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U. S. DEPARTMENT OF LABOR

BUREAU OF LABOR STATISTICS
ROYAL MEEKER, Commissioner

BULLETIN OF THE UNITED STATES)
/WHOLE 0 ^ 1
BUREAU OF L A B O R STATISTICS J * * * \ NUMBER L
I N D U S T R IA L

A C C ID E N T S

AND

H Y G IE N E

S E R IE S :

NO.

17

M O R T A L IT Y F R O M R ESPIRATO RY
DISEASES




IN

DUSTY

TRADES

(INORGANIC DUSTS)

B Y FREDERICK L. HOFFMAN

JUNE, 1918

WASHINGTON
GOVERNMENT PRINTING OFFICE
1918




CONTENTS.
Page.

Chapter I .— General in tro d u ctio n ...................................................................................... 11-50
T he decline of tu b ercu losis.......................................................................................... 11,12
Wage earners in dusty trades.......................................................................................
12
Relation of atmosphere to life and h ealth ...............................................................
13
Practical im portance of atmospheric p u rity ........................................................... 13,14
A ir contam ination and disease resistance................................................................ 14,15
Chemical aspects of atmospheric p ollu tion ............................................................. 15,16
T he infectiousriess of tuberculosis..............................................................................
16
Lung injury from irritating dusts............................................................................... 16,17
Varied forms of pulmonary tuberculosis.................................................................. 17,18
Comparative m ortality statistics................................................................................. 18,19
Industrial lung diseases.................................................................................................
19
Lim ited value o f occupational m ortality statistics............................................... 19, 20
Dusts and fumes, foes to industrial life ............................................................. ..
20-24
Observations on the air in m ines...............................................................................
24
Principles of tuberculosis prevention ....................................................................... 25, 26
Ventilation and dust rem oval......................................................................................
26
Dust in relation to occupational diseases........- ........................................ .............. 26, 27
The dust problem in in d u stry..................................................................................... 27, 28
Scientific term inology of industrial dusts..................................................... ..
28, 29
Diseases resulting from dust inhalation.................................................................... 29-31
H armful consequences of industrial dust exposure..............................................
31
Observations on nontuberculous respiratory diseases.......................................... 31, 32
British governm ental investigations..........................................................................
32
T y pical forms of fibroid phthisis................................................................................ 32, 33
Fibroid phthisis and occupational disease.................................................. „ .......... 33-35
Sources of statistical inform ation...............................................................................
35
P rinciples of statistical analysis.................................................................................. 35-38
Industrial insurance mortality statistics..................................................................
38
The proportionate m ortality from pulm onary tuberculosis................................ 38, 39
D escriptive definitions of industrial dusts............................................................. 39, 40
The classification of dusty trades............................................................................... 40, 41
Age in relation to occupation and dust exposure.................................................. 42, 43
Age distribution of em ployees in dusty trades...................................................... 43-50
Chapter 11.— Occupations with exposure to m etallic du st..................................... 51-161
The occupational menace of metallic du st............................................................ 51,52
Relation of variations in occupational conditions to dust exposure and
m ortality.........................................................................................................................
52
Proportionate mortality— U nited States registration area................................. 52-55
Proportionate m ortality— industrial insurance exp erien ce................................ 55-59
English mortality statistics...........................................................................................
59
General conclusions.................................................................................. . .................... 59, 60




3

4

CONTENTS.

Chapter I I .— O ccupations w ith exposure to m etallic dust— Continued.
Pa^e.
The iron and steel in du stry.......................................................................................... 60-82
Variations in occupational dust exp osu re....................................................... 60, 61
O ccurrence of injurious dust among steel w orkers....................................... 61, 63
Dust exposure at blast furnaces..........................................................................
64
Dust exposure at Bessemer converters............................................................. 64-66
Dust exposure at open-hearth furnaces............................................................
66
Dust exposure at puddling m ills ........................................................................ 66, 67
Observations on the physique of iron and steel workers............................ 67, 68
H ealth-injurious conditions at iron and steel works.................................... 68, 69
The hygien ic menace of steel d u s ts .................................................•
............... 69, 70
Mortality of grinders and polishers....................................................................
70
Dust exposure in the ch ipping of iron and steel castings..............................
71
Mortality of iron and steel workers— U nited States registration a re a .. . 71, 72
Mortality of iron and steel workers— industrial insurance e x p e rie n ce .. 73-78
M ortality of pu ddlers.....................................................................................
74
M ortality of rollers.......................................................................................... 74, 75
Mortality of heaters........................................................................................ 75, 76
Mortality of furnace tenders........................................................................
76
M ortality of laborers at iron and steel w orks......................................... 76, 77
M ortality of miscellaneous em ployees at iron and steel w orks.........77, 78
E vidence of unsatisfactory health conditions................................................
78
English m ortality statistics..................................................................................
79
R ecen t English occupational-disease in v e stig a tio n s.................................. 80, 81
Mortality from pneum onia among English iron and steel workers............. 81, 82
General conclusions................................................................................................
82
Metal grinders................................................................................................................... 82-91
The hygiene of metal grin din g............................................................................ 82, 83
T y p ica l diseases of grinders.................................................................................. 83, 84
Injuriousness of dry-grinding processes............................................................ 84, 85
85
Im provem ent in the health of German cutlery grinders..........................
Sanitary precautions in German cutlery shops..............................................
86
M ortality of Sheffield metal grinders................................................................ 86-88
Mortality of grinders— industrial insurance exp erien ce..............................88, 89
M ortality of insured grinders— m edico-actuarial exp erien ce.....................
89
Sanitary investigations b y the Ohio State Board of H e a lth .................... 89, 90
M ortality experience of the Stove Mounters’ International Union . . . .
90
General conclusions................................................................................................
91
Polishers.............................................................................................................................. 92-98
Polishing processes in relation to du st..............................................................92, 93
Sickness experience of the Metal Polishers’ U n io n .....................................93, 94
Polishing processes in various in d u stries........................................................ 94, 95
Ventilation and sanitary con dition s.................................................................. 95, 96
Dust hazards in buffing.........................................................................................
96
Mortality of buffers, finishers, and polishers— medico-actuarial exp e­
rien ce.......................................................................................................................96, 97
Mortality of polishers— industrial insurance ex p erien ce............................ 97, 98
Card grin din g.................................................................................................................... 98, 99
File cu ttin g.................................................................................................................... 99-103
Variations in occupational exposu re.............................................................
99-101
D escriptive account of sanitary conditions in O h io................................. 101,102
File cutting b y hand and b y m ach in ery.........................................................
102
~ ............................................ 102,103
Lead poisoning.......................................
General conclusions................. *.................. ..........................................................
103




CO N TE N TS.

5

Chapter I I . — O ccupations w ith exposure to m etallic dust— Continued.
Page.
Tool and instrument m akers................................................................................... 103-109
Sanitary conditions of em ploym ent in Massachusetts.................................
104
Difficulties in effective ven tilation ................................................................ 104,105
Vital statistics of English tool and cutlery m akers.................................. 105,106
Mortality from pulm onary tuberculosis and nontuberculous respira­
tory diseases..................................................................................................... 106,107
M ortality of tool and cutlery makers— U nited States registration area. 107,108
M ortality of tool and instrument makers— industrial insurance e x p e ­
rien ce................................................................................................................... 108,109
109
General con clu sion s...............................................................................................
S a n db la stin g........................................................................•
....................................... 109-114
D escriptive account of sand-blasting processes.............................................
110
Dust and other health hazards........................................................................ 110, 111
Most dangerous of all mineral dust hazards................................................ I l l , 112
Com bined m etallic and mineral dust e x p o su re ........................................ 112,113
Protective, safety, and sanitary d ev ice s...................................................... 113,114
Gold-leaf m anufacture................................................................................................ 114-117
Early occupational-disease observations...................................................... 114,115
Descriptive account of manufacturing processes...................................... 115,116
Mortality of gold-leaf beaters— industrial insurance exp erien ce.......... 116,117
General conclusions................................................................................................
117
Jewelers........................................................................................................................... 117-122
Ascertained unhygienic conditions............................................................... 118,119
D escriptive account of the jew elry in du stry.............................................. 119,120
Mortality from tuberculosis and pneum onia..................................................
120
M ortality of jewelers— United States registration a rea........................... 120,' 121
Mortality of jewelers— industrial insurance e x p e rie n ce ..............................
122
General con clu sion s................................................................................................
122
T he printing trades..................................................................................................... 122-146
L inotype and m onotype o p e ra tio n ............................................................... 123,124
O ccupational hazards of the printing trade....................................................
124
Sanitary and m edical considerations............................................................ 124,125
English and Am erican m ortality statistics.................................................. 125,126
Experience of the International Typographical U n io n .......................... 126-128
Comparative vital statistics of compositors in the State of New Y o r k ..
128
Excessive frequency of pulm onary tuberculosis....................................... 128,129
Sanitary control of the printing industry in Germ any................................
129
Dust hazards in the printing industry in O h io......................................... 129,130
O ccupational diseases of printers................................................................... 130,131
Causes of excessive frequency of pulm onary tuberculosis..................... 131,132
Sanitary conditions in G overnm ent printing and engraving................ 132,133
Average weight and height of printers......................................................... 133,134
English mortality statistics of printers......................................................... 134-136
Facts disclosed b y the New Y ork State Factory Investigating Commis­
sion....................................................................................................................... 136,137
Special occupational hazards in the printing trades................................ 137,138
Mortality of printers— U nited States registration area............................138,139
M ortality of printers— industrial insurance exp erien ce.......................... 139-142
M ortality of printers— m edico-actuarial exp erien ce................................. 142,143
Special consideration of the m ortality and disease liability of com ­
positors................................................................................................................143,144
Special consideration of the mortality and disease liability of pressmen. 144-146
M ortality of pressmen— m edico-actuarial e x p e rie n ce ..................... 145,146
General conclusions.................................................................................................
146




6

CO N TE^m

Chapter I I . — O ccu pations w ith exposure to m etallic dust— C on cluded.
Page.
Engravers............................................................................ ............................................146-150
R elative freq u en cy of pulm onary tuberculosis...................... .......................
147
148
Mortality of engravers— U nited States registration area ....................
Mortality of engravers— industrial insurance e x p e r ie n c e .........................
149
General con clusion s................................................................. ...........................149,150
Brass workers................................................................................................................. 151-159
Sanitary conditions in the British brass in d u s t r y .................................. 151-153
English m ortality statistics of brass w orkers.............................................. 153-155
Investigations b y the Illinois Commission on O ccupational Diseases. . .
155
Mortality of brass molders in O h io................................................................... 155,156
Medical aspects of the brass industry in C on necticu t..................................
156
Mortality of brass workers— U nited States registration area ................. 157,158
158
Mortality of brass workers— industrial insurance exp erien ce ...................
General conclusions............. .............. ................................................................ 158,159
Artificial flowers................................................... .......................................................159-161
Processes of artificial-flower m akin g........................................... .................. 159,160'
General conclusions.................................................................................................
160
Chapter I I I .— O ccupations w ith exposure to mineral du st................................... 163-322
Mineral dust and pulm onary tuberculosis...............................................................
164
Lung diseases and mineral and m etallic dust exposu re..................................164,165
M ortality from pulm onary tuberculosis in occupations w ith exposure to
mineral dust— U nited States registration area............................................ . 165,166
Inconclusive occupational m ortality statistics.................................................. 166,167
Comparative m ortality b y industries or occupations ...................................... 167-169
M ortality from nontuberculous respiratory diseases.............................................
169
Industrial insurance m ortality e x p erien ce......................................................... 169, 170
171
E xcessive frequen cy of pulm onary tuberculosis.................. ................................
Proportionate m ortality b y industries or o c cu p a tio n s .................................... 171,172
Mortality from nontuberculous respiratory diseases......................................... 172,173
English occupational m ortality data ......................... ................................. ......... 173,174
General conclusions..................................................................... ...............................174-176
Asbestos............................................................................. .............................................176-180
Methods of m in in g .......................................................... i .............................
176-178
H ealth-injurious occupational con dition s................................ .................. 178,179
E vid e n ce of dust exp osu re........................................................ ..
179,180
M ica .................................................... .............. ...................... ....................................... 180,181
The stone in du stry......................... .......................... ................................................. 181-209
E arly observations on health-injurious con ditions....................................182,183
Experience of the Operative Masons’ S ociety of L on d on ............. ............
183
D escriptive account o f occupational con ditions........................................ 183,184
Results of official investigation in Massachusetts...............*.....................184,185
U rgency of special scientific inquiries.......................................................... 185,186
186
Differential effects of dust exposu re...................................... ..........................
Lung diseases of flint knappers and buhrstone dressers......................... 186,187
M ixed mineral and m etallic dust exposure................................................. 187, 188
Secondary im portance of bacillary in fection ..............................................188,189
M orbidity and m ortality of the stone workers of D erbysh ire............... 189,190
Comparative phthisis death rates according to dust exp osu re..............190,191
Am erican m ortality statistics........................ ................................................. 191,192
English occupational m ortality investigations.................. ...........................
192
M ortality of the granite cutters of A b erd een ..............................................192,193
Com parative occupational m ortality of the stone workers of A ber­
d e e n .................. - ................................................................... .............................193-195




CONTENTS.

7

Chapter I I I . — O ccupations w ith exposure to mineral dust— Continued.
The stone industry— C on cluded.
Page.
Phthisis, and pn eum atic tools............................................................ ........... 195-197
Comparative frequen cy of lung diseases in A berdeen and in E din b u rgh .
197
P h ysique of stone w o rk e rs ..............................................................................198,199
Practical value of physical exam inations................................... ................ 199, 200
D escriptive account of silica or quartz.............................................................
200
Suggestions for protective precautions.................................... . .................. 200, 201
Injurious occupational con d ition s....... ................................... . . . .............. 201, 202
U rgency of drastic regulations.................. .........................................................
202
Practical possibilities of dust prevention .................................................... 202, 203
M ortality of m arble and stone cutters—U nited States registration a re a ..
204
Tuberculous and nontuberculous lung diseases........................................ 204, 205
Comparative m ortality from nontuberculous respiratory diseases—■
U nited States registration area................................................................... 205, 206
Mortality of journeym an stonecutters— m edico-actuarial experience . .
206
Mortality of marble and stone workers— industrial insurance ex p erien ce.
207
General conclusions........................... ................................................................ 207-209
Marble w orkers...................................... ................................................. - ................ . 209-211
Slate w orkers..........................................— ............................................................... 211-217
212
H ygiene of the slate in du stry.............................................................................
M ortality of slate-pencil m akers..................................................................... 212, 213
English sanitary investigations....................................................................... 213, 214
Social and sanitary conditions in the Am erican slate industry...........214-216
O ccupational hazards in slate m ills.............................................................. 216, 217
Lim e w orkers..................................... ................. ...................... ................................. 217-221
Lim e dust and pulm onary tuberculosis...................................... . .............. 218, 219
R elative in frequ ency of respiratory diseases.................................................
219
General conclusions........... .. ..............................................................................2I§ -221
Plasterers........................................................................................................................ 221-227
Early observations on the health of plasterers............................... .......... 221, 222
English m ortality data............................................ ........................................ 222, 223
R e ce n t Am erican investigations........................................................................
224
Methods of plaster of Paris m an ufactu re.............................. .................... 224, 225
M ortality of plasterers— U nited States registration area........................ 225, 226
M ortality of plasterers— industrial insurance exp erien ce ...................... 226, 227
Cem ent w orkers.......................... ................................................................................ 227-241
Gas, fum e, and dust exposure in cem ent-m aking' processes............. ........
228
Q uantitative extent of atmospheric p ollu tion ...... . . . . ............................ 228, 229
Processes of m anufacture................................... . ..................................... ..........
229
M edical observations on cem ent d u s t................................................. ........ 229-231
Com parative dust hazards in the dry and wet processes........................ 231, 232
Specific occupational diseases............ ............................................. . . . . . . . 232, 233
Efforts at restrictive legislation....... ............................................... ..................
233
E xperim ental m ed ica l research...................................................................... 233-235
Chem ical aspects of cem ent dust in relation to disease..............................
235
M echanical aspects of cem ent dust in relation to disease...................... 235, 236
P h ysique of cem ent w orkers.......................................................................... 236, 237
In frequency o f pulm onary tuberculosis..........................................................
237
Problem s of dust con trol................................................. « . . . ........................ 237, 238
Noninjuriousness of lim e dust................................. ....................................... 238, 239
Mortality of cem ent workers—industrial insurance experience........... 239, 240
General con clusion s................... .......................................... - ...............................
241
B rick r tile, and terra-cotta makers _ .__________________________ ___ ______ 241-247
Brickm aking p ro ce ss e s ................................................ ........................................
242




8

CONTENTS.

Chapter I I I . — O ccupations with exposure to mineral dust— Continued.
Page.
B rick , tile, and terra-cotta makers— C oncluded.
H ealth-injurious con ditions............................................................................. 242, 243
243
N eglect of sanitary precautions.................................................................... ..
G rinding, m ixing, and pressing...................................................................... 243, 244
K iln setting, firing, and drawing................................................................... 244, 245
M ortality of b rick and tile makers— U nited States registration area. 245, 246
M ortality of brick, tile, and terra-cotta makers— industrial insurance
exp erien ce......................................................................................................... 246, 247
Potters............................................................................................................................. 247-271
Sanitary aspects of the pottery in du stry............................ ......................... 248, 249
Effects of silica dust...............................................................................................
249
L iability to lead poisoning and pulmonary diseases............................... 249, 250
Specifically injurious processes...................................................................... 250, 251
English occupational m ortality statistics.................................................... 251-253
Investigations b y departmental com m ittee on industrial diseases.........
253
D escriptive account of the Am erican pottery in du stry..............................
254
D escription of processes according to dust e x p o s u r e .............................. 255, 25fr
Pathology and sym ptom ology of the dust problem ......................................
256
P otters’ asthma.................................................................................................... 256, 257
Comparative occupational m ortality statistics..............................................
257
Results of sanitary im provem ents................................................................. 257, 258
Injuriousness of scouring process.......................................................................
258Injuriousness of flint du st................................................................................. 258-260
Continuousness of injurious con ditions............................................................
260
Sanitary aspects of the pottery industry in O h io....................................
261
Injuriousness of fiint-dust m aking.....................................................................
261
M old and sagger m aking................................................................................... 261, 262
Jiggermen, jollym en, and pressers................................................................. 262, 263
Lead poisoning and pulm onary diseases...................................................... 263, 264
M ortality of potters—U nited States registration a rea............................. 264, 265
M ortality of pottery em ployees— m edico-actuarial exp erien ce........... 265, 266*
Mortality of potters— industrial insurance exp erien ce........................... 266, 267
Foreign sanitary regulations of the pottery in du stry.............................. 267-271
General con clu sion s................................................................................................
271
Paint and color w orkers............................................................................................. 271-278
Chem ical aspects of paint m anufacture....................................................... 271, 272
Exposure to m etallic d u st....................................................................................
272
H ygiene of the pain ters’ trade....................................................................... 272, 273
Sanitary conditions in the German paint in d u s t r y ................................ 273? 274
L ia b ility to m etallic poison ing...........................................................................
274
M ortality of painters, glaziers, and varnishers.......................................... 274, 275
Comparative mortality of painters, glaziers, varnishers, and agricul­
tural la b orers.................................................................................................... 276,277
M ortality of paint m ixers— industrial insurance exp erien ce................. 277, 278
General con clu sion s................................................................................................
278
Lithographers................................................................................................................ 278-283
M ortality of English lithographers................................................................ 279-281
281
M ortality of lithographers— industrial insurance exp erien ce...................
General con clu sion s............................................................................................ 281-283
F oundry-m en and m old ers....................................................................................... 283-290
M ortality of molders— industrial insurance exp erien ce.......................... 284, 285
285
Sanitary conditions in Massachusetts foundries............................................
Dust exposure in sand blastin g....................................................................... 286, 287
P hysical exam ination of molders in the Fall R iver d istrict.....................
287




CONTENTS.

9

Chapter I I I . — O ccupations with exposure to m ineral dust— C oncluded.
F oundry-m en and molders— C oncluded.
.
Page.
Nature and properties of m olding sands and d u s t s ................................. 287, 288
288
F oundry investigations in O h io.........................................................................
A ir contam ination b y gas and sm oke........................................................... 288, 289
Dust exposure in casting cleaning.....................................................................
289
General conclusions............................................................................................ 289, 290
Core m akers................................................................................................................... 290-292
Sanitary conditions in foundries........................................................................
290
New Y ork State factory investigation.......................................................... 290, 291
291
Mortality of core makers— industrial insurance exp erience......................
General conclusions................................................................................................
292
The glass in du stry....................................................................................................... 292-304
Early observations on the health of glassw orkers........................................
293
English occupational m ortality statistics................................................... 293, 294
Comparative m ortality from all causes and from diseases of the
lu n g s ................................................................................................................... 295, 296
Materials used in glass m anufacture............................................................. 296-298
Labor conditions in Ohio and New Y o rk .................................................... 298, 299
O ccupational hazards in glass m anufacture...................................................
299
Practical sanitary precautions........................................................................ -299, 300
Present-day labor con ditions.......................................................................... 300, 301
301
Specific liability to respiratory and tuberculous diseases.........................
Industrial insurance m ortality statistics..................................................... 301, 302
Mortality of glassworkers— U nited States registration a r e a .................. 302-304
General conclusions................................................................................................
304
Glass cutters................................................................................................................. 304-310
Sanitary aspects of glass cutting and polishing......................................... 304, 305
Exposure to mineral and m etallic dusts..................................................... 305, 306
M ortality of glass cutters— m edico-actuarial exp erien ce............................
306
M ortality of glass cutters— industrial insurance exp erien ce.....................
307
Labor conditions in Massachusetts................................................................ 307, 308
Labor conditions in Pennsylvania and O h io ............................................ 308, 309
General conclusions........................................................................................... 309, 310
Glass blow ers................................................................................................................ 310-319
D escriptive account of glass-blowing processes.............................................
310
Special occupational hazards......................................................................... 310, 311
F requ ency of lung diseases..................................................................................
311
Glass blow ers’ cataract..........................................................................................
312
312
M ortality of glass blowers— m edico-actuarial exp erien ce..........................
M ortality of glass blow ers—industrial insurance exp erien ce....................
313
M ortality experience of the Glass B ottle B low ers’ A ssociation............ 313,314
Specific disease lia b ility of glass blow ers.................................................... 314-316
Predisposition to pulm onary tuberculosis.................................................. 316, 317
Possibilities of dust prevention ...................................................................... 317, 318
M echanical glass blow ing and pressing........................................................ 318, 319
D iam ond cutters.......................................................................................................... 319-322
Processes of m anufacture......................................................................................
319
M orbidity of diam ond cutters and polishers.............................................. 319, 320
Health-injurious results of diam ond cu ttin g.............................................. 320, 321
General conclusions............................................................................................ 321, 322
Chapter IV .— The mineral industries (mines, quarries, ore reduction, and
sm elting)............................................................................................................................. 323-437
Varied conditions of em ploym ent.......................................................................... 323, 324
Lim itations of occupational statistics.................................................................... 324, 325




10

CONTENTS.

