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U. S. DEPARTMENT OF LABOR

BUREAU OF LABOR STATISTICS
ROYAL MEEKER, Commissioner

BULLETIN OF THE UNITED STATES \
/ WH O L E o n c i
BUREAU OF LABOR STATISTICS/ • • • I NUMBER ^ U J
IN D U S T R IA L

A C C ID E N T S

AN D

H Y G IE N E

S E R IE S :

No.

10

ANTHRAX AS AN OCCUPATIONAL DISEASE




By JOHN B. ANDREWS, Ph. D.

JANUARY, 1917

WASHINGTON
GOVERNMENT PRINTING OFFICE
1917




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CONTENTS.
Page,
5-7
Introductdry summary..............................................................................................
Chapter I.—General description and history of anthrax..................................... 9-13
Early studies of the disease...............................................................................
9
Discovery of the bacillus...................................................................................
10
Characteristics of bacillus and spore................................................................. 11,12
Animals subject to anthrax, and countries where the disease is prevalent..
12
Conditions of soil and temperature favorable to the development of anthrax.
13
Modes of infection...............................................................................................
13
Chapter II.—Medical aspects of human anthrax................................................... 15-18
Symptoms............................................................................................................ 15,16
Treatment............................................................................................................ 16-18
Chapter I I I .—Industries affected............................................................................ 19-23
Agriculture and other industries involving direct contact with animals........
19
Leather industry................................................................................................. 19,20
Animal hair and bristle industry...................................................................... 20, 21
Wool industry...................................................................................................... 21, 22
Horn and bone industry.....................................................................................
22
Transportation.....................................................................................................
22
Nonoccupational anthrax...................................................................................
23
Chapter IV.—Anthrax in the United States......................................................... 25-93
Early experience................................................................................................. 25-32
Recent experience.............................................................................................. 32-80
Experience of a leading morocco-leather center.................................
32-35
Cases reported under New York occupational disease reporting law........35-37
Cases reported under New Jersey occupational disease reporting law. . 37, 38
Cases reported under Pennsylvania infectious disease reporting law. . . 38, 39
Cases on record in a Philadelphia hospital.............................................. 39-41
Cases on record in a Massachusetts hospital........................................... 41-43
Cases reported by tanners and leather manufacturers............................ 43-46
Fatal cases reported in registration area of the United States, 1910 to
1915............................................................................................................ 46-77
Distribution by industry, place of death, etc................................... 47-55
Statistical summary............................................................................ 55-59
Individual histories of fatal cases...................................................... 60-78
Probable ratio of deaths to total number of cases................................... 78-80
Legislation......................................................................................................... 80-93
Reporting.............................................................................................*.___ 80-82
Prevention.................................................................................................... 82-88
Agriculture............................................................................................ 82, 83
Trade and manufacture....................................................................... 84-88
Compensation............................................................................................... 89-93
Chapter V.—Anthrax in Europe............................................................................ 95-114
Private activity................................................................................................... 95-98
Anthrax Investigation Board for Bradford and District......................... 95, 96
German employers’ mutual trade associations......................................... 96,97
3




4

CONTENTS.

Chapter V.—Anthrax in Europe—Concluded.
Private activity—Concluded.
Association of French Manufacturers for the Prevention of Industrial Page.
Accidents.................................................................................................
97
Milan Labor Clinic and other private activity in Italy.......................... 97,98
International organizations and congresses...............................................
98
Governmental investigations............................................................................ 98,99
Systematic reporting and resultant data......................................................... 99-106
Great Britain.............................................................................................. 99-102
Germany....................................................................................................102-104
104
France.................................................. ................ .......................................
Holland..................................................................................................... 104,105
Italy.............................................................................................. ............105,106
Russia............................................................................................................
106
Protective legislation.......................................................................................106-111
Wool, hair, and bristles........................................................................... 107-110
Hides and skins..................................................... .................................. 110, 111
Compensation for anthrax as an industrial injury....................................... 112-114
Chapter V I.—Present status of the problem of disinfection............................. 115-120
Chapter V II.—Recommendations for control and prevention of anthrax___ 121-125
Recommendations of the subcommittee of International Association for
Labor Legislation, 1914.............................................................................. 121-123
Recommendations by Prof. L. Devoto and F. Massarelli.......................... 123,124
Recommendations by C. H. W. Page........................................................... 124,125
Appendix A.—Rules and regulations in the United States............................... 126-135
United States: Treasury Department and Department of Agriculture Joint
Order No. 1, Regulations governing the certification and disinfection of
hides, fleshings, hide cuttings, parings, and glue stock, sheepskins and
goatskins and parts thereof, hair, wool, and other animal by-products,
hay, straw, forage, or similar material offered for entry into the United
States, 1916.................................................................................................. 126-130
Massachusetts: Rules and regulations suggested for the prevention of
anthrax, 1916................................................................................................ 131-134
New York: State industrial commission, division of industrial hygiene,
recommendations, 1916............................................................................... 134-135
Appendix B .—Text of European regulations....................................................... 136-150
Great Britain: Regulations for handling dry and dry-salted hides and skins
imported from China or from the West Coast of India, 1901.......................
136
Great Britain: Sorting, willowing, washing, combing, and carding wool,
goat hair, and camel hair, and processes incidental thereto, 1905......... 137-140
Great Britain: Regulations for the processes involving the use of horsehair
from China, Siberia, or Russia, in effect April 1, 1908........................... 141-143
France: Decree relating to special hygienic measures for establishments
where the workers are exposed to anthrax infection, 1913..................... 143-145
Germany: Order concerning the equipment and operation of horsehairspinning establishments, of shops where other animal hair and bristles
are manipulated, and of brush factories, 1902.......................................... 145-148
Prussia: Order relating to the propagation of anthrax through animal skins,
1902................................................................................................................ 148,149
Prussia: Regulations for the protection of workers against the dangers of
anthrax, 1910................................................................................................149,150




BULLETIN OF THE

U . S. B U R E A U
WHOLE NO. 2 0 5 .'

O F L A B O R S T A T IS T IC S .

W A S H IN G T O N .

JANUARY, 1917.

ANTHRAX AS AN OCCUPATIONAL DISEASE.
B Y J O H N B. A N D R E W S , P H . D .1

INTRODUCTORY SUMMARY.
A sudden and startling increase in the number of illnesses and
deaths from anthrax in the United States drew public attention to
this occupational disease during the closing months of 1915 and
the early part of 1916. Most of the increase took place in seaports
and tannery towns in the three States o f New York, Massachusetts,
and Pennsylvania. New York, for instance, reported more deaths
from the malady in 1915 than had previously occurred in any State
in any single year since the Census Bureau began to give anthrax
a separate place in the mortality statistics. In Massachusetts more
cases were reported during the first six months of 1916 than in any
preceding whole year since the infectious disease reporting law in
that State went into effect.
The relative importance of anthrax is shown by the fact that for
every five deaths from lead poisoning reported in the United States
registration area there is one death from anthrax, and that the total
number o f anthrax cases is about five times the number o f fatalities.
One Delaware physician was able to furnish, from his own prac­
tice, data on 48 cases treated within six years. During the same
period a single Philadelphia hospital treated 32 cases, 6 of which
were fatal. In three years one State workmen’s compensation com­
mission passed upon 30 claims arising from this occupational disease.
Anthrax is primarily a disease of animals such as cattle and sheep,
but is transmitted to man in a number of industrial pursuits. In ­
cluded among those who have died of it in this country are hide and
skin handlers and other tannery employees, longshoremen, wool1 Of information from scores of physicians, hospitals, and public officials in this
country and Europe during the past five years, and of painstaking analysis by two
faithful assistants, Anna K alet and Solon de Leon, grateful acknowledgment is here
made.




5

6

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

sorters, hair workers, brush makers, paper makers, farmers, ranch­
men, liverymen, and veterinarians. Among nonfatal cases reported
in several States and by a number of hospitals the same groups of
occupations are strongly represented. Infection has even taken place
in a carpenter, a steam fitter, and a stationary engineer, all of whom
worked in tanneries, and in a customhouse official who weighed hides
and wool on the docks. In some nonoccupational cases the disease
has been spread by insects and by pet animals which had been feed­
ing on diseased carcasses.
The bacillus of anthrax is one o f the largest and most easily recog­
nized o f disease-producing organisms, and its discovery about the
middle o f the last century marks the beginning o f modem bacteri­
ology. The bacillus, however, is not so much to be feared as a cause
of disease as the spore, which is so resistant that it is used as a test
object for standardizing germicides. The spore can survive for as
long as 17 years without nutriment, is easily carried about, and when
provided with a favorable environment rapidly germinates and sets
up a focus o f infection.
In man contagion commonly occurs through an abrasion o f the
skin, resulting in the so-called “ malignant pustule ” or in “ malignant
edema.” Woolsorter’s disease, or pulmonary anthrax, is a less fre­
quent but almost invariably fatal form of the malady, caused by
inhaling dust or particles of hair or wool from diseased animals.
In rare cases the spores find entrance to the digestive system and pro­
duce a gastrointestinal attack. The method o f treatment most fre­
quently used hitherto is excision o f the pustule where possible, some­
times supplemented by intravenous injections o f antianthrax serum.
Now, however, some successful physicians are advocating for ex­
ternal cases nothing more drastic than rest for the affected part,
stimulants, and local treatment with iodine and wet bichloride of
mercury dressings. Often in internal cases, physicians admit, the
disease fails to be diagnosed and its discovery is a “ surprise o f the
autopsy.”
In Europe both private and public forces have combined to carry
on an energetic campaign against industrial anthrax. The Anthrax
Investigation Board for Bradford and District, in England, the
German and the French employers’ mutual trade associations, and
the famous Labor Clinic at Milan, Italy, have all made valuable
studies o f the disease and assisted in establishing preventive measures.
The governments o f the leading countries long ago drafted and se~
cured the careful enforcement of sanitary rules for the dangerous
industries, including wool sorting, washing, combing, and carding,
hair sorting, brush making, and tanning. Further researches in
efficient and practicable methods of disinfection are still under way.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

7

In at least seven foreign countries anthrax is compensated as an
industrial accident.
In the United States, on the other hand, the problem has as yet
been given less consideration, although legislation for the report­
ing o f anthrax, both as an infectious and as an occupational disease,
is now fairly widespread and in some progressive States valuable
data are regularly being collected.
In the field o f prevention, especially, the United States lags
behind. Precautions taken by employers on their own initiative
are crude and few in number. Antianthrax serum is scarce and not
readily available. No specific factory or workshop regulations for
safeguarding working men and women from the disease have yet
been enacted by any State. The most effective American provisions
on the subject are contained in joint administrative orders of the
Federal Departments o f the Treasury and Agriculture, which, be­
ginning January 1, 1917, prohibits the importation of hides, hoofs,
wool, hair, or other products from animals affected with anthrax
and establishes detailed requirements for the disinfection o f these
products if imported from districts where anthrax is prevalent and
for the disinfection of conveyances and o f certain premises. The
period during 1915 and 1916 when much laxer requirements were
in force corresponds roughly with the period o f highest anthrax
frequency yet recorded in the United States, especially among long­
shoremen and tannery employees, and the connection would seem
to be more than accidental.
Two States authorize workmen’s compensation for all anthrax
contracted in the course of employment, and in one State (Massa­
chusetts) a score of awards under this enlightened principle have
already been rendered. In a few other States compensation pay­
ments have been made for anthrax contracted as the result of a
definite injury received while at work. With the gradual spread of
workmen’s compensation to include all personal injuries in the
course o f employment, and with the probable development of health
insurance in this country, an added incentive will be furnished for
the prevention of this deadly disease.







CHAPTER I.
GENERAL DESCRIPTION AND HISTORY OF ANTHRAX.

EARLY STUDIES OF THE DISEASE.
It was not until the latter half of the eighteenth century that
valuable treatises on the subject of anthrax or splenic fever (French,
“ charbon” ; German, “ M ilzbrand” ) began to appear.1 In 1769
Fournier, of Dijon, France, published his historic work “ Charbon
Malin,” wherein a step was made toward recognizing the connection
between the various forms of anthrax. At about the same time the
ravages o f the disease became so serious and the need for a remedy
so urgent that the Academy of Dijon offered a prize for essays on
the subject. Some of the works submitted were remarkable for the
thoroughness and precision with which they described the main symp­
toms of human anthrax. These first scientific researches practically
mark the beginning of the literature. Since then, at more or less
regular intervals, treatises on the disease, both in man and in ani­
mals, have continued to appear.
It was not, however, until a century later that the true nature of
anthrax was revealed. In France in 1849 an investigation was under­
taken by a group of medical men, in the course o f which it was
established that anthrax in man and anthrax in animals are identical.
Then began a search for the causes o f the disease. The theories ad­
vanced are characteristic o f the ante-Pasteur period when the mys­
teries of bacteriology were still undisclosed and infectious diseases
were explained by spontaneous generation and by other subsequently
discarded hypotheses. For anthrax, the influence of soil, the sum­
mer’s heat, storms, insanitary conditions o f stalls and stables, and
errors in d iet2 were some of the causes assigned.
l f The origin of anthrax is lost in antiquity. Some authors trace it even to the time of
Moses and identify it w ith the sixth plague of Egypt. Allusions to it are believed to be
found in Homer. Virgil at the end of the Third Georgic gives a very vivid description
of an outbreak among domestic animals, the symptoms of which leave little doubt as to
its being anthrax.
Hippocrates, Galen, and Pliny the Elder all describe carbuncles,
which are diagnosed as anthrax by some modern authorities.
Periodic devastating
epidemics of the disease are mentioned by numerous writers, medieval and modern.
2
Thus Delafond, a French veterinary surgeon, held at one time that anthrax in sheep
was caused by “ an excess of blood circulating in the vessels,” due to “ too copious and
too substantial feeding.”
(Delafond : T raits sur la maladie du sang des b§tes & laine,
1843.
Quoted by J. Cavaille : Le Charbon Professionnel, 1911, p. 8.) A t a still earlier
date Chabert, director and inspector general of the Royal Veterinarian College of France,
declared that “ anthrax tumors in general may, and should, be regarded as the effects of
an effort of nature to rid itself of the humor with which it is surcharged and the expul­
sion of which it is important to assist by all means that may achieve this result.”
(Traite du charbon ou anthrax dans les animaux, Paris, 1782, p. 33.)




10

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

DISCOVERY OF THE BACILLUS.

The anthrax bacillus was the first bacterium of disease ever dis­
covered, and its isolation marks the birth of the modern science of
bacteriology. In 1850 a French village physician named Rayer, in
collaboration with Davaine, found in the blood of a sheep which had
died of anthrax what he called “ little threadlike, motionless bodies,
about twice the length of a blood globule.” 1 Five years later, in
1855, a similar result was obtained by a German scientist, Pollender.
None of these men at the time of their discovery, however, was able
to explain the nature of these bodies or their relation to the disease,
nor was anyone aware of the greatness of their contribution to human
knowledge.
Davaine, after a long series of experiments, came to the conclusion
that these bodies, constantly present in the blood and organs of
animals dying of anthrax, were absolutely distinct from the bacteria
of putrefaction which were being studied by his contemporaries, and
that in them would undoubtedly be found the cause of the disease.2
This forecast was brilliantly fulfilled in 1876 by Robert Koch, who
later discovered the bacillus of tuberculosis. Koch conclusively
proved3 the causal relation of the bacterium to the disease, and fur­
thermore demonstrated that the anthrax organism passed through
the two stages of bacillus and spore which had previously been made
out by Pasteur in connection with a silkworm blight.
At this point Pasteur took up the inquiry. The fact that certain
investigators, even after Koch’s demonstration, maintained that the
disease often occurred without the presence of bacteria led him to
subject the work of his predecessors to rigorous verification. He
resorted to the method of successive cultures. In a nutritive liquid
he placed a minute quantity of fresh anthrax blood; a large number
of bacteria appeared; a drop of this liquid produced a new culture
which also showed germs, and so on to 20 cultures. Since the last
culture certainly contained not a particle of the original anthrax
blood, and since it had the power to produce anthrax by inoculation,
Pasteur decided that it was not blood, but bacteria, that constituted
the cause of anthrax. He also verified Koch’s observations of the
reproduction of the bacteria through fission and by spores. The
experiments of these men, by presenting for the first time a complete
account of the etiology of anthrax, answered the most important
question in connection with this disease and made possible its further
scientific study.
1 Comptes rendus de la Soci€t6 de Biologie, 1850, p. 141.
Charbon Professionnel, 1911, p. 11.

Quoted by J. C a v a illg : Le

2 Comptes rendus de l’Acad&nie des Sciences, 1863, vol. 57, pp. 320, 351.
Cavaillg, op. cit., p. 14.

Quoted by J.

3 Robert Koch : Die Aetiologie der Milzbrandkrankheit begriindet auf die Entwicklungsgeschichte des Bacillus Anthracis, 1876.
Leipsig, 1910.
47 pp.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

11

CHARACTERISTICS OF BACILLUS AND SPORE.
The bacillus o f anthrax (B a cillu s anthracis) is a cylindrical or
rodlike body o f
to
inch in length and about y bI iju inch in
diameter. Viewed with a microscope it is motionless, straight, and
transparent. In the blood and other fluids o f a living animal, which
form the most favorable media, the bacillus multiplies very rapidly
by fission. The rodlike body becomes longer and divides into two
or more individuals similar to the parent. The multiplication of the
bacillus can take place only in the presence o f substances entering
into the composition o f the bacillus itself, namely, water, nitrates,
carbohydrates, and minerals; a temperature o f 53.6° to 113° F. and
a supply o f oxygen are also necessary.
Another mode of reproduction is by means o f spores. Spores can
be formed in a medium similar to that favorable to the segmentation
o f the bacillus, except that free oxygen is necessary; for this reason
spores never form in the blood o f a living animal. Given the pres­
ence o f free oxygen, sporulation takes place when the medium be­
comes “ impaired, either because it was deprived by the bacillus of
some of its essential substances or because it became adulterated by
the accumulation of products secreted by the microbe.’51 Under
such conditions the bacillus instead of dividing into segments
grows into a long thread inside of which oval-shaped spores appear,
regularly spaced, “ like peas in a pod.” The surrounding protoplasm
is dissolved or reabsorbed, and the spores are liberated. Thus the
spore seems to be formed at the expense of the bacillus itself; it is, so
to speak, the bacillus in a condensed form, and when placed in a fa ­
vorable medium it germinates and again becomes a bacillus. The
spore has been the subject of numerous researches and its nature is
well known. It has been discovered that, unlike the bacillus, the spore
is marvelously resistant, a circumstance which makes the struggle
with the disease particularly difficult. The spore contains in itself the
elements necessary for life and can subsist for years in an environ­
ment entirely devoid of nutritive materials, while the bacillus, left
to itself, very soon dies. Dr. Kebentisch,2 of Offenbach, Prussia,
states that after having lain dormant for 17 years the spore is still
capable o f germination.
In their susceptibility to heat, the microorganisms also differ con­
siderably. Blood of anthrax-infected animals, containing bacilli
only, loses its virulence if exposed for 15 minutes to a temperature
o f 131° F. The spore, however, is much more resistant. Two hours
o f boiling are required to kill all spores contained in a liquid culture;
raised in such a medium to 221° F. a few spores may resist for about
1 J. C a v a ille : Le Charbon P ro fe ssio n a l, Berger-Levrault, editeurs, Paris, 1911, p. 48.
2 Gewerbliehe Milzbrandvergiftungen, in Zentralblatt fur Gewerbehygiene, M ay, 1913,
p. 201.




12

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

15 minutes. In a dry medium the spores stand a temperature o f 248°
to 266° F. Drying, if carried out rapidly, destroys the bacillus but
hardly affects the spore.
Equally resistant is the spore to antiseptics; numerous experi­
ments have shown that while the bacillus is easily destroyed, only
very high doses and prolonged exposure have any effect on the
spore. Nammack states that “ even catgut, prepared from the sub­
mucosa o f the intestines o f infected sheep, has been known to defy
all the elaborate preparations of modern surgical technique, and
still convey anthrax infection to a wound.” 1 In fact, so hardy are
the spores that they have long been used as test objects for determin­
ing the efficacy of germicides and o f other destructive agencies.2
This circumstance explains the difficulties in the way of sterilization
o f materials, a question which will be taken up later in detail.

ANIMALS SUBJECT TO ANTHRAX, AND COUNTRIES WHERE THE
DISEASE IS PREVALENT.
Anthrax is primarily a disease of animals, from whom it is con­
tracted directly or indirectly by human beings. It is particularly
frequent among cattle and sheep, but may also be transmitted to
goats, horses, hogs, dogs, cats, and certain kinds o f game. Mice,
rabbits, and guinea pigs, in the laboratory experiments, are very
susceptible, while fowl are practically immune. This considerable
variety o f animals subject to anthrax aggravates the dangers of the
disease.
Another serious factor is its world-wide distribution. Hardly a
country in the world is known to be entirely exempt, while a number
o f localities are reputed to be particularly affected. O f the European
countries, Russia and Italy are reported to be most severely affected
by both animal and human anthrax. Well-enforced laws prescrib­
ing preventive vaccination of animals and complete destruction of
carcasses have succeeded in making it comparatively rare in Eng­
land, Germany, France, and a few other European countries. In
the United States, anthrax is frequent among animals in the lower
Mississippi Valley, in the Gulf States, in the East (chiefly on the
banks o f the Delaware R iver), and in some of the Western States.
On the South American Continent it is prevalent in the less civ­
ilized districts of Argentina, and in Patagonia and Uruguay. The
worst ravages o f the disease, however, are reported from Asiatic
countries, mainly Siberia, Persia, Asia Minor, Tibet, China, and
India, where physiographical conditions, deplorable ignorance, and
utter indifference conspire to make the materials exported from
those countries the most dangerous known to anthrax experts.
1 Charles E. Nammack : A Case of A n th ra x ; E xcision ; Recovery, in New York Medical
Journal, 1897, vol. 66, p. 80.
2 E. O. Jordan: General Bacteriology, 1912, p. 217.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

13

CONDITIONS OF SOIL AND TEMPERATURE FAVORABLE TO THE
DEVELOPMENT OF ANTHRAX.
The frequency o f animal anthrax in certain countries is explained
not only by the absence o f precautionary measures, the most urgent
o f which are preventive vaccination, complete destruction of car­
casses, and rational disposal of waste products of manufacture, but
also by conditions of soil and temperature. Anthrax is mainly
observed on black, loose, humus soils, also on swampy land under
which impervious strata are found. Outbreaks are frequent in
places where spring inundations, which frequently wash over un­
buried carcasses, are followed by a dry hot summer. The moisture
contained in these kinds of soil, and the organic matter always abun­
dant, furnish, if combined with favorable temperature, an excellent
medium for the development of bacilli and spores when, after the
inundation, the land dries, and the germs are either left in the ground
or disseminated by the wind.

MODES OF INFECTION.
Most cases of animal anthrax are attributed to infection from
fodder, either through grazing on fields where carcasses o f victims
of the disease have been left, or through eating hay cut from such
fields. Water from streams receiving discharges from establish­
ments using infected material, artificial manure, and imported food­
stuffs are also frequent causes.1 Transmission through blood-sucking
insects has been experimentally demonstrated,2 but only rarely is the
disease due to the entrance o f germs into the air passages, and seldom
does it occur in animals through infection of wounds.
Human beings contract the disease mainly through the handling
o f infected animal materials, either when these materials are ob­
tained by them directly from animals or else when they are being
transported or manipulated in industrial processes.
Workers
handling infected goods sometimes transmit the disease to members
o f their families, either by means of clothing3 or through contact,
while they themselves may escape. Bites of insects and even of pet
animals which presumably had been feeding on diseased material have
been known to convey the infection, and in some cases the eating of dis­
eased meat has been suspected. A certain number of cases are also
due to the spores which have sometimes been found in shaving brushes.
1 In November, 1915, for instance, an anthrax outbreak occurred among the cattle of
farmers owning grass lands along the Johns River, N. H., who fed their live stock hay
cut from those lands.
According to the State department of agriculture, the trouble
seemed to arise from a tannery which emptied its waste into the river. A State veteri­
narian contracted the disease while making a post-mortem examination, but recovered.
See also pp. 28 and 30.
2 M. B. M itzmain : Experimental Transmission of Anthrax, reprint No. 162 from the
U. S. Public H ealth Reports.
3 The Journal of the American Medical Association for Apr. 26, 1918, for instance,
contained an account of a woman in London who contracted anthrax presumably from
the clothes of her husband, who was a laborer handling hides.







APPEARANCE O F A N T H R A X BACILLI AND S P O R E S .

(M G IF D A O T 800 diameters).
A N IE
BU

(magnified about

1200

diameters).

C O M M O N APPEARANCE O F A N T H R A X O N T H E SKIN.




FIG. 5.— LATER STAGE.

A nnC.Bltim™
.He s n a a .

C H A P T E R

II.

MEDICAL ASPECTS OF HUMAN ANTHRAX.
SYM PTOM S.

Human anthrax is caused by the entrance into the body of anthrax
bacilli or spores, and by their rapid development and multiplication
in the favorable media there encountered. In a majority o f cases in­
oculation takes place through a scratch or cut in the skin; in such case
external anthrax results. This can be of two kinds, (1) malignant
pustule, (2) malignant edema or erysipelatous anthrax. More rarely
the germs are inhaled and infect the respiratory organs, or enter
with food into the digestive tract; this is the origin of internal
anthrax, with its two forms, (1) pulmonary and (2) gastrointestinal.
Many exaggerated ideas o f the deadliness o f the disease have been
current,1 but it is now known that the vast majority of cases end in
recovery. Rebentisch2 describes the main symptoms o f malignant
pustule as follow s: The disease begins with a red pimple o f the size of
a pin’s head, formed at the point of inoculation. As there is hardly
any pain, very little attention is paid by the patient to the disease
in this stage. The pimple rapidly increases in size. It becomes sur­
rounded by a peculiar, resilient swelling, often o f considerable extent,
the so-called anthrax edema. In the center of the pustule there is
a black spot around which the skin rises in blisters, this black spot
having given to the disease its French name of charbon. The ap­
pearance of the affected place is very characteristic and makes a last­
ing impression on anyone who sees it. On the third or fourth day
the lymphatic glands in the vicinity of the pustule are usually swollen
and painful. In cases where the pustule is situated in the front part
of the neck, the inflammation may attack the larynx and thus endan­
ger the patient’s respiration. Pustules may appear on several parts
of the patient’s body, but such cases are rare.3
Except for the local symptoms, slight cases are uneventful. Se­
rious attacks are marked by fever and by accelerated heart activity.
In critical cases the patient complains of weakness and pain, and
1 An up-State New York paper in 1913 even went so far as to print the remarkable
statement: “ So malignant is the disease that there is no known remedy for it, infection
being invariably fatal.”
2 Gewerbliche Milzbranderkrankungen, in Zentralblatt fur Gewerbehygiene, May, 1913,
pp. 202, 203.
8
See colored plate; also Plate 2, facing p. 18. Figs. 1 and 2 are from Associazione
degli Industriali d’Italia per prevenire gli infortuni del lavoro: Istruzioni agli operai per
prevenire il Carbonchio.
Milano, 1909.
Figs. 3, 4, and 5 are from Great Britain,
Factory Inspector’s office, Form 410, March, 1908.

42806°— Bull. 205— 17------ 2




15

16

B U LLETIN OF THE BUREAU OF LABOR STATISTICS.

delirium is not infrequent. I f the bacilli penetrate into the blood
stream and are not quickly overcome, the condition of the patient
becomes worse and the disease takes a fatal turn. The complete
cycle o f the disease occupies on the average 9 or 10 days. Sometimes
death occurs much sooner.
In the other form of external anthrax, malignant edema, the pus­
tule is absent. The edema or swelling usually covers an extensive
surface and is most frequently situated on the eyelid, neck, or fore­
arm. 4 The local symptoms,” states Bell, 4 are the extensive edema,
4
4
in slight cases, without redness, vesication, or eschar; in severe cases,
with redness, vesication, and a gangrenous appearance o f the skin.
There may be no pain, no distress, and no fever. Even in fatal cases
these are not very marked.” 1 This form o f the disease occurs much
less frequently than the pustule.
The internal varieties of anthrax are comparatively rare. The
symptoms are not characteristic and can be easily mistaken for those
of a number o f other infectious diseases; this makes diagnosis very
difficult and causes frequent error. According to Nebolioubov, inter­
nal anthrax is often a 4 surprise o f the autopsy ” ; it is also very pos­
4
sible that many cases escape diagnosis.
Gastrointestinal anthrax, says Straus,2 4 begins quite suddenly with
4
general weakness, pains, and shivering; this is followed by digestive
troubles, vomiting, colic, distention o f the stomach, diarrhea; the
whole body is affected; there is difficulty in breathing, weak pulse,
and cyanosis; death, most frequently in a state o f collapse, but excep­
tionally with tetanus-like convulsions, occurs in from two to five days
after the appearance of the first symptoms.”
Pulmonary anthrax, more frequent than the intestinal form of the
malady, is also known as woolsorter’s disease. According to the
authority just cited, one o f its first symptoms is 4 extreme weakness,
4
combined with headache and profuse perspiration; soon there appear
constrictive pains in the chest, difficult breathing, and cyanosis; aus­
cultation reveals congestion and edema in the lungs; sometimes there
is delirium; the patient dies in a collapse; the disease usually lasts
from 4 to 8 days, but sometimes death comes more suddenly.” 3

TREATMENT.
In the treatment of anthrax the resistance of the human body to
bacterial infection is a factor of considerable importance. A number
of physicians have tested the method of 4 expectant treatment,” based
4
only on the resistance of the body, and found it successful in both
1 Anthrax— Its Relation to the Wool Industry, John Henry Bell, in Dangerous Trades,
by Thomas Oliver, London, 1902, p. 637.
2 I. Straus: Le Charbon des Animaux et de l’Homme, 1887, p. 203.

3 Idem, p. 207.




AN TH RAX AS A N OCCUPATIONAL DISEASE.

17

local and general affections. The prevailing tendency among med­
ical men, however, has been toward more energetic therapeutic
methods.
The kinds of treatment now' most frequently used are extirpation,
medicinal treatment, and serotherapy, either singly or in combina­
tion. Extirpation of the lesion by excision, when it is in an operable
location, has been practiced since the eighteenth century. A vari­
ant o f this method is extirpation by cautery— either actual cautery
with a hot iron,1 or cautery by means of phenol or some other corro­
sive acid. By some, however, including a number of very success­
ful practitioners, the method of extirpation, especially by excision,
is at present held to be unreliable and dangerous. The excision, it
is said, does not always remove all the infected tissue, while the knife
in opening the vesicles may facilitate the entrance of the bacteria
into the circulation and thus make conditions worse.
For the medicinal treatment of anthrax, great -faith was at one
time placed in such supposed remedies as oak bark, lemon juice,
tobacco leaves, and roast onions, but these have now been discarded
in favor o f more scientific applications.2 For instance, one experi­
enced American physician who in the last eight years has treated
more than 42 cases affecting the cutaneous and cellular tissues thus
describes his method:
The part is thoroughly but gently washed with 1: 2,000 chloride o f mercury
solution,3 dried well, then swabbed with 10 per cent tincture o f iodine and
some alkali applied. This is repeated daily for several days until the slough has
come away. It takes about two or three weeks for an ulcer to heal, which it does,
with very little scar as compared with the tissues involved., No systemic treat­
ment is necessary other than cleaning out the bowels, though some require
strychnine and alcoholic stimulants. I f the trachea becomes much involved,
nothing will prevent death by suffocation. It has been my experience that
if the vesicles are kept unruptured it is better for the patient. The fatal
cases I have seen were those in which the vesicles had been ruptured.4

In some cases internal administration of certain antiseptics, chiefly
iodine, is resorted to. These antiseptics can not be given in doses suf­
ficient to destroy the bacteria, but they are effective in impeding their
multiplication. Tonics and stimulants such as quinine, alcohol, wine,
A Successful treatment of an anthrax case by actual cautery was reported from
Riverhead, N. Y., in the summer of 1916. The patient was a prosperous farmer.
2 A. N. Bell, one of the first American writers on anthrax, records a case in which
“ a physician was called, who, thinking the disease to be erysipelas, ordered the applica­
tion of 24 leeches, to be followed by a poultice of cow manure.”
(Malignant Pustule in
the United States, 1862, p. 16.)
3 The danger attending the use of mercuric chloride in this manner is illustrated by an
instance described'by Balderston. A physician called in to a case found the patient
suffering from anthrax, and around the pustules a number of punctures made by a hypo­
dermic needle. On being asked what he had injected, the physician who first had the
case in charge replied bichloride of mercury. “ He was not able to say exactly how much
had been given, but the man died of bichloride poisoning.”
(Journal American Leather
Chemists’ Association, July, 1916, p. 341.)
4 John Palmer, jr., in Journal American Medical Association, Nov. 6 , 1915, p. 1670.




18

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

or coffee, as well as the inhalation of oxygen, are also reported to be
beneficial.
Serotherapy, the third modern method, is as yet hardly beyond
the experimental stage, but it holds out important promise for the
future. It consists of the injection, usually intravenously, of fluids
from an immunized animal, containing germicides or having a neu­
tralizing effect on the germ’s secretions. Several kinds of serum
have been tested and found more or less effective. Perhaps the
greatest success is credited to the serum produced in 1895 by
Prof. Sclavo, of Siena, Italy. A t first he experimented on ani­
mals, but in 1897 began to use his serum on human beings. After
six years he collected the records of all cases in which his* serum
had been applied, and found that, out o f 164 cases, only 10 had
resulted fatally. This mortality rate of 6.1 per cent is very low
as compared with that of 24.1 per cent which is the general rate re­
ported by Italian statistics. The value of this serum is recognized in
Italy to such an extent that in some cities workers in tanneries and
hair factories demand vaccination as soon as they notice a suspicious
mark on their skin.1 Recently the manufacture of antianthrax serum
has been undertaken by a well-known American firm, but even the
American article is highly expensive, 80 to 100 cubic centimeters
being required for the initial dose, at a cost of from $28 to $35.
It is still too early to form a definite judgment of the value of
serotherapy, but it is commended by a number of anthrax authorities,
and its use is continually extending. It is, for instance, combined
with excision when possible in the routine treatment for all cases
o f anthrax admitted into certain prominent American hospitals and
into the Bradford Infirmary in England. In other anthrax centers
serum is given without practicing excision and with very successful
results.
No matter what mode o f treatment is adopted, prompt diagnosis
and rest for the affected part are stressed by leading authorities.




1 J. Cavaiile: Le Charbon Professional, p. 112.




A N T H R A X IN FECTIO N.

PH TO RA S O PATIEN
O G PH F
T.

PLATE

1 BEFORE
.—

INFECTION.

PLATE

2.— M O S T

ACUTE STAGE OF

INFECTION.




PLATE

3.— S O R T I N G

Chi ef l y imported

UNWASHED

HORSEHAIR.

frorr ^ hi na, Russi a, and Sout h

C H A P T E R

H I.

INDUSTRIES AFFECTED.

AGRICULTURE AND OTHER INDUSTRIES INVOLVING DIRECT
CONTACT WITH ANIMALS.
Anthrax in man is, in the great majority of cases, of occupational
origin. In a number of occupations anthrax is transmitted to the
workers directly by animals. Farm laborers, shepherds, butchers,
flayers, and veterinarians, for instance, contract the infection by
coming in immediate contact with the diseased animals or with their
carcasses.
More numerous are the groups o f persons who handle, for the pur­
pose o f manufacture, materials derived from infected animals. Such
materials are used in several very important industries, including the
wool industry, the manufacture of leather and leather goods, work
on bristles and hair, and making artificial manure. Protection of
the workers is particularly difficult in the leather industry, since
reliable and practicable means of disinfection, such as exist for hair
and bristles, have not yet been conclusively worked out for hides
and skins.

LEATHER INDUSTRY.

No country in which the leather industry has developed to any de­
gree of importance can depend entirely on its own supply of hides
and skins. These products come in enormous quantities from less
highly developed countries, where manufacturing is hardly known
but where vast lands furnish favorable conditions for successful stock
raising. In these regions sanitation is usually unknown or neglected,
and clean materials are packed in the same bale with those which
have been infected. Materials imported from China, India, and
other Asiatic countries, and from some localities in A frica and South
America, are considered particularly dangerous.
The hides and skins are usually imported in a raw state. Before
being used in manufacture they must be subjected to the process
of tanning. Upon their arrival at the tannery the skins are sorted
and then soaked. This soaking brings the “ dry ” hides to a moist
flexible state, which is necessary for a more complete absorption of
the tannin from the subsequent tan liquors. A ll kinds o f skins—
“ dry,” “ wet salted,” and “ green” (fresh)— are cleansed, in the
“ soak,” from earth, blood, and dirt adhering to them and from any




19

20

.

B U LLETIN OF TH E BUREAU OF LABOR STATISTICS.

preservatives with which they may previously have been treated.
The “ soak ” may consist of fresh water or o f water to which anti­
septics have been added, the contents of the fluid, the time of ex­
posure, and the details of the process varying in different establish­
ments. This treatment, although it does not succeed in destroying
the spores, nevertheless diminishes considerably the risk of anthrax
infection, because it washes away the blood, dirt, and other sub­
stances containing spores. The next step is to remove the hair. For
this purpose the materials are placed in pits containing a saturated
solution o f slaked lime, where they remain for several days, accord­
ing to the class to which they belong. Even this prolonged lime bath,
which is a powerful disinfectant for many purposes, is unable to
kill the anthrax spores. As a result of the action of the lime the
hair is easily removed with a special knife. Then, any adhering
particles o f flesh are scraped o ff; the skins are 4 delimed,” that is,
6
the remains o f the lime are washed o ff; and this is followed by the
steps immediately preceding tanning and by tanning itself.1
The incidence o f anthrax varies in the different processes. Rebentisch,2 as a result o f his own researches and those o f the German
Leather Industry Accident Association, came to the conclusion that
only a small number o f cases occurred among workers in the depart­
ments where dry skins were manipulated, whereas the majority of
victims were engaged in the processes o f soaking and washing.
Cavaille, from his study of the tawing works in the city o f St. Denis,
France, reached a similar conclusion.3 American and British ex­
perience, however, seems to contradict this, the majority o f tannery
cases in both these countries occurring in the early dry processes
such as unloading, storing, and sorting.
The various manufacturing processes, by additional cleaning o f the
skins, still further reduce the danger of anthrax, but are not capable
o f removing it completely. There is always the possibility of fin­
ished leather conveying the disease. In support o f this theory
Constant Ponder gives the following evidence collected by him from
various authors:4 (1) Shoemakers who have handled only leather
have contracted anthrax; (2) horses have contracted anthrax on the
flank where a new pair o f reins touched them; (3) it has been shown
that the spore sometimes survives, unharmed, the processes of tanning.

ANIMAL HAIR AND BRISTLE INDUSTRY*
Another group o f industries where the danger of anthrax is pres­
ent is that involving the manipulation of animal hair and bristles.
1 See Plates 4 and 5.
2 Gewerbliche Milzbranderkrankungen, in Zentralblatt fur Gewerbehygiene, June, 1913,

p. 249.
8 J. Cavaill6 : Le Charbon Professionnel, p. 132.
4
Constant Ponder: A Report to the Worshipful Company of Leather Sellers on the
Incidence of Anthrax among Those Engaged in the Hide, Skin, and Leather Industries,
with an Inquiry into Certain Measures Aiming at Its Prevention. London, 1911, p. 17.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

21

The hair is obtained from horses, asses, mules, and oxen; the bristles
from hogs and wild boars. The hair is used for making haircloth,
cords, gloves, and a number o f other articles, and for stuffing pillows,
mattresses, chairs, and saddles. The manufacturing countries do not
depend upon their own supply o f hair but import large quantities
from China, Russia, South America, and other places, China supply­
ing more bristles than any other oriental country. O f all the vari­
eties o f hair, Russian horsehair is considered the most dangerous.
The hair reaches the factory in large compressed bales weighing
several hundred pounds. Upon the bales being opened the hair is
sorted according to color, length, and strength.1 Then it is either
shaken on a screen or combed. This process removes the dust from
the hair and separates the long hair from the short. The former
method is used in weaving, the latter in brush making. To make per­
manent the curl in hair used for stuffing pillows, mattresses, chairs,
and saddles, the hair is steamed for 15 to 20 minutes under a pressure
o f 1 to 2 atmospheres; other methods, such as exposure to dry heat
under ordinary pressure, are also used for the purpose. After dyeing,
if this takes place, the hair is rinsed, dried, and packed. Dyeing is a
very welcome process as far as prevention o f anthrax is concerned,
because the hair is left for several hours in a solution heated by the
passage o f steam. The heat is never sufficient to destroy the ^erms,
but the dirt is removed and probably the virulence of the spores is
diminished; however, the hair is not often dyed.
The early processes o f opening, sorting, and combing involve a
greater degree of risk than the subsequent manipulation. This risk
is increased by the filth and dust, both o f which are notorious carriers
o f anthrax germs.
Bristles upon their arrival at the factory are also sorted and sepa­
rated from the dirt and from all bulky foreign matter; to remove
the finer particles of filth the bristles are arranged in layers, sprayed
with water, and left for a time. This produces decomposition of
the still adhering foreign substances, which are then easily carried
away with steel combs. After that the bristles are rinsed in cold
water, tied in packages, and dried. Frequently the better sorts of
bristles arrive sorted and cleansed. As in the case o f hair, the first
operations—unpacking, sorting, and combing— are more risky than
the others, and the prevalence of anthrax among the workers en­
gaged in them has attracted considerable attention.2

WOOL INDUSTRY.
The danger o f anthrax is also present to a very marked degree
in the wool industry. W ool is obtained chiefly from goats, sheep,
1 See Plate 3, facing p. 19.
2 Two days after he injured his finger while at work in

the factory of the New
Haven Brush Co., its president, Elmer W . Griswold, died Dec. 24, 1916, of anthrax
which the physicians believed was communicated to the wound from an infected bristle
of a hairbrush.




22

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

and camels and is imported from some of the oriental countries, such
as Asiatic Turkey, Arabia, Tibet, and Persia, also from Kussia and
from some localities in South America and Australia. Like hair and
bristles, it frequently reaches the factory in a filthy state. Upon
opening, the wool is sorted according to color and quality, after
which it is freed from dust in the willowing machines, and blended
so as to obtain a uniform color in bulk. Then each sort is put several
times in succession through an alkaline bath at 130° F. This re­
moves any remaining dust and dirt and dissolves the blood clots,
which adhere to the wool with extreme tenacity and which, if from
an animal which has suffered from anthrax, contain abundant spores.
After rinsing and drying the wool is either-combed or carded, ac­
cording to the use for which it is designed. The processes in the
wool industry, as in the industries previously described, vary in
different establishments. Particularly dangerous are the early opera­
tions, since the dirt and dust are laden with germs; indeed, pulmo­
nary anthrax owes its special title, “ woolsorter’s disease,” to its
appearance almost exclusively among workers in dusty wool proc­
esses. The liberation of the spores by the alkaline bath accounts for
cases in the later processes of carding and combing.

HORN AND BONE INDUSTRY.
Among other imported animal materials utilized in industry, horns
and bones are occasionally a source of infection. They are used in
the manufacture of combs, buttons, knife handles, corset bones, and
smoking pipes. During the breaking, cutting, and chipping, small
sharp fragments are projected which wound the worker and in this
way facilitate inoculation.

TRANSPORTATION.
The simple handling of infected goods during their transportation
has also been shown to cause anthrax. Longshoremen, porters in
warehouses, and other transportation workers frequently contract
anthrax while loading or unloading infected materials. Sometimes
anthrax is transmitted to these workers not through immediate con­
tact with animal products, but indirectly. Cases are known of
laborers having become infected from cargoes o f com, wheat, and
barley. Apparently the grain had come in contact with infected
animal products or was stored in places where such merchandise was
previously kept.
Cases of anthrax also appear among workers in glue factories,
rag-sorting works, felt factories, and establishments where fertilizers
and artificial animal food are being prepared. The danger of in­
fection in these occupations is comparatively slight.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

23

NONOCCUPATIONAL ANTHRAX.
Anthrax statistics also include many cases of persons between
whose occupation and the disease no connection can be traced, such
as children, housewives, persons without any occupation, schoolboys,
teachers, and professional men. In 1915 and 1916 several widely
scattered British cases of the disease, including one death, were
definitely traced to shaving brushes, manufactured by one firm from
bristles o f Chinese origin; a number of the suspected brushes were
examined and found to contain anthrax spores which had survived
the processes of manufacture.1 This possibility of unexpected at­
tack and the fatal consequences which may ensue, even despite
energetic treatment, add greatly to the urgency of adequate measures
for eradicating the menace.
1
Report of the County Medical Officer and School Medical Officer for the year 1915.
London County Council, August, 1916, quoted in M o n t h l y R e v i e w of the U . S. Bureau
of Labor Statistics, November, 1916, pp. 108-110.










PLATE

4.— S E L E C T I N G

RAW SKINS

IN W A R E H O U S E O F K I D F A C T O R Y .




PLATE

5.— D R Y I N G

HAIR AFTER R E M O V A L F R O M

SKINS

IN A K I D

FACTORY.

C H A P T E R

IV .

ANTHRAX IN THE UNITED STATES.

The record of anthrax in the United States forms an absorbing
chapter in the annals of the country’s tardy but gradual movement
toward the recognition and prevention of occupational 1
disease.
Practically all the industries in which anthrax occurs are to be found
in this country, and cases have been known to medical men for the
better part of a century. It is only in recent years, however, that
industrial and community responsibility for the disease has been
brought to the fore, and social activity for its control is still in the
early stages.

EARLY EXPERIENCE.

Early American experience with anthrax is recorded only in
occasional papers by medical men who came in contact with inter­
esting cases, and the story thus preserved is necessarily very incom­
plete. Perhaps the first human cases so recorded in the United
States occurred in Philadelphia in 1834.1 An epizootic o f “ mur­
rain ” broke out among the cattle near that city and finally spread
to the city itself, prevailing especially among cattle that fed on the
common. Several persons who had been engaged in skinning animals
that had died of murrain were affected with the malignant pustule.
O f the three patients who were treated by the historian of the out­
break, one stated that “ while he was skinning a cow dead of murrain
a mosquito bit him on the back of the hand. With the other hand,
which was covered with the blood of the cow, he brushed away the
mosquito and rubbed the itching bite.” In all three cases the infec­
tion was on the hand, and all ended in recovery. A fourth case
occurred in the following year (1835). A milkman skinned a cow
which had died o f murrain and carried the hide on his bare arm.
Several days later he noticed a pustule on his arm, from which he
eventually recovered. In all these cases the symptoms o f the malig­
nant pustule in man were well characterized.
By 1835, also, large numbers of human cases had occurred in Lou­
isiana. Eight o f these were described by one physician,2 who traced
1 C. W. Pennock : On the Malignant Pustule; With Cases, in American Journal of Medi­
cal Science, Vol. X IX , November, 1836, pp.. 13-25.
2 William M. Carpenter : A Treatise on Malignant Pustule.
Thesis submitted to the
faculty of the Medical College of Louisiana, 1836; also Southern Medical Journal, Febru­
ary, 1839, pp. 257-274.




25

26

B U LLETIN OF THE BUREAU OF LABOR STATISTICS.

the history o f malignant pustule in the region back to the time o f
its settlement by the French and believed that the disease was first
noticed in America among deer feeding on the salt marshes near the
mouth o f the Mississippi River. Later it attacked the planters5
cattle, returning annually, and by the time he wrote it was prevalent
in nearly every part o f the State, but “ seems not to have been even
noticed in the medical annals of America.” During 1851 Louisiana
was visited by an anthrax epidemic which was compared1 to that
described in the first book of Homer’s Ilia d :
On mules and dogs the infection first began,
And last the vengeful arrows fixed on man.

In several cases the disease was communicated to men by fly bites,
and once by dressing the lesion of an infected mule. In Mississippi
outbreaks o f anthrax among animals occurred at intervals after 1836,
the losses o f cattle in 1865 and 1867 being particularly heavy.
In New England anthrax seems not to have attracted attention
until a later date than in the Southern States. In 1852 detailed
accounts of six cases were published by a Salem (Mass.) physician,2
who stated that for some time previously he had seen a case every
few years. He enumerated several occupations in which the disease
occurred, but, in common with other physicians o f the period, he
indicated little knowledge of its nature. Seven years later four
cases in New York, three o f which terminated fatally, were described.3
An important addition to the literature on anthrax was made in
1862, in the report on “ Malignant pustule in the United States,”
by A. N. Bell, a physician at the Brooklyn (N. Y .) City Hospital. In
this work Bell summarizes several previous American publications
on the subject and describes cases which occurred in his own prac­
tice. He states that when a fatal case of malignant pustule came
up for discussion before the Kings County Medical Society in July,
1859, members declared the disease had existed in Brooklyn for only
about four years. In December o f the same year three other cases
were reported to the society. Bell himself saw several other cases,
and heard of 10 more in Brooklyn and of several in New York.
He also gave the names o f several physicians in the States of Maine,
Massachusetts, Rhode Island, and New York who had treated cases
of anthrax. Bell’s experience with the disease convinced him of
the value o f early diagnosis, the importance of which has been
proved by later authorities. “ O f all the diseases that man is heir to,”
he states, “ there is none in which an early diagnosis is more im­
1 James H. Baldridge: Malignant Pustule, in New Orleans Medical Journal, September,
1851, pp. 200-204.
2 A. L. Peirson: Malignant Tubercle, in Boston Medical and Surgical Journal, Aug. 25,
1852, pp. 75-78.
8 Buck, in New York Journal of Medicine, 1859.




AN TH RAX AS A N OCCUPATIONAL DISEASE.

27

portant than in malignant pustule. It is indeed o f such moment
that the lapse o f a few hours or a day may entail the most deplorable
consequences.”
Struck by the repeated occurrence o f anthrax in the vicinity of
Walpole, Mass., a Massachusetts physician1 made careful inquiry
and found that in 1853 there first appeared in the town a “ most
singular disease, which was recognized by the attending physician
as charbon, or malignant vesicle, a malady known from remote an­
tiquity as prevailing among animals, but observed among mankind
only within a comparatively recent period.” The malady had been
reported from that locality at irregular intervals until during a
period o f 17 years 26 cases had come under observation. Twentyfour o f these cases occurred among hair workers, one victim was a
carpenter employed in a hair factory, and the remaining case was
that of the wife o f one o f the victims.
The difficulties in the way of diagnosing anthrax and the conse­
quent underestimate o f the real number of cases were recognized at
a comparatively early period. “ The transmission o f this disease
to man,” said one practitioner in 1881, “ is far more frequent than
is generally supposed. * * * Under the names o f black erysipe­
las, carbuncle, diphtheria, etc., many cases occur that are easily
traceable to infection from animals. * * * In the last decade
I have been personally cognizant of 13 cases, and four of these have
occurred within the past two years in a town of 10,000 inhabitants
and independently of factories working up hair or hides, which
prove the most frequent sources of infection.” 2 The author con­
sidered the problem of sufficient moment to demand sanitary legis­
lation and “ the most rigid measures for the suppression of anthrax
outbreaks.”
The year 1892 is considered an important date in the history
o f anthrax in Delaware, a State where outbreaks of the disease
among both human beings and animals have been particularly fre­
quent. In that year, according to Dr. Charles F. Dawson of the
Delaware College Agricultural Experiment Station, anthrax was
“ officially recognized as existing in Delaware.” This date seems
late as compared with 1834, the year of the epidemic, previously
discussed, near Philadelphia, and 1836, the date of the earliest re­
ported outbreak in Mississippi. However, Dr. Dawson admits that
“ while anthrax has been known to exist in the State only since
1892, it is highly probable that the first cases occurred much earlier
1 Arthur H. Nichols: On the Occurrence of Charbon, or Malignant Vesicle, in Massachu­
setts. Massachusetts Board of Health, Annual Report, 1872.
2 James Law : Glanders and Anthrax, in Cyclopedia of Practical Medicine (supp.), New
York, 1881, p. 202.




