidenversicherung. Jena, 1906. 244 p. Sutherst, Thomas. Death and disease behind the counter, 1884. Tallada, Jose Maria. El trabajo en las camaras de aire; Madrid, Imp. de la sucesora de M. Minuesa de los Rios, 191 1. 14 p. (Asociacion internacional para la proteccion le- gal de los trabajadores. Seccion es- pahola, num. 24.) Los venenos industriales en el trabajo a domicilo. Madrid, Imp. de la sucesora de M. Minuesa de los Rios, 1911. 7 p. (Asociacion internacional para la proteccion le- gal de los trabajadores. Seccion espahola. num. 22) Tanquerel des Planches, R. Contri- bution a I'etude des intoxications professionnelles (cuprisme, zincisme, hydrargyrisme). Paris, 1902. Teleky, Ludwig. Die Phosphorne- krose. Ihre Verbreitung in Oster- reich und deren Ursachen. Bericht erstattet der Internationalen Verei- nigung fiir gesetzlichen Arbeiter- schutz. Wien, F. Deuticke, 1907. V p., I 1., 182 p. inch illus., tables. (Schriften der Osterr. Gesellschaft fiir Arbeiterschutz. xii. hft. "Lit- eratur": [i79]-i82. Die gewerbliche Quecksil- bervergiftung. Dargestellt auf Grund von Untersuchungen in Os- terreich. (Schriften des Institutes fiir Gewerbehygiene). Berlin, Poly- technische Buchhandlung, 1912, p. 1-228. Bibliography. Vorlaufige Mitteilungen liber die Quecksilbervergiftung in Osterreich. [Wien, 1910] 7 p. (Os- terreichische Gesellschaft fiir Ar- beiterschutz) Wiener Arbeiten aus dem Gebiete der sozialen Medizin. Wien, Moritz Perles, 1910. ix, 189 p. Vorlaufige Mitteilungen iiber die Quecksilbervergiftung in Oesterreich. Arbeiterschutz, Wien, 1910, xxi. 22. Thackrah, Charles Turner. The ef- fects of arts, trades, and profes- sions, and of civic states and habits of living, on health and longevity: with suggestions for the removal of many of the agents which produce disease, and shorten the duration of life. 2d ed., greatly enl. Lon- don, Longman, Rees, Orme, Brown, Green, & Longman; [etc., etc.] 1832. I p. 1., [viii]-viii p., i 1., 238 p. Thienen, G. J. van. Gesetzlicher Schutz der Caissonarbeiter. Neder- landsche Vereeniging voor wet- telijke Bescherming van .A-rbeiders. Section der Internationalen Vereini- gung fur gesetzlichen Arbeiter- schutz, Geschriften N. S. no. 6. Amsterdam, 1910. Thilo, O. Die arztliche Behandlung der Arbeiter in Deutschland. St, Petersburger imedicinische Woch- enschrift, 1898, n. s., V. 15: 259-267. Thompson, Symes. On the influence of occupation on health and life. (In National Association for the Promotion of Social Science. Trans- actions, 1862. London, 1863, p. 587- S9S.) 4l6 American Labor Legislation Review Tissot, Samuel Auguste Andre David. De la sante des gens de lettres. 2. ed. augm. Lausanne, F. Grasset & comp., 1769. xvi, 260 p. Essai sur les maladies des gens du monde. 3d. ed. Paris, 1771- An essay on diseases in- cident to literary and sedentary persons. The 2d ed., with very large additions... With a preface and notes by Kirkpatrick, M .D. London, Printed for J. Nourse [etc.] 1769. xxiv, 189 p. Ubeda y Correal, Jose. Medios de prevenir los peligros del manejo del plomo en las fabricas de colores, de acumuladores, etc Memoria laureada por la "Asociacion inter- nacional para la proteccion legal de los trabajadores, de Basilea, en el concurso internacional de 1906. Ma- drid, Imp. de la sue. de M. Minuesa de los Rios, 1908. 83 p. (Asocia- cion internacional para la protec- cion legal de los trabajadores; sec- cion espanola, num. 5) Ueber die prakische Durchfiihrung der Fabrikhygiene. [Discussion] Deutsche Vierteljahrsschrift fiir oef- fentliche Gesundheitspflege, 1878, v. 10: 137-200. L'Ufficio di consulenza medico-legale, Milan. L'Ufficio di consulenza me- dico-legale nel 1909. Milano, 1910. Unhealthy occupations. Builder (Lon- don), Feb. 5-19, 1876, V. 34; 128; 150; 173-174. Untersuchung, inwiefern die psycho- physichischen und die ausseren Be- dingungen die Zahl und Schwere der gewerblichen Unfalle und Krankheiten der Erwerbenden be- einflussen und Erorterung der Vor- kehrungen, welche seitens der mass- gebenden Faktoren und der Gesell- schaft durchgefiihrt werden >miissten um auf diese Einfliisse entsprechend einzuwirken. Zeitschrfit fi.ir Ge- werbe-Hygiene [etc], 1904, v. 11; 49; 73; 97; 121. Vacher, F. Occupation in relation to disease. Health lectures for the people. Manchester & London, 1887. Vandenbroeck, V. P. Apergu sur 1' etat physique et moral de certaines classes ouvriers. Annales de med- ecine beige et etrangere, 1834, v. — 220; 224; 234;; 242; 263; 272; 289; 293- Vanderrijdt, H. Les mdustnes msalu- bres en Belgique. 