Chapter IV — T h e mineral industries (m ines> quarries, ore reduction, and
sm elting)— C on cluded.
Page.
Com parative m ortality of E nglish'm iners................................................................
325
R ela tive frequen cy of tuberculous and non tuberculous respiratory dis­
eases............................................................................................................................. 326,327
T he m ining in d u stry................................................................................................... 327-414
G old m ining in South A frica ........................................................................... 331-335
Miners* phthisis in South A frica............................................................ 332, 333
R eport of miners’ phthisis prevention com m ittee.............................
333
M iners’ m ortality in R h odesia ................................................................ 333, 334
Practical preven tive measures................................................................ 334, 335
M iners’ phthisis in New South W ales......................................................... 336-342
Official investigations in the U nited States and N ew South W ales. . 342, 343
A ccu ra cy of death certification...................................................................... 343, 344
Miners’ pneum oconiosis and anthracosis............- .......................... ................
344
Differential diagnosis of m iners’ phthisis........................................................
345
Questionable occupational statistics.................................................................
345
R ela tive frequen cy of m iners’ phthisis........................................................ 345, 346
Disease lia b ility of rock driHers..........................................................................
346
Pathological considerations..................................................................................
347
Pneum oconiosis and tuberculosis.................................................................. 348, 349
M ortality of miners and quarrymen— U nited States registration area. 349, 350
Mortality of miners from nontuberculous respiratory diseases.................
350
M ortality of miners and quarrym en— industrial insurance exp erien ce. 350, 351
E xcessive frequen cy of nontuberculous respiratory diseases................ 351, 352
G old and silver m in in g...................................................................................... 352-354
Lead and zin c m inin g........................................................................................ 354-366
Copper m in in g...................................................................................................... 366-370
Iron m inin g............................................................................................................ 370-377
C o a lm in in g ........................................................................................................... 377-414
'
M ortality of m iners in the U nited K in gd om ...................................... 383-389
M ortality of miners in the N orthum berland coal field .................. 389, 390
M ortality o f miners in the Lancashire d istrict.................................. 390, 391
M ortality of m iners in the W est R id in g district............................... 392, 393
M ortality of miners in the Derbyshire and Nottingham shire dis­
tricts........................................................ .................................................... 393, 394
Mortality of miners in the Staffordshire district............................... 394, 395
Mortality of m iners in the Monmouthshire and South W ales dis­
tricts............................................................................. ............................... 395-397
E ffect of variations in local conditions on th e m ortality from
respiratory diseases................................................................................. 397, 398
R elative frequen cy of anthracosis......................................................... 398-400
Com parative m ortality in coal m ining and agriculture.................. 400-403
Anthracosis and phthisis.............. ............................................................ 403-406
M ortality of Am erican coal m iners............................................. .......... 406-411
General con clusion s............................................................................
411-414
Q uarrying........................................................................................................................414-426
Am erican m ortality ex p erien ce................................................... ......................
418
Dust hazards o f the quarrying in d u stry................... *................................. 419, 420
Vital statistics of the centers of the granite in d u stry.............................. 420-422
Vital statistics of the centers of the m arble in d u stry..................................
422
Vital statistics of the eenters of the sandstone in du stry.............................
423
Vital statistics of th e centers of th e lim estone in du stry.............................
424
V ital statistics of the centers of th e bluestone in du stry......................... 424, 425
Vital statistics of the centers o f the slate in d u stry................................... 425, 426
Metallurgical industries...................................................................... ...................... 426-443
Som e general observations and co n c lu s io n s ..................................................... 437-443




BULLETIN OF THE

U. S. BUREAU OF LABOR STATISTICS.
WHOLE Nt>. 231.

WASHINGTON,

JUNE, 1918,

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY
TRADES.
CHAPTER L— GENERAL INTRODUCTION.
The administrative control of tuberculosis in American States and
cities has heretofore been concentrated chiefly upon legislative enact­
ments, and their enforcement, for the registration of existing cases*
the voluntary or compulsory segregation and detention of tubercu­
losis patients, the establishment of Federal, State, county, and m u-'
nicipal tuberculosis sanatoriums, and the enforcement of sanitary
ordinances against indiscriminate expectoration in public places. Some
progress has been made in the direction of labor legislation aiming
at the control of tuberculosis in industry, principally in the so-called
dusty trades, but the results have been far from satisfactory, chiefly
because of an inadequate realization of the seriousness of the situa­
tion. The statistical evidence that certain trades or occupations are
distinctly more unfavorable to health and longevity than others is so
entirely conclusive that no additional proof seems to be necessary to
reemphasize the earlier conviction that the State regulation of indus­
try with special reference to the dusty trades and tuberculosis is a
National and State labor problem of the first order in practical im­
portance, yet there continues to prevail a lamentable degree of apathy
and indifference to the urgency of necessary changes and reforms.1
THE BECLINE OF TUBERCULOSIS.

The mortality from tuberculosis, it is true, has gradually declined
from an average rate of 32 per 10,000 for large American cities for
the five years ending with 1884, to 16.1 per 10,000 for the five years
1 E sp ecia lly su g g e stiv e as reg a rd s m od ern e fforts in the d ire ctio n o f a d m in istra tive
co n tr o l o f the d u sty tra d es are “ T h e L a b o r L a w and the In d u s tria l C od e,” o f the N eif
Y ork S ta te D ep a rtm en t o f L a b or, A lb a n y , 1916 ; “ T h e S a n ita ry an d E n g in e e rin g In d u s­
tria l S ta n d a rd s,” p u b lish ed by th e D ep a rtm en t o f L a b o r o f th e S ta te o f N ew Jersey.
1 9 1 6 ; S pecial B u lletin N o. 8 2 o f th e D ep a rtm en t o f L a b o r o f the S ta te o f N ew Y ork
on “ H ood s fo r R e m o v in g D u st, Ftrmes, a n d G a ses,” an d th e e x te n d e d d iscu ssio n oi
d u sty occu p a tio n s in th e a n n u al re p o rt o f the D ep a rtm e n t o f L a b o r o f the S ta te o t
N ew J ersey, f o r 1 910, T re n to n , N. J., 1917.




11

12

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES

ending with 1914. This reduction in the death rate has, however, only
to a limited degree affected the persons most seriously concerned—
the workmen and workwomen employed in the so-called dusty trades.
On the basis of a conservative estimate it appears that of the 44,130,000
American wage earners of both sexes, approximately 4,000,000, or
9.06 per cent, work under conditions more or less detrimental to health
and life on account of atmospheric pollution or the relatively excessive
presence of atmospheric impurities predisposing to, or accelerating
the relative frequency of, tuberculous and nontuberculous respiratory
diseases.
WAGE EARNERS IN DUSTY TRADES.

Table 1 presents the details of this estimate for the seven recognized
branches of industry more or less exposing to health-injurious dust
and fumes.
T able 1 .—A M E R IC A N WACxE E A R N E R S E M P L O Y E D IN D U S T Y IN D U ST R IE S. T R A D E S ,
A N D OCCUPATIONS.
[C om p iled fro m R e p o rt o f B ureau o f the C ensus on O ccu p a tio n
occu p a tion s included, see pp. 4 6 -5 0 .]

S ta tistics, 1910.

Males.

For

Females.

Trade group.
Number.
L. Metallic d u s t .....................................................................

Per cent.

Number.

Per cent.

Mineral industries.................: ............................ .............
Vegetable fiber dust ........................................................
Animal and mixed fiber dust ........................................
Organic d u s t .....................................................................
Mixed organic and inorganic (public) dusts...............

258,454
514, 693
844,897
336,323
183,937
531,911
594,285

7.9
15.8
25.9
10.3
5.6
16.3
18.2

33,255
15,332
550
296,135
149,262
177,545
1,399

4.9
2.3
.1
44.0
22.2
26.4
.2

T otal..............................................................................

3.
4.
5.
6.
7.

3,264,500

100.0

673,478

100.0

This formidable array of employments with exposure, more or less,
to health-injurious conditions, attributable chiefly to the single factor
of dust in its varied forms, suggests the practical importance of
consideration, by those qualified, not only of the evidence itself, but
also of the methods and means by which a truly deplorable situation
can be brought effectively under administrative control.1
1
It has been p oin ted ou t in th is co n n e ctio n th a t the “ im p o rta n ce o f d ust o f va riou s
kind s as a ca u sa tiv e fa c t o r in r e sp ira to ry diseases is bein g borne in u p on us w ith greater
w eigh t.
H eim and A g a sse -L a fo n t {A r c h . gen. de m ed., 1 9 1 4 ), a fte r re v ie w in g the va riou s
ill effects o f in d u stria l dusts, cam e to the co n clu sio n th a t th e cla ssific a tio n should n ot
re st upon the orig in o f the dust, b u t ra th er upon the n a tu re o f its h a rm fu l influence.
T h e y recognize dusts o f an a ctiv e and o f a passive nature. T h e effects o f the first are
to x ic , p red isp osin g o r in fe ctio u s , w h ile the dusts a ctin g p a ssively a ct by th eir m ere
presence as fo re ig n bodies upon the su rfa ces o f the re sp ira to ry system . T hese p a ssively
a c tin g m aterials m ay be o f s o ft or hard con sisten cy.
T he la tte r are m ore effective
in b rin g in g abou t the com m on ciiron ic p n eu m ocon iosis. T h ey p o in t o u t th a t the a ctiv e
a gen ts are by fa r the m ost im p o r ta n t in b rin g in g abou t the acute re sp ira to ry d iseases o f
w h ich pneu m on ia and acute b ro n c h itis are the m ost frequen t. T h ey do n o t fo llo w the
ch ro n ic lesions resu ltin g from passive agents to a con clu sion to illu stra te the increased
p re d isp o sitio n o f the dam aged tissues to o th e r secon d a ry p rocesses.”




GENERAL INTRODUCTION.

13

RELATION OF ATMOSPHERE TO LIFE AND HEALTH.

The relation of the atmosphere to human life and health has been
made the subject of numerous scientific investigations. For a num­
ber of years prize essays have been published by the Hodgkins Fund
of the Smithsonian Institution, established for the purpose of in­
creasing human knowledge regarding a problem of great practical
and every-day importance. In 1896, through the medium of the
fund, there was published an essay by Francis Albert Rollo Russell
on “ The atmosphere in relation to human life and health,” 1 in
which, among other basic facts, the following is laid down as a
prerequisit-e for the rational understanding of the scientific ques­
tions involved in a consideration of the atmospheric influence on
health and longevity:
The average volume of air breathed in at each breath is about 30
cubic inches, and the volume of air which may be breathed in by
an effort, and by expanding the chest, is about 130 cubic inches, or
about four times as much. After a very full inspiration about 230
cubic inches can be expired by a man of average height and in good
health. The total capacity of the lungs, however, is much more than
this—about 330 cubic inches. Thus in ordinary quiet breathing we
only fill about one-tenth of the available air space of the lungs.
After every outbreath, or expiration, a quantity of air is left in the
lungs. This residual air amounts to about 100 cubic inches. An
adult at rest breathes about 686,000 cubic inches in the course of 24
hours; a laborer at full work, about 1,586,900 cubic inches—more than
double. The amount of air passing into the lungs per diem har been
^
estimated at 400 cubic feet in a state of rest, 600 in exercise, 1,000 in
severe exertion. The number of air cells in the lungs is estimated
at 5,000,000 or 6,000,000 and their surface at about 20 square feet.
The epithelium or membranous film between the blood and air is
exceedingly thin, and in many parts the capillaries are exposed, in
the dividing walls of cells, to air on both sides. The a eight of air
v
inhaled in the course of the day is seven or eight times that of the
food eaten. * The mechanical work of breathing represents energy
expressed by the lifting of 21 tons 1 foot in 24 hours. From every
volume of air inspired about 4^ per cent of oxygen is abstracted, and
a somewhat smaller quantity of carbonic acid gas is at the same time
added to the expired air.2
PRACTICAL IMPORTANCE OF ATMOSPHERIC PURITY.

The foregoing extract emphasizes the importance of atmospheric
purity under working conditions, since, as said in the statement
quoted, the amount of air passing into the lungs in 24 hours in a
state of rest is about 400 cubic feet, in normal exercise 600, and in
1 See also in th is co n n e ctio n “ T he a tm osp h ere In its re la tio n to the hum an m ech a n ism ,”
by R. C. H olcom b, su rgeon , U. S. N a vy, in U. S. N aval M ed ica l B u lle tin , vol. 10, No. 3,
W ash in g ton , 1916.
2 See a lso an a rtic le in the S cien tific A m erica n S up p lem ent, J u ly 1, 1916, on “ M od ern
a ir ,” by P r o f. J oh n F . N orton , P h . D .




14

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY* TRADES.

severe exertion 1,000. Considering' this fact in connection with con­
ditions of work in metal mining, for illustration, brings out in a
startling way the strikingly injurious effect of the continuous inhala­
tion of air grossly polluted by minute particles of mineral and metallic
dust, aside from gaseous impurities which, under given conditions,
may add materially to the health-injurious results of dust exposure.
As observed in the same essay, “ The deficiency of oxygen and
excess of carbonic acid, which are common to nearly all living rooms,
schools, churches, theaters, and workshops where many persons are
gathered, are very favorable not only to the spread of various infec­
tious diseases, but to the maintenance of a number of minor ailments;
and where the exposure to foul air is prolonged, as in workshops,
offices, and mills, to a continued depression of vitality.” In the same
connection it is pointed out that the normal requirement is the supply
of about 3,000 cubic feet of fresh air per head per hour, which, it is
safe to maintain, is rarely met with in any of the dusty trades in
which the mortality from tuberculosis materially exceeds the average
for out-of-door occupations.1
AIR CONTAMINATION AND DISEASE RESISTANCE.

Aside from atmospheric impurities of an inorganic nature, of which
dust in the more restricted sense of the term is chiefly constituted, the
air is frequently contaminated by living germs, the microbes, bac­
teria, fungi, and molds, which may, or may not be, of a pathogenetic,
or disease-producing, nature. Experiments have conclusively proved
that microbes are much more abundant in the town than in the
country, and, as a general rule, they are more frequently present in
dwellings and workshops than immediately outside of the habitations
or buildings concerned. Most of the germs and spores which are
inhaled are not directly injurious, as far as known, but there are
reasons for believing that the vitality is always reduced by a con­
taminated atmosphere, irrespective of the nature of the inorganic or
organic impurities.. Russell, in his discussion of “ The atmosphere
in relation to human life and health,” concludes that—
Many severe forms of disease, especially of the respiratory organs,
are caused by the dust inhaled in various trades and occupations.
These are generally proportionate to the sharpness and angularity of
the dust and its quantity. Coal dust is among the least harmful.
Among lead miners, bronchitis and lead poisoning; in copper mines,
gastric disorders; in pottery works, in stonecutting, steel grinding, in
flax and cotton factories, in shoddy works, and m metal polishing,
lung diseases are common, and the death rate is high. Thus the
1
See a p a p er b y M fller a n d C ocks on ** E ffects o f ch an ges in a tm o sp h e ric co n d itio n s upon
th e u p p er re s p ira to ry t r a c t ,” in T ra n s a ctio n s o f A m erica n C lim a to lo g ie a l and C lin ica l
A ss o cia tio n , 191 5 .




GENERAL INTRODUCTION.

15

mortality of file makers was 300, compared with 108, that of gar­
deners; of earthenware makers 314, compared with 139, that of
grocers; of cutlers and scissors makers 229, compared with 129., that
of paper makers. The dust of soft woods and of flour seems to have
little bad effect. As regards phthisis and lung diseases the figures of
several trades are as follows, when compared with fishermen, 100:
Carpenters, 170; bakers, 201; cotton workers, 274; file makers, 398;
stone and slate quarrymen, 294; pottery makers, 565; northern coal
miners, 166. The injuriousness of the dust in cotton mills is increased
by the use of mineral substances for sizing. The mortality of cutlers,
etc., from these diseases is almost as great as that of fishermen from
all causes put together, including accidents. The comparative exemp­
tion of colliers in well-ventilated coal mines deserves investigation,
for there would appear to be some ground for the supposition that it
may be owing to the inhibitive action of this particular dust upon
the development of tuberculosis; on the other hand, it may be simply
through living in fairly good air of an even temperature, where the
specific germs of phthisis are few or absent. The homes of the men
are generally comfortable, and much larger fires are kept up than in
the South, so that their rooms are dry and well ventilated.
CHEMICAL ASPECTS OP ATMOSPHERIC POLLUTION.

Within recent years there has been an important change of quali­
fied opinion regarding the health-injurious consequences of atmos­
pheric pollution due to chemical causes. In a publication of the
Hodgkins Fund, issued by the Smithsonian Institution in 1913, on
“ The influence of the atmosphere on our health and comfort in con­
fined and crowded places',” by Leonard Hill, Martin Flack, James
McIntosh, R. A. Rowlands, and H. B. Walker, an effort is made “ to
demonstrate that no evidence has yet been brought forward which
shows that the chemical quality of the air has anything to do with
these ill effects, and that, apart from the influence of infecting bac­
teria, the ventilation problem is essentially one of temperature, rela­
tive humidity, and movement of the air.” This important conclusion
is diametrically opposed to the principles generally laid down in
elementary textbooks on hygiene that the chemical aspect of atmos­
pheric pollution is of fundamental importance, and that the effects
of life and work in ill-ventilated rooms or workshops are attribut­
able to changes in the chemical quality of the air, whether it be
want of oxygen, or excess of carbon dioxide, or the addition of some
exhaled organic poison, etc. The authors maintain that the terms
“ devitalized ” or “ dead ” air are misleading, and, differing from the
prevailing opinions, that the health-giving properties of a pure at­
mosphere are “ primarily those of temperature, light, movement, and
relative moisture.” None of these observations or conclusions, how­
ever, bears upon the broader problem of atmospheric pollution by
dust in any of its many varieties, which to a measurable degree re­




16

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

duces vitality and predisposes to respiratory and tuberculous diseases,
but chiefly tuberculosis of the lungs.1
THE INFECTIOUSNESS OF TUBERCULOSIS.

As early as 1881-82, when the infectiousness of tuberculosis had
just been determined by the discovery of the bacillus of the disease
by Koch, Dr. Arthur Ransome, in an address before the Manchester
and Salford Sanitary Association pointed out that—
Wherever people are collected together, the death rate from con­
sumption is in direct proportion to the*degree of crowding together,
and to the deficiency of ventilation. I will give only one instance of
this, that was first remarked by Dr. Guy, with reference to letter­
press printers. He found that of 104 compositors who worked in
rooms of less than 500 cubic feet for each person 12.5 per cent had
had spitting of blood; of 115 in rooms of from 500 to 600 cubic feet,
4.35 per cent showed this sign of consumption; and in 100 who
worked in rooms of more than 600 feet in capacity, less than 2 per
cent had spat blood.2
LUNG INJURY FROM IRRITATING DUSTS.

The same author, in an address on the “ Prevention of consump­
tion,” delivered on September 22, 1887, before the Sanitary Congress
at Bolton, directed attention to the relation of the inhalation of
irritating substances, or dusts, arising from various kinds of indus­
trial activities, such as steel grinding, glass cutting, brush making,
etc., to the relative frequency of the disease, and he amplified his
observations by quotations from the medical reports made by
Dr. Headlam Greenhow to the Privy Council in 1860 and 1861,
in Avhich attention was called to the large mortality from tuber­
culous-complaints among “ those who worked in an atmosphere im­
pregnated with dust consisting of fine particles of metal or of sand­
stone, etc.” Granting that no statistical evidence can materially aid
in disclosing the immediate causative factors of the disease, Ilansorne observes that—
No one, indeed, who has studied the vital statistics of these occu­
T
pations, or who has medically attended the workpeople, can doubt
i-B a n d elier and R oep ke, in th eir trea tise on A C lin ica l S ystem o f T u b e rcu lo sis (L o n don, 1913, pp. 14, 1 5 ), m en tion am on g the a cq u ired p re d isp o sin g influences fa v o ra b le to
the disease “ slig h t in ju rie s to the sm a llest b ron ch ia l tubes from the in h a la tio n o f p a r­
ticles o f m in eral, m eta llic, vegetable, o r a n im al d u s t.”
T h e y add th e re to th a t “ the
hard er, sharp er, m ore p oin ted the d u st p a rticles, the m ore lik ely are th ey to in ju re the
lu n g tissue, to open the w a y to tu b ercle b a cilli, and to fa v o r th e ir d evelop m en t by se ttin g
up ch ro n ic infla m m a tion .
L ik ew ise som e substances, as co rro siv e v a p o rs and gases,
cause ch em ica l in ju rie s .”
T h ey con clu d e t h a t :
“ A s a n a tom ica l lesion s m ay be ca u sed by v a rio u s fine m ech a n ica l irrita n ts, so g ross
tra u m a tic in ju rie s fro m d ire ct o r in d ir e c t v iolen ce (p u n ctu re s, sh ots, b lo w s, fa lls , and
cr u sh in g ) p rod u ce in ju r y to the lu n g tissu e an d fa v o r p ossib le in fe ctio n s . B u t m uch
m ore freq u en tly it w ill happen th a t a la ten t in a ctiv e fo cu s, u su a lly in th e b ro n ch ia l
glands, is b rou g h t in to a c t iv ity by an in ju ry , o r a la te n t b ut a ctiv e tu b e rcu lo s is m ade
evid en t, w h ich , h ow ever, is the sam e th in g from the lega l p o in t o f v ie w .”
2 A C am p aign A g a in st C on su m ption , by A rth u r R an som e, M. D ., L o n d o n , 1915, p. 9.




GENERAL INTRODUCTION.

17

the power of irritating dusts in inducing a state of the lungs that
is favorable to the reception of the specific organism.
He, therefore, concludes that—
Just as in the case of lungs otherwise injured tubercle may readily
be ingrafted upon a miner’s or a needlemaker’s lung; but the dis­
ease that is first caused by the particles these men inhale is not
tuberculous at all. It is simply a chronic inflammation, affecting
chiefly the connective tissue and causing the formation of a fibroid
tissue in the alveolar Avails. It leads ultimately to a contraction,
and, so to speak, a strangling of certain portions of the lung tissue.
But no bacilli are found either in the tissues or in the expectoration
of such patients, as I can testify from frequent stainings.1
This conclusion, which is of great practical importance, is fre­
quently ignored in superficial discussions, particularly of miners’ lung
diseases, which' in their origin are not tuberculous, but rather a
fibrosis ultimately terminating in a true tuberculosis in consequence
of a subsequent infection. Ransome is, therefore, apparently quite
justified in his statement that “ Dusts, although they are a serious
danger, and though they ought on this account to be kept away from
workpeople as a preventive measure against consumption, are yet
only remotely a cause of the disease.” It, however, has probably
never been seriously maintained by anyone familiar with the subject
that the inhalation of health-injurious dust is to be considered a
primary cause of tuberculosis, but it is rather to be looked upon as a
more or less injurious contributory causative factor, largely amen­
able, within reasonable limits, to effective methods of administra­
tive sanitary control.
VARIED FORMS OF PULMONARY TUBERCULOSIS.

Pulmonary tuberculosis exists in many and varied forms. As said
in a treatise on The Expectation of Life of the Consumptive after
Sanatorium Treatment, by Noel D. Bardswell—
The disease, for instance, may be very acute and prove fatal in a
few weeks (miliary tuberculosis), it may commence very acutely
and gradually develop into a more chronic process; or, again, it may
from its commencement run a slowly progressive course, extending
in all over a great many years. This last form, by far the commonest
type of the disease, is generally spoken of as “ chronic ” pulmonary
tuberculosis. It has for long been recognized that the prognosis, or
expectation of life, in these various types of pulmonary tuberculosis
is widely different; hence the necessity for considering them sepa­
rately when dealing with statistics as to the curability of the disease
83 a whole.
* A C am paign A g a in st C on su m ption , b y A rth u r K ansom e, M. D ., L o n d on , 1915, p. 2 6.

106811°— 18— Bull. 231------ 2




18

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

Unfortunately, the mortality statistics, as a general rule, do not
permit of such a precise differentiation, and least of all in their
practical application to tuberculosis as an occupational disease. The
five forms of tuberculosis generally distinguished are tuberculosis of
the lungs, acute miliary tuberculosis, tuberculous meningitis, tuber­
culosis of other organs, and disseminated tuberculosis. In the United
States registration area, during the period 1911 to 1915, the mortality
per 100,000 of population, from these five groups was as follows:
Tuberculosis of the lungs, males, 13-9.8, females, 109.5; tuberculous
meningitis, males, 8.8, females, 8.1; tuberculosis of other organs,
males, 9.9, females, 9.T; and disseminated tuberculosis, males, 1.3,
females, 1.2. It is therefore shown that tuberculosis of the lungs is
of primary importance; but the different forms of pulmonary tuber­
culosis are not disclosed by the general mortality returns.
COMPARATIVE MORTALITY STATISTICS.

The term “ phthisis n is generally used as a convenient expression
for the term “ tuberculosis of the lungs.”1 Extreme caution is neces­
sary in the use of international tuberculosis statistics, since there
are reasons for believing that the same terms have not an identical
meaning in foreign usage. The mortality from phthisis in England
and Wales, for illustration,- is invariably lower than in this country;
in contrast, the mortality from bronchitis, both acute and chronic, is
decidedly higher. In England and Wales the mortality from tuber­
culosis during the period 1911 to 1915, per 100,000 population, was
as follows: (1) Tuberculosis of the lungs, males, 115.8, females,
80.0; (2) acute miliary tuberculosis, males, 11.2, females, 9.3; (3) tu­
berculous meningitis, males, 15.-3, females, 12.T; (4) tuberculosis of
other organs, males, 10, females, 13.1; (5) disseminated tuberculo­
sis, males, 6.9, females, 5.3. In other words, all the nonpulmonary
forms of tuberculosis are more common in England and Wales than
in the United States registration area. In the latter the mortality
from bronchitis was 17.1 for males and 19.5 for females; but in con­
trast, the corresponding mortality for England and Wales was 1147
for males and 109.4 for females. These and many other statistical
facts should be kept in mind in an effort to interpret with at least
approximate accuracy the comparative international statistics of
tuberculosis with special reference to occupation and the incidence
of tuberculosis in the dusty trades.
The table following shows the comparative international death
rates for tuberculosis for the years 1911 to 1915, inclusive.
l r F2ie s tr ic tly teefenrieal m etlicai a sp e cts o f the q u estion s in v o lv e d in th e p re cise defini­
tion o f tu b ercu losis versu s p h th isis are sum m ed up by M a u rice F ish b c rg , M. D., in his
trea tise on P u lm on a ry T u b ercu losis, P h ila d elp h ia an d N ew Y o rk , 1916, p. 103.