28

B U LLETIN OF THE BUREAU OF LABOR STATISTICS.

and that the disease is as old as the morocco industry.” 1 In the
outbreak o f 1892, when the officials were admittedly “ inexperienced
in the management of this disease,” several farmers contracted pus­
tules. Since that year outbreaks o f anthrax have been common
in Delaware. “ Estimates made by veterinarians practicing in the
State show from 175 to 200 farms in Delaware that are perma­
nently infected with anthrax. * * * The infected territory com­
prises about one-third o f the total area o f the State.”
Information on the prevalence of anthrax in the southern and
southwestern parts of the country is comparatively limited. In 1894
an epidemic o f anthrax was reported near Como, La., where live stock
perished in large numbers and many people contracted the disease,
in some instances with fatal results. In the same year a California
medical m an2 stated that in Yentura County, Cal., alone, over 100
cases o f malignant pustule had occurred between the time of its
first recognition and the date o f his article, and he suggested that
some cases had escaped diagnosis.
A remarkable case is recorded by Dr. W . P. McIntosh, o f the
United States Marine Hospital Service, as having occurred at Boston.
Eighteen months before falling ill the patient worked on a tramp
steamer which carried hides from a South American port;' since
that time he had been employed on ordinary seagoing vessels.
“ The most probable exposure was at the time when the man was
employed on the vessel transporting hides from South America.
This, however, would presuppose that he had carried the infective
agent about with him as part of his personal baggage for a period
o f 18 months. This is not inconsistent with the life history o f the
anthrax bacillus.” 3
The difficulties encountered by early physicians in the diagnosis of
anthrax are well described by Nammack.4 One patient, a young
fruit handler in New York City, felt a slight pricking or burning
sensation in the right eyebrow and upper eyelid; on the following
day the lid became swollen. A surgeon was consulted and ordered a
lotion. Next morning the patient went to an eye clinic, where he
was told that there was nothing wrong with his eye, but that he had
cellulitis o f the lid ; he was referred to the surgical class and again
given a lotion. A day later he called at Nammack’s office. The lid
then presented the appearance o f phlegmonous cellulitis, and the
doctor prescribed hot boric acid lotions and ordered him to return
next day for incision. The next morning a messenger called to say
1 Bui. No. 90, Delaware College Agricultural Experiment Station, 1910. Anthrax, p. 17.
The manufacture of morocco leather from imported goatskins was established on a small
scale in Wilmington, Del., as early as 1840.
2 C. L. Bard, in Southern California Practitioner, 1894, p. 121.
SW . P. McIntosh, in Medicine, 1897, Vol. I ll , pp. 459-461.
* Charles E. Nammack : A Case of Anthrax; Excision; Recovery, in New York Medical
Journal, 1897, Vol. L X VI, pp. 78-80.




AN TH RAX AS A N OCCUPATIONAL DISEASE.

29

that the patient wasi delirious and that during the night a black
pimple had developed on the eyelid. H e was immediately conveyed
to a hospital where the area surrounding the “ charbon ” was excised,
cauterized, swabbed out with pure carbolic acid, and then inoculated
with cultures o f the bacillus pyocyanicus. Portions o f the excised
tissue were sent to three laboratories and anthrax bacilli were re­
ported. “ Three observers had treated the case as one o f ordinary
phlegmonous cellulitis.” The probable mode o f infection in this
case was very unusual. In most of the cases which Nammack had
previously seen the men had been handling hides. This patient was
repacking fruit sent to a commission house. Some o f the fruit came
from Spain in crates which were bound with strips o f rawhide.
A s he cut these strips one would occasionally fly up and hit him in
the face. I t is probable, says the writer, that in this way the skin
was bruised and a way was opened for the entrance o f the microbe.
D uring the closing five years o f the last century, accounts o f anthrax
became very frequent. In 1896 the fatal case occurred o f a Philadel­
phia brush maker, who had been working on hogs’ bristles and
horsehair imported from Siberia and from the southern part o f
European Russia.1 T h e existence o f the disease was proved bacteriologically,
T he next year five cases (fou r fa ta l) occurred among the opera­
tives o f a F alls Creek, P a., tannery. H ides imported from A sia and
infected with anthrax were found to be the source o f contagion.2 The
death o f a porter in a Boston leather warehouse was described in
1898.3 T his man had been carrying hides on his shoulders. One
m orning while shaving he noticed a small “ pimple ” on his neck.
H e continued his work on that and on the follow ing day, but was
taken ill the day after and went to the hospital, where the pustule
was excised; he died a day later. Smears from the vesicles surround­
ing the pustule showed abundant bacilli.
Another fatal case o f a hide handler was reported the same year
from New Orleans.4 T he patient had been employed in one o f the
largest hide stores in the city. W h en he was brought to the hospital
the two physicians who saw him concurred in diagnosing the disease
as anthrax. Antistreptococcic serum was injected, but the patient
died on the tenth day o f his illness. In his account o f the case D r.
Dabney comments on the “ scant precautions which the dealers in
hides and wool in this country take for the protection o f their em­
ployees against this disease.”

Dabney, like several other writers, is

1 M. B. M iller: A Case of Anthrax, in Philadelphia Medical Journal, 1898, Vol. I,
pp. 340-342.
2 Medical News, January, 1897.
8 Abner Post, in Medical and Surgical Reports of the Boston City Hospital, 1898,
pp. 226-232.
4 T. S. Dabney: A Case of Anthrax (Charbon), in New Orleans Medical and Surgical
Journal, 1898-99, Vol. LI, pp. 377-383.




30

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

convinced that many anthrax cases remain unrecognized. “ I can
not believe,” he says, “ that m alignant pustule is as rare as our hos­
pital and board o f health reports would lead us to infer. A rather
careful look through the incomplete reports o f the Charity H ospital
from 1875 to 1897 fails to find a single case treated in that institu­
tion.

*

*

*

W e are forced to the conclusion that m any cases o f

anthrax must have died in private practice as well as in our public
institutions, under the diagnosis o f erysipelas, cellulitis, carbuncle
(ord in ary), blood poisoning, etc.”
An th rax, however, is by no means confined to the E ast and South.
In W isconsin, which is an im portant tanning center as wall as an
agricultural and stock-raising State, an epizootic o f anthrax oc­
curred during July and A ugust o f 1899 among the cattle in a certain
district. N ot less than five persons contracted the disease through
skinning anim als; in all these cases the pustules were on the exposed
parts o f the body. Investigation by the health authorities led to
the conclusion that the cases among animals were produced by drink­
ing water from a river into which the tannery waste was discharged
and by grazing on meadows adjoining this river.1 In the same sum­
mer an outbreak o f anthrax occurred among tannery workers in
another part o f the State.
In a Philadelphia case2 in 1900 the patient was a “ card stopper ”
in a large woolen m ill.
T he illness began when he sustained a
punctured wound on his forearm while at work. E ig h t days later
he was admitted to the h ospital; the arm was dressed with a solu­
tion o f bichloride o f mercury, 1 to 10,000, and kept wet constantly.
N ext day 1 dram o f 10 per cent carbolic acid was injected; on the
day after, 1 dram o f pure carbolic acid was used. A similar injection
was made daily during each o f the five follow ing days. A week
after admission the patient was up.
L e w a ld 3 describes a rapidly fatal case o f anthrax in a New Y o rk
stevedore in 1902. The man had been unloading hides, and was
admitted to the erysipelas pavilion o f Bellevue H ospital on M arch 1.
Three days previously he had noticed a small pimple on his neck;
24 hours after that he was ill and unable to work. U p on his ad­
mission to the hospital he continued to grow worse and died on the
follow ing day. “ A smear was made from the wound a few hours
before death, and the examination made at the laboratory confirmed
1 In November, 1916, an anthrax outbreak occurred among the cattle of farmers own­
ing grass lands along the Johns River, N. H., who fed their live stock hay cut from
these lands. According to the State department of agriculture, the trouble seemed to
arise from a tannery which emptied its waste into the rivef. A State veterinarian
contracted the disease - while making a post-mortem examination, but recovered.
See
also pp. 13 and 8 8 .
2 E. W. Fisher: A Case of Anthrax Successfully Treated by Local Injection of Pure
Carbolic Acid, in Therapeutic Gazette, Detroit, 1900, 3s., Vol. X V I, pp. 508-510.
3 L. F. Lewald: A Case of Anthrax, in Proceedings of the New York Pathological
Society, February and March, 1902, pp. 24-26.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

31

the diagnosis o f anthrax.” In the discussion on the case the opinion
was expressed that anthrax is more frequent in New Y o rk City
than was commonly supposed.
“ W ith in the last three or four
years, four or five cases have come into the dispensary o f the H u d ­
son Street H ospital.
Singularly good results have been obtained
from early radical excision.”
I n 1905 Drs. G . J. Schwartz and B . F . R ayer,1 both o f Philadel­
phia, described to the Academ y o f Surgery o f that city a case o f
anthrax in a farmer, who contracted the illness through skinning a
cow. In the pustule which form ed on the wrist anthrax bacilli were
found. The pustule was excised and the patient recovered after an
illness o f 35 days. In their report o f the case the authors make the
follow ing comment on the lack o f serum: in this country: “ F rom data
presented by Legge * * * and Sclavo, it would appear that the
time had come when we in this country should have a supply o f anti­
anthrax serum kept by health boards or research laboratories, where it
m ight be gotten in a few hours by those called upon to treat anthrax.”
W h en the patient came to the hospital requests for serum were sent
to two private laboratories, to the Marine H ospital Laboratory, and
to the Bureau o f H ealth o f New Y ork , but no serum could be found.2
E a rly cases o f human anthrax were frequent also in several other
States, including Texas. In that important stock-raising State out­
breaks among domestic animals occurred repeatedly, with conse­
quent infection o f human beings. A young woman, for instance, was
bitten in the face by an insect while anthrax was raging among the
cattle in the neighborhood.3 She died two days after admission to a
hospital. Another Texas victim was a dairyman who contracted the
internal form o f the disease from a cow and died on the eighteenth day.3
D uring the first decade o f the present century five States passed
laws for the reporting of anthrax, among other infectious diseases.
These States are Massachusetts and Illinois (190T ), Pennsylvania
and California (1 9 0 9 ), and New Y ork (1 9 1 0 ). In Massachusetts be­
tween A ugust 1, 1907, and the end o f 1909 nine cases were reported,
seven o f which occurred in L ynn, an important center o f the leather
and shoe industry. The fatal cases recorded are somewhat more nu­
merous. Between 1865 and 1906, for example, a period o f 41 years,
128 deaths from anthrax were recorded in Massachusetts alone.4 The
U nited States registration area in 1900, the first year fo r which
deaths from anthrax were listed separately, included only 40.5 per
cent o f the country’s population, and in 1909 had increased only
enough to cover 56.1 per cent o f the population. Y e t, in this re­
1 Transactions of Philadelphia Academy of Surgery, 1905, p. 76.
2 A few years later the Philadelphia Municipal Hospital and at least one progressive

manufacturer began to keep Sclavo’s serum.
8 H. A. Barr : Report of Two Fatal Cases of Anthrax, in Texas Medical News, 19O5~-0,
Vol. X V , pp. 277-281.
*U. S. Public Health Reports, Dec. 15, 1916, p. 3399.
42806°— Bull. 205— 17------




3

32

BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

stricted area 227 fatal eases o f anthrax were recorded for the 10-year
period. Deaths from this disease have steadily increased in number.
RECENT EXPERIENCE.

EXPERIENCE OF A LEADING MOROCCO-LEATHER CENTER.
A Delaware city, for two generations the center o f the moroccoleather industry in this country, furnished a favorable opportunity
io r a community study o f occupational anthrax. M ost o f the. im ­
ported goatskins come dry in immense burlap-covered bales, weigh­
in g often more than 1,000 pounds each, from goat-eating countries,
including China, In dia, A rabia, North A fric a , B razil and other
parts o f South Am erica, M exico, Spain, Macedonia, and Russia.1
These untanned skins form erly came by steamer to New Y o rk , pre­
sumably under United States consular certificate to the effect that
the foreign agents o f this Government “ have not required disinfec­
tion under quarantine regulations because the shippers have declared
that anthrax, rinderpest, and foot-and-m outh disease do not prevail
in the districts in which the skins originate.” 2 T h e usual practice
has been to reship the skins, by smaller boats, from New Y o rk to
Philadelphia and then again, sometimes by still smaller vessels,
to the Delaware city. Cargoes are now frequently shipped by train
from New Y ork , and recently the urgent demand has resulted in
some railroad shipments direct from the Pacific coast.
U pon arrival at the company’s warehouse the skins are unloaded,
sorted, and hauled as needed to the factory, where they are dumped
into tanks o f water to soak fo r 24 hours. W h en softened they are
drawn out and churned in large drums which separate from the
skins the most easily dislodged particles o f waste matter. N ext
they are thrown into a second series o f vats and immersed for two
weeks in a solution o f lime and arsenic or other agents which loosen
the hair. These, the preliminary processes o f handling and pre­
paring the skins, menace the worker with the greatest danger o f
infection because the anthrax bacilli and spores have not yet been re­
duced in number or virulence by the later tanning processes. On
the contrary, each process preceding that o f lim ing is well adapted
to cause the anthrax germ to flourish.
A t other tanneries the especially dangerous prelim inary processes
are similar to those just described, differing principally with the
kind of skins or hides to be manufactured into leather. The tanners
regard the danger as slight after the pelts have passed through the
lim ing process. T h at the danger, though in diminished degree, con­
tinues through later processes is indicated by occasional outbreaks o f
the infection among the beamers, fleshers, and splitters. The story
is told of an engineer who came from another city to install a new
1 As a by-product one company
yearly to be made into blankets
infection to other establishments
2 Copied in April, 1916, from a




sells in this country about $200,000 worth of goat hair
or carpets according to grade. This spreads danger of
and to other communities.
consular certificate from Hankow, China.

AN TH RAX AS AN OCCUPATIONAL DISEASE.

33

mechanical device in a Delaware morocco factory and who contracted
anthrax when he bruised his hand while working among scraps of
waste material on the floor beneath the old machine. But in this
Delaware city, as among tanneries elsewhere considered in this report,
most o f the cases of anthrax have occurred among the handlers and
sorters o f imparted dry skins in the receiving warehouses.
One physician in this morocco-leather center, who has in recent
years been most frequently called upon by the manufacturers to treat
victims o f the dread disease, furnished to the investigator the names
and descriptions o f 48 cases o f human anthrax treated in his prac­
tice during the past six years. A l l but h alf a dozen, o f these were
from the receiving warehouse o f one morocco-leather factory. T his
physician reports that only three o f his cases resulted fatally.1 The
infection in the m ajority o f cases was on the face or neck. In a few
cases it was on the shoulder, arm, hand, abdomen, or thigh. One
patient reinfected him self from the back o f his neck to his cheek.
Another suffered two attacks, first on the neck and then, nine months
later, on the arm. In no instance was the disease contracted from a
previously existing case in a human subject.

Other physicians interviewed gave meager accounts o f their
anthrax experiences, speaking largely from memory, aided as to
names and dates by their cash accounts with leather manufacturers.
A ll referred to a local company physician, now several years de­
ceased, as having treated the greatest number of cases o f anthrax.
According to his widow, who had acted as his drug clerk and was
familiar with his practice for 20 years,, he often had as many as
four or five such cases at a time.
Local, hospitals, on the plea that they are “ not equipped,” refuse
to receive anthrax patients, although a nurse in charge o f a private
institution cared for two or three such patients several years ago,
and one o f these, a serious case, is reported to have been sent to the
hospital by a physician under the mistaken impression that the
workman was suffering with erysipelas.2 One untrained woman told
the investigator that she had nursed four cases, including her own
son, in a room o f her boarding house, much to the consternation of
the other lodgers, whose fear o f the disease made them reluctant to
pass through the sick room on their way to their own bedchambers.3
1 For methods of treatment followed by this experienced physician and by others in the
same city, see p. 17.
2 The refusal of hospitals to admit cases of anthrax seems not to be confined to Del­
aware. R. L. Moore, of Elkland, Pa., states: “ In one case which proved fatal the
physician in charge was away, and a long automobile ride was necessary to reach the
nearest hospital. On being refused admission there, the patient was taken on an all-night
trip to the nearest physician who was acquainted with the disease. Although he was
in fair condition, it was too late to save the patient.”
(Journal American Leather
Chemists’ Association, July, 1916, p. 342.)
8
The ghastly appearance of some of the anthrax patients, with heads swollen until
their features practically disappear, is terrifying to their friends and leaves an impression
not quickly forgotten.




34

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

T h is untrained nurse, whose personal dread o f the disease led her to
don gloves and a mask, was o f the greatest assistance to the physician
in bringing back to health these patients, one of whom suffered two
attacks within a year. “ I ran the additional risk of losing m y
boarders and lodgers,” said this woman, “ but the hospitals wouldn’t
take anthrax patients. W h a t else could I do? ”
Conversations with morocco workers’ families brought out the fact
that fear o f this disease was common, and this fact probably in­
fluenced the State board of health in issuing strict orders, which went
into effect A p r il 1, 1915, placing anthrax on the list of infectious
diseases to be quarantined. The quarantine placards, printed by the
State and posted by the city health officials, read as fo llo w s:
This notice must be tacked on the front door.
ANTHRAX.
Until this notice is legally removed all persons
not occupants of these premises are forbidden to
enter, and no person must leave this house or re­
move any article except by permission of the health
authorities.
I t is also required that every house in which a case o f anthrax
has occurred or exists shall be “ completely disinfected” upon the
recovery, death, or removal from such house o f the patient. Q uar­
antine shall be continued for 14 days after disinfection.
A t the work places precautions against infection from materials
handled are not elaborate. A t only one warehouse was a warning
notice found posted. I t was in two languages and read as fo llo w s :
NOTICE TO EMPLOYEES.
Use soap, water, flesh brush, and towels liber­
ally.
Rinse your hands in bucket of disinfectant before
drying on towels.
Give special attention! to finger nails, always
keep them short and clean.
Do not scratch or pick any broken surface of
the skin.
Report to office any form of sickness, cuts, acci­
dents, bruises, pimples, or sores, for immediate at­
tention.
See that dressing rooms, washbasins, and toilets
are kept clean, and report to foreman any violation
of above rules, for your own protection.
Caution all new employees.
Working gloves may be obtained at office.




AN TH RAX AS AN4 OCCUPATIONAL DISEASE.

35

Universal was the testimony that the workers paid little or no
attention to written or verbal warnings except as the foreman or
superintendent with watchful eye detected an abrasion o f the skin
or a suspicious looking “ pim ple ” and personally required the use
o f a disinfectant. I t was commonly stated that in conform ity with
the requirements o f the local health officials a supply o f bichloride
o f mercury was constantly kept in readiness for disinfecting pur­
poses.
A t three o f the warehouses visited, special inquiry was
made for the disinfectant, and in two cases bottles o f bichloride
of mercury tablets were shown at the office, once, however, with the
bottle unopened and thickly covered with dust, while at the third
warehouse the foreman, with some embarrassment and after a per­
functory search, remarked that he believed the tablets had been
borrowed by the factory in the next block. In the same warehouse
there was one sink with a single faucet and one piece o f soap for
the ablutionary convenience o f the workmen, but it was admitted
that no warm water was available even in winter. “ The men all
wear gloves at their work,” said the foreman. Careful inspection
h a lf an hour later, however, disclosed six out of eight skin sorters
and truckers in a near-by corner working with hands unprotected.
“ W e ll, they wear gloves in the winter,” was the forem an’s amend­
ment.
V ery general was the opinion among physicians and laymen that
hides and skins imported from districts where anthrax is prevalent
should be disinfected before they are landed in this country. One
official o f a tannery company, however, complained that the Federal
Government, during the preceding week, had required them to dis­
infect 700 hides, at a cost o f $120, because the hides had come
through without a consular certificate from the country o f ship­
ment to the effect that certain diseases, including anthrax, were not
prevalent at the time.

CASES REPORTED UNDER NEW YORK OCCUPATIONAL DISEASE REPORTING LAW.
The New Y o rk occupational disease reporting la w 1 went into
effect on September 1, 1911, and between that date and M arch 31,
1916, 23 cases o f anthrax, 13 o f which were fatal,2 were reported
to the State department o f labor. N early twice as m any o f the total
number o f cases (15 out o f 23) and three times as many o f the
fatal cases (10 out o f 13) occurred in the last 12 months as during
the entire preceding period o f 43 months since the law became opera­
tive. T h is increase is probably due in part to more active compliance
o f physicians with the law, but as it coincides with large increases in
1 New York, Laws of 1911, ch. 258.
2 For detailed accounts of 12 of these cases which occurred prior to 1916, see pp.
60 to 78.




36

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

the number of cases treated by hospitals in other States, as will
later be shown, there can be little doubt that it is, in the main,
indicative of a real and startling growth in the prevalence o f the
disease. E ig h t o f the cases were reported from New Y o rk City,
including B roo k ly n ; four from Gloversville, the center o f the
Am erican glove in d u stry; four from Endicott, where there are large
tanneries and shoe shops; and one from each o f seven other cities
and towns. Tw enty o f t h e ,patients were males, while three were
females. H a lf o f them were between the ages o f 41 and 6 0 ; the
youngest was a little girl o f 6 ; the oldest a retired lawyer o f 71.
The occupational group most largely represented was the hide,
skin, and leather workers, o f whom there were 10 (4 o f whom
d ied ), including 6 employees o f hide tanneries, 3 workers on sheep­
skins, and 1 shoemaker. T h e shoemaker was employed in a large
factory and m ay have contracted the disease from an infected
hide in which the spores had survived the tanning processes.1 The
workers on sheepskins are described, respectively, as 4 washer o f
4
sheepskins,” 4 trim m ing sheepskins,” and 4 limer and general helper,”
4
4
who had, however, just before infection, been “ helping store away
raw sheepskins.” A m o n g the hide-tannery employees were one beam
hand, two who apparently worked in a freight gang conveying green
hides to one tannery only, two whose exact occupation was not stated,
and— worthy o f special note— one steam fitter. A second occupa­
tional group was the transportation workers, represented b y three
cases (two fa ta l). One was a dock laborer, one a baggage-master on
a dock, and one a driver. There were three farm ers (two o f whom
d ie d ), and one from each o f the follow ing ca llin g s: 4 Laborer in skin
4
m ill— drying sheep wool,” spinner in rug m ill, veterinarian, candy
packer, and la w y er; two were not engaged in industry. There were,
therefore, at least seven persons, and possibly nine, who became in­
fected through the transportation and early treatment o f hides and
skins before actual tanning was begun. The rug-m ill employee had
a pustule on the thumb 4 follow ing scratch from piece o f tin on floor
6
o f spinning ro o m ” ; anthrax bacilli were fcund. T he veterinarian
was infected while vaccinating cows, suffering from anthrax, on three
lip-State farms. One farm er, who died, is believed to have caught the
disease from a sick cow which he slaughtered and dressed for beef.2
i See p. 20.




2 See fatal case No. 78, p. 71.

37

AN TH RAX AS AN OCCUPATIONAL DISEASE.

CASES OF ANTHRAX REPORTED TO THE NEW YORK STATE DEPARTMENT
OF LABOR UNDER THE OCCUPATIONAL DISEASE REPORTING LAW, SEPTEMBER,
1911, TO MARCH, 1916.
September 1912
January
to Decem­
1913
1914
1915 to 1916.
March, Total.
ber, 1911.
Occupation. Cases
re­ cases. Cases cases. Cases Fatal Cases cases. Cases cases. Cases cases. Cases Fatal
re­
re­
re­
re­
re­
re­
port­ Fatal port­ Fatal port­ cases. port­ Fatal port­ Fatal port­ Fatal port­ cases.
ed.
ed.
ed.
ed.
ed.
ed.
ed.

T able 1 .—

Hi de,leather
and skin,
workers......
Tranworkers.
tion sportaFarmers........
Veterinarians
Miscellaneous.
Not in indus­
try.............
Total...

1
1

1
1

2

1

1
1

3

1

1

1

4

1

2
2
2
2
1
2

1

2

1

2
2
1
2
2

9

3
1

4

1
0

4

1

2
2

2

1

3
3
1
4

2

23

3

13

None of the cases is specified as having been internal. Eight of
the lesions were on the face, four on the neck, three on the hand,
two on the arm, two on the chest, two on the hip, one on the leg, and
one not stated. In eight cases anthrax bacilli were actually found,
either in cultures from blood serum or by post-mortem examination
o f the organs, and six of the cases in which bacilli were found resulted
fatally. On two patients antianthrax serum was used; one of these
recovered.1
The result o f applications filed in certain of these cases for indem­
nity under the New Y o rk workmen’s compensation law is taken up on
p. 92.
CASES REPORTED UNDER NEW JERSEY OCCUPATIONAL DISEASE REPORTING LAW.

The law requiring the reporting o f occupational diseases in New
Jersey 2 w^as passed a year later than the New Y o rk statute, the re­
sults o f which have just been described, and went into effect on July 4,
1912. T he State board o f health, to whom reports are to be sent,
states that from that date to M ay 1, 1916, it received 13 certificates
regarding cases of anthrax, all but one o f which arose in the city of
Camden, the seat o f extensive leather, kid, and morocco works. The
remaining patient was a feed merchant in a small town, whose infec­
tion, his physician thinks, may have been “ due to carrying bags o f
feed on shoulder.”
1 In addition to the 23 cases here discussed, reports of human anthrax in New York
State have been obtained from reliable sources, as follow s: 1911— New York City, assorter
and packer of ready-made clothing, aged 30, treated at hospital; recovered. 1915— New
York City, Government weigher handling hides, aged 34, died; New York City, medical
student, aged 25, died; Saratoga Springs, farmer, contracted disease by performing
autopsy on cow, outcome not learned. 1916— New York City, hide handler, employed by
importer, aged 39, treated at hospital, recovered; New York City, fruit company employee,
aged 16, died; Endicott, tannery laborer, handling dry hides, recovered; Utica, cattle
dealer and butcher, outcome not learned. Further details of the two fatalities in 1915
will be found on pp. 75 and 78.
2 New Jersey, Laws of 191.2, ch. 351.




38

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

O n ly one o f the 13 cases was fatal— that o f a receiver and checker
o f Russian horsehides. A ll the patients were men ranging from
21 to 55 years of age; 7, or more than h alf of the total number,
were between the ages o f 21 and 30. Four o f the lesions were on
the neck, two were on the face, and two were on the arm. “ Infected
part resembled a typical vaccination, except black,” says the physi­
cian o f one o f these. In another case the form o f the disease is
stated as external, but the location is not given ; in the remaining
four cases the form is not stated, but since the patients recovered it
was probably external in these also. In only one case is the finding
o f anthrax bacilli reported; 100 c. c. o f antianthrax serum were used,
and recovery followed. Three other patients who recovered were
also treated with serum, one being given 10 c. c. and another “ about
eight injections,” while the third “ had 20 injections o f antianthrax
serum, 200 c. c.”
The occupations are known for nine o f the patients in addition to
the feed merchant, and all but one o f these were in contact with hides
and skins. Three were engaged at the same leather works, one as
a “ checker and receiver o f incoming horsehides” imported from
Russia, one as a “ stock assorter, exam ining hides and skins,” and the
third at “ assorting and handling hides.” O f three men employed
in a single kid shop two are designated only as kid or morocco work­
ers, while one was a wool washer. A patient from another kid plant
handled wet raw skins, while a stationary fireman in still another
factory o f this class contracted the disease after acting for the “ last
few months as sorter o f raw hides from Mexico and Central A m erica.”
The ninth man o f this group was a teamster, and had helped load
trucks with Russian sheepskin. Thus, at least six o f these men were
infected by raw skins during their transportation to and receiving
and sorting at the tanneries.1
CASES REPORTED UNDER PENNSYLVANIA INFECTIOUS DISEASE REPORTING LAW.

In Pennsylvania under the infectious disease reporting law 49
cases o f anthrax were reported in the three years between January 1,
1913, and January 1 ,1 9 1 6 . E igh t o f the sufferers, including two hair
sorters and a tannery hand, were females. Nearly one-half o f the
cases, or 23, occurred in 1913, and 10 o f these were in the city o f
Philadelphia, one of the centers of the glazed-kid industry. A ll o f
the six cases reported in the first h a lf o f 1914 also came from P h ila­
delphia, thus m aking for that city a total o f 16 cases in 18 months.
1
Additional anthrax cases reported to the New Jersey department of health under the
preventable disease notification law (Laws of 1911, ch. 381) are: 1912— Camden, occu­
pation not given, recovered; Camden, handler of imported hides, recovered; place and
occupation not given, recovered; place and occupation not given, died.
1914— Cam­
den, occupation not given, recovered; two cases, place and occupation not given, died.
1915— Two cases, place and occupation not given, died. Record has also been secured
of a tannery worker who recovered under serum treatment at a Newark hospital early
in 1916.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

39

H ere, as in the two States whose experience with anthrax under
occupational disease reporting laws has been described, the occu­
pational group most largely represented is hide and skin workers.
F ive were given as tannery employees, two as leather workers, one as
a raw hide sorter, and one as a skin washer. M ost o f the 12 classed
as laborers were also, it is reported, employed by tanneries. There
were eight hair workers, o f whom one was a haircloth examiner, two
were sorters, and one a brush m aker; a ninth case is given as 4 a car
4
builder who m ight be included as a hair worker.” There were two
longshoremen, and one from each o f the follow ing callings: W o o l
handler, “ raw stock ” inspector (without designation o f the kind o f
stock), liveryman, teamster, merchant, carpenter, and roofer. T w o
were infants 1 year and 10 months old, respectively, the father o f one
being a tanner and of the other a coal miner. In eight cases the
occupation is not stated.
A t least 7 o f the 27 cases reported during the first 18 months
are known to have been fatal, and are discussed more in detail in the
section on anthrax fatalities reported in the United States registra­
tion area. A number o f the nonf atal cases were treated in a Philadel­
phia hospital and are considered, together with other cases at the
same hospital, in the next section.
CASES ON RECORD IN A PHILADELPHIA HOSPITAL.

One Philadelphia contagious-disease hospital reports a total o f 32
cases (6 fatal) from January 1, 1909, to A p r il 30, 1916. The great
m ajority o f the patients in these cases were men, only three— a hair
sorter, a hair twister, and one other hair worker— being w om en; all o f
the six deaths occurred among men. T he patients were all residents
o f Philadelphia. T heir prevailing age was markedly lower than that
o f the cases reported in New Y o rk State, 12 o f them being between
the ages o f 31 and 40, and 10 between 21 and 3 0 ; the youngest was a
woman hair sorter aged 19, and the oldest a haircloth inspector o f 67.
The distribution o f these cases by years and by occupations was as
fo llo w s:

.—CASES OF ANTHRAX RECORDED BY A PHILADELPHIA HOSPITAL, JAN. 1,
1909, TO APR. 30, 1916.
1913
1914
1915 toJan. 1
Apr. 30, Total.
1909 to 1911 1912
1916
Occupation. Cases
Cases Fatal Cases Fatal Cases Fatal Cases Fatal Cases Fatal Cases Fatal
re­
re­
re­
re­
re­
re­
re­
port­ Fatal port­ cases. port­ cases. port­ cases. port­ cases. port­ cases. port­ cases.
ed.
ed.
ed.
ed. cases. ed.
ed.
ed.
Hideworkers 2
1
1 1
0
3 1 1
3
3 1
skin and
Wool and hair 3
2
3 2 17 3
4
5 1
workers...... 1
1
2
Longshoremen
1
2
Miscellaneous. 1
Onotu pation 1
c c reported.
1
4
Total... 8
7 1 6 1 4 1 3
3 32 6
T able

2




40

BU LLETIN OF THE BUREAU OF LABOR STATISTICS.

I t w ill be noticed that the rate o f one case per month with
which 1916 began is nearly double the next highest rate, that for
1912, during which year seven cases were recorded. The increase in
fatal cases is still more striking, as many having occurred in the
first four months o f 1916 as in all the preceding seven years.1
T he largest number o f patients were workers in wool or hair, due
no doubt to the local prominence o f this industry. Seventeen, three
o f whom died, were in this group, which covered a particularly wide
range of processes. Thus there were four hair sorters,2 one wool
sorter, one hair picker, one hair twister, three hair spinners, one wool
teamster, and four laborers in wool or hair plants (duties not differ­
entiated) ; even men comparatively remote from danger contracted
the infection, as witness a haircloth-loom fixer and a haircloth in­
spector. One o f the hair sorters worked in a horsehair fa cto ry ;
the hair picker and at least one o f the hair spinners were employed
in a single curled-hair plant. T he group next most largely repre­
sented is that o f the hide and skin workers, o f whom there were 10
(three o f whom d ied ). One was a hide sorter, one a hide washer,
and one a sorter o f raw stock in a glazed-kid factory, while the
precise process carried on by seven tannery workers is not given.
T w o sufferers from the disease were longshoremen, and in both cases
the hospital records state that fo r some days previous to the attack
the men had been unloading hides. O f the two classified in the table
as “ miscellaneous,” one was a shoddy worker who m ay easily have
contracted anthrax from the dirty rags he h an d led ; the other was a
glue-factory hand who m ay have got it from hoofs or other parts
o f a diseased animal, although the hospital record further states that
he “ occasionally handled leather.” In only one case among this
valuable set o f records is the occupation not stated. Throughout, the
connection between occupation and contagion is much closer than
in the New Y o rk series.
In all o f the cases recorded by this hospital the disease took the
external form . T he pustule occurred in 19 cases on the face and in 10
cases the neck, the six deaths being distributed equally between these
two groups. Three lesions were on the arm, and one on the h an d ;
one case is noted— that o f a girl hair sorter— in which lesions ap­
peared both “ on jaw and wrist.”
Due to the care with which these records were kept, valuable data
regarding the duration o f anthrax attacks are available. The six
cases with the shortest duration— ranging from three to eight days
1 O n Apr. 11, 1916, Chief Medical Inspector Cairns, of Philadelphia, stated that from
10 to 12 cases of anthrax developed in Philadelphia annually and that “ already, in 1916,
four deaths have resulted from the malady.”
2
One of these, who contracted the disease in 1916, filed a claim for compensation,
which was denied on the ground that infection had not taken place through a “ wound or
other unusual incident.” (See p. 92.)




A N TH RAX AS A N OCCUPATIONAL DISEASE.

41

after appearance of the first symptoms—were all fatal, and these
were the only cases which so resulted. The next shortest case termi­
nated in recovery and discharge from the hospital on the seventeenth
day o f the disease. The most protracted illness lasted for 51 days.
The duration o f illness and number o f cases of death were as follow s:
T a b l e 3 . — D U R A T IO N

OF IL L N E S S , A N D D E A T H S A M ON G 32 CASES OF A N T H R A X IN
A P H IL A D E L P H IA H O S P IT A L .

Duration of illness.
Under 1 w eek..................................................
1 week and under 2 weeks..........................
2 and under 3 weeks....................................
3 and under 4 weeks....................................
4 and under 5 weeks......................................
5 and under 6 weeks......................

6 and under 7 weeks.................................
Over 7 weeks.................................................
T otal......................................

Cases.

Deaths.

5

5
1

1

5
8
4
5
3
1

32

6

In the overwhelming majority of cases, 22 out of 32, treatment
was by excision and serum; of these, three died. In five cases ex­
cision alone was performed, and two deaths resulted. One man was
brought to the hospital moribund and neither method was applied;
he died eight hours later. In four cases the mode of treatment was
not reported.1
CASES ON RECORD IN A MASSACHUSETTS HOSPITAL.

The records of one Massachusetts hospital show 35 cases of an­
thrax between June 27, 1881, and April 26, 1916. O f these 6 were
fatal, 26 were nonfatal, and 3 patients were still in the wards at
the time of the investigation. The recent increase in prevalence
revealed by the New York and Pennsylvania reporting laws is
here paralleled. The number admitted during the first three months
and 26 days of 1916 (9 out of the 35) is thrice that admitted
in 1915, and equals the number treated during the whole period
1881-1904, inclusive.2 The largest number of cases from single cities
came from Boston (5), Woburn (5), and Winchester (4) ; five other
towns in the vicinity of Boston sent 2 cases each, and 11 towns 1
case each. Only 1 of the 35 patients was a woman. Fifteen were
1 The numerous instances of death from anthrax in Philadelphia was one of the rea­
sons given for the establishment during the summer of 1916 of the clinic for occupational
diseases at the University of Pennsylvania Hospital in that city.
2 The total number of cases reported in the State during the first half of 1916 was
25. “ This was the severest outbreak of this disease ever recorded in Massachusetts.”
Twenty oi: the cases occurred in three tanneries and were traced to* a common source,
a single cargo of dried “ China ” hides from infected territory.
(United States Public
Health Reports, Dec. 15, 1916, p. 3401.)




42

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

between the ages of 21 and 30, 15 were between 31 and 5U, 2 were
between 61 and 70, and the remaining 3 were between 11 and 20
years of age.
Hide and skin workers made up nearly half of the total number
o f patients— 16 out of 35. Thirteen o f these were tannery workers,
one was a morocco worker, one a leather worker, and one a “ laborer
handling raw hides.” The “ leather worker ” was in charge of men
cutting fresh hides. O f the tannery employees two were “ beamers,”
who scraped hides and put them through rollers; two split hides; two
others took hides from the soaking pits; three of these six were re­
ported as handling wet hides. One man handled hides as a teamster
for a tannery, one was a flesher, one is designated merely as “ la­
borer” in a tannery; one was engaged on sheep and goat skins; in
the three remaining cases no information was given beyond the
word “ tanner.”
Transportation workers were represented by nine cases, two fatal.
Four were dock laborers; two were freight handlers, one o f whom
handled raw hides and w ool; two were weighers of skins and hides;
and one was a teamster. Five patients were employed in the wool
and hair industry. Two were employed in a wool factory, one of
them as a carder; in the other case the infection was so serious that
it necessitated amputation of the arm at the shoulder. One was
an upholsterer’s helper and handled wool used for stuffing. Two
days before coming to the hospital he cut his neck while shaving;
infection developed on neck and chest, and four days later “ patient
looked as if he weighed over 200 pounds.” One was a teamster cart­
ing wool, and one was employed in a hair factory.
In addition to these workers, whose employment bears a welldefined relation to the disease, two patients were designated merely
as laborers. One o f these, however, was employed in a soap factory.
Three weeks before he was admitted to the hospital, it is reported,
a box of skins was sent by mistake to the factory, where it was
opened and a skin was kicked about by a fellow workman, striking
the patient in the back of the neck. E-ag workers, factory girls, and
machinists were also represented by one case, each.




43

AN TH RAX AS AN OCCUPATIONAL DISEASE.
T a b l e 4 . — CASES

O F A N T H R A X A D M IT T E D TO A M A SSA CH U SETTS H O S P IT A L , JU NE 27,
1881, TO A P R . 26, 1916, B Y O C C U P A T IO N S.

June 27,1881,
to Dec. 31,
1911

1912

1913

1914

Jan. 1 to
Apr. 26,
1916

1915

Total.

Occupation.
Cases
Cases
Cases
Cases
Cases
Cases
Cases
re­ Fatal re­ Fatal re­ Fatal re­ Fatal re­ Fatal re­ Fatal re­ Fatal
port­ cases. port­ cases. port­ cases. port­ cases. port­ cases. port­ cases. port­ cases.
ed.
ed.
ed.
ed.
ed.
ed.
ed.
H ide and skin
workers
W ool and hair
workers........
T ra n sp orta ­
tion workers
Miscellaneous.
T otal.

5

2

3

1

4
5

1
2

17

4

2

1

7

10

2

1

1

5
1

2
3

1

1

3

1

2
1

1
5

9

2
2

9

1

35

6

The duration of illness was short in the 6 fatal cases. One such
case lasted 3 days and another 5 days; 3 patients died after an illness
o f 7 days each and 1 after 8 days. The shortest of the nonfatal cases
lasted 10 days; in another the patient was ill 13 days; 6 lasted be­
tween 14 and 21 days; in 9*cases the duration was 21 days but under
28; 8 persons were ill 28 days or more. O f those remaining, 1 was
an out-patient and 3 were still in the hospital wards at the time
of investigation.
The situation of the pustule is given in all but one fatal case,
which, according to the symptoms, was probably internal. In a
majority o f cases (20 out of 35) the lesion was on the neck, 9 lesions
were on the face, and 5 were on the arm or hand. In 18 of the total
number of cases and in 5 of the 6 which ended fatally, examination
disclosed anthrax bacilli.1
CASES REPORTED BY TANN ERS AND LEATH ER M ANUFACTURERS.

In the course of preparing this report the Bureau of Labor Sta­
tistics sent about 1,400 circular letters in regard to anthrax to tanners
and leather manufacturers. To these, 592 replies were received.
Nineteen establishments reported 70 cases of anthrax within the
last two or three years, 6 of these cases being fatal.2
While these cases probably duplicate to some extent the cases else­
where discussed in the report, it is convenient to present them to­
gether.
1 For additional records of Massachusetts cases, see pp. 26, 27, 28, and 89-91.
2 At the same time, 1,600 similar inquiries were sent to wool dealers and wool manufac­

turers, but elicited a report of only one case, that of a Boston laborer trucking wool, who
recovered under hospital treatment.




44
T

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

able

5 .— A N T H R A X

Location.

Maine:
Island F a lls. .
Massachusetts:
North W oburn.

N orw ood .
W ob u rn ..

Michigan:
C heboygan.

CASES R E P O R T E D B Y N IN E T E E N T A N N IN G
M A N U F A C T U R IN G E S T A B L IS H M E N T S .

Firm.

Occupation
of victim .

Treatment.

Result.

No. 1 ..

Sweater in
tannery.

A t hom e—local p h y ­
sician.

Full recov­
ery.

Tanner......... A t Massachusetts Gen­ ........d o ...........
eral Hospital.
Flesher......... A t h om e........................
.d o .
.d o .
Beam-house A t Massachusetts Gen­
hand.
eral Hospital.
N o. 3 .. N o informa­ Local physician........... ........d o ...........
tion.
No. 4 .. Beamster___ A t Massachusetts Gen­ R ecovery e x ­
eral Hospital.
pected.
No. 5 .. 2 cases; oc­ ____d o ............................. Full recov­
ery.
cupations
not given.
. . d o .........
1 case........... A t h om e........................
No. 6 .. 5 cases; oc­ Some b y local p h y ­
. .d o .........
sicians, and others
cupations
not given.
at hospitals.
No. 2 ..

No. 7 .. 3 -yea r - old
d a u g h ter
o
beamhouse em ­
ployee.
Beam ster. . .

Antianthrax serum; ........d o .........
tincture iodine in­
jected hypoderm ic­
ally around area of
infection.
Antianthrax
serum Full recov­
and early excision of
ery
(32
prim ary lesion.
days).
Sores washed w ith car­ Full recov­
bolic acid and io­
ery.
dine; face and neck
washed with iodine,
vitriol ? and cam ­
phor oil; gauze pack
saturated with boric
acid and epsom salts
(hot water) applied
to face for 5 days;
ice-cold baths when
fever over 103°.

Munising.

No. 8.

B eam ster. . .

N ew Hampshire:
W hitefield___

N o. 9 ..

-----d o .......... Hospital treatm ent_ ........d o .
_
___ d o ......... . ____d o .............................
..d o .
___ d o ......... .
..d o .

New Jersey:
Cam den.

N o. 10. ........d o .........

R aw - stock
d ep a rt­
ment; dry
horsehides
.d o .

.d o.

Newark.

A t hom e, b y com pany
physician.
Diagnosed as anthrax
too late to be treated
for same.

Fatal.

Antianthrax serum; in­ Full recov­
jecting 20 c. c. every
e r y ^ weeks
4 to 6 hours; high fre­
4 days).
quency electricity
and fulguration used
over primary lesion;
lachisis used inter­
nally.

LEATH ER

Precautions now taken.

None.
H ave discontinued use
o f China hides.

N o information.
D aily exam ination of
all em ployees.
Use solution recom ­
m ended b y State in­
spectors; stoppedtanning dry China hides.
Carbolacitin used as
wash b y m en, and in
soak pits.
China hides put into
corrosive sublimate
solution; employees
wear wet sponges
over m outh and nos­
trils when unloading
these hides.
Carbolic-acid wash kept
on hand for use on
cuts, etc.

Disinfect hides in solu­
tion of bichloride of
m ercury and com ­
mon salt.
Antianthrax
serum;
solution of bichloride
of m ercury on hand
for use b y employees.
Breaks in skin of em­
ployees in raw-stock
department cauter­
ized b y factory d o c­
tor.

.d o.

Full recov­
ery (5 weeks
2 days).
Antianthrax serum ___ N o informa­
tion.

No. 12. 3 or 4 cases in
raw - skin
d ep a rt­
ment or in
beam house.
No. 13 B e a m s t e r A t Newark City Hos­
engaged in
pital.
trim ming
hides.




........d o ____

AND

Full recov­
ery.

Doctor in attendance
every m orning for
treatment of minor
accidents.

Rubber gloves.

45

ANTHRAX AS AN OCCUPATIONAL DISEASE.
T a b le 5.—A N T H R A X

CASES REPO RTE D B Y NINETEEN"* TANNING AND L E A T H E R ,
MANUFACTURING ESTABLISHMENTS—Concluded.

Location.

Firm.

Occupation
of victim.

New Y ork:
Endicott.........

Treatment.

No. 14. U nloadin g At Johnson City Hos­
hides.
pital.
Repairman.. At Mead's Hospital,
Endicott, N .Y .
H a n d l i n g .......do...........................
hides.
Beamster_ .......do...........................
_
U nloadin g .......do...........................
hides.
Gloversville. . . No. 15. Beamster___ At home......................

Pennsylvania:
Corry...............

Result.

Fatal
Full recov­
ery.
.......d o ..........
....... d o..........
....... d o..........

Precautions now taken

Hides whitewashed at
shipping point; bales
c o n t a i n in g hides
whitewashed; hides
soaked in solution of
mercury at tannery.

.......d o.......... Gloves to employees in
beam house.
No. 16. Raw - skin ___ d o ........................... ....... d o .......... Raw material naphthalened; solution of
trimmer.
weak lime liquor for
Bagging hair .. ..d o .......................... Fatal...........
washing hands.
from raw
material.

No. 17. 2 cases; occu­
pation not
given.
Elkland........... No. 18. H a n d lin g
hides in
beam
house.
....... d o ..........
Various tanneries.. No. 19. 27 cases; occ u p ation
not given.
3 cases; occ u p ation
not given.

At hospitals................. Full recov­
ery.

Antiseptic solution for
washing hands.

At home...................... ....... d o .......... Antianthrax serum on
hand.
....... d o .......................... ....... d o ..........
Not given.................... ....... d o .......... Immediate care of all
wounds; inquiry as
to cause of illness if
d o ______________ Fatal_______
absent.

O f the 70 cases here reported, in 41, or more than half, no infor­
mation as to occupation is given. O f the remaining 29 victims, the
majority (16) were beamsters or beam-house workers, while only 6
are reported to have been working on dry hides. This is apparently
a reversal of the ordinary tannery situation, but may be partially
accounted for by the unusually large proportion of cases in which
the occupation is not given. Other workers affected were a sweater,
a flesher, a raw-skin trimmer, one engaged in bagging hair from raw
material, and a repair man. Particularly striking is the case of the
3-year old daughter of a beam-house employee, to whom the bacillus
was probably carried on her father’s clothing.
Information with regard to sanitary precautions, given by the 19
tanneries and leather plants which reported cases, is unusually full.
Prophylactic measures ranged from the mere furnishing of a disin­
fecting wash for the men to daily examination of all employees and
even discontinuance of the use of the more dangerous materials. In
addition to these 19 plants, 54 which reported no cases indicated
that they took precautions as follow s:
Instruction to employees of danger__________________________
Immediate treatment of wounds_____________________________
Furnishing of gloves______,___________________________________




10
21
23

46

BULLETIN OF THE BUREAU OF LABOB STATISTICS.

Furnishing of respirators.
Employ physician
Employ nurse
Disinfect hides before handling.

2
1
2
16

During the summer of 1916 the National Tanners’ Association
took up the question of more thoroughly disinfecting their plants
to guard against contagion from imported hides. Upon applying
to the Bureau of Animal Industry for suggestions as to how to
proceed with the work, the tannery owners were advised that “ next
to fire, bichloride of mercury appears to be the most efficient agent
in the sterilization of the anthrax spore.” The bureau therefore
recommended that all parts of the premises be thoroughly sprayed
with a 1 to 1,000 bichloride of mercury solution, then scraped and
swept (the debris being carefully burned), next scrubbed with the
same solution, and finally given another spraying with it, which
should be allowed to dry in. Special warning was issued against
continuous wetting of the hands or clothes with the solution, in
order to avoid mercurial poisoning.2
FATAL CASES REPORTED IN REGISTRATION AREA OF THE UNITED STATES,
1910 TO 1915.