1902. Publica- tion no. 3. Belgian section. Inter- national association for labor legis- lation. Vaucel, C. N. Quelques causes de maladies chez les ouvriers. Paris, 1833- Vellguth, L. H. K. Ueber emen eigen- artigen Erkrankungsfall in der Zuckerindustrie. Gottingen, 1901. Vernois, Maxima. Traite pratique d' hygiene industrielle et administra- tive, comprenant I'etude des etab- lissements insalubres, dangereux et incommodes. Paris, J. B. Bailliere et fils; New York, Bailliere brothers; [etc., etc.] 1869. 2 V. Vienna. Statistisches Departement. Die Sterblichkeit an Tuberkulose und Krebs in Wien im Jahre 1904, nach Berufen. Wien, 1907. 87 p. Viry, C. Quelques mots sur I'hygiene des ouvriers de fabriques de crin ve- getal en Algerie. Revue d'hygiene et de police sanitaire (Paris), 1884, v. 6: 1918-10-22. Vooys, Js. Peter de. Bericht iiber Bleivergiftung in den polygraphi- schen Gewerben in den Niederland- en... Amsterdam, Drukkerij Plan- tiin. 1908. 27 p. (Nederlandsche vereniging voor wettelijke bescher- ming van arbeiders, Section der Internationalen Vereinigung fi.ir ge- setzlichen Arbeiterschutz.) Bleivergiftungen in der nie- derliindischen keramischen Indus- trie. . . . Amsterdam, Druck von J. H. De Bussy, 1908. 83 p. (Neder- landsche vereeniging voor wettelijke bescherming van arbeiders, section der Internationalen Vereinigung fiir gesetzlichen Arbeiterschutz.) Die gewerblichen Gifte mit Ausnahme von Blei und Phos- phor in den Niederlanden. Dutch Association for labor legislation. Wachter, Karl. Die gewerbliche Blei- vergiftung und ihre Bekampfung im deutschen Reich. Karlsruhe i. B., G. Braun, igo8. 2 p. 1., 107 p. (Volks- wirtschaftliche Abhandungen der badischen Hochschulen ... x. Bd. 2. Hft.) Ward, Leonard. The efifect, as shown Bibliography (Other Than American) 417 by statistics, of British statutory- regulations directed to the improve- ment of the hygienic conditions of industrial occupations. Royal Sta- tistical Society. Journal, Sept. 30, 190S, V. 68: 435-525. Weyl, Theodor. Handbuch der Ar- beiterkrankheiten. Jena. G. Fisch- er, 1908. 809 p. Bibliographies at end of chapters. Handbuch der hygiene... Bearbeitet von Dr. Albrecht, Ber- lin; Prof. Assmann, Berlin; [etc., etc.] Hrsg. von Dr. med. Th. Weyl. Jena, G. Fischer, 1896-1901. 10 V. illus., fold, plates, plans, diagrs. Supplement. Jena, 1901 — Wieber, Franz. Der Arbeiterschutz in der gesundheitsschadlichen und schvireren Industrie nebst slatistis- chen Erhebungen iiber Lohn, Ar- beitszeit und hygienische Verhalt- nisse in den Hiittenwerken. Duis- burg, 1909. 247 p. Wiener Arbeiten aus dem Gebeite der sozialen Medicin... [i.— Folge] 1910 — Wien, 1910 — Whitelegge, B. A. The epidemiologi- cal aspects of industrial diseases. (In Epidemiological Society of Lon- don. Transactions, 1904-05. Lon- don, 1905. n. s., V. 24, p. i-ii.) Willis, T. Facts connected with the social and sanitary condition of the working classes in the city of Dub- lin, with tables of sickness, medical attendance, deaths, expectation of life, etc.; together with some glean- ings from the census returns, 1841. Dublin, 1845. Wing, C. Evils of the factory system demonstrated by parliamentary evi- dence. London, 1837. Wolffensperger. De afhankelijkheid der ziekten van oeconomische ver- hondingen. Geneeskundige Courant voor het Koningrijk der Nederland- en, 1909, V. 63: 170. Wretched state of the working classes. Medico-chirurgical review and jour- nal of practical medicine, (Lon- don), 184s, V. 43: 290-326. Zangger, Heinrich. Uber die Bezie- hungen der technischen und gewer- blichen Gifte zum Nervensystem. (Sonderabdruck aus Ergebnisse der inneren M'edizin und Kindjerheil- kunde, V. Band, 1910.) Zentralstelle fiir Arbeiter-Wohlfahrts- einrichtungen. Kommunale Wohl- fahrtseinrichtungen. Die planmas- sige Schwindsuchtsbekampfung durch Errichtung von Heilstatten fiir Lungenkranke . . . Berlin, C. Heymann, 1897. 