19

GENERAL INTRODUCTION.
T

able

2.— DEATH RATE PER 100,000 OF POPULATION FROM PULMONARY AND
ACUTE MILIARY TUBERCULOSIS, 1911 TO 1915.
United States England and
registration
Wales.
area.

Scotland.

Ireland.

Year.
Acute
Pulmo­ Acute Pulmo­ Acute Pulmo­ Acute Pulmo­ mili­
nary. mili­ nary. mili­ nary. mili­ nary. ary.
ary.
ary.
ary.
1911.............
1912.............
1913.............
1914.............
1915.............

132.5
124.8
122.8
123.1
123.0

5.5
5.0
4.9
4.7
4.7

99.1
94.3
91.3
94.5
106.6

9.3
10.3
9.9
10.0
11.3

110.1
108.1
104.3
100.6
107.9

6.9
5.8
5.4
4.4
4.0

169.4
164.1
163.4
160.5
172.2

3.6
5.9
4.8
3.0
1.8

Aus­
Hol­
tralia.1 land.1

70.5
67.7
67.7
63.2
62.1

118.8
110.7
106.4
107.3
110.1

Nor­ Switzer­
way.1 land.1

176.0
176.0
173.7
175.9
175.5

161.5
150.3
147.2
143.6
141.1

1 Includes b oth forms.

INDUSTRIAL LUNG DISEASES.

In this connection it has been appropriately said by J. M. Beattie,
M. D., in an address on the “ Hygiene of the steel trade,” con­
tributed to the Transactions of the Royal Sanitary Institute of Great
Britain (Vol. X X X I II , 1912, p. 501), that—
A great deal of attention has been centered on the dust problem,
and much of the legislation relating to the industries with which
we are dealing is concef-ned with the protection of the workers from
dust inhalation. A much more serious problem, however, is the pre­
vention of infection with B. tuberculosis, which has not received
r
justice at the hands of factory inspectors and factory legislators.
During a five years’ experience in Sheffield it has been abundantly
demonstrated that cutlers and grinders die from tuberculosis and
not from nontuberculous fibrosis of the lungs.
Dr. Beattie therefore strongly protests against the loose use of the
word “ phthisis ” and remarks—
Rightly or wrongly, phthisis is now understood by medical men to
mean tuberculosis of the lungs, with cavity formation; and the term
“ grinders’ phthisis 5 should be confined to that condition of the lung
5
in which tuberculosis is added to the interstitial fibrosis. For the
condition which is produced by the inhalation of dust, the term
“ fibrosis” is perhaps the most suitable; I shall therefore describe
the condition resulting from the inhalation of dust as fibrosis. The
misuse of the term “ phthisis ” makes it difficult to obtain entirely
satisfactory statistics, and we can only, therefore, regard the usual
data as an approximation to the truth.
* LIMITED VALUE OF OCCUPATIONAL MORTALITY STATISTICS.

Dr. Jacques Bertillon, in a paper on “ Mortality and the causes of
death according to occupations,” contributed to the- Transactions of
the Fifteenth International Congress on Hygiene and Demography
(Vol. I, 1912, p. 339), points out that—
The frequency of phthisis varies much with the occupation. I f a
man is poisoned either by alcohol or by lead, phthisis is very common.




20

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

It is common, also, in most occupations in which the man is exposed
to dustj especially mineral dust. It has an average frequency in
occupations pursued in confined quarters. It is infrequent with shop­
keepers, in the liberal professions, and especially among farmers, as
well as in most occupations carried on in the open air and involving
muscular exercise. It is very uncommon among iron and coal miners.
These are the general conclusions indicated by my figures and the
diagram. They are subject to many exceptions which should be
examined more closely.
These cautious observations regarding the general use of occupa­
tional mortality statistics apply to English and American as
well as to French, German, and other continental data. The same
qualification applies to the terminology of the disease and the con­
tributory atmospheric conditions such as dust and gaseous impurities.
Simeon Snell, M. D., in an address on “ Coal mining and the health
of colliers,” contributed to the Transactions of the Sanitary Institute
of Great Britain (Vol. X V I, 1895, p. 110), directed attention to the
fact that—
The influence of dust, whether metallic or nonmetallic, in the pro­
duction of phthisis is now well known, and the subject received atten­
tion in these lectures last year. A collier passes a third of his day in
an atmosphere which is laden with fine particles of coal dust. Mines
differ very much in the prevalence of this dust. Thus men speak of
the mines in which they work as being dusty or not. A dry mine will
be dusty/and a wet one not so much so. That colliers will be con­
stantly breathing these fine particles can not be questioned, and* yet
Dr. Ogle says that “ Be the explanation what it may, there can be no
possibility of doubt that the mortality of coal miners from phthisis
is remarkably low.”
DUSTS AND FUMES, FOES TO INDUSTRIAL LIFE.

The relative immunity to pulmonary tuberculosis of coal miners
seems to be conclusively established; but in contrast to a low death
rate from tuberculous disease, coal miners almost invariably expe­
rience a high death rate from nontuberculous lung diseases. Among
the important contributions to the subject are the results of the in­
vestigations of Sir Thomas Oliver, M. D., included in an address on
“ Dust and fumes, foes to industrial life,” published in the Trans­
actions of the Fifteenth International Congress on Hygiene and
Demography (Vol. I, pp. 309, 322, 327, 332), restated, in an abbrevi­
ated form, as follows:
Dust, silioke, and fume are the products of industrial activity to
be feared. In what relation do these stand to each other? Dust is
usually regarded as matter in a state of fine division, but modern
research shows that dust, from a medical point of view, is something
more than this. Smoke and fume differ from dust in being the
products of heat, and these two again differ from each other in this
respect, that smoke is the outcome of incomplete combustion of




GENERAL INTRODUCTION.

21

hydrocarbons, such as coal, wood, and oil, while fume is, firstly, the
gaseous form of metals, nonmetals, and their compounds, and,
secondly, the return of these from the gaseous to the solid state, as
seen in the flue deposit of a lead smelting factory. Soot, on the
other hand, is a hydrocarbon, which has not completely combined
with oxygen to form gases.
Although we are more immediately concerned with the effects of
dust upon the lungs, yet the whole body, including the skin, mucous
membranes, and the internal organs, suffers in due course by ex­
posure to dust. We seldom think of the part which dust and smoke
have played indirectly in shaping the social habits of a people.
How to get rid of dust and fume in the factory, of smoke in the
atmosphere, and of the incidence of all these upon the skin and the
respiratory organs of man has formed not only the subject of many
a scientific discussion, but has stimulated enterprise and encouraged
manufacture. In trying to combat their begriming effects we have
become a well-washed people. The dispersion of these waste prod­
ucts has led to the manufacture and use of soap in proportions
hitherto unparalleled in the history of man, white these again have
indirectly added to employment, wealth, and health. Frequent ablu­
tion has become the rule, so that baths, a luxury to the Eomans in
the palmy days of empire, and unknown in even large houses in
my own country four or five decades ago, are now a necessity, for
they find a place in many of the modern houses of the working
classes. Dust and fume, begriming agents as they are, have there­
fore done something to socialize mankind, to promote health, and to
advance civilization, for those nations are leading in the path of
progress to-day whose workers not only require soap and water for
themselves, but who, by the factory dust and smoke they create,
oblige all of us to resort to similar usages.
What are the possible remote effects of carbon monoxide? Pneu­
monia sufficiently frequentfy develops in miners who have been ex­
posed to the firing of explosives as to suggest a causal relationship
between the two. Dr. Hotchkiss, of the United States Public Health
Service, states that in the Cripple Creek district one man died of
'edema of the lungs, probably the result of exposure to powder smoke,
and that in the same district 20 similar cases had been reported
within 10 years, of which 18 proved fatal. Dr. Dale Logan tells me
of two men who returned to a particular working in a coal mine three
and one-half minutes after having exploded 1 pottnd' of gunpowder.
Shortly afterwards both complained of the foulness of the air and
of their work becoming more difficult; they also had headache, giddi­
ness, and vomiting. They made their way home, staggering all the
way. In the case of one of the men speech was so thick that his wife
could not understand what he said. Both men seemed to be intoxi­
cated. During the night one of the men vomited frequentty. Next
day, although giddy and suffering from headache, he returned to
work, but on the second day he developed pneumonia and died from it
on the fourth day. The pneumonia was regarded as the sequel of
carbon monoxide poisoning, and compensation was awarded. Among
South African miners pneumonia is extremely common. It is very
fatal both to white men and to black, owing largely to the diminished
vital resistance, caused by breathing mine air charged with the




22

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

products of explosives. Sudden exposure to air containing a large
percentage of carbon monoxide gives rise to serious symptoms which
immediately attract attention, but the effects produced upon men by
the combined influence of fatigue and of breathing for several hours
daily small percentages of carbon monoxide in the high temperature
of the mine are not so well known. Although the symptoms observed
in miners after the use of explosives are for the most part due to
CO, it is not maintained that nitrous fumes can be inhaled with im­
punity. On the contrary, owing to their irritating properties, they
set up congestion of the lungs v
*
edema. In an ordinary way the
symptoms appear much earlier than those caused by carbon monoxide.
Shortly after exposure to nitrous fumes, a burning sensation in the
nostrils and throat is complained of, followed by a dry, hacking
cough, and by expectoration frequently tinged with blood. Should
the miner die, the mucous membrane of the trachea and bronchi is
found to be acutely congested, and there are signs of acute broncho­
pneumonia and hemorrhagic edema of the lungs.
What becomes of the dust when it is inhaledl It is a natural sup­
position that, while some of it reaches the lungs, the major part of
it is retained in the nares. Saito, working in Prof. K. B. Lehmann’s
laboratory in the Institute of Hygiene in Wurzburg, has tried to
determine experimentally the fate of dust breathed by workmen in
factories. In his preliminary experiments dogs and rabbits inhaled
air charged with white-lead dust from 1 to 33 hours. He found that
the greater part of the dust was subsequently recovered not from the
lungs, as might have been expected, but from the alimentary canal.
In five out of six experiments 4 to 24 per cent of the total amount of
lead dust breathed in was located in the respiratory organs and the
remainder in the digestive. In an ordinary way the dust caught in
the nasal mucous membranes mixes with the mucus which is secreted
and is unknowingly swallowed. Experiments were also carried out
on man with white-lead dust., the mouth and nares being previously
carefully washed. The experiments were conducted from 10 to 15
minutes on 20 occasions, care being taken by the men not to swallow
the saliva. Inspiration and expiration took place, through the mouth
and nose, singly and combined, with the result that, provided sneez­
ing did not take place, 95 per cent of the dust inhaled remained be­
hind in the body, 50 per cent of which was primarily retained in the
nares. Z j processes of exclusion 12 per cent probably finally found
Z
its way into the lungs, for the bulk of the lead dust, 60 to 80 per cent,
was recovered from the alimentary canal. Saito’s experiments demon­
strate that the principal portal of entrance of soluble dust into the
body when inhaled is the alimentary canal and not the lungs. Where
two such channels of entrance as the respiratory and alimentary are
so close to each other, it is not always easy to say upon which the
dust has exerted its baneful influence. In Laborde’s experiments
with guinea pigs exposed to air laden with fine white-lead dust, the
animals died within two hours. In the lungs were found intense
congestion and ecchymoses. When the exposure was less intense and
the animals lived longer, similar but equally profound vascular
changes were found in the lungs, pointing, therefore, to direct
irritation by dust.
In my early cases of gold miners’ phthisis the physical signs showed
that the disease was located for the most part toward the base of one




GENEEAL INTRODUCTION.

23

or other of the lungs. The men, although bronzed and healthy look­
ing, were yet the subjects of a difficulty of breathing on the slightest
exertion, a difficulty of breathing far in excess of what the physical
signs on examination of the chest suggested. In its inception pneu­
moconiosis- is a nontuberculous disease; it is the direct result of dust
irritation. The course of the malady is hastened by the recurrence
of bronchial and pulmonary catarrh. The changes set up in the
lungs by previous catarrh prepare the soil for infection by tubercle;
but in some of my patients the disease ran its course from com­
mencement to finish without becoming tuberculous. Within recent
years a change has apparently been taking place in the mines on the
Rand. Ten years ago, when I first drew attention to gold miners’
phthisis, there was a much smaller percentage of tuberculous disease
amongst the men than in recent years. In making this statement I
am supported by the medical experts of the recent Commission, who
report that it was the opinion of the medical men on the Rand who
examined patients in 1902-1904, that at that period miners’ phthisis
terminated fatally without any clinical or bacteriological evidence of
tubercle and that man continued at work until a week or two of their
death, which often came by heart failure, with cyanosis and urgent
dyspnea. Death, indeed, sometimes came to men quite suddenly from
heart failure when they were working in the mine. As it is not
always easy to find the bacilli of Koch in the sputum even of ordi­
nary cases of pulmonary tuberculosis, so their absence for months
from the expectoration of a gold miner is no proof that the disease
in him is not tuberculous. When, however, tubercle bacilli are ab­
sent all through the illness and the lungs after death do not give
evidence either macroscopically or microscopically of tubercle, then
gold miners’ phthisis in its typical form is nontuberculous. Sooner or
later, as the malady progresses, tubercle becomes grafted upon the
pulmonary lesions, and with the invasion of the microorganisms the
character of the illness becomes almost immediately changed. While
the hard and fibrotic portion of the lung of a gold miner is not a
suitable soil for microorganisms the concurrent catarrhal conditions
in ether parts of the lungs offer little resistance both to the bacillus
of Koch and the pneumococcus of Friedlander, and yet I have seen a
Rand miner with silicosis in the early stage develop an acute inflam­
matory affection of the lungs, with high temperature and with
physical signs indicating extensive consolidation, make an excellent
recovery. In the case I refer to the microorganism found in the
expectoration was the bacillus catarrhalis. In the Transvaal the high
mortality rate of miners from pneumonia led the mining authorities
of South Africa a few months ago, with the view of treating the
disease by a vaccine, to call to their assistance the service of Sir
Almroth Wright. The high death rate from pneumonia and the
increasing number of cases of gold miners’ phthisis, which in later
years have been assuming a tuberculous type, raises the question as
to whether the mines themselves or the lodgings of the men may not
be partly responsible for this fact.
Since dust is the foe of workmen means ought to be employed for
its removal from factory and workshop. General ventilation is all
very good, so long as the question is simply one of a vitiated atmos­
phere due to the air having been rendered impure by the respiratory




24

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

products of the workpeople, and by artificial heating and lighting,
but where the dust is generated by machinery or is evolved during
the ordinary course of production general ventilation only dissemi­
nates the dust, so that recourse must be had to local ventilation such
as is afforded by an exhaust apparatus. Exhausts are superior to
water spraying. The wearing of respirators is no doubt in many
instances a necessity, but the men complain of the heat engendered
by them and of the restraint imposed upon their breathing. Still
it remains a fact that men working in color grinding, when they have
taken to wearing respirators, have recovered the weight they had lost
and regained their health.
OBSERVATIONS ON THE AIR IN MINES.

In this connection the further observations by Sir Thomas Oliver
on fumes more or less contaminated by dust are also of exceptional
practical importance. The extract is from an address on “ The
metallic poisons, lead and arsenic, as met with in our industries,”
contributed to the Transactions of the Sanitary Institute of Great
Britain (Vol. X IV , 1893, pp. 157-161) :
Carbonic acid is one of the great dangers to the men, and there
is a tendency for it always to be present in excess, as it is given off
from the lungs of the miners in respiration, and the combustion of
the candles, as well as from the strata in which the men are working.
T
Add to these facts the deterioration of the air of the mine by the use
of dynamite and from the explosions of gunpowder, and you have an
atmospheric condition in the mine which frequently obliges the men
to retire to the mouth of the pit in order that the needs of respiration
may be satisfied. What -with the impure air and the inhalation of
the dust and grit from the limestone rock, the lead miner is exposed
to risks that are in constant operation during the whole period he is
at work. When to these are added the fact that the mines are warm
and the men on leaving are overheated, owing to the exertion re­
quired in scaling the ladders, and are obliged to trudge home 2 or 3
miles across a bleak moor exposed to biting winds and in all kinds of
weather, we can readily understand how it is that many of them
succumb to such acute illnesses as pneumonia, or how the neglected
cold or pleurisy, acting in conjunction with a family predisposition,
too frequently throws the miner into consumption.
When we come to consider the manufacture of white lead, we
T
T
observe that at certain stages of the process a good deal of dust is
evolved. It is the* inhalation of this fine penetrable dust, and the fact
that women are largely employed in the trade, that have gained for
this industry a bad name. We believe that women are much more
susceptible to the influence of lead than men. This statement, for
which I am largely responsible, has been disputed, but an increasing
acquaintance with the subject, an extensive hospital experience of
plumbism, and renewed experimental investigation upon animals,
lend weight to the opinion that women are not only more susceptible
than men but they are so at an earlier age. In addition, there is a
greater tendency for lead poisoning to assume its most serious form,
in which headache followed by convulsions and coma are the most
prominent symptoms.




GENERAL INTRODUCTION.

25

PRINCIPLES OF TUBERCULOSIS PREVENTION.

The conveyance of tuberculosis infection through the medium of
industrial dust has been referred to with brevity in an address of
exceptional importance on “ The prevention of tubercular disease,” by
Sir James Crichton-Browne, contributed to the Transactions of the
Sanitary Institute of Great Britain (Vol. X V , 1894, pp. 445, 446,
448), as follows:
The presence of tubercle bacilli and their spores in the air breathed
by consumptive patients, floating independently or buoyed up by
particles of dust, is now indisputable. Dr. Williams hung up glass
slides smeared with glycerin in the ventilating shafts of the Brompton Hospital and shortly found tubercle bacilli adhering to the
glycerin; and Dr. Cornet, by elaborate experiments, conducted in
the rooms of private consumptive patients and in hospitals, has shown
that tubercle bacilli are expired by consumptive patients in small
numbers, and that they and their spores, which, remember, are very
indestructible and will retain, their vitality even when dried, are
given off in clouds from the handkerchiefs and bed linen of consump­
tive patients and from the floors or walls of the rooms they inhabit,
if they are not scrupulously cleanly in their ways—from any place
or thing, in short, with which their expectoration has come in contact.
Cornet has further shown that tubercle bacilli may be caught in open
spaces and in the air of streets and squares where tubercular persons
are present, and in all these cases he has shown that the dust
collected when inoculated into animals sets up tubercular disease.
Klein has shown that guinea pigs become tubercular when finely
divided tubercular matter is diffused by a spray producer in the air
of their hutches, and he has succeeded in communicating tubercle
to those animals by keeping them for a time in cages in the ventilation-extraction shaft at the Brompton Hospital, through which
the foul air from the wards passes. And quite recently M. Straus
has communicated to the Academie de Medecine in Paris a very in­
structive observation. By means of little plugs of cotton wool the
dust and mucus from the nasal orifices of 29 healthy nurses and
medical students serving in the wards of hospitals containing con­
sumptive patients were collected, and solutions prepared from these
were injected into 29 guinea pigs, of which 9 manifested tubercular
disease within a month. There can no longer be any doubt that the
air of apartments occupied by consumptive patients is loaded with
virulent dust; that the germs of tubercle exist in the atmosphere
of all populous districts; and that the inhalation of the dried virus
floating in the air is one of the commonest ways of the propagation
of the disease.
Then ventilation is not less necessary for the prevention of tuber­
cular diseases in mines, factories, and workshops than it is in public
institutions. The loading of their atmosphere with particular kinds
of dust appertaining to the trades carried on in them is a prolific
cause of tubercle in the lungs, and we have come to speak of
miners’ and knife-grinders’ and potters’ consumption. The dust in
such cases penetrates the lungs and by its hardness and angularity
wounds the mucous membrane, setting up irritation and catarrh and




26

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

creating that raw surface on which the tubercle bacillus loves to
fasten ai}d batten.
VENTILATION AND DUST REMOVAL.

Dr. D. D. Kimball, in a paper on “ Ventilation and public health,”
contributed to the Annals of the American Academy of Political and
Social Science (Vol. X X X V II, No. 2, March, 1911, p. 212), directs
attention to the fact that “ Many ventilating systems are worse than
useless because the air is taken in at or below the street level or from
other dust-contaminated sources, and is passed into the building
without filtration, the result being that the last state of the building
is worse than the first.” The problem of effective ventilation and dust
control1 does not, however, fall within the scope of the present
discussion, but it is necessarily of the first importance in any
and all efforts to mitigate the lamentable consequences which arise
out of a needlessly dust-contaminated atmosphere, under which so
large a number of industrial processes are carried on at the present
time.
DUST IN RELATION TO OCCUPATIONAL DISEASES.

The importance of dust as a factor in occupational mortality Jias
attracted the attention of every authority on occupational diseases
from Eamazzini to Sir Thomas Oliver. It requires no extended con­
sideration to prove that human health is much influenced by the
character of the air breathed and that its purity is a matter of very
considerable sanitary and economic importance. Aside from the risk
of exposure to so-called air-borne diseases, the pollution of the
atmosphere by organic and inorganic dusts is unquestionably
the cause of a vast amount of ill-health and premature mortality,
chiefly among men and women engaged in the many indispensable
trades and occupations that minister to human needs. The sanitary
dangers of air contaminated by disease-breeding germs are possibly
not so menacing as generally assumed, while the destructive effects of
the dust-laden atmosphere of factories and workshops are a decidedly
1 In a m ore recen t a d d ress b y S ir J. C rich ton -B row n e b e fo re the S a n ita ry I n s p e cto rs ’
A ss o cia tio n o f L on d on (M od ern H osp ita l, N ovem ber, 1 9 1 3 ), he observes th a t “ to w n d u st is
m ost to be fea red as a ca rr ie r o f p a th og en ic germ s an d m icrob es o f m an y kinds w h ich can
resist d ry in g and m ay be w a fte d a bou t w ith the p a rticle s.
So ca ta rrh , influenza, hay
fev er, etc., m ay be d issem in ated . T u b ercu losis, too, is sim ila rly spread in th e d ust o f the
d ried sputum .
In all d ust the d a n ger o f im p la n ta tion o f germ s, fresh o r dried, is e n ­
h a n ced i f a ssocia ted w ith co rrosiv e, ch em ica l, or m ech a n ica lly w ou n d in g elem ents.
S harp
p a rticle s o f m in eral m a tter m ay p low a w a y in the tissu es th ro u g h w h ich p a th o ge n ic
germ s m ay enter. E ven tetanu s m ig h t be caused b y roa d d u st ca rr y in g it to som e su p er­
ficia l w ou n d , fo r the org an ism lives in the a lim en ta ry ca n a l o f the horse, and so is fo u n d
in the m an u re o f street refu se a s w ell as in the so il o f garden s and oth er places. T h e
teta n u s a n tito x in is efficacious i f used im m ed ia tely, and in these da ys o f d u s t-s ca tte rin g
m o to rs the p resid en t suggested th a t a tube o f a n tito x in m ig h t w ell form a p a rt o f the
fu r n itu re o f a ca r, so th a t in case o f a ccid en t it m ig h t in s ta n tly be adm in istered i f any
w ou n d com es in c o n ta c t w ith th e d u s t.”




GENERAL INTRODUCTION.

27

serious menace to health and life. While the investigations of Dr.
McFadden and Mr. Lunt seem to prove the paucity of bacteria in
very dusty air, the evidence otherwise available is entirely conclusive
that the risk to disease infection is much greater indoors than out
in the open, where sunlight, rain, and wind in combination go far
to purify the atmosphere by destroying the bacterial life contained
in minute particles of suspended matter. Apart, however, from the
transmission of disease through a dust-contaminated atmosphere, dust
in any form, when inhaled continuously and in considerable quantities,
is prejudicial to health because of its inherent mechanical properties,
which are destructive to the delicate membrane of the respiratory
passages and the lungs. It has long been known that those who live
most of their time out of doors have a decided advantage over these
who, because of their employment, are compelled to spend their work­
ing hours inside the home, the office, the factory, or the workshop, and
it is an accepted axiom of modern sanitary science that measures and
methods for the prevention of dust are an essential preliminary con­
sideration in rational methods of sanitary reform. All that sanitary
science can suggest or that sanitary legislation can regulate and
change should be done for humane reasons and as a matter of gov­
ernmental concern, to mitigate the needless hardships of those who
suffer in health and life as the result of conditions over which they
themselves have but a very limited control.
The importance of dust as a factor in occupational diseases has
been emphasized by all who have written on the subject, but by no
one more precisely and clearly than by Sir James Crichton-Browne, in
his address on “ The dust problem,” read at the Sanitary Congress
held at Manchester, England, in 1902, from which the following pro­
foundly suggestive extract is taken:
The mortality of the principal dust-producing occupations, com­
pared with that of agriculturists, who live and work in what is practi­
cally dustless atmosphere, is excessive to a startling degree. It is not
suggested that this excess is to be ascribed to dust alone, no doubt
various factors contribute to it, but the facts that it is due mainly to
respiratory diseases, that it is distributed amongst the several occupa­
tions pretty much in proportion to their dustiness, and that it has
diminished in some instances where dust has been effectually dealt
with, justify the conclusion that it is largely dust begotten.
THE DUST PROBLEM IN INDUSTRY.