During the six years from January 1, 1910, to December 31, 1915,
no fewer than 132 deaths from anthrax were officially reported in
the United States registration area, which covers less than two-thirds
of the total population of the country.8 Were comparable informa­
tion available for the entire country there is no doubt that this total
would be considerably augmented. In Texas, for instance, during
the years 1912 to 1915 there were reported to the State board of
health four deaths, none of which appears in the United States list
1 Of the 742 w ool dealers or w ool m anufacturers who replied to the circular letters
previously mentioned, the replies o f eight indicated that precautions were taken to prevent
anthrax. T w o establishments reported cautioning their employees to give immediate treat­
ment to cuts and scratches, besides using exhaust fans to carry off the d u s t ; one m ill
posted notices w arning employees not to neglect w o u n d s; fou r concerns used exhaust f a n s ;
and one m anufacturer o f w ool yarns stated that he disinfected hides before handling.
2 F or fu ll text o f the bureau’s com m unication, see Journal o f the Am erican Leather
Chemists’ A ssociation, September, 1916, pp. 510, 511.
3 The registration area in 1913 included 24 States— California, Colorado, Connecticut,
Indiana, Kentucky, Maine, M aryland, M assachusetts, M ichigan, M innesota, M ississippi,
M ontana, New, Hampshire, New Jersey, New York, North Carolina (cities which had
1,000 or more inhabitants in 19 00), Ohio, Pennsylvania, Rhode Island, Utah, Vermont,
Virginia, W ashington, and W is co n sin ; and 41 additional cities— Birmingham , Mobile,
and M ontgomery, A l a .; W ilm ington, D e l.; Jacksonville, Key W est, and Pensacola, F la .;
A tlanta, Augusta, and Savannah, G a .; A urora, Belleville, Chicago, Decatur, Evanston,
Jacksonville, Quincy, and Springfield, 111.; A tchison, Coffeyville, F ort Scott, Hutchinson,
Independence, Kansas City, Lawrence, Leavenworth, Parsons, Pittsburg, Topeka, and
W itchita, K a n s .; New Orleans, L a .; L incoln and Omaha, N eb r.; Portland, Oreg. ; Charles­
ton, S. C . ; Memphis and Nashville, T e n n .; E l Paso, Galveston, and San Antonio, T e x .;
and W heeling, W. Va. The population covered at that date was 63,298,718, or 65.1 per
cent o f the total.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

47

o f 132, presumably because they occurred in outlying districts not in­
cluded in the registration area. Although 12 Kansas cities are so
included, a farmer reported to the State board of health as having
died o f anthrax in 1915 is not among the cases known to the Census
Bureau. Similarly a certificate of death from the pulmonary form of
the disease filed with the Iowa health department did not get into the
Federal statistics because Iowa is entirely outside the registration
area. Since the close of 1915, also, at least 23 deaths from anthrax
are already known to have occurred.1 In 15 out of the 23 cases
the probable source o f the disease can be traced through the occupa­
tion or other facts given. Six of the persons worked with skins,
hides, or hair, two handled cargoes, and one was a teamster in a
seaport town where infected materials are known to have been re­
ceived. Three were farmers, one a “ sheepman,” and the death
certificate of one, having no occupation, stated that she was infected
from a sick cow. A Kansas child was apparently infected by a cat
which, it is reported, had the disease. In the absence of specific
information as to occupation or surroundings, the cause of the dis­
ease can not be traced in the cases o f five “ laborers,” a “ foreman
in mill,” a “ housewife,” and a boy without stated occupation.
This information is, however, scattering and incomplete, and while
several o f these cases are discussed, as indicated, in the sections
o f this report dealing with their respective localities, it has been
thought best to confine this section of the study to those fatalities
officially reported to the United States Bureau of the Census for the
six years specified.
Distribution by Industry, Place of Death, Etc.

O f the 132 persons reported as dying of anthrax during this sixyear period, 27 were designated on the official death certificates
merely as “ laborers,” a very unsatisfactory classification; 6 others
were designated as “ laborer, clay,” “ laborer, paper mill,” “ laborer
in tannery,” “ laborer, morocco works,” “ laborer, freight yard,” and
“ laborer, longshore ” ; 12 as housewives or housekeepers; 9 as farm­
ers; 7 as morocco workers; 3 as stevedores or longshoremen; 2 as
liverymen; 2 as barbers; 2 as carpenters; 2 as tailors; 2 as young
single women “ at home,” and 2 as “ at school.” The following desig­
nations occur once each: Handling dry hides, paper-mill hand, tan­
nery worker, leather worker, stationary engineer in morocco works,
mixing hair, hair-cloth maker, bristle comber, mill hand in carpet
factory, freight agent, freight handler, weigher, ranch foreman,
farm hand, veterinary surgeon, hairdresser, merchant, baker, cake
baker, candy packer, cigar maker, retired cigar maker, chair maker,
painter, molder, printer, mechanic, foreman, electrical supply sales­
1 See footnote, p 55.

42806°—-Bull. 205— 17------ 4.




48

BULLETIN O F THE BUREAU OF LABOR STATISTICS.

man, domestic, retired pilot, retired farmer, musician, lawyer, drug­
gist, physician, medical student, and undertaker. Eight of the de­
ceased were reported to have had no occupation, and in 10 cases no
information on this point was given. Other data on the certificates,
however, show that of these last 18 persons, one was a little girl
aged 6 and five were infants of 1 year or younger.
In a few cases in which the statement o f occupation given on the
official death blank did not agree with more precise information
subsequently obtained from other sources the real occupation was
without significance as regards causation of the disease. Thus one
woman who was reported as a cigar maker had left the bench at the
time o f her marriage, 30 years before she died. One woman who
was stated to have no occupation was acting as a housekeeper and
nurse, and another was a teacher. A man reported as a lawyer had
retired and had no active occupation except caring for his own
country home.
On the other hand, in other cases investigation brought out occu­
pational information o f great significance. Thus, the man reported
as a weigher w as employed by the Federal Government in the cus­
T
toms service and had been weighing hides and skins from South
America. The one reported as freight handler worked on the
wharves and was really a longshoreman. The man reported as a
carpenter was employed around a tannery. The man reported as a
molder was not engaged at his trade, but for six months previous to
death had been a limer and general helper in a leather factory. The
man reported as an undertaker had given up his business to become
an employee in a tannery establishment, where he checked and
received imported horsehides. One young woman who was reported
as staying at home helped on her father’s dairy farm ; two more,
designated as housewives, are believed to have contracted the disease
from a sheep and from a cow, respectively, which had died of anthrax
a few days before; a boy whose occupation was not stated did chores
about home; so that all four o f these persons may appropriately be
classed as farmers. Moreover, of the 30 reported as “ laborers,” it
was found that 6 were tannery employees, 4 were farm or ranch hands,
4 were longshoremen, 1 was a freight handler, 1 a woolsorter, 1 a
curled-hair worker, 1 a driver who had been unloading hides from
a vessel, 1 a worker in a morocco factory, and 1 a paper-mill employee.
In brief, then, although in about 50 cases the connection between
occupation and disease is obscure or nonexistent, 77, or a majority of
the persons under consideration, were in occupations where the
menace o f anthrax is well recognized. Twenty-three were hide and
skin workers or were otherwise employed about tanneries, 21 were
farmers, ranchmen, or women living on farms, 13 were transporta­




AN TH RAX AS AN OCCUPATIONAL DISEASE.

49

tion workers, 6 worked with wool, hair, or bristles, 2 were rag han­
dlers in paper mills, 2 were liverymen, 1 was a veterinarian, and 9
were laborers, probably in one or another of the foregoing branches
o f industry.
T anning.— T he largest single occupational group among the 132
recorded persons who succumbed to anthrax in the United States
registration area during the six years 1910 to 1915 is composed of
tannery employees, o f whom there were 23.
While the available information is too fragmentary to permit a
positive statement, there is strong reason for believing that most
o f these 23 workmen were engaged not in the late but in the earliest
tannery processes. Thus No. 105, one of the cases given in detail
on pages 60 to 78, was unloading at the factory dry South American
and Chinese hides. Another (No. 80) was a checker and receiver,
and dealt with Russian horse hides. A third (No. 35) had been
employed for two years as an assorter of hides. Only with the next
man (No. 58), who was a limer and general helper, do we come
to an actual tanning process, and even he, at the time of his infection,
had been helping store away raw sheepskins. A fifth (No. 87) was a
skin washer, while a sixth (No. 50) was a “ lumper ” in the coloring
room o f a morocco and calfskin tannery. This last operation, which
occurs well along in the tanning process, is the latest one mentioned
in any of these cases. Special note should be made of the circum­
stances that one tannery employee (No. 1) who died was a carpenter
and that another (No. 54) was a stationary engineer.1 The remaining
15 tannery employees (Nos. 2, 3, 5,10, 20, 41, 49, 69, 74, 93, 94, 97,103,
126 and 128) are described merely as “ laborer in tannery,” “ morocco
worker,” or by some similar indefinite term; but, judging from the
experience in the groups of local cases previously examined,2 it
is reasonable to believe that many of these were porters, warehouse­
men, and the like, who handled the hides in the earliest stages, be­
fore actual tanning had begun. Fourteen of the total number here
grouped as working at “ tanning” are described as employed in
tanneries or leather factories (i. e., establishments curing cow, horse,
and similar large hides), while nine are described as employed in
morocco works, where goat, sheep, and other light skins are tanned.
F arming and R anching .—T wenty-one of the 132 fatal cases of
anthrax under discussion occurred among farmers, ranchmen, or
others engaged in similar pursuits. In half o f the cases (Nos.* 8, 18,
22, 48, 70, 71, 75, 104, 124, and 132) the source of infection remains
unknown. One young woman (No. 120) in this group, however,
assisted her father on his dairy farm. A boy of 16 (No. 65) helped
%
___________________________________________________ _____
1 F or the case o f a steam fitter who contracted the disease in a tannery, see p. 36.
2 See pp. 32 and 43.




50

BU LLETIN OF THE BUREAU OF LABOR STATISTICS.

care for his father’s cow and horse. A California farm laborer
(No. 99) at the time o f his attack handled cattle and cattle hides of
local origin. A California woman (No. 33) who lived on a farm 16
miles from town is believed to have been infected indirectly from a
dead sheep. In the case of another California housewife (No. 84),
evidently the wife of a farmer, and in that of a Vermont farm hand
(No. 24), the contagion was traced directly to sick cows, one of
which died. Three men, in Louisiana, Kansas, and Pennsylvania,
respectively (Nos. 26, 15, and 12), were infected by skinning cattle
which had died of the disease. A Wisconsin farmer (No. 83) opened
a cow to ascertain the cause o f its death, and even dissected the
characteristic black spots he found in its abdomen. Particularly
striking is the story o f a New York farmer (No. 78) who, according
to the physician, “ was in the habit of buying up old and poorly
nourished cattle, butchering them, and selling them where he could.”
While awaiting trial on charges o f selling tuberculous meat this man
apparently slaughtered for sale an animal suffering from anthrax,
and died as a result. The possibility of acquiring the disease by
eating the meat of anthrax-infected animals seems to be well recog­
nized.1
L ongshore W ork.— A t least 9 of the 13 transportation workers re­
ported as dying from anthrax were longshoremen at the ports of
Boston (Nos. 43, 76, 108, 110, and .127), Philadelphia (Nos. 56, 82,
and 89), and New York (No. 131). Probably the Boston 6 freight
4
handler ” (No. 4) and the New York “ laborer and driver” (No. 116),
elsewhere discussed, also belong in this group. Six o f the nine men
unloaded hides, specified in one instance as coming from South
America and from “ America ” ; one unloaded hides and w ool; one
hair from China; and the nature and source of the materials handled
by the other are not stated. The death-bearing hides in two cases
are known to have been dry. These hides arrive sometimes in large
burlap-wrapped bales, sometimes loose. In either case the labor of
fastening tackle upon them, hauling them from the hold, and lugging
them onto the pier offers manifold opportunities for abrasions and
scratches o f the skin, which readily become infected by the spore­
laden hides or the dust therefrom. (See cut facing this page.) Five
of the lesions in this group appeared on the face, three on the
neck, and the position o f one is not given. In one of these cases
application for indemnity was made under the Massachusetts work1 T hat the business methods o f this man are not unprecedented is shown by the state­
ment o f R avenal that he had “ known an animal in the last stages o f anthrax to be
slaughtered and dressed fo r market by a th rifty farm er who saw his cow about to die
and wished to avoid loss. E xam ination o f the blood o f this animal proved it to be
swarm ing w ith anthrax.”
(A rticle on A nthrax in M odern M edicine, 1907, Vol. I l l ,
pp. 4 2 -5 1 .)







PLATE

6.— U N L O A D I N G

A CARGO OF HIDES

FROM

SOUTH

AMERICA.




PLATE

7.— W E I G H I N G

DRIED CATTLE H ID E S I M P O R T E D F R O M

SOUTH

AMERICA.

A N TH RAX AS A N OCCUPATIONAL DISEASE.

51

men’s compensation law, but was denied on the ground that the infec­
tion occurred while the workman wa's in the employ o f a -steamship
line other than the one named in the application.1
C ustoms W eighing.— A case (No. I l l ) which brought into
striking relief the inadequacies of the Federal Employees’ Compensa­
tion Act o f May 30, 1908, was that of a Government weigher in the
customs service. This man’s duties included tearing open the bales
of hides, examining their contents, and weighing them. (See cut
facing this page.) Just before falling ill he had worked on hides and
skins from South America. His widow, though left with three
small children, was unable to secure indemnity from the United
States Government because customs weighers were not covered by
the act.
T ruck D riving.—A nother transportation worker (No. 116) whose
attack o f anthrax proved fatal is reported as laborer and driver;
he had, however, for the week preceding illness, been “ unloading
hides from a vessel,” so that, as previously stated, he probably be­
longs among the longshoremen. In his case the anthrax papule
appeared on the chest.
F reight H andling.— T he two remaining fatal cases occurring in
transportation work were those of freight men— one designated as
an agent and the other as a handler (Nos. 61 and 4, respectively),
The latter, however, was most likely a Boston longshoreman. His
infection was on the right arm. The freight agent worked in a
small Pennsylvania town, but nevertheless contracted anthrax from
handling foreign hides.
H air W orking and W eaving.— F our of those who died of anthrax
were engaged in different processes of hair working and hair weav­
ing. One (No. 55) had been employed for only eight months as
a laborer in a curled-hair factory using large quantities of imported
material. Another (No. 17) mixed animal hair in machines, pre­
paratory to spinning; a third (No. 63) was a haircloth maker and
was taken fatally ill after working over a bale of Siberian hair;
and the fourth of this group (No. 106) was employed in a carpet
factory where the coarser grades of hair are woven.
W oolsorting.— One man (No. 7) who succumbed to anthrax came
in contact with raw American sheep wool, and according to the
physician’s statement, was probably a woolsorter. In this work the
bales o f wool are first placed on racks over steam pipes, which heat
the wool and soften the natural grease it contains so that the fleeces
can easily be opened out. The workbench has a top of wire screen,
through which the dirt and impurities drop, and within easy reach




1 See pp. 89 and 91.

52

BU LLETIN OF THE BUREAU OF LABOR STATISTICS.

are a number of baskets or crates, one for each grade of wool which
is to be separated. (See cut facing p. 53.) Usually the only tool is
a pair of woolsorter’s scissors, for clipping off tar and other matter
which may be found adhering to the fleece. The whole process is
very simple, but gives rise to large quantities o f dust, the fine parti­
cles o f which form convenient vehicles for the anthrax spores.
B ristle C ombing.— One fatal case (No. 38) was that of a man
employed as a bristle comber and hair dyer. The materials he
worked with came from Siberia.
P aper M aking .—T wo of those who died with anthrax symptoms
handled rags in paper mills. One (No. 11) unloaded baled rags
from cars, and trucked them into the storage sheds and to the cutting
rooms, where the rag cutters would open the bales and feed the rags
into the cutting machines. The other (No. 14) was engaged as a
bleach boy in the rag room. Both workers handled large quantities
of imported rags from such countries as England, Ireland, Germany,
France, Italy, and Spain.
L iverymen.—T wo of the deaths (Nos. 67 and 95) were among
liverymen. The former had a pustule on the lower lip, which at his
request was opened with a penknife by a relative. The penknife,
however, had previously been used by the patient to incise what he
considered an “ abscess ” on one of his horses, so that the physician
is not certain whether the case was anthrax from the start or whether
inoculation occurred through the knife. The knife had disappeared
and could not be examined for anthrax bacilli.
V eterinary S urgery.— One of the most interesting cases of fatal
anthrax (No. 47), from the clinical point of view, which was disclosed
in this study was that of a veterinary surgeon. Some 12 days be­
fore becoming alarmed over his condition he had performed an
autopsy on some cows, in the course of which he scratched his fore­
finger. He cauterized the scratch and nothing developed there, but
he probably scratched himself at the same time on the other wrist, for
a week later there developed in that location the pustule which
caused his death.
B arbers and H airdressers.— T wo of the 132 persons dying of
anthrax (Nos. 21 and 77) were barbers and one (No. 40) was a hair­
dresser. A ll were men. In none of these cases were details ob­
tainable, but a possible source of infection is indicated by the evidence
presented on page 23 regarding infection through shaving brushes.
Early in March, 1916, also, the New York city bureau of public
health education received a communication from Dr. A. K. Chalmers,
health officer o f Glasgow, Scotland, stating that two shipments of
London-made shaving brushes had been received in Glasgow and
that each brush had been found to contain anthrax germs. The New







PLATE

8.— A

“ D R U M ” IN W H I C H

S K I N S A R E C H U R N E D , IN O R D E R T O S O F T E N

AND

REMOVE WASTE

MATTER.




PLATE

9.— W O O L

SORTING.

In wool manuf ac t ur i ng centers occupational ant hr ax is c o m m o n l y known as “ wool sor t er s ’ di sease. '

AN TH RAX AS AN OCCUPATIONAL DISEASE.

53

York health department thereupon announced that all future im­
portations o f shaving brushes would be thoroughly examined for the
presence o f the germs.
“ L aborers.”—I n nine fatal cases the occupation of the deceased
workman is obscured under the vague designation “ laborer.” Two
o f these deaths (Nos. 101 and 102) occurred within two and one-half
weeks of each other in Pennsylvania tannery towns, a third (No. 29)
occurred in a Massachusetts city with large shoe works as well as tan­
neries; and a fourth (No. 34) took place in Philadelphia, where in
both hair works and tanneries the risk o f occupational anthrax is
great. In these cases wnat the victims worked at can be surmised
with approximate accuracy, but in the remaining five cases (Nos. 25,
31, 42, 91, and 109) there is no clue whatever. From the standpoint
both o f accurate morbidity statistics and of efficient prevention of
occupational disease, such loose reporting should be discouraged. .
M usician.— One man (No. 30) was a traveling musician, and at
the time o f his death is believed to have been with a circus. As he
was fond o f horses it is suggested that he may have contracted the
disease from one of the circus animals.
H ousekeeping.— F ourteen of the fatalities reported as from
anthrax occurred among women who were acting as housewives (Nos.
6, 9, 39, 53, 57, 68, 85, 96, and 119), housekeepers (Nos. 28 and 52),
housekeepers and nurses (No. 66), domestics (No. 62), or (No. 92)
simply living “ at home ” with no definite occupation. In no case is
the source o f infection indicated.
I nfants.— F ive o f the reported victims of anthrax were infants
1 year old or less. In three of these cases (Nos. 16, 73, and 88) the
mode o f infection is unknown. A girl baby of 4 months (No. 64)
was struck on the mouth with a fly swatter in the hands of an older
child who was tending her, breaking the skin and perhaps intro­
ducing the fatal bacillus or spore from a fly which had previously
been killed with the implement. The physician^ history in the
remaining case (No. 98) is most convincing. This little boy, aged 1,
lived on a farm. He was scratched on the leg by the teeth o f a pet
dog with which he was playing. The dog had been feeding on the
unburied carcass of a calf that had died of anthrax. A pure culture
o f anthrax was taken from the child’s leg.
No O ccupation.— Of the eight persons who, according to the
official death blanks, had no occupation, six are elsewhere considered.
The seventh (No. 32) was a man of 38, and the last (No. 79) a girl
o f 14. In none o f these cases could additional information o f
importance be secured.
O ccupation N ot S tated.—I n seven cases the occupation was not
stated on the official death certificates and could not be determined




54

B U LLETIN OF TH E BUREAU OF LABOR STATISTICS.

from other sources. Three of these (Nos. 81, 86, and 117) were men,
aged 52, 54, and 52 years, respectively. One (No. 107) was a girl
6 years old, the discharges from whose nose, contained a bacillus
“ having all the characteristics of the bacillus anthracis.” The other
three were women. One (No. 113) was on a visit to New York
when she pricked a pimple on her lip with a needle. The records
for the remaining two (Nos. 13 and 37) are brief and afford no clue
to the cause o f the disease.
M iscellaneous Cases, O ccupation N ot S ignificant.— T here re­
main 23 recorded victims of fatal anthrax attacks whose occupations,
as given by the official death certificates, checked up from other
sources, bear no visible relation to the disease and are too scattered
to be considered in groups. The cause of infection in a few o f these
cases has been roughly surmised. A tailor (No. 90) and a young
woman school-teacher (No. 44) are believed by their physicians to
have been infected by insect bites. Two girls, one (No. 115) a postoffice clerk, and the other (No. 121) a candy packer, are supposed by
some physicians to have contracted the disease from fur neck pieces,
but this theory is opposed by medical men of high standing. In the
19 cases still remaining no explanation for the onset of the disease
has been offered.
P lace and D ate of D eath .—J ust half o f the total number of
deaths, or 66 in all, occurred in the three States of Pennsylvania,
New York, and Massachusetts. The distribution by States in detail
was— Pennsylvania, 31; New York, 23; Massachusetts, 12; California
and Ohio, 9 each; Connecticut, 8; Delaware, 7; Louisiana, Minne­
sota, and New Jersey, 4 each; Indiana and Kentucky, 3 each; Colo­
rado, Missouri, Wisconsin, Virginia, and Maine, 2 each; Washing­
ton, Montana, Utah, Nebraska, Maryland, and Vermont, 1 each.
Grouped by years, the deaths took place as follows: Nineteen hun­
dred and ten, 22; 1911, 14; 1912, 17; 1913, 25; 1914, 19; 1915, 35;
total, 132.
Considered by months, there seemed to be a period of high fre­
quency during March, April, and May, followed by a lull in the
summer and early autumn, and another high-frequency period, even
higher than the first, toward the close of the year. In half of the
six years, the largest number o f deaths in any single month occurred
in March or M ay; in two years it occurred in November and Decem­
ber; and in the remaining year the three months which had the
same high number of fatalities were March, April, and December.
Whether this apparently regular fluctuation is accidental only or
indicates a real variation in the risk of infection can not yet be
decided.
N ativity, A ge, Sex, and C onjugal C ondition.— Seventy-nine, or
not quite three-fifths, of 'the persons who died of anthrax in these




AN TH RAX AS AN OCCUPATIONAL DISEASE.

55

six years were born in America, and 51 of them died in the States
where they were born. There were also 8 Russians, 7 Poles, 6
Irishmen, 5 Germans, 5 Austrians, 5 Italians, 5 Canadians, 3 Eng­
lishmen, 3 Scotchmen, 1 Frenchman, 1 Greek, 1 Bohemian, 1 Hun­
garian, 1 Swede, and 1 native of the Azores Islands. Their ages
ranged from 3 months to 81 years, but more died between the ages
o f 31 and 40 and 51 and 60 than in any other age decade. One
hundred three were males, and 29 were females. Seventy-nine were
married, 46 single, 6 widowed, and 1 was divorced.®

STATISTICAL SUMMARY.
The following table presents in chronological order the 132 deaths
recorded as from anthrax in the United States during the six years
1910 to 1915, inclusive, showing the place of death, birthplace, con­
jugal condition, date of death, age, occupation, and recorded cause
o f death:
T able 6 .—D E A T H S F R O M A N T H R A X R E P O R T E D IN T H E U N IT E D S T A T E S , 1910 TO 1915.
[Data drawn from official certificates of death.]

Case
No.

Place of death.

Birth­
place.

Con­
jugal Date of
condi­ death.
tion.

Age.

Occupation.

Elmira, N. Y .

P a ...

M.

1910
Jan. 2

Carpenter 1.........

W ilm ington, D e l. . .
San Francisco, Cal..
Boston, Mass...........
Philadelphia, P a . . .
Jackson, O h io..........

Germany
G reece..
Ireland .
England
O h io___

M.
S.
S.
M.
M.

Jan. 10
Jan. 11
Jan. 29
Feb. 15
Mar. 8

Morocco w orker.
Laborer 2.............
........do a................
........d o 3................
Housewife..........

W illiamsport, Pa.
Pierceton, In d ____

Ita ly ----I n d ........

M.
M.

Mar. 28
Apr. 1

Laborer 4...............
Law and farming.

Reading, Pa..........
W ilm ington, D el.

P a ..
D el.

S.

Apr. 22
June 4

Cigar maker 6___
Morocco worker..

Cause of death.

Anthrax (external);
tetanus.
Anthrax.
E xhaustion;anthrax.
Anthrax.
Do.
Septicemia; anthrax
and Bright’s.
Anthrax.
Anthrax; heart fail­
ure.
Anthrax.
Do.

Special inquiry disclosed that the actual occupation just prior to death was as—
1 Carpenter at tannery.
2 Laborer in tannery.
3 Freight handler.
* W orker with raw sheep w ool; probably a woolsorter.
e Housewiie.
a B etw een th e b e g in n in g o f 1 916 a n d th e final p r o o f r e a d in g o f th is re p o r t (D e c . 2 4 ,
1 9 1 6 ), 18 a d d itio n a l ca ses o f d ea th fro m a n th ra x h a d been d is c o v e re d by cle rk s in th e
C ensus Office in th e co u rse o f th e ir r o u tin e c o m p ila tio n o f d e a th ce r tifica te s f o r t h a t
ye a r. T h e v ic tim s w ere, in c h r o n o lo g ic a l o r d e r : “ S h eep m a n ,” C o lu m b ia C o u n ty , W a s h .;
O c cu p a tio n n o t giv en , H o d g e n sv ille , K y ., a n th ra x in fe c t io n fr o m sick c o w ; W o o l
w a sh er, J o h n s to w n , N. Y . ; T a n n er, C h ic a g o ; B o y , o c c u p a tio n n o t g iv e n , N ew Y o r k
c i t y ; “ L a b o r e r ,” B o s to n ; F o re m a n in m ill, P h ila d e lp h ia ; “ L a b o r e r ,” P h ila d e lp h ia ;
F a rm e r, G o ld s b o r o , N. C . ; T ea m s ter, B o sto n ; “ L a b o r e r ,” P h ila d e lp h ia ; L o n g sh o re m a n ,
B o sto n ; “ L a b o r e r ,” S t. J a m es, M o . ; F a rm er, G len d a le S p rin gs, N. C . ; C u rrie r, B o s to n ;
“ L a b o re r,” P h ila d e lp h ia ; F a rm e r, B ea u m on t, T e x . ; H o u s e w ife , San A n to n io , T e x .
In
a n a c c o u n t o f th e ou tb rea k in M a s sa ch u se tts, 191 6 , in th e U n ite d S ta te s P u b lic H e a lth
R e p o rts fo r D ec. 15, 1916, th e t w o a d d itio n a l fa ta litie s w e re re c o rd e d o f a ta n n e ry
w o r k e r (b eam h o u s e ), W in ch e s te r, a n d a d ock la b o r e r, C h elsea .
T w o o t h e r ca ses o f
d e a th tra ce d th ro u g h th e U n ited S ta tes P u b lic H e a lth R e p o rts a n d th ro u g h n e w sp a p e r
a cco u n ts , res p e ctiv e ly , w ere th a t o f a cu rled -h a ir w o r k e r in D e tro it, M ich ., o n A u g . 12,
1 916, a fte r an illn ess o f 24 h ou rs, a n d o f a ta n n e ry w o r k e r in A r r o y o , P a ., on N ov. 19,
1916. T h e r e w a s lik e w ise o n r e c o rd th e fa ta l ca se o f a K a n s a s ch ild w h o w a s a p p a r­
e n tly in fe c te d b y a ca t. S ev era l o f th e s e cases h a v e a lre a d y been d iscu sse d in th e s e c­
tio n s d ea lin g w ith the ex p erien ce o f p a r tic u la r S ta tes o r h o s p ita ls.




56

B U LLETIN OF THE BUREAU OF LABOR STATISTICS.

T able 6 .—DEATHS FROM ANTHRAX REPORTED IN THE UNITED STATES, 1910 TO 1915—
Continued.

Place of death.

No.

Birth­
place.

Con­
jugal Date of
condi­ death.
tion.

Greensburg, Pa..

A ustria.

M.

Canada.

M.

July 19

Philadelphia, P a .
Holyoke, Mass___

England

W.
S.

Aug. 8
Aug. 20

L a Junta, Colo.
Fairport, O hio.

Scotland
O h io ....

Baltimore, M d.

Germany

Pom ona, C a l...
Newcastle, P a .

111..

20

E lm ira, N . Y .

21

60
15

Occupation.

Cause o f death.

Laborer,
paper
mill.
....... d o .....................

1910
June 29

Howe, P a ...........

Age.

A nthrax; septic in­
toxication.
Anthrax;
skinning
cow dead with the
disease.
Anthrax; bronchitis.
General sepsis; an­
thrax.
A nthrax.
Cramps—disease o f
bowel; anthrax.
T oxem ia; anthrax.

N ot reported.
Paper m illJ. .

O ct. 2
Oct. 13

Ranch forem an....
N on e..................... .

Dec.

46
4
mos
62
2

M.
W.

D ec. 8
D ec. 19

Mixing hair (ani­
mal)
in ma­
chines, prepar­
ing for spinning.
Farmer (retired). .
Baker......................

N. Y ....

M.

Dec. 22

M echanic2.

Fresno, Cal.

Germany

M.

Dec. 28

Barber.

K ittery, M e..............

17

M e ...

M.

Dec. 29

Farm er.

Pa.

M.

Canastota, N . Y ...........

N. Y ....

M.

1911
Jan. 27

W aterford, V t.
Harrison, I n d ..

V t..
In d .

M.
S.

Feb. 28
A p r. 28

M.
S.
M.

A p r. 28
M^y 7
May 16

N ew Orleans, L a .......... L a . . .
W indham Co., C on n ... C onn___
N ew Britain, C onn___ Ireland..

Cigar maker (re­
tired).
L a b orer3
........d o . . .
F arm er..........
Tailor * ..........
H ousekeeper.

L yn n, Mass.................... .. d o .......

S.

May 30

Cleveland, O h io............ Bohemia

M.

June 21

M usician5.

Monterey, C al...............

D.

July 10

Laborer___

C al...

Dubois, P a ..................... Hungary

M.

July 28

N one...........

Bakersfield. Cal. .
Philadelphia, P a .

F rance..
A u stria .

M.
M.

Oct. 16
N ov. 7

H ousewife.
Laborer___

W ilm ington, D el.

Pa.

M.

N ov. 20

New Orleans, L a .

La.

Assorter of hides,
morocco works...
Salesman, electric
supplies.

37

Logan County, K y ___

K y ..

39

Philadelphia, P a ..........
Mesopotamia, O hio___

P a ....
O h io ..

Philadelphia, P a .
W ilm ington, D el.

M d.........
Russian
Poland

Dec. 27

M.
S.

1912
Feb. 3

Not reported____

Feb. 6
Feb. 13

M.

Bristle comber «..
H ousewife.......... .

Mar.
Mar.

Hairdresser..........
Morocco worker *.

2
6

Special inquiry disclosed that the actual occupation just prior to death was as—
i Bleach Doy in rag room of paper mill,
a Handler of hides in leather com pany.
* Farm laborer.
* Tailor and presser.
6 Musician traveling with circus.
6 Bristle comber and hair dyer.
1

Morocco worker; probably in the beam house.




A nthrax; senility.
A nthrax;
exhaus­
tion following dis­
ease.
A nthrax, external,
and general tox­
emia.
A nthrax,
followed
b y septic abscesses
and pyem ia.
Septicemia w ith ma­
lignant pustule.
Anemia; malignant
pustule,
r ig h t
cheek.
A nthrax.
A nthrax;
septice­
mia.
A nthrax.
D o.
A nthrax (malignant
pustule); septice­
mia.
A nthrax; pulm onary
tuberculosis.
Malignant pustule;
edema of glottis.
A nthrax; acute ure­
mia.
A n t h r a x ; a n th ra x
edema.
A nthrax.
A nthrax; due to ba­
cillus anthracis.
Anthrax.
A nthrax (carbuncle);
malignant pustule.
M alignant pustule;
heart paralysis.
A nthrax.
M alignant p ustu le
on right side of face;
abscess of right kid­
ney.
A nthrax.
Do.

AN TH RAX AS A N OCCUPATIONAL DISEASE.

57

Table 6.—DEATHS FROM ANTHRAX REPORTED IN THE UNITED STATES, 1910 TO 1915—
Continued.

No.

Place of death.

42

Toledo, O h io___

43

Birth­
place.

O h io ....

Con­
jugal Date of
condi­ death.
tion.

M.

Boston, Mass
New Y ork, N. Y
Cincinnati, Ohio

1912
Mar. 7

Mar.
N . Y ..
O h io..

W.

Allegheny County, Pa. Ireland
Orange, N . J.................. N . J ... .

Age,

57

9

Occupation.

Laborer.

L a b o re r—lo n g ­
shore.!
Not reported 2___
Retired p ilot........

E x h a u s t io n fro m
c h ro n ic cy stitis ,
b lo o d p oison in g;
a n t h r a x — malig­
nant pustules on
leg ana hand.
Septicemia; anthrax.

Malignant pustule.
A nthrax or carbun­
c l e ; s e p t ic e m ia
and asthenia.
Forem an................. Anthrax.
Veterinary surgeon Inoculation b y an­
thrax bacilli, caus­
ing general sys­
temic poisoning.
F a r m e r ...
Anthrax.
L aborer3. .
D o.
Morocco 4.
Do.
A t school..
Malignant pustule;
blood poisoning.
Housekeeper.
Anthrax.
Housewife___
Do.

June 2
July 23
Aug. 6
Sept. 13

Richland, M o.......
Philadelphia, P a .
P eabody, Mass. . .
St. Paul, M in n .. .

I n d ....
Russia.
. . d o ...
M inn ...

Oct.
N ov.
N ov.
N ov.

Graves County, K y ___
Ballard County, K y . . .

K y .......
T en n ...

Dec. 4
Dec. 23

W ilm ington, D el.

M d ...

M.

1913
Jan. 19

Philadelphia, P a .

P oland..

M.

Jan. 23

....... d o.............................
S n o h o m i s h County,
Wash
Gloversville, N. Y ___

D e l..
W is.

M.
M.

Feb. 13
Feb. 15

Ireland.

M.

Mar.

Molder

Italy -----

M.

Apr.

Druggist.

Brooklyn, N. Y .

Cause o f death.

14
14
18
20

30

Morocco, station­
ary engineer.
Laborer 6...............
....... d o.6 ___
Housewife..
.

Gardner, Mass..

Mass___

M.

Apr. 12

Chair m aker...

Cascade, P a ___

P a ...

M.

May

2

Freight agent 8

Racine, W is ___

R u ssia ..

M.

May

5

Poland..
P a ........ .

Hennepin County .Minn M in n ...
North Attleboro, Mass. Canada .
W indsor Locks, C on n .. C o n n ....

W.
M.

25
4
mos,
16 L a b orer» . . .
July 17
76 None 10.........
July 20
A ug. 5
49 L iverym an.

Brighton, P a ........
W ilm ington, D el.
Lincoln, M o..........

P a ........
Ireland
Mo..........

M.
S.
S.

Aug. 13
Aug. 23
Sept. 8

34
54
28

H ousewife...........
Morocco worker.
Farmer..........

Gates, N . Y ...................

N. Y . .. .

Sept. 29

16

N ot reported11. . .

Anthrax carbuncle
of neck.
Anthrax.
Anthrax
of right
hand.
Anthrax; edema of
glottis.
Anthrax of the neck;
fatty degeneration
of heart.
Anthrax infection of
face.
Anthrax.

Dom estic.........

Philadelphia, P a ..
Wilkes-Barre, P a .

Malignant pustule.

Malignant pustule on
face, also internal
in m outh; edema
of glottis.
Haircloth m ak er.. Anthrax.
Malignant pustule.

May 9
May 28

Elyria, Ohio.,

O h io___

M.

Oct.

Physician.............

U nity, P a ___

P a ...

S.

Oct.

N on e......................

Special inquiry disclosed that the actual occupation just prior to death was £
1 Longshoreman handling hides.
2 School-teacher.
* Laborer in tannery.
< Lum per in coloring room of morocco and calfskin factory.
5 Laborer in curled-hair factory.
• Longshoreman loading hides and wool.
7 Limer and general helper in leather-dressing establishment.
8 Freight agent handling foreign hides.
9 General helper on small-fruit farm.
Housekeeper and nurse.
“ Chore-boy around home.




Anthrax.
M alignantpustule.
Malignant pustule;
septicemia.
Anthrax.
Do.
Anthrax; metastatic
pneumonia.
Splenic fever; malign a n t facial an­
thrax.
Anthrax; c h r o n i c
nephritis.
Cholera i n f a n t u m
and anthrax.

58

BU LLETIN OF THE BUREAU OF LABOR STATISTICS.

T able 6.—DEATHS FROM ANTHRAX REPORTED IN THE UNITED STATES, 1910 TO 1915—
Continued.

Case
No.

Con­
jugal Date of
condi­ death.
tion.

Place of death.

Birth­
place.

Lycom ing C ounty,P a.

N. Y ....

M.

1918
Oct. 23

Hanford, Cal.................

S.

Boston, 1
W inchester, V a .

A zores
Islands.
Mass___
M d.........

U nion, N . Y ..................

N . J.......

Age.

Occupation.

Cause of death.

N ov. 11

H a n d l i n g dry
hides.1
Laborer2............... .

A nthrax;
infection
upon the neck.
Anthrax.

S.
M.

Dec. 13
Dec. 20

Longshorem an3. .
Barber...................

S.

Dec. 24

Farmer

Anthrax; toxem ia.
B lood poisoning, the
result of anthrax.
A n t h r a x infection.

South W indsor, Conn..

Conn___

S.

1914
Jan. 16

Camden, N . J.

N . J..

M.

Jan. 29

Fremont, O h io.

O h io ....

M.

Mar.

Philadelphia, P a ........
Pleasant Prairie, W is.

N .C ....
Ill...........

S.
M.

Mar. 15
Mar. 20

Calexico, Cal................

Scotland

M.

A pr.

85

86

Philadelphia, P a .
Norfolk, V a ..........

P oland..
V a .........

M.
M.

. .d o .......
A pr. 11

88

87

Philadelphia, P a .
N ew Orleans, L a .

Germany
L a ___

M
.

May 6
May 29

89
90

Philadelphia, P a .
Cincinnati, O hio..

M d.........
O h io___

S.
M.

June 17
Aug. 8

mos.
35
41

91

Lewiston, Me..

Canada .

M.

Aug. 19

45

92
93

Hollidaysburg. P
Pa..
W ilm ington, Del

P a .........
R ussia. .

Sept. 10
Oct. 10

94

Brooklyn, N . Y .

Germany

N ov. 25

95
96

McKeesport, P a .
Lincoln, N e b r ...

V a .........
Iow a___

Dec. 8
. . . d o ___

97

Camden, N . J..

P oland..

98
99

Fort Morgan, C olo.
Fresno, Cal.............

C an ad a.
Ita ly—

1915
Mar. 29
Apr. 3

N one.........
L a b orer10.

100
1
01

Hartford City, Ind..
W illiamsport, P a . . .

O h io___
A u stria .

Apr. 4
Apr. 25

Merchant..
L aborer...

102

Coudersport, P a ........... . . . d o .......

May 12

-----d o........

103

.d o .

.do..

M.

M.

9

6

Dec. 31

May 18

Anthrax or malig­
nant pustule; tox­
emia.
U ndertaker5.
Anthrax (malignant
pustule); infected
from h a n d l i n g
hides in a local
leather factory.
R heum atism and an­
N ot reported.
thrax; pericarditis.
Anthrax.
Stevedore6..
Anthrax; general in­
Farm er........
fection.
Septicemia, almost
Housewife..
certainly due to an­
thrax in a cow .
Anthrax.
........d o .............
Anthrax (malignant
Not reported.
edem a); toxem ia.
Leather worker7.. A nthrax.
None....................... Anthrax at base of
spine; scrofula.
Laborer 8................ Anthrax.
Tailor and presser. Anthrax infection of
face;
nephritis,
acute.
Laborer.................. Endocarditis; chron­
ic rheumatism; an­
thrax.
A t hom e............... . Malignant pustule.
Anthrax; edema of
Morocco w orker. .
larynx.
Anthrax;
infection
Laborer 9..
bacillus anthracis.
L iverym an .,
Anthrax.
Septic infection due
H ousew ife...
to anthrax bacillus.
Laborer, m orocco Anthrax.
works.
N one____

29

. .d o .9.............

Farmer and stu­
dent.1!
Special inquiry disclosed that the actual occupation just prior to death was as-r1 Handler of dry hides in tannery.
2 Ranch laborer.
8 Longshoreman handling hides.
<Farmer who made a practice of butchering cattle.
6 Checker and receiver of horsehides in leather factory.
6 Stevedore unloading hair.
* Skin washer in leather factory.
« Longshoreman unloading hides.
®Laborer in tannery.
io Farm laborer handling cattle and cattle hides,
u Schoolboy who also did chores around home.

104

Nunda, N. Y .




N. Y . . . .

S.

May 24

14

Anthrax; measles.
Anthrax; due to ba­
cillus anthracis.
Malignant anthrax.
A nthrax c a u s i n g
edema of larynx,
facial anthrax.
A nthrax,
internal;
typical case o f true
anthrax.
Septic i n f e c t i o n ;
typical case of true
anthrax.
Septicemia; anthrax
of back.

59

AN TH RAX AS AN OCCUPATIONAL DISEASE.

T able 6.—DEATHS FROM ANTHRAX REPORTED IN THE UNITED STATES, 1910 TO 1915—
Concluded.
Case
No.

Place of death.

Birth­
place.

Con­
jugal Date of
condi­ death.
tion.

Occupation.

1915

Cause of death.

105

E ndicott, N . Y ........

Russia..

June 1

Tannery worker i.. Bacillus

106

Hartford, Conn........

Poland..

June 7

107

Brooklyn, N . Y .......

N. J..

June 29

108

Boston, Mass...........

July 4

109

New Orleans, L a ___

New
Bruns­
wick.
La.......

anthrax;
septicemia; an­
thrax.
Mill hand, carpet Anthrax infection;
factory.
genuine anthrax;
from initial ulcera­
tion of neck.
Not reported......... General astheni a
from anthrax in­
fection of nose.
Stevedore2............. Anthrax.

July 8

Laborer................... Acute nephri t i s;

110

Boston, Mass............

Russia..

...do......

111
112

Manhattan, N. Y .......... N. Y ....

July 29

Weigher 4...............

113

Salt Lake City, U ta h .. N. Y ....
Manhattan, N. Y .......... Md........

Aug. 24
Aug. 30

Carpenter............
Not reported.........

Laborer,
yard.3

freight

114

N ew London, C o n n ...

N. Y ....

Sept. 3

Printer.................

115

Brentwood, N. Y .........

N. Y ....

S.

Sept. 29

None5....................

116
117

Manhattan, N. Y .......... U. S .. ..
Madison, N. Y .............. N .J ....

s.

Oct. 7
Oct. 12

Laborer 6...............
Not reported.........

118
119

Manhattan, N. Y .......... U. S ....
Blue Earth Co., M in n .. Minn....

Oct. 15
Oct. 22

Lawyer 7
................
Housewife.............

120
1
21
122

N. Y ....

Nov. 12

At home8
..............

Manhattan, N. Y .......... Russia..
Philadelphia, P a .......... Scotland

Nov. 18
Nov. 20

Candv packer.......
Cake Daker............

123
124

Johnson City, N. Y . . .
Lewis tow n, M ont........

Pa........
England

M.
S.

...d o ....
Nov. 21

Laborer in tannery
Farm hand. . . .

125

Kings County, C al. . . .

Ohio....

M.

Nov. 26

126

New Brunswick, N. J . . Italy----

M.

.. .do......

Bainbridge, N. Y .........

Poland..

M.

Nov. 27

128
129

Boston, Mass................. Italy—
Manhattan, N. Y .......... N. Y . . . .

M.
S.

...do......
Nov. 28

Chelsea, Mass.................

56 Painter 9..........
Laborer, clay 10,

40

Freight handler
Laborer 1 .........
1
Medical student,

130

W illington, Conn........

N. Y ....

S.

Dec.

131

Brooklyn, N. Y ............

Russia..

M.

Dec. 18

Laborer1 ........ .
2

132

St. Paul, M inn.............. Sweden.

W.

Dec. 27

Farmer............

5

At school........

Special inquiry disclosed that the actual occupation just prior to death was as—
1 Worker in leather factory, unloading dry hides.
2 Longshoreman working in hold of vessel and unloading dried hides.
* Laborer unloading dry hides at wharves.
4 Weigher in United States customhouse.
* Clerk in post office.
* Laborer and driver, and unloading hides from vessel.
7 Retired lawyer, caring for his own home.
8 Helper on father’s dairy farm, doing housework and milking,
sLaborer with no particular kind of work.
1 Laborer working in clay pit.
0
*
Worker in tannery.
1 Laborer handling'hides at docks.
2




edema of lungs;
bacillus anthracis;
septicemia.
Anthrax; neck in­
fection with bacil­
lus anthracis.
Anthrax inlection of
neck.
Anthrax.
Pustula maligna on
under lip; pyemia;
anthrax.
Malignant pustule;
convulsions.
Malignant anthrax
edema.
Anthrax.
Poisonfromanthrax;
cardiacparalysis.
Anthrax.
External and inter­
nal anthrax.
Septicemia; probably
anthrax bacillus.
Anthrax.
Septicemia due to
malignant pustule
on hip; cirrhosis
of liver.
Anthrax.
Anthrax infection;
septicemia.
Anthrax on back of
neck; exhaustion.
Cellulitis of neck;
sepsis;
anthrax;
valvular heart
disease.
Anthrax; malignant
pustule.
Anthrax.
Malignant anthrax;
edema.
Malignant pustule;
general septicemia.
Anthrax; edema
of glottis; acute
cardiac dilatation.
Malignant anthrax
(carbuncle) on back
of neck.

60

BULLETIN OF THE BTJBEATT OF LABOR STATISTICS.
Individual Histories of Fatal Cases.

In this section a more detailed account is given of each of the
foregoing 132 cases of death from anthrax. The facts were secured
by correspondence and interviews with hospital authorities and with
attending physicians, supplemented in some cases by visits to the
family and friends of the deceased. By such inquiries many addi­
tional particulars were obtained which were important as throwing
light on the relation between occupation and cause of death.
No. 1, of Elkland, Pa., died at the age of 39 on January 2, 1910, of “ an­
thrax (external) ; tetanus.” He was a carpenter at a tannery, and upon
contracting the infection from hides was sent to Elmira, N. Y., to be treated
by a physician who had previously practiced near Elkland and had had much
experience with anthrax. “ I think,” says the physician, “ he would have
recovered from anthrax if tetanus had not developed about two weeks after
the appearance of anthrax symptoms; he lived only 24 hours from the time
tetanus developed. Of course he probably would not have developed tetanus
if he had not suffered from anthrax first.” As near as the physician could
find out the diseased hides “ were imported from South American countries,
and from cattle that had died o f anthrax.” The physician further states that
in five years’ practice near Elkland he treated “ quite a number o f cases suffering
from anthrax contracted by employees handling hides ” at the tanneries of three
neighboring towns, and that this was his “ first case that succumbed to the
disease.”
No. 2, of Wilmington, Del., died at the age of 50 on January 10, 1910, o f
“ anthrax.” He was a morocco worker by trade.
No. 3, of San Francisco, Cal., died at the age of 24 on January 11* 1910,
of “ exhaustion; anthrax.” He was a laborer in a tannery, where, according
to the physician, he became infected by hides. The illness lasted only three
days, and death occurred in a hospital.
No. 4, of Boston, Mass., died *at the age of 34 on January 29, 1910, o f “ an­
thrax.” He was a freight handler. His right arm was affected. Upon admis­
sion to the hospital an excision o f the affected area was made. Serum was not
used. A pure growth of anthrax bacilli was obtained from the blood. He had
been in the hospital about a day when death occurred.
No. 5, of Philadelphia, Pa., died at the age of 32 on February 15, 1910, of
“ anthrax.” For six weeks preceding his illness he had worked as a laborer
in a tannery. According to the hospital physician, the disease began three
weeks prior to his admission to the hospital “ with a small pustular eruption
on the face. Next day the neck became edematous, until on admission the
whole neck was purplish in color and doughy to the feel.” He died on the
day he was admitted to the hospital.
No. 6, o f Jackson, Ohio, died at the age of 68 on March 8, 1910, o f “ septi­
cem ia; anthrax and Bright’s.” She was a housewife.
No. 7, of Williamsport, Pa., died at the age of 51 on March 28, 1910, of
“ anthrax.” The physician states that the man came in contact with raw
sheep wool o f American origin, and that he probably was a wool sorter. The
disease took the form of “ malignant pustule— external anthrax,” according to
the physician, who goes on to sa y : “ He had all the classic symptoms, especially
a marked edema o f shoulder which spread to face and breast. He lived about
five days. Crucial incisions were made about shoulder and breast. No relief
was derived from this treatment.” Anthrax bacilli were found. Antianthrax
serum was not available at the hospital where the patient was treated.







PLATE

1 .— A
0

"BEAM

H O U S E ” IN A T A N N E R Y .

Scrapi ng hi des t aken f r om l i me vats in whi ch t he y have been s u b me r g e d until t he hair is l oos e ne d.




PLATE

1 .— “ F L E S H I N G ”
1

HIDES

BY M A C H I N E .

AN TH RAX AS A N OCCUPATIONAL DISEASE.

61

No. 8, of Pierceton, Ind., died at the age of 52 on April 1, 1910, of “ anthrax ;
heart failure.” His occupation was law and farming, and death followed
within five days, the physician states, after “ bite of fly.” A carbuncle ap­
peared on the cheek, with “ papules, pustule, vesicles, great induration.”
Phenol (carbolic acid) was injected and stimulants were given. When asked
whether antianthrax serum was injected the physician replied: “ N o; none
to be had.”
No. 9, of Reading, Pa., died at the age o f 49 on April 22, 1910, of “ anthrax.”
According to the physician the patient “ was the mother o f a large family, and
a hard-working housewife. She claimed to become infected through an abra­
sion of the skin of the back. She was treated in the beginning by domestic
remedies. When I saw the case the patient was so weak and the slough so
large that I made no attempt at excision.” Her husband states that the de­
ceased had been a cigarmaker for a few years before her marriage.
No. 10, of Wilmington, Del., died at the age of 17 on June 4, 1910, of
“ anthrax.” He was employed at $1.75 a day by a large morocco firm and came
in contact with goat skins imported from South America and from China.
The skins, according to the physician, were washed, but not disinfected, before
the boy handled them; hot water, gloves, nailbrushes, and disinfectants were
provided for the workers. Bloodstained materials were eliminated “ as far
as possible,” but there was no special ventilation. The illness lasted four days.
“ When he sent for me,” declares the physician, “ I found the pustule on his
right chest, which, with the history o f his working in the morocco factory, I
decided was probably anthrax. A slide confirmed it.” That is, anthrax bacilli
were found by microscopic examination. “ The course was very rapid,” con­
tinues the medical man, “ the people poor and could not afford serum treat­
ment, and he died. I cut out the pustule, but it did him no good.” No in­
demnity was received by the family for the boy’s death.
No. 11, o f Latrobe, Pa., died at the age o f 84 on June 29, 1910, of “ anthrax ;
septic intoxication.” He was a laborer in a paper mill, his duties, according to
one who was connected with the mill at the time, being to unload baled rags from
cars and to truck them into the storage sheds and to the cutting room, where
the rag cutters would cut the bales open and feed the rags into the cutting ma­
chines. The rags were principally cotton, coming in the main from “ all parts of
the United States and Canada,” but occasionally as many as “ 50 cars of foreign
rags ” would arrive at one time from England, Germany, France, Ireland, and
Spain. The rags were “ never treated with any disinfectant ” or cleaned. This
man’s work was done in the open air, on a platform which was “ cleaned as
often as needed.” No hot water, gloves, nailbrushes, or disinfectants were pro­
vided ; in fact, says the informant, “ there has never been any precaution taken
in regard to the prevention of disease.” The man went for treatment to a hos­
pital in Greensburg, Pa. The physician in charge of the case states that the
clinical symptoms were so typical that he holds the case was one o f anthrax.
“ Two o f my colleagues who saw the case with me are o f the same opinion.
The man had a virulent infection above the ankle. There was at this point a
circular area, probably 2 inches in diameter, much reddened and elevated, with
a rather clear serous and somewhat depressed center. There was a marked
lymphangitis extending up the leg and thigh. The man was profoundly toxic
and had a high temperature range. When the diagnosis was made, which was
very soon after his admission to the hospital, he was removed to a tent which I
had erected in the yard, and there he died during the night following admission.”
The duration of the illness was 10 days. Antianthrax serum was not available
for injection.