172 p. (Schriften der Centralstelle fiir Arbeiter-Wohl- fahrtseinrichtungen. Nr. 12) 14. konferenz, 1905. Die Belehrung der Arbeiter iiber die Giftgefahren in gewerblichen Be- trieben. Vorbericht und Verhand- lungen der 14. Konferenz der Centralstelle fiir Arbeiter- Wohl- fahrtseinrichtungen am 5. und 6. Juni 1905 in Hagen i. W. Berlin, C. Heymann, 1906. iv, 129 p. (Schriften der Centralstelle fiir Ar- beit er-Wohlfahrtseinrichtungen. Nr. 28) PUBLICATIONS American Associati on fo r Labor Legislation No. i: Proceedings of the First Annual Meeting, 1907. No. 2: Proceedings of the Second Annual Meeting, 1908. No. 3 : Report of the General Administrative Council, 1909. No. 4: (Legislative Review No. i) Review of Labor Legislation of 1909. No. 5 : (Legislative Review No. 2) Industrial Education, 1909. No. 6: (Legislative Review No. 3) Administration of Labor Laws, 1909. No. 7: (Legislative Review No. 4) Woman's Work, 1909. No. 8: (Legislative Review No. 5) Child Labor, 1910. No. 9: Proceedings of the Third Annual Meeting, 1909. No. 10: Proceedings of the First National Conference on Industrial Dis- eases. Introductory Address, Henry W. Farnam. Importance of Industrial Hygiene, Henry Baird Favill. Phosphorus Poisoning in the Manufacture of Matches, John B. Anarews. Occupational Diseases in Illinois, Chas. R. Henderson. Lead Poisoning in Illinois, Alice Hamilton. Problem and Extent of Industrial Diseases, Fred'k. L. Hoffman. No. 11: (Legislative Review No. 6) Review of Labor Legislation of 1910. No. 12: (American Labor Legislation Review, Vol. I, No. i.) Proceedings of the Fourth Annual Meeting, 1910. Lead Poisoning in Illinois, Alice Hamilton, Neurasthenia in Garment Workers, Sidney I. Schwab. Industrial Diseases in America, Frederick L. Hoffman. Compulsory Compensation for Injured Workmen, D. L. Cease. Voluntary Indemnity for Injured Workmen, F. C. Schwedtman. Problems and Progress of Workmen's Compensation in tke United States, Thomas I. Parkinson, Memorial on Occupational Diseases. No. 13 : (American Labor Legislation Review, Vol. I, No. 2.) Comfort, Health and Safety in Factories : Comparative Analysis of Existing Laws, Prepared by Maud Swett and Ruth Whitt under the direction of John R. Commons. Topical Criticism of Existing Laws; The Prevention of Accidents, Leonard W. Hatch. Legal Protection from Injurious Dusts, Frederick L. Hoffman. Ventilation — Air Space, Humidity and Temperature, C. E. A. Winslow. Factory Lighting, E. Leavenworth Elliott. Protection from Gases, Fumes and Vapors, C. T. Graham-Rogers. Scientific Standards in Labor Legislation, John and Irene Andrews. No, 14: (American Labor Legislation Review, Vol. I, No. 3.) Review of Labor Legislation of 1911. No. IS : (American Labor Legislation Review, Vol. I, No. 4.) Prevention and Reporting of Industrial Injuries. Scientific Accident Prevention, John Calder. Practical Safety Devices, Robert J. Young, The Wisconsin Industrial Commission, John R, Commons, Safety Inspection in Illinois, Edgar T, Davies. The Massachusetts Board of Boiler Rules, Joseph H. McNeill. The Beginning of Occupational Disease Reports, John B. Andrews. Accident Reports in Minnesota, Don D. Lescohier. Advantages of Standard Accident Schedules, Edson S. Lott. A Plan for Uniform Accident Reports, Leonard W. Hatch. No. 16: (American Labor Legislation Review, Vol. II, No. i.) Proceedings of the Fifth Annual Meeting, 191 1. Relation of State to Federal Workmen's Compensation and Insurance Legislation. Introductory Address, Henry R, Seager, Compulsory State Insurance from the Workman's Viewpoint, John H. Wallace. Accident Compensation for Federal Employees, I, M. Rubinow. Constitutional Status of Workmen's Compensation, Ernst Freund. Uniform Reporting of Industrial Injuries: Report of Special Committee on Standard Schedules, Leonard W. Hatch. Unemployment Problem in America: Introductory Address, Charles Nagel. Unemployment as a Coming Issue, William Hard, Experience of the National Employment Exchange, E, W, Carpenter. Recent Advances in the Struggle Against Unemployment, C. R. Henderson. Safety and Health in the Mining Industry: Introductory Address, Walter Fisher. Work of the United States Bureau of Mines, J, A, Holmes. Occupational Diseases in the Mining Industry, S. C. Hotchkiss. A Federal Mining Commission, John R. Haynes, No. 17 • (American Labor Legislation Review, Vol. II, No. 2.) Proceedings of the Second National Conference on Industrial Diseases, 1912. Life let us cherish