Sir Crichton-Browne in continuation of his remarks pointed out
that a detailed examination of the conditions of work in each of the
22 principal dusty trades brought out clearly the fact that the un­
healthiness was born of or was primarily due to the dust inhaled by
the workmen, and that there was always a well-defined relation




28

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

between the death rate and the quantity and quality of dust present
in the atmosphere. There is apparently no very material difference
in the manner in which the different varieties of dust act upon the
human organism, except where, in addition to mechanically-injurious
properties, the dust is of a poisonous character^ which leads to diseases
such as lead poisoning, phosphorus poisoning, anthrax poisoning, etc.
Industrial mineral dust apparently acts with greater rapidity upon
the lungs than organic dust, which is slower and more insidious in its
operations, but in a general way follows similar lines. All varieties
of dust that are the immediate result of occupation are therefore com­
prehended under the term of “ industrial dust,” which is specifically
limited by Sir Crichton-Browne as follows:
I select this dust for my further remarks, because it is readily
recognized and defined, because its pernicious effects are well marked
and indisputable, because it is to a large extent, if not entirely, pre­
ventable or removable, and because the efforts already made to pre­
vent or remove it have been rewarded with conspicuous benefit. And
I still further simplify and abbreviate what I have to say by restrict­
ing my observations to those varieties of it which are dust and noth­
ing more., which are injurious by their physical properties and
mechanical operations, and not as poisons to the systems, chemical
destructives of the tissues, or bearers of bacterial invaders.
A similar but even more restricted limitation has been^adopted for
the present purpose, and only such occupations will be considered in
detail in the following discussion as expose to the continuous and
considerable inhalation of metallic and mineral, or other inorganic
fiber dust, and in which the evidence is at least fairly conclusive that
the resulting disease liability and mortality from tuberculosis and
other respiratory diseases is above the average for occupied males
generally.
SCIENTIFIC TERMINOLOGY OF INDUSTRIAL DUSTS.

Preliminary to a discussion in detail of the mortality from tuber­
culosis in dusty trades it may prove of some advantage to those
who do not have access to the original sources of information to
present a brief summary of qualified medical opinion regarding dust
as a factor in occupation diseases and mortality. In a course of lec­
tures on “ Unhealthy trades,” delivered before the Society of Arts,
London, in 1876, Dr. B. W. Richardson1 placed injuries from the
inhalation into the lungs of fine particles of solid matter, usually
defined as dust, at the head of the causes responsible for industrial
diseases, and from his discussion the following is quoted:
The term “ dusts,” as I would here apply it, includes all those fine,
solid particles which are thrown off from various substances in the
processes of manufacture or treatment of articles in common use in
1 S cien tific A m erica n S upplem ents, N os. 9, 10, 18, 19, and
F eb. 26, M ar. 4, A p r. 29, M ay 6, an d M ay 27, 1876.




22,

d ated,

re sp e ctiv e ly ,

GENERAL INTRODUCTION.

29

daily life, such as earthenware utensils, knives, needles, or mechan­
ical instruments, like files or saws; or ornamental things, such as
ornaments of pearl, ivory, and turned wood; or articles that are
\^orn, of silk, cotton, hemp, fu r; or things that are used for food,
such as flour; or for creating warmth, such as coal; or for using as
a supposed luxury, such as tobacco and snuff. These are only a few
illustrations; many others will naturally occur to those who think
on the subject.
The dusts which inflict injury are of varied quality, as will be
seen from the brief sketch just given. They are also of varied effect
in regard to the specific injuries which they produce. We may profit­
ably study them divided into different groups, according to their
physical characters, as follows:
(a) Cutting dusts, formed of minute hard, crystallized particles
which have Sharp, cutting, and pointed edges. These dusts are com­
posed of iron or steel, of stone, of sand or glass, of dried silicates in
earthenware, of lime, of pearl.
* (b) Irritant dusts, derived from woods, from ivory, from textile
fabrics, fluffs of wool, of silk, of cotton, of flax, and of hemp, from
hair, from clay.
(c) Inorganic poisonous dusts, derived from some poisonous chem­
ical compounds used for coloring artistic products, or for preserving
organic substances, such as furs. These dusts are charged with ar­
senical salts.
(d) Soluble saline dusts, derived from soluble crystalline sub­
stances used for dyeing purposes. The sulphate of iron, copperas,
yields a dust of this class.
(e) Organic poisonous dusts, which are thrown off during the
making up of tobacco into cigars and snuff.* These dusts carry with
them particles of the dried tobacco plant.
(/) Obstructive and irritating dusts composed of carbon, of fine
particles of coal dust, of scrapings of carbon or of soot, of dust of
rouge, and of flour.
Whatever may be the kind of dust to which the workman is sub­
jected, to whichever of the above named he may be exposed, the
primary cause of danger lies in the circumstance that the fine par­
ticles are borne by the air into the lungs. They pass, wafted by the
air, through the mouth and nostrils into the windpipe; they pass
along the bronchial tubes; in some instances they reach and traverse
the bronchial passages which lie between the larger bronchial tubes
and the minute air vesicles, or they even reach the air vesicles them­
selves.x
DISEASES RESULTING FROM DUST INHALATION.

An American authority on occupational diseases has referred to the
subject at some length in an article contributed to Buck’s Hygiene
1 One o f the m ost im p o rta n t co n tr ib u tio n s to th e s cie n tific stu d y o f in d u s tria l d u sts is
the secon d and en la rg ed ed ition o f a trea tise issued by th e M useum o f In d u s tria l H yg ien e
o f V ien n a in 1895.
T h e title o f the p u b lica tio n is “ In den g e w e rb lich e n B etrieb en
vorkom m en de S ta u b a rten in W o r t und B ild .”
T h e p u b lica tio n in clu d e s 14 p ages o f 5(5
m ic ro -p h o to g r a p h ic illu stra tio n s o f ty p ica l in d u s tria l d u sts an d an exten d ed ex p la n a to ry
t e x t by D r. F . M igerka, w ith th e d iv isio n s o f : ( 1 ) m e ta llic d ust, (2 ) m in era l dust,
(3 ) d u st in p olis h in g an d tu rn in g, (4 ) w o o d d ust, (5 ) te x tile dust, ( 6 ) m iscella n eou s
d ust. I t is reg retta b le th a t th is v a lu a b le trea tise sh ou ld n o t h ave been tra n s la te d in to
th e E n g lis h la n gu age.




SO

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

and Public Health, printed in 1879. This writer, Dr. Roger S. Tracy,
for many years registrar of vital statistics of New York City and
sanitary inspector of the board of health, makes the following statement, with particular reference to the special form or type of disease
resulting from the inhalation of metallic and mineral dusts:
The disease comes on very gradually, like the more slowly de­
veloped forms of phthisis pulmonalis, and its duration may be ex­
tended over four or live years. It begins with the cough of irritation,
dry and hacking at first, with very scanty expectoration, whitish and
stringy in character; there is no haemoptysis, but sometimes nausea
and vomiting in the morning. Auscultation at this time reveals
puerile respiration,^ with occasional slight rales. The expectoration
gradually increases in amount and becomes reddish, and soon after
this tinge appears there may be haemoptysis. There is dyspnea on
slight exertion, and dullness over the whole chest, with weak respira­
tion and mucous rales. There is no fever, and the appetite and
strength are still good. I f work is abandoned at this time, recovery
is not only possible, but in most cases probable. I f work is continued,
the lung tissue begins to break down, and cavities form near the
apices. Expectoration is very profuse, and there may be severe
hemorrhages. There is general dullness on percussion, and the last
traces of vesicular respiration give way to sibilant, large mucous and
cavernous rales. Fever is continuous, with evening exacerbations,
night sweats, emaciation, insomnia, and great dyspnea, soon followed
by death.
Very suggestive also are the observations and conclusions of Dr.
John Syer Bristowe, F. JR S., who, in an -address on industrial dis­
.
eases, read at the conference on sanitary subjects held in connection
with the International Health Convention of 1884, discussed the
effects of nonpoisonous irritants on the lungs, in part as follows:
Occupations which habitually expose the workmen to the inhala­
tion of abundant solid particles that are incapable of solution or
removal by the animal tissues or secretions, in many cases induce
chronic diseases of the lungs, which are known as the asthmas or
consumptions of the several occupations referred to, and tend very
materially to shorten life among those engaged in them. Workers in
coal mines and in copper mines, grinders, millstone makers, and flax
dressers are perhaps especially liable to suffer from such causes. It
is marvelous how tolerant the bronchial tubes and lungs are of for­
eign particles which are drawn into them with the breath. Wherever
smoke impregnates the atmosphere, as in London and other manufac­
turing towns, its particles are conveyed in greater or less abundance
into the lungs; whence some are expelled with the expectoration,
which presents, consequently, a slaty or black appearance, while some
get absorbed,. and becoming deposited in the tissue of the lungs, pro­
duce in them that black mottling which increases with advancing
years, and is well known to pathologists. Yet, as a general rule, the
soot-studded organs remain practically healthy, and no clinical evi­
dences of pulmonary disease manifest themselves. The same remarks
doubtless apply to the inhalation of the siliceous particles of ordinary




GENERAL INTRODUCTION.

31

dust. The effects are different* however, when such matters are in­
haled in large excess. * * * The symptoms under which the suf­
ferers labor have some resemblance to those of chronic phthisis, some
to those of chronic bronchitis and emphysema, for either of which
they may well be mistaken. They consist in gradually increasing
shortness of breath, lividity of surface, feebleness of circulation, and
cough, with more or less abundant expectoration; to which, at a later
period, general dropsy and haemoptysis may be superadded. There is
generally a total, or almost total, absence of fever. The only meth­
ods, so far as I knftw, by which the irritative diseases of the lung:?,
just considered can be lessened or prevented, are by providing good
ventilation, and (when possible) by adopting methods to prevent
the diffusion of particles of dust in the atmosphere which the work­
men have to breathe. It is obvious, too, that since the diseases are
insidious in their progress, and increase in proportion as the inhaled
particles accumulate, it would be well for persons who present early
traces of them to seek at once some other kind of employment.
HARMFUL CONSEQUENCES OF INDUSTRIAL DUST EXPOSURE.

The most qualified and extended discussion of the entire subject of
the inhalation of dust, its pathology and symptomatology, with
special reference to dusty trades, is by Dr. J. T. Arlidge, who, in 1892,
published a treatise on The Hygiene, Diseases, and Mortality of Occu­
pations. u Few, indeed,” he argued, “ are the occupations in which
dust is not given off,” and “ in none can it be absolutely harmless, for
the lung tissue must be just so much the worse, and less efficient for
its purpose, in proportion to its embarrassment by dust.” And in
continuation—What occurs to the ordinary citizens becomes magnified ten or a
hundred fold to those engaged in dusty occupations, and more espe­
cially where the dust itself possesses noxious properties. But unless
dust has this latter quality, it is remarkable with what indifference
its inhalation is treated by the majority of workmen. In one sense,
indeed, it is unfortunate that it does not, for the most part, awaken
attention by any immediate tangible consequences. Its disabling
action is very slow, but it is ever progressive, and until it has already
worked its baneful results upon the smaller bronchial tubes and air
cells and caused difficulty of breathing, with cough and spitting, it
T
is let pass as a matter of indifference—an inconvenience of the trade.
OBSERVATIONS ON NONTURERCULOUS RESPIRATORY DISEASES.

Arlidge called attention to the fact that bronchitis, asthma, and
pulmonary fibrosis and tuberculosis were foremost in the causes of
British mortality, holding that without doubt these maladies were
largely attributable to the inhalation of dust operating per se, or in
conjunction with constitutional proclivities and insanitary surround­
ings, In further ’continuation he observes—
Pathologists tell us of the presence of bacilli in tubercular disease,
and favor the belief that these minute bodies are the cause of it.




32

MORTALITY FROM RESPIRATORY DISEASES I^T DUSTY TRADES.

This notion may represent a whole truth or only a partial one; in my
opinion, the latter. For I doubt if these bacilli actually develop
phthisis unless there be some antecedent change in the vitality of the
affected tissue; a change wrought by depressing causes connected
with the mode of life, or with constitutional debility and inherited
taint, or with the occupation followed; of which contributory factors
two or more may cooperate. And assuredly the breathing of dust
may be reckoned as one such of no light energy. In other words, I
look upon a phthisical lung as one prepared for the germination and
multiplication of bacilli, and not a primary product of those micro­
scopic organisms, nor of the products of their organic existence.
The conclusions of Arlidge are summarized in the statement that
“ One practical lesson is to be gained by these considerations—
namely, that p e r s o n s p r e d i s p o s e d t o r e s p i r a t o r y d is e a s e s a n d p h t h i s i s
o u g h t n o t t o e n g a g e i n d u s t y o c c u p a t io n s

BRITISH GOVERNMENTAL INVESTIGATIONS.

More recently the subject of occupational diseases in their re­
lation to workmen’s compensation has been considered at length
and in much detail by a British departmental committee appointed
to consider the pressing and important question of workmen’s com­
pensation for industrial diseases. In its observations upon respira­
tory diseases, and in particular bronchitis, pneumonia, and phthisis,
and their relation to occupation exposure, the committee concluded
that—
Pulmonary disease manifests itself in three kinds or forms—as
ordinary tuberculous phthisis, acute or chronic; as “ fibroid phthisis,”
and as a mixed form when a tuberculous process is ingrafted sooner
or later upon the fibroid. Fibroid phthisis is always a slow disease.
It consists in a chronic inactive inflammation around the many
minute foci of dust inhalation, which by coalescence gradually in­
vades large areas, impairing and strangling the proper lung tissues in
corresponding measure. Again, a lung so impaired is very apt to
harbor bacilli, especially the bacillus of tubercle, by the influence of
which it may be still further destroyed. Thus both fibroid phthisis
uncomplicated and fibroid phthisis with the supervention of tubercle
are in their nature occupational diseases.1
TYPICAL FORMS OF FIBROID PHTHISIS.

The committee, in its final report, describes the typical forms of
ilbroid phthisis as induced by the inhalation of industrial dust, hold:r.g that—
The first symptom is a cough which insidiously, and for a while
almost imperceptibly, becomes habitual. At first in the morning
only, it gradually becomes more frequent during the day, and expec­
toration, nominal at the beginning^ becomes more marked, though
1
R e p o rt o f the D ep a rtm en ta l C om m ittee on
L on d on , 1907, p. 13.




C om p e n sa tio n

fo r

I n d u s tria l D iseases,

33

GENERAL INTRODUCTION.

not profuse until the latter stages of the disease. Leaving out of
account the more rapid progress of the disease in tin and gold miners,
these symptoms of a negative phase of purely local damage ma}^ last
for years—10 or 15 or even more—without advancing to such a
degree as to throw the workman out of employment or even to cause
him serious inconvenience. At some period, however, rarely less
than 10 years and frequently more than 20, of continuous employ­
ment, in a like imperceptible manner the breathing gets shorter
and the patient finds himself less and less capable of exertion. Yet,
even when the cough and dyspnea have reached a considerable
degree, there are no signs of fever, as is the case of pulmonary tuber­
culosis ; the flesh does not fall and the muscles retain their strength
and volume. Thus even at a period when the malady is fully estab­
lished the general health may be but little impaired, and the patient
may not be compelled to cease work. Herein fibroid phthisis pre­
sents a well-marked difference from pulmonary tuberculosis; and
even if, as we have said, the disease becomes complicated with tuber­
cle, yet the rate of progress may be determined rather by the charac­
ter of the primary than of the secondary disease, though usually the
supervention of tubercle hastens the sufferer into a more rapid con­
sumption.1
The results of all these researches into an almost neglected field
of preventive medicine prove that occupation diseases, properly so
called, demand the most thoroughly qualified medical supervision of
factories and workshops and the periodical medical examination
and inspection of persons employed in recognized unhealthy trades.
For., as the committee referred to points out, “ If in the early stage of
fibroid phthisis the workman leaves the dusty employment for work
in agriculture or in other occupation in air free from irritating parti­
cles, the disease may be practically arrested; that is, although the
part affected may proceed to obliteration, the disease would not ex­
tend to other parts of the lung, and the portion destroyed would be
negligible as a factor of health and capacity.” 2
FIBROID PHTHISIS AND OCCUPATIONAL DISEASE.

The conclusion of this investigation, the most important official
inquiry ever made into the subject of industrial diseases, fully war­
rants the view that while ordinary tuberculous phthisis can not be
regarded as a disease peculiar to any occupation, fibroid phthisis in its
latter stage, and when the history of the case is known, can be clearly
distinguished from tuberculous phthisis; so that it may be regarded
as an established fact that fibroid phthisis is a disease peculiar to
employment in certain trades, of which the committee mentions the
following: Grinders continuously using either grindstones or emer}^
for the abrasion of metals, especially steel; potters engaged in certain
1 R e p o rt o f the D ep a rtm en ta l
1907, p. 13.
2 Idem , p. 14.

C om m ittee

106811°— 18— B ull. 231-------3




on

C om p en sa tion

fo r

In d u s tria l

D iseases,

34

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

processes; stone workers employed on certain kinds of stone, espe­
cially if not working in the open air; tin miners, in particular such
as have previously been exposed to the exceedingly unhealthy condi­
tions of the gold mines of the Transvaal; and ganister miners, in­
cluding men employed in certain processes of ganister brickmaking.
The committee did not arrive at final conclusions regarding persons
employed in the slate industry, or employees in the working of
asbestos and many other recognized unhealthy trades, partly, no
doubt, because of the limited scope of the inquiry arid the paucity of
conclusive statistical data. It is pointed out by the committee that
it was not possible to separate the English death rates for fibroid
phthisis from those for other diseases of the respiratory system, since
medical men do not, as a rule, distinguish that disease when certify­
ing the causes of death. It is clearly established by the results of the
investigation that such a distinction should be made and that medical
practitioners should qualify the death returns from tuberculosis in
all cases where the death was the result of fibroid phthisis.
The committee, having arrived at the opinion that fibroid phthisis
is a specific and distinguishable trade disease, concluded that em­
ployers might properly be required to pay compensation to their
workpeople who contract it; but it did not, however, recommend
the extension of the workmen’s compensation act to the disease for
two reasons. The first was that, owing to the long period of its
development, it would not be right to lay the whole burden on the
employer under whom the workman had been serving during the
12 months prior to the incapacity. The other and even more impor­
tant reason was that for several years before the nature of the disease
can be definitely diagnosed the patient may suffer from symptoms
that, while not distinctive, are sufficient to prevent him from securing
employment.
In the brief descriptive account of 118 industries and occupations
considered in detail in this discussion only the most general facts
have been included in order to emphasize, as far as possible, the in­
dustrial processes productive of conditions more or less injurious to
health in general, and conducive to the development of tuberculosis in
particular. Authorities are referred to only so far as this has seemed
necessary to establish clearly, in the case of each trade or occupation
considered, the facts of a more or less excessive degree of frequency of
pulmonary tuberculosis, aside from the statistical sources of informa­
tion which form the basis of the subsequent conclusions, except in the
case of a few employments for which neither general vital statistics
nor insurance mortality experience are as yet available. The term
“ tuberculosis ” is used in a very general sense, but as a rule limited
to phthisis pulmonalis, or pulmonary tuberculosis, unless otherwise
stated. All of the references to insurance mortality experience are




GENEEAL INTRODUCTION.

35

limited to the mortality from phthisis pulmonalis and do not include
that from other forms of tuberculosis or other forms of respiratory
diseases unless specifically stated in the text,
SOURCES OF STATISTICAL INFORMATION.

The principal statistical data utilized in the present discussion are
the following: First, the occupation returns according to age and
sex as published in 1914 by the Thirteenth United States Census for
the year 1910; second, the occupation mortality statistics of the
Twelfth Census, published in 1904; third, the occupation mortality
data published in the annual reports on the mortality of the United
States registration area for the years 1908 and 1909; fourth, the occu­
pation mortality statistics published decennially as a supplement to
the Report of the Registrar-General of Births, Marriages, and Deaths
for England and Wales for the two periods, 1890-1892 and 1900-1902
(no later data have as yet been published) ; fifth, the corresponding
decennial mortality statistics of Scotland; sixth, the industrial mor­
tality statistics of the Prudential Insurance Co. of America for the
period 1897 to 1914, published in connection with the company’s
exhibits at the British Congress on Tuberculosis, 1901, the Louisiana
Purchase Exposition, 1904, the International Congress on Tuber­
culosis, 1908, the International Congress on Hygiene and Demog­
raphy, 1912, and the Panama-Pacific International Exposition, 1915;
seventh, the industrial mortality statistics of the Metropolitan Life
Insurance Co., presented at the annual meeting of the American
Public Health Association, 1915; and eighth, miscellaneous occupa­
tion mortality statistics derived from special sources or made public
in connection with local investigations, including, among others,
medico-actuarial experience data, the mortality returns for the tex­
tile industry of Blackburn, England, the cutlery industry in Shef­
field, England, the quarry industry of Derbyshire, England, the
stone industry of Aberdeen, Scotland, the mining industry of Corn­
wall, South Africa, Montana, southwest Missouri, etc.
PRINCIPLES OF STATISTICAL ANALYSIS.

At least four different statistical methods are available for the
purpose of determining with approximate accuracy the degree of
tuberculosis frequency in different trades or specified occupations.
Absolute accuracy is not obtainable in investigations of this kind, nor
is this absolutely essential for the practical ends in view.
The first method is to determine the proportion of persons in
specified occupations living at ages 65 and over, and to compare the
same with the corresponding proportion for occupied males gener­
ally. This method is never conclusive by itself, but is occasionally
useful in connection with the use of other statistical data. It is




36

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

self-evident that other factors besides mortality determine the pro­
portion of persons in different occupations at ages 65 and over.
It has been shown, for illustration, by the census of 1910, that of the
male population, ages 14 to 44, the proportion employed in gainful
occupations is 89.3 per cent, in contrast with only 28.6 per cent for
the female population. The proportion employed in the general
population varies materially according to sex and age, there being a
gradual increase from ages 14 to about 45, subsequent to which the
proportion either unemployed for physical or retired for economic
reasons gradually increases. At ages 21 to 44, for illustration, in
the American population 96.7 per cent of the males but only 26.3 per
cent of the females are employed in gainful occupations. The maxi­
mum proportion of employed among women occurs at ages 16 to 20,
when 39.9 per cent are engaged in gainful occupations.
In the general population, ages 10 years and over, according to the
census of 1910, 81.3 per cent of males and 23.4 per cent of females
were engaged in gainful occupations. The corresponding percentages
in 1900, according to the census, were 80 for males and 18.8 for
females. The proportions for the aggregate employees in the principal
occupations with exposure to dust, according to the census of 1910,
are shown in Table 3.
T a b le 3 .— A G E D IS T R IB U T IO N OF PE R SO N S IN G A IN F U L O CC U P A T IO N S W I T H E X P O ­
S U R E TO IN D U S T R I A L D U STS.
[Compiled from Report of Bureau of the Census on Occupation Statistics, 1910.
see pp. 4G to 50.]

Males.

For occupations included,

Females.

Age group.
Number.
10 to 13 years................................
14 to 15 years................................
16 to 20 years................................
21 to 44 years................................
45 years and over........................
Total, 10 years and over.

11,817
64,110
435,105
2,094,694
658,774
3,264,500

Per cent.

0.4

8,211

1.2

2.0
20.1

55,671
251,477
308,130
49,989

8.3
37.3
45.8
7.4

100.0

673, 478

100.0

13.3
64.2

By way of further illustration attention may be directed to the
fact that of 5,606,789 farmers 2,457,572, or 43.8 per cent, were 45
years and over. In contrast, out of 210,566 males employed in cotton
mills only 34,476, or 16.4 per cent, were 45 years and over. It, of
course, would be quite erroneous to conclude that the differences in
percentages measure the full effect of an excessive mortality, since
for obvious reasons the age distribution is primarily determined by
occupational requirements and conditions. The illustration is suffi­
cient for the purpose of emphasizing the practical limitations of the
method of ascertaining occupational mortality by means of the pro­
portion of persons living at advanced ages in specified employments.




GENEEAL INTRODUCTION.