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BU LLETIN OF TH E BUREAU OF LABOR STATISTICS.

No. 12, of Howe, Pa., died at the age of 52 on July 19, 1910, of “ anthrax;
skinning a cow dead with the disease.” The man’s occupation is given merely
as “ laborer.” Illness lasted five days.
No. 13, o f Philadelphia, Pa., died at the age of 60 on August 8, 1910, of
“ anthrax; bronchitis.” The disease lasted eight days. The patient was a
widow. No occupation is given on the death certificate.
No. 14, o f South Hadley, Mass., died at the age of 15, on August 20, 1910,
o f “ general sepsis; anthrax.” According to the physician, he was employed at
$1.35 a day as bleach boy in the rag room o f a paper mill, but some time after
the occurrence the superintendent of the mill is reported to have asserted that,
while the boy “ had access to the rag room and was probably there, he was not
supposed to be there.” The physician states that, although the rags used were
imported from France and Italy, they were “ all new clippings.” The physician’s
story indicates infection through a scratched arm. “ On Saturday night, August
13,” he says, “ patient slept out o f doors in a tent.” The next morning he
“ noticed an ‘ insect bite ’ on middle o f left forearm which was swollen and
extremely itchy.” On Monday he returned from work “ in the middle of the
forenoon, feeling sick. Had a chill, nausea, and vomiting.” The physician saw
the patient first on Wednesday afternoon. He “ had some fever and increased
pulse rate.” On the left forearm was a small localized swelling that looked like
a b o il; “ rest of arm was normal, but left axillary glands and the whole left
chest wall was swollen. Patient had an extremely septic look.” Under local
treatment and catharsis the patient apparently improved for one day, but
Friday morning he was worse. The swelling was opened, and a very small
amount of pus obtained. “ Friday night patient was very restless and looked
very sick. Temperature and pulse were both high, and patient was vomiting.
Saturday morning patient was in a state of collapse— subnormal temperature,
and radial pulse absent until stimulated with strychnia and camphor. Skin was
a dark livid red, cold, and covered with sweat. Was still vomiting and passing
black urine. It was not until now that I suspected anthrax.” The patient was
removed to a hospital in Holyoke, Mass., and a consultant called. “ Excised
localized area (about 2 inches in diameter) and swabbed surface with pure
carbolic acid followed with alcohol. Swelling involved only the skin and sub­
cutaneous tissue. Patient died Saturday night.” The excised specimen was sent
to Harvard for diagnosis, and the report was anthrax.
No. 15, o f Maple Hill, Kans., died at the age of 46 on October 2, 1910, of
“ anthrax.” He was a ranch foreman, and according to the physician’s state­
ment “ infection was through the skin in the forearm,” where the man “ had
a little abrasion.” Three or four days before the disease broke out he “ helped
to skin and take care o f a dead cow,” and it is supposed that he “ got the
infection at that time.” Death occurred in a hospital at La Junta, Colo.,
after five days’ illness, the disease taking the form of “ malignant anthrax
edema.”
No. 16, o f Fairport, Ohio, died at the age of 4 months 11 days on October
13, 1910, of “ cramps— disease of bow el; anthrax.” How this infant girl con­
tracted the disease the physician was unable to state.
No. 17, of Baltimore, Md., died at the age of 62 on December 2, 1910, of
“ toxem ia; anthrax.” He was employed at mixing animal hair in machines,
preparatory to spinning. Illness was fatal after two days.
No. 18, o f Pomona, Cal., a retired farmer, died at the age of 72 on December
8, 1910, of “ anthrax; senility,” according to the official death certificate.
No. 19, of Newcastle, Pa., died at the age of 78 on December 19, 1910, of
“ anthrax; exhaustion following the disease.” The deceased was a baker,
and death occurred in a hospital after an illness of one month’s duration.




AN TH EAX AS AN OCCUPATIONAL DISEASE.

63

No. 20, of Breesport, N. Y., died at the age of 46 on December 22, 1910,
o f “ anthrax, external, and general toxemia.” He was employed by a leather
company and handled hides, which the physician thinks were imported from
Australia. For the purpose o f treatment he was taken to Elmira, N. Y.
“ The local lesion,” says the doctor, “ was single and situated under the
lower jaw, about over the submaxillary gland. Undoubtedly infection gained
access through abrasion o f the skin at that point. He rapidly became toxic
and unconscious and died within a few days from onset o f constitutional
symptoms. The local symptoms were first papular, then rapidly vesicular,
with an area of cellulitis, and soon local gangrene.”
No. 21, of Fresno, Cal., died at the age o f 52, on December 28, 1910, of
“ anthrax followed by septic abscesses and pyemia.” His occupation is given
as barber.
No. 22, of Kittery, Me., died at the age of 24, on December 29, 1910, of “ septi­
cemia with malignant pustule.” He was a farmer, but the mode of infection
could not be ascertained. The physician states that he displayed “ all the
typical clinical symptoms.” Death occurred after three days’ illness.
No. 23, of Canastota, N. Y., died at the age o f 75, on January 27, 1911, of
* anemia; malignant pustule, right cheek.” For much o f his life he had
worked as a cigar maker, but at the time of his death had retired. Anti­
anthrax serum was not available.
No. 24, o f Waterford, Vt., died at the age o f 29, on February 28, 1911, of
“ anthrax.” He did farm work about the neighborhood. According to the phy­
sician, eight days before the man’s death “ malignant pustule ” appeared in
the form of “ pimple on face,” contracted by “ contagion from a sick cow.”
Curative serum was not available. There were no dependents.
No. 25, o f Harrison, Ind., died at the age of 62, on April 28,1911, of “ anthrax;
septicemia.” His occupation is given as “ laborer.” Illness lasted, according
to the official death certificate, 21 days.
No. 26, of Youngsville, La., died at the age o f 34, on April 28, 1911, of
“ anthrax.” Deceased was a farmer. The record at the New Orleans hospital
to which he was sent furnishes these d a ta : “ Patient admitted to ward in
delirious state. Was unable to give coherent account o f illness. Friend, who
accompanied him to hospital, said that eight days prior to admission a small
sore like a boil appeared on bridge of nose (this told him by patient’s w ife).
The inflammation process spread rapidly and involved the skin o f forehead and
both eyelids, together with some o f the skin covering cheeks, in a gangrenous
process with necrosis and sloughing pustules here and there. Patient gradu­
ally grew worse and died.” The eyes were “ closed by exudate from skin
lesion,” and “ punched-out ulcers with undermined edges ” were found on nose
and forehead. Anthrax bacilli were found. The patient had skinned a dead
cow some time before he became ill.
No. 27, o f Windham County, Conn., died at the age of 72, on May 7, 1911, of
“ anthrax.” He was a self-employing tailor, and was partially supported by
an Army pension of about $12 a month. His work consisted of “ mending and
pressing old clothes,” states the physician. No antianthrax serum was avail­
able.
No. 28, of New Britain, Conn., died at the age of 52, on May 16, 1911,, of
“ anthrax (malignant pustule) ; septicemia.”
Her occupation is given as
housekeeper.
No. 29, of Lynn, Mass., died at the age of 38, on May 30, 1911, of “ anthrax;
pulmonary tuberculosis.” His occupation is given only as laborer. From the
hospital record it is learned that the patient went to the accident room “ with
42806°—Bull. 205—17------ 5




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BULLETIN OF THE BUREAU OF LABOR STATISTICS.

a small red spot on right cheek which he had had for two days.” There was
also small swelling and redness around the spot. A “ slide was taken and
anthrax bacilli found.” The patient, however, refused treatment and went
home, saying he would return in an hour. He did not go back until the follow­
ing morning, when the spot had “ increased in size, swelling greatly in­
creased, and some edema.” Excision was then performed under ether, the
wound cauterized with carbolic acid, and corrosive poultices applied. The
man died on the fourth day after first applying at the hospital.
No. 30, of Cleveland, Ohio, died at the age o f 40, on June 21, 1911, o f
“ malignant pustule; edema o f glottis.” He was a traveling musician, “ with
a circus ” at the time of infection, the physician is sure. While in a Pennsyl­
vania city he “ had a small infection on upper lip which he squeezed; following
this the infection rapidly involved the whole upper lip, and he was advised to
hurry home.” When called the physician “ recognized a very severe infection
with rapidly extending edema involving cheek and eye, temperature 105°,
with extremely rapid pulse.” Treatment consisted in local injections o f car­
bolic acid, ichthyol applications to his face, which was edematous, with tem­
perature baths and supportive treatment; medication mostly by hypodermic in­
jection. “ A strong attempt was made to get anthrax vaccine, locally and
by telegraph.” One firm sent a supply through a local representative, “ but
patient died before application could be made.” The history of the patient’s
“ traveling with the circus, his fondness for horses (by his own statement), the
initial lesion with extremely rapid progress o f disease, characteristic pustule,
gangrenous, vicious appearing ulcer, high temperature, and rapid disinte­
gration,” are considered by the physician convincing evidence o f anthrax.
No. 31, o f Monterey, Cal., died at the age o f 38, on July 10, 1911, o f “ an­
thrax ; acute uremia.” The statement of occupation is merely “ laborer.”
No. 32, o f Dubois, Pa., died at the age of 38, on July 28, 1911, of “ anthrax;
anthrax edema.” Under the head o f occupation the death certificate says,
“ None.”
No. 33, of Bakersfield, Cal., died at the age o f 42, on October 16, 1911, o f
“ anthrax.” The woman lived on a farm 16 miles from town. A pustule broke
out on her neck, but she paid little attention to it for 10 days, when she called
a physician, who pronounced it anthrax. “ It seems,” says the medical man,
“ a sheep had died in the neighborhood, and as there was an abundance o f flies
in the house there is no doubt that the infection was carried by the flies.”
Death occurred on the fifth day o f treatment. There were two dependents.
No. 34, o f Philadelphia, Pa., died at the age of 38, on November 7, 1911, o f
“ anthrax; due to bacillus anthracis.” His occupation is given as laborer.
No. 35, of Wilmington, Del., died at the age o f 48, on November 20, 1911, o f
“ anthrax.” For two years previously he had been employed as an assorter o f
hides in a morocco works, at $1.20 a day. The hides were imported in a raw
state, and, according to the physician, were domestic cleaned, but the cleanli­
ness of the workroom was “ not what it should be ” and no gloves or nail­
brushes were provided. The patient “ showed all the symptoms o f anthrax ” ;
no test for bacteria was made. Antianthrax serum was injected, but “ too
late.” The wife and four dependent children received no indemnity beyond
funeral expenses.
No. 36, of New Orleans, La., died at the age of 25, on December 27, 1911, o f
“ anthrax (carbuncle) ; malignant pustule.” He was a salesman for an elec­
trical supply house. The attack lasted 10 days, appearing first, the hospital
physician says, as “ infection on upper lip, right side.” It then “ spread to nose
and face o f same sid e; subsided after drainage and cauterization, followed by




AN TH R AX AS AN OCCUPATIONAL DISEASE.

65

ichthyol dressing.” The final symptoms were “ rapid invasion o f other side of
faee, neck, chest, pharynx, etc.” Serum treatment was not utilized.
No. 37, of Logan County, Ky., died at the age o f 51, on February 3, 1912, of
“ malignant pustule; heart paralysis.” The woman’s occupation is not given
on the official death blank.
No. 38, of Philadelphia, Pa., died at the age of 52, on February 6, 1912, of,
“ anthrax.” He was a bristle comber and hair dyer, earning $1.50 a day, and
the materials he worked with came from Siberia. The illness lasted seven
days, but the doctor in the case states that the man “ had no physician until
the day before his death, when I was called in to attend him.” Six days
before he had noticed a pimple on the back o f his neck, but “ thought it of
little consequence, working every day and using antiphlogistine, and in fact
intended to work the day before hi$ death, but feeling very sick he sent for
me.” On examination the physician found on the back of the patient’s neck
what at first seemed to be a carbuncle, but closer observation proved it was
not one. It was probably anthrax. The man was “ suffering severe pain and
had every evidence o f septic infection.” A few hours later excision was per­
formed, which the patient said gave him great relief, “ as if a bar o f iron
had been removed from his neck.” The following morning the physician “ was
called early and found him in extremis.” Examination o f the specimen re­
moved showed anthrax.
No. 39, o f Mesopotamia, Ohio, died at the age o f 30, on February 13, 1912,
o f “ malignant pustule on right side of fa ce; abscess of right kidney.” She
was a housewife, and the physician’s history shows a long period o f neglect o f
initial symptoms, “ as her people were strong Christian Scientists.” When a
medical man was finally summoned he found a temperature o f “ about 103$°,
pulse 110; patient went from bad to worse, until death finally ended the
scene.”
No. 40, o f Philadelphia, Pa., died at the age o f 47, on March 2, 1912, o f “ an­
thrax.” Death occurred in a hospital. The man’s occupation is given as
hairdresser.
No. 41, of Wilmington, Del., died at the age of 19, on March 6, 1912, of
“ anthrax.” He was a morocco worker, probably in the beam house. The
pustule appeared at the angle o f the jaw, and caused death by strangulation
in 48 hours.
No. 42, o f Toledo, Ohio, died at the age o f 57, on March 7, 1912, o f “ ex­
haustion from chronic cystitis; blood poisoning; anthrax, malignant pustules
on leg and hand.” Nothing more definite than “ laborer ” is given as his
occupation. Death occurred in a hospital.
No. 43, of Boston, Mass., died at the age o f 26, on March 9, 1912, o f “ sep­
ticemia; anthrax.” He was a longshoreman, and for some time preceding
the date o f infection had been handling hides. The assistant superintendent
o f the hospital where he died on the day after admission and three days
after the beginning o f the attack states that the disease took the form of a
“ small pimple, increasing until sides o f face became swollen.” Examination
disclosed “ very numerous, very large bacilli—bacillus anthracis.” Treatment
was by excision o f a “ wide area about pustule.”
No. 44, o f New York, N. Y., died at the age of 18 on June 2, 1912, o f “ malig­
nant pustule.” As far as the physician can recollect she was a school-teacher,
“ well developed, and in good physical condition, with a previous good history.”
She had been “ bit by a mosquito on the left cheek immediately below the
mouth.” On the following day there was observed a “ hard, tense swelling,”
which in three or four days became “ much worse, much bigger, and exceedingly




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BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

painful.” The mass was opened, but as there was no improvement a second and
more extensive operation was performed the next morning. “ The patient was
given appropriate vaccine treatment and everything was done for her, but she
died on the following day.”
No. 45, o f Cincinnati, Ohio, died at the age o f 81 on July 23, 1912, of “ anthrax
or carbuncle; septicemia and asthenia.” He was. a retired pilot.
No. 46, o f Allegheny County, Pa., died at the age of 55 on August 6, 1912, of
“ anthrax.” The physician who made out the death certificate gave the occupa­
tion as foreman, but did not state in what kind of an establishment he worked.
No. 47, of Orange, N. J., died at the age of 52, .on September 13, 1912, of
“ inoculation by anthrax bacilli, causing general systemic poisoning.” He was a
veterinary surgeon, and the medical record of the case is so clear and striking
that it deserves to be quoted at length. When the patient first went to secure
medical advice he had, reports the physician, “ a brownish spot at his left wrist
about the size o f a wart, and his left forearm was swollen and edematous up to
the elbow. He gave a history of performing an autopsy on some cows about
12 days or more previous to seeing me, at which time he scratched his right
forefinger, but at once cauterized it. Nothing developed at this spot, but it
seems probable that he must have scratched himself on the left wrist at the
same time without knowing it.” However, “ no symptoms o f any kind developed
for at least a week or more after the autopsy, and I think it was nearly two
weeks afterwards that he first saw me. That morning (September 9) he walked
into my office not looking sick and with a normal temperature and pulse, and his
forearm, though swollen and tense, was not angry looking.” The physician did
not know what to make o f his condition and immediately consulted two other
surgeons, who agreed with him that “ there was evidently some form of infec­
tion, but none of us knew what it was.” The patient was consequently taken to
a local hospital, where the pathologist took a culture from the “ wartlike
brownish spot at the wrist ” and reported next morning that the culture
“ showed anthrax bacilli.” By this time the swelling had “ extended 2 inches
above the elbow, and the spot at the wrist was as big as a quarter.” A physi­
cian from a large New York hospital was called in consultation, who advised
that a few drops o f blood from the patient’s right ear be taken for examination.
This was done, “ and the slide showed anthrax bacilli, which indicated that
the bacilli were then in the general circulation.” The patient was again taken
to the local hospital, where that afternoon the New York practitioner operated,
cutting out the original focus at the left wrist and making long incisions in the
arm and forearm. No pus was found, but the incisions were made to relieve
the tension and promote drainage. Though this operation was performed within
30 hours after the patient first presented himself for treatment, there was little
hope that it would save him, as the bacilli were all through the system, as
evidenced by the blood taken from the lobe o f the right ear. “ A Philadelphia
firm supplied through special messenger some anthrax serum made in Italy
(I believe), and this was injected subcutaneously in large doses and repeated
at intervals. No instructions were given at first as to the method of injection,
but latterly the serum was injected directly into the veins as advised. In spite
o f all that was done, the patient gradually grew weaker and died quietly in
bed September 13, 1912.” The infected spot, adds the physician first consulted,
“ was unlike anything I have ever seen, and its extraordinary development
within 24 hours was a sight not likely to be forgotten.”
No. 48, of Stoddard County, Mo., died in Richland, Mo., at the age of 59,
on October 14, 1912, o f “ anthrax.” Deceased was a farmer.
No. 49, of Philadelphia, Pa., died at the age of 34 on November 14, 1912, of
“ anthrax.” The man was a laborer in a tannery and was admitted to a




AN TH EAX AS AN OCCUPATIONAL DISEASE.

67

hospital on the fourth day o f the attack with “ anthrax lesion on neck.” He
died the following day, leaving a widow.
No. 50, of Peabody, Mass., died at the age of 20, on November 18, 1912,
of “ anthrax.” He had worked for about a year as a “ lumper ” in the color­
ing room in a morocco and calfskin tannery, at $1.50 a day. According to
the hospital physician there was no special ventilation, but the workroom
was cleaned daily and hot water was provided, also bichloride of mercury as a
disinfectant. The disease took the form of “ pustule, immense swelling.” The
pustule was cut out under local anesthetic, but death resulted suddenly from
“ embolism; blood vessels obstructed at site of swelling.” From the indus­
trial accident board which administers the workmen’s compensation act in his
State it was learned that the pustule appeared on the right breast. On No­
vember 18 the man “ told the foreman when he went home at night that
he felt sick.” Two days later he called a physician, and he was removed
to the hospital, where he died next morning. The man was married, and
his dependents were entitled to compensation, but lived in Europe and the
accident board was unable to locate them.
No. 51, of St. Paul, Minn., died at the age o f 7, on November 20, 1912, of
“ malignant pustule; blood poisoning.” The patient was a schoolgirl, and the
hospital authorities “ do not know how the disease was acquired.” Illness
lasted 14 days; antianthrax serum was not available.
No. 52, of Graves County, Ky., died at the age o f 17, on December 4, 1912,
o f “ anthrax.” She was a housekeeper.
No. 53, of Ballard County, Ky., died at the age o f 28, on December 23, 1912,
of “ anthrax.” Her occupation is given as housewife.
No. 54, of Wilmington, Del., died at the age o f 39, on January 19, 1913, of
“ malignant pustule.” He was a stationary engineer in a large morocco works.
No. 55, of Philadelphia, Pa., died at the age o f 30, on January 23, 1913,
of “ anthrax carbuncle of neck.” He had worked for only eight months at
the establishment where he contracted the fatal infection. The uncle with
whom he lived states that he complained of having a painful neck two days
before he called a physician, death occurring within the succeeding 24 hours.
The coroner’s inquest developed the following information: Deceased earned
$9 a week working as a laborer about a factory where “ curled hair was
handled.” Most of the hair was imported from Russia, South America, and
England. The firm stated that “ the usual precaution, by sterilizing the hair,
had been taken.” According to the coroner the firm “ supplies freely serum
imported from Italy,” but the man and his uncle “ apparently neglected avail­
able means of treatment until too late.”
No. 56, of Philadelphia, Pa., died at the age of 55, on February 13, 1913, of
“ anthrax.” He was a longshoreman, and seven days before death had loaded
hides and wool. First symptoms appeared seven days before death, in the
form of “ pimple on right cheek.” On the day of his death the patient was
ordered removed to a hospital, but died before the arrival o f the ambulance.
No. 57, of Snohomish County, Wash., died at the age of 58, on February 15,
1912, of “ anthrax of right hand.” She was a housewife.
No. 58, of Gloversviiie, N. Y., died at the age of 37, on March 1, 1913, o f
“ anthrax; edema of glottis.” Deceased was by trade a molder in a foundry,
but at the time o f contracting the disease had been employed about six months
in a leather-dressing establishment, liming skins and as general helper. Here,
according to the official occupational disease certificate, he “ had been helping
store away raw sheepskins, and picked small pimple on side of neck.” The
chief symptoms were “ papilla (small) on left side o f neck over tonsil, chills.




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BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

moderate fever, 101°-102£°; rapid pulse, 120-140; edematous swelling about
head, neck, and chest.” The swelling was “ extremely rapid,” and the physician
elsewhere states that “ within 24 hours it involved all the lymphatics of the
neck and axilla.” Anthrax bacilli were found, but protective serum was not
available. Death occurred in four days. The sheepskins the man handled were
imported from South America and from Africa, and were frequently blood­
stained. Bloodstained materials were not eliminated, and were disinfected
only by the “ tanning solutions, lime, naphthalin, etc.” The cleanliness of the
workroom is described as “ generally good ” by the physician, who further
states that hot water and disinfectants were furnished to the men, but no
gloves or nailbrushes. The wife received a small indemnity.
No. 59, of Brooklyn, N. Y., died at the age of 46, on April 6, 1913, o f “ anthrax
of the n eck; fatty degeneration o f the heart.” Deceased was a druggist, and
the physician who attended him was unable to determine the manner of con­
tagion, but found anthrax bacilli and a true anthrax pustule. Treatment was
by “ antiseptic solution and antiseptic dressing.”
No. 60, of Gardner, Mass., died at the age of 33, on April 12,1913, of “ anthrax
infection of face.” The man was a chair maker, and the physician states that
he “ could find no history of contact with hides, leather, wool, or animal mat­
ter.” Nevertheless, anthrax bacilli were found. April 5 he squeezed a small
pimple on the right side o f his lip, and it immediately began to pain and swell.
He was seen by a physician on April 7, when he had a “ congested pimple on
upper lip ” and “ temperature 104°.” Two days later he returned to the phy­
sician, with “ extreme inflammation of side of face, hardened area with car­
buncle appearance.” The following day he was taken to a hospital, where he
died within 48 hours. Antianthrax serum was not available.
No. 61, o f Cascade, Pa., died at the age of 34, on May 2, 1913, o f “ anthrax.”
He was a freight agent, and the physician states that “ infection was caused
by handling foreign hides.”
No. 62, o f Racine, Wis., died at the age of 33, on May 5, 1913, o f “ malignant
pustule on face, also internal in mouth; edema of glottis.” The woman was
a domestic servant.
No. 63, of Philadelphia, Pa., died at the age o f 25, on May 9, 1913, o f “ an­
thrax.” The man was a haircloth maker. According to a local newspaper he
felt ill after working over “ a bale of hair from Siberia,” and went home.
“ Shortly afterwards, apparently slightly better, he went for a walk with his
wife. Then came a sudden seizure which laid him unconscious in the street.”
A physician had him sent to a hospital, but “ he died on the way.” The paper
further states that the home was placed under quarantine. The hospital
physician describes the symptoms as “ anthrax lesion o f left cheek.”
No. 64, of Wilkes-Barre, Pa., died at the age of 4 months, on May 28, 1913, o f
“ malignant pustule.” The physician states that he was called in on May 24
and found the baby girl with a “ brawny swelling about 1 inch in diameter
on the left side of the face just above the lip.” Thinking it was an insect bite
or an ordinary boil, he gave an antiseptic wash, but on calling the next day
he found the swelling “ had extended up to and was closing the eye, and skin
was of a dark purple co lo r; fever quite pronounced.” The mother then stated
that she suspected the infant had been struck in the mouth with a fly swatter
by an older child. The abscess grew until it involved the whole left side of
the face, and then opened spontaneously. Large quantities o f pus were dis­
charged. The physician states positively that, “ while no microscopic exami­
nation was made, the clinical symptoms clearly pointed to infection by anthrax
bacillus.”




AN TH RAX AS A N OCCUPATIONAL DISEASE.

69

No. 65, o f Hennepin County, Minn., died at the age o f 16, on July 17, 1913, o f
anthrax. The boy was the son o f a small berry farmer, and helped to cultivate
the berries and also to care for the cow and horse. The boy first complained
of pain between the shoulder blades, and believed an insect had bitten him.
When he consulted a physician two or three days later the latter “ told him
it was a big carbuncle, as it had all that appearance,” and ordered 24 hours’
poulticing. “ When he came back,” says the doctor, “ I opened it, making a
cross incision to the bottom o f it, then with iodized phenol thoroughly cauter­
ized it out and dressed it with antiseptic gauze.” Three days afterwards the
boy came back, “ having considerable temperature ” and “ more pain.” The
lesion was curetted out, cauterized again, and then dressed twice daily, but
“ the malignancy kept spreading, delirium developed, as well as all the marked
symptoms o f blood poisoning.” A consultant was called, who pronounced the
case anthrax. “ No matter how thoroughly the gangrenous parts were cleaned
out and strong antiseptics used, it kept extending. Temperature kept going
up until it reached 107°.” No laboratory examination was made, but the
attending practitioner states that the case “ was pronounced anthrax by two
physicians.”
No. 66, o f North Attleboro, Mass., died at the age of 76, on July 20, 1913, of
“ malignant pustule.” She had been acting as housekeeper and nurse for one
o f her daughters in a neighboring town who, according to her own family
physician, died of puerperal sepsis. While so engaged the woman “ scratched
her finger on a nail in cellar stairway,” and was seized with “ chills ” and
“ high fever.” Two days after returning to her own home the woman called
a physician, who found her arm swollen and “ of dark purple,” fever 104°.
“ Next morning small pustules appeared on the whole extent o f limb, and
glands of axilla appeared to be a whole solid mass.” General treatment was
administered to reduce the fever, three incisions were made the entire length
o f the arm, and a wet bichloride o f mercury dressing (1 to 3,000) was applied.
Death occurred on the fourth day o f treatment. The physician states that in
his opinion “ infection was due to inoculation with bacillus anthracis.”
No. 67, o f Windsor Locks, Conn., died at the age o f 49, on August 5, 1913, of
“ malignant pustule; septicemia.” He was a liveryman and the physician
states that “ it has never been cleared whether the case was anthrax from the
start, or if the patient was inoculated with the disease subsequently when, at
his request, the small pustule was opened with a penknife in the hands o f a
relative.” The knife had previously been used by the patient in incising what
he thought was an “ abscess ” on one o f his horses, but had disappeared before
the reporting physician took charge o f the case. The disease lasted five days,
appearing as “ pustule on upper lip, profound toxemia from start.” Bac­
teriological examination was not complete, but antianthrax serum was injected.
Local treatment was by incision, drainage, and antiseptic applications.
No. 68, o f Brighton, Pa., died at the age o f 34, on August 13, 1913, o f “ an­
thrax.” She was a housewife, and the physician states that the “ symptoms
convinced him as to bacillus anthracis.”
No. 69, of Wilmington, Del., died at the age o f 54, on August 23, 1913, o f
“ anthrax.” He was employed by a large morocco plant.
No. 70, of Lincoln, Mo., died at the age o f 28 on September 8, 1913, of “ an­
thrax ; metastatic pneumonia.” Deceased was “ a robust, rugged young farmer.”
On September 3 the physician who was called to examine him found “ a large
vesicle at the seat o f infection ” on the septum of the nose, and “ several small
vesicles on the external part of the nose.” The disease had then been progress-,
ing two or three days, and the whole nose was “ o f a very dark color and badly




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BULLETIN OF THE BUREAU OF LABOR STATISTICS.

swollen ” and one eye was “ swelled shut.” The nose was gangrenous in appear­
ance, “ and also in fact, as when I cut the nose with my knife he did not have
any painful sensations.” Temperature at the first visit was 99°, pulse 90, “ and
not a great deal of constitutional disturbance.” On September 4 there was little
change, “ except that the gangrenous condition had extended to the left cheek.”
The following day, however, “ he had a severe pain in the left side, temperature
101°, dullness on percussion over the lower lobe o f left lung, bloody expectora­
tion, crepitant r&les on auscultation, and a further extension of the gangrenous
condition o f the face.” On the 6th there was less pain in the side, but the
gangrenous condition on the face was “ still spreading.” By the 7th the right
lung had become involved, there was “ considerable difficulty o f breathing, pulse
rate greatly increased in frequency; gangrenous condition at this time extended
below the angle o f the jaw .” On September 8 all the symptoms had become more
severe, and when last seen by the physician he was “ going into a state o f
collapse and died in a short time. Anything I did for him did not check the
progress of the disease in the least, and had he not been of a very robust consti­
tution would have died sooner than he did.” None of the pathological specimens
were examined microscopically, but from the clinical symptoms the doctor has
no doubt that he had “ to deal with a very severe case o f anthrax.”
No. 71, o f Gates, N. Y., died at the age o f 16, on September 29, 1913, o f “ splenic
fe v e r; malignant facial anthrax.” The physician states that the boy “ chored
around home,” and that the source o f the infection is unknown. “ Pustule
appeared on lower lip, spread rapidly over whole left side o f fa c e ; chills, enlarge­
ment of spleen, high fever, gastroenteric hemorrhages and meningitis; died
in coma.”
No. 72, o f Elyria, Ohio, died at the age o f 67, on October 7, 1913, of “ anthrax;
chronic nephritis.” He was a physician.
No. 73, of Unity, Pa., died at the age o f 1, on October 22, 1913, of “ cholera
infantum and anthrax.” The physician states that the child, a girl, was ill about
three weeks. He did not think it necessary to make a microscopic examination,
but is certain case “ was due to inoculation with bacillus anthracis.” Protective
serum was not available. The family, he declares, was “ very unclean, and child
could have contracted the disease by toying with a diseased dog or cat, or from
partaking o f milk or butter, or through the agency o f flies or insects, or by
inhaling dust containing the virus.”
No. 74, o f Elkland, Pa., died at the age o f 52, on October 23, 1913, o f
“ anthrax; infection upon the neck.” He handled hides in a tannery, re­
ceiving $2 a day. The hides were imported from South America and China.
Bloodstained materials were not eliminated at the plant, the physician says,
and he does not think disinfection was carried on or that gloves or nail­
brushes were furnished. The man sought medical assistance only when
it was “ too late for human aid.” He was taken to Lycoming County. Anti­
anthrax serum was obtained in Philadelphia and freely used, but the disease
had already progressed too far, and he died on the sixth day of the attack.
The company paid the funeral expenses and offered the widow $500 in settle­
ment, which she refused. The lawyer in whose hands she put the case secured
a judgment for $300, out o f which he charged a $90 fee. Apparently the suit
dragged until the beginning o f 1916, for the widow states that “ they are now
paying me $10 per month ” since January 1 o f that year.
No. 75, of Hanford, Cal., died at the age o f 33, on November 11, 1913, of
“ anthrax.” He was a ranch laborer, earning $2 a day. First symptoms
•appeared on November 6, but a physician was not called until the 9th. At
that time, says the - latter, “ the face was swollen on right side over antrum




AN TH RAX AS AN OCCUPATIONAL DISEASE.

71

and was quite tender to pressure. Tenderness on canine and biscuspid teeth
was shown when pressure was made. Eyelid edematous and red. Diagnosis
at that time was made as abscess o f antrum, and operation for draining was
advised.” The same evening the floor of the antrum was perforated under
ether “ and a dark, bloody discharge escaped.” The patient regained con­
sciousness, but the next morning the swelling had greatly increased on right
side, closing the eye and assuming a dark purplish hue. The left side o f the
face became involved. Bloody secretions drained from nose on right side and
from opening draining the antrum. “ A peculiar odor from the patient caused
me to associate it with the odor I had noted in a cow dying from anthrax.
Specimens taken from secretions o f nose and antrum each showed the anthrax
bacillus in large numbers. At noon on the 10th the patient became uncon­
scious. Patient died at 3 o’clock on the afternoon o f the 11th.” Death oc­
curred in a sanatorium.
No. 76, o f Boston, Mass., died at the age of 23, on December 13, 1913, of
“ anthrax; toxemia.” Deceased was a longshoreman. From the hospital
record it is learned that two weeks before admission he “ handled South Ameri­
can hides,” and three days before admission he “ handled American hides.”
Four days before he entered the hospital a “ pimple appeared on his right neck
below the angle of the jaw. Several blebs appeared later around the pimple
which broke down. Pain and swelling with redness and induration followed.”
At the time of admission the patient presented “ a small brown ulcer on right
side of neck one-third inch in diameter, surrounded by a circle o f white blebs
near by. Considerable edema o f whole right side o f neck extending as far
forward as point o f ja w ; temperature, 102° ; white blood count, 32,400.” A
circular excision was made and swabbed out with iodine; forced nourishment
and stimulants were given; corrosive 1/5,000 dressing every four hours.
Blood culture was positive for anthrax bacillus. “ Edema soon extended down
whole right side of chest, turning a dusky red. Patient failed gradually since
operation,” though suffering little pain. Finally he “ became delirious and in a
few hours sank into coma and died.” The deceased left a dependent mother,
but indemnity, which under the Massachusetts workmen’s compensation law is
paid for cases of anthrax, was refused in this case, because the insurance com­
pany contended that the disease was not contracted while the deceased was
in the employ of their policyholder, but while working for another company.
No. 77, of Winchester, Va., died at the age o f 46, on December 20, 1913, of
“ blood poisoning, the result o f anthrax.” He was a barber. .
No. 78, of Union, N. Y., died at the age o f 56, on December 24, 1913, of
“ anthrax infection.” The disease took the form o f “ anthrax edema ” ; it
“ developed on the fa c e ; advance was very rapid to extensive involvement of
face, head, and neck ” ; diagnosis was made on the third day and was con­
firmed by the State laboratories. The deceased was a farmer, and, according
to the physician, “ was in the habit o f buying up old and poorly nourished cat­
tle, butchering them, and selling them where he could. He certainly handled
diseased meat.” At the time of his death he was awaiting trial for selling
tuberculous meat. “ The hired man,” continues the doctor, “ says he has gone
home at night leaving a very sick cow in the stable and found in the morning
a beef dressed and the sick animal missing. No questions were asked or
answered in regard to it.” It therefore seems to the physician “ likely that
infection took place during, or as a result of, his occupation as a handler of
domestic beef, and that often diseased.” .
No. 79, of South Windsor, Conn., died at the age o f 14, on January 16, 1914,
of “ anthrax or malignant pustule; toxemia.” The girl had no occupation.
The illness lasted 10 days.




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B U LLETIN OF THE BUREAU OF LABOR STATISTICS.

No. 80, of Camden, N. J., died at the age o f 47, on January 29, 1914, o f
“ anthrax (malignant pustule).” He had been employed for eight months
as a checker and receiver of horse hides imported from Russia in an estab­
lishment where leather was tanned and finished. Diagnosis was made on the
second day of the illness. The pustule was located under the right ear. The
physician also found edema o f upper chest, rapid pulse, cold extremities, no
pain, and no complicating conditions. Serum treatment was used, but with
no improvement. The illness lasted four days. Previous to entering the occu­
pation which caused his death he had been an undertaker.
No. 81, o f Fremont, Ohio, died at the age of 52, on March 9, 1914, of “ rheu­
matism and anthrax; pericarditis.” According to the official death certificate
the illness lasted three months. The occupation of the patient is not stated.
No. 82, o f Philadelphia, Pa., died at the age of 30, on March 15, 1914, o f
“ anthrax.” “ Anthrax bacillus was proved by finding the organism in the
discharge from his cervical lesion.” The man was colored and worked as a
stevedore, and three days before his death he had been “ unloading a cargo
o f hair from China.” The physician who examined him at the hospital “ found
a diffuse swelling of the right cervical region, with evidence o f a small pustule
which had ruptured and was rather inconspicuous because o f the dark surface
of the skin. The case was not diagnosed at the time as one o f malignant
pustule, and an incision for the purpose o f drainage was made in the neck.”
The patient came to the hospital next day, and a number o f incisions were
made on his neck for the purpose of relieving his respiratory difficulty. “ He
grew progressively worse, and died in the hospital ward 60 hours from
the time he applied for treatment. Our cultures showed the anthrax bacillus
in both cultures.”
No. 83, o f Pleasant Prairie, Wis., died at the age of 55, on March 20,
1914, of “ anthrax, general infection.” He was a farmer. Physician states
that the man opened a cow to ascertain the cause of its death and found
in its abdomen black spots, which he dissected. The “ pubic region and limbs ”
were affected. Examination showed “ various necrotic areas which rapidly
broke down. Scrotum very much enlarged and necrotic.” Patient was de­
lirious for two days. The illness lasted seven days.
No. 84, of Calexico, Cal., died at the age of 70, on April 6, 1914, o f “ sep­
ticemia, almost certainly due to anthrax in a cow ; died of it a few days
ago.” The illness lasted five days. The patient was a housewife.
No. 85, of Philadelphia, Pa., died at the age of 38, on April 6, 1914, o f “ an­
thrax.” She was a housewife.
No. 86, o f Norfolk, Va., died at the age of 54, on April 11, 1914, o f “ anthrax
(malignant edema) ; toxemia.” Illness lasted five days.
No. 87, of Philadelphia, Pa., died at the age o f 60, on May 6, 1914, of
“ anthrax.” He was a skin washer in a leather factory. Illness lasted four
days. The physician at the hospital where he was admitted on the third day
o f the disease describes the attack as “ anthrax lesion on left side of face.”
No. 88, o f New Orleans, La., died at the age of 3 months, on May 29,. 1914, of
“ anthrax at base of spine; scrofula.” He was ill one month.
No. 89, o f Philadelphia, Pa., died at the age of 35, on June 17, 1914, o f
“ anthrax.” The patient was colored; he worked as a longshoreman, and three
days previous to admission to the hospital where he died he was unloading
hides. “ Two days after that,” writes the physician, “ a pimple on the face
began to swell rapidly, causing little pain. The swelling progressed and
involved all the tissues of the neck. Anthrax serum was not used in the
treatment.”




AN TH RAX AS A N OCCUPATIONAL DISEASE.

73

No. 90, of Cincinnati, Ohio, died at the age of 41, on August 8, 1914, of
“ anthrax infection of fa c e ; acute nephritis.” He was a tailor and presser.
He became sick on August 2; the first symptom “ appeared on the upper lip,
where a horsefly bit him while out in the country. Entire face swelled up and
was somewhat red and edematous. Both eyes were closed from extensive
swelling.”
No. 91, of Lewiston, Me., died at the age of 45 years, on August 19, 1914, of
“ endocarditis, with chronic rheumatism and anthrax.” His occupation was
given by the official certificate as laborer, and the physician states that his
average earnings were $1.75 a day. The attack is described as “ cauliflower
on the back of the neck.” The treatment given was “ cruciform opening and
burning with cautery.” Serum was not used.
No. 92, of Hollidaysburg, Pa., died at the age of 18 years, on September 10,
1914, of “ malignant pustule.” She had no occupation.
No. 98, of Wilmington, Del., died at the age o f 29, on October 10, 1914, of
“ anthrax; edema of larynx.” He was a morocco worker.
No. 94, o f Brooklyn, N. Y., died at the age o f 56, on November 25, 1914, of
“ anthrax; infection bacillus anthracis.” The official death certificate desig­
nated him merely as “ laborer,” but from other sources it was learned that he
worked in a tannery. “ Two days before admission to the hospital patient
noticed a small pimple on neck; he said he pinched it; from that time on the
neck became more and more swollen. At first there was little pain, but a diffi­
culty in breathing developed just before admission.” In the hospital “ excision
of pustule and incisions of indurated area ” were made. The patient died four
days later. Anthrax bacilli were “ recovered from all organs.”
No. 95, of Smithson, Pa., died at the age of 42, on December 8, 1914, of
“ anthrax.” He was a liveryman. He was two days at a hospital in
McKeesport, Pa.
No. 96, of Lincoln, Nebr., died at the age o f 39, on December 8, 1914, of
“ septic infection due to anthrax bacillus.” Her occupation was given as house­
wife. She was ill one month.
No. 97, o f Camden, N. J., died at the age o f 53, on December 31, 1914, of
“ anthrax.” He was a laborer in a morocco factory. The physician, when
called in, found the patient dying. Examination disclosed “ external anthrax,
malignant pustule, high fever, edema o f glands and surrounding parts.” The
illness lasted five days.
No. 98, of Fort Morgan, Colo., died at the age of 1, on March 29, 1915, of “ an­
thrax ; measles.” The child, according to the physician, was scratched on the leg
by the teeth of a small dog with which he was playing. The parents attached no
importance to the incident, and did not even wash or cauterize the scratch. Two
or three days later, the child was taken, with a badly swollen leg, to the phy­
sician, who discovered that a calf had died o f anthrax on the farm and that
the dog had been getting his meals from the carcass, which had not been
burned or buried. “ The child was very ill when I saw it first. No serum was
available when I recognized the cause of infection. The temperature was
high. The secretion from the limb was bloody. No pus. The swelling con­
tinued to increase and extended upward to the abdomen. The leg was kept in
a wet dressing of bichloride, while stimulants were given internally.” A cul­
ture in blood serum was made and “ a pure culture o f anthrax ” resulted.
The child was ill two weeks.
No. 99, of Dos Palos, Cal., died at the age of 25, on April 3, 1915, of “ anthrax;
due to bacillus anthracis.” He was a farm laborer, and at the time o f the at­
tack he handled cattle and cattle hides of local origin. “ Patient was taken sick




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BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

about March 21, 1915,” writes the physician of a hospital in Fresno where the
man was taken for treatment. “At this time he was treated by a doctor who
made the diagnosis of pleurisy with rheumatism. At the onset he had severe
pain in the left side with several chills. This was shortly followed by a
swelling of the right ankle, which was quite tender and painful. Patient
came under our care on March 28, 1915.” In the hospital his case was diagnosed
as “ pulmonary anthrax, with general blood infection.” Local treatment was
applied to the pustules, which were situated on the lower eyelid and on the
anterior surface o f the thigh, and smears from both lesions showed anthrax
bacilli. On April 1, 40 cubic centimeters of antianthrax serum were injected
intravenously; on the following day a dose of 60 cubic centimeters was given.
“ This is all the antianthrax serum we were able to secure on the coast,”
writes the hospital physician. The patient died on the thirteenth day of his
illness.
No. 100, o f Hartford City, Ind., died at the age o f 69, on April 4, 1915, o f
“ malignant anthrax.” He was a merchant. The physician in charge stated
that this was a case o f “ infectious febrile disease due to the inoculation into
the hand o f the anthrax bacillus. Death being due to obstruction o f circula­
tion by these bacilli; much subcutaneous edema near the inoculation wound,
and also metastatic lesions.”
No. 101, o f Williamsport, Pa., died at the age o f 53, on April 25, 1915, o f
“ anthrax causing edema of la ryn x; facial anthrax.” Occupation is given
merely as “ laborer.”
No. 102, of Coudersport, Pa., died at the age o f 31, on May 12, 1915, of “ in­
ternal anthrax; typical case true anthrax.” His occupation is given as laborer.
No. 103, of Coudersport, Pa., died at the age of 29, on May 18, 1915, of “ septic
infection; typical case true anthrax.” For several years he had been em­
ployed at about $1.60 per day as a laborer in a tannery, where sole leather was
made. He came in contact with imported dried hides. According to the
physician in charge o f the case, no sanitary precautions were taken. Not all
the hides were disinfected; there was no special ventilation; the workrooms
were very dirty. The disease took the form of a pustule on the neck. At the
hospital, where the patient was taken, excision was performed and carbolic acid
was injected around the affected area. Serum was not available; the illness
lasted six days.
No. 104, of Nunda, N. Y., died at the age o f 14, on May 24, 1915, o f “ septi­
cemia ; anthrax o f back.” Physician says “ all symptoms point to true an­
thrax.” The disease was not suspected until three days before the boy’s death,
when diagnosis was made. The patient had high fever and delirium, and the
disease developed rapidly. The boy was attending school and choring about
the house.
No. 105, of Endicott, N. Y., died at the age of 22, on June 1, 1915, o f “ septi­
cemia ; anthrax.” The deceased was employed in a leather factory unloading
dry South American and Chinese hides. They were said to have been disin­
fected. Examination showed “ infection on arm and neck, and swollen chest.”
The hospital physician states that he “ injected with 12 per cent carbolic acid
and removed infected area.” No serum was given. The illness lasted two days.
“ Positive diagnosis was made after death by bacteriological test of blood and
tissue of arm.”
No. 106, o f Thompsonville, Conn., died at the age of 35, on June 7, 1915, of
“ anthrax infection; genuine anthrax; from initial ulceration on neck.” The
anthrax organism was “ diagnosed in smear and culture.” He was employed in
a carpet factory. The physician at the Hartford hospital, where the patient




A N TH R AX AS A N OCCUPATIONAL DISEASE.

75

was taken, states that there was a “ pustule on anterior neck, and edema and
cyanosis of anterior chest.” Serum was not available. The illness lasted §ix
days.
No. 107, of Brooklyn, N. Y., died at the age o f 6, on June 29, 1915, o f “ general
asthenia from anthrax infection of nose.” “ An infectious febrile disease with
local symptoms,” says the physician, “ manifested itself in nose and its accessory
and other sinuses; the discharge showed a bacillus having all the characteristics
o f the bacillus anthracis.” The child’s illness lasted 15 days.
No. 108, of Charlestown, Mass., died at the age o f 50, on July 4, 1915, o f
“ anthrax.” Autopsy showed that “ he suffered from anthrax septicemia, with
associated leptomeningitis and hydrothorax.” He was a longshoreman. “ In­
vestigation brought out,” states the physician of the Boston hospital where the
man died, “ that on May 25, 1915, he worked in the hold o f a vessel laden with
dried blood, ground bones, and phosphate, and subsequently to that date assisted
in the discharging o f dried hides.”
No. 109, o f New Orleans, La., died at the age o f 23, on July 8, 1915, o f
“ acute nephritis; edema o f lungs; bacillus anthracis; septicemia.” He was a
laborer.
No. 110, o f Boston, Mass., died at the age o f 38, on July 8, 1915, o f “ anthrax;
neck infection with bacillus anthracis.” He was unloading dry hides at the
wharves. The physician at the hospital where the patient was admitted on the
day before his death describes his disease as “ septicemia with brawny swelling
of right face and neck and bulla formation. No local carbuncle. Blood cultures
were positive.”
No. I l l , of New York City, died at the age o f 34, on July 29,1915, o f “ anthrax
infection of neck.” He was a weigher in the United States customhouse and
handled skins and hides from South America. His duty was to tear open bales
to inspect and weigh their contents. Not all the materials he handled were
disinfected, and no care was taken to prevent danger. He had been in the
work since 1908 and was earning on the average $4.50 a day. The physician
to whom he applied for treatment performed “ excision o f lesion and drainage.”
No serum was used. The illness lasted five days. A portion o f the excised
tissue was sent for examination to the research laboratory of the New York
City Department o f Health, which reported: “ Microscopic examination of gland
removed from neck shows anthrax bacillus in culture and liver o f dead injected
mice.” The physician considered the case particularly pathetic because the
widow was “ left without means and with three small children,” and since the
Federal Workmen’s Compensation Act o f 1908 does not cover the employees of
the customhouse, the physician’s efforts to obtain a pension from the United
States Government for the widow were unsuccessful, as “ there appears to be no
provision for such cases. It would seem that the Government should make some
provision for the ones left dependent through its employment o f workers at
occupations likely to cause their death.” A special bill for the relief of this
family was finally introduced in Congress, almost a year after the man’s death,
but up to the time this report was written the House Committee on Claims, to
which the bill was referred, had taken no action on it.
No. 112, of Bountiful, Utah, died at the age o f 65, on August 24, 1915, of
“ anthrax.” Death occurred in the farmers’ ward of the county hospital at Salt
Lake City, after three days’ treatment. Tlfe man was a carpenter.
No. 113, of Baltimore, Md., died at the age of 20, on August 30, 1915, of “ pug
tula maligna on under lip ; pyem ia; anthrax.” The victim had no employment;
she lived at home with her parents and at the time of her illness was visiting




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BU LLETIN OF TH E BUREAU OF LABOR STATISTICS.

New York. The first symptoms appeared about August 18. The young woman
“ had a pimple on her lower lip and, as it annoyed her, she pricked it with a
needle. It steadily grew worse,” and she went to a hospital across the street.
There she was treated as an outpatient for a few days. The diagnosis o f an­
thrax was made on August 25, and then “ injections of iodine and other germi­
cides ” were made and “ constitutional treatment internally ” was given. Serum
was “ not obtainable. The pus filtration was very rapid and spread to the
right cheek and neck alarmingly.” The physician was unable to find out to
what uses the needle had been put with which the patient pricked the pimple
on her lip.
No. 114, o f New London, Conn., died at the age o f 57, on September 3, 1915,
o f “ malignant pustule; convulsions.” His occupation is given as printer.
No. 115, o f Brentwood, N. Y., died at the age of 23, on September 29, 1915,
o f “ malignant anthrax edema.” She Was a clerk in the post office. The hospital
physician who attended the case diagnosed it as “ infection with bacillus
anthracis, which bacillus was recovered from the excised papule at the New
York City research laboratory. The source of this infection, which was on
the side o f the neck, was not determined.” The physician states, however,
that the young woman had “ tried on clothing trimmed with fur at various
department stores in New York City.” The disease took the form o f malignant
edema, “ without pustule except fleabitelike papule.” Curative serium was se­
cured from Philadelphia, after unsuccessful efforts to obtain it in New York,
and injected both subcutaneously and intravenously. Supportive treatment was
also given, but death occurred on the sixth day.
No. 116, o f New York City, died at the age o f 52, on October 7, 1915, o f
“ anthrax.” The first symptom was an “ itching sensation on chest.” Examina­
tion by the hospital physician disclosed “ papule on chest, with spreading in­
flammation over left side o f body. Fever and prostration. Both microscopical
examination and autopsy proved case to be due to bacillus anthracis.” The
patient had been working for five years as a laborer and driver and during
the week before illness was unloading hides from a vessel. He was ill four
days; diagnosis was made on the day preceding his death. No serum was
available.
No. 117, o f Madison, N. Y., died at the age o f 52, on October 12, 1915, o f
“ poison from anthrax; cardiac paralysis.” His occupation is not given on
the official certificate. The physician stated that death was due to “ true
anthrax; fever and involvement of the glands.”
No. 118, o f Riverhead, N. Y., died at the age o f 71, on October 15, 1915, o f
“ anthrax.” The patient was a retired lawyer and did no work except caring
for his own home. The manner o f infection was a puzzle to the physicians, as
he came in contact neither with nondisinfected material nor with animals. The
man was never ill before. On October 8 he first noticed on his face a small
lump, which soon became a red itching spot. The disease spread rapidly over
his face, it reached the chin and attacked the glands of the neck. On the fol­
lowing day he was taken to the hospital and the disease was diagnosed as
anthrax; 130 c.c. o f Eichorn’s serum were injected during the period o f three
days, but without avail. Anthrax bacilli were demonstrated.
No. 119, o f Blue Earth County, Minn., died at the age o f 35, on October 22,
3915, of “ external and internal anthrax.” The physician’s statement gives
“ diagnosis o f inoculation with bacillus anthracis.” The patient was a house­
wife. Her illness lasted 12 days.
No. 120, o f Bainbridge, N. Y., died at the age of 24, on November 12, 1915, of
“ septicemia; probably anthrax bacillus.” The deceased was helping on her




AN TH RAX AS A N OCCUPATIONAL DISEASE.

