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the cost of illness arising from trade conditions-unless some part of it was borne by the general community in the form of philanthropic relief. On this point the report is silent. The largest number of cases found, 181, was among the workmen in smelters and metal shops; 5 of these reported an average of two months apiece lost time, and 4 reported an average loss of $71.25 each in wages. The painting trades stand next in point of numbers with 157 cases; 77 workmen reported time lost aggregating 43 years 4 months, and 72 reported an aggregate wage loss of $46,092.
From the legal side the study throws considerable light on the responsibility of the workmen and on their assumption of the risks of the employment. Many of the dangerous conditions, such as the prevalence of dust and fumes, are absolutely beyond the workmen's control; either they must stay out of the occupation altogether or they must accept such degree of danger as the employer does not guard them against. In some of the most dangerous occupations, such, for instance, as the work in smelters and white-lead factories, intelligent workmen, as a rule, take the first alternative, and only the most ignorant, unskilled, and helpless class will enter them. How far these workmen are responsible for their own disregard of precautions, and how far they deliberately assume the risks of their employment is shown by the following quotation:
For instance, a young Bulgarian went to work in a white-lead factory the first week he arrived in Chicago, and was put to emptying pans of dry white lead. He was given no respirator and had no idea that he had a right to ask for one. Nobody told him the white dust on his hands and mustache was poisonous. He had only one suit of clothes and wore his working clothes home. He had a severe attack of lead poisoning at the end of five weeks. Another foreigner, a Russian Jew, was set to making red-lead paste in a storage battery factory. He was utterly ignorant of the substances he was handling and used to moisten his fingers in his mouth as he made the paste. He became severely poisoned after 10 days' work. We have found almost no effort in the lead works to instruct the foreigners in the care of their persons and in the avoidance of danger.
Another illustration is afforded by the mechanical artists or retouchers. This is highly skilled work, employing about 520 workers in Chicago, carried on by educated and intelligent people. "They use white paint, putting it on with a fine brush, which they habitually suck to bring it to a fine point." They also use an air brush which by means of compressed air sends a fine spray of white paint where needed. Most of the artists believe that they are using white-zinc paint and say that their employers and foremen assured them of this. Nevertheless, they say they all find the work very unhealthful and that many could not stand it more than a few years. On analyzing the white paints used it was found that 7 out of 11 were white
lead paints, and only four establishments were found in which at least one variety of white-lead paint was not used.
From the practical side the report shows that it is entirely possible at no prohibitive cost to make most processes safe and to reduce immensly the risks of the most dangerous operations. Some employers are voluntarily taking the necessary precautions, but others neglect them altogether. The difference in the risks when strict regulation is enforced and when regulations are left almost entirely to the employer's option is strikingly shown by some comparisons between conditions in England and in Illinois:
In one English white-lead factory employing 182 men careful medical inspection failed to discover one case of lead poisoning in the year 1909-10. In an Illinois factory employing 142 men partial inspection revealed 25 men suffering from lead poisoning last year. In another English factory employing 90 men no case was discovered for five successive years. In an Illinois factory employing 94 men 28 per cent of all employees have had lead poisoning, and 40 per cent of all employed in the dustier work. The other two Illinois factories have not had medical inspection and accurate figures can not be given. One has sent four cases of lead poisoning to a hospital during the last month, the other three. These figures certainly do not represent even one-half of the probable number of cases, for many do not seek hospital care, yet even these would mean an average yearly of 36 and 48 cases, respectively.
The report does not claim to be more than a preliminary view of the field, indicating where more study is needed. It was impossible in the limited time and with the limited means available to make anything like a complete survey, to show how many were exposed to given dangers or to obtain full data as to the number and severity of the cases of lead poisoning annually occurring. It gives some indication of the annual amount of physical suffering, impaired capacity, and economic loss suffered by workers in the lead trades in Illinois, and it shows-in some cases by citing conditions prevailing abroad, in others by the experience of the more enlightened and careful employers in Illinois-how the dangers attendant on the various lead employing industries can be reduced or wholly obviated. The study by Dr. Hayhurst of brass working in Chicago and zinc smelting in La Salle County shows that numerically these are less important than the lead employing industries. The risks seem less and the toxic effects, when incurred, less immediately and acutely harmful. Nevertheless, the work is very generally recognized as unhealthful. The brass worker's danger comes principally from zine, though lead and other metals are used in some branches of the industry. In plating, polishing, and lacquering acid fumes and metallic dusts are encountered. Zinc is one of the important constituents of all the brass compounds, and as it volatilizes at a much
lower point than copper, the other leading constituent, it is given off freely whenever brass is made or superheated after having been made. Also, it is given off very freely when the ores containing zinc are smelted. Inhaling these fumes is liable to cause a peculiar affection known as brass founders' ague. This, Dr. Hayhurst found, was very common among workers in brass foundries, zinc smelters, and other foundries in which zinc and zinc alloys are poured. This disease is practically never found in foundries with good ventilation, either natural or artificial. It is not regarded as serious by the workmen themselves, who rarely consult a doctor for it, but continued exposure to the conditions producing it tends to establish chronic diseases affecting the lungs, digestive tract, nervous system, and kidneys, so that occupational ill health is common. Of 187 workmen questioned, 146 complained of trade sickness or disease. In view of the recent discussions of the toxic effects of fatigue it is interesting to find the workmen themselves assigning overwork as a cause of occupational disease. "Workmen complain that they are now required to do from one-half to double again as much as they were wont to do 10 to 20 years ago."