37

The second method is to ascertain the average age at death in par­
ticular occupations from all and specified causes. This method was
quite extensively employed in the earlier *registration reports for
certain New England States, and while occasionally useful in con­
nection with other data the method by itself is frequently seriously
misleading. According to the combined statistics for the State of
Rhode Island (1852-1910), the average age at death of farmers was
67.4 years, against 55.86 years for florists. There are no reasons for
believing that on the average florists experience a higher death
rate than farmers and certainly not to the extent indicated by
the difference of 11.5 years in the average age at death. Another
interesting illustration is the high average age at death of clergymen,
given according to the Rhode Island experience1 as 63.78 years, and
the very low average age at death of electricians, given as 36.14 years.
These illustrations are sufficient for the purpose of emphasizing
the uselessness and misleading character of a method still occasion­
ally employed in determining the relative mortality in different
occupations from all causes or special causes by means of the average
age at death.
The third method is to determine the exact mathematical rate of
mortality from all causes or specific causes, such as tuberculosis or
industrial accidents, by the ascertainment of the number of deaths
occurring among every 1,000 persons of any particular trade or occu­
pation exposed to risk of death for a given period of time, usually a
single year. This method is probably the most satisfactory; but it is
often quite impossible to secure strictly accurate information regard­
ing the number of persors employed in particular trades or occupa­
tions and the corresponding number of deaths in precisely the same
group of employments. Estimates of the numbers exposed to risk in
particular occupations are quite likely to be seriously misleading, and
the chance of error is materially increased by differences in the pre­
vailing methods of occupation classification. It is rarely the case
that both the census enumeration and the occupation mortality re­
turns are ascertained in exactly the same manner by the census and
the health authorities or registration officials throughout the country.
The fourth method is to determine the exact proportion of deaths
from a specific cause, such as pulmonary tuberculosis, occurring in
the mortality from all causes, without reference to ages at death.
When this method is used with the required caution, the proportions
thus determined are often sufficiently suggestive of abnormal condi­
tions and occasionally conclusive.
A fifth method is a modification of the fourth and is generally known
as the proportionate mortality figure, by means of which the propor­
1 F ifty -e ig h th R e g istra tio n R ep ort, R hod e Isla n d , 1910, p. 631 et seq.




38

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

tion of deaths from any particular disease, such as pulmonary tuber­
culosis, is calculated as a percentage of the deaths from all causes
occurring during specified periods of life. This method has been
extensively employed in the present discussion, since otherwise the
available industrial insurance mortality statistics could not have
been fully utilized. This method, in a measure, is, however, the most
satisfactory and practically conclusive, since it presents with approx­
imate accuracy the true proportionate incidence of pulmonary tuber­
culosis or the degree of its frequency at specified periods of life.
INDUSTRIAL INSURANCE MORTALITY STATISTICS.

The industrial insurance mortality statistics utilized in the present
discussion are derived largely from the experience of two thoroughly
representative companies which have from time to time given
publicity to the facts of their experience. The resulting propor­
tionate mortality returns, however, indicate a specific mortality from
p'ulmonary tuberculosis somewhat below the actual, since the experi­
ence is, to a certain extent, modified by medical selection; in other
words, the proportionate mortality from pulmonary tuberculosis, or
the true, actual loss from the disease at specified age periods
would have been somewhat higher if medical selection had not been
made use of. In comparing this experience with the corresponding
standard for the registration area of the United States the compari­
son is, therefore, somewhat more favorable to the various trades and
occupations considered than would have been the case if the returns
could have been derived from the registration records of the different
States and cities comprehending the experience of the companies
referred to.
Of the aggregate number (34,997,474) of industrial policies in
force with all American industrial companies on December 31, 1916,
the proportion in force with the Prudential and Metropolitan com­
panies was 84 per cent. The experience utilized, therefore, may be
considered as thoroughly representative for the industrial population
of the country at large.
THE PROPORTIONATE MORTALITY FROM PULMONARY
TUBERCULOSIS.

The proportionate mortality figures may briefly be explained as
follows: At ages 25 to 34, out of every 100 deaths from all causes
in the registration area of the United States during the 14 years
ending in 1913, 30.5 deaths were from pulmonary tuberculosis. The
corresponding proportion of deaths in the industrial insurance friortality experience of the Prudential Co. was 67.9 per cent' for
grinders, 55.9 per cent for printers and compositors, 53 per cent for




GENERAL INTRODUCTION.

39

upholsterers, 45.3 per cent for potters, etc. The difference between
the average mortality from pulmonary tuberculosis for the registra­
tion area as a whole and the corresponding proportionate mortality
from pulmonary tuberculosis in the occupations considered in
some detail, measures approximately the health-injurious circum­
stances for different employments. It, however, does not follow that
all of the difference is necessarily or specifically attributable to the
employment as such, or to the health-injurious conditions under
which the industry may be carried on.
DESCRIPTIVE DEFINITIONS OF INDUSTRIAL DUSTS.

Preliminary to the analysis of the mortality data and the observa­
tions having reference to the specific occupations or employments
considered, the following descriptive definitions of industrial dusts,
by Charles Baskerville, Ph. D., are included in explanation of the
statistical data and groupings of occupations with exposure to indus­
trial dust. The extract is from an exceptionally useful and trust­
worthy dissertation on “Air impurities: dust, fumes, and gases,” in
the New York Medical Journal, November 23 and 30, 1912.
First, as regards insoluble inorganic dusts, it is said that “ this
class includes metals (antimony, arsenic, type metal, brass, bronze,
copper, aluminum, iron, steel, lead, manganese, vanadium and ferrovanadium, silver, tin,jsinc, and solder) in a state of fine division
(dusts, atomized metals, metallic powders) ; flue dusts; various ore
dusts (iron ore, etc.) ; silica, sand, emery, flint, glass powders; carbon
graphite, diamond, coal, soot; brick dust, marble, granite, cement,
terra cotta; lime, gypsum, plaster, meerschaum; phosphates, guano,
etc.” The continuous and considerable exposure fto the inhalation of
e
insoluble inorganic dusts, according to Baskerville (who is sustained
by numerous other authorities) may result in fibrosis of the lungs,
chiefly because of the inhalation of siliceous or metallic particles, as,
for example, is the case in the so-called potters’ asthma and grinders’
phthisis. Pneumonia has been reported as frequent among work­
men in blast furnaces, owing, in part, directly or indirectly, to the
inhalation of slag dust. The disease known as siderosis is commonly
met with among metal polishers, knife grinders, and others engaged
in metal working.
Second, soluble inorganic dusts.—This class, according to Basker­
ville, includes such substances as are likely to be swallowed and ab­
sorbed, as, for illustration, metal particles, including lead, brass, cop­
per, zinc, arsenic, mercury, and silver, as well as soluble inorganic
salts. Many dusts of this class, it is pointed out, “ are dangerous
not only because of their irritating or poisonous properties, but also
because of their inflammability, e. g., potassium chlorate.”




40

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

T h i r d , o r g a n i c d u s t s .— This class is defined as comprising such
widely varying materials as “ sawdust, fur, skins, feathers, broom
and straw, grains and flours, jute, flax, hemp, cotton, wool, carpet
dust, street sweepings, tobacco-box dust, hides and leather, felts,
rags, paper, horsehair, etc.” Typical of the diseases caused by or­
ganic dusts are: “ Flax dressers’ disease, a kind of pneumonia due
to the inhalation of particles of flax; pneumoconiosis due to the
inhalation of dust by ganister workers; alkaloidal poisoning from
African boxwood by workmen engaged in shuttle making; and ma­
lignant pustule and a febrile disease among rag sorters.”
T H E C L A S S IF IC A T IO N O F D U S T Y T R A D E S .

The occupational grouping adopted for the purposes of the present
discussion is necessarily a more or less arbitrary one, since all em­
ployments involve exposure to more than one particular kind of dust*
It is, however, safe to assume that the predominating characteristic of
a particular kind of dust exposure primarily determines the resulting
departure of the mortality from pulmonary tuberculosis from the
normal for the general population. All the groupings of dusty trades
which have been adopted by Benoiston de Chateauneuf, in Oesterlen’s
JVledical Statistics,1 by Hirt, Sommerfeld, Merkel, Arlidge, Oliver,
and others have this limitation in common, since no entirely con­
clusive scientific investigation has been made to afford the material
for a final and strictly scientific classification of dusty trades. The
present classification, however, will at least serve the purpose of
a convenient arrangement, with a strict regard to the facts as they
are known and understood at the present time.
The occupational grouping as given below has been adopted to
emphasize in a rather general way the principal dust hazards in 118
occupations or groups of employments, and to facilitate the con­
venient reference to the particular industries considered in more or
less detail in the subsequent discussion.
IN D U S T R IA L A N D O C C U P A T IO N A L C L A S S IF IC A T IO N A C C O R D IN G /T O T H E K IN D
OF U N A V O ID A B L E D U S T E X P O S U R E , W I T H S P E C IA L R E F E R E N C E T O T H E
M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS .

SECTION A.—INORGANIC DUSTS.
Group 1.— Metallic dust.
A rtificia l-flow er m akers.
B ra ss w orkers.
Chippers, at b last fu rn a ces and steel
ro llin g m ills.
C om positors and typesetters.
C u tlery m akers.

D ie setters and sinkers.
E lectroty p ers and stereoty^ers.
E n gravers.
F ilers.
G old beaters.
G rinders.

1 H a n d b u ch d er m ed icin isch en S ta tistik . by D r. F r. O esterlen, T u b in gen , 1874, p. 389.




GENERAL INTRODUCTION.
G rinders,
Jew elers,
Polishers,
P ressm en

ca rd (cotton m ills ).
m an u factu rin g.
buffers, and finishers.
and press feeders.

41

Sand blasters.
Saw filers.
Solderers.
T oolm akers.

Group 2.— Mineral dust.
A sbestos w orkers.
B rick , tile, and terra -cotta factories.
C ore m akers.
C olor m ixers.
G lass blow ers.
G lass fa cto rie s (oth er than b lo w e rs ).
L a cq u erers, japann ers, enam elers.
Lim e, cem ent, and gypsum factories.
L ithograph ers.

M arble and stone w orkers.
M ica w orkers.
M irror m akers.
M olders.
P a in t fa ctories.
Paper hangers and helpers.
P lasterers.
Potteries.
W liitew asliers.

Group 3.— Mineral industries.
M ica m iners.
Ph osph ate m iners.
Q uarries.
Q uicksilver m iners.
Spar m iners.
Sulphur m iners.
O ther and not specified m iners.

A sph a lt m iners.
B a u x ite m iners.
C oal m iners.
C opper m iners.
G old and silver m iners.
G raph ite miners.
Iro n m iners.
L ea d and zin c m iners.

SECTION B.—ORGANIC AND MISCELLANEOUS DUSTS.
Group J Vegetable fiber dust.
f.—
B room and brush fa ctories.
C orn shellers, grain thrashers, w ood
saw yers, et<?;, in a gricu lture.
C otton ginners.
Cotton spinners.
C otton w eavers.
Other cotton m ill em ployees.
H a y and stra w balers.
H em p and- ju te m ills.
K n ittin g m ills.
L a ce and em broidery.
Linen m ills.
P aper and pulp m ills.
P a p er-b ox m akers.
R a g dealers.
R a g pickers, sorters, and cleaners.

R ope and cord age fa ctories.
Sail, aw ning, and tent fa ctories.
Straw factories.
T e x tile m ills— dyeing, finishing, prin t­
ing.
T e x tile m ills (n o t sp ecified ).
W ood— cabinetm akers.
W o o d — b ox m akers.
W o o d carvers.
W o o d — fu rn itu re fa ctories, excep t p ol­
ishers and finishers.
W o o d — pian o and organ factories, e x ­
cept polish ers and finishers.
W o o d polish ers and finishers.
W ra p p ers and packers.

Group 5.— Animal and mixed fiber dust.
C arpet m ills.
F u rriers.
H a ir w ork ers.
H a t fa ctories.
M attress m akers.




U pholsterers.
Silk m ills.
W oolen and w orsted spinners.
W oolen and w orsted w eavers.
W oolen and w orsted m ills.

42

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.
Group 6.— Organic dust.

B akeries.
B on e and ivory w ork ers.
B u tton factories.
Candy factories.
C ellu loid w orkers.
C h arcoal and cok e w orks.
C igar and tob a cco fa ctories.
F e rtilizer fa cto ries.
G love factories.

G rain and flour m ills.
G rain -elevator em ployees.
H arness and saddle fa ctories.
P ock etb ook and belt m akers.
R u bb er factories.
Shoe factories.
Shoem akers (n o t in fa c to r ie s )
Tanneries.
T ru n k factories.

Group 7.— Mixed organic and inorganic ( public) dusts.
C arriage and h ack drivers.
Chauffeurs.
Coachm en.
D riv e rs and team sters.
G arbagem en and scavengers.

Street ca r con du ctors.
Street ca r m otor men.
Street cleaners.
Sw eepers, car.
W a ste produ cts (ju n k )

AGE IN RELATION TO OCCUPATION AT^D DUST EXPOSURE.

For convenience and ready reference the so-called dusty indus­
tries, trades, and occupations have been arranged in seven large
groups, which include specific subgroupings and an aggregate of
3,264,500 males and 673,478 females, as returned by the occupation
census of 1910. The grouping in matters of detail is unquestionably
open to criticism, but in the absence of a thoroughly worked out de­
scriptive account of the industries, trades, and occupations referred
to it is exceedingly difficult to adopt a more satisfactory arrangement.
Since each subgrouping will be discussed in detail, the errors inherent
in the main groupings are not, as a matter of practical.certainty, of
sufficient importance to invalidate the final conclusions concerning
the specific injuriousness of particular forms of dust. Since the age
distribution of wage earners in particular occupations varies widely,
the details according to sex and for all the seven subdivisions are
given in Table 6 (pp. 46 to 50), included in which is a column show­
ing for each and every industry, trade, or occupation the proportion
living at ages 45 and over. The wide differences in age distribution
disclosed by this analysis are of special importance in the scientific
consideration of the mortality data and the descriptive observations
concerning the conditions under which the various dusty trades are
carried on. The same conclusion applies to differences in the sex dis­
tribution of employees; for, as elsewhere shown, the specific death
rates from tuberculosis vary considerably, according to age and sex.
For illustration, at ages 15 to 24 the mortality from tuberculosis of
the lungs is 12.15 per 10,000 for males, against 14.15 per 10,000 for
females; in other words, the normal tuberculosis mortality of females




GENERAL INTRODUCTION.

4S

is excessive at this period of life. If, therefore, an industry, trade, or
occupation includes a disproportionately large number of young
women wage earners, the general mortality from tuberculosis might
be higher without necessarily implying a very definite relation to the
more or less considerable degree of dust exposure.
Conceding the general untrustworthiness of morbidity and mor­
tality conclusions based exclusively upon the age distribution of per­
sons employed in different industrial groups according to the kind
of dust exposure, some value may safely be attached to this method
of analysis when made use of with exceptional caution on account of
the large variety of special conditions and circumstances which have
an important bearing upon the age distribution of men and women
in different industrial pursuits. Some employments are obviously
only for the young, while others are chiefly for the old. In
some no special trade ability is required, with the result that there
are frequent occupation changes, while in other groups the required
degree of specialized skill is such that the employment becomes
practically the pursuit of a lifetime. Furthermore, in certain occu­
pations there is a constant elimination of employees with advancing
age on account of unsuitability for the special industrial pursuits
carried on, which, of course, tends materially to disturb the propor­
tion of aged persons under the conditions stated.
A G E D I S T R IB U T IO N O F E M P L O Y E E S IN

DUSTY TRADES.

Table 4 shows the proportionate distribution of males in the seven
groups of dusty trades according to three subdivisions of age—under
16, from 16 to 44, and 45 and over. It is most regrettable that
the census age grouping by occupation should not have been extended
to the age period 65 and over, which, of course, for certain morbidity
and mortality purposes is distinctly more useful and conclusive than
the age period of 45 and over:
T able 4 .—P R O P O R T IO N A T E ACxE D IS T R IB U T IO N OF MALES IN D U S T Y T R A D E S .
[Compiled from Report of Bureatfof the Census on Occupation Statistics, 1910. For occupations included,
see pp. 46 to 50.]
Per cent in age group—
Trade groups.
Under 16.
1
2
3
4
5
6
7

16 to 44.

45 and over.

Metallic dust
...................................................................................
Mineral dust .
Mineral industries .................................................... - .......... ...............
Vegetable fiber dust ...............................................................................
Animal and mixed fiber dust .............................................................
Organic dust
. . ................................................................................
Mixed organic and inorganic (public) dusts......................................

0.54
1.86
1.74
7.73
4.06
2. 28
.77

82.52
78. 43
79.65
75.01
75.49
72.53
77. 91

16.94
19. 71
18. 61
17. 26
20. 45
25.19
21.32

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

2.33

77. 49

20.18




44

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

According to this table, the proportion of young persons is largest
in the group of occupations with exposure to vegetable fiber dusts,
which, of course, is inclusive of the entire cotton-textile industry.
The proportion is least in the group of occupations with exposure to
metallic dusts, largely because of the practical absence of an appren­
tice system and the highly specialized skill required of a large number
of employees in the cutlery, tool, jewelry, printing, and related trades.
In the entire group of dusty trades the proportion of men aged 45
and over is 20.18 per cent, being lowest among the workers with
exposure to metallic dusts, or 16.94 per cent, and highest among work­
ers with exposure to organic dusts, or 25.19 per cent. This result
is of special significance in the case of men employed with exposure
to metallic dusts, on account of the small proportion employed at
ages under 16, which ordinarily, of course, would tend to raise the
proportion at ages 45 and over. The abnormal age distribution in
the case of this group of employees, therefore, confirms the mortality
data suggestive of an excessive death rate among men employed in
this group of occupations, particularly or largely in consequence
of considerable and continuous exposure to metallic dusts. In the
case of men employed in occupations with exposure to vegetable
fiber dusts the proportion aged 45 and over is 17.26 per cent, but
this low proportion is in part due to the very high proportion of
persons employed at ages under 16. Here, however, also to a limited
extent the high figure is fairly conclusive and indicative of a rela­
tively high mortality in middle adult life. The group of occupations
following, in the order of the proportion of persons aged 45 and
over, is composed Of men employed in mineral industries, followed
by men employed in occupations with exposure to mineral dusts,
which two groups, of course, have much in common, and for which
the age distribution is almost the same. A more favorable propor­
tion is shown for persons employed in occupations with exposure to
animal and mixed fiber dusts, or 20.45 per cent, and these are followed
by persons with exposure to public or street dusts (21.32 per cent),
and, finally, by persons in the group of occupations with exposure to
organic dusts, or 25.19 per cent. As shown elsewhere, in this group
of occupations the result of dust exposure is apparently least harmful
where the proportion of workers 45 years and O r is correspondingly
Aer
the largest. In a general way, therefore, the age distribution fairly
conforms to the conclusion based upon mortality statistics. .
Table 5 exhibits the corresponding information for females, but
the data must be considered distinctly less conclusive and, in the case
of certain groups, practically valueless, on account of the small
number of employees concerned.




45

GENERAL INTRODUCTION.

Table 5.—PROPORTIONATE AGE DISTRIBUTION OF FEMALES IN DUSTY TRADES.
[Compiled from Report of Bureau of the Census on Occupation Statistics, 1910. For occupations includedj
see pp. 46 to 50.]
Per cent in age group—
Ai.c*u.e,gi.uuiJ,
Under 16.

16 to 44.

45 and over.

Metallic d u st............ .................................................................................
Mineral d ust..............................................................................................
...................................
Mineral industries................................'............... *
Vegetable fiber dust.................................................................................
Animal and mixed fiber dust................................................................
Organic dust..............................................................................................
Mixed organic and inorganic (public) dusts.......................................

4.27
7.99
7. 27
11.94
8.44
7.45
1.00

90.50
85. 26
80.91
81.75
82. 20
84.55
78.20

5.23
6.75
11.82
6.31
9. 36
8.00
20.80

T otal.....................................................................................................

1.
2.
3.
4.
5.
6.
7.

9.50

83.10

7.40

No safe deductions can be based upon this table, which is merely
included here for the purpose of completeness. The chief factor of
uncertainty inherent in this table is the constant elimination of
women from industry on account of marriage and for other reasons,
naturally tending toward a decidedly lower proportion of women
ages 45 and over in industrial pursuits, regardless of the fact that
in the population at large the proportion of women at this period
of life exceeds the corresponding proportion of men. Even subject
to these qualifications it is suggestive that the proportion of women
aged 45 and over employed in occupations with exposure to metallic
dusts should be the lowest of the seven groups, 5.23 per cent, against
7.40 per cent for the aggregate number of female employees in occu­
pations with exposure to industrial dusts. There are practically no
women employed in mineral industries, but as shown by the intro­
ductory tables most of the occupied females are employed in the
occupations with exposure to vegetable fiber dusts, animal and mixed
fiber dusts, and organic dusts, which are, of course, inclusive of all the
different subdivisions of the textile industry. It is suggestive in this
connection that no definite conclusions can be drawn from tfie table
further than as stated.
The analysis could have been extended to the 118 individual occu­
pations, employments, or industries, but the table following makes
this unnecessary. The details, however, in the case of many occupa­
tions are distinctly indicative of unfavorable health conditions, and
especially is this true for grinders, polishers, and buffers, toolmakers,
and sand blasters in the iron and steel industries. An analysis in
detail, however, is much more subject to the qualification of extreme
care in the use of the data for the purpose of emphasizing the pos­
sibly injurious results of any particular occupation, industry, or trade
on the basis of the proportion of men or women employed at ages 45
and over. The data are included primarily for the purpose of mak­
ing the statistics conveniently available, and to bring the facts of age
distribution into intelligent correlation to the general discussion of




46

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

the circumstances and conditions more or less accountable for healthinjurious results of certain occupations, trades, and industries by
reason of the approximately ascertainable exposure to different kinds
of industrial dust.
T able 6 . —AGE D IS T R IB U T IO N OF E M P L O Y E E S IN D U S T Y T R A D E S , B Y S E X A N D OCCU­
P A T IO N GROU PS.
Compiled from Report of Bureau of the Census on Occupation Statistics, 1810.]
G R O U P 1 .—M E T A L L I C D U S T .

Sex and occupation group.

Total
em­
ploy­
ees.

Number in age g r o u p 30 to
13.

14 to
15.

Per
cent
45 years
45 and
and
over.
over.

16 to
20.

21 to
44.

267
1,665
62
21,902
889
290
510
1,850
320
103
1,070
66
1,243
4,241
6,851
20
387
97
2,282

672
11,166
722
70,726
2,894
1,996
3,097
7,574
1,769
327
5,346
726
4,257
21,759
16,677
65
4,910
278
14,1S6

235
2,999
181
18,834
945
454
660
1,864
895
165
1, 705
294
1,432
5,367
1,971
14
2,046
56
3,669

44,115 169,147
17. 07
65. 45

43,786
16. 94

MALE.
Artifieial-flowpx makers

. - ..............................

Chippers (blast furnace and steel rolling m ill).
Compositors and typesetters...............................
Cutlery makers ...........
..................
Die setters and sinkers
..
........................
Electrotvpers and stereotypers
......................
Engravers...............................................................
F ile rs ......................................................................
G old beaters........................................................
Grinders...................................................................
Grinders, card........................................................
Jewelers, manufacturing......................................
Polishers, buffers, and finishers..........................
Pressmen and press feeder*.................................
Sand blasters, iron and steel.............................
Saw filers ....................................
Solderers................................................................
T oolm akers.........................................................

1,238
IS,912
96S
111,189
4,840
2, 744
4,268
11,315
3,016
607
8,214
1,087
6,943
31,772
25,951
99
7,345
434
20,212

Total.............................................................. 258,454
Per cent in each age group................................... 100. 00

7
4
5

1

4
15

57
82
3
23
107
4
1
27
31
12
93
1
11
401
437
2
3
75

36
0. 01

1,370
0. 53

Artificial-flower makers ....................................
8, 616
50
Brass workers.....................................................
1S7
Compositors and typesetters............................... 13, 681
Cutlery makers.......................................................
543
Die setters and sinkers..........................................
4
Electrotvpers and stereotypers...........................
100
Engravers...............................................................
451
Filers ...................................................................
227
Gold b eaters........................................................
76
G rin d ers.................................................................
364
Grinders, oard........................................................
4
Jewelers, manufacturing......................................
1, 435
Polishers, buffers, and finishers.......................... 3, 204 ......... i ‘
Pressmen and press feeders.................................
4,133
Sand blasters, iron and steel...............................
2
2
Saw filers...............................................................
Solderers..................................................................
161
T oolm akers..........................................................
65

919
4
7
39

19.0
18.8
18.7
16.9
19.5
16.5
15. 5
16.5
29.7
27.2
20.8
27.0
2\6
16. 9
7.6
14.1
27.9
12.9
18.2

FEMALE.

Total.............................................................. 33,255
Per cent in each age group.................................. 100. 00

51
0.15

3.791
S2
4, 567
263
2
27
158
100
32
189
1
550
1, 269
1,863
2

3,297
88
8,411
218
2
62
268
111
35
157
3
789
1, 577
1,862

2

73
16

2
85
44

1,369
4.12

12,985
39. 05

1
2
4
2
11
28
176
174

559
13
696
23

6.5
7.0
a. l
4.2

10
23
12
7
7

10.0
5 1
5.3
9.2
1.9

6S
181
134

4.7
5.6
3.2

1
5

6
7.7

17,111 1 1,739
51. 45'
5. 23

G R O U P 3 . —M I N E R A L D U S T .