77

father’s dairy farm doing housework and milking. The disease was diagnosed
as anthrax by two physicians who had seen cases before. The illness lasted
10 days. Serum was not available.
No. 121, of New York City, died at the age o f 17, on November 18, 1915, o f
“ anthrax.” The cause o f the death is further described by the hospital super­
intendent as “ infectious febrile disease due to inoculation with bacillus anthracis.” The patient was a candy packer. On November 14 she was taken
ill. A physician was called, and found a small gray spot on her chest, which,
according to the patient, had appeared five days previously. Within the next
three days the spot became red and inflamed and her condition grew so alarm­
ing that she was sent to the hospital, where 40 c.c. o f serum were injected.
The patient died 12 hours later. The presence o f anthrax bacilli was proved.
Some physicians believed that the patient became infected from a neck piece
made of cat’s fur. As a result official medical inspectors examined a large num­
ber o f fur-making shops, mostly on the lower East Side, where the victim
bought her fur. The theory was opposed, however, by another group o f official
medical men, who maintained that infection from cat’s fur is exceptionally rare.
No. 122, o f Philadelphia, Pa., died at the age o f 69, on November 20, 1915, o f
“ septicemia due to malignant pustule on h ip ; cirrhosis o f liver.” The dura­
tion of the anthrax attack is given as 1 month and 10 days, and the man’s
occupation is given on the death certificate as “ cake baker.”
No. 123, of Johnson City, N. Y., died at the age of 49 on November 20, 1915,
o f “ anthrax.” He was a laborer in* a large tannery. His widow made a claim
for indemnity under the New York workmen’s compensation law, and from
the decision o f the State industrial commission it appears that “ while being
shaved on November 16 his neck was slightly cut with a razor. Shortly after
commencing work the following morning his neck began to swell, anthrax germs
having presumably entered the cut.” On that morning, the widow states,
“ there was a little white spot in the middle o f the pimple which appeared to
be festered and appeared as though there was pus in it. I took a needle and
pricked it and lifted up the edge o f the white part, but no pus was discharged
but it bled a little.” Next day the patient was removed to a hospital where
he died two days later. Smears from the anthrax bacilli were found. The
industrial commission agreed that the cause o f death was anthrax and that it
was contracted from the hides among which the deceased was working.
Indemnity was, however, denied on the ground that the cut on the neck
through which infection took place was not received in the course of employ­
ment.
No. 124, of Lewistown, Mont., died at the age of 16, on November 21, 1915,
of “ anthrax infection; septicemia.” He was a farm hand.
No. 125, of Kings County, Cal., died at the age o f 56, on November 26, 1915,
from “ anthrax on back of neck; exhaustion.” He was first reported as a
painter but later as a laborer, not having any particular kind o f work. His
illness was stated by the hospital physician to be “ due to infection of bacillus
anthracis producing carbuncle and general infection.” Stimulants were given
but serum was not available. He was ill two days, and died an hour after
arrival at the hospital.
No. 126, ©f New Brunswick, N. J., died at the age o f 25, on November 26,
1915, of “ cellulitis of neck; sepsis; anthrax; valvular heart disease.” De­
ceased was a laborer and worked in a clay p it The malady took the form
of a large pustule on the neck, which the physician reported was “ genuine
anthrax.” Anthrax bacilli were found. Serum was not available; the illness
lasted three days.




78

BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

No. 127, o f Chelsea, Mass., died at the age of 40, on November 27, 1915,
o f “ anthrax; malignant pustule.” He was a freight handler at the wharves.
“ Autopsy showed that he died from anthrax septicemia, the principal ana­
tomical lesions being pustule o f the cheek, focal necrosis with hemorrhage o f
the stomach, jejunum, and ileum; hemorrhage* of the cervical and mesenteric
lymph nodes.”
No. 128, o f Winchester, Mass., died at the age of 31, on November 27, 1915,
o f “ anthrax.” He was employed in a tannery. According to the physician
at the Boston hospital where the man died, it was a fairly typical lesion. A
crucial incision was made on the day o f admission. “ Autopsy showed that he
died from anthrax septicemia, the principal anatomical lesions being pustule
of the upper arm (incised) ; enlargement with hemorrhage of the axillary,
mesenteric, and aortic lymph nodes; enlargement and softening of the spleen;
focal necrosis and hemorrhage o f the gastrointestinal tract.”
No. 129, o f New York City, died at the age of 25, on November 28, 1915, o f
“ malignant anthrax; edema.” He was a medical student.
No. 130, o f Willington, Conn., died at the age o f 9, on December 5, 1915, o f
“ malignant pustule; general septicemia.”
No bacteriological culture was
taken, but according to the physician the case presented a “ perfect clinical
picture of true anthrax.” The girl’s occupation is given as “ at school.”
No. 131, of Brooklyn, N. Y., died at the age of 45, on December 18, 1915,
o f “ anthrax; edema of glottis; acute cardiac dilatation.” He was a laborer
and handled hides at the docks. On admission to the hospital “ he showed two
typical punched-out ulcers with escharotic bases, small vesicles surrounding
each lesion with marked inflammatory areolae. There was intense swelling
and edema of the whole right side of neck extending down to chest. Anxious
face, sweating o f head, pulse barely perceptible, marked difficulty in respira­
tion and dilated heart. * * * Patient complained o f intense general ab­
dominal pain (for which no reason could be discovered on ante mortem ex­
amination).” “ Smears from lesions o f neck showed anthrax bacilli.” Serum
“ could not be obtained in time.” He died in 15$ hours after admission to the
hospital, the illness lasting altogether three days.
No. 132, of St. Paul, Minn., died at the age of 60, on December 27, 1915,
o f “ malignant anthrax (carbuncle) on back of neck.” He was a farmer,
and also occasionally did carpentering. When the physician was called he
found a “ carbuncle on the posterior region of neck.” The neck was badly
sw ollen; an incision was made.” The wound was dressed every day. Food
and remedies to sustain strength were given and the patient was kept in
bed. He was under the doctor’s care only three days.

PROBABLE RATIO OF DEATHS TO TOTAL NUMBER OF CASES.
Because o f the variety and the incomplete nature o f the material,
any attempt to estimate the probable ratio o f fatal to total cases
o f anthrax is surrounded with difficulty. In the course o f this study,
data givin g figures for both fatal and nonfatal cases were secured
from a number o f different sources, including a company physician,
the infectious-disease reports o f four States, occupational-disease
reports in two States, four hospitals, and a State workmen’s com­
pensation commission. The proportion o f fatal to total cases varied
widely, from 3 out o f 48, or 6 per cent, in the experience o f the




AN TH RAX AS AN OCCUPATIONAL DISEASE.

79

company doctor, to 15 out o f 18, or 83 per cent, in the figures reported
for two years to the New Y o rk State B oard o f H ealth.
U pon closer examination, however, the discrepant figures seem to
be susceptible o f considerable adjustment. The ratio o f fatalities
experienced by the physician in question was probably extraordi­
narily low, due in part to his being employed directly by the tannery
companies, so that he received the cases in the early stages, and in
part to his considerable experience with the disease and the conse­
quent development o f a more successful treatment. The reports from
the four State boards o f health all covered periods o f two years or
less, and showed, respectively, a fatality rate o f 2 cases out o f 17, or 12
per cent (Massachusetts), 4 cases out o f 17, or 24 per cent (T e x a s ), 3
cases out o f 5, or 60 per cent (C a lifo rn ia ), or 15 cases out o f 18, or
83 per cent (N ew Y o r k ). T he wide range displayed by these fig­
ures from similar sources is remarkable. Perhaps the largest single
factor o f error they contain is that deaths from anthrax are likely
to be reported as a matter o f routine with all other deaths, but
that reports o f nonfatal cases are more likely to be neglected.
T his would tend toward a preponderance o f fatalities among the
cases reported, a tendency the effect o f which is evidenced by the
fact that three o f the ratios in this group are higher than the median
ratio secured, and that tw o o f them are the highest obtained from
any source. Moreover, the low ratio in this group, that from M assa­
chusetts, covers a period o f only two months and four days, while
there was an epidemic o f the disease in that State, so that the figures
are likely to be unusual.
Another group o f figures, those secured through the occupationaldisease reports o f tw o States, shows a sim ilar diversity, the New
Jersey ratio for nearly four years being 1 fatal case out o f 13,
or 8 per cent, while the New Y o r k ratio fo r a slightly longer period
was 13 fatal cases out o f 23, or 57 per cent. Occupational-disease
reports, however, are likely to suffer from the defects already men­
tioned as affecting infectious-disease reports, and from the further
circumstance that the occupational disease reporting laws are com­
paratively new, are not even yet known to all physicians to whom
they apply, and for business reasons are not so likely to be lived
up to or enforced. T he figures from the Massachusetts W orkm en ’s
Compensation Commission showed 3 fatal cases out o f 30 in which
claims fo r compensation were made in three years, or 10 per cent.
D ata secured from such a source should be fa irly com plete; but, since
the ratio is the third lowest in the series, it is probably best not to
attach too much importance to it.
T he figures which from the standpoint o f accuracy o f diagnosis
and completeness o f recording are probably most valuable for the
42806°— Bull. 205— 17------ 6




80

BU LLETIN OF THE BUREAU OF LABOR STATISTICS.

purpose in hand are those from hospitals. Returns from four o f
these institutions fo r widely varying periods were secured, and it is
interesting to note that the ratios they present group closely together
near the middle o f the range o f ratios studied. T hus two M assa­
chusetts hospitals had, respectively, fatality rates o f 6 out o f 35,
or 17 per cent, and 2 out o f 4, or 50 per cent. A Philadelphia
hospital had 6 fatal cases out o f 32, or 19 per cent, while a New
Orleans institution had 1 out o f 5, or 20 per cent. The first,
third, and fourth o f these ratios are in substantial agreement; the
variation shown by the second set o f figures is possibly due to their
coming from a small hospital in the same city as the much larger
institution from which the larger number o f cases was reported.
I f the three sets o f hospital figures which are in closest agreement,
and which incidentally include the largest numbers o f hospital cases
reported, are taken as a reasonable gauge, the probable proportion
o f fatal to total cases would seem to be.about 1 out o f 5, or 20 per
cent.1
LEGISLATION.
Am erican legislation regarding anthrax deals (1 ) with the re­
porting o f cases, (2 ) with measures for prevention, and (3 ) with
compensation or insurance for those who contract the m alady in the
course o f employment. In none o f these fields is the legislation as
thoroughgoing, as widespread, or as vigorously enforced as the sit­
uation demands, but the beginnings have been made and further
study o f the subject should result in its extension and substantial
improvement.

REPORTING.

In the United States, as in most civilized countries, the value o f
reporting or n otifyin g infectious diseases is generally recognized.
M ortality statistics compiled from the official certificates o f death
indicate roughly the geographical distribution o f a disease and its
trend toward higher or lower frequency. A s has been seen, however,
the m ortality statistics o f anthrax cover but about one-fifth o f the
total number o f cases, and therefore fa il to give any adequate in fo r­
mation on its actual extent, occupational causation, and numerous
other features o f social interest. S till more im portant, only by re­
p orting infectious diseases as soon as diagnosed can epidemics
be recognized, checked, or prevented.
R eporting o f human anthrax is, nevertheless, a comparatively re­
cent advance in this country, being required, even as late as July,
1
This figure is in substantial accord with that of the British authorities, Bell and
Legge, who state that “ In Europe about 25 per cent of all cases prove fatal.”
(Allbutt
and Rolleston: System of Medicine, 1906, p. 252.)




AN TH RAX AS AN OCCUPATIONAL DISEASE.

81

1911, in only seven States. B u t because o f the grow ing frequency
o f anthrax, together with more lively interest in occupational as
well as infectious diseases, reporting laws spread rapidly, and by
January, 1916, anthrax had been made notifiable in the follow ing
24 States and in Porto R ic o :
A labam a, California, Connecticut, Delaware, F lorida, Illinois,
Kansas, Louisiana, M aine, M aryland, Massachusetts, M ichigan, M in ­
nesota, New Ham pshire, New Jersey, New Y ork , Ohio, Pennsylvania,
Rhode Island, South Carolina, South Dakota, Texas, Verm ont,
and W ashington.
In most of these anthrax is on the list o f notifiable infectious
diseases, and reports must be sent to the local board o f health
or health officer, by whom they are transmitted to the State board
o f health. The obligation to report usually rests upon the p h y­
sician, and in some States, i f there is no physician in attendance,
any other person knowing o f the case is required to report it. Some
States provide for the payment o f a small fee to the physician or
other person m aking the report. In New Y o rk , for instance, the
fee is 25 cents in cities and 20 cents in villages and towns. In M ich­
igan and New Jersey, 10 cents is paid, whereas in some States, such
as Connecticut and California, the person reporting is entitled to
50 cents. Failure to report is usually punished by a fine, varying
from $5 in M aryland to $50 in New Jersey. In some States the
provisions for enforcement are more stringent. Thus in W ashington
the State board o f health m ay remove from office any health officer
who refuses or neglects to make prompt and accurate reports.1
In addition to requirements for notification o f infectious diseases,
12 o f these S ta te s2 have adopted statutes or administrative orders
requiring physicians to report, as an occupational disease, every case
o f anthrax “ contracted as the result o f the nature o f the patient’s
employment.” T he standard certificates used under these statutes
are usually made returnable to the State board o f health, which
often must transmit them to the State department o f labor; some­
times, however, the reports go directly to the labor department. The
blanks are more detailed than the ordinary infectious-disease blank,
asking, in addition to the name and address and nature o f the illness
o f the employee, his occupation, length o f time therein, and the
1 According to the weekly United States Public Health Reports there were reported
between the first of the year and Nov. 1, 1916, under the infectious disease reporting
laws, 48 cases of anthrax, distributed as follow s: California 7, Louisiana 6 , Massachu­
setts 25, Michigan 1, New Jersey 3, New York 5, Ohio 1. For special discussion of
anthrax reports received under the infectious disease reporting laws of Pennsylvania
and Massachusetts, see pp. 31, 38, and 79.
2 California, Connecticut, Maine, Maryland, Massachusetts, Michigan, Minnesota, New
Hampshire, New Jersey, New York, Ohio, and Rhode Island.




82

BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

employer’s name, address, and business. A careful study o f occupa­
tional hazards is thus facilitated. T w o o f these 12 States (C a li­
fornia and Connecticut) offer a 50-cent fee as an inducement toward
more thorough reporting; penalties for failure to report range from
$5 to $50, while Minnesota provides as alternative to a $10 fine,
imprisonment for not more than 10 days.1

PREVENTION.
The story told by such statistics o f anthrax as the present m or­
tality registration and disease-reporting laws have made available
is one o f steadily and, o f late, even sharply increasing prevalence.
T h e cause o f this condition must be sought in the incomplete and lax
character o f existing efforts at prevention, both in agriculture and
in trade and manufacture, especially in the latter.

Agriculture.
Since anthrax in man is practically always the result o f contagion
in some manner from animals, one essential in eradicating the dis­
ease is to prevent it among animals. Law s and regulations for the
suppression o f animal anthrax have been enacted in all civilized
countries and in all the large stock-raising sections o f the U nited
States.
Congressional action covering this matter dates from 1865, when
an act was passed prohibiting the importation o f cattle from any
foreign country into the U nited States.2 The Secretary o f the Treas­
ury was, however, given power to suspend the prohibition whenever
he determined that such importation would “ not tend to the intro­
duction or spread o f contagious or infectious diseases am ong the
cattle o f the U nited States.” E xcept fo r an extension to be men­
tioned later, this provision has been embodied practically unchanged
in successive tariff laws, and to-day form s subsection 1 o f Section
I V - H o f the tariff act o f October 3, 1913. U nder its terms im porta­
tions o f neat cattle were permitted in the summer o f 1916 only from
Great Britain, Ireland, the Channel Islands, New Zealand, and
North Am erica. In 1884, with the organization o f the Bureau o f
A n im al Industry- in the Department o f Agriculture, the formulation
o f rules governing importations of live stock was taken over by that
department.
1 For summaries of cases reported under the New York an# the New Jersey occupa­
tional disease reporting statutes, see pp. 35 and 37. In New Hampshire 2 cases were
reported under this law in 1815. Both patients were laborers in a tannery, and both
recovered. In Maryland the remarkable case was reported in 1914 of a 15-year-old boy
who contracted the disease while working as a doffer in a woolen mill.
2 United States, Statutes at Large, Vol. X IV , p. 1.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

83

In most States, also, the regulations do not refer specially to
anthrax, but apply to infectious cattle diseases in general. A lm ost
all o f these States forbid the importation o f animals affected with
contagious or infectious diseases. Cases o f such diseases must be re­
ported, and an official o f the veterinary department is required to in­
vestigate, to examine the stock, and to prescribe necessary measures
for the protection o f healthy stock. Diseased animals or those which
have been exposed to the disease must be quarantined. T o prevent
further spread o f the disease many States prescribe the killing o f
affected or exposed anim als; frequently in such cases an official or a
committee appraises the animals and the owner is compensated for
the loss. Complete and careful destruction o f carcasses o f animals
dying o f the disease and disinfection o f their stalls are also required.
Failure to comply with the regulations is punishable by a fine
ranging, fo r ordinary offenses, from $5 to $500. Penalties as high
as $5,000 may be levied in Tennessee fo r im porting diseased stock,
and in V irginia for failure to disinfect freight cars.
Several States, however, chiefly in the W est and South, where
stock raising is an important industry and where anthrax is prev­
alent, have prescribed measures specifically fo r the prevention and
eradication of this scourge. These measures are on the whole similar
to the general regulations just described. Periodic vaccination o f
herds, which is compulsory in a number of countries abroad and
which has proved its effectiveness as a preventive measure, is strongly
advocated by agricultural stations in this country but is required in
only a few States. In Kentucky, vaccination is prescribed for all
animals which have been exposed to the disease. T he vaccine must
be approved by the U nited States Bureau o f A n im al Industry, by
the Kentucky Agricultural Experim ent Station, or by the State live
stock sanitary board. In Pennsylvania the State live stock sanitary
board, according to one o f its officials, prepares and distributes to
qualified veterinarians, free o f cost, anthrax vaccine for use on ex­
posed animals. E a rly each spring, for years, it is reported, the
board has vaccinated the stock on all premises where anthrax is
known recently to have existed. Form erly the vaccine was furnished
free o f cost and the work carried on at the expense o f the State.
Since 1916, however, the State merely supplies the vaccine and does
not pay fo r its administration. Sim ilar precautions are being taken
in other States.1
1
During June and July of 1916 serious anthrax outbreaks occurred among cattle in
the neighborhood of Buffalo, N. Y., in Arkansas and Texas and in the Mississippi Delta
region of Louisiana. Prompt work by State veterinary officers in killing infected cattle,
securing their burning or deep burial in quicklime, vaccinating exposed herds, and estab­
lishing quarantines, succeeded in checking the plague. Several human cases were re­
ported in this connection, including the death of the State veterinarian of Texas.




84

B U LLETIN OP TH E BUBEATJ OP LABOB STATISTICS.

Trade and Manufacture.
T he question o f prevention o f anthrax among industrial workers,
which is the subject o f extensive legislation in the leading countries
o f Europe, has so fa r received little attention in the United States.
N ot a single special factory or workshop regulation for the safe­
guarding o f employees against this disease has yet been enacted
by any State. W h a t governmental precautions do exist refer only
to the importation o f dangerous animal materials and until January

1, 1917, these were limited in application to hides and glue stock
from “ neat cattle.” T he dangers lurking in imported hair, wool,
and bristles, in horsehides, and in goat and sheep skins were com­
pletely ignored.®
Imports for the six years ending June 30,1915, of animal materials
liable to carry anthrax are shown in the following table, in which the
figures represent thousands of pounds:
T able 7.—IMPORTS OF ANIMAL PRODUCTS LIABLE TO BE INFECTED WITH
ANTHRAX, 1910 TO 1915.
(Compiled from reports of United States Bureau of Foreign and Domestic Commerce on imports of mer­
chandise into the United States. Figures represent thousands of pounds.]

Materials and exported. from which
the country

Year ending June 30—
1910

1911

1912

1913

1914

1915

H ES AND SKINS, RAW OB UNCURED.
ID

Dry:Total................................................
South America..................................
Asia..................................................
Africa...............................................
Green or pickled:
Total................................................
South America..................................
Asia..................................................
Africa...............................................

i 608,615 51,639 76,324
1152,802 177,746 234,914
i 17,490 45,433 45,515
89,235 6,593 6,317
197,140 302,849
(2)
27,295 57,656
(2)
22,345 26,331
(2)
2
2
(2)

257,373 231,183
55,972 60,873
72,177 54,107
6,432 5,676
314,817 329,880
52,504 71,809
26,995 23,440
399 1,209

209,119
71,085
64,881
13,777
329,095
135,191
18,835
420

Total...................................................... 263,927 137,646 193,399 195,292 247,645
2 ,0 1
12
South America........................................ 37,341 38,987 30,626 55,415 47,504
50,679 29,188 44,343
Asia........................................................ 59,921
11
2
145
342
387
711
Africa.....................................................

308,081
95,734
40,959
25,068

WOOL, H
AIR O TH CAM GOAT, ALPACA,
F E
EL,
AND OTH
ER LIKE ANIM
ALS, M
ANUFAC­
TURED.

H R AND O ER ANIM
O SE
TH
AL H
AIR MANU­
FACTU
RED.

Total......................................................
South America........................................
Asia.......................................................

18,759
2,941
130

7,534
2,426
75

16,176
2,625
343

16,495
2,313
451

14,245
1.573
20
0

11,689
1,872
416

B ISTLE
R
S.

4,029
1,722

3,553
1,491

3,461
1,565

3,578
1,483

3,436
1,592

4,061
2,482

Total......................................................
Asia........................................................

1 Including dry, green, and picked hides and skins.
2 Included in dry hides and skins.

*
° Certain regulations did exist regarding the disinfection of wool, horse, and other hair
imported from South America, but these had reference only to foot-and-mouth disease.
(Treasury decisions 30783, July 13, 1910, and 32027, Nov. 23, 1911.) It is said that in
one State the board of health requires hair shipped into the State to be submitted to a
temperature of 200° F., but this report could not be verified.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

85

Precautions for obviating the danger o f anthrax from imported
animal materials were first taken by Congress in 1866. In that year
the same Congress which had limited the importation o f cattle as
already described amended the law to apply as well to the “ hides of
neat cattle.” 1 Incorporated in the original statute which it extended,
this amendment also has come down to the present time as part o f
the tariff law. W h ile the Department o f Agriculture, as stated, has
taken over the regulation o f live-stock importations, the Treasury
Department still has charge o f the regulation o f hide imports, the
actual administration o f both sets of rules, however, being performed
by the Quarantine D ivision o f the Bureau o f A n im al Industry.
The tariff clause under discussion, however, provides only fo r the
unregulated entry or the absolute exclusion o f hides from suspected
areas, and is therefore likely in application to be either too lax or
too strict. M ore precise safeguards against anthrax were needed,
and are now authorized by section 2 o f the act o f February 2, 1903.2
T h is section empowers the* Secretary o f Agriculture to take meas­
ures against the introduction o f contagious diseases o f animals from
a foreign country into the United States or from one State o f the
United States into another.

In pursuance o f this act the Secretary

o f Agriculture has at various times made recommendations for the
disinfection o f imported hides, with special care against anthrax,
and rules embodying these recommendations have been issued by the
D ivision o f Customs o f the Treasury Department.
The rules in force during 1916 were based on an order which went
into effect June 1, 1910.3 I t required that untanned hides o f neat
cattle (later interpreted to include bu ffalo4) , hide cuttings or par­
ings, and glue stock, shipped from districts where anthrax was known
to the Am erican consul to be prevalent, undergo disinfection by im ­
mersion fo r at least 30 minutes in a 1 to 1,000 solution o f bichloride o f
mercury. Consuls in such districts were instructed to refuse the
certification o f invoices covering the above products fo r shipment to
this country unless they were disinfected by the prescribed method,
and admission was refused to products requiring disinfection which
lacked the proper certificate. Disinfection o f suspected products on
the dock upon arrival in this country or their transportation across
Am erican territory was not permitted, as it m ight tend to propa­
gate the disease in this country. Disinfection was also required
for hides produced in North America if landed and transshipped in
another country in the course o f importation. The rules did not
1 United States, Statutes at Large, Vol. X IV , p. 3.
2 United States, 32 Stat., 791.
8 Treasury decision 30583, May 2, 1910. Also known as Treasury Department Circular

No. 23 (Division of Customs).
4 Treasury decision 31981, Nov.




2,

1911.

86

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

apply, however, to goatskins, sheepskins, or articles manufactured
from the hides o f neat cattle.
The delay and expense necessitated by even these mild regulations
caused considerable opposition among American importers, which
may have been increased by the cutting off, through the war, of
hide importations from Europe, especially from Russia, and the
consequent augmentation o f imports from more dangerous sources,
such as China. Moreover, tests seemed to show that soaking in
bichloride o f mercury solution o f the prescribed strength for so
brief a period as half an hour was totally insufficient to exterminate
anthrax spores.1
Accordingly, late in 1915, the regulations were modified2 to permit
the substitution of either o f two methods of disinfection which ex­
periment had indicated were more efficacious. One of these was
immersion for not less than 48 hours in a solution containing 10
per cent o f sodium chloride (common salt) and 2 per cent o f hydro­
chloric acid in water; the other was immersion for not less than 24
hours in a solution containing 2,500 parts o f a 1 per cent formic
acid solution and 1 part of mercuric chloride.3 The Secretary of
Agriculture, according to the order, stated that “ these methods of
disinfection for anthrax hides or anthrax suspected hides will be
acceptable to his department.”
In a little over four months, however, another amendment to the
regulations was issued which, as far as anthrax is concerned, almost
completely frustrated their purpose. This remarkable amendment4
provided that “ in future when a shipment of hides which requires
* * * a certificate of disinfection arrives without such certificate ”
the importer might apply for permission to perform the disinfection
at his tannery. I f the importer had “ proper facilities ” the Depart­
ment o f Agriculture was to permit the disinfection under supervision
o f an inspector from the Bureau of Animal Industry, and the cus­
toms collector, upon being so advised, “ shall permit the hides to go
forward from the port of entry to the tannery under customs seals,”
notification o f his action being sent to the inspector who is to super­
vise the disinfection.
It has been seen, however, that in almost every group o f cases
studied most o f the tannery workers contracting anthrax did so in
the early processes of trucking the hides to the tannery, receiving,
checking, sorting, and storing them. Another striking revelation is
the large proportion of cases among longshoremen, teamsters, and
other baggage handlers, including even a Government weigher at­
1 See p. 118.
2 Treasury decision 3 5761, Oct. 11, 1915.




3 The same as bichloride of mercury.
4 Treasury decision 36188, Feb. 25, 1916.

ANTHRAX AS AN OCCUPATIONAL DISEASE.

87

tached to the customhouse.1 In view of these facts, it would seem
that permitting suspected materials to arrive in America and to
spread contagion in their wake from dock to railroad, from railroad
to dray, and from dray to warehouse and tannery before they were
finally disinfected was a violation of elemental principles of caution
and sanitation.
Nevertheless, the Agriculture and the Treasury Departments con­
tinued to weaken their requirements. Under date of April 20, 1916,
still another modification 2 was promulgated, setting forth that there­
after even “ foreign hides which can not be certified by an American
consul as coming from a district in which * * * anthrax is not
prevalent” were to be allowed the right o f shipment. The only
restriction was that the bales must “ have been whitewashed under
consular supervision,” and that they were “ subject to disinfection
after arrival at destination in this country.” The provisions for
supervising the disinfection at destination remained the same as
before, but the process was made more thorough, immersion in a
1 to 1,000 solution of bichloride o f mercury for at least 48 hours
being now required. While this rule extended a measure of protec­
tion to tannery workers in the later processes which even the original
requirement o f disinfection for 30 minutes did not afford, it still
left transportation workers and those engaged in receiving the
hides at the tanneries exposed to the full hazard of the disease.
However, even the prescribed method o f disinfection was not always
sufficient to destroy the anthrax spore. Moreover, there were serious
difficulties in the way of enforcement, since the consuls, who were to
require the whitewashing of hides coming from anthrax-infected
districts, did not always possess sufficient information as to the loca­
tion of the outbreaks. This source of danger was pointed out as early
as 1897. “ Some of these officers (consuls) have frankly stated that
the regulations for the disinfection of hides were not and could not
be enforced by them.” 3
Under these circumstances the increasing number of anthrax cases
continued to force attention, and in the fall of 1916 a special commit­
tee o f the National Association of Tanners cooperated with the
Federal authorities in the preparation of more effective provisions
for the disinfection of imported hides.4 Under the new regulations
the importation of hides, wool, glue stock, or other products from
animals affected with anthrax is prohibited. For hides from
anthrax-infested districts the 30 minutes’ immersion in 1 to 1,000
1 See fatal case No. I l l , p. 75.
2 Treasury decision 36332, Apr. 20, 1916.
3 Delaware College Agricultural Experiment Station : Anthrax, A Study of National
and of State Legislation on This Subject, Bui. No. X X X V I I , 1898.
4 Now issued as United States Treasury Department and Department of Agriculture
Joint Order No. 1, effective Jan. 1, 1917.
(See Appendix A .)




88

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

bichloride of mercury solution allowed at the port of shipment is
extended to 24 hours’ immersion. Materials shipped without disin­
fection and without a consular certificate showing nonprevalence of
anthrax may still be received in this country and transported, under
customs seals, to the tannery, where they are to be disinfected under
supervision o f an agent o f the Bureau o f Animal Industry at the
tannery’s expense.. The previous method o f disinfection at the
tannery, namely, soaking for not less than 48 hours in a 1 to 1,000
bichloride o f mercury solution, is still accepted, but as a substitute
hides may be immersed for not less than six days in a 1 to 5,000
bichloride o f mercury solution, followed by not less than 5 days in
lime o f the usual strength for dehairing, which is believed by the
bureau effectively to disinfect hides against anthrax.1 The new
regulations also contain for the first time detailed requirements for
the disinfection o f glue stock, bones, hoofs, wool, and hair, and of
cars, boats, other vehicles, and certain premises.2
The growing frequency of anthrax among industrial workers in
New York and Massachusetts during 1915 and the early part o f 1916
stimulated interest in the question among officials of these States.
In New York the industrial commission investigated the reported
cases which developed during the last 10 months o f 1915, and called
a conference on the subject for March 27, 1916. Four State depart­
ments were represented— the conservation commission, the depart­
ment of agriculture, the department of health, and the industrial
commission. The conservation commission reported that in response
to a petition from the residents o f one county, who complained o f a
leather factory as the polluting agent, it was studying the relation
t)f stream pollution to anthrax. Appointment o f a committee o f one
representative from each department was suggested for the purpose
of studying the question thoroughly. Recommendations later issued
by the division o f industrial hygiene of the industrial commission
are reprinted in Appendix A.
In Massachusetts the occurrence, early in 1916, o f 25 cases, at least
four o f which were fatal, and which centered among the tannery
workers at Woburn and Winchester, started an investigation by the
State department of health, with the cooperation o f the board of
labor and industries. Investigators were sent to near-by States to.
trace the suspected shipments of hides to their source and to learn
whether cases had been caused by them elsewhere. It was found
that 20 o f the cases were infected from one source, a cargo of dried
hides from China.3 Rules subsequently suggested by the State board
o f labor and industries for the handling o f hides, skins, and wool
are reprinted in Appendix A.
1 See p. 120.
2 See Appendix A .
3 United States Public H ealth Reports, Dec. 15, 1916, pp. 3 3 9 9 -3 4 0 2 .




89

ANTHRAX AS AN* OCCUPATIONAL DISEASE.
COMPENSATION.

Also, in the matter o f workmen’s compensation for victims of oc­
cupational anthrax the United States has made but little progress—
much less than other leading countries. While Great Britain, Ger­
many, France, Holland, Italy, South Australia, and the Canadian
Province o f Ontario have for years been awarding such compensa­
tion, in the United States only one State is as yet acting consistently
on this principle.
The Massachusetts workmen’s compensation law, when it was
drafted, was made to cover “ personal injury,” instead of merely
“ personal injury by accident” as did most of the other State laws.
Occupational diseases were thus included, and during the first three
years o f the operation of the act, closing June 30, 1915, there were
filed with the industrial accident board 30 claims for compensation
on account o f occupational anthrax, in 17 o f which awards were
made.
8 .—CLAIM S F O R C O M P E N SA T IO N ON ACCOU N T OF A N T H R A X F IL E D U N D E R
T H E M A SSA C H U SE TTS W O R K M E N ’ S C O M P E N SA T IO N L A W , 3 Y E A R S E N D IN G JU N E
30, 1915.

T a b le

Compensation.
Occupation.

Duration of
disability.
Indemnity for wage loss.

Medical aid.

H
IDE AND SKIN WORKERS.
Lumper in beam house...................... No disability___ None due.............................. . . .
Not reported.
1 week................. ........do................................................
Beamster................................................
Do.
Do.
Machine operator in beam house___ If weeks.............. ........do................................................
Lumper.................................................. If weeks.............. ........do................................................
Do.
Lumper in dry loft.............................. 2f weeks.............. $2.86..................................................
Do.
Lumper in storehouse......................... 2f weeks.............. $2.57..................................................
Do.
Do.
Lumper in beam house...................... 2f weeks.............. $5.43..................................................
Do.
Tanner ................................................ 3 weeks................ Not reported...................................
Do.
D o.................................................... 3f weeks.............. ........do................................................
Do .................................................. 4 weeks................ ........do................................................
Do.
weeks.............. $14.28................................................ $5.00.
Leather finisher doing “ seasoning” .
Foreman in rough stock department. 6 weeks................ $18.00................................................ Not reported.
Do.
Laborer in leather factory.................. ........do................... $16.00................................................
Do.
Tanner.
......................................... 6f weeks.............. Not reported...................................
..
Do.
Lumper ............................ ................... 7 weeks.............. $21.43................................... .
weeks.............. $23.79................................................
Splitter of skins in leather factory...
Do.
Lumper in coloring room of a calf­ Fatal.................... Unable to locate dependents in
Do.
Europe.
skin tannery.
Do.
Worker in soaks in beam house........ ........do.................. ........do................................................

5f

7f

:

TRANSPO
RTATION WORKERS.
Longshoreman......................................
D o....................................................
.................................
Do
Do
.........................................
D o....................................................
Do
.................................

1 week.................
3f weeks..............
5? weeks..............
6weeks................
85- weeks..............
Fatal....................

Do.
None due........................................
$11.42................................................
Do.
$23.22................................................ $16.00.
$24.00................................................ Not reported.
Do.
$58.04. ..........................................
C
1)

0

)

Laborer for private weigher............. 7 f weeks............ $34.46....................................._ ............. Not reported.
Do............................................. 15 weeks.............. $78.00................................................ $56.00.
Do
....................... 15? weeks............ $110.86................................................... $1.00.
W
OOL AND HAIR WORKERS.

Foreman wool-pulling department.. 2weeks............. None due.........................................
Picker hand in felt factory................. I l f weeks............ $83.84................................................
Over 2 years; $754.69..............................................
Brush drawer in brush factory .




exact time not
reported.

i Compensation refused.

$9.50.

Not reported.

$18.29.

90

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

Hide and skin workers made up over one-half of the claimants,
or 18 out o f the 30. O f these, seven were “ lumpers ” in leather fac­
tories, six o f whom were employed in one establishment in Salem.
One was a foreman in the “ rough stock ” department in a goat and
sheepskin tannery; one was splitting skins in a leather factory; one
was a leather finisher engaged in “ seasoning ”—he applied finish to
skins with a sponge, and an “ eruption on both his hands and fore­
arms ” is reported. One tannery employee worked in “ soaks in beam
house” ; there were also a “ machine operator in beam house,” a
“ beamster,” and a laborer, all employed in leather factories. In four
cases it was merely stated the “ men worked in tanneries.”
Transportation workers were represented by nine claimants. Six
o f these were longshoremen, of whom five were employed by one
concern in Boston. One was, by his own testimony, on or about July
24, “ discharging buffalo hides from a steamship. I had been on this
job four days when I got a scratch on my arm. The following day
I noticed something like a Avart which was itchy. I finished the job
and there was no work until August 5. I started to go to work on
this day, but my arm was itchy and sore, and I went to the hospital
instead, where they said I had anthrax, and was operated on right
away.” Another of the longshoremen “ had been pushing behind
truck unloading hidfcs for three days, and he stopped work at the end
o f the third day, as his hands began to swell ” ; two were “ handling
salt hides,” and one “ green ” hides, at the time they contracted an­
thrax; the sixth was unloading wool and hides, in addition to other
cargo. The remaining three transportation workers were reported as
“ laborers,” all employed by a firm of weighers in Boston.
Two cases occurred among woolworkers; one was a foreman in the
wool-pulling department o f an establishment where wool was pulled
and scoured; the other was a “ picker hand ” in a felt factory. The
report reads: “ Sliver ran into his leg. It was removed and leg was
poisoned from wool. Anthrax and complications on left lower ex­
tremity.”
One applicant for compensation was a brush drawer. She scratched
her face over the left eye, and as a result anthrax developed.
The periods o f disability ranged from one week to over two years.
In one case no disability resulted and the employee remained at
work; five workers were disabled from one to two weeks. In none
of these six cases was compensation awarded, as the law requires a
waiting period of two weeks. Medical aid is allowed by the Massa­
chusetts law from the day o f disability, but in only one of these six
cases was it stated that such aid was given. In the remaining cases
disability lasted beyond two weeks, and 17 awards for compensation,
beginning with the third week and equal to two-thirds o f average
weekly wages, were made. The amounts ranged from $2.57 for a




ANTHRAX AS AN OCCUPATIONAL DISEASE.

91

disability of two and two-sevenths weeks to $754.69 for a disability
o f over two years. This case was finally disposed of by a lump-sum
payment toward the close of the second year of weekly payments.
In addition to the weekly indemnity for loss of wages, medical
attendance costing from $1 to $56 was paid for in at least six cases.
Three o f the claims were filed in behalf of workers whose anthrax
attacks ended fatally, the course of the disease being extremely rapid
in all three instances. Two o f the victims were taken to a hospital
two days after they began to feel i l l ; one died in five hours and the
other in 17 hours after admission. In neither of these cases was
compensation paid, as it was impossible to locate the dependents in
Europe. In the third fatal case, in which death occurred three days
after admission to the hospital, the claim for compensation filed by
the victim’s mother was disallowed by the arbitration committee to
which it was referred. While there was no question as to the cause
o f death, the insurer contended that the disease was not contracted
while the deceased was in the employ o f their policyholder, but while
working for another company, which was not insured under the act.
One-third (10) of the cases considered in this section occurred in
Boston. Six were from Salem; Haverhill, Peabody, and Lynn fur­
nished each two cases; Worcester, Davenport, Millbury, and Woburn,
one case each; in the remaining four cases the place o f employment
could not be ascertained. Only one of those injured was a woman.
The youngest was 17 years old; one-half, or 15, were between the
ages o f 20 and 29, eight were between 30 and 39, five between 40 and
49, and one was 60 years o f age.
Most frequently, or in nine cases, the lesions were on the face. In
seven they were on the hand or arm ; five workers, of whom one died,
had the pustule on the neck; one, who died, had it on the chest, and
one on the leg. In the seven other cases the location o f the lesion was
not stated; one o f these, however, ended fatally and, judging by the
symptoms, it was probably a case of internal anthrax. The cause o f
death was given as “ lobar pneumonia,” and for this reason the case
was not listed among those reported in the United States registration
area. Nevertheless, a blood smear sent to Harvard Medical School
showed the presence o f anthrax bacilli.
Another State which has taken the same enlightened position as
Massachusetts is California. The compensation statute o f this
western Commonwealth applied, as enacted, only to “ personal in­
jury sustained . . . by accident.” By amendment in 1915 the words
“ by accident” were stricken out, so that the law is now as broad
in scope as that o f Massachusetts. Up to May 1, 1916, however,
no claim for anthrax had been presented to the industrial accident
commission, so that the first California award for this trade illness
had still to be made. In 1915, also, Pennsylvania amended its




92

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

constitution to allow the passage o f a law establishing compensa­
tion for occupational diseases, and the legislature o f 1917 will have
an opportunity to enact the necessary legislation.
The compensation laws of the remaining States do not cover dis­
eases o f occupation. Nevertheless in a certain number of cases
indemnity for anthrax has been allowed when infection developed
as a result o f an accidental injury sustained by the worker in the
course o f employment.
In New York, for instance, five such claims were filed during the
first 22 months of the operation o f the act (July 1, 1914, to May 1,
1916). In three cases agreements were arrived at between the in­
jured workmen and the insurance carriers, and compensation for
periods ranging from two to six and two-sixths weeks had already
been paid at the time o f this writing. In another case, in which
death occurred, it was recommended that the claim be disallowed as
the scratch through which infection occurred was received while the
man was being shaved, and was not due to an accident in the course
o f employment.1 On the remaining claim, which was the first to be
presented in New York, the commission awarded seven and fivesixths weeks’ compensation. The insurance company took an appeal,
but later withdrew it and paid the claim. The workman concerned,
an employee in a plant where raw skins are handled, was trimming
sheepskins on the day o f the accident. He hit his jaw against the
beam on which he was placing skins for the purpose of cutting off
the head, tail, and legs. The accident occurred in the forenoon and
caused an abrasion o f the skin, with pain and smarting, so that
during the afternoon the claimant frequently rubbed the sore place
with his hand. On the next day a doctor was called in, found a
pustule at the seat o f the injury, and diagnosed the case as anthrax.
The commission decided that the injury “ was an accidental injury,
and arose out o f and in the course of his employment.” The in­
surance carrier appealed on the ground that anthrax is an occupa­
tional disease in tanning, and that therefore the compensation act
does not require damages, but the court sustained the commission,
thus establishing a favorable precedent for New York State.2
The situation in New Jersey is the same as that in New York.
Records o f the employers’ liability commission in that State for the
year 1915 reveal four cases in which “ there was previously a specific
accident which later became infected (anthrax).” In three cases
the employees were working on hides and skins; the occupation of
the fourth worker is not given; it is merely stated that he was in­
jured on a shearing machine. One was a fatal case; the other em­
1 For authentic cases of infection through shaving brushes, see p. 23.
2 The appeal was argued in the Appellate Division of the Supreme Court, a t Albany,
during the M ay, 1916, term.




ANTHRAX AS AN OCCUPATIONAL DISEASE.

93

ployees were out for three, five and two-sixths, and eight weeks, re­
spectively. The amounts awarded in the fatal case, where there
were no dependents, were $100 for burial and $13 for medical aid.
In the other cases compensation at half the average wages amounted
to $29.17, $16.67, and $36, respectively, and for medical aid $33,
$41.50, and $44 was allowed.
In Pennsylvania the workmen’s compensation law of 1916, similar
in intent to the laws o f New York and New Jersey, provides that “ the
terms ‘ in ju ry ’ and ‘ personal in ju ry’ as used in this act shall be
construed to mean only violence to the physical structure of the body,
and, such disease or infection as naturally results therefrom.” When
in April, 1916, a claim was filed with the workmen’s compensation
board on the part o f a hair sorter1 who had contracted anthrax,
the claim was disallowed, as the examination o f the physician u dis­
closed no evidence o f any wound or cut upon the person of the
claimant nor did the investigation, made at this time, discover any
unusual incident or occurrence that had happened to the employee
in the course o f his employment. The claimant also admitted that
there had been no wound or other unusual incident.”
As far as can be learned no other State has yet been called upon
to decide a compensation claim arising from anthrax, but probably
the outcome would be the same as in New York and New Jersey.
While this would permit indemnity for a limited number o f cases—
those resulting from a definite physical wound—such a policy is
far from just. In equity to sufferers from the disease, no less than
from the standpoint o f enlisting the full interest o f employers in
methods o f preventing infection, all cases of occupational anthrax
should be compensated upon the same terms as industrial accidents.




1 W orking in a tannery.




C H A P T E R

V .

ANTHRAX IN EUROPE.
In Europe, where occupational, anthrax has been a matter of public
moment for a much longer period than in the United States, the cam­
paign against it has been pressed with a consistency and vigor not
yet displayed in this country. Among legislators and administrative
officials, no less than among employers and physicians, there has been
keen realization of the dangers o f the scourge and of the urgency o f
measures for its eradication.

PRIVATE ACTIVITY.
The dramatic acuteness and high mortality of anthrax have led
abroad to considerable private activity for its study, cure, and pre­
vention. In England, Germany, France, and Italy influential associ­
ations of manufacturers have interested themselves in the problem,
while scientific societies o f international scope have cooperated in
the campaign.
ANTHRAX INVESTIGATION BOARD FOR BRADFORD AND DISTRICT.

Since in England the manipulation of dangerous kinds of wool is
practically confined to the West Riding of Yorkshire, the chamber
o f commerce o f that district, at a joint meeting with representatives
o f labor unions, organized in 1905 the now famous Anthrax Investiga­
tion Board for Bradford and District. The purposes of this organi­
zation are (1) the investigation of anthrax generally; (2) the more
precise determination of the classes o f wool and hair in connection
with which the danger of anthrax arises; and (3) the discovery of
further means of prevention. The investigation is carried on
through inquiries into cases of anthrax, and samples are collected of
the material causing the infection. The data thus obtained are
brought to the knowledge of the manufacturers. The board has en­
gaged the services of a bacteriologist, some of whose duties are
(1) the examination of material which has caused outbreaks o f
anthrax; (2) systematic examination of samples irrespective o f any
such outbreaks; (3) studying o f the part played in infection by the
sand, dirt, and organisms present in the material; (4) verification of
doubtful cases and examination o f material submitted by physicians*
Particularly careful study is given to the urgent question of disin­
fecting raw wool, and especially to the removal of blood clots and
bloodstained fibers, which are frequent carriers o f spores.
42806°— Bull. 205—17------ 7




95

96

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

In order to secure effective results a large and representative mem­
bership was considered necessary. The board is therefore composed,
in addition to the bacteriologist, the honorary consulting chemist,
and the secretary, of 18 members, elected annually from among the
manufacturers, the members of the Bradford Chamber of Commerce,
and the health committee of the Bradford City Council; occasionally
representatives of organized labor are included. The activity of the
board is made possible chiefly by private contributions, the majority
o f contributors being employers, although labor organizations and
occasionally private individuals also subscribe. A point deserving
special mention is the annual subvention of $250 granted for several
years by the Home Office'^ which in 1913 was raised to $500.
T o obtain the highest possible degree of efficiency the board is con­
stantly seeking the cooperation of the medical profession. Circulars
are distributed inviting physicians to send in information of each
case o f suspected anthrax, together with serum or blood for examina­
tion. The board emphasizes the necessity o f speedy action in sus­
pected cases and urges particular care with regard to bloodstained
materials. Its statistics, which will be discussed later, are excellent,
and the educational propaganda which it carries on is undoubtedly
an important factor in the antianthrax campaign.
GERMAN EMPLOYERS' MUTUAL TRADE ASSOCIATIONS.

The activity of the German manufacturers has taken an entirely
different form. In Germany preventive measures are introduced
by the employers’ mutual trade associations ( Berufsgenossenschaften )
in those trades where the danger o f anthrax is present. These asso­
ciations are organized primarily for the purpose o f carrying mutual
Workmen’s compensation insurance. Since it is to their financial ad­
vantage to have as few industrial accidents as possible, the activity
of these associations is remarkably effective, aiming at the pre­
vention o f both industrial accidents and diseases. The employ­
ers o f practically all industries have combined into such associations
and, as anthrax is compensated as an industrial injury, the
associations for the leather, wool, hair, and brush industries have
set forth carefully worked out rules based on the latest achieve­
ments o f technical and sanitary science. These rules when officially
indorsed have the force of law. A considerable incentive to the ob­
servance o f these rules is provided in the cleverly arranged sliding
scale o f premiums required from the employer and based on the
number and effectiveness o f safeguards introduced in his factory;
that is, the more attention is paid to disease and accident prevention,
the lower are the insurance premiums charged the owner of .the
establishment.




ANTHRAX AS AN OCCUPATIONAL DISEASE.

97

The employers conduct the accident insurance activity of the trade
associations, but in order to elicit the fullest cooperation of the
workers they have given the latter a voice in framing the safety
and sanitation rules; they have gone even further and have made
the workers responsible for compliance with those rules which con­
cern them. The value o f personal appeal has also been appreciated
by these associations; they have addressed warnings to the workers
instructing them in the dangers and urging precaution. The remark­
able thoroughness with which these employers’ mutual associations
have carried out their tasks has placed them in the foreground as
powerful factors in the promotion o f industrial health and safety.
ASSOCIATION OF FRENCH MANUFACTURERS FOR THE PREVENTION OF INDUS­
TRIAL ACCIDENTS.

The idea o f employers’ mutual organization for the purpose of
accident prevention has found application in other countries also. In
France in 1883 the manufacturers combined into the “ Association
des industrials de France contre les accidents du travail,” which by
a Government order was recognized in 1891 as a public service or­
ganization ( Etablissem ent (Putilite publique ).1 This association pub­
lishes instructions to workers similar to those issued by the Home
Office in England and by the German trade associations, and re­
quires that they be posted in work places* where the danger o f anthrax
is present.
MILAN LABOR CLINIC AND OTHER PRIVATE ACTIVITY IN ITALY.

In 1910 the celebrated Labor Clinic at Milan, the first of its kind
in the world, was established by a group of socially minded medical
men “ for the scientific study and prevention of occupational dis­
eases.” In cooperation with the Permanent International Commis­
sion for the Study o f Occupational Diseases, which has its head­
quarters in the same city, the clinic has issued sanitary regulations
and is carrying on an educational propaganda among workers and
employers in the industries which involve exposure to anthrax.
There exists in Italy also the Industrial Employers’ Association for
the Prevention o f Industrial Accidents ( Associazione degli Ind us tria li per prevenire g li In fo rtu n i del Lavo ro ), an organization very
similar to the French association which has already been described.
This body issues instructions for workers, and also publishes occa­
sional studies on occupational anthrax.
A notable instance of self-imposed but rigidly observed regula­
tions is found in the hair works o f Carlo Pachetti & Co., at Pavia.
This is the largest establishment of its kind in Italy, and it re­
ceives practically all the hair imported. The firm is equipped with
1 Walter Abelsdorff: Gewerbliche Milzbrandvergiftungen in Deutschland, Frankreich,
England, und Holland, 1915, p. 7.