In the polishing, plating, and buffing processes the risks from metallic dusts and acid fumes are those found wherever such processes are carried on, and can be minimized or wholly done away with by the use of hoods and exhausts. There was considerable variation in the degree to which these devices were used. Of 30 plating firms visited, 27 had processes involving the use of large tanks of potassium cyanide solutions, and only 3 had any devices for removing the fumes rising from these.
In the zinc smelters the employees, about 2,000 in number, were almost exclusively Polish; no women and only a small per cent of boys and youths were employed. In the foundries and brassworking shops, a considerable proportion of English-speaking workmen were found. Women were employed to a limited extent in the foundries as coremakers, and in the brass-working shops mainly in the lacquering rooms and at polishing and buffing.
The study as a whole shows considerable risk to health in the industries considered, due in part to the nature of the materials used, but more to imperfect ventilation and other unhygienic conditions which might easily be remedied.
Owing not only to the enormous amounts of gas produced in the steel industry, but also to the large numbers of men engaged in it, the investigation into carbon monoxide poisoning was practically confined to the five large steel plants in South Chicago and Joliet. The peculiar intoxication produced by exposure to this gas in sufficient quantities is well known; the chief concern of the investigatorsDrs. Matthew Karasek and George L. Apfelbach, under the direction
of Dr. Walter S. Haines-was to determine the effect of frequent or constant exposure to smaller amounts of the gas. In this respect the results obtained were inconclusive. A critical examination was made of 240 workers who were frequently exposed to the gas, but though the great majority of them were under par physically it was extremely difficult to decide how much of this was due to carbon monoxide and how much to such other factors, as unhygienic living, alcoholic excesses, etc. One constant and striking feature presented itself, however a deficient muscular power, as indicated by the hand dynamometer.
This was so marked that a comparison was made between steelworkers and two groups of other workers. This gave the following results in 400 cases selected as being strictly comparable:
Ages 20-40. Steel company workers, South Chicago, exposed to CO, average strength, 117.13; ages over 40, average strength, 94.30. Ages 20-40. Car company workers not exposed to CO, general hygiene, etc., good, average strength, 146.11; ages over 40, average strength, 127.35.
Ages 20-40. Workers in three companies not exposed to CO, general hygiene ordinary, average strength, 134.43; ages over 40, average strength, 113.01.
Mentally a majority of the men examined seemed below the average, but since nearly all used alcoholic liquors and 70 per cent admitted using them in excessive quantities, the investigators found it very difficult to decide what part in producing this condition should be ascribed to CO. "Since it is a well-known fact, however," they say, "that prolonged exposure to carbon monoxide may produce a profound impression on the nervous system, we regard it as by no means improbable that a part of the sluggish mentality observed among the steelworkers may be due to frequent exposure to the gas. Further investigation along this line is to be strongly recommended."
The prevalence of such exposure to the gas may be judged from the number of cases of gassing occurring yearly. At the time of the investigation the steel works were running at half or less than half of their full capacity. Of 10,000 men employed, 1,178 were working in the following departments and showed the following number of cases of poisoning:
The dangers arising from this form of poisoning are greater than either the frequency or severity shown in the above table indicate, since even a mild degree of poisoning produces unconsciousness and a consequent risk of falling, sometimes from a height, sometimes against hot furnaces or metals, or into other dangerous positions. "Of 22 men acutely gassed, 3 showed notable burns and 3 showed bruises. * * One worker was burned almost to a crisp before being taken out, and another fell to his death 25 feet below. Many other illustrations like these could be given."
The investigators find that within the past decade or two there has been a marked decrease in the cases of poisoning of this kind occurring in the Illinois Steel Works. This is partly due to the introduction of safer furnaces and methods of conveying gas, partly to greater care in keeping employees out of dangerous places, the use of oxygen helmets for those obliged to work in the most hazardous places, and the education of employees as to the dangers by oral or printed instructions. They recommend further precautions along the same or similar lines.
The effect upon health of turpentine as used in the painters and varnishers' trade forms the subject of a brief study by R. H. Nicholls and Drs. Flynn and Hayhurst. Observations were made upon a total of 62 men engaged in indoor branches of the work, because turpentine vapors are much less harmful when work is carried on in the open air. The age of those studied varied from 24 to over 60 years, only 9 being 51 years or over; the length of time they had spent at their trade varied from 2 to over 36 years. Nearly all claimed to have suffered from the effects of turpentine vapor more or less frequently; 14 were found to have organic diseases presumptively due to this cause, 21 had inflammation of the eye, 14 complained of respiratory symptoms, and 54 of urinary disturbances. According to their own statements these men had lost 1,098 days, representing about $5,200 in wages, through sickness from temporary effects, or actual acute Bright's disease following the inhalation of turpentine vapors. Five of the 62 had received benefits from their unions aggregating $236, but none had received any compensation from employers. Nine had sought charitable relief from dispensaries and hospitals. The particularly striking point in connection with these figures is that the loss, both physical and economical, involved in this form of industrial injury is absolutely unnecessary, since the simple measure of providing proper ventilation in places where the work is done would safeguard the men absolutely against the harmful effects of these fumes.
A report on caisson or compressed-air disease is presented by Dr. Peter Bassoe, who gives a résumé of the most important studies of the subject, with the results of a personal investigation of 167 men