MALE.
Asbestos workers..................................
Brick, tile, and terra-cotta factories..
Core m ak ers..........................................
Color mixers (not pain t)......................
Glass blowers.........................................
Glass factories (excluding blow ers)..
Lacquerers, japanners, enamelers. . . !
Lim e, cement, and gypsum factories.
Lithographers........................................
Marble and stone yards.......................
Mica w ork ers ....................................... .
Mirror m aters............. .........................




1,197
92,823
16.479
858
15,474
61,299
1,225
46,898
7,661
52,813
27
687

2
566
4

15
2,112
411
15
17
395
4.104
23
78 .
414
11
23
278
1
1
8

891
121
14,663 59,862
4,049 10 638
114
512
957 11,885
14.416 34,135
174
811
5,573 33,340
1.299 ‘ 5,001
4,138 33,731
10
14
100
482

168
15,620
1.377
217
2,615
8,249
217
7,493
1.3«L
14, 643
2
96

14.0
16.8
8.4
25.3
16.9
13.5
17.7
Hi 0
17.6
27.7
7.4
14.0

47

GENERAL INTRODUCTION.

Table 6 .—AGE DISTRIBUTION OF EM PLOYEES IN DUSTY TRADES, B Y S E X AND OCCU­
PATION GROUPS—Continued.
G R O U P 2 .—M I N E R A L D U S T —Concluded.

Sex and occupation group.

m a l e — concluded.
M olders....................................................................
Paint factories........................................................
Paper hangers, apprentices, and helpers..........
Plasterers................................................................
Potteries..................................................................
W hile washers........................................................

Total
em­
ploy­
ees.

Number in age group—
10 to
13.

113,617
4,727
25,561
50,525
21,159
1,663

4
14
18
44
1

T otal............................................................. 514,693
Per cent in each age group................................... 100.00

1,150
0.22

14 to
15.

16 to
20.

37 : 8,165
91
730
255
2,362
147
3.452
488
3,578
4
65
8,431
1.64

21 to
44.

84,070
3,010
16.636
30,564
13,397
696

Per
cent
45 years
45 and
and
oyer.
over.

21,345
892
6,294
16,344
3,652
897

18.8
18.9
24.6
32.3
17.3
53.9

63.966 339,675 101,471
12.43
66.00
19.71 j

FEMALE.

Asbestos workers...................................................
Brick, tile, and terra-cotta factories.................
Core m akers...........................................................
Color mixers (not paint)......................................
Glass blowers..........................................................
Glass factories (excluding blowers)...................
Lacquerers, jap aimers, enamelers.....................
Lim e, cement, and gypsum factories................
Lithographers........................................................
Marble and stone yards.......................................
Mica w ork ers.........................................................
Mirror m akers........................................................
Molders....................................................................
Paint factories........................................................
Paper hangers, apprentices, and helpers..........
Plasterers................................................................
Potteries..................................................................
W hite washers........................................ ...............

129
1,581
1,836
37
90
3,874
289
281
477
224
164 '
33
66
213
823
8
5,202
5

Total.
15 332
Per cent in each age group................................... 100.00

21
135
90
3
2
451
17
9
1
22
6
2
2
21
4

55
613
1,016
23
39
1,957
140
87
222
85
119
10
20
109
18

16

377

2,030

62
0.40

1.163
7.59

6,543
42.68

8

33
1
1

3

47
711
708
10
45
1,338
120
146
238
96
36
19
35
70
466
4
2,438
2

6
114
22
1
95
11
39
16
20
3
2
9
10
335
4
341
3

6,529
42.58

1,035
6.75

4

4.7
7.2
1.2
2.7
4.4
2.5
3.8
13.9
3.4
8.9
1.8
6.1
13.6
4.7
40.7
50.0
6.6
60.0

G R O U P 3 .—M IN E R A L I N D U S T R IE S .
MALE.

Asphalt miners and laborers...............................
Bauxite miners and laborers...............................
Coal miners.............................................................
Copper miners........................................................
Gold and silver m iners.........................................
Graphite miners and laborers.............................
Iron miners.............................................................
Lead and zinc miners........................... ................
Mica miners and laborers....................................
Phosphate miners and laborers..........................
Quarries...................................................................
Quicksilver miners and laborers........................
Spar miners and laborers.....................................
Sulphur miners and laborers...............................
Mines not specified...............................................
Other miners and laborers..................................

132
200
591,024
35.117
53, 869
178
45,917
18,526
277
4,582
73,954
126
501
485
19,117
892

T otal............................................................. 844,897
Per cent in each age group.................................. 100.00

1,292
16
5
1
152
4
3
80
118

1
2
11,319
86
43
2
427
100
8
131
815

10
1
15
4

14
1
55
16

106
14
9
128
36
34
73,514 402,631 102,268
2,632 27,034
5,349
2,154 32,915 18, 752
19
134
22
5,681 34,189
5,468
2,093 13,363
2,966
169
45
52
665
3,201
505
9,029 49,097 : 14,895
88
3
35
330
68
79
78 .
338
67
973 11,561
6,513
549
.
119
204

1,703
0.20

13,020
1.54

97,123 575,833 157,218
11.50
68.15
18.61

2

27

94

1

3
1
3

8
5
13
1
8

2

6.8
17.0
17.3
15.2
34.8
12.4
11.9
16.0
18.8
11.0
20.1
27.8
15.8
13.8
34.1
22.9

FEM ALE.

Bauxite miners and laborers...............................
Coal miners................................ ; ..........................
Copper miners.................................... . .................
Gold and silver miners.........................................
Iron miners.............................................................
Lead and zinc miners..........................................
Mica miners and laborers....................................
Phosphate miners and laborers..........................
Quarries...................................................................
Spar miners and laborers.....................................
Oilier miners and laborers..................................

1
368
15
39
32
14
29
11
28
1
12

2

1

1

1
214
12
19
17
8
10
9
18
1
6

T otal..............................................................
Per cent in each age group...................................

550
100.00

5
0.91

35
6.36

130
23.64

315
57.27




31
3
20
4

8.4
20.0
51.3
12.5

2
1
2

6.9
9.1
7.1

2

16.7

65
11.82

48

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

Table 6 .—AGE DISTRIBUTION OF EM PLOYEES IN DUSTY TRADE S, B Y SE X AND OCCU­
PATION GROUPS—Continued.
G R O U P 4 .—V E G E T A B L E F IB E R D U S T .

Sex and occupation group.

Broom and brush factories.................................
Corn shellers, grain thrashers, wood sawyers
etc., agriculture.................................................
Cotton ginners, other miscellaneous industries.
Cotton spinners.....................................................
Cotton weavers......................................................
Other cotton-mill employees...............................
Hay and straw balers...........................................
Hemp and jute mills............................................
Knitting mills........................................................
Lace and embroidery............................................
Linen mills.............................................................
Paper and pulp mills............................................
Paper-box makers.................................................
Rag dealers.............................................................
Rag pickers, sorters, and cleaners.....................
Rope and cordage factories.................................
Sail, awning, and tent factories..........................
Straw factories.......................................................
Textile mills—dyeing, finishing, printing........
Textile mills, (not specified)...............................
Wood—cabinetmakers........................................
Wood—box makers.............................................
Wood carvers.........................................................
Wood—furniture factories, except polishers
and finishers......................................................
Wood—piano and organ factories, except pol­
ishers and finishers...........................................
Wood polishers and finishers..............................
Wrappers and packers..........................................

Total
em­
ploy-

10,563

Number in age group—
10 to
13.

39

14 to
15.

16 to

20.

21 to
44.

Per
cent
45 years
45 and
and
over.
over.

370

1,825

6,096

2,233

21.1

1,810
1,383
8,985
32
144
2,421
325
97
72
381
9
18
304
34
9
692
1,266
a
432

107
81
‘ 4,387
9,758
18,379
197
722
7,816
1,305
280
1,037
1,600
79
135
1,327
288
54
4,459
4,468
405
1,690

1,107
391
1,833
5,765
11,042
332
473
2,867
690
267
1,189
683
763
360
1,164
837
27
7,260
5,005
2,665
970
3,489

28.2
29.1
11.5

66

1,101

2,701
854
6,848
31,779
38,077
1,128
2,092
13,510
2,872
603
4,635
3,002
952
702
3,555
1,444
115
17,949
12,983
4,069
3,143
7,397

4,146

120

756

2,381

635
20,271
6,460

4
224
273

87
2,324

385
13,360
3,746

158
4,360
1,219

65,879 186,378
55.42
19.59

58,038
17.26

3,919
1,342
15,874
48,929
80,778
1,698
3,438
27,236
5,199
1,248
6,933
5,688
1,805

244
4,295
9
7
622
7

1

1,220
6,372
2,604
205
30,382
23,800
7,142
G 382
,
12,054

Total............................................................. 336,323
Per cent in each age group................................... 100. 00

147

1

1,212

6,541
1.94

19,487
5. 79

199

1,018

3,520
330
1,242

5,906
2,047
5,664
163
7,237
1,266
135
138
1,865
4
56
410
44
77

6

13,564
11,867
21,030
1,361
28,682
5,747
• 584
1,076
7,014
32
393
1,991
281
589
1,446
10 455
369
45

6

66

12.0
42.3
29.5
18.3
32.1
13.2
23.9

21.0
37.3
15.2
28.9

167
2,717

24.9
21.5
18.9

1

117
4,058

13.7
19.6
13.8
10.5
13.3
21.4
17.1

21.4

65

2

11.8

FEM ALE.

Broom and brush factories..................................
Cotton ginners, other miscellaneous industries.
Cotton spinners......................................................
Cotton weavers......................................................
Other cotton-mill employees...............................
Hemp and jute mills............................................
Knitting mills........................................................
Lace and embroidery............................................
Linen mills..............................................................
Paper and pulp mills............................................
Paper-box makers.................................................
Rag dealers.............................................................
Rag pickers, sorters, and cleaners.....................
Rope and cordage factories.................................
Sail, awning, and tent factories..........................
Straw factories..............................: .......................
Textile mills—dyeing, finishing, printing........
Textile mills (not specified)...............................
Wood—box makers..............................................
Wood carvers.........................................................
W’ ood—furniture factories, except polishers
and finishers.......................................................
Wrood—piano and organ factories, except pol­
ishers and finishers............................................
W'ood polishers and finishers..............................
Wrappers and packers..........................................

2,359
39
32,151
43,911
59,372
2, 781
69,414
15,820
1,540
2,744
14,226
170
1,806
4,162
1,074
2,378
4,083
28,908
778
145

2
918
75
3
4
56

1
1
10
253
16

144
3
346
7,781

Total......... •
................................................... 296,135
Per cent in each age group................................... 100.00




1

200
2,572
91

22
755
6,490
2.19

1,018
29
8,706
25,379
27,320
1,142
28,962
7,201
678
1,278
4,875
971
1,542
590
1,300
2,154
13,297
279

66

28,863 111,788 130,308
44.00
37.75
9.75

120
9
455
4,288
3,616
113
3,615
1,531
140
248
416
63
384
193
158
411
273
2,331
23
28

5.1
23.1
1.4
9.8

6.1
4.1
5.2
9.7
9.1
9.0
• 2.9
37.1
21.3
4.6
14.7
17.3
6.7

8.1
3.0
19.3
4.9

11.0
2.9
18,686
6.31

49

GENERAL INTRODUCTION.

Table 6 .—AGE DISTRIBUTION OF EM PLOYEES IN DU STY TRADE S, B Y SEX AND OCCU­
PATION GROUPS—Continued.

G ROU P 5.—A N IM AL AND M IX E D FIBER DU ST.

Sex and occupation group.

Total
em­
ploy­
ees.

Number in
10'to
13.

e bg r o u p -

Per
cent
45 years
45 and
.and
over.
over.

14 to
15.

16 to
20.

21 to
44.

3,680
1,168
467
4,162
524
1,971
7,503

11, 485
5,303
829
15,575
2,150
11,084
19,887

3,691
1,595
262
5,297
455
5,645
5,173

18.9
19.6
16.0
20.8
14.2
.30.0
14.7

89
1,671
2,060
8,502

608
3,887
11,718
24,534

1,441
969
3,252
9,828

67.0
13.8
18.9
21.5

37,608
20.45

M A LE.

Carpet m ills .........................................................................
Fu rriers................................................................................
H air w orkers..................................................................... .
H a t factories.......................................................................
M attress m ak ers.............................................................. .
U p h olsterers.......................................................................
Siik m ills .................. ............................................................
W e a v ers (carpets, "blankets, etc ., n ot in fac­
to r ies)..................................................................................
W c o le n and w orsted spinners................................. .
W o o le n and w orsted w eav ers...................................
W o o le n and w orsted m ills ........................................ .

19,534
8,127
1,636
25,500
3,202
18,808
35,165

4
146

656
58
61
458
65
104
2,456

2,151
6,997
17,197
45,620

2
23
10
106

11
447
157
2,650

T o ta l......................................................................... .
Per cent in each age g ro u p ........................................ .

183,937
100.00

7,123
3.87

31,797 107,060
17.29
58.20

Carpet m ills .......................................................................
F u rriers................................................................................
H air w orkers.....................................................................
H a t factories......................................................................
M attress m ak ers..............................................................
U p holsterers......................................................................
Silk m ills..............................................................................
W e a v e rs (carpets, blankets, etc., not in fac­
tories) ................................................................................
W o o le n and worsted spinners.................................
W o o ie n and w orsted w eavers...................................
W o o le n and w orsted m ills ........................................ .

14,163
2,734
1)894
10,735
924
1,291
52,504

662
64
187
563
29
13
6,098

5,063
921
773
3,631
307
318
23,027

7,180
1,458
624
5,425
477
706
21,495

1,250
291
305
1,099
107
254
1,601

8.8
10. ft
16.1
10.2
11.6
19.7
3.0

10,781
6,390
14,660
33,186

57
16
14

122
806
350
3,203

976
3,550
3, 728
12,465

4,098
1,883
9,002
15,584

5,528
135
1,566
1,836

51.3
2.1
10.7
5.5

T o t a l.........................................................................
P er cent m each age group........................................ .

149,262
100.00

502
0.34

12,097
8.10

54,759
36.69

67,932
45.51

13,972
9.36

14,079
98
1,853
3,772
93'
1,036
14,644
12
1,036
2,506
540
1,736
894
2, 405
19,141
2,384
5,540
255

61,425
291
4,822
8,994
329
7,016
54,878
90
3,355
20,508
4,382
11,027
3,012
8,405
64,097
30,821
29,787
538

17,665
115
1,017
2,002
103
1,737
21,594
15
1,094
12,809
1,518
7,404
816
2,272
18,044
35,337
10,264
177

FEM ALE.

283

G R OUP 6 .—OR G AN IC D U S T .
M ALE.

B ak eries..................................................................................
B on e and ivory w o r k e r s .. ..........................................
B u tto n factories................................................................
C andy factories..................................................................
C elluloid Avorkers..............................................................
Charcoal and coke w o rk s.............................................
Cigar and tobacco factories..........................................
Fertilizer factories, m ix e r s..........................................
G love factories....................................................................
G rain and flour m ills ......................................................
Grain elevator e m p lo y e e s ...........................................
Harness and saddle factories......................................
P ocketbook and belt m akers.....................................
R u b b er factories................................................................
Shoe factories......................................................................
Shoemakers (no t m factories)...................................
T anneries..............................................................................
T ru n k factories...................................................................

95,026
520
8,101
15,438
538
9,928
95,060
118
5,681
36,065
6,484
20,271
4,842
13,422
104,430
68, 788
40,142
1,057

T o ta l...........................................................................
Per cent in each group...................................................

155
1
30
40

5
49
9
1
1
6
97
18
37
5

1,702
15
379
630
13
103
2,996
1
191
193
35
103
119
334
3,051
228
514
82

531,911
100.00

1,438
0.27

10,689
2.01

11,333
121
4,707
12,553
249
12

43
23
72

821
14
468
1,656
28

36
948

18. a
22.1
12.6
13.0
19.1
17.5
22.7
12.7
19.3
35.5
23.4
36.5
16.9
16.9
17.3
51.4
22.2
16.7

72,024 |313,777 133,983
13.54 j 58.99
25.19

FEMALE.

Bakeries..................................................................................
Bone and ivory w orkers...............................................
B u tto n factories................................................................
Candy factories..................................................................
(_ell” loid w orkers..............................................................
Charcoal and coke w o rk s.............................................

106811°— IS— Bull. 231------- 4




4,069
55
2,269
6,311
124
4

4,613
41
1,805
4,254
94
3

1,787
11
142
260
3
5

15.8
9.1
3.0
2.1
1.2
41.7

50

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

T able 6 .—AGE DISTRIBUTION OF EMPLOYEES IN DUSTY TRADES, BY SE X AND OCCU­
PATION GROUPS—Concluded.
G R O U P 6 .—O R G A N IC D U S T —Concluded.

Sex and occupation group.

fem ales—

Total
em­
ploy-

Number in age g r o u p 16 to
20.

21 to
44.

45 and
over.

28,968
4,199
130
5
88
545
2,853
14,423
148
749
145

36,719
7,278
188
6
147
415
4,257
24,060

5,438
1,978
55

128
488
2,181
6
121
28

10 to
13.

14 to
15.

12,132
6.83

65,085
36.66

85,028
47.89

concluded.

Cigar and tobacco factories...........
Glove factories.................................
Grain and flour m ills......................
Grain elevator employees..............
Harness and saddle factories........
Pocketbook and belt makers....... .
R ubber factories.............................
Shoe factories....................................
Shoemakers (not in factories)____
Tanneries.........................................
Trunk factories...............................
Total...................................... .
Per cent in each age group...........

177,545
100.00

5,463
704
20

77,468
14,172
396
11
290
1,128
7,955
44,485
782
1,614

G R OUP 7.

1,099
0.62

" ” *49"
36
346
3,776
232
74
9
14,201
8.00

M IX E D O R 6AN IC AND IN O R G A N IC (PUBLIC) D U S T S .

M ALE.

166
5
34
380
8

722
116
159
2,907
33

Street cleaners...............................................
Sweepers, car (street and steam railroad).

57,844
44,973
25,171
332,141
4,227
56,932
56,218
9,946
6,833

2
5

22
27

Total.....................................................
Per cent in each age group..........................

594,285
100.00

600
0.10

3,990
0.67

Carriage and hack drivers...........................
Chauffeurs......................................................
Coachmen.......................................................
Drivers............................................................
Garbagemen and scavengers......................
Street car conductors...................................
Street car motormen........................................

4

6,113 36,183
8,208 34,775
1,534 16,379
38,461 209,103
310
2,653
3,573 48,174
1,057 46,432
270
4,571
675
4,554

14,660
1,869
7,065
81,290
1,223
5,181
8,729
5,081
1,572

25.3
4.2
28.1
24.5
28.9
9.1
15.5
51.1
23.0

60,201 402,824 126,670
10.13
67.78
21.32

F EM ALE.

Carriage and hack drivers...........................
Chauffeurs......................................................
Drivers............................................................
Sweepers, car (street and steam railroad)

36
32
67
1,264

Total.....................................................
Per cent in each age group..........................

1,399
100.00




1

12

6
3
15
163

2
0.14

12
0.86

187
13.37

1

20
25
35
827

10
3
17
261

907
64.83

291
20.80

27.8
9.4
25.4
20.6

C H A P T E R

I I .— O C C U P A T IO N S
M E T A L L IC

W IT H

E X P O S U R E

T O

D U S T .

TH E OCCUPATIONAL MENACE OF M ETALLIC DUST.

The continuous and considerable exposure of workmen to the
inhalation of metallic dust in its various forms is generally recog­
nized by medical and other authorities on occupational diseases as
probably the most serious health hazard with particular reference to
a material increase in liability to pulmonary tuberculosis and nontuberculous respiratory diseases. The term “ metallic dust ” for practi­
cal reasons is for the present purpose limited to finely comminuted
particles of iron, steel, brass, gold, silver, bronze, lead, arsenic, and
other metallic substances. Some of these are exceedingly common in
connection with industrial processes, while others are rarely met with.
Occasionally the pathological aspects of the problem are complicated
by chemical considerations, aside from the physical or mechanical
properties of the several varieties of metallic dust referred to. In
the vast majority of mechanical operations in which metallic dust
is generated there is more or less intermixture with particles of min­
eral dust, which quantitatively may exceed in importance the ascer­
tainable presence of metallic dust. On account of the heavier weight
of metallic particles the relative degree of air pollution in factories,
workshops, mines, etc., where metallic dust is generated is considerably
less than the corresponding amount of air impurities resulting from
atmospheric pollution by mineral dust. The injurious consequences
of industrial dust exposure are, broadly speaking, proportionate to
the amount of dust inhaled into the lungs, but important exceptions
to this conclusion are brought out by the consideration in detail of
the several kinds of metallic dust, of which, perhaps, lead and arsenic
are the most harmful, on account of the additional liability to indus­
trial poisoning. Quantitatively the most important kind of metallic
dust as met with under typical industrial conditions is the dust of
iron and steely which, however, is generally more or less intermixed
with dust of other metallic or mineral substances. Pure iron and
steel dust is rarely met with except under laboratory and other con­
ditions which are not within the plan and scope of the present dis­
cussion. Typical employments with metallic dust exposure are file




51

52

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

cutters, coppersmiths, engravers, printers, lithographers, nail makers,
machinists, gunsmiths, etc. Persons in all of these employments or
industries are subject, as a general rule, to an exceptionally high
mortality rate from all causes, and a high specific death rate from
pulmonary tuberculosis. Some emplojTnents in addition are subject
to an excessive incidence of nontuberculous respiratory diseases, and
particularly is this the case where there is quantitatively a consider­
able degree of intermixture with silica and similar forms of exces­
sively irritating kinds of mineral dust. The most common form of
tuberculosis in occupations with iron and steel dust exposure is medi­
cally known as pneumoconiosis, met with in its most typical form
in steel grinding and polishing processes, particularly in the manu­
facture of cutlery and tools and instruments.
RELATION OF VARIATIONS IN OCCUPATIONAL CONDITIONS TO
DUST EXPOSURE AND MORTALITY.

The conditions of employment in the 13 industries, trades, and
occupations which are considered in detail in the following discussion
are so widely at variance with each other that a grouping of the
mortality data results in averages which are applicable only with
extra caution to particular employments with a more or less ascer­
tainable degree of exposure to metallic dust. Such exposure is
nearfy always an important predisposing cause of pulmonary tuber­
culosis and is met with to an exceptional degree of frequency in
the grinding and polishing of small metallic objects during the
final (finishing) stages of manufacture. On account of the high
degree of specialized skill required in many of these occupations, the
social loss represented by prolonged illness and premature death
from preventable pulmonary tuberculosis is, therefore, of special
economic significance.
PROPORTIONATE MORTALITY—UNITED STATES REGISTRATION AREA.

Table 7 is merely intended as a general statement of the essential
mortality facts concerning this group of occupations, with special
reference to pulmonary tuberculosis, derived from the available
official statistics of the Division of Vital Statistics of the United
States Census. Subsequently, in addition thereto, tables are included
of the more extended experience of a representative industrial in­
surance company. The practical usefulness of this analysis is natu­
rally rather limited for the reasons stated, but the data provide a
fairly trustworthy measure of the relative frequency of pulmonary
tuberculosis in the group of occupations under review with a more
or less ascertainable degree of health-injurious exposure to metallic
dust.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

53

T able 7 . — P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O SIS AMONG

W O R K E R S E X P O S E D TO M E T A L L IC D U S T, U N IT E D ST A T E S R E G IS T R A T IO N A R E A ,
3908 A N D 1909, B Y A GE G R O U PS.

Workers exposed to metallic
dust.

Per cent o f deaths
from- pulmonary
t u b e r c u lo s is
among—

Deaths from pul­
monary tuber­
culosis.

Age at death.
Deaths
from all
causes.

Per cent
Number. o f deaths
'from all
causes.

A ll oc­
cupied
males.

Farmers,
planters,
and farm
laborers.

15 to 24 years.......................................................................
25 to 34 years.......................................................................
35 to 44 years.......................................................................
45 to 54 years.......................................................................
55 to 64 rears.......................................................................
65 years and over...............................................................
Age unknow n.....................................................................

1,230
2,006
2,291
2,166
1,738
1,944
10

412
719
656
378
150
80
1

33.5
35.8
28.6
17.5
8.6
4.1
10.0

28.1
30.9
24.0
14.4
7.6
2.6
8.3

23.5
26.2
19.1
12.1
6.7
2.4
7.9

Total, 15 years and over........................................