98

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

all the requisites of modern industrial hygiene, and has adopted the
most advanced measures for the prevention o f anthrax. Each
process is carefully regulated. The hair is disinfected; great care is
given to ventilation, cleanliness, and the elimination o f dust; and
medical supervision o f the highest order is instituted, even a bac­
teriological laboratory being provided and a supply o f the Sclavo
serum being kept. The proprietor states that cases of anthrax are
detected in the earlier stages and promptly treated, and that the
patients usually recover “ without cessation o f work for more than
a day or two.” 1
INTERNATIONAL ORGANIZATIONS AND CONGRESSES.

Anthrax has also been carefully studied outside o f industry.
Besides the Permanent International Commission for the Study of
Occupational Diseases, already mentioned, both international con­
gresses on occupational diseases which have so far taken place, one
at Milan in 1906 and the other at Brussels in 1910, have discussed the
subject. More prominence was given to it on the program o f the
proposed third congress on occupational diseases, which was scheduled
for Vienna in 1914 but was postponed on account of the war. In that
congress, papers were to be read by such authorities as Dr. Legge
o f England, Cavaille o f France, and Dr. Holtzmann of Germany.
Keen interest is also taken in the subject by the International Asso­
ciation for Labor Legislation, o f which the American Association for
Labor Legislation is an active branch. At the seventh delegates’
meeting o f the international body, which took place in Zurich Sep­
tember 10 to 12, 1912, a subcommittee was appointed for the study
o f occupational anthrax, the recommendations o f which will be found
in the concluding part o f this report. The subject was also on the
program o f the eighth delegates’ meeting, which was expected to
meet in Bern September 14 to 17, 1914.

GOVERNMENTAL INVESTIGATIONS.
Probably the first official investigation of anthrax was made in
1842 in France. In that country severe epidemics of the disease
among animals in certain districts and its consequent frequency
among human beings had led to these areas being called “ champs
maudits,” or cursed fields. The investigation was undertaken at a
time when medical science was rather primitive, and antedated by
eight years the discovery o f the bacterium. Hence it did not bring
forth any considerable results, but the interest of the Government is
significant. In later years the question of anthrax was taken up by
a commission on industrial hygiene organized under the Ministry o f
Labor.
1

See C. H. W. Page : British Industrial Anthrax, in Journal of Hygiene, December,

1909, p. 373.




ANTHRAX AS AN OCCUPATIONAL DISEASE.

99

In England the initiative against anthrax was taken by Parlia­
ment, where this subject was considered as early as 1878. In the
year 1880 the Government, alarmed by the large number of cases
among workers, appointed a commission to study the situation. In
1893 another official investigation was undertaken. These efforts,
however, did not solve the problem, and in the year 1913 the Home
Office considered it necessary to appoint a departmental committee
for the purpose o f investigating anthrax in the textile industries.
In Germany the Government was stirred by the alarming propor­
tions which the disease assumed in the hair factories of Nuremberg
and in 1894 an investigation was ordered all over the Empire.
Inquiries on a more limited scale had been made as early as 1875.
In Belgium anthrax has been a familiar subject for many years,
but it was not until 1900 that Government interest became active.
A t that time several cases occurred in an important tannery and the
Government ordered the medical factory inspectors to make an
investigation, which, at first limited to skin and hair industries, was
afterwards extended to all other occupations subject to the danger
of anthrax.
Moved to action by the number of anthrax cases reported in the
tanning industry under the accident compensation law of 1901, the
general director o f labor in Holland also ordered a painstaking
investigation o f that industry, the report of which was published in
1913.1

SYSTEMATIC REPORTING AND RESULTANT DATA.
Illuminating as are most of the studies just mentioned, they cover
only limited periods, and emphasize the necessity for more thorough,
continuous collection of data. This has been sought in various coun­
tries, usually through the enactment of compulsory reporting laws.
GREAT BRITAIN.

Apparently the earliest requirement concerning the reporting of
anthrax as an occupational disease is found in section 29 of the Brit­
ish Factory and Workshop Act o f 1895,2 later superseded by the
similar law of 1901.3 Section 73 of the latter act, referring to dan­
gerous and unhealthful industries, requires every medical practitioner
called in to visit a patient suffering from lead, phosphorus, arsenic,
or mercury poisoning, or anthrax, contracted in a factory or work­
shop, to report the case to the chief inspector of factories at the Home
Office, London. For every notice sent, the physician receives a fee
o f 2s. 6d. (61 cents), while failure to comply with the law makes
1 Directie van den Arbeid.
2 57 and 58 Viet., ch. 37.
S i Edw. V II, ch. 22.




De Looinijverheid in Nederland, The Hague. 1913.

100

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

him liable to a fine o f not over 40s. ($9.73). Similarly the manager
or owner o f the factory must report every case o f any of the abovementioned diseases to the inspector and to the certifying surgeon for
the district. Upon receipt of the report the latter must visit the
patient and the place where the case occurred and report to the chief
inspector.
The report by the factory management must cover the following
points:
1. Name o f establishment.
2. Name and address o f proprietor.
3. Kind o f work done.
4. Nature o f the disease.
5. Name and address o f the patient.
6. Age and sex.
7 . Precise statement as to occupation.
In the report of the factory inspector to the Home Office, which
must be sent within seven days after receipt o f the report from the
certifying surgeon, the sorts of suspected wool, hair, bristles, hides,
or skins must be stated, as well as the country o f origin.
For the first few years but a small number o f cases was reported—
only 114, for instance, for the years 1896 to 1899, inclusive. Since
that date reporting has been more complete, and larger numbers of
cases have been brought to official attention.
The following table is compiled from the annual reports of the
chief factory inspector o f Great Britain and shows the number of
cases o f anthrax reported to that official for the years 1900 to 1913
and the number o f these cases which were fatal:
T a b le 9 . —CASES OF A N T H R A X AN D NU M BER OF D EATH S T H E R E F R O M R E P O R TE D
TO CHIEF F A C T O R Y INSPECTOR OF G R EAT B R IT A IN , 1900 TO 1913, B Y IN D U ST R IE S
A N D Y E A R S.
[Source: Seventeenth Abstract of Labor Statistics of the United Kingdom, 1015, pp. 124,125.]

Wool industry.

Skins and
hides.

Horsehair.

Other
industries.

Total.

Year.
Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths
re­
re­
re­
re­
re­
re­
re­
re­
re­
re­
ported. ported. ported. ported. ported. ported. ported. ported. ported. ported.
1900..............................
1901..............................
1902..............................
1903..............................
1904..............................
1905..............................
1906..............................
1907..............................
1908..............................
1909..............................
1910..............................
1911 ............................
1912..............................
1913..............................

9
6
12
20
12
34
24
23
18
28
28
35
31
43

2
4
2
5
1
12
8
3
3
3
3
10
6
4

12
9
10
7
12
7
10
17
10
8
6
8
7
5

3
1
2
1
4
1
5
4

Total................

323

66

128




1
5
5
1
3
4
5
2
1
6
3

1

9
20
11
12
18
17
18
12
13
18
14
20
8
19

26

209

2
1
1

2

7
4
5
8
8
1
14
6
6
2
3
1
1
3

38

69

1
5
2
1
3
2
3
1
2

37
39
38
47
50
59
66
58
47
56
51
64
47
70

7
10
9
12
10
18
21
11
7
12
9
11
6
7

20

729

150

AN TH RAX AS AN OCCUPATIONAL DISEASE.

101

These data show a marked though irregular increase in the number
o f cases reported, which appears rather unexpected in view of the
several preventive measures introduced during that period. The
increase, however, may be due not to the lack or ineffectiveness of
protective legislation, but to more extensive use o f dangerous mate­
rials or to a more satisfactory compliance with the notification law.
Probably the fact that the "Workmen’s Compensation Act o f 19061
made anthrax a compensable disease has had much to do with
securing fuller reports. As will be seen from the table, the frequency
of anthrax varies considerably in the different industries. It is
significant that in 11 o f the 14 years for which the data are given
the largest number o f cases occurred in the wool industry, which is
more developed in England than any o f the other industries subject
to anthrax. In 6 o f these 11 years, also5 one-half or more of the total
cases of anthrax reported each year occurred in that industry. Next
in the prevalence o f anthrax is the leather industry. Practically
all industrial cases o f the disease occur among workers in the wool
and leather industries and in animal-hair works; in the remaining
occupations anthrax is less frequent.
Air important element in anthrax statistics is the death rate. A
high rate may mean absence o f curative measures, or it may mean
lack o f familiarity with the symptoms of the disease, which prevents
early diagnosis and postpones treatment to a stage when cure is no
Longer possible. The death rate for the seven years 1900 to 1906 was
25.9 per 100 cases; but a marked improvement took place in the
subsequent similar period, when it was only 16 per cent.
More detailed statistics are available for the wool industry o f the
West Riding o f Yorkshire, which is under the supervision o f the
anthrax investigation board organized for that district. The fol­
lowing table illustrates the situation in that industry:
10.—CASES OF ANTHRAX IN THE WOOL INDUSTRY REPORTED TO THE AN­
THRAX INVESTIGATION BOARD FOR BRADFORD AND DISTRICT, 1906 TO 1914.

T a b le

[Com
piled from annual reports of the Anthrax Investigation Board for Bradford and District.!




C
ases reported.
Year ending
Oct. s i -

External. Internal.

igo?............
1908............
1909............
1910............
1911............
1912............
1913............
1914............
1915............

1
4
15

Total. ..

129

1 6 Edw.

11
8

1
7
12

20

18
1
4

Total.

1
2
1

12
10

5
3

19
18

1

Deaths
reported.

21

2

15

1
8
12

1
8
16

144

VII, ch. 47, third schedule.

3
*3
2
1
8

5
3
5

2

32

102

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

Comparison of these data with the data for the wool industry of
the whole country for the almost exactly corresponding period of
1906 to 1913 shows that more than one-half of the anthrax cases in
this industry occur in the district o f the West Kiding. The high fre­
quency o f anthrax in that district is caused by the use of wool im­
ported from such countries as Persia, Turkey, India, and Russia,
where anthrax is endemic and where very little or no attention is
given to the requirements of hygiene.
GERMANY.

In another leading European country, Germany, where consider­
able attention is being given to the subject of anthrax, fairly com­
plete data are obtainable, but only for the last few years. For the
years 1894 to 1903 admittedly incomplete statistics are reported by
Dr. Legge.1 He states that in that period there were 901 cases of
anthrax, including those in agriculture as well as in manufacturing,
o f which 128 were fatal.
A great improvement in the collection of information was brought
about in 1910, when an order of the Federal Council went into effect,
extending to anthrax the notification and other provisions of the
act o f 1900 relative to diseases constituting a public menace.
Besides the usual data as to name, sex, age, address, and occupa­
tion, the following information, important from the medical point of
view, must be given:
1. Date when taken ill.
2. Date o f first medical treatment.
3. Date o f admission to a hospital.
4. Date when the disease was diagnosed by the doctor as anthrax.
5. Was the disease bacteriologically recognized as anthrax ? When ?
B y whom?
6. Nature o f the disease: Anthrax of the lungs, anthrax of the
bowels, anthrax o f the skin? I f anthrax of the skin, what part of
the body was affected?
7. Has the sick person recovered ? Has he died ? When ?
Even more minutely are taken up the questions o f the patient’s
occupation and o f the manner in which infection was transmitted.
The method o f filling out the schedule calls for cooperation between
several governmental agencies, namely, the police authorities, the
district medical man or veterinary surgeon, and the factory inspec­
tor. A duplicate of the filled-in schedule is sent to the authority in­
trusted by the provincial government with its verification. Upon
verification a copy is transmitted to the Imperial Health Office at
Berlin, where it must be received within two weeks o f recovery or
death o f the patient.
1 T. M. Legge, in The Lancet, Mar. 18, 1905, p. 692.




103

AN THE AX AS AN OCCUPATIONAL DISEASE,

The statistics obtained under this law are published annually and
are of more interest than the English figures because they include all
cases, nonoccupational as well as occupational. Up to the present,
figures are available only for the years 1910 to 1912.
T a b le

11.—CASES OF ANTHRAX REPORTED TO THE IMPERIAL HEALTH OFFICE
OF GERMANY, 1910 TO 1912.
[Com
piled from Reichs-Arbeitsblatt, July, 1914, p. 588.]
1910
Industry.

Agriculture.........................
Cattledealers, veterinarians,
and fl£|yers.......................
Tannery and other leather
workers...........................
Hair and brush workers...
Wool com
bing................ . .
M
iscellaneous......................

1911

1912

C
ases Deaths Deaths C
ases Deaths Deaths Cases Deaths Deaths
report­ report­ per 100 report­ report­ per 100 report­ report­ per 100
ed.
ed.
ed.
cases.
ed.
ed.
cases.
ed.
cases.
121

142

12

14
103
15

19
3

1

9

Total occupational..,

287

10

1

17

1

75
19
9

10

78

7
4

4

21

5

i6

6

36

13.7

261

36

13.8

246

28

11.4

40

13.9

281

40

14.2

274

36

13.1

2

263

Total anthrax............

114

16

16

-

..........
1

1

Taking the cases in the last four groups as those of anthrax in
manufacturing pursuits, we obtain for the year 1910, 128 such cases;
for 1911, 103 cases; and for 1912, 115. A comparison o f the individ­
ual occupations shows that agriculture, followed by the leather in­
dustry, heads the list in each o f the three years. The death rate is
somewhat higher than that shown by the English figures (17.6,
17.2, and 12.8) for the corresponding years; it is also higher for
the nonoccupational group than for the occupations, which is true
in other countries also. This is explained by the comparative in­
frequency of nonoccupational. anthrax and consequent lack of fa­
miliarity with the symptoms on the part of the victims and their
physicians.
• Owing to the brief period covered by the data no conclusions can*
be drawn as to fluctuations in the prevalence of the disease, but the
situation in the leather industry is worth noting. The number of
cases dropped from 103 in 1910 to 75 in 1911, and to 78 in 1912.
This was probably due to the effective preventive regulations for
that industry which went into effect in the latter part of 1910.
The distribution by sex of all cases reported in the three years
was as follows:




Year.
1910.........
1911.........
1912.........

M
ales.
257
264
254

Fem
ales.
30
1
7
20

Total.
287
281
274

104

BU LLETIN OF THE BUREAU OF LABOR STATISTICS,

The small number o f eases among women is explained by their
more limited employment in the occupations subject to anthrax.

FRANCE.
In France, also, anthrax statistics are of a very recent origin.
They are now being collected as a result of the ministerial order of
July 20, 1910, but, as in England, only cases of industrial anthrax
are included. For the years 1910 to 1912 the cases reported were
distributed among the industries as follow s:
TABLE 1 2 .—CASES

OF ANTHRAX REPORTED IN FRANCE,

1910

TO

1912.

[Com
piled from Reichs-Arbeitsblatt, July, 1914, p. 589.]
Industry.

1910

1911

1912

Leather......................
Wool..........................
Hair..........................
Other.........................

36

23
7
3
9

22
6

4
4

Total...................

54

42

38

10

5
5

According to sex the cases were distributed as follows:
Year.

M
ales.

1910..........
1911..........
1912.........

Fem
ales.

39
35
29

Total.
54
42
38

15
7
9

HOLLAND.
Until 1905, when it was decided that workmen suffering from
anthrax should receive indemnity in accordance with the workmen’s
compensation act, there was no obligation upon either employers,
patients, or physicians to report cases of the disease. Nevertheless,
subsequent inquiry in North Brabant, the principal seat of the Dutch
tanning industry, yielded the following data:
T a b l e 1 3 . — CASES

OF HUMAN ANTHRAX REPORTED IN HOLLAND, 1898 TO 1911.

[Source: D
ireccie van den Arbeid. De Looinijverheid in Nederland, The Hague, 1913, p. 115.]

Year.

1898
........................
1899 ............................
1900...............................
1901 ..............................
1902...............................
1903 ............................
1904
1905...............................
4
_.-




Total C
ases Fatal
cases am
ong cases.
re­
ported. tanners.
2
1
2

2
1
2

2

2

2
2

2
2

1

1

Year.

Total C
ases Fatal
cases am
ong cases.
re­
ported. tanners.

1906...............................
1907...............................
1908...............................
1909...............................
1910...............................
1911...............................

5
9
5
9
5
3

5
9
4
8

1

Total....................

47

45

4

1

5
3

105

AN TH RAX AS AN OCCUPATIONAL DISEASE.

The influence of the compensation law in encouraging the report­
ing o f cases is clearly seen in the figures for the later years. The
general director o f labor estimates that in the tanning industry there
are annually, per 1,000 workmen, 4.7 cases of infection and 0.3 deaths.
In 1911 a new labor code was enacted, section 21 o f which requires
the reporting o f occupational diseases. The reports are to be sent to
the general director of labor within eight days o f the diagnosis. For
each report a fee of 22 cents is paid, and a fine of $20 is provided for
failure to comply with the law. The report is made according to a
prescribed form, giving name, sex, age, and residence of the patient,
also the diagnosis, nature of establishment, kind and duration o f
work, and other necessary data. An interesting educational section
o f the law requires the doctor to have a manual describing the
causes and symptoms of each disease to which the statute applies, as
well as the occupations in which the disease may occur.
For the year 1912, 16 cases of industrial anthrax were reported,
7 o f which occurred among brush workers.1 These figures are prob­
ably incomplete, as is usually the case with data obtained for the first
year o f the operation of a law.
ITALY.

Data for Italy, where anthrax is reportable as an infectious dis­
ease, show tremeiidous prevalence of the disease. Sclavo gathered,
from 1880 to 1890, records of 24,052 cases among human beings, of
which 5,812 were fatal. These figures are carried down to the end
of 1904 in the following table:
T a b le

14.—RECORDED. CASES OF HUMAN A N T H R A X IN IT A L Y , 1890 TO 1904.

[Source: C. H. W. Page, British Industrial Anthrax, in Journal of Hygiene, November, 1909, p. 291.|

Year.

1890.
1891.
1892.
1893.
1894.
1895.
1896.
1897.

Cases.

2,047
2,241
2,077
2,461
2,400
2,179
1,985
2,123
2,327

Deaths.

526
645
650
598
635
621
453
460
433

Deaths
per 100

25.7
28.8
31.3
24.3
26.5
28.5

22.8
21.7
18.6

Year.

189 9
190 0
190 1
190 2
190 3
190 4

Cases.

2,672
1,867
1,992
3,528
3,423
3,104
Total

36,426

Deaths.

461
330
341
403
397
355

Deaths
per 100

17.3
17.7
17.1
11.4

11.6
11.4

20.1

1
Walter Abelsdorff: Gewerbliche Milzbrandvergiftungen in Deutschland, Frankreich,
England, und Holland, 1915, p. 9.




106

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

For later years the data have been published irregularly, but the
following are obtainable: 1
Year.

Cases.

1 9 0 5 _______________________________________________________________ 2, 893

August-December, 1908^____________________________________ 2,188
190 9
2, 736
191 0
2,252
364
January-M ay, 1911_______________________________________________

Most of these cases, it should be said, arise in the nonmanufac­
turing districts.
RUSSIA.

In Russia epidemics of the malady are common, under the name
u Siberian pest,” 528 persons having died of it from 1867 to 1870 in
the single Province of Novgorod. Javorsky is authority for the
statement that in the whole country more than 10,000 cases are annu­
ally observed. Even this appalling figure would seem to be too low,
for P op ov2 declares that in the years 1904 to 1908, inclusive, there
were 80,498 cases, or more than 16,000 a year. As in Italy, however,
it is believed that the majority of cases occur outside of the manu­
facturing industries.
The data for other European countries are even less reliable. In
Austria the law of April 14, 1913, made human anthrax, among
several other infectious diseases, reportable. Earlier reports of the
factory inspectors give the following data for the years 1903 to
1906: 1903, 15 cases; 1904, 5 cases; 1905, 13 cases; 1906, 4 cases.
These fluctuations, however, seem improbable, and the figures as
a whole appear to be too low, for in the report for 1907 a factory
inspector stated that in the brush factories of his district alone 50
cases of anthrax had occurred in the preceding 10 years.
P R O T E C T IV E L E G IS L A T IO N .

Absolute prohibition of the importation of animal materials from
countries where anthrax is known to exist, unless such materials are
first thoroughly disinfected, would probably put an effective stop to
the ravages of the malady among industrial workers. No country,
however, has yet found such a step either commercially or adminis­
tratively possible. Many of them— France, Germany, Great Britain,
Holland, Hungary, Italy, and Spain, for instance— do prohibit the
employment of women or of children of different ages in dangerous
processes, but the great mass of European legislation on occupational
anthrax is confined to more or less careful general regulation of the
hazardous trades and occupations.
1 Compiled from Rivista di Igiene e di Sanita Publica.

aH. B. Popov: Russki Vratch [The Russian Physician], June 14, 1914, p. 848.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

107

WOOL, HAIR, AND BRISTLES.

O f the industries in which there is danger of anthrax, those which
involve the handling of wool, hair, and bristles have been most
widely and thoroughly brought under Government regulation.
In England the wool industry has reached a high degree of devel­
opment, and much of its raw material comes from Persia, East India,
China, and other countries where anthrax is endemic and precau­
tionary measures are almost unknown. Its attention having been
drawn by the frequency of anthrax among wool sorters, the English
Government called in 1884 a conference of public health officials,
representatives of the workers, and wool merchants. At this con­
ference the first tentative set of regulations for the wool industry was
adopted. In 1897 instructions were published for wool-sorting and
in 1900 for wool-dyeing establishments.
In 1905 the Home Office issued regulations which codified and
amplified the earlier rules. They refer1 to the work of sorting,
“ w illeying” (willowing), washing, combing* and carding wool, goat
hair, and camel hair, and the incidental processes. Only certain
specified materials, imported chiefly from Asiatic countries, come
under these regulations. Detailed instructions are given for the
opening and handling o f wool or hair. Each bale may be opened
only after it has been thoroughly steeped in water and only by men
skilled in judging the condition of the material; screens, sorting
boards, and willowing machines of specified construction are
required. Several kinds of materials must not be sorted except in a
damp state and after being washed. Goods must be stored only in
places set apart for the purpose. Detailed regulations are set forth
for ventilation, cleanliness, disposal of waste, working clothes, and
requisites for treating scratches and slight wounds. Strict require­
ments apply to the places where unwashed wool or hair of the kinds
named is handled or stored. For persons working in those rooms
there must be sufficient washing accommodations, with soap, nail­
brushes, and towels, and proper places for keeping food and clothing.
A worker having an open cut or sore must not be employed in any
such room.
The regulations prescribed for the employers are followed by
instructions to the workers, who are also made responsible for com­
pliance with the rules. Attached to the regulations is a note describ­
ing the dangers o f anthrax and urging personal cleanliness.
These regulations apply only to the more dangerous kinds o f
wool, and therefore protect only part of the woolworkers of the
United Kingdom; all other kinds of wool are disregarded, as, for
instance, those coming from South Africa and South America, which




1 See pp. 137-140.

108

B ULLETIN OF THE BUREAU OF LABOR STATISTICS.

are not classified as “ dangerous,” but which also cause anthrax,
although less frequently than the materials mentioned by the regula­
tions. The insufficiency o f the regulations is, indeed, generally agreed
upon, and revision is now being considered by the departmental
committee on anthrax.
Prevention o f anthrax in the trades using the coarser kinds of hair
was not taken up by the British Government until several years
later, probably because the danger was less conspicuous than in the
wool industry. Processes involving the use of horsehair from
China, Siberia, or Russia were made subject to regulation in 1908.1
These countries are specified because hair shipped from there is con­
sidered particularly dangerous. These rules contain for the first
time the significant requirement o f disinfection, which may be car­
ried out by steam or by any other method certified by a Governmentrecognized laboratory. Rules are also set forth for the opening,
sorting, and storing of nondisinfected material, exhaust drafts of
a prescribed kind are required, and instructions are given for the
disposal o f dust collected during the various processes. The require­
ments with regard to working clothes, respirators, supplies for treat­
ing wounds, cloak and lunch rooms, and lavatories are similar to
those contained in the regulations for work on wool. As in those
regulations, also, the workers are called upon to observe the pre­
scribed rules. An important factor in the success of these measures
is the provision which imposes a penalty not only upon the recal­
citrant employer but also upon the worker who fails to observe the
law. This provision is found in section 85 (2) o f the Factory and
Workshop Act o f 1901: “ I f any person other than an occupier,
owner, or manager, who is bound to observe any regulations under
this act, acts in contravention of, or fails to comply with the regula­
tions, he shall be liable for each offense to a fine not exceeding £2
[$9.73].” 2
In Germany industrial anthrax appears to be particularly preva­
lent among hair and brush workers, and detailed legislation for that
industry was secured fairly early. The question is taken up by an
order o f the Federal Council o f October 22, 1902,3 which superseded
a similar order of January 28, 1899. The German order agrees in
its main points with the British regulations. Both require disinfec­
tion o f materials, isolation o f nondisinfected goods, special working
clothes, and dressing rooms and lunch rooms for the workers who
come in contact with raw products. Factory sanitation and personal
hygiene are also prescribed along similar lines. But, contrary to
the English law, the German decree applies not only to goods coming

1 Appendix

B, p. 141,




2I

Edw. VII, ch. 22.

8See

Appendix B, p. 145.

AN TH RAX AS AN OCCUPATIONAL DISEASE.

109

from certain countries but to all horse, cattle, and goat hair and pigs’
bristles o f foreign origin. It also differs from the English law in
several other important points. For instance, public disinfection
stations are established, indicating great interest on the part of the
Government. The employer is required to furnish the workers facili­
ties for warm bathing twice a week and to see that each individual
wears the working clothes assigned to him. Perhaps the most sig­
nificant provision is that allowing the employer to discharge without
notice and without liability for breach o f contract any worker who,
after repeated warning, persists in violating the rules. In addition
to its salutary disciplinary effect upon the employee, this provision
is o f considerable consequence in a country like Germany where
anthrax is compensated as an industrial injury, as it safeguards the
employer’s financial interests against the employee’s possible care­
lessness.
French regulations for the prevention o f anthrax in the industries
under discussion are contained mainly in the decree o f October 1,
1913,1 which superseded all earlier laws. This decree, like its prede­
cessors o f 1908 and 1910, does not follow the English or German
method o f special regulations for each industry or allied group of
industries, but applies to all establishments in which the employees
are menaced by anthrax, including those “ where skins, fur, horsehair,
hogs’ bristles, wool, horns, or bones, or. other animal products liable to
be infected ” are handled. Special attention is given to the protection
o f workers engaged on nondisinfected material or on the process
of disinfection. The methods of disinfection used must, as in Eng­
land and Germany, be officially approved. The rules referring to
sanitation in the work place, working clothes, dressing rooms, lava­
tories, and personal cleanliness are very similar to those prescribed
by the two countries already discussed, but lack their minuteness and
definiteness. Walls, floors, tables, and benches, for instance, must
be washed, not at definitely stated intervals, but “ whenever neces­
sary,” or “ as often as may be necessary,” and must be “ frequently ”
disinfected. The vital matter of dust prevention, which is taken up
with considerable care in England and Germany, has received little
thought from the French authorities. Instead o f requiring dustremoving devices the law simply states that wool, horsehair, other
animal hair, and bristles must be handled, “ whenever possible/’ in
closed vessels. I f this is impracticable, as for instance, in the case
o f opening bales or beating, the operations must be carried out
“ under such conditions as will allow the collection o f all offal and
its subsequent destruction.”




1 See Appendix B, p. 143.

110

BU LLETIN OF TH E BUREAU OF LABOR STATISTICS.

Another preventive dev’ ce which escaped the attention of the
French lawmakers is that of imposing some responsibility upon the
workers. Overalls and respirators provided by the firm can not
serve their purpose unless they are worn, and the best equipped
lavatories and dressing rooms are useless if the worker ignores them.
Consequently, pressure must be exercised not only on the employer
but on the worker also. French employees, however, are merely
asked, through regulations posted in the workrooms5 to use the vari­
ous working articles provided for them, as well as the washstands
and dressing rooms, to clean themselves before leaving the premises,
and to bring no food into the workrooms.
In Hungary workers in brush factories and in all establishments
where horse and cattle hair and pigs’ bristles are manipulated are
protected against anthrax by an order o f the minister o f commerce,
issued on May 18, 1903. This order is practically the same as the
order of the German Federal Council o f October 22, 1902.
The majority of cases o f anthrax in Belgium have occurred among
brush workers, and this circumstance prompted the royal order of
August 20, 1908. In striking contrast to the previously discussed
legislation, this order consists of only two short sections and merely
prescribes, imperatively, the disinfection of hair in a manner “ suffi­
cient to kill the anthrax spore.” Medical inspectors are to test,
through samples of disinfected hair, the effectiveness o f the method
used.
HIDES AND SKINS.

Another large group of industries in which the need o f Govern­
ment activity against anthrax has been felt by several European
countries is that connected with hides and skins, especially in the
processes o f tanning. The problem of infection from imported hides
and skins was taken up in Great Britain in 1899. In 1901 rules were
published by the Home Office for establishments using dry and drysalted hides and skins imported from China or from the west coast
o f India.1 It was required that provision be made for overalls and
gloves, for the keeping o f food and clothing, for washing accom­
modations, and for the dressing of wounds. Notes are added to
the rules, one calling the worker’s attention to the dangers of an­
thrax, and another reminding him of his obligation to observe the
law:
Prussian workers engaged on imported hides and skins are covered
by a ministerial order issued on May 9, 1902. It briefly describes the
nature o f anthrax and its danger to the worker and emphasizes the
necessity of precautionary measures.2

1 See

Appendix B, p. 136.




2 See

Appendix B, p. 148.

AN TH RAX AS AN OCCUPATIONAL DISEASE.

Ill

A later and more effective measure was the decree of the Prussian
minister o f commerce dated December 20, 1910. This directs factory
managers to adopt for the protection of tanners the regulations issued
by the Leather Trade Association, which were based on the latest
scientific investigations and were framed in conformity with the re­
quirements of the Imperial Health Office.1 The rules apply to raw
sheep and goat skins and to all skins and hides imported in a dry,
raw state. These materials must be kept in isolated storerooms.
Detailed rules are prescribed for the sanitation o f the storerooms
and for the transportation and handling o f the goods. The familiar
instructions with regard to working clothes, lavatories and lunch­
rooms are also found, as well as an interesting rule forbidding the
worker to enter the lunch room, to eat any food, or to leave the
premises until he has changed his working clothes and has thoroughly
washed the face, head, hair and beard, neck, hands, and arms. Each
new worker receives a copy of regulations for the prevention of
accidents, and instructions concerning anthrax.
Other States of the German Empire have also accepted these regu­
lations. Stuttgart, the capital o f the Kingdom of Wurttemberg,
for instance, is an important center of the glove industry. There
were revealed in the first year o f the operation o f the compulsory
notification law o f 1909 22 cases o f anthrax^ o f which 2 were fatal.
This indicated a greater prevalence o f anthrax among tannery
workers than was shown by earlier data, and as a result the regula­
tions for the leather industry were introduced by ministerial order.2
The French regulations for tanneries have been discussed in the
preceding section.
Incidentally it may be remarked that in Italy, the home of the
Sclavo serum and the scene o f much intelligent private activity
against anthrax, the Government remains practically inactive on the
question. Despite the appalling prevalence of the disease no legis­
lation exists for its prevention among industrial workers.3 In 1911,
in accordance with a decree of the minister of agriculture, industry,
and commerce and a decision of the administrative council of the
national workmen’s accident insurance fund, prizes were offered for
the best essays on a number of topics connected with industrial
safety and hygiene. One of the subjects was prevention of anthrax
among workers employed in the transportation and treatment of
skins, but none o f the essays submitted were deemed worthy of the
prize.
1 See Appendix, p. 149.
2 Bulletin of the International Labor Office, Vol. V III, 1913, p. X V I.
3 L. Devoto and F. Massarelli: II Charbonchio Professional, II Lavoro, July 15, 1914,
p. 194.

42806°— Bull. 205— 17------- 8




112

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

COMPENSATION FOR ANTHRAX AS AN INDUSTRIAL INJURY.
Thorough as is much o f the administration of European factory
law, the “ policing ” method alone has not been depended upon for
the enforcement of regulations for the prevention of anthrax. The
method o f cooperative pressure on employers through workmen’s
compensation, which has proved so effective in reducing work acci­
dents, while at the same time it safeguards the economic position
o f the injured or of their dependents, has already been applied to a
number o f occupational diseases, but to none so early or so widely
as to anthrax. A t least five European countries (Great Britain,
Germany, France, Italy, and Holland), and two Provinces of one of
these (South Australia and Ontario), already provide compensation
for this disease.1
The British Workmen’s Compensation A ct o f 1897, the first o f its
kind in any English-speaking country, established indemnity for
personal injury “ by accident” arising out o f and in the course of
employment. In 1905 the House of Lords was called upon to deter­
mine, on an appeal, whether the dependents o f a workman who had
died o f anthrax were entitled to compensation under this act. The
House decided in the affirmative, Lord Macnaghten saying:
It is plain, I think, that the mischief which befell the workman in
the present case was due to accident, or rather, I should say, to a
chapter o f accidents. It was an accident that the noxious thing that
settled on the man’s face happened to be present in the materials
which he was engaged in sorting. It was an accident that this
noxious thing escaped the down draft or suck of the fan which
the Board o f Trade, as we were told, requires to be in use while work
is going on in such a factory as that where the man was employed.
It was an accident that the thing struck the man on a delicate and
tender spot in the corner o f his eye. It must have been through some
accident that the poison found entrance into the man’s system, for
the judge finds that there was no abrasion about the eye, while the
medical evidence seems to be that without some abrasion infection is
hardly possible. The result was anthrax, and the end came very
speedily. Speaking for myself, I can not doubt that the man’s death
was attributable to personal injury by accident arising out of and
in the course of his employment. The accidental character of the in­
jury is not, I think, removed or displaced by the fact that, like many
other accidental injuries, it set up a well-known disease, which was
immediately the cause of death, and would no doubt be certified as
such in the usual death certificate.2
1 In addition it should be remembered that in most European countries, including
Austria, Germany, Great Britain, Holland, Hungary, Luxemburg, Norway, Roumania,
Russia, and Serbia, anthrax is covered by compulsory health-insurance laws, while in
six countries, Belgium, Denmark, France, Iceland, Sweden, and Switzerland, a limited
amount of protection is given by systems of subsidized health insurance.
2 Brin tons (Ltd.) v . Turvey, 92 L. T. R., 578 (1905).




113

AN TH RAX AS AN OCCUPATIONAL DISEASE.

Other cases of occupational disease also arose which caused litiga­
tion under the law, so that when Parliament enacted the present
British compensation statute in 1906 it included a list of six trade
diseases (since expanded to 25) which were to be compensated on
the same terms as accidents. One of these six was anthrax.1 Sec­
tion 8 o f the law states that if the certifying surgeon for the dis­
trict testifies that a workman is suffering from a disease to which the
act applies and is thereby either unable to earn full wages or is sus­
pended from work, or if death is caused by any such disease and “ the
disease is due to the nature of any employment in which the work­
man was employed at any time within the 12 months previous to the
date o f the disablement or suspension, whether under one or more
employers, he or his dependents shall be entitled to compensation
under this act as if the disease or such suspension as aforesaid were a
personal injury by accident arising out of and in the course of that
employment.”
In the seven years 1908 to 1914, the only years for which data are
available, 233 cases of anthrax have been compensated under the
law. The following table shows the distribution of the cases by
year and by industry:
T a b l e 1 5 . — CASES

O F A N T H R A X C O M PE N SA TE D F O R T H E F IR S T T IM E D U R IN G T H E
Y E A R U N D E R T H E B R IT IS H W O R K M E N 'S C O M P E N SA T IO N A CT, 1908 T O 1914.

[Compiled from H om e Office annual reports on statistics of compensation and of proceedings under the
W orkm en's Compensation A ct, 1906, and the Em ployers’ L iability A ct, 1880.!)

Year.

Cotton.

1908............
1909............
1910............
1911............
1912............
1913............
1914............

1

Total___

1

W ool,
worsted,
and
shoddy.

6
19
20
26
24
16
111

Engi­
neering
Other
textiles. and ship­
building.

China
and
earthen­
ware.

Other
metal
work.

1

4
3
1
1
5

i

1

2

1

8
7
5
5
6
18
13

8
5
10
4
6
2
5

23
22
35
30
43
44
36

1

62

40

233

1

15

Miscella­
neous
factories.

1

Docks.

Total.

1

It is interesting to note, in connection with the British experience,
that the example of the mother country has encouraged both South
Australia2 and Ontario3 to write into their compensation laws the
principle o f indemnity' for occupational diseases, each Province
adopting the schedule of six compensable diseases, including anthrax,
with which Great Britain began.
The terms of the German workmen’s compensation code cover only
injuries by “ accident,” but, as in Great Britain under the law o f




1 6 Edw. V II, ch. 47, third schedule.
2 South Australia, 2 Geo. V, No. 1053 (1911).
* Ontario, 4 Geo. V, ch. 25 (1914).

114

BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

1897, anthrax is held to be an accident and is compensated as such.1
The same situation obtains in Holland by a decision of 1905,2 and in
France.3 In the last-named country the question o f indemnity for
trade diseases came up soon after the enactment o f the compensation
law in 1898, and a committee on industrial hygiene was appointed
under the Ministry o f Commerce to study it. The commission’s
report, published in 1903, concluded with regard to anthrax:
Anthrax has always an external origin and is due to infection by
a microbe; this infection takes place at a given moment, and it cer­
tainly furnishes the element of suddenness required by the law of all
accidents which come under the act of 1898.4
Since the publication of this report the French courts have reversed
their previous opinion^ and in the years 1903 to 1909 they decided
four contested cases which came before them in favor of the injured
workers.
The movement abroad in favor of compensation for occupational
anthrax, as well as for other trade diseases, is not confined to these
seven countries and parts of countries. Section 68 o f the Swiss
industrial accident insurance law of 1912 empowers the Federal
Council to “ prepare a list o f substances, the production or employ­
ment o f which occasions dangerous diseases. Every disease exclu­
sively or essentially due to the action of one o f those substances in
an enterprise subject to insurance is deemed an accident within the
meaning o f the present law.” It can hardly be doubted that anthrax
would find a place on a list of this kind, but apparently the Federal
Council has not yet exercised its power.
1 Pickenbach, Beitrag zur Milabranderkrankung in der Lederbranche, Aertztlicher Sachverstandigen Zeitung, 1914, No. 18, p. 365.
2 H. A. Van Ysselsteyn, General Director of Labor: Anthrax, 1912, p. 1.
3 J. CavaillS: Le Charbon Professionnel, Paris, 1911, p. 344.
4 France, Commission d’Hygi&ne Industrielle, Maladies professionnelles, Paris, 1903,
p. 140.




C H A P T E R

V I.

PRESENT STATUS OF THE PROBLEM OF DISINFECTION.
It is obvious that the success of the extensive and energetic cam­
paign against occupational anthrax depends to a considerable degree
on the effectiveness of methods of sterilizing industrial materials.
The significance attached to the question of disinfection has stimu­
lated numerous investigations in the more advanced countries. The
work is chiefly done in private laboratories, but important experi­
ments have also been made under the auspices of the United States
Bureau o f Animal Industry and of the Imperial Health Office in
Germany, while facilities for such work are furnished by the Home
Office in England.
The task of finding an adequate and practicable disinfectant is
greatly complicated by several factors. For instance, various kinds
o f materials require different modes of treatment. The cost of the
disinfectant and the time of exposure necessary for destroying the
bacilli and spores are also essential considerations, since an expensive
disinfectant, or one acting only slowly, will be rejected by the manu­
facturers. Still more important is the effect of the disinfectant on
the material, since it has been shown that a large number of disin­
fectants otherwise desirable can not be applied without injury to
the goods.
O f the materials liable to convey anthrax to the workers, bristles,
horsehair, goat hair, and a few other kinds of hair have proved most
susceptible to disinfection. A number of methods have been pro­
posed, three o f which are considered the most effective and the most
acceptable for industrial purposes. These are: (1) Exposure to steam
for a period varying according to temperature and atmospheric
pressure; (2) boiling in water for two hours; and (3) boiling for at
least 15 minutes in a 2 per cent solution of permanganate of potas­
sium with a subsequent bleaching in 3 to 4 per cent sulphuric acid.
In the disinfection o f wool much less has been accomplished. Up
to the present no disinfectant has been found entirely satisfactory
for industrial purposes. In England constant and diligent study of
various germicides is being made by the Bradford Anthrax Investi­
gation Board, which, after nine years o f work, reports:1 4 So far
4
1

Anthrax Investigation Board for Bradford and District, Ninth Annual Report, 1914,

p. 6 .




115

116

BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

formaldehyde, in the proportion of 1 per cent of neat or proof
strength to 99 per cent of water, with a saturation of the opened
material for seven hours, is the only germicide that has been found
reliable, and even the effect o f this germicide must depend upon the
absence of ammonia and of large blood clots. The effect of formalde­
hyde upon the spinning qualities o f the material is, however, very
marked, and this germicide can only be recommended for extreme
cases o f infected wool or hair.” Further experiments are being
made.
Steam disinfection of wool was also the subject of a series of
experiments by the staff o f the board. The results have brought out
the fact that while steam succeeds in destroying the germs its effect is
to discolor light-colored material and to turn yellow white. The wool
becomes brittle, its elasticity and luster are considerably affected,
and the strength o f the fiber is also somewhat impaired. As a result
a committee o f the board agreed that “ disinfection by steam can not
be applied to ordinary wool or hair except under conditions that
would stop any trade in the sorts so treated.” 1
However, even the officially approved methods of disinfection are
not considered absolutely effective, and occasionally fail to prevent
the occurrence o f anthrax. C. H. W. Page, an English authority,
expresses himself with considerable pessimism. “ That steam is
ever likely to be certainly effective in disinfecting horsehair is im­
probable,” he says, “ since the damper the steam the better chance
o f destroying the spores, but the greater the damage to the hair;
and the drier the steam the less chance of destroying the spores and
the less damage to the hair. These antagonistic results produce a
deadlock.” 2 He also criticizes the use o f steam on bristles because
steam bursts or loosens the bundles, which necessitates an expendi­
ture o f time and money for putting them in order again; nor does
he find boiling satisfactory, for in the time necessary to destroy the
spores— two to three hours—the material would be considerably
damaged. His stand on the question of disinfection in general he
summarizes in the words: “ Great care and constant supervision are
necessary to secure satisfactory results, and steam can not be regarded
as absolutely certain in effect, though the great bulk of spores are
destroyed and the vitality o f the rest is diminished.”
Very similar is the opinion expressed by another English authority,
Legge, who states that to secure certain destruction of all anthrax
spores absolute reliance can not be placed on either steam disinfection
or simple boiling in the absence of effective supervision; however,
the adoption o f one or the other is a material safeguard.
1 Anthrax Investigation Board for Bradford and District, Eighth Annual Report, 1913,
p. 23.
2 Journal of Hygiene, Industrial Anthrax, 1909, p. 369.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

117

This unreliability of disinfection has attracted official attention in
the Grand Duchy of Baden, where, notwithstanding the practice of
sterilization, the number of cases of anthrax has increased rather than
diminished. Prompted by this circumstance the minister of the in­
terior, by an order which went into effect October 28,1909, instructed
the proper authorities to make annual examinations of fresh disin­
fected samples o f materials used in manufacture.1 The examinations
have shown that disinfection does not kill the spores. Some cases
o f failure the author attributes either to the wrong construction of
the apparatus or to the wrong use of it. The individual characteris­
tics of certain kinds of hair also sometimes impede disinfection. In
this connection the author mentions goat hair, which comes in hydraulically pressed bales. Upon unpacking, the whole bale, which
owing to the nature of the hair shows hardly any tendency to fall
apart, is exposed to steam; naturally the steam can not penetrate very
deeply, and after an exposure of one-half hour the temperature 8
inches below the surface is only 114.8° F., which is insufficient for
sterilization.
Still greater obstacles are in the way of disinfection of hides and
skins. Numerous experiments with these materials have so far failed
to discover a reliable and convenient germicide. Sterilization by
steam, frequently applied in the hair industry, is impracticable for
hides and skins, as it injures them for manufacture. Experiments
have been conducted with low-temperature steam disinfection in a
vacuum, which does not affect the skins, but the question of the ap­
plicability of this method for manufacturing purposes has not so far
been settled.
Researches, remarkable for their range and thoroughness, have
been made under the auspices of the Imperial Health Office of Ger­
many. Hailer, one of the investigators, states2 that disinfection of
skins is not an impossibility. Numerous methods have been sug­
gested, but so far they have not been applied outside the laboratory.
The high cost o f the disinfectants, their poisonous properties, and
their more or less deleterious effects on the skins, serve as ob­
stacles to their introduction into industry. O f the several layers of
which the animal skiij. is composed the one used for leather is, ac­
cording to Hailer, sensitive to a temperature o f over 104° F., and
also to whole classes o f chemical substances, such as the phenols,
aldehyde acids, and heavy metal salts— in fact, to the strongest
germicides. However, some of the substances contained in the skin,
1 Laubenheimer, Uber die Disinfection yon Tierhaaren zur Zerhiitung yon gewerblicher
Milzbrand, Zeitschrift fiir Hygiene und Infections-Krankheiten, 1912, Vol. L X X , pp.
324, 325.
2 E. Hailer, Die Abtotung von Milzbrandsporen an H&uten und Fellen durch SalzsaureKochsalzlSsungen. Arbeiten aus dem Kaiserlichen Gesundheitsamte. Berlin, 1914,
Vol. X L V II, p. 69.




118

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

chiefly the albuminoids, make insoluble compounds with these chemi­
cals, and as a result the skins change in appearance and become less
valuable for manufacture. Numerous efforts for the removal of
these difficulties have met with little success.
A t present there are two methods of disinfection which give prom­
ise of meeting the necessary requirements; neither has yet been
applied on a large scale, but one, recommended by Seymour-Jones
o f England, chairman of the International Commission for the
Preservation, Cure, and Disinfection of Hides and Skins, seems to
be meeting with more approval than the other. This process con­
sists in soaking the dry skins for 24 hours in a 1 to 5^000 solution
of bichloride o f mercury to which is added a 1 per cent solution of
formic acid. After this treatment the skins are transferred for an
hour or so to a saturated solution of common salt in water. The acid
helps to render the bichloride effective because it prevents the forma­
tion o f the insoluble albuminate of mercury, and also because by its
penetrating action the fluid is carried into the center o f the mass of
any organic material that may serve as a protection for the spores.
The process has been the subject o f an exhaustive investigation by
Constant Ponder, who considers it simple, cheap, and effective, and
“ believes that it holds out greater promise of success than any pro­
cess hitherto suggested.” 1 He suggests that the sterilization be car­
ried out in the port o f shipment.
The other process was discovered by a German scientist, Schattenfroh. This investigator recommends that hides and skins be
soaked for six hours at a temperature o f 104° F., or for two days at a
temperature o f 68° F., in a 2 per cent solution o f hydrochloric acid to
which a 10 per cent solution of ordinary salt is added. For practical
reasons he considers the former method superior. He maintains that
no injury is done to the skins by this process?
In the United States numerous studies o f disinfection against
anthrax have been made by the Federal Bureau of Animal Industry,
as well as by the National Association of Tanners and by the Ameri­
can Leather Chemists’ Association, at whose meetings the problem
is the subject of frequent reports and discussions. In 1910 John H.
Yocum, of the leather chemists’ organization, pointed out that be­
cause of the action of the mercury salt in forming insoluble com­
pounds with albuminoids and thereby depriving itself of further
power to act on bacteria, immersion in a simple 1 to 1,000 solution
o f bichloride of mercury as then required by the Government could
“ not possibly be effective.” He proposed m odifying the process by
1 Constant Ponder: A Report to the Worshipful Company of Leather Sellers, etc., 1911,
p. VI.
2 E. H ailer: Die Abtotung von Milzbrandsporen an Hauten und Fellen durch SalzsaureKochsalzlosungen. Arbeiten aus dem Kaiserlichen Gesundheitsamte. Berlin, 1914, Vol.
X L V II, p. 69.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

119

adding the bichloride to a saturated solution of common salt, which
would prevent interference with the germicide. This method, how­
ever, he found efficacious only for wet salted hides. For dry hides he
declared it impracticable because of the long time the fluid required
for penetration, and recommended instead the Seymour-Jones proc­
ess, 1 to 5,000 bichloride of mercury with 1 per cent formic acid.
This latter process, Yocum estimated, would entail an expense of
about 7 cents a hide, which he held would be more than equalized
by economies in the selection and tanning of hides which it would
make possible. I f the process were carried on at the point of ship­
ment, it was further pointed out, shippers would not be likely to
dry the hides out again, so that many of the hides now received in
the “ flint dry ” state would be received as “ wet salts,” with a con­
sequent reduction of the danger of anthrax infection through flying
dust. The paper was circulated for discussion at the following
meeting of the tanners,1 who seemed to feel, however, that it should
be subjected to important modification.
Perhaps the most extensive series of American experiments on the
subject are those undertaken by F. W. Tilley, of the United States
Bureau o f Animal Industry.2 These experiments tend to show that
the original Seymour-Jones process, immersion in 1 to 5,000 mercuric
chloride solution with 1 per cent formic acid for 24 hours, is not
efficient in killing anthrax spores, even if the germicide is not later
neutralized as it would be by other substances in the regular course
o f tanning. A modification of the Seymour-J ones method, however,
by using a mercuric chloride solution of twice this strength (1 to
2,500), with 1 per cent of formic acid, is efficient in 24 hours if there
is no neutralization. Hence this latter method, the investigator con­
cluded, seems usable “ provided the treated hides are not to be sub­
jected within a week or two to the action of any substances which
will neutralize the disinfectant. This would be the case, for in­
stance, if the hides were disinfected at foreign ports before ship­
ment to this country.”
Similar researches carried on with the Schattenfroh method, 2 per
cent o f hydrochloric acid in a 10 per cent solution of sodium chloride,
with 48 hours’ exposure, are reported to have “ proved efficient in
every instance.” A European bacteriologist,3 however, is quoted as
having found that this method works well for thin skins, but that
if the skins were “ thick and heavily infected he was able, after
iJohn H. Yocum: Disinfection of imported hides. National Association of Tanners,
1913.
2 F. W . Tilley : A bacteriological study of methods for the disinfection of hides infected
with anthrax spores. Journal of Agricultural Research, Mar. 15, 1915, pp. 65— 2 ;
9
abridged in Journal of the American Leather Chemists’ Association, March, 1916.
3 Franz Sevcik : Zur Desinfection von Milzbrandhauten. In Weiner Aertaliche Monatschrift, Vol. I, No. 3, pp. 127-141.