11,385

2,396

21.0

14.9

8.7

In Table 8 are given data relative to the proportionate mortality
from nontuberculous respiratory diseases among workers exposed to
metallic dust, 1908 and 1909.
T able 8 .—P R O P O R T IO N A T E M O R T A L IT Y FROM N O N TU BE R CU LO U S R E S P IR A T O R Y
DISEASES AMONG W O R K E R S E X P O S E D TO M E T A L L IC DUST, U N IT E D STATE S
R E G IS T R A T IO N A R E A , 1908 AND 1909.

Deaths of workers ex­
posed to metallic dust.
Cause of death.
Number.

Per cent
of deaths
from all
causes.

Per cent of deaths from
all causes among—

All oc­
cupied
males.

Farmers,
planters,
and farm
laborers.

Asthm a.....................................................................................
Bronchitis................................................................................
Pneumonia..................................................................... .......
Other nontuberculous respiratory diseases.......................

23
92
969
132

0.2

0 .3
.9
7 .8
1.1

0.3

.8
8 .5
1.2

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

1,216

10.7

10.0

9 .3

1 .2
7 .0

.9

The aggregate experience, according to Table 7, for the two years
under observation (no subsequent official statistics having been pub­
lished), indicates a proportionate mortality from pulmonary tuber­
culosis among those employed in occupations with exposure to metal­
lic dust of 21 per cent. As subsequently shown, this compares with
21.3 per cent for occupations with exposure to mineral dust as ascer­
tained by an analysis of the corresponding data derived from the same
official sources. The table indicates an excessive degree of frequency
of pulmonary tuberculosis at every divisional period of life, but by
reference to the corresponding statistics for occupations with ex­
posure to mineral dust the latter present an even more serious tend-




54

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

ency toward an excess in the proportionate mortality ; but upon
further analysis of the occupations in detail it is shown that exposure
to metallic dust is unquestionably on general principles more of a
menace to health with particular reference to pulmonary tuberculosis
than is exposure to mineral dust. In addition to an excessive mor­
tality from pulmonary tuberculosis the comparative mortality from
nontuberculous respiratory diseases, particularly pneumonia, is higher
among occupations with exposure to metallic dust than among occu­
pations with exposure to mineral dust.
The details of the proportionate mortality from pulmonary tuber­
culosis in the principal occupations for which the information is
ascertainable from the reports of the Division of Vital Statistics of
the United States Census for the two years, 1908 and 1909, are, for
purposes of convenience, shown in Table 9.
T able 9 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U L O SIS IN
S P E C IF IE D IN D U S T R IE S OR OCCUPATIONS W IT H E X P O S U R E TO M E T A L L IC D U S T ,
U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1908 A N D 1909, B Y A G E G R O U PS.

15 to 24 years.

Occupation group.

Brass workers............
Engravers..................
iTon and steel workers..
Iron and steel workers
(listed as other).........
Jewelers, gold and sil­
ver workers, etc.........
Metal workers, other. . .
Printers, lithographers,
pressmen.....................
Tinplate and tinware
workers........................
Total.....................

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

45 to 54 years.

Deaths
from pul­
monary
tubercu­
losis.

Deaths
from pul­
monary
tubercu­
losis.

Deaths
Deaths
from pul­
from pul­
monary
monary
Deaths
Deaths tubercu­ Deaths tubercu­
Deaths
from
from
from
from
losis.
losis.
all
all
all
all
causes.
causes.
causes.
causes.
Num­ Per
Num­ Per
Num­ Per
N um ­ Per
ber. cent.
ber. cent.
ber. cent.
ber. cent.
64.0
50.0
19.8

42
23
915

21 50.0
8 34.8
239 26.1

35
20
1,084

25.6

149

53 35.6

150

51 34.0

50.0
34.6

78
82

31 39.7
28 34.1

94
93

22 23.4
21 22.6

427

186 43.6

551

614

104

41 39.4

166

201

1,230

33.5

2,006

25
10
460

55 to 64 years.

Brass workers.................
Engravers.......................
Iron and steel workers...
Iron and steel workers
(listed as other)..........
Jewelers, gold and sil­
ver workers, etc.........
Metal workers, other. . .
Printers, lithographers,
pressmen......................
Tinplate and tinware
workers........................

35 to 44 years.

25 to 34

278 50.
61 36.7
719 35.

65 years and over.

26
19
754

15.4
15.8
8.5

16.0
4.0
4.7

2,291

11 31.4
5 25.0
253 23.3

16.7
1 6.7
166 16.7
19.9 .
128
77

14.1
15.6

223 36.3

522

112 21.5

70 34.

248

656

2,166

Age unknown.

25.0

34 13.7
378

Total, 15 years and
over.
201
112
5,035

64 31.8
23 20.5
853 16.9

133

14.3

142
73

8.5
6.8

177
97

3.4
1.0

686
475

350

7.7

381

3.7

2,-847

840 29.5

241

6.6

3.0

1,229

230 18.7

1,738

4.8
122
85

11,385

Table 10 shows the proportionate mortality from nontuberculous
respiratory diseases in occupations with exposure to metallic dust.




55

OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

T able 1 0 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M N O N T U B E R C U L O U S R E S P IR A T O R Y

DISEA SES IN S P E C IF IE D IN D U S T R IE S O R OCCUPATION S W IT H E X P O S U R E
M E T A L L IC D U ST, U N IT E D S TA TE S R E G IS T R A T IO N A R E A , 1908 A N D 1909.

TO

Deaths caused b y —

Asthma.

Occupation group.

Num ­
ber.
Brass workers.................
Engravers........................
Iron and steel workers .
Iron and steel workers
(listed as oth er).........
Jewelers, gold and sil­
ver workers.................
Metal workers, oth er...
Printers, lithographers,
pressmen......................
Tinplate and tinware
workers........................
T otal.....................

Pneumonia.

Bronchitis.

Per
cent.

N um ­
ber.

Per
cent.

A ll nontuberOther respira­ culous respira­
tory diseases. tory diseases.

Num ­
ber.

Per
cent.

Num­
ber.

Per
cent.

N um ­
ber.

18
3
508

9.0
2.7
10.1

1
1
54

0.5
.9
1.1

22
4
609

10.9
3.6
12.1

Per
cent.

3

1.5

0.2

35

.7

2

.3

11

1.4

54

6.7

11

1.4

78

9.8

2
2

.3
.4

8
6

1.2
1.3

40
49

5.8
10.3

*
1
5

1.0
1.1

57
62

8.3
13.1

12

2

.1

14

.5

193

6.8

41

1.4

250

8.8

3

.2

15

1.2

104

8.5

12

1.0

134

10.9

92

.8

969

8.5

132

1.2

1,216

10.7

23

PROPORTIO NATE M O R T A L IT Y— IN D U ST R IA L
EXPERIEN CE.

INSU R A N CE

The industrial mortality experience of the Prudential Insurance
Go. of America is more conclusive, in that the number of specific occu­
pations is more representative of the industries and employments
with exposure to metallic dust when considered as a group.1 The
details of the experience are set forth in Tables 11 and 12.
1 A d d itio n a l in su ra n ce exp erien ce d a ta are con ta in ed in B u lle tin N o. 207 o f the B u rea u
o f L a b or S ta tistics o f the U. S. D ep a rtm en t o f L a b or, en title d “ C auses o f D eath by O ccu ­
p a tio n ,” O ccu p a tion a l M o r ta lity E xp erien ce o f the M e tro p o lita n L ife In su ra n ce C om p a n y ,
In d u s tria l D ep a rtm en t, 1 9 1 1 -1 9 1 3 , by L ou is I. D u blin, Ph. D., W a sh in g to n , 1917. T h is
exp erien ce, h ow ever, w ith referen ce to d u sty tra d es w ith e x p o su re to in o rg a n ic d u st is
p ra ctica lly lim ited to b lack sm ith s, coa l m iners, com p o sito rs and p rin ters, iro n m old ers,
m a ch in ists, m ason s and b rick la y ers, p a in ters, p a p er ha n gers, an d v a rn ish e rs, an d
p lum bers, gas fitters, a n d steam fitters. The m ost recen t d a ta are f o r the ye a r 1914, f o r
the c it y o f N ew York* (R e p r in t N o. 400, U. S. P u b lic H e a lth S e rvice , W a sh in g to n , 1 9 1 7 ),
fo r selected occ u p a tio n s . T h e p ro p o rtio n a te m o r ta lity fro m p u lm o n a ry tu b e rcu lo s is w a s
as f o l l o w s :

Proportionate mortality (per cent of all'causes) from pulmonary tuberculosis,
New York City, 191$.

Years of age.
Occupation.
15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 and
over.
Blacksmiths...........................................................................
Cigar makers and tobaceo workers....................................
Compositors, printers, e t c ...................................................
Machinists..............................................................................
Painters, paperhangers, and varnishers...........................
Teamsters and drivers.......................................................

40.0
53.0
40.5
18.2
35.0

23.5
21.0
66. 6
30. 6
45.1
45.2

33.3
31.4
35. 7
34.4
32.2
44.0

15.1
31.1
27. 6
24. 6
23. 7
28.7

3.4
17.6
19.2
16.3
21. 5
12.1

3.5
6.2
10.3
1.8
6.1
5.9

All occupations...........................................................

33.6

33.5

24.8

15.9

7.8

1.9




56

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

T able 1 1.— P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U L O SIS AM O N G
W O R K E R S E X P O S E D TO M E T A L L IC D U S T , IN D U S T R IA L
D E N T IA L CO.. 1897 TO 1914, B Y A G E G R O U PS.

E X P E R IE N C E

OF

PRU­

Workers exposed to metallic dust.

Age at death.

Per cent of
deaths due
to pulmo­
nary tu­
berculosis
among all
Per cent of occupied
males.
deaths from
all causes.

Deaths from pulmonary
tuberculosis.
Deaths
from all
causes.
Number.

15 to 24 years......... .........................................................................
25 to 34 years...................................................................................
35 to 44 years...................................................................................
45 to 54 years...................................................................................
55 to 64 years...................................................................................
65 years and over...........................................................................
Age unknown.................................................................................

1,912
2,504
2,449
1,889
1,541
1,267
1

812
1,243
966
420
170
49

42.5
49.6
39.4
22.2
11.0
3.9

33.2
40.9
32.9
19.0
8.8
2.9

Total, 15 years and over..................................................

11,563

3,660

31.7

20.5

T able 12 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M N O N T U B E R C U L O U S R E S P IR A T O R Y
D ISE A SE S AM O N G W O R K E R S E X P O S E D TO M E T A L L IC D U S T, IN D U S T R IA L E X P E ­
R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914.

Deaths of workers ex­
posed to metallic dust.
Cause of death.
Number.

Per cent of
deaths from
all causes
Per cent of among all
deaths from occupied
males.
all causes.

A sthm a......................................................................................................................
Bronchitis.................................................................................................................
Pneumonia...............................................................................................................
Other nontuberculous respiratory diseases..................................................

74
116
1,003
182

0.6
1.0
8.7
1.6

0.6
1.1
8.8
1.4

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

1,375

11.9

11.9

The insurance experience is not strictly comparable with the gen­
eral mortality for the country at large in that the principle of adverse
selection should be considered in view of the fact that only a consid­
erable proportion of the adult risks accepted for industrial insurance
are at entry required to submit to a thorough medical examination.
A much more important factor, however, is that the occupational
analysis in the Prudential experience is more strictly limited to
specific occupations with metallic dust exposure, as separate and
distinct from industries or groups of closely allied employments
which, it is safe to assume, are more representative of the census
mortality returns. According to Table 11, the proportionate mor­
tality from pulmonary tuberculosis in occupations with exposure to
metallic dust is 31.7 per cent for all ages, which compares with 21
per cent as shown by the census occupation mortality returns. The
differences are quite marked and a maximum proportion is reached
at ages 25 to 34 when out of 2,504 deaths from all causes among men
with exposure to metallic dust, 1,243, or 49.6 per cent, were deaths




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

57

from pulmonary tuberculosis. The two groups of occupations are
not identical and erroneous inferences must be guarded against which
might seem justified in view of the apparent discrepancies in the re­
sults. Each class of data requires to be considered by itself, for
under existing conditions no identical groupings can be made for
the occupation mortality of the registration area and the more se­
lected occupation mortality of the industrial insurance company
previously referred to. The extremely high proportionate mortality
from pulmonary tuberculosis, particularly at the younger ages,
among occupations with exposure to metallic dust confirms the earlier
conclusion that this form of dust exposure must be considered as
the contributory cause of the most serious form of pneumoconiosis,
or dust phthisis, as the disease has been called in a strictly scientific
discussion of the subject by Collis in the Milroy Lectures, 1915.
The proportionate mortality by specific industries or occupa­
tions and by divisional periods of life is shown in Table 13, which
will facilitate comparison with the corresponding table for the
registration area, but which is subject to the same suggestion of ex­
treme caution as regards the scientific interpretation of the data de­
rived, as explained, from quite different sources.

13.—
PROPORTIONATE M
ORTALITY FROM PULM
ONARY TUBERCULOSIS IN
SPECIFIED INDUSTRIES O OCCUPATIONS W EXPOSURE TO METALLIC DUST,
R
ITH
INDUSTRIAL EXPERIENCE O PRUDENTIAL C ., 1 9 TO 1 1 , BY AGE GROUPS.
F
O 87
94

T able

1 to 2 years.
5 4
O
ccupation group.

A
rtificial-flow m
er akers
Brass w
orkers...........
Com
positors and type­
setters.................
C
utlery makers.........
D setters and sinkers.
ie
Electrotypers and
stereotypers...........
Engravers...............
G beaters............
old
Grinders.................
Ironandsteel w
orkers..
Jew
elers..................
Polishers.................
Pressm
en................
Tool and instrum
ent
m
akers.................
Total..............




2 to 3 years.
5 4

3 to 4 years.
5 4

4 to 5 3«ars.
5 4

D
eaths
D
eaths
D
eaths
D
eaths
frompul­
frompul­
frompul­
frompul­
m
onary
m
onary
m
onary
m
onary
Deaths tubercu­ D
eaths tubercu­ D
eaths tubercu­ D
eaths tubercu­
fromall losis. fromall losis. fromall losis. fromall losis.
causes.
causcs.
causes.
causes.
Num Per
­
Num Per
­
Num Per
­
Num Per
­
ber. cent.
ber. cent.
ber. cent.
ber. cent.
2 1 50.0
11 0
0 .0
1
9 5 58.2
1 3
1 9 7 51.0
4
6
16
4
9 4 5 5 55.9 8 1
0 0
7 5 3 8 46.3
9 6
5
5
1
1 5 4.5
1
1
1
1 3 27.3
5
5 3 60.0
1
0 2 2 .0
0
2
0 9 45.0
1
9
9 5 55.6
7 28 39.4
1
9 5 54.3
2 0
7
4
7 3 42.9
1
2 8 66.7
1
1
1
7 7 41.2
7
4
5 3 67.9
6 8
4 3 11 30.0 6 0 2 5 34.1
0 2
3 1
68
4
1 4 8 58.3
4
4
10 5 50.9
1
6
16
0
21
4
3 2
1 6 5 43.4 2 0 1 9 56.1
3
9
1 1 7 47.7 1 6
5
2
1 8 7 42.9
6
2
1
1
9 4 52.7 11
3 9
8 3 37.5
8 3
1,912 8 2 42.5 2,504 1,243 49.6 2,449
1

4 1 25.0
6 43.8
4
9 2 24.2
9 4
35 41.1
0
5 7 1 1 24.9
6 4
4 36.4
8 1 12.5
4 1 25.0
1 2 .0
0
4 2 .1
1
9 3 33.3
3 47.3
5
6 1 1.9
3 0 5
4 36.4
8 2 25.0
!
4 59.5
4
7 3 4.
3 5 7
2 4 31.3
1
6 6 8 It. 7
0
9
4 45.3
8
1 2 2 2 .2
3
8 1
1 6 44.0
0
13 4 2 . ■
7
3 4>
5 44.0
1
4
5 9 2.
0
4 36.9
1
9 3 33. 7
8 3
9 6 39.4 1,889 4 0
6
2

58

MORTALITY PROM RESPIRATORY DISEASES IN DUSTY TRADES.

T able 1 3 .—P R O P O R T IO N A T E

M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U LO SIS IN
S PE C IFIE D IN D U S T R IE S OR OCCUPATION S, ETC.—Concluded.

55 to 64 years.

Occupational group.

65 years and over.

Deaths
Deaths
Deaths
Deaths
from pul­
from pul­
from pul­
from pul­
monary
monary
monary
monary
Deaths tubercu­ Deaths tubercu­ Deaths tubercu­ Deaths tubercu­
losis.
losis.
losis.
losis*
from all
from all
from all
from all
causes.
causes.
causes.
causes.
Num­ Per
ber. cent.

Artiflcial-flower makers.
Brass workers................
Compositors and type­
setters ..........................
Cutlery makers..............
Die setters and sinkers..
E l e c t r o t y p e r s and
stereotypers.................
Engravers.......................
Gold beaters...................
Grinders..........................
Iron and steel workers..
Jewelers___\ ..................
Polishers.........................
Pressmen........................
T ool and instrument
makers.........................
T otal.....................

Total. 15 years
and over.

Age unknown.

Num ­ Per
ber. cent.

Num­ Per
ber. cent.

4
93

1 25.0
15 16.1

2
55

427
8
3

42 9.8
3 37.5
1 33.3

318
6
1

6
' 41
4
55
550
144
112
27

1 16.7
3 7.3

2
43
U
30
459
176
72
16

Num ­ Per
ber. cent.

14
48
16
16
3

25.5
8.7
11.1
14.3
11.1

4 30.8
232 36.7

13
633
1

14 4.4
1 16.7

1

3,863 1,420 36.8
17 3a 9
55
28
8 28.6
65
384
53
305
3,332
812
964
523

2.3

5 16.7
13 2.8
6 3.4
2 2.8

67

7 10.4

76

7

9.2

1,541

170 11.0

1,267

49

3. 9

22
127
17
143
700
238
355
207

533

33.8
33.1
32.1
46.9
21.0
29.3
36.8
39.6

170 31.9

11,563 3,360 31.7

1

On account of the importance of nontuberculous respiratory dis­
eases Table 14. is also included, showing the proportionate mortality
from asthma, bronchitis, pneumonia, and other respiratory diseases
among workers in occupations with exposure to metallic dusf, but
without reference to divisional periods of life.
T able 1 4 .—P R O P O R T IO N A T E

M O R T A L IT Y FR OM N O N T U B E R C U L O U S R E S P IR A T O R Y
D IS E A S E S IN S P E C IF IE D IN D U S T R IE S OR O CCU PATION S W IT H E X P O S U R E TO
M E TA LLIC D U S T , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914.
Deaths caused b y nontuberculous respiratory diseases.

Occupation group.

Asthma.
N um ­
ber.

Artiflcial-flower makers.
Brass workers................
Compositors and type­
setters...........................
Cutlery makers..............
Die setters and sinkers
E le c t r o t y p e s and
stereotypers................
j ^
Engravers........................
G old beaters...................
Grinders..........................
Iron and steel workers..
Jewelers...........................
Polishers.........................
Pressm en........................
Tool and instrument
makers..........................
T o t a l...................




Bronchitis.

Per
cent.

Num­
ber.

Pneumonia.

Other.

Total.

Num­
ber.

Per
cent.

Num ­
ber.

Per
cent.

N um ­
ber.

7.7
.2

1
51

7.7
8.1

19

3.0

2
75

15.4
11.8

343
4
4

8.9
7.3
14.3

55
1

1.4
1.8

452
5
5

11.7
9.1
17.9

4
34
5
28
307
61
77
45

6.2
8.9
9.4
9.2
9.2
7.5
8.0
8.6

5
2
9
50
7
17
9

1.3
3.8
3.0
1.5
.9
1.8
1.7

5
43
7
46
430
83
104
59

7.7
11.2
13.2
15.1
12.9
10.2
10.8
11.3

Per
cent.

4

0.6

1
1

19

.5

35

.9

1

3.6

1
2

1.5
.5

6
46
10
5
3

2.0
1.4
1.2
.5
.6

Per
cent.

2

.5

3
27
5
5
2

1.0
.8
.6
.5

7

1.3

5

.9

39

7.3

8

1.5

59

11.1

74

.6

116

1.0

1,003

8.7

182

1.6

* 375
1

11.9

.4

OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

59

Tt does not seem necessary to enlarge further upon the facts dis­
closed by the preceding comparative statistics which emphasize with
a sufficient degree of scientific conclusiveness the obvious health*
injurious consequences of considerable and continuous exposure to
the inhalation of metallic dust. It is clearly recognized that the sta­
tistical data utilized for the present purpose are of limited intrinsic
value, but they are in the main quite fully confirmed by the mora
extended special consideration of occupations or industries, where
the exposure to metallic dust is sufficient to warrant inclusion within
the plan and scope of the present discussion.
ENGLISH MORTALITY STATISTICS,

In conclusion, however, it has seemed advisable to add to the pre­
ceding observations Table 15, obtained from English official sources
and showing the combined mortality of tool and instrument makers,
brass workers, and printers and compositors. This table may safely
be considered sufficiently representative of the entire group of occu­
pations with exposure to metallic dust in the absence of more ex~
tensive information, which, unfortunately, is not available.
T able 1 5 .— M O R T A L IT Y FR O M A L L CAUSES, FR O M P U L M O N A R Y T U B E R C U L O SIS , A N D

F R O M O T H E R D ISEA SES OF TH E R E S P IR A T O R Y SYSTEM , IN OCCUPATIONS E X P O S E D
T O M E T A L L IC D U ST, C O M P A R E D W IT H T H A T OF A L L OCCUPIED M A LE S, IN ENG­
L A N D A N D W A L E S , 1900 TO 1902, B Y A G E GROU PS.
C
’Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths*
and Marriages in England and Wales.]

Death rate per 1,000 due to
all causes among— *

Death rate per 1,000 -due to
pulmonary tuberculosis
among—

Death rate per 1,000 due tu
other diseases of the re­
spiratory system.

Age at death.
A ll occupied Occupations All occupied Occupations All occupied Occupations
exposed to
exposed to
exposed to
males.
* males.
males.
metallic dust.
metallic dust.
metallic dust.
15 to 19 years.........
20 to 24 years.........
25 to 34 years.........
35 to 44 years.........
45 to 54 years.........
55 to 64 years.........
65 years and over..

2. 44
4. 41
6.01
10. 22
17.73
31.01
88.39

2.73
5.28
6.29
11.68
20.97
36.03
92.52

0.54
1.55
2.03
2.74
3.04
2.16
1.11

0.73
2.73
3. 33
5.05
5.22
3.91
L 54

0.24
.48
.77
1.66
3.32
6. 54
17. 77

0. 30
.45
.69
1.62
3. 55
7. 94
22. 46

GENERAL CONCLUSIONS.

According to this table the general death rate from all causes and
the specific death rate from pulmonary tuberculosis among, men in
occupations with exposure to metallic dust is decidedly excessive
at all ages, and extremely high during the age period 25 to 54, which,
for economic reasons, is obviously of special social and medical im­
portance. The mortality from nontuberculous respiratory diseases
in the English experience was slightly below the average for occupa­
tions with exposure to metallic dust, a condition which is not con­




60

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

firmed by the data derived from American sources. It should be
considered in this connection that many important specific employ­
ments with exposure to metallic dust show a mortality from pneu­
monia, asthma, and bronchitis distinctly above the average. The
relative frequency of these two groups of diseases among persons em­
ployed in occupations with exposure^to metallic dust occasionally
T
involves serious difficulties in medical diagnosis and death cer­
tification, and the conclusion of Sir Thomas Oliver, with reference
to miners applies to metal workers, though possibly to a lesser degree,
that “ it is difficult to say where and how miners with pneumo­
coniosis become tuberculous, but there is nothing to suggest that they
become infected differently to other people.” This, of course, applies
to the precise process of infection rather than to the increased lia­
bility resulting from a preexisting mechanical injury to the lungs in
consequence of considerable and continuous inhalation of metallic
and mineral dust. As further said by Sir Thomas Oliver in this
connection, u The infection must take place either in the mine, in
the home, in the public house, or in some place of amusement.” It
may safely be asserted, however, that “ in the absence of sanitary
control of work places and a general conformity to sanitary rules,
especially with reference to indiscriminate expectoration, the liability
to tuberculous infection must be increased on account of the occupa­
tion in the case of persons employed in occupations with more than
normal exposure to irritating dusts, whether of organic or inorganic
origin, or both.” This conclusion applies as much to occupations
with exposure to metallic dust as to those with exposure to mineral
7
dust, but of the two, under given conditions, persons engaged in the
former are in all probability more liable to pulmonary tuberculosis
than those engaged in the latter and less liable to nontuberculous
respiratory diseases, particularly asthma and bronchitis.
THE IRON AND STEEL INDUSTRY.
VARIATIONS IN OCCUPATIONAL DUST EXPOSURE.