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BULLETIN OF THE BUREAU OF LABOR STATISTICS.

very effective neutralization, to extract from pieces of the treated
hides anthrax spores which were virulent.”
In all his work Tilley has emphasized what he considers the ex­
tremely slow and superficial action of bichloride of mercury. “ Cer­
tainly for a short time,” he says, “ the combination between the bi­
chloride and the spores is what we might call a 4reversible ’ combina­
tion,” and the effect of a neutralizing agent, such as the lime used
in later processes, “ will be to break the combination, and the spores
will, so to speak, come to life again.” 1 For this reason he recom­
mends a long immersion in a relatively weak solution as preferable
to a brief immersion in a stronger solution. On the whole he con­
siders the Schattenfroh method, though not perfect, “ far superior to
other methods and well worth a trial as a standard method for the
disinfection of hides.”
On the other hand, a committee report submitted to the annual
meeting o f the American Leather Chemists’ Association in June,
1916, stated that tanners who had tried the Schattenfroh method de­
clared it “ positively injurious” to hides, while at the same time bi­
chloride o f mercury solution o f the strength (1 to 1,000) then re­
quired by the Government was complained o f as “ burdensome in
point o f cost.” 2 The committee therefore tentatively proposed a new
method to supersede both of these. Stating that no cases of anthrax
had occurred in glue or hair factories using by-products from Ameri­
can tanneries, the committee suggested that bichloride of mercury
1 to 5,000 or possibly 1 to 10,000, followed by the regular liming
process, “ will prove effective in rendering the anthrax spores in­
nocuous. If, after further investigation, this proves to be a fact it
will meet the situation and relieve the tanners from undue burden or
cost.” This suggestion had already been conveyed to the Bureau of
Animal Industry, and as has been seen a slight modification of the
proposed process is embodied in the rules prepared by the Federal
authorities, in cooperation with the tanners’ committee, later in the
year.3
The other products liable to convey anthrax, chiefly bones and
horns, are used to a more limited extent than hair, wool, or hides,
and danger o f infection from them is also comparatively slight. For
these reasons their sterilization is less urgent, and it has been almost
disregarded in the spirited campaign for protection against the more
common carriers of the disease.
1 Journal of the American Leather Chemists’ Association, July, 1916, p. 350.
2 C. R. Oberfell: Cure and Disinfection of Hides. Committee report, 1916. Journal of
the American Leather Chemists’ Association, July, 1916, pp. 333-339.
3 See Appendix A.




C H A P T E R

V II.

RECOMMENDATIONS FOR CONTROL AND PREVENTION
OF ANTHRAX,
The serious difficulties in the way o f a satisfactory solution of the
occupational anthrax problem have been the subject o f considerable
expert study. Since it has not yet proved possible to eradicate
anthrax even in the countries where the most advanced legislation
on the subject is combined with enlightened private activity, addi­
tional measures of protection are necessary.
After careful study of the problem several authorities of world­
wide reputation have set forth recommendations in which they take
up not only the question o f anthrax in manufacturing centers, but
also in the stock-raising countries of export, and in which the neces­
sity of international action is emphasized.
O f the recommendations published in recent years three sets are
conspicuous for their thoroughness and for the extensiveness of the
ground covered, and are here given entire.

RECOMMENDATIONS OF SUBCOMMITTEE OF INTERNATIONAL
ASSOCIATION FOR LABOR LEGISLATION, 1914.1
A. It is important (in order to be in a position to know the extent of the
risk of anthrax infection in industries and the preventive measures necessary
to combat it) that in each country full statistics should be kept o f cases which
arise.
Such statistics should always supply the following inform ation: Age and sex
of the patient; precise occupation; the kyid and source of the materials
handled at the time of the attack; situation and clinical form o f the disease;
result.
It is desirable that these statistics should be as wide as 'possible and cover
all cases of anthrax— agricultural as well as industrial.
B. In all premises where the products (wool, hair, bristles, hides, and skins)
of animals susceptible of anthrax are stored and handled in the raw state
the occupier should post up a notice containing—
( a ) An illustration showing the commonest and most characteristic form
of external anthrax (malignant pustule) ;
(&) A brief account of its origin and the typical forms of infection;
( c ) A warning to the persons employed as to the importance of personal
cleanliness and the necessity of prompt treatment for every lesion, however
slight.
1 Appointed to consider the question of anthrax, in accordance with the decision of the
seventh delegates’ meeting of the association, 1912.




121

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B ULLETIN OF THE BUREAU OF LABOR STATISTICS.

C.
In all premises where wool, hair, bristles, hides, and skins coming from
suspected countries are stored and handled in the raw state, the occupier should
adopt the following measures. (It will fall to the Government of each coun­
try to decide on and classify in one or more schedules, according to the degree
of risk and quantity of material imported, the countries to be declared “ sus­
pected.” )
1. Inspectors of factories should b e permitted by the occupier to inspect
either the stock book in which is entered the purchase of material for the
factory or workshop or a special register with entries as follow s: Nature and
quantity of material introduced; date of receipt; country of origin; state
( whether raw or disinfected) of the products; name of the vendor. And in the
case of material said to have been disinfected before introduction into the fac­
tory, an approved certificate to that effect.
2. All scheduled raw materials which can be subjected to the operation with­
out damage should be disinfected.
3. Opening of bales of wool, hair, bristles, hides, and skins should always
be intrusted to persons skilled in judging the portions which are damaged.
4. Preliminary operations regarded as particularly dangerous should always
be carried out in a room, or portion o f a room, set apart for the purpose.
(It will fall to the Government of each country, having regard to the different
processes of manufacture and manipulation customary in each country and in
each industry under regulation, to define what are the preliminary operations
to be regarded as dangerous.)
5. Wool and hair sorting should always be carried on so as to permit of the
removal of blood clots adhering to the fleece, and of bloodstained portions.
These fragments should either be burned or sterilized by a process recognized
as efficient.
6. The preliminary ,manipulations as defined above, which are carried out on
dusty material treated in a dry state, should be carried on under an efficient
exhaust draft preferably in a downward direction. The dust should never
be allowed to escape into the open air.
The dust collected in a special receptacle should either be burned (unless
coming from material that has previously been washed) or rendered harmless
by treatment, chemical or otherwise.
7. The workrooms in which the preliminary processes are carried on should
be kept in a constant state of cleanliness; the floors should be impermeable,
and the walls treated in such a way. as to permit o f thorough washing, or
limewashed at least once a year.
The floor, wall§, tables, benches, tools, and machines should be frequently
cleaned.
8. The occupier should provide for the persons employed in the preliminary
manipulations means for securing personal cleanliness; a cloakroom (with
arrangements for keeping separate the ordinary clothes from clothing worn
while at work) and a lavatory with an abundant supply o f water (hot and
cold whenever possible), soap, nailbrushes, and towels.
Every person employed in handling raw material should be provided with his
own overalls and head covering.
Persons employed in cleaning dust-extracting machines and receptacles for
dust should be provided with respirators.
No food or drink should be deposited or partaken of in rooms where danger­
ous processes are carried on.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

123

9. Medical treatment should be organized on the following lines:
Every person employed having a pustule or pimple resembling anthrax
should report the fact without delay at the manager’s office, whereupon the
occupier, on his part, should cause him to be examined by a surgeon appointed
for the purpose.
The name and address of the surgeon should be entered on the notice provided
under B, above.
10. Every factory and workshop should be provided with an ambulance box
kept in good condition and in a place easily accessible.
11. No person under 18 years of age should be employed in the preliminary
operations defined above.
D.
It is desirable that in all countries where stock is raised, sanitary regula­
tions drawn up on the same lines should be seriously applied with a view to
bring about diminution in the epizootic spread of anthrax, and destruction by
efficiently organized methods of all the products or offal of animals that have
died of anthrax.
The members of the subcommittee:
D r. K o e l s c h , Chief Medical Inspector, Munich.
D r . Legge, Medical Inspector, London.
J. C a v a i l l e , Inspector of Labor, Castres.

RECOMMENDATIONS BY PROF. L. DEVOTO AND F. MASSARELLI.1
1. Compulsory antianthrax vaccination of animals. The committee can not
ignore the fact that such a measure is very difficult if not impossible of execu­
tion in foreign countries where anthrax is endemic, and if limited to our own
country it can not have the slightest influence in the prevention o f occupational
anthrax.
2. Concentration o f the cargoes of animal material coming from foreign
sources in specially designated ports having special and exclusive storehouses
for said material, fitted up with smooth walls and floors to facilitate periodical
disinfection.
3. Adoption of sanitary regulations for the transportation of said material
at the points o f disembarkation— regulations which might be formulated as
follow s:
(a)
Isolate from other merchandise the hides, etc., of suspected animals on
board sailing vessels and steamboats, and after the discharge of every invoice
disinfect the place o f storage while in transit.
(&) Use for discharging cargoes o f animal material special lighters which,
until disinfected, are not to serve for other transportation.
(c) Forbid the transportation o f suspected material on the bare shoulder,
and furnish laborers with impermeable clothing and head covering, this last to
protect securely the throat, back of the head, and face by means of a cape;
also supply all facilities for washing after work, soap, etc., if not disinfecting
solutions.
Analogous regulations should be adopted in railway transportation.
4. Request the Governments to make compulsory sanitary regulations (after
the manner of those established in Germany, France, etc.) obligatory on the
part of manufacturers and on the part o f workmen in establishments where
animal substances are handled.
1 From an article on II Charbonchio Professionale, II Lavoro, July 15, 1914. p. 197.




124

BULLETIN OP TH E BUREAU OP LABOR STATISTICS.

5. Preventive vaccination o f the workmen who come into immediate contact
with the imported material.
6. Diffuse among the workmen by means o f pictures, publications, and
models a knowledge o f methods for the early recognition o f the pustules, and
institute a propaganda in favor of using antianthrax serum as a prophylactic
and curative agent.

RECOMMENDATIONS BY C. H. W. PAGE.1
The fact that practically all bristles and horsehair on arrival in this country
are centered for a time in two or three London warehouses raises the question whether it would not be possible to disinfect the material before distribu­
tion. Were disinfection thus centralized it would be a comparatively simple
matter to protect the limited number o f people exposed to risk in cutting the
knots o f the bundles and spreading the horsehair out for disinfection; then
the necessity for formal regulations in horsehair and brush-making factories
and workshops in a great measure would be obviated. The manufacturers
would gain in being freed from risk o f anthrax among their employees and,
further, would be able to use hair that many of them have preferred to discard
on account o f its dangerous properties.
With regard to the measures introduced in Germany a few years ago,
and quite recently in England, more stress might be laid on the necessity of
washing, use o f nailbrush, keeping the nails short; in washing, the use o f an
efficient disinfectant is advisable; for this purpose Cyllin does admirably, being
compatible with soap. Experience shows that soap and water are the true
safeguards after handling infected material, and those who use the same stuff
after disinfection should wash hands, face, and neck before going home to a
meal. By these means, too, the likelihood o f workers carrying infection outside
would be diminished. The ignorance and carelessness of the workers are
undoubted factors in the spread of anthrax. The use o f overalls and gloves,
though unpleasant and disliked by the workpeople, yet is very necessary, as
cases quoted show.
Facilities for bacteriological examination given by the Home Office since 1899
for verification of doubtful cases might with advantage be extended to exami­
nation of suspected samples of hair, etc.
It would be advisable to require the registrar to communicate with the coroner
in all fatal cases of anthrax.
When possible, walls and pavements of factories and workshops should be
painted or glazed so as to be easy to clean and disinfect.
Early diagnosis o f anthrax being difficult, it is essential for a medical man
to be attached to each factory, or group of factories, to whom all cases may be
referred, so that in making a diagnosis the nature o f the employment may be
taken into consideration. By this timely vigilance, remedies, harmless in any
case, may be used with far greater prospect o f success.
The duties of certifying factory surgeons might be extended with advantage
to include the above work, and that there might be no delay they should be
supplied with serum by the Home Office. The surgeons should collect samples
of suspected material for bacteriological examination, should undertake the
entire treatment of all cases o f anthrax, and, in conjunction with the local
factory inspector, conduct an inquiry into the source of infection.
1 From summary of article on British Industrial Anthrax, Journal of Hygiene, Decem­
ber, 1909, pp. 390—
395.




AN TH RAX AS AN OCCUPATIONAL DISEASE.

125

Employees absent from work should report to the employer the cause, and
in the case of illness of any kind the employee should be visited at once by
the certifying factory surgeon.
The employer should exclude as far as possible workpeople with cuts or
abrasions unless suitably covered, and for the carrying out of all regulations
each factory and workshop should be supplied with, or compelled to supply,
means for dressing small cuts, etc.
All cases of human anthrax, whether industrial or agricultural, should be
notified. Both human and animal cases o f anthrax should be notified to one
authority, or to both the board of agriculture and the Home Office, so that if
thought advisable the inquiry may be made in common.
Human anthrax being so closely associated with animal anthrax, more sys­
tematic efforts should be made (1) by limiting the spread of the disease in
nature, and (2) by the immunization of animals against anthrax to exterminate
the disease among animals.
It is necessary to dispose of the carcasses without shedding of blood, so that
no part may be used, either (1) by burning, or (2) by deep burial, preferably
in quicklime. These methods are equally effective, but perhaps for smaller
carcasses burning is to be recommended and for larger ones deep burial. All
places likely to have been contaminated with any discharges should be thor­
oughly disinfected, as with 1 in 1,000 corrosive sublimate.
Investigations should be undertaken in each country or by some international
organization, to determine accurately the nature and extent o f anthrax districts,
which should be then kept under supervision and, where possible, drained or
rendered innocuous by other means. Such measures would result in a consider­
able reduction in anthrax among animals and consequently among human beings.
Such an organization would give warning o f the prevalence of anthrax in these
districts, so that export of infected material might be controlled.
Dust from horsehair factories is not infrequently sold. * * * Hence it
is necessary to prevent the sale of dust arising in the manipulations of
dangerous or nondisinfected raw animal products and t o , do this separate
tables and rooms should be used for such material. Such dust should be burned.
The effluent from wool, hair, and skin factories should be rendered inert by
some reliable process, such as prolonged boiling, before being discharged, or
treated by a suitable strength o f some such disinfectant as Cyllin.
Other general measures, as notification o f all cases of deaths of animals
from any acute disease and of those rendering necessary slaughter on the farm
are desirable. A fee should be paid for notification and compensation for
animals slaughtered, while failure to comply with these regulations should be
punishable by a heavy penalty.
Animals, except in emergencies, should not be slaughtered or their carcasses
disposed of except on licensed and inspected premises, and, in all cases of ani­
mals slaughtered otherwise than by butchers in the ordinary course of their
business, a veterinary should inspect the carcasses and give a certificate of the
cause of death or disease, stating the uses to which the carcass may be put,
a copy o f the certificate to be forwarded to the board of agriculture as well as
to the medical officer o f health.
Information should be furnished to factory and market officials; no butcher
or knacker should purchase the carcass without having seen the certificate.




APPENDIX A.— RULES AND REGULATIONS IN THE
UNITED STATES.

UNITED STATES: TREASURY DEPARTMENT AND DEPARTMENT
OF AGRICULTURE JOINT ORDER NO. 1. REGULATIONS GOV­
ERNING THE CERTIFICATION AND DISINFECTION OF HIDES,
FLESHINGS, HIDE CUTTINGS, PARINGS, AND GLUE STOCK,
SHEEPSKINS AND GOATSKINS AND PARTS THEREOF, HAIR,
WOOL, AND OTHER ANIMAL BY-PRODUCTS, HAY, STRAW, FOR­
AGE, OR SIMILAR MATERIAL OFFERED FOR ENTRY INTO THE
UNITED STATES, 1916.
[Effective January 1, 1917.]
W a s h i n g t o n , D. C., October 21, 1916.
Under authority of the act of Congress approved October 3, 1913, entitled
“An act to reduce tariff duties and to provide revenue for the Government,
and for other purposes ’’ (38 Stat., 114), and the act of Congress approved Feb­
ruary 2, 1903, entitled “ An act to enable the Secretary of Agriculture to more
effectually suppress and prevent the spread o f contagious and infectious dis­
eases of live stock, and for other purposes ” (32 Stat., 791), the following regu­
lations are issued for the purpose of preventing the introduction of anthrax,
foot-and-mouth disease, and rinderpest from a foreign country into the United
States.
R e g u l a t i o n I.
HIDES AND SK IN S.
S e c t i o n 1. All hides of neat cattle, calfskins, buffalo hides, sheepskins, goat­
skins, and deerskins offered for entry into the United States from any foreign
country (except abattoir and hard, sun-dried hides and skins as hereinafter pro­
vided) must be accompanied by a certificate signed by the United States con­
sular officer of the district from which such hides or skins are shipped or by a
certificate issued by the chief of the veterinary service or the duly authorized
sanitary inspector of the country from which such hides or skins are shipped,
authenticated by the said United States consular officer, stating that anthrax is
not prevalent, and that neither foot-and-mouth disease nor rinderpest exists in
such district, or by a certificate signed by the said consular officer showing that
such hides or skins have been disinfected by immersion for not less than 24
hours in a 1 to 1,000 bichloride o f mercury solution.
Sec. 2. I f such hides or skins (other than abattoir and hard, sun-dried hides
and skins) offered for entry into the United States are certified, as required by
section 1, to be from a district where anthrax is not prevalent, but in which
either foot-and-mouth disease or rinderpest exists, they will be admitted if
certified by the United States consular officer of the district from which shipped
to have been disinfected by immersion for not less than 30 minutes either in a
1 to 1,000 bichloride o f mercury solution or in a 5 per cent solution of car­
bolic acid.

126




ANTH RAX AS AN OCCUPATIONAL DISEASE---- APPENDIX A.

127

S ec. 3. Such hides or skins (other than abattoir and hard, sun-dried hides
and skins), if packed in bales the exterior surface o f each of which is thor­
oughly whitewashed under consular supervision prior to shipment, may be
imported without previous disinfection upon the conditions that they will be
disinfected at the owner’s expense after arrival at destination in the United
States; that the destination is a tannery having proper facilities for disinfect­
ing the same; that they will move from the port o f entry only under customs
seal; and that they will be disinfected at destination under the supervision of
the Bureau of Animal Industry ( a ) when certified as required by section 1 to
be from a district where anthrax is not prevalent by immersion in a 5 per cent
solution of carbolic acid or a 2 per cent solution o f chloride o f lime or a 1 to
5.000 solution of bichloride of mercury, with not less than 24 hours’ exposure; or
(b ) when not certified in any of the forms aforesaid by immersion in a 1 to
1.000 bichloride of mercury solution with not less than 48 hours’ exposure, or in
a 1 to 5,000 bichloride of mercury solution with not less than 6 days’ exposure
plus not less than 5 days in lime of the usual strength for dehairing.
Sec. 4. Hard, sun-dried hides and skins may be imported without disinfec­
tion if certified as required in section 1 to be from a district or districts where
anthrax is not prevalent, if each bale or hide is distinctly marked for identifi­
cation, each shipment showing invoice number, names, and addresses o f con­
signees and consignor as such hard sun-dried hides and skins so certified
showing freedom from anthrax can be considered as having been disinfected by
the process of curing and need not be submitted to any further treatment, or
such hides or skins may be imported without being certified to be from a dis­
trict where anthrax is not prevalent if accompanied by a consular certificate
showing them to have been disinfected prior to shipment by immersion for not
less than 24 hours in a 1 to 1,000 bichloride o f mercury solution, or such hides
and skins may be imported without any certification upon the conditions pre­
scribed in section 3 for importations to be disinfected at destinaton in the
United States by immersion in a 1 to 1,000 bichloride of mercury solution with
not less than 48 hours’ exposure, or in a 1 to 5,000 bichloride of mercury solu­
tion with not less than 6 days’ exposure plus not less than 5 days in lime of
the usual strength for dehairing.
R

e g u l a t io n

II.

ABATTOIIl HIDES AND S K IN S.

Abattoir hides and skins taken from animals slaughtered in Sweden, Nor­
way, Australia, New Zealand, Great Britain, Uruguay, and Argentina, when
accompanied by a certificate of an official veterinarian of the country where such
animals were slaughtered, showing that such hides or skins were taken from
animals free from disease at the time of slaughter, may be imported into the
United States without disinfection.
R

e g u l a t io n

III.

GLUE STOCK.

Fleshings, hide cuttings and parings, or glue stock shall be subject to disin­
fection and certification under the requirements o f these regulations the same
as hides and skins, except that such fleshings, hide cuttings and parings, or
glue stock may be imported without disinfection if shown by a consular invoice
used upon entry or by a consular certificate to have been sterilized by heat
(not less than 200° F.) or by acidulation, or to have been lime dried after
42806°— Bull. 205—17------ 9




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B ULLETIN OF THE BUREAU OF LABOR STATISTICS.

soaking for not less than 7 days in a strong lime wash made by slaking quick­
lime in water in such proportion as to be of a creamy consistency, or to have
been dried by exposure to the action of the sun and air for a sufficient time to
render each piece of the hardness of a sun-dried hide, provided the consignee
or his agent files a satisfactory bond or agreement that said materials and
containers will be handled or sterilized in a manner acceptable to the Bureau
of Animal Industry before distribution from the factory or establishment to
which consigned.
R e g u l a t i o n IV.
BONES, HOOFS, AND HORNS.
S e c t i o n 1. Bones, hoofs, and horns which are clean, dry, and free from
pieces of hide, flesh, or sinews may be imported without restrictions other than
a satisfactory agreement on the part of the consignee or his agent to destroy
or sterilize the bags or containers thereof at destination.
S e c . 2 . Bones, hoofs, and horns with pieces of hides or tendons attached and
also horn piths either will be subject to the requirements of Regulation III
or may be forwarded to a factory or other establishment in sealed cars after
the bags or containers have been sprayed with lime wash under the supervision
of an inspector of the Bureau o f Animal Industry, provided the consignee or
his agent files a satisfactory bond or agreement that such materials will be
sterilized in an acceptable manner before distribution from the factory or other
establishment to which shipped, and that the bags or containers thereof will
be sterilized or destroyed.
R e g u l a t i o n V.
w ool

and

h a ir

.

S e c t i o n 1. Clipped wool may be imported in bales if accompanied by an
affidavit of a competent authority of the district from which the wool is
shipped, authenticated by the United States consul at the port o f shipment,
designating the bales by their markings, indicating the consignor, consignee,
and number of the invoice, and stating that all the wool contained in such
bales was clipped from live animals free from foot-and-mouth disease, rinder­
pest, and anthrax, and that the same has not been exposed to the infection
of these diseases.
S e c . 2. Picked or pulled wool or hair may be imported if accompanied by a
declaration of the exporter, authenticated by the United States consul at the
port of shipment, to the effect that such wool or hair, designated in the manner
provided in section 1 o f this regulation for clipped wool, came from animals free
from anthrax. The consignee or owner of such wool or hair or his agent shall
be required to file a satisfactory bond or agreement assuring proper facilities
of disinfection at the establishment to which the shipment is consigned, and
that all of such wool or hair will be disinfected or sterilized by proper exposure
to a temperature of not less than 200° F. prior to any transfer or reshipment
from such establishment. I f such wool or hair, when offered for entry, is un­
accompanied by the above-mentioned declaration, its entry will be permitted
upon the condition that the consignee or owner thereof or his agent files a satis­
factory bond or agreement assuring proper facilities for disinfection at the
establishment to which the shipment is consigned, and that all of such wool or
hair will be disinfected or sterilized by proper exposure to a temperature of
not less than 212° F. for at least 15 minutes prior to any transfer or reshipment from such establishment.




ANTH RAX AS AN OCCUPATIONAL DISEASE---- APPENDIX A.

129

S ec. 3. Importation of abattoir pulled wool will be permitted without restric­
tions from any country maintaining a veterinary inspection system ascertained
by the Secretary of Agriculture and certified by him to the Secretary of the
Treasury, from time to time, to be the substantial equivalent of the veterinary
inspection system maintained by the United States, when accompanied by a
certificate signed by an official veterinary inspector o f such country to the
effect that said wool was procured from sheep slaughtered therein under
Government inspection, and that in the process of wet pulling and drying it
has been subjected to a temperature o f not less than 200° F. Such certificate
must indicate the number of bales, marks, names, and addresses of consignor
and consignee, district of origin, date of shipment, invoice number, and vessel
transporting.
Sec. 4. All wool and hair unaccompanied by certificates, affidavits, and decla­
rations herein provided, when permitted to be entered without such certificates,
affidavits, and declarations, must be shipped from port of entry to destination
in sealed cars after the bales or bundles have been whitewashed at such port
of entry under the supervision o f an inspector of the Bureau o f Animal In­
dustry, and the destination of such wool or hair must be a factory or estab­
lishment having satisfactory facilities for sterilizing or disinfecting the same
in the manner provided by these regulations or as may be directed by the Chief
of the Bureau of Animal Industry. The consignee, owner, or his agent will be
required to file a satisfactory bond or agreement to fulfill all requirements as
to shipment and disinfection or sterilization.
R

e g u l a t io n

VI.

H A Y , STRAW, ETC., AND MEATS PACKED IN H A Y OR STRAW.
S e c t i o n 1. On account of the existence of foot-and-mouth disease in the
countries of continental Europe and South America, and the impracticability
of disinfecting hay and straw used as the packing on meats offered for entry
without injuring the meats for food purposes, the entry into the United States
from any of those countries of any meats packed in hay or straw is prohibited.
Sec. 2. Bran, middlings, and mill feed may be imported from Argentina with­
out being disinfected as prescribed in section 4 if accompanied by a certificate
signed by the United States consul of the district from which shipped showing
that such bran, middlings, or mill feed was conveyed by chutes directly from
the mill in which produced into the vessels transporting the same to the United
States.
S ec. 3. Because of lack o f danger of the communication of disease through
the importation of hay, straw, forage, and similar materials, including bran,
middlings, or other mill feed originating in and transported directly from
Great Britain, Ireland, the Channel Islands, Cana4a, and Mexico, such articles
may be imported into the United States from these countries as long as the
above condition continues to exist without being disinfected as prescribed in
section 4.
S ec. 4. Except as otherwise provided in this regulation all hay, straw, for­
age, or similar materials, including bran, middlings, or other mill feed, offered
for importation from any foreign country shall be disinfected in the manner
prescribed by the Chief of the Bureau of Animal Industry, at the expense of
the owner, before being unloaded from the vessel or conveyance bringing the
same into any port of the United States, and when unloaded and landed shall
be stored and held in quarantine for a period of not less than three months




130

BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

at some place acceptable to the Chief of the Bureau of Animal Industry and
under directions prescribed by him.
R

VII.

e g u l a t io n

CANADA.

Because of the lack of danger of the introduction of disease into the United
States through the importation of the articles enumerated in these regulations
originating in and transported directly from Canada, such articles may be im­
ported from Canada as long as the above condition continues to exist without
being disinfected or certified as prescribed by these regulations.
R

e g u l a t io n

VIII.

PRODUCTS FROM DISEASED A N IM ALS.

Importation into the United States of any hides, skins, fleshings, hide cut­
tings, parings, and glue stock, hair, wool, or other animal products covered by
these regulations, taken or removed from animals affected with anthrax, footand-mouth disease, or rinderpest, is prohibited.
R

e g u l a t io n

IX.

DISINFECTION OF CARS, BOATS, OTHER VEHICLES, AND PREMISES.

Cars, boats, other vehicles, yards, and premises which have been used in the
transportation, handling, and storing o f uncertified or nondisinfected imported
hides, skins, and parts thereof, hair, wool, and other animal by-products, hay,
straw, forage, or similar material, permitted entry subject to disinfection, shall
be cleaned and disinfected, under the supervision of the Bureau of Animal In­
dustry, subject to the conditions and in accordance with the requirements o f
the regulations of the United States Department o f Agriculture contained in
B. A. I. Order 245, governing the disinfection of cars, boats, other vehicles,
yards, and premises used in interstate movement o f live stock, except that all
such cars, boats, other vehicles, yards, and premises, storage places used in
the transportation, handling, and storing of any of said articles uncertified for
nonprevalence of anthrax, or which have not been disinfected against anthrax,
shall be disinfected with a 1 to 1,000 bichloride of mercury solution. The per­
mitted disinfectants specified in the said B. A. I. Order 245 may be used in
disinfection against the other communicable diseases.
PRIOR ORDERS ANNULLED.

Treasury Department Circular No. 23, dated May 2, 1910, and all amend­
ments thereto, and B. A. I. Order 129, dated October 4, 1904, and all amend­
ments thereto, shall cease to be effective on and after January 1, 1917, on and
after which date this order, which for purposes of identification is designated
as United States Treasury Department and Department of Agriculture Joint
Order No. 1, shall become and be effective until otherwise ordered.
(Signed)
W m . P. M a l b u r n ,




Acting Secretary of the Treasury.

D. P.

H

o u ston ,

Secretary of Agriculture.

ANTHRAX AS AN OCCUPATIONAL DISEASE---- APPENDIX A.

131

MASSACHUSETTS: RULES AND REGULATIONS SUGGESTED FOR
THE PREVENTION OF ANTHRAX, 1916.1
PREAM BLE.

Anthrax may be transmitted to man by infected hides, skins, wool, horse
hair, cow hair, goat hair, pigs’ bristles or pigs’ wool, as well as by dried blood,
bones, and other animal products. The bacillus o f anthrax soon dies out
when dried at the ordinary temperature, but the spores o f the disease may
remain active, under favorable circumstances, for many years. These spores,
inclosed in blood clots, dried and caked on the hair, skin, or wool, are the
usual sources of infection, owing to the clots breaking up into dust. The dust
arising in the handling, sorting, and manipulation of the animal products
readily finds its way into the lungs in breathing, or is swallowed in the act
of eating or drinking. More often, however, the dust finds its way into broken
skin by cuts, bruises, or scratched pimples. The result of this infection is
anthrax. Anthrax, therefore, is chiefly a dust disease. (It can be caused
by eating diseased meat and by the bite o f an insect which has fed upon
infected carcasses or other material.) While the, danger o f anthrax is greatest,
according to all statistics, in the manipulation of animal products imported
from China, Russia, and Siberia, nevertheless the disease is so widely dis­
tributed that in no country is it unknown. Consequently, the precautions
which are most necessary where hides, skins, hair, and wool from the, coun­
tries named are handled can, with advantage, be applied to products from
other countries. In the United States there is no interstate, quarantine law
nor disinfection regulation against anthrax.
Protection against anthrax can be grouped under these headings, v iz .:
1. Disinfection of the material.
2. The avoidance o f dust.
3. The instruction o f the workers.
The experience o f countries where anthrax has been more prevalent than
it has been in this country shows (1) that wool or hair can be readily disin­
fected by steam without injury to the material, and (2) that hides and skins
can be disinfected without damage to these articles and without injury to
subsequent manufacturing processes.
The following rules and regulations shall apply to all establishments where
hides, skins, fur, horse hair, bristles, wool, horns, bones, or other animal prod­
ucts liable to be infected with anthrax are handled.
For the enforcement of these rules and regulations all products or parts
of animals shall be considered in a raw state unless they have undergone a
treatment as follow s:
Hides and skins— tanning.
W ool— scouring.
Horse hair, fur, and hog bristles— bleaching.
Horns and bone— boiling for two hours, or treatment with a strong antiseptic.
The following industries shall be considered dangerous within these rules
and regulations, and they shall apply in a special manner in those departments
where these processes are carried on, v iz .:
1. The unpacking, unloading, or other handling, when dry, or before disin­
fection of the material.
2. The preparation of horse hair.
3. Tawing, tanning, and fur dressing.
4. The pulling, scouring, and sorting of wool.
1 Massachusetts Board of Labor and Industries, Industrial Bulletin No. 6 .




132

BULLETIN OF THE BUREAU OF LABOR STATISTICS.
DISINFECTION.

All foreign1 hides, skins, horse hair, cow hair or goat hair, pigs’ bristle, and
pigs’ wool, before they are manipulated in any factory or establishment in
this State, shall be disinfected (unless exempted as hereinafter provided) at
the choice of the manufacturer in one of the following prescribed w ays:
A. Hides and Skins.

-

(1) By the Seymour-Jones method, viz: To 1 pound of per chloride of mer­
cury add 500 gallons of water, and to this mixture add 5 gallons of formic
acid (commercial 50 per cent strength). In this bath steep the material for
24 hotirs; or,
(2) By the Schattenfroh method, viz: In a 2 per cent hydrochloric acid solu­
tion to which 10 per cent of common salt has been added, steep the material
for a few days. A quicker method can be used by substituting a 1 per cent solu­
tion of hydrochloric acid and 8 per cent o f salt, provided the temperature of the
solution is maintained at 40° C. (104° F.) for a period of six hours.
B. Hair, Bristles, and Pigs' Wool.

(1) By letting a current of steam act on the material for not less than onehalf hour at a pressure of 17 pounds (0.15 above atmospheric pressure) ; or,
(2) By boiling for at least one-quarter of an hour in a solution containing
2 per cent of per manga nite of potassium, and subsequent bleaching with a 3 or
4 per cent solution of sulphurous a cid ; or,
(3) By boiling in water for not less than two hours.
Exemptions.

The disinfection by the manufacturer may be dispensed with if he presents
proof in writing stating that the material has been disinfected in accordance
with the requirements of the United States Treasury Department or o f the
Massachusetts State Department of Health.
The manufacturer shall not be required to disinfect white bristles which he
subjects to a subsequent bleaching process before further manipulation, or
w^hich he has bought already bleached (so-called French bristles) and which
have been kept apart from nondisinfected material.
Exemption from the requirements o f section B may be authorized by the
State Board of Labor and Industries for those materials. that, according to
present experience, would be seriously damaged, or for those materials that
can be certified to as having already undergone an equally effective disinfection
in the country or State from which they have been exported.
Prior to disinfection prescribed by these rules and regulations only such steps
as are indispensable to the examination of the quality of the material, to the
prevention of their being spoiled, and to the preparation and the execution of
the disinfection are permitted in relation to material required to be disin­
fected, e. g., unpacking and preparing for disinfection.
The stock of nondisinfected materials which are required to be disinfected,
or which are exempted from disinfection, shall be stored in separate rooms and
kept apart from the stock that has been disinfected. Access to this room should
be restricted as much as possible so, as to avoid unnecessary exposure of
workmen.
Records.

The employer shall keep a record of the skins, hides, hair, bristles, wool, and
other material mentioned in these rules and regulations, in such a manner that
the quantity, the source of supply, and, so far as is known, the origin of the
merchandise received, as well as the time and the method of disinfection, or the
1 Also domestic whenever anthrax is prevalent in the locality from which the material
has been exported.




AN TH RAX AS AN OCCUPATIONAL DISEASE---- APPENDIX A.

133

reason for its omission, are clearly set forth. Such records shall be accessible
to the State Board of Labor and Industries or its representatives.
SANITATION OF WORKSHOPS.

Floors.— In those parts of the establishment where material capable of trans­

mitting anthrax is stored or manufactured the floors shall have a waterproof
covering or other suitable material that permits the ready washing of such
floors. The floors of these departments should be washed daily if the workroom
is dusty or if cases of anthrax have occurred recently at the establishment.
Walls and ceiling.— The walls and ceiling of such workshop or room, unless
covered with a smooth washable coating pr oil painting, should be washed fre­
quently with a disinfectant solution. If whitewash is used this coating should
be renewed on the outbreak of cases of anthrax among workmen employed in
that establishment.
Tables, workbenches and seats.—These articles should be washed twice a
week with a disinfectant solution, especially if cases of anthrax have occurred
recently in the establishment.
Ventilation.— The workroom shall be well aired twice daily by means of
open windows, for at least half an hour, viz, during noonday meal hour and
after the day’s work has been finished, or before it has begun again. No work­
man should be permitted to remain in the room during this period.
Dust removal.— In all workrooms in which dust is a factor there shall be
an adequate exhaust system installed capable of removing the dust at its origin
and conveying it to a suitable receptacle for subsequent destruction.
It is recommended that hides and skins be submitted to the ordinary “ wet
salting” process immediately after flaying; or if cured by drying, that the hides
and skins be converted back to the “ wet salted ” state by the formic-mercury
processes as soon as possible.
In horsehair factories and horsehair dressing, the sorting and hackling shall
not be done except in special workrooms separate from the other workroom.
The dust created shall be collected and destroyed.
Carding and dust-extracting machinery as well as mixing, willowing, and
hackling machines, shall be closed over and provided with an adequate and
effective dust exhaust system. The dust shall be collected in a dust chamber
and burned.
The treatment o f wool, horsehair, hog bristles, and furs shall take place
whenever possible in closed vessels. In those operations, such as opening of
bales or beating, which can not take place in closed vessels, the process shall
be carried on in such a way as to allow the collecting of the refuse and its sub­
sequent destruction.
PERSONAL PRECAUTIONS.

Printed notices issued by the State Board of Labor and Industries shall be
kept posted in a conspicuous place in each department, setting forth the dangers
of anthrax infection, the early signs and symptoms of the disease, and the
precautions that shall be taken in order to avoid this infection.
Any employee who is suffering from a cut, scratch, pimple, or crack of the
skin that has not healed readily shall report the same to the person in charge
or to factory physician.
Employers shall furnish to employees impermeable aprons and leggings (or
rubber boots) in all operations where the body is liable to come in contact with
the water used in tanning, scouring, boiling, or bleaching o f animal product.
Employees shall wear a suitable respirator (loose g&uze cloth tied over nose
and mouth may be used) while engaged in the dusty processes of handling,
sorting, or of manufacture.




134

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

Employers shall provide for the use of employees overalls and gloves when
handling raw material, and neck protectors when carrying raw material on the
shoulder. Haw material shall be transported on carts or handbarrows when­
ever practicable.
Employers shall see that the materials provided for the use of employees are
worn by the persons for whom they are intended, and that when these articles
are not in use they are kept in a special place, and that they are disinfected at
least once a week.
Dressing rooms, wash rooms, and a suitable dining room shall be provided and
fitted up outside the place where dangerous operations are carried on.
There shall be provided an adequate supply o f running hot and cold water,
toilets, washing and drinking facilities, all in accordance with the rules of the
State Board of Labor and Industries on toilets. Lockers shall be provided so
that street clothes and work clothes may be kept separate and apart.
Employees shall not bring food into the workroom. The eating of food in
workroom shall be strictly prohibited.
Employees shall be required to take off their work clothes before entering the
dining room, and to wash hands, arms, neck, and face before taking their meals
or leaving the premises.
Employers shall keep posted in a conspicuous place in each department a
notice legible to all employees stating—
1. The text of these rules and regulations.
2. Workshop regulations imposing on employees the following obligations:
{a) To make use of the various working clothes and other articles provided
for them by the employer.
(&) To make use of the dressing room and washing facilities.
(c) To take the necessary measures for cleanliness before eating and before
leaving the workshop.
( d ) To bring no food into the workroom.
3. The dangers of anthrax infection, and the precautions that should be taken
to avoid them, and the necessity of employees reporting at once all skin
affections.
4. Name and address of physician in charge o f the medical service o f the
establishment.
Note.

The first symptom of anthrax is usually a small inflamed swelling like a pim­
ple or boil. This is often painless. In a few days the pimple becomes black at
the center and is surrounded by other “ pimples.” The poison is now liable to
be absorbed into the system and will cause risk of life if not removed by prompt
and effective treatment. Early treatment is usually successful; delay or neglect
usually leads to blood poisoning, often to death.

NEW YORK: STATE INDUSTRIAL COMMISSION, DIVISION OF
INDUSTRIAL HYGIENE, RECOMMENDATIONS, 1916.
I. Every physician should report at once to the State industrial commission
every case of anthrax coming under his care.
II. In every establishment where articles liable to be infected with anthrax
are handled a competent physician should be employed.
III. In every such establishment the employer should make such special
provision for the protection of his employees as the commission shall deter­
mine.
IV. Every employee should be required to make use of the means provided
for his safety by the employer.




ANTHRAX AS AN OCCUPATIONAL DISEASE---- APPENDIX A.

135

V. It should be the duty of the shop foreman or superintendent to enforce
the use by the employees of the means provided by the employer.
VI. Attention of physicians and of the public should be called to the dangers
o f anthrax.
A ll. Cooperation with Federal and contiguous State authorities should be
maintained to prevent the entrance of infected materials into commerce.
THE

PH YSIC IA N .

1. He should visit the establishment every day and sign a register showing
the time of his visit, this register to be subject to inspection by the State indus­
trial commission.
2. He should examine every workman at entrance upon employment, and as
often thereafter as necessary. He should instruct new employees individually,
and the others frequently in classes, in methods of preventing anthrax.
3. He should be provided with facilities for the prompt diagnosis and early
treatment of anthrax. He should have charge of the first-aid kits, as approved
by the commission. He should instruct foremen and others selected in the
use of first aid.
4. He should keep a record of all examinations and of all treatments, such
record to be subject to inspection by the commission. He should report
promptly to the commission every case of anthrax, together with a record of
the source of the infecting material.
THE EMPLOYEE.

1. In factories the floors should be of cement or waterproofed easily washed
material. The walls should be whitewashed. When a case o f anthrax de­
velops the floors should be thoroughly cleaned and the walls whitewashed.
Tables, work benches, and other articles coming in contact with materials
should be washed as often as necessary with a disinfecting solution.
2. Dressing rooms, wash rooms, and lunch rooms should be provided, sepa­
rate from the work rooms. The dressing room should be so arranged that the
working clothes may be kept separate from the street clothes. The wash
rooms should be provided with basins, water, soap, individual towels, etc., as
directed by the industrial code. No food should be allowed in the workrooms.
3. Where dust is evolved in the process special ventilating apparatus should
be installed according to the judgment of the commission.
4. To avoid, as much as possible, contact with materials, suitable clothing,
waterproof aprons, overalls, shoes, gloves, etc., should be provided the work­
men.
5. Notices in different languages should be posted conspicuously throughout
the workrooms:
(a) Requiring the use of protective clothing; requiring the use of dressing
rooms and wash room s; forbidding food in workrooms.
(b) W'arning of dangers of anthrax; instructing as to methods of avoiding
i t ; requiring the report to foremen of even slight accidents or injuries.
6. The foreman or superintendent should be held responsible for observance
of the regulations.
THE

EMPLOYEE.

1. He should realize the danger of anthrax and the necessity o f avoiding
infection.
2. He should wear the clothing and use the dressing rooms, wash rooms, and
lunch rooms provided by the employer. No food should be taken into the work­
rooms.
3. He should report at once to the foreman even slight injuries and should
follow strictly directions of the physician.
4. He should assist the foreman in enforcing the regulations.




APPENDIX B.— TEXT OF EUROPEAN REGULATIONS.1

GREAT BRITAIN: REGULATIONS FOR HANDLING DRY AND DRYSALTED HIDES AND SKINS IMPORTED FROM CHINA OR FROM
THE WEST COAST OF INDIA, 1901.
DUTIES OF OCCUPIER.

1. Proper provisions to the reasonable satisfaction of the inspector in charge
of the district shall be^ made for the keeping of the workmen’s food and clothing
outside any room or shed in which any of the above-described hides or skins
are unpacked, sorted, packed, or stored.
2. Proper and sufficient appliances for washing, comprising soap, basins, with
water laid on, nailbrushes and towels, shall be provided and maintained for
the use of the workmen, to the reasonable satisfaction of the inspector in charge
of the district.
3. Sticking plaster and other requisites for treating scratches and slight
wounds shall be kept at hand, available for the use of the persons employed.
4. A copy of the appended notes shall be kept affixed with the rules.
DUTIES OF PERSONS EMPLOYED.

5. No workman shall keep any food, or any articles o f clothing other than
those he is wearing, in any room or shed in which any of the above-described
hides or skins are handled. He shall not take any food in any such room or
shed.
6. Every workman having any open cut or scratch or raw surface, however
trifling, upon his face, head, neck, arm, or hand shall immediately report the
fact to the foreman, and shall not work on the premises until the wound ia
healed or is completely covered by a proper dressing after being thoroughly
washed.
N o t e 1. [States that these rules must be kept posted in conspicuous places in
the factory, workshop, or other premises to which they apply, where they may
be conveniently read by the persons employed. Any person who is bound to
observe them and fails to do so, or acts in contravention o f them, is liable to
a penalty; and in such cases the occupier is also liable to a penalty unless he
proves that he has taken all reasonable means, by publishing and, to the best
of his power, enforcing them, to prevent the contravention or noncompliance.
A printed copy must be supplied by the occupier to any person affected by
them if such person applies for it. Pulling down, injuring, or defacing any
copy so posted is punished by a fine not exceeding £5 ($24.33).]
N o t e 2. [Is an earlier and less complete form o f the note shown on page 140.]
N o t e 3.— Suitable overalls, protecting the neck and arms, as well as ordinary
clothing, add materially to the safety of the workmen, and should be provided
and worn, where practicable, if dangerous hides are handled. They should be
discarded on cessation of work. Similarly, for the protection of the hands,
gloves should be provided and worn where the character of the work permits.
1 From monthly bulletin of the International Labor Office.

136




ANTH RAX AS AN OCCUPATIONAL DISEASE---- APPENDIX B.

137

GREAT BRITAIN: SORTING, WILLEYING [WILLOWING], WASHING,
COMBING, AND CARDING WOOL, GOAT HAIR, AND CAMEL HAIR,
AND PROCESSES INCIDENTAL THERETO, 1905.
DEFINITION.

For the purpose of regulations 2, 3 and 18, opening of wool or hair means
the opening of the fleece, including the untying or cutting of the knots, or, if
tlie material is not in the fleece, the opening out for looking over or classing
purposes.
DUTIES OF OCCUPIERS.

1. No bale of wool or hair of the kinds named in the schedules shall be opened
for the purpose of being sorted or manufactured, except by men skilled in
judging the condition o f the material.
No bale of wool or hair of the kinds named in schedule A shall be opened
except after thorough steeping in water.
2. No wool or hair of the kinds named in schedule B shall be opened except
(a) after steeping in water, or (b) over an efficient opening screen, with
mechanical exhaust draft, in a room set apart for the purpose, in which no
other work than opening is carried on.
For the purpose o f this regulation, no opening screen shall be deemed to be
efficient unless it complies with the following conditions:
(a) The area of the screen shall, in the case of existing screens, be not less
than 11 square feet, and in the case of screens hereafter erected be not less
than 12 square feet, nor shall its length or breadth be less than 3£ feet.
(&) At no point o f the screen within 18 inches from the center shall the
velocity of the exhaust draft be less than 100 linear feet per minute.
3. All damaged wool or hair or fallen fleeces or skin, wool or hair, if o f the
kinds named in the schedules, shall, when opened, be damped with a disin­
fectant and washed without being willowed.
4. No wool or hair o f the kinds named in schedules B or C shall be sorted
except over an efficient sorting board, with mechanical exhaust draft, and
in a room set apart for the purpose, in which no work is carried on other
than sorting and the packing o f the wool or hair sorted therein.
No wool or hair o f the kinds numbered (1) and (2) in schedule A shall be
sorted except in the damp state and after being washed.
No damaged wool or hair of the kinds named in the schedules shall be sorted
except after being washed.
For the purpose of this regulation, no sorting board shall be deemed to be
efficient unless it complies with the following conditions:
The sorting board shall comprise a screen of open wirework, and beneath
it at all parts a clear space not less than 3 inches in depth. Below the center
of the screen there shall be a funnel, measuring not less than 10 inches across
the top, leading to an extraction shaft, and the arrangements shall be such that
all dust falling through the screen and not carried away by the exhaust can
be swept directly into the funnel. The draft shall be maintained in constant
efficiency while the sorters are at work, and shall be such that not less than
75 cubic feet of air per minute are drawn by the fan from beneath each sort­
ing board.
5. No wool or hair of the kinds named in the schedules shall be willowed
except in an efficient willowing machine, in a room set apart for the purpose,
in which no work other than willowing is carried on.




138

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

For the purpose of this regulation, no willowing machine shall be deemed to
be efficient unless it is provided with mechanical exhaust draft so arranged
as to draw the dust away from the workmen and prevent it from entering the
air of the room.
6. No bale of wool or hair shall be stored in a sorting room ; nor any wool or
hair except in a space effectually screened off from the sorting room.
No wool or hair shall be stored in a willowing room.
7. In each sorting room, and exclusive of any portion screened off, there shall
be allowed an air space of at least 1,000 cubic feet for each person employed
therein.
8. In each room in which sorting, willowing, or combing is carried on, suit­
able inlets from the open air or other suitable source shall be provided and
arranged in such a way that no person employed shall be exposed to a direct
draft from any air inlet or to any draft at a temperature of less than 50° F.
The temperature of the room shall not, during working hours, fall below
50° F.
9. All bags in which wool or hair of the kinds named in the schedules 1ms
been imported shall be picked clean and not brushed.
10. All pieces of skin, scab, and clippings or shearings shall be removed daily
from the sorting room and shall be disinfected or destroyed.
11. The dust carried by the exhaust draft from opening screens, sorting
boards, willowing or other dust-extracting machines and shafts shall be dis­
charged into properly constructed receptacles and not into the open air.
Each extracting shaft and the space beneath the sorting boards and opening
screens shall be cleaned out at least once in every week.
The dust collected as above, together with the sweepings from the opening,
sorting, and willowing rooms, shall be removed at least twice a week and
burned.
The occupier shall provide and maintain suitable overalls and respirators, to
be worn by the persons engaged in collecting and removing the dust.
Such overalls shall not be taken out of the works or warehouse, either for
washing, repairs, or any other purpose, unless they have been steeped over­
night in boiling water or a disinfectant.
12. The floor of every room in which opening, sorting, or willowing is car­
ried on shall be thoroughly sprinkled daily with a disinfectant solution after
work has ceased for the day, and shall be swept immediately after sprinkling.
13. The walls and ceilings of every room in which opening, sorting, or willow­
ing is carried on shall be limewashed at least once a year and cleansed at least
once within every six months, to date from the time when they were last
cleansed.
14. The following requirements shall apply to every room in which unwashed
wool or hair of the kinds named in the schedules, after being opened for sort­
ing, manufacturing, or washing purposes, is handled or stored:
(a)
Sufficient and suitable washing accommodation shall be provided out­
side the rooms and maintained for the use of all persons employed in such
rooms. The washing conveniences shall comprise soap, nailbrushes, towels,
and at least one basin for every five persons employed as above, each basin being
fitted with a waste pipe and having a constant supply o f water laid on.
(&) Suitable places shall be provided outside the rooms in which persons
employed in such rooms can deposit food, and clothing put off during working
hours.
(c) No person shall be allowed to prepare or partake o f food in any such
room. Suitable and sufficient meal-room accommodation shall be provided for
workers employed in such rooms.




ANTH RAX AS AN OCCUPATIONAL DISEASE---- APPENDIX B.

139

(tf) No person having any open cut or sore shall be employed in any such
room.
The requirements in paragraph (c) shall apply also to every room in which
any wool or hair of the kinds named in the schedules is carded or stored.
15. Requisites for treating scratches and slight wounds shall be kept at hand.
16. The occupier shall allow any of H. M. inspectors of factories to take at
any time, for the purpose of examination, sufficient samples of any wool or hair
used on the premises.
DUTIES OF PERSONS EMPLOYED.

17. No bale of, wool or hair o f the kinds named in the schedules shall be
opened otherwise than as permitted by paragraph 1 of regulation 1, and no
bale of wool or hair of the kinds named in schedule A shall be opened except
after thorough steeping in water.
If on opening a bale any damaged wool or hair of the kinds named in the
schedules is discovered, the person opening the bale shall immediately report
the discovery to the foreman.
18. No wool or hair of the kinds named in schedule B shall be opened other­
wise than as permitted by regulation 2.
19. No wool or hair o f the kinds named in the schedules shall be sorted other­
wise than as permitted by regulation 4.
20. No wool or hair of the kinds named in the schedules shall be willowed
except as permitted by regulation 5.
21. Every person employed in a room in which unwashed wool or hair of the
kinds named in the schedules is stored or handled shall observe the following
requirements:
( a ) He shall wash his hands before partaking of food or leaving the premises.
(&) He shall not deposit in any such room any article o f clothing put off
during working hours. He shall wear suitable overalls while at work and shall
remove them before partaking of food or leaving the premises.
( c)
I f he has any open cut or sore, he shall report the fact at once to the
foreman and shall not work in such a room.
No person employed in any such room or in any room in which wool or hair
of the kinds named in the schedules is either carded or stored shall prepare or
partake of any food therein or bring any food therein.
22. Persons engaged in collecting or removing dust shall wear the overalls as
required by regulation 11.
Such overalls shall not be taken out of the works or warehouse, either for
washing, repairs, or any other purpose, unless they have been steeped overnight
in boiling water or a disinfectant.
23. If any fan, or any other appliance for the carrying out of these regula­
tions, is out of order, any workman becoming aware of the defect shall imme­
diately report the fact to the foreman.
SCHEDULE A .

(W ool or hair required to be steeped in the bale before being opened.)
1. Van mohair.
2. Persian locks.
3. Persian or so-called Persian (including Karadi and Bagdad), if not sub­
jected to the process o f sorting or willowing.




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BULLETIN OF THE BUREAU OF LABOR STATISTICS.
SCHEDULE B.

(W ool or hair required to be opened either after steeping or over an efficient

opening screen.)

Alpaca.
Pelitan.
East Indian cashmere.
Russian camel hair.
Pekin camel hair.
Persian or so-called Persian (including Karadi and Bagdad), if subjected to
the process of sorting or willowing.
SCHEDULE C.

(W ool or hair not needing to be opened over an opening screen, but required
to be sorted over a board provided with downward draft.)
%
All mohair other than Van mohair.
Note.

The danger against which these regulations are directed is that of anthrax—
a fatal disease affecting certain animals, which may be conveyed from them
to man by the handling of wools or hairs from animals which have died of
the disease. The germs of the disease (anthrax spores) are found in the dust
attaching to the wool or in the excrement, and in the substance o f the pieces
of skin, and may remain active for years. In this country and Australia
anthrax is rare, consequently there is little danger in handling wools from the
sheep of these two countries; but in China, Persia, Turkey, Russia, the East
Indies, and in many other parts o f the world, the disease is common, and
infected fleeces or locks (which may not differ from others in appearance) are
often shipped to Great Britain. Hence, in handling foreign dry wools and hair,
the above regulations should be carefully observed. Greasy wools are com­
paratively free from dust, and therefore little risk is incurred in handling them.
The disease is communicated to man sometimes by breathing or swallowing the
dust from these wools or hair, and sometimes by the poison lodging in some
point where the skin is broken, such as a fresh scratch or cut, or a scratched
pimple, or even chapped hands. This happens more readily on the uncovered
parts of the body, the hand, arm, face, and most frequently o f all, on the neck,
owing either to infected wool rubbing against the bare skin, or to dust from
such wool alighting on the raw surface. But a raw surface covered by clothing
is not free from risk, for dust lodging upon the clothes may sooner or later work
its way to the skin beneath. Infection may also be brought about by rubbing
or scratching a pimple with hand or nail carrying the anthrax poison. Use of
the nailbrush, and frequent washing and bathing of the whole body, especially
of the arms, neck, and head, will lessen the chance o f contracting anthrax.
The first symptom o f anthrax is usually a small inflamed swelling like a
pimple or boil— often quite painless— which extends, and in a few days becomes
black at the center and surrounded by other “ pimples.” The poison is now
liable to be absorbed into the system, and will cause risk of life, which can be
avoided only by prompt and effective medical treatment in the early stage, while
the poison is still confined to the pimple. Hence it is of the utmost importance
that a doctor should be at once consulted if there is any suspicion o f infection.




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141

GREAT BRITAIN: REGULATIONS FOR THE PROCESSES INVOLVING
THE USE OF HORSEHAIR FROM CHINA, SIBERIA, OR RUSSIA,
IN EFFECT APRIL 1, 1908.1
DEFINITIONS.

“ Material ” means tail or mane horsehair from China, Siberia, or Russia,
whether in the raw state or partially or wholly prepared, notwithstanding that
such preparation may have taken place in some country other than those named.
“ Disinfection” means (a) exposure to steam at a temperature not less than
212° F. for at least half an hour of material so loosened, spread out, or ex­
posed as to allow the steam to penetrate throughout; or ( b ) exposure of material
to such disinfectant under such conditions of concentration and temperature of
the disinfectant, and duration and manner o f exposure of the material to it, and
otherwise, as are certified to secure the destruction of anthrax spores in all
parts of all horsehair subjected to the process: Provided, That such a certificate
shall have no force unless and until (1) a copy o f it has been submitted to the
secretary of state, and (2) a copy of it is kept in the register required under
regulation 1: Provided further, That any such certificate may at any time be
disallowed by the secretary of state, either generally or with regard to a factory
or workshop in which anthrax has occurred.
“ Certified ” means certified by the director of a bacteriological laboratory
recognized by a corporation in the United Kingdom having power to grant
diplomas registrable under the medical acts, 1858 to 1905.
It shall be the duty o f the occupier to observe Part I of these regulations.
It shall be the duty of all persons employed to observe Part II of these regu­
lations.
PART I.— DUTIES OF EMPLOYERS.

1. A register shall be kept containing the prescribed particulars2 of the
disinfection of all material.
2. Material which has not undergone disinfection shall not be stored except
in a room set aside for the purpose, in which no other horsehair shall be placed.
3. Material which has not undergone disinfection shall not be opened from
the bale or sorted except in a room set aside for the purpose, in which no other
horsehair shall be placed; nor shall any such material be opened from the bale,
except over or by the side of an efficient screen, or sorted except over an
efficient screen.
For the purposes of this regulation no screen shall be deemed to- be efficient
unless it is provided with an exhaust draft so arranged that at every point
of the screen within 18 inches of the center the velocity of the exhaust draft
shall be at least 300 linear feet per minute.
4. No material shall be subjected to any manipulation other than opening or
sorting until it has undergone disinfection.
5. Every willowing and dust-extracting machine shall be covered over and
provided with efficient exhaust draft so arranged as to carry the dust away
from the worker.
6. The dust from the opening and sorting screens, and from the willow or
other dust-extracting machines, shall be discharged into furnaces or into
chambers so constructed as to intercept the dust.
7. Each extracting shaft and the space beneath the opening and sorting
screen shall be cleaned out at least once in every week.
1 Great Britain, Home Office. Factory and Workshops Orders, London, 1909, p. 93.
2 See appended schedule, p. 143.




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BULLETIN OF TH E BUREAU OF LABOR STATISTICS.

8. All dust collected from the opening and sorting screens shall be burned.
9. There shall be provided and maintained for the use o f persons employed
on material which has not undergone disinfection—
( a) Suitable overalls and head coverings, which shall be collected at the end
of every day’s work, and washed or renewed at least once every week, and
shall not be taken out of the works for any purpose whatever unless they have
previously been boiled for 10 minutes or have undergone disinfection after
last being used; and
( b ) A suitable meal room, separate from any workroom, unless the works are
closed during meal hours; and
( c ) A suitable cloakroom for clothing put off during working hours; and a
suitable place, separate from the cloakroom and meal room, for the storage of
the overalls; and
( d ) Requisites for treating scratches and slight wounds.
10. There shall be provided suitable respirators for the use of persons
employed in work necessitated by regulations 6, 7, and 8. Each respirator
shall bear the distinguishing mark of the worker to whom it is supplied, and
the filtering material shall be renewed after each day on which it is used.
11. There shall be provided and maintained in a cleanly state and in good
repair for the use of all persons employed on material which has not undergone
disinfection, a lavatory, under cover, with a sufficient supply of clean towels,
renewed daily, and o f soap and nailbrushes, and with either—
(a) A trough with a smooth impervious surface, fitted with a waste pipe
without plug, and of such length as to allow at least 2 feet for every five such
persons, and having a constant supply of warm water from taps or jets above
the trough at intervals of not more than 2 fe e t; or
( b ) At least one lavatory basin for every five such persons, fitted with a
waste pipe and plug or placed in a trough having a waste pipe, and having
either a constant supply of hot and cold water or warm water laid on, or (if
a constant supply of heated water be not reasonably practicable) a constant
supply of cold water laid on and a supply of hot water always at hand when
required for use by persons employed.
12. No person under 18 years o f age shall be employed on material which has
not undergone disinfection.
13. No persons employed on material which has not undergone disinfection
shall be allowed—
(a ) To work having any open cut or sore; or
(&) To introduce, keep, prepare, or partake o f any food or drink, or to­
bacco, in any room in which such material is stored or manipulated.
14. A cautionary notice as to anthrax, in the prescribed form, shall be kept
affixed with these regulations.
PART II.— DUTIES OF PERSONS EMPLOYED.

15. No person employed shall—
(a) Open, sort, or willow or otherwise manipulate any material except in
accordance with the foregoing regulations.
(&)
Introduce, keep, prepare, or partake of any food or drink, or tobacco,
contrary to regulation 13 (&).
16. Every person employed on material which has not undergone disinfection
shall—
(a)
Wear the overall and head covering provided in pursuance o f regula­
tion 9 (a) while at work, and shall remove them before partaking of food or




ANTH RAX AS AN OCCUPATIONAL DISEASE---- APPENDIX B.

143

leaving the premises, and shall deposit in the cloakroom provided in pursuance
o f regulation 9 (c) all clothing put off during working hours; and
(b) Wash the hands'and clean the nails before partaking of food or leaving
the premises; and
(c) Report any cut or sore to the foreman, and until it has been treated,
abstain from work on any such material.
17. Every person employed shall wear the respirator provided in pursuance
of regulation 10 while engaged in work necessitated by regulations 6, 7, and 8.
18. If the arrangement for disinfection, or any fan, or any other appliance
for the carrying out of these regulations, appears to any workman to be out
of order or defective, he shall immediately report it to the foreman.
SCHEDULE: PROCESSES INVOLVING THE USE OF HORSEHAIR, 1908.

By an order dated March 11, 1908, the particulars to be entered on the
register under regulation 1 o f the order as to use of horsehair are to be:
With regard to each consignment of such horsehair received in the factory
or workshop—
1. Weight of material.
2. Date of receipt on the premises.
3. Country of origin.
4. Whether raw or partially or wholly prepared.
5. Method of disinfection.
And in the case of material disinfected on the premises—
6. Date of disinfection.
And in the case of material disinfected elsewhere than on the premises—
7. Name of person from whom the material was obtained.

FRANCE: DECREE RELATING TO SPECIAL HYGIENIC MEASURES
FOR ESTABLISHMENTS WHERE THE WORKERS ARE EXPOSED
TO ANTHRAX INFECTION, 1913.
1.
In the establishments contemplated in section 65 of Book II of the Labor
Code, where are handled in the raw state skins, fur, horsehair, liogs’ bristles,
wool, horns, bones, or other animal products liable to be infected with anthrax,
the principals, directors or works managers shall be required, irrespective of
the general measures prescribed by the decree of July 10, 1913,1 to adopt the
special measures of protection and hygiene mentioned in the following articles.
In regard to the application of the present decree, such product or animal
remains as have not undergone the treatment mentioned below shall be consid­
ered as in the raw state:
Horsehair, hogs’ hair and bristles: Stoving at 103° for one hour, or soaking
for two hours in boiling water, or bleaching.
Skins: Tanning.
W ools: Industrial degreasing.
Bones and horns: Stoving at 103° for one hour or soaking for two hours in
boiling water, or treatment with powerful antiseptics.
All other methods of disinfection which the minister of labor, after taking
the opinion of the consultative committee for arts and manufactures, shall
recognize as equivalent, may also be allowed.
1

p. 63.

For text of this decree see Bulletin o f the International Labor Office, Vol. I X , 1914,

42806°— Bull. 205— 17-------10




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BULLETIN OF THE BUREAU OF LABOR STATISTICS.

2. A physician appointed by the principal of the establishment shall carry
out the following inspections and make the required reports; his remuneration
shall be at the expense of the establishment.
As soon as it shall come to the knowledge of principals, directors, or works
managers that a workman is suffering either from a form of pimple, cut,
abrasion, or crack which has not healed up after three days’ dressing in the
factory, they shall have him at once examined by the physician, who shall
prescribe the necessary treatment. The name and age of the worker and
the work in which he was engaged, the origin of the materials recognized as
liable to have caused the infection, as also the riesult of the medical examina­
tion, shall be entered in a special register.
Every establishment shall be provided with a “ first-aid ” box containing the
remedies and materials for dressing, as prescribed by ministerial order. This
♦box shall always be kept in good condition, and placed in an easily accessible
place.
3. The principals of works, directors, or managers shall be required to pro­
vide the workers with impermeable aprons and legging overalls for all work in
which the body is liable to come in contact with the water used in the treatment
of the products of animal remains mentioned in section 1.
4. The following industries shall be considered as dangerous within the mean­
ing of section 5 hereunder, where materials are treated which have come from
districts indicated in an order o f the minister of labor, after consultation with
the minister o f commerce and industry and the minister o f agriculture.
(1) The preparation o f horsehair.
(2) The plucking, washing, and sorting of wools.
(3) Tawing, tanning, and furriery.
(4) The sorting and working up of bones and horns.
The following operations shall also be regarded as dangerous within the
meaning o f the same section: The unpacking, manipulation, and other opera­
tions performed in a dry condition, before disinfection of the materials enu­
merated in section 1, which have come from the regions indicated in the order
above referred to.
5. In those parts of the establishment specially devoted to the carrying on
o f the industries or to the performance of the dangerous operations defined
under section 4, the following precautions shall be observed:
In the workrooms the flooring shall consist of an impermeable covering or
of a sectional paving which can be easily washed. The walls shall have a
coating which can be thoroughly washed, or shall be limewashed.
This limewash coating shall be renewed whenever necessary, and especially
when a case of anthrax has occurred. The tables, benches, and seats, also the
floors and walls, shall be washed as often as may be necessary with a disinfect­
ing solution. The tools shall be subjected to frequent disinfection.
In the storehouses where the materials referred to in section 1 are kept,
every space temporarily unoccupied shall be cleaned with a disinfectant.
In the case of wool, horsehair, hogs’ hair and bristles, the handling shall
be done wherever possible in closed vessels.
As regards the material referred to in the preceding paragraph, the operations
which it is impossible to carry out in a closed vessel— such as the opening of
bales and, if necessary, the beating—must be carried out under such conditions
as will allow o f the collection of all the offal and its subsequent destruction.
The dressing and washing rooms for the use o f the workers shall be fitted up
outside the places where dangerous operations are carried on.




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145

The said dressing and washing rooms shall be fitted with a sufficient num­
ber of basins or taps, with an ample provision o f water and soap and a towel
for each worker, which latter shall be renewed at least once a week. They
shall, moreover, be provided with wardrobes or boxes which can be closed by
key or a padlock, and which are divided into two compartments, so that the
outdoor clothes may be kept separate from the working clothes.
In default of a separate cupboard divided into two compartments, every
worker shall have at his disposal two clothes pegs on opposite sides of the
dressing room, for the purpose o f receiving on one side his ordinary and on
the other side his working clothes. The clothes pegs shall be separated by a
space of at least 30 centimeters [11.8 inches].
The workers shall be provided with overalls for handling materials in the
raw state. They shall also be provided with protections for the neck, for the
transport of those materials which have to be carried on the shoulder. Un­
less impracticable, all raw materials shall be carried in carts or handbarrows.
6. The minister o f labor, by order issued on the report o f the industrial in­
spectors, and after consultation with the consultative committee of arts and
manufactures, shall have power to grant to an establishment, for a fixed term,
relief from the whole or a portion o f the provisions of section 5 (paragraphs
5 and 6) if it is recognized that the application o f these provisions is practically
impossible, and that the health of the workers is insured under conditions at
least equal to those which are fixed by the present decree.
7. The principals, directors, or works managers shall be required to affix
in a conspicuous position of the working premises—
(1) The text of the present decree.
(2) Shop rules, imposing on the workers the following duties: That they
shall use the various working clothes and other working articles placed gratui­
tously at their disposal; that they shall make use o f the dressing room and the
washstands referred to in section 5 (paragraphs 7, 8, and 9) ; make good use
o f the provisions for cleanliness whenever leaving the premises; and bring no
food into the workroom.
(3) A notice pointing out the dangers of anthrax, as also the precautions to
be taken to avoid them, and the necessity o f the workers to make the declara­
tion indicated in section 2.
(4) The name and address of the physician intrusted with the medical serv­
ice of the establishment.
The terms of the notice mentioned in the present section under (2) shall be
fixed by a ministerial order.
GERMANY: ORDER CONCERNING THE EQUIPMENT AND OPERA­
TION OF HORSEHAIR SPINNING ESTABLISHMENTS, OF SHOPS
WHERE OTHER ANIMAL HAIR AND BRISTLES ARE MANIPU­
LATED, AND OF BRUSH FACTORIES, 1902.
GENERAL RULES.

1. The following rules apply to all establishments where horse, cattle, and
goat hair and bristles or hair o f hogs are manipulated or spun into curled hair,
as well as to brush factories.
2. Imported animal hair and bristles must not be manipulated unless disin­
fected in the establishment where they are to be used.
Disinfection must be effected by one of the following methods:
(1)
Exposing the materials for at least half an hour to a current of steam
under a pressure of 0.15 over atmospheric pressure.




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BULLETIN OF THE BUREAU OF LABOR STATISTICS.

(2) Boiling the materials for at least a quarter of an hour in a 2 per cent
solution of permanganate o f potassium and then bleaching them in a 3 or 4
per cent solution o f sulphurous acid.
(3) Boiling them for at least two hours in water.
Other processes o f disinfection may be authorized by the imperial chancellor.
The higher administrative authorities may order that the disinfection pro­
vided in section 2, No. 1, be effected in a public disinfecting establishment if
there is one in the place where the factory is situated or in its immediate
vicinity.
3. The manufacturer may be permitted to dispense with disinfection if he
can prove, in conformity with regulations to be issued by the central State
authorities, that the materials had already been disinfected according to the
above rules when he received them and that he has stored them separately
from nondisinfected material.
The manufacturer may omit disinfection of white bristles provided that he
bleaches them before they are being worked up or if he has received them
bleached (so-called French dressed bristles) and stored them separately from
other nondisinfected material.
4. The central administrative authorities may authorize exemptions from the
rules in section 2 for materials which—
(1) According to previous experience can not be subjected to the disinfec­
tion prescribed in section 2 without beihg exposed to considerable injury.
(2) Are proved to have been subjected abroad to treatment which is con­
sidered equivalent to disinfection in conformity with the rules in force in the
German Empire.
The central administrative authorities must keep a register of the cases and
reasons for which exemptions are granted. It must also indicate in the cases
mentioned in paragraph (2) o f this section the kind of treatment to which the
materials have been subjected abroad. A copy of this register must be sub­
mitted annually, not later than February 1, to the central authority o f the
State.
5. The materials for which disinfection is required must, before disinfection,
be subjected only to operations required to ascertain their condition, to pre­
vent them from deteriorating, or to prepare them for disinfection, such as
unpacking, cutting the hair adhering to the tails, transporting to the disin­
fecting apparatus, tying o f the bristles in bundles, etc. Sorting is allowed only
so far as it is necessary for the separation of hair which has to be subjected to
different processes o f disinfection.
6. Juvenile workers must not be employed either in disinfecting processes,
or on materials exempted from disinfection in conformity with section 4, para­
graph (1 ), nor are they allowed to work in the processes specified in section 5.
7. The employer must see that workers who have skin sores, especially on
the neck, face, and hands, are not employed in the processes specified in section 6.,
8. The employer must keep a register in which he must enter the stock of
hair and bristles received by him in such a way that the quantity o f these mate­
rials, the seller and, if possible, also the place of origin, the time at which they
were disinfected and the processes used, or the reason for which disinfection
was omitted become evident.
If the disinfection took place in a public establishment, the certificates given
on that occasion must be collected, preserved, and produced whenever required
by the supervisory officers.
9. Supplies of nondisinfected materials which are subject to disinfection
and those which are exempt from disinfection according to section 4, para-




ANTHRAX AS AN OCCUPATIONAL DISEASE— APPENDIX B.

147

graph (1 ), must be kept in special locked rooms and may be taken to these
rooms or removed from them only by passages and staircases which are not
used by workers occupied on disinfected or on domestic materials. Disin­
fected or domestic goods must not be transported through those passages
and staircases.
The operations which must necessarily precede disinfection, disinfection
itself, and the manipulation o f materials exempted from disinfection in ac­
cordance with section 4, paragraph (1 ), must not take place in rooms where
disinfected or domestic materials are kept or manipulated.
The places where disinfected materials or those exempted from disinfection
according to section 4, paragraph (1 ), are kept or manipulated, the entrance
ways to those rooms, also the passages and staircases through which the mate­
rials of this category are transported, must be kept constantly clean. In clean­
ing them care must be taken to make as little dust as possible. The sweepings
from, and the wrappings in which the nondisinfected materials arrived, must
be burned or disinfected ( section 2, paragraph 2 ). These measures apply equally
to dust generated by, and refuse resulting from, the working up of nondisin­
fected materials and to rubbish.
REGULATIONS FOR LARGE ESTABLISHM ENTS.

10. In establishments regularly employing 10 or more workers, the floor of
the workshop must be solid and tight and must allow an easy removal of dust
by washing. Wooden floors must be smoothly planed and water-tight.
The walls and ceilings, unless they are covered with a hard glazed surface
which allows washing or are oil painted, must be whitewashed at least once a
year.
In the construction of new and the enlargement of existing establishments,
measures must be taken that in new workrooms where operations generating
considerable dust are to be carried out, the number of workers should be so
calculated that each will have at least 15 cubic meters [530 cubic feet] air
space.
11. Workrooms must be completely aired for at least half an hour twice a
day, i. e., during the noon hour and after the close or before the beginning of
work. During this time workers must not be allowed in the shops.
The floors of rooms where work generating dust is carried on must be cleaned
at least once a day by washing. The work tables in these rooms must be washed
at least twice a week.
12. In establishments where horsehair is spun or otherwise prepared the
sorting and hackling must be done in special rooms separated from the others.
The dust generated and the rubbish must be gathered and removed.
13. Mixing, cleaning, and hackling machines (beating and willowing ma­
chines) must be covered and provided with effective exhaust drafts. The dust
must be collected in a special chamber, and if it comes from nondisinfected
materials it must be burned.
14. The workers employed on the processes preliminary to disinfection or in
disinfection itself or in the treatment of materials exempted from disinfection
according to section 4, paragraph (1 ), must be provided at the employer’s
expense with working clothes and caps in sufficient number and of proper
materials.
By issuing suitable regulations and providing supervision the employer must
see to it that the work clothes are used only by those workers to whom they
are assigned, and that during the time when they are not in use the work
clothes are kept in places designated for that purpose and disinfected at least




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BULLETIN OP THE BUREAU OF LABOR STATISTICS.

once a week. The employer must give to the workers mentioned in the first
paragraph of this section the opportunity of taking a warm bath at least twice
a week.
15. In a part o f the establishment, free from dust, a dressing and washing
room shall be kept for the w orkers; also a lunch room if necessary. The lunch
room must be separated from the dressing room. These rooms must be kept
clean and free from dust, and during the cold season they must be heated. In
the lavatory the workers must be supplied with a sufficient quantity of water,
soap, and towels, and with an adequate number of places for keeping the clothes
which are taken off before beginning work.
16. The employer must issue for the workers manipulating the materials
mentioned in the first paragraph of section 2 the following rules:
(1) The workers must use the working clothes provided for them during
those operations for which these clothes are assigned.
(2) The workers must not bring any food into the workshops. They must
eat only outside o f these places.
(3) The workers are not allowed to enter the lunch rooms, to eat, or leave
the establishment, except after taking off the working clothes prescribed in the
first paragraph of section 14 and carefully washing their faces, necks, hands,
and eyes.
In rules which are issued it must be stipulated that workers who violate the
above regulations in spite of repeated warnings will be discharged without
notice before the expiration of their time.
If shop rules are issued for an establishment, the above regulations must be
included.
17. Sections 1-16, legibly written or printed, must be posted in each work­
shop, dressing room, and lunch room.
PRUSSIA: ORDER RELATING TO THE PROPAGATION OF ANTHRAX
THROUGH ANIMAL SKINS, 1902.
INSTRUCTIONS W IT H REGARD TO THE DANGERS TO H E A LTH IN V O L V E D IN THE
M A N IPU L ATIO N OF R A W FOREIGN SKINS.

Experience has shown that the traffic in raw skins and hides, especially
those of foreign origin, involves danger to the health of human beings and
animals. Researches have proved that some of the raw skins (especially deer
and kipskins coming from America, East India, and China) were taken from
anthrax-infected animals. The cause of the disease is contained in these skins
and hides in the. form o f very resistant anthrax spores. The usual processes
to which the skins are subjected, such as drying, or treatment with salt, salt­
peter, or arsenic, do not destroy the spore. The dust which is generated during
sorting, packing, and transportation, and also during the opening of the bales
and becomes mixed with shed hair is the principal carrier of the disease. The
particles o f dust and the hair, to which the anthrax spores adhere, are deposited
on the clothes and bodies of persons near by, and enter the mouth, nose, ears,
etc. Even the smallest abrasion of the skin may be instrumental in producing
infection. Danger lies in the manipulation of raw materials and in the evil
habit o f removing with the finger nails dry crusts on the skins. The persons
employed on raw skins can carry infection to other places on their soiled
clothes, hair, hands, etc.
It has also shown that anthrax may be produced by the pollution of fodder
and straw with particles of dust and hair from imported raw skins by the
use of tanbark refuse as bedding in stalls and passageways, and by the tending




ANTHRAX AS AN OCCUPATIONAL DISEASE— APPENDIX B.

149

of animals by persons handling raw foreign hides. Even the use of refuse
from tanneries for the purpose of fertilizing pastures and fields, also the soaking
of skins in rivers and similar waters, may lead to the propagation of anthrax.
A reliable and practical process of disinfection which does not injure the
skins is not known. For the purpose o f minimizing the danger of infection the
following precautionary measures can be recommended, especially to persons
regularly engaged in the handling o f raw skins:
(1) Storage places for raw foreign hides should be situated in out of the
way localities at considerable distance from dwellings and from stables. They
must be carefully fenced so that animals can not enter them.
(2) Sheds, etc., for the storage of straw and fodder must not be used as
storage places or workrooms for the preparation o f raw hides.
(3) The generation of dust must be avoided as much as possible during the
opening of the bales, also during sorting, piling, packing, and other manipula­
tions of skins; when necessary the skins should be sprinkled with water.
(4) The places where raw foreign hides are stored or worked up must be
carefully cleaned after they are used; they must be disinfected at proper
intervals.
(5) Tanbark used in the tanning, the hair and other refuse from the tan­
neries, and other remains, the straw, rags, cords, etc., which were used in pack­
ing the raw foreign hides, as well as the sweepings, must be either burned or
buried after disinfection.
(6) Persons having external wounds should not be allowed to manipulate
raw foreign hides.
(7) Before leaving the work place persons occupied in handling raw foreign
hides must carefully clean their faces, arms, hands, hair, and beard.
(8) The storerooms, work places, etc., must be cleaned only by wet processes.
(9) A solution of chloride o f lime (one part chloride of lime and three parts
water) or a mixture o f sulphuric and carbolic acid (one part of sulphuric acid,
two parts of crude carbolic acid, and four parts o f water) are recommended as
disinfectants. These disinfectants should be also used on sweepings and other
refuse.
PRUSSIA:

REGULATIONS FOR THE PROTECTION OF WORKERS
AGAINST THE DANGERS OF ANTHRAX, 1910.

1. Raw sheep and go^t skins, as well as dry imported raw skins, shall be
stored in separate storerooms, capable o f being locked, which are used for this
purpose only, and are not in direct communication with living rooms, stables or
rooms for storing fodder.
2. The storerooms shall be provided with floors made of cement, asphalt or
other impervious material, the joints being perfectly tight. Premises which
have already been in existence may be used for a further period not exceeding
10 years, should they be provided with floors of the nature referred to above.
The storerooms shall be cleaned at least once a week, by means of damp
sawdust or damp tanbark, for instance. Storerooms shall be disinfected after
they have been wholly or partially emptied, by washing them with a solution o f
1 part fresh chloride of lime in 20 parts water, in conformity with the regula­
tion that the whole of the storeroom shall be disinfected in this manner at least
once a year, but walls and ceiling only in so far as they have come in contact
with raw skins. The said whitewash shall not be removed for a space of 24
hours at least.




150

BULLETIN OF THE BUREAU OF LABOR STATISTICS.

Refuse and valueless packing material (straw, bast, ropes, etc.) shall be
burned.
3. Raw sheep and goat skins, as well as dried imported raw skins, shall be
handled with special care. Above all, care must be taken not to subject the said
skins to an unnecessary amount of shaking and not to throw them about.
For the transport o f skins the use o f special contrivances, such as wagons
(trolleys), etc., is very strongly recommended.
Workers shall not be allowed to carry skins unless they have been provided
with protective hoods, which cover the head, neck, and shoulders.; while they
must also be provided with a sufficient number of smocks of good quality when
handling dried foreign skins.
The employer shall insure that, by means of suitable arrangements and
proper supervision, smocks and protective hoods are worn only by those workers
to whom they have been handed for use, and that they are disinfected at once
after having been in use for one week. The said disinfection shall be effected
as the employer may direct, either by steaming at a pressure of not less than
0.15 above atmospheric pressure, or by boiling for at least one hour.
4. Workers who come in contact with raw sheep or goat skins or dried im­
ported raw skins shall have their attention drawn at the commencement of
their employment to the dangers o f anthrax, to which they may be exposed, and
they shall be handed a copy of the regulations for the prevention of accidents,
and likewise instructions in regard to anthrax. The said instructions shall
further be posted up in the workrooms. The necessary number o f copies of the
same will be placed at the disposal o f the employers by the association.
5. A part of the works, as far as possible free from dust and suitable for the
purpose, shall be reserved for washing rooms and, where it is customary for
workers to take their meals within the works, lunch rooms shall be provided.
The said lunch rooms shall be kept clean and free from dust, and shall be
heated during the cold season.
6. The employer shall also insure that any worker who exhibits symptoms
o f anthrax shall immediately place himself under medical treatment, and, fur­
ther, that any workers suffering from anthrax shall be admitted to the hospital
indicated by the trade association.
7. Workers who are engaged in working up raw sheep and goat skins, as- also
dried imported raw skins, shall not be allowed to enter the lunch room, to take
any meals, or to leave the works, until they have divested themselves of their
working clothes and have thoroughly washed the face, head, hair and beard,
neck, hands, and arms.
The workers shall not be permitted to take beverages in open containers or
foodstuffs into the workroom. They shall likewise be forbidden to take meals
in the latter.
8. Should the worker become aware of an itching or burning sensation on the
head, or pain arising from a darkish pimple, which, although at first of small
size, rapidly grows larger, he shall immediately inform the works management
and place himself under medical treatment or enter the hospital to which he
has been referred, since delay is dangerous and would probably lead to the
death of the worker.




INDEX.

A.
Age.
(S ee N ativity, age, sex, and conjugal condition of fatal cases, etc.)
Page.
Agriculture and other industries involving direct contact with anim als_____________
19
Agriculture, Department of, and Department' of Treasury, joint order No. 1 _____1 2 6 -1 3 0
Agriculture, prevention of anthrax in, legislation in regard to, United States_____82, 83
Animal products liable to be infected with anthrax, imports of, 1910 to 191 5 _____
84
Animal skins, propagation of anthrax through, text of order relatii;g to, Prussia,
1902 ______________________________________________________________________________________ 1 4 8 ,1 4 9
Anim als subject to anthrax, and countries where the disease is prevalent__________
12
Anthrax, cases o f :
Bradford (England) and D istrict Anthrax Investigation Board, 1906 to 1914_
101
France, 1910 to 1 9 1 2 _ _________________________________________________________________
104
Germany, Imperial Health Office, 1910 to 1912_________________________________ 103, 104
Great Britain, chief factory inspector, by industries, 1900 to 19 1 3 _____________
100
Great Britain, workmen’s compensation act, cases compensated under, 1908
to 1 9 1 4 ------------------------------------------------------------------------------------------ --------------------------------113
Holland, 1898 to 1911__________________________________________________________________
104
Italy, 1890 to 19 0 4 ____________________________________________________________________
105
43
Massachusetts hospital, by occupations, June 27, 1881, to April 26, 1916_____
Massachusetts workmen’s compensation law, claims filed under_________________
89
New York State Department of Labor, under occupational disease reporting
law, September, 1911, to March, 1 9 1 6 ____________________________________________
37
Philadelphia hospital, duration of illness among 32 cases in a __________________
41
Philadelphia hospital, January 1, 1909, to April 30, 1 9 1 6 _______________________
39
R u s s ia --------------------------------------------------------------------------------------------------------------------------------106
Tanning and leather m anufacturing establishments ( 1 9 ) ______________________ 4 4 ,4 5
United States registration area, 1910 to 1 9 1 5 _____________________________________ 5 5 -5 9
Anthrax in Europe (Chapter V ) _________________________________________________________ 9 5 -1 1 4
Anthrax in United States (Chapter I V ) _________________________________________________ 2 5 -9 3
B.
Bacillus of anthrax and its spore, discovery, characteristics, etc., of_____________6 , 1 0 -1 2
110
Belgium, wool, hair, and bristles industry, protective legislation in _________________
Bichloride of mercury solution, disinfection of hides by, Treasury Department
requirements as to_____________________________________________________________ 8 5 -8 8 , 126, 127
Boiling.
( See Disinfection.)
Bones, hoofs, and horns, disinfection of, joint order No. 1 ____________________________
128
Bradford (England) and District Anthrax Investigation Board______________________ 95, 96
Bradford (England) and District Anthrax Investigation Board, cases in wool in­
dustry reported by, 1906 to 1 9 1 4 -----------------------------------------------------------------------------------101
Bristles, imports of, into the United States, 1910 to 1 9 1 5 _____________________________
84
C.
China or W est Coast of India, hides and skins imported from, text of regula­
tions governing, Great Britain, 190 1 -----------------------------------------------------------------------------136
China, Siberia, or Russia, horsehair from, processes involving use of, text of regu­
lations governing, Great Britain, 1908______________________________________________ 1 4 1 -1 4 3
Compensation for anthrax as an industrial injury, Europe_________________________ 1 1 2 -1 1 4
Compensation for victims of occupational anthrax, legislation as to, United S tates- 8 9 -9 3
Conditions of soil and temperature favorable to the development of anthrax_______
13
Conjugal condition.
(S ee N ativity, age, sex, and conjugal condition of fatal
cases, etc.)
D.
Deaths, recorded causes of, in fatal cases, registration area, United States, 1910
to 1 9 1 5__________ ____________________________________________________________________________ 5 5 -5 9
151




152

INDEX.

Deaths.
(See also F atal cases, etc.)
Page.
Delaware, morocco-leather center, experience in _________________________________________ 3 2 -3 5
Delaware, quarantine placards and notice to employees in_____________________________
34
Devoto, Prof. L ., and F . Massarelli, recommendations by, for control and preven­
tion of anthrax__________________________________________________________________________ 1 2 3 ,1 2 4
Diagnosis, early, importance and difficulties of, etc____________________________________26—
28
D isin fection :
Bichloride of mercury solution, Treasury Department requirements__ 8 5 -8 8 , 126, 127
Boiling, general rules, Germany, 1 9 0 2 -------------------------------------------------------------------- 1 4 5 ,1 4 6
Boiling, in w a te r ; in permanganate of potassium solution---------------------------------115
Formaldehyde as a germicide for wool, report of Bradford (England) and Dis­
trict Anthrax Investigation Board_____________________________________________ 1 1 5 ,1 1 6
France, special hygienic measures, text of decree relating to, 1 9 1 3 ____________1 4 3 -1 4 5
Germany, horsehair-spinning establishments, text of order concerning, 1902_ 1 4 5 -1 4 8
Great Britain, general regulations, text of, 1905, 1 9 0 8 --------------------------------------- 1 3 7 -1 4 3
M assachusetts, suggested rules and regulations_______ =
---------------------------------------1 3 2 ,1 3 3
Potassium, permanganate of, boiling in solution o f______________________________
115
Problem of, present status of (Chapter V I ) --------------------------------------------------- 1 1 5 -1 2 0
Prussia, text of regulations, 1902, 1910___________________________________________1 4 8 -1 5 0
Schattenfroh method of, for hides and skins______________________________ 1 1 8 -1 2 0 ,1 3 2
Seymour-Jones method of, for hides and skins_____________________________ 1 1 8 ,1 1 9 , 132
116
Steam sterilization, effect of, on wool________________________________________________
United States, joint order No. 1, Departments of Treasury and Agriculture------- 1 2 6 -1 3 0
Duration of illness in 32 cases o f anthrax, Philadelphia hospital-------------------------------41
E.
England, wool, hair, and bristles industry, protective legislation in------------------------ 1 0 7 ,1 0 8
England.
(See also Great Britain.)
Europe, anthrax in (Chapter V ) _________________________________________________________ 9 5 -1 1 4
F.
Factory inspector, chief, anthrax cases reported to, Great Britain, 1900 to 1 9 1 3 __
100
F atal cases, place and date of, in registration area, United States, 1910 to 1 9 1 5 ___ 5 4 -5 9
F atal cases reported in registration area, United States, 1910 to 1915, his­
tories, e t c ------------------------------------------------------------------------------------------------------------------------------ 4 6 -7 8
F atal cases to total number of cases, probable ratio of, United States______________ 7 8 -8 0
Formaldehyde as a germicide for wool, report of Bradford (England) and District
Anthrax Investigation Board_________________________________________________________ 115, 116
F ra n c e :
Cases reported, 1910 to 1 9 1 2 _________________________________________________________
104
Establishm ents where workers are exposed to anthrax infection, text of decree
affecting, 1 9 1 3 ____________________________________________________________________ 1 4 3 -1 4 5 '
Manufacturers’ Association for Prevention of Industrial Accidents, activ­
ity o f -----------------------------------------------------------------------------------------------------------------------------97
W ool, hair, and bristles industry, protective legislation________________________1 0 9 ,1 1 0
G.
Germany :
Compulsory reporting laws and resultant data__________________________________ 102—
104
Em ployers’ Mutual Trade Association, activity o f_________________________________ 96, 97
Horsehair-spinning establishments, and hair, bristles, and brush factories,
equipment and operation of, text of order governing, 1 9 0 2 __________________ 1 4 5 -1 4 8
Imperial Health Office, anthrax cases reported to, 1910 to 1 9 1 2 ______________ 1 0 3 ,1 0 4
W ool, hair, and bristles industry, protective legislation______________________ 1 0 8 ,1 0 9
Germany.
(S ee also Prussia.)
Glue stock, certification and disinfection, joint order No. 1 ________________________1 2 7 ,1 2 8
Governmental investigations, Europe_____________________________________________________ 98, 99
Great Britain :
Compulsory reporting laws and resultant data__________________________________ 9 9 -1 0 2
Factory inspector, chief, anthrax cases reported to, 1900 to 1 9 1 3 ______________
100
Hides and skins imported from China or W est Coast of India, text of regu­
___________
lations governing, 1 9 0 1 _________________________________________________ •
±S6
Horsehair from China, Siberia, or Russia, text of regulations governing
use of, 1 9 0 8 _______________ _______________________________________________________ 1 4 1 -1 4 3




INDEX.

153

Great Britain— Continued.
Page.
W ool, goat hair, and camel hair, sorting, washing, etc., of, text of regulations
governing, 1905 ------------------------------------------------------------------------------------------------------- 1 3 7 -1 4 0
W orkm en’ s compensation act, anthrax cases compensated under, 1908 to
1 9 1 4 ____________________________________________________________________________________
113
Great Britain.
( See also England.)

H.
Hair, bristle, and brush factories, text of order concerning equipment and oper­
ation of, Germany, 1 9 0 2 _______________________________________________________________ 1 4 5 -1 4 8
H air, bristles, and pigs’ wool, disinfection of, suggested rules and regulations,
M assachusetts, 1 9 1 6 _______________________________________________________________________
132
Hides and sk in s:
Disinfection by bichloride of mercury solution, Treasury Department require­
ments as to________________________________________________________________ 8 5 -8 8 , 1 2 6 ,1 2 7
Disinfection of, joint order No. 1 _________________________________________________ 126, 127
Great Britain, text of regulations governing hides and skins imported from
China or W est Coast of India, 1901_____________________________________________
136
Imports of, into the United States, 1910 to 1 9 1 5__________________________________
84
Legislation, protective, covering the industry, E urope.;_________________________ 110, 111
Massachusetts, rules and regulations suggested as to disinfection of__________
132
Histories, individual, of fatal cases reported in registration area, United States,
1910 to 1 9 1 5 _______________________________________________________________________________ 6 0 -7 8
History and general description of anthrax (Chapter I ) ______________________________
9 -1 3
Animals subject to anthrax, and countries where disease is prevalent__________
12
Bacillus and its spore, characteristics o f_________________________________________ 1 1 ,1 2
Bacillus, discovery o f_________________________________________________________________
10
Conditions of soil and temperature. favorable to development of anthrax_____
13
Disease, early studies of the-----------------------------------------------------------------------------------------9
Infections, modes of___________________________________________________________________
13
Holland, anthrax cases reported in, 1898 to 1 9 1 1 ________________________________________
104
Holland, compulsory reporting laws and resultant data________________________________
105
Horse and other animal hair manufactured, imports of, into the United States,
1910 to 1915_______________________________________________________________________________
84
Horsehair from China, Siberia, or Russia, use of, text of regulations governing,
Great Britain, 19 0 8 ____________________________________________________________________ 1 4 1 -1 4 3
Horsehair-spinning establishments, equipment and operation of, text of order con­
cerning, Germany, 1902_______________________________________________________________ 1 4 5 -1 4 8
Horsehair workers, personal precautions of, text of regulations governing, Great
Britain, 190 8 ____________________________________________________________________________ 142, 143
Hungary, wool, hair, and bristle industry in, protective legislation__________________
110
Hygienic measures, special, affecting establishments where workers are exposed to
anthrax infection, text of decree relating to, France, 1 9 1 3 -----------------------------------1 4 3 -1 4 5
I.
Imports of animal products liable to be infected with anthrax, 1910 to 1915________
84
Industries affected (Chapter I I I ) _________________________________________________________ 1 9 -2 3
Infants, fatal cases reported of, registration area, United States, 1910 to 1915_____
53
In fectio n :
Animal hair and bristle industry, risk o f____________________________________________20, 21
Horn and bone industry, risk of_____________________________________________________
22
Leather industry, risk o f_____________________________________________________________ 19, 20
Modes o f________________________________________________________________________________
13
Nonoccupational________________________________________________________________________
23
Transportation industry, risk o f_____________________________________________________
22
W ool industry, risk o f_________________________________________________________________ 21, 22
International Association for Labor Legislation, subcommittee of, recommenda­
tions o f___________________________________________________________________________________ 1 2 1 -1 2 3
International organizations and congresses, activity of, Europe______________________
98
Italy, anthrax cases reported in, 1890 to 1 9 0 4 ___________________________________________
105
Italy, compulsory reporting laws and resultant data_______________________________ 105, 106
L.
Legislation, protective, in Europe_________________________________________________ ______ 1 0 6 -1 1 1
Legislation, United S ta t e s __________________________________________________________________8 0 -9 3
Locality.
( S ee Place, etc.)




M.
Page.
Manufacture and trade, prevention of anthrax in, legislation in regard to, United
States________________________________________________________________________________________8 4 -8 8
M assachusetts:
Board of Labor and Industries, rules and regulations suggested by, 1 9 1 6 ___ 1 3 1 -1 3 4
Hospital, cases on record in a ________________________________________________________ 4 1 -4 3
Workm en’s compensation law, claims filed under, on account of anthrax, three
years ending June 30, 1 9 1 5 _ _ ----------------------------------------------------------------------------------89
Massarelli, F ., and Prof. L . Devoto, recommendations by, for control and preven­
tion of anthrax___________________________________________________________________*------- 123, 124
M eats, packed in straw, import from certain countries prohibited, joint order
No. 1 ______________________________________________________________________________________ 129, 130
Medical aspects of human anthrax, symptoms, treatment, etc. (Chapter I I ) ______ _ 1 5 -1 8
M ilan (Ita ly ) Labor Clinic, activity o f___________________________________________________ 97, 98
Morocco-leather center, in Delaware, experience o f--------------------------------------------------------- 3 2 -3 5
N.
Nativity, age, sex, and conjugal condition of fatal cases reported in registration
area, United States, 1910 to 191 5 ------------------------------------------------------------------------------------ 54—
59
New Jersey occupational disease reporting law, cases reported under_______________ 37, 38
New York :
Occupational disease reporting law, cases reported under________________________35—
37
State Industrial Commission, recommendations_________________________________ 1 3 4 ,1 3 5
Nonoccupational anthrax------------------------------------------------------------------------------------------------------23
O.
Occupations reported in anthrax c a se s:
Barbers and hairdressers-------------------------------------------------------------------------------------------------52,
Bristle com bing________________________________________________________________________
Customs w eigh in g--------------------------------------------------- -------------------------------------------------------Farm ing and ran ch in g________________________________________________________________ 49,
Freight h a n d lin g_______________________________________________________________________
H air working and weaving____________________________________________________________
Hide and skin workers________________________________________________________________
Housekeepers_____________________________________________________________________________
L ab orers-----------------------------------------------------------------------------------------------------------------------------Liverym en________________________________________________________________________________
Longshore w o rk ----------------------------------------------------- ---------------------------------------------------------- 50,
M u sicia n _________________________________________________________________________________
Paper making___________________________________________________________________________
Tanning and leather manufacturing, various occupations in____________________44,
Tanning, United States_______________________________________________________________
Transportation workers________________________________________________________________
Truck driving___________________________________________________________________________
Veterinary surgery______________________________________________________________________

53
52
51
50
51
51
43
53
53
52
51
53
52
45
49
43
51
52

W ool and hair workers________________________________________________________________
43
W oolsortin g______________________________________________________________________________51, 52
P.
Page, C. H. W ., recommendations by, for control and prevention of anthrax_____ 124, 125
Page, C. H . W ., recorded cases of human anthrax in Italy, 1890 to 1 9 0 4 ____________
105
Pennsylvania infectious disease reporting law, cases reported under_______________ 38, 39
Personal precautions of workers :
Great Britain, horsehair, processes involving use o f__________________________ 142, 143
Great Britain, wool, goat hair, and camel hair_____________________________________
139
Massachusetts, suggested rules and regulations________________________________ 133, 134
New York, recommendations_________________________________________________________
135
Philadelphia hospital, cases on record in a ______________________________________________ 3 9 -4 1
Place and date of fatal cases, registration area, United States, 1910 to 1 9 1 5 ________5 4 -5 9
Potassium, permanganate of, disinfection by boiling in solution o f_________________
115
Prevention and control of anthrax :
Devoto, Prof. L., and F. Massarelli, recommendations by_____________________ 123, 124
France, text of regulations_________________________________________________________ 1 4 3 -1 4 5
Germany, text of regulations_______________________________________________________ 1 4 5 -1 4 8
Great Britain, text of regulations________________________________________________ 1 3 6 -1 4 3




INDEX.

155

Prevention and control of anthrax— Continued.
,
Page.
International Association for Labor Legislation, subcommittee of, recom­
mendations o f______________________________________________________________________ 1 2 1 -1 2 3
Legislation in United S ta te s __________________________________________________________ 8 2 -8 8
M assachusetts, rules and regulations suggested--------------------------------------------------- 1 3 1 -1 3 4
Page, C. H. W ., recommendations by_____________________________________________ 1 2 4 ,1 2 5
Prussia, text of regulations--------------------------------------------------------------------------------------- 1 4 8 -1 5 0
Prussia, propagation of anthrax through animal skins in, text of order relat­
ing to, 190 2 _____________________________________________________________________________148, 149
Prussia, protection of workers against anthrax in, text of regulations for, 1910_ 1 4 9 ,1 5 0
Prussia.
(S ee also Germany.)

Q.
Quarantine and vaccination of farm anim als____________________________________________
Quarantine placards and notice to employees, Delaware-------------------------------------------------

83
34

R.
Regulations for the control of anthrax. (S ee Prevention and control of anthrax.)
Reporting, compulsory, legislation in regard to, United States------------------------------------- 8 0 -8 2
Reporting, systematic, and resultant data, Europe------------------------------------------------------- 9 9 -1 0 6
Russia, cases of anthrax____________________________________________________________________
106
Russia.
( See also China, Siberia, or Russia, horsehair from, etc.)
S.
Sanitation of workshops, recommendations, New York_________________________________
135
Sanitation of workshops, suggested rules and regulations, Massachusetts, 1916_____
133
Sanitation of workshops, text of order concerning, Germany, 1 9 0 2 ________________147, 148
Schattenfroh method of disinfection, for hides and skins_____________________ 1 1 8 -1 2 0 ,1 3 2
Serums_________________________________________________________________________________________
18
Sex of anthrax cases reported, in France, and in Germany, 1910 to 1 9 1 2 _________ 1 0 3 ,1 0 4
Sex.
(S ee also Nativity, age, sex, and conjugal condition of fatal cases, etc.)
Seymour-Jones method of disinfection for hides and skins_____________________ 1 1 8 ,1 1 9 , 132
Siberia.
(S ee China, Siberia, or Russia, horsehair from, etc.)
Steam sterilization, effect of, on w ool___________________________________________________
116
Symptoms of human anthrax_________________________________________________________ 1 5 ,1 6 , 134

T.
Tanners and leather manufacturers ( 1 9 ), cases reported by__________________________ 4 4 ,4 5
Trade and manufacture, prevention of anthrax in, legislation in regard to,
United S ta t e s__________________________________________ 1 __________________________________8 4 -8 8
Treasury, Department of, and Department of Agriculture, joint order No. 1 ___ 126—130
Treatm ent of human anthrax_____________________________________________________________ 16—
18
U.
United States, anthrax in (Chapter I V ) _________________________________________________ 2 5 -9 3
V.
Vaccination and quarantine of farm animals____________________________________________

83

W.
W ool and hair, disinfection of, joint order No. 1 ____________________________________128, 129
W ool, goat hair, and camel hair, sorting, washing, combing, etc., of, text of regu­
lations governing, Great Britain, 1905_________________________________________ ______ 1 3 7 -1 4 0
W ool, goat hair, camel hair, etc., imports of, into the United States, 1910 to 1 9 1 5 84
W ool, hair, and bristles industry, protective legislation as to, Europe_______ ______ 1 0 7 -1 1 0
W ool industry, anthrax, cases in, reported by Bradford (England) and District
Anthrax Investigation Board, 1906 to 191 4__________________________________ ________
101
Workm en’s compensation act, British, cases of anthrax compensated under, 1908
to 1 9 1 4 _____________________________________________________________________________________
113
Workmen’s compensation law, claims filed under on account o f anthrax, M assa­
chusetts, three years ending June 30, 1 9 1 5 ____________________________________________
89
Workshops, sanitation of, recommendations, New York___ _____________________________
135
Workshops, sanitation of, suggested rules and regulations, M assachusetts__ _________
133
Workshops, sanitation of, text of European regulations as to (Appendix B ) _____136—150




O


Federal Reserve Bank of St. Louis, One Federal Reserve Bank Plaza, St. Louis, MO 63102