The iron and steel industry is inclusive of such a large number of
more or less specialized and widely varying employments that any
and all general mortality data relating thereto can not be considered
conclusive concerning any one particular group of occupations. The
conditions of employment in the iron and steel industry in the United
States, with detailed descriptive accounts of particular occupations,
were reported upon by the United States Bureau of Labor Statistics
in response to a Senate resolution, in 1911. The large number of
individual employments therein described proves conclusively the
practical limitations of general data concerning the mortality and
morbidity of iron and steel workers considered as a group. Most of




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

61

these have, therefore, for the present purpose, been discussed sepa­
rately in the 14 groups of occupations with exposure to metallic and
mineral dusts. Out of 172,706 enumerated employees in. the iron and
steel industry, according to the report of the United States Bureau
of Labor Statistics on Conditions of Employment in the Iron and
Steel Industry, 61.9 per cent were employed in producing depart­
ments and 38.1 per cent in connection with power, mechanical opera­
tions, or the yard force. As to the branches of the industry in the
producing departments, 18.2 per cent of the employees were at work
on blast furnaces; 3.3 per cent at Bessemer converters; 8.5 per cent at
open-hearth furnaces; 3.9 per cent at puddling mills; 0.4 per cent
at crucible furnaces; 3.3 per cent at blooming mills; 3.4 per cent at
plate mills; 2.6 per cent at standard rail mills; 2 per cent at struc­
tural, light rail, and other shapes mills; 1.9 per cent at miscellaneous
mechanical mills; 10 per cent at bar mills; 1.4 per cent at garrett rod
mills; 0.5 per cent at miscellaneous rod mills; and 2.5 per cent at tube
mills. It is, therefore, shown that numerically the men employed in
direct connection with producing operations at blast furnaces, Besse­
mer converters, open-hearth furnaces, puddling mills, and crucible
furnaces constitute 34.3 per cent of the total labor force. The dust
exposure in even these closely related employments varies quite con­
siderably, aside from important variations in exposure to heat, tem­
perature changes, etc. The remainder of the group of iron and
steel workers, 27.6 per cent, were employed in iron and steel mills,
including a large number of highly specialized occupations, with
possibly even greater variations in exposure to dust, heat, tempera­
ture changes, etc. Conclusions applicable to the health or mortality
of one group of employees, for illustration, connected with
work at blast furnaces, would probably not apply to another group
of employees at work in the plate mills. It is, however, quite im­
practicable to give individual consideration to the hygiene of all the
numerous employments in the iron and steel industry, since most of
the available mortality and morbidity data have reference only to the
industry as a whole. The experience of several important and longT
established benefit funds, if subjected to critical analysis, would un­
doubtedly throw much light upon important sanitary and medical
conclusions concerning the health conditions in the steel industry;
but thus far only a general analysis of the experience has been at­
tempted.
OCCURRENCE OF INJURIOUS DUST AMONG STEEL WORKERS.

The most qualified scientific investigation of the occurrence and
mitigation of injurious dust among steel workers is by Dr. J. A.
Watkins j of the United States Public Health Service in cooperation




62

MORTALITY FROM RESPIRATORY DISEASES IK DUSTY TRADES.

with the Bureau of Mines (Technical Paper 153, Washington, 1917).
The report includes a brief discussion of the pathogenicity of indus­
trial dusts, differentiating the three chief ways in which dust may act
injuriously according to the character of the dust particles, (1) by
irritant action, (2) by toxic action, and (3) by mechanical action.
The conclusion is advanced that much of the dust inhaled never
reaches the lungs because of its being retained in the nose, throat
and mouth. Some of these dusts, it is pointed out, interfere with
the proper physiological action of the stomach and intestines, while
others have serious effects on the skin, acting as local irritants. The
principal places where dust is found in steel works are storage bins,
blast furnaces, gas stoves, gas washers and blowers, dolomite sheds,
open-hearth furnaces, rolling mills, soaking pits, gas producers,
Bessemer converters, foundries, and in connection with the grinding
equipment. The observations in detail are entirely too brief for
practically useful conclusions. In order to determine the extent to
which the various dusts are found to be suspended in the atmosphere
of the work places examined, an apparatus was used devised by
Lanza and Higgins and described in Technical Paper 105, Bureau
of Mines, Washington, 1915. The descriptive accounts of the dusts
collected are exceptionally valuable. The description of iron ore
dust is given in full as follows:
The table shows that at times iron-ore dust is suspended in the
atmosphere around the ore bins in exceptionally large quantities—as
much as 23.5 mmg. per 100 liters. While this dust contains many
particles varying from 4 to 10 microns in size, a characteristic feature
noted in the study of this dust was the enormous number of ultramicroscopic particles. The larger particles readily break up into
these ultramicroscopic particles in a fluid medium. A somewhat
similar occurrence probably takes place in the respiratory tract; and
if so would make the removal of these particles by coughing or ex­
pectorating very difficult, if not impossible. The larger particles
are irregular, roughly spherical, and have few sharp edges but some
points. Iron-ore dust has no toxic action and the particles examined
were not very hard. Its physiological effect on man can be surmised
only, but is probably limited to that caused by the mechanical action
of the particles, which act as irritating bodies where they lodge in
the respiratory tract.
Additional descriptions are of coke dust, limestone dust, flue dust,
graphite dust, dolomite dust, and other refractory material and roll
scale. With reference to dolomite dust, it is said that—
As regards industrial hygiene, dolomite, CaMgC03, is the most
important dust in a steel plant, not only because of its character and
action but also because of the enormous quantities of it suspended
in the atmosphere of certain working locations. The dolomite par­
ticles examined are very irregular, with few sharp points, but gener­
ally with some sharp edges, and are hard. The particles examined




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

63

were 5 to 15 microns in size. Calcined dolomite contains a large per­
centage of free lime which on becoming moist slakes and is then very
irritating to the tissues of the body, particularly those of the nose,
throat, and eyes. Its effect on the delicate membranous lining of the
respiratory tract can be readily surmised.
Of special interest is the descriptive statement of ganister dust,
in which it is referred to as a highly siliceous sandstone, used to
some extent in patching and repairing the interior of an open-hearth
furnace. The silica particles examined were 5 to 20 microns in size,
irregular, angular, sharp, and exceedingly hard.
The general methods of mitigating the dust menace in steel works
are (1) preventing dust suspension, (2) removing suspended dust
from air, and (3) providing against the inhalation of dust. A fourth
method is “ to house in completely the department in which there is
much suspended matter and prohibit employees from working or
remaining therein.” The suggestions, to be entirely conclusive and
practically useful, require to be further amplified by illustrations
of existing methods which are known not to have been a matter
of material interference with at least a moderate degree of working
efficiency. It is, of course, a mere commonplace that a foremost
among the methods employed for dust removal is that of an efficient
system of exhausting and supplying air. A system of electric pre­
cipitation can be used, but its usefulness is limited largely to dust in
flues.” Both of these are extremely difficult of installation in many
plants constructed in conformity with the factory methods of the
past.
The observations in the report on the abatement of dust at the ore
bins, the blast furnaces, and the dolomite shed are of considerable
value. With reference to the dust problem in foundries it is said,
in conclusion, that—
Many and diverse conditions give rise to dust in the foundry. To
abate the dust a great deal of effort and every means of prevention
and mitigation must be employed. Castings should be cleaned and
“ blasted ” in a separate room where only those men needed for the
work are allowed to remain. These employees should be required
to wear respirators. Casting, especially the casting of brass and
similar alloys, should be done in a separate building where precau­
tions are taken to insure ample ventilation by natural and artificial
means. The main foundry room should be given more floor space
pjid, except where molds are made, should have suitable flooring of
steel plate or brick. This flooring should be sprinkled with water
frequently. In addition provision should be made for an abundant
supply of fresh air. Grinding wheels should be supplied with an
effective exhaust system, and as an additional safeguard the men en­
gaged. should be required to wear respirators.
The report is a promising indication of more qualified scientific in­
quiries into a field of industrial hygiene which has heretofore been
practically neglected almost in its entirety.




64

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

DUST EXPOSURE AT BLAST FURNACES.

In the report of the Bureau of Labor Statistics each important
branch of the industry is separately described and much useful
information is contained therein regarding occupational exposure in
at least the more important employments. At the blast furnaces,
for illustration, the so-called larry men are exposed to the dust of
limestone, coke, and other materials, including, of course, a more
or less important proportion of metallic dust. So-called bottom
fillers are considerably exposed to dust in connection with the shovel­
ing of materials into barrows, while top fillers and stove cleaners are
still more exposed to dust and heat, in addition to the serious risk
of overexertion, on account of the heavy physical labor required,
and frequently, also, to trying weather conditions. The stove cleaners*
it is explained in the report referred to, “ remove the cinder, dust,
and various debris that accumulate in the stoves,” which obviously
T
must involve an exceptional amount of metallic and mineral dust
exposure. The so-called “ dustmen,” which term includes slag-dust
laborers, dust wheelers, and dust-catcher men, “ remove the dust
which accumulates in the gas flues and in the dust catcher,” and the
work is particularly referred to as being “ disagreeable on account
of the hot dust, and likely to be dangerous if the dust is not thor­
oughly wetted down while being removed,” which, it may be said,
is not often the case. At the blast furnaces the so-called clay men
“ prepare and deliver the clay for the stopping of the tap hole,”
but the exposure here is to mineral rather than to metallic dust. Iron
breakers, however, who break up the iron molds or “ pigs,” are in
all probability subject to considerable inhalation of mineral dust
mixed with minute iron particles, but in modern plants where pigcasting machines are used this risk is eliminated. These brief ref­
erences to a single important branch of the steel industry illustrate
the widely varying conditions of dust exposure and suggest the prac­
tical importance of much more specialized investigations than have
heretofore been made into the health-injurious effects of particular
occupations or groups of employment. At the blast furnaces alone
35 particular occupations are differentiated or briefly described in
the report of the Bureau of Labor Statistics previously referred to.
DUST EXPOSURE AT BESSEMER CONVERTERS.

At the Bessemer converters there are at least 29 specialized occu­
pations, of which apparently those with most serious dust exposure
are the cupola hoist men, the cupola chargers, the cupola liners,
the vessel scrapers, the vessel men and vessel men’s helpers, and, most
of all, the bottom makers and helpers, who repair and rebuild con­
verter bottoms. The last-named operation is of special interest and




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

65

hygienic importance and is briefly described in the report of the
Bureau of Labor Statistics, as follows:
The bottom consists essentially of (1) a cylindrical steel casing
sloping out at the top to the diameter of the vessel, the lower part of
which forms the “ blast box ” into which the blast is admitted by a
large pipe. This casing is provided with keys or with other appli­
ances by which it can be quickly and securely fastened to the body of
the converter. (2) Above the “ blast box” is the refractory bottom,
which is pierced by a large number of small holes for admitting
and distributing the blast in the vessel. In acid vessels these
“ti^eres” or holes are formed in fire-clay bricks of special design
(in practice the entire brick is known as a “ tuyere” ) around which
ganister is rammed. When the bottom is removed by the vessel men,
the bottom makers and helpers cool it with water and then chip out
all the ganister and knock out the “ tuyere bricks.” New tuyere
bricks are then placed in position, and crushed moist ganister is
tightly rammed around them until it ‘is level with their top. The
entire bottom is then placed in an oven where it is kept at a steady
heat until thoroughly dried. In addition to this work the bottom
makers’ helpers in many plants also grind the refractory materials
used for this purpose and also for repairing vessels and ladles.
The ganister which is used in connection with this operation gives
rise to a dust of a very high degree of injuriousness, but the degree
of such exposure is much less in bottom making than in the manu­
facture of the dust itself. Ganister mining and crushing has been
described in Oliver’s Dangerous Trades, in part, as follows:
Workers engaged in crushing basic slag, in the breaking of cer­
tain rocks, in the manufacture of millstones, in stonemason's work,
and kindred occupations, are peculiarly liable to chronic inflam­
mation of the air tubes, caused by the inhalation of dust of an
irritant kind. This, it is believed, leads to lung fibrosis. Where the
operatives form part of a large community in which individuals are
employed in many and varied trades, it is conceivable that fibrosis
of the lungs may be mistaken for tubercular pulmonary consumption,
and it may not be realized that the cause is due to the occupation of
the sufferer.
Ganister is a hard, close-grained, silicious stone which often forms
the stratum that underlies the coal seam. A footnote in Dr. Percy’s
Fuel says: “ Dinas rock is believed to be a millstone grit of the car­
boniferous system, and the geological equivalent of the bed termed
‘ ganister’ at Sheffield.” It is found in Yorkshire, Durham, North
and South Wales, and elsewhere. When crushed and ground into
dust it is used as a fire-resistant, chiefly for lining Bessemer and other
steel converters, for the manufacture of bricks likely to be subjected
to great and continuous heat, and it is sometimes mixed with, or sub­
stituted for, Stannington or other clays, which, together with ground
cinders and old ground pot, are used for the manufacture of crucibles
in which certain kinds of steel are made.
The exposure here, of course, is to mineral rather than metallic
dust, but in the United States, at least, employments in connection
106811°—18—Bull. 231-----5




66

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

with ganister are chiefly in the iron and steel industry, and especially
in the repairing and rebuilding of converter bottoms. For a
thoroughly well considered discussion of the subject the extended
account in Oliver’s Dangerous Trades, by Hamilton P. Smith, should
be consulted.1
Other important occupations in connection with Bessemer con­
verters where the dust exposure appears to be exceptional are ladle
liners, ingot strippers, and cinder men, the latter cleaning up and
removing the cinder and metal from the pit or floor of the^Bessemer
building, and taking care of the slag on the cinder dump. As ex­
plained in the report of the Bureau of Labor Statistics, this work,
for the most part, “ is done under conditions of great heat, and,
when working around and under the vessels and ladles, of great
danger of being severely burned or of receiving minor injuries.”
DUST EXPOSURE AT OPEN-HEARTH FURNACES. ‘

Twenty occupations of the open-hearth furnaces are described in
detail in the report of the Bureau of Labor Statistics, and of these
occupations the following involve the most serious risk of dust ex­
posure : Stokers, who unload the materials and sort and assemble the
different grades of scrap iron in piles, etc.; charging-machine oper­
ators, who generally work on more or less dust-covered floors and
in front of furnaces while discharging materials under, frequently,
rather trying conditions; pitmen, who prepare the pit for casting,
set the molds, build the runners, etc.; and general laborers, including
ash men, ash wheelers, cinder dump men, clean-ups, grinding labor­
ers, mixing laborers, mixing-house laborers, etc. In most of these
occupations the dust exposure is quite considerable, but naturally the
major portion of the dust is of a mineral nature. The highest degree
of health-injurious exposure is probably in connection with the relin­
ing of the furnaces where frequently all reasonable and necessary
safeguards, such as the previous spraying of the materials, etc., are
neglected. Most of the work, however, is done by casual labor, so
that only in rare cases are occupations of this character followed for
a long period of years.
DUST EXPOSURE AT PUDDLING MILLS.

In puddling mills the number of special occupations is not fewer
than 23 and most of these involve more or less dust and heat ex­
posure, frequently, however, quite difficult of precise ascertainment.
1 See also S ir T h om a s O liv e r’ s o b serv a tion s on sla g cru sh in g, in A llb u tt and R o lle s to n ’ g
A System o f M ed icin e, v ol. 5, p. 457 ; and his rem arks on g a n iste r cr u sh in g and m in in g,
in the sam e volu m e, p. 456 ; and a d d ition a l ob serv a tion s in his D iseases o f O ccu p a tio n ,
p. 298 et seq.
S ir T h om a s O liv er's m ost recen t co n clu sio n s a re set fo r t h briefly in
K ob er and H a n s o n ’ s O ccu p a tion a l D iseases and V o ca tio n a l H yg ien e, N ew Y o rk , 191 6 ,
p. 222.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

67

Puddling is a highly skilled occupation and, according to the report
of the Bureau of Labor Statistics, “ requires considerable experience,
and the puddler’s work is perhaps the hardest physical labor in the
industry, and, moreover, the largest part of it is done under con­
ditions of extreme heat.” Wherever work is done under conditions
of extreme heat the dust exposure is increased on account of the ex­
treme dryness of practically all the materials used, directly or in­
directly, in productive operations. Puddlers’ helpers assist in the
lining of the furnaces and in the charging and drawing of the metal,
which naturally involves exposure to mixed mineral and metallic
dust. Cinder men tap the slag from the furnace, quite frequently
under rather primitive conditions, involving considerable dust ex­
posure. Many of the other occupations resemble those previously
referred to. The crucible process in steel manufacture is now of
relatively small importance, but of exceptional interest from sanitary
and medical points of view. Conditions vary widely in different
plants, according to whether the furnaces are heated by gas, coal, or
coke, and whether modern processes or the antiquated methods of an
earlier period are employed. The principal occupations are melters,
pullers out, and molders. The latter prepare and set the small ingot
molds into which the steel is cast, and they strip the same when
the cast is completed. All this involves considerable dust exposure
and the liability to sudden temperature changes. Frequently these
men while at work near the furnaces are not properly protected
against cold drafts and other trying weather conditions. Among
the unclassified employments chiefly carried on by unskilled labor
are mixers, pot shakers, pot boj^s, pipe makers, compounders, and
ladle men, all more or less exposed to considerable mixed metallic
and mineral dust.
OBSERVATIONS ON THE PHYSIQUE OF IRON AND STEEL WORKERS.

The foregoing are the principal converting branches of the modern
iron and steel industry,' preliminary to manufacturing processes
proper. The special occupations in these are also extremely varied
but in most respects they resemble, as regards at least the most dan­
gerous employments, those previously referred to. Working gen­
erally in rolling, rod, and tube mills involves, naturally, a continuous
and probably considerable exposure to the inhalation of metallic
dust, aside from other more or less health-injurious conditions, such
as sudden temperature changes, extreme heat^ etc. As a natural proc­
ess of occupational selection, most of the men employed in the iron
and steel industry are physically of a superior class, and, therefore,
more resistant to disease than ordinary laborers or men employed
chiefly in indoor occupations. There is the additional advantage




68

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

that in most of these employments the wages are above the general
average, while, except in the continuous processes, the hours of labor
are rarely excessive. Regarding any and all of these employments,
there is at present only fragmentary information as to the healthinjurious effects of the different employments, but considered in the
aggregate the available data are fairly conclusive that the mortality
and morbidity are not above the average. This conclusion, however,
must not be carried too far, for it can not be made to apply to the
numerous and thoroughly specialized occupations which are carried
on under frequently very trying conditions of extreme heat* sudden
temperature changes, and exposure to metallic and mineral dust.
HEALTH-INJURIOUS CONDITIONS AT IRON AND STEEL WORKS.

W. Gilman Thompson, in his treatise on “ The Occupational Dis­
eases” (pp. 191-196), refers at some length to the iron and steel in­
dustry, chiefly to foundry men and rolling-mill men, and he includes
among the health-injurious circumstances exposure to toxic gases,
glare of excessive light, and irritation of the lungs from steel dust,
causing pneumoconiosis. He also suggests an exceptional liability
to chronic nephritis and arteriosclerosis. He quotes Ropke to the
effect that in German steel mills 20 to 22 per cent of the illnesses
among the workmen concern the respiratory organs. He observes
that—
Iron is in no sense a chemical irritant to the body, being a natural
ingredient of the hemoglobin. Iron and steel dust, however, by virtue
of the hardness and sharpness of the particles, are irritant to the
bronchial mucosa when inhaled, and foster the development of
fibroid phthisis and subsequent acquisition of pulmonary tubercu­
losis. The smelting of iron and steel and various hardening processes
are capable of being injurious in several ways. Thus the workmen
are exposed to great heat and perspiration which is often suddenly
checked, especially in winter. The excessive heat and light to which
puddlers and founders are exposed when the glare from furnace
doors reaches them may injure the eyes permanently, and they may
acquire superficial or more serious burns. Particles of iron or steel
may be driven into the skin of the face and exposed upper half of the
body, marking it like tattoo. The workmen, as a result of frequent
extreme changes in temperature, are prone to lumbago or myalgia
and chronic rheumatism, and, from heavy lifting, frequently have
sprains and muscle strain. In galvanizing sheet iron hydrochloric
acid is used, the fumes of which are injurious. Various processes of
steel hardening are liable to prove harmful through the action of
other substances, such as the cyanides, ferrosilicon, etc. Cutlery and
other articles of steel manufacture are dipped into baths of molten
lead or boiling oil, the fumes from which may prove highly injurious.
In the hot rooms in which smelting and hardening processes are con­
ducted the workmen are subject to acute and chronic nasal catarrh,
and Sager and Weickert have found otitis media as a further not




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

69

uncommon result. Ropke (Berufskrankheiten des Ohres) has de­
scribed perichondritis of the external ear caused by the packing of
hard metallic dust in the auditory meatus. He also found laby­
rinthine inflammation in some cases.
The metallurgy of iron is of course quite closely related tojnetallurgical processes generally as carried on in continuation of mining
industries. Smelting processes are elsewhere considered, though
briefly, since thus far no extensive and conclusive investigations have
been made concerning the differential occupational health hazards in
the several important branches of the smelting industry with a due
regard to the nature of the metallic substances produced. Conclu­
sions applicable to copper smelters are, for illustration, quite inappli­
cable to quicksilver reduction works, and the same observation
applies to gold and lead smelting, separately considered. As ob­
served by Thompson—
In smelting works the laborers are much exposed to the inhalation
of toxic gases from the ovens, especially carbon monoxide derived
from coke or otherwise. In such cases headache, vertigo, and tinnitus
are complained of, and anemia and nervousness ensue. Kayser
(Wiener med. Woch. 1893, No. 41) reported a case of such poisoning
in which the victim remained 36 hours in coma, and on recovery pre­
sented symptoms of labyrinthine disease. Such extreme cases are
very rare. Rohrer (Haugs klin. Yortr., Bd. 1, Heft 3) reported 5
cases among furnace stokers who were subjected to the inhalation of
water gas, with the result of chronic carbon monoxide poisoning.
They suffered from headache, nausea, and disturbances of hearing
which were both nervous and due to otitis. Erosions of the nasal
septum and atrophic rhinitis were also observed occasionally.
THE HYGIENIC MENACE OF STEEL DUSTS.

To a limited extent this observation applies also to the iron and
steel industry, chiefly, of course, to work in connection with initial
conversion processes. In the continuation of these processes and
toward the final finishing of the product, it is quite apparent, as
pointed out by Thompson, that the danger to the lungs in the clean­
ing of iron and steel castings is most serious, and that in open-hearth
processes and in the breaking up of iron molds and castings particles
of coal or charcoal and iron rust are inhaled and the workmen
sweat heavily. They are, therefore, peculiarly exposed to nasal,
bronchial, and middle-ear catarrh, and he remarks, in this connec­
tion, that—
The sharp particles of dust accumulate in crusts with the nasal
mucus and cause ulceration and epistaxis. There may be atrophic
rhinitis with loss of sense of smell and uncomfortable dryness of the
nose. The atrophy may involve the mucosa of the nasopharynx,
which becomes reduced in sensibility so that mucus accumulates with­




70

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

out exciting expulsive effort. This lack of sensation may favor the
further entrance into the bronchi and lungs of irritant material.
Graphite and coal dust were found by Merkel embedded in the lungs
in four autopsies upon men who had been employed as iron molders.
Particles of steel and iron dust which reach the pulmonary alveoli
choke them up and become embedded in their walls, where they excite
perialveolar irritation with inflammatory products, chiefly fibrous.
MORTALITY OF GRINDERS AND POLISHERS.

These observations bear directly upon the extremely important
practical question of differentiating fibroid phthisis from ordinary
pulmonary tuberculosis as modified by conditions of employment in
the metal trades. The more delicate methods of manufacture with
exposure to iron,and steel dust have been briefly described under
grinders, polishers, and tool and instrument makers, as well as
less important allied occupations. A statement, however, by W.
Gilman Thompson, based on experience had at Sheffield, England,
during the eight years ending with 1909, among steel grinders and
polishers in the hardware industries may be here referred to, it being
stated that the death rate was 30.4 per 1,000, of which, however, onehalf was attributable to tuberculosis and more than one-sixth to
other pulmonary diseases. Thompson properly emphasizes the fact
that this class of workmen is representative of a selected group as
to age and original physical strength, so that the excessive mortality
is on that account decidedly more significant. Thompson also refers
to the mortality of Solingen, which is the center of the German
cutlery industry, where during 1910 the general mortality from
tuberculosis was 1.8 per 1,000, while in the cutlery and tool industry
it was 9.3, and he quotes in this connection from a report of the
State Board of Health of Massachusetts for the year 1907, with
special reference to the tool industry at Northampton, Mass., that
the grinders and polishers employed in these industries showed a
mortality from pulmonary diseases, including tuberculosis, of nearly
73 per cent of the mortality from all causes. He also makes mention
of a rather rare case of pulmonary emphysema reported to the New
York State Bureau of Labor which resulted from manufacturing
steel wool. He remarks in conclusion that—•
In foundries, rolling mills, steel-plate works, and the like, the lift­
ing of heavy weights tends in time to strain the circulation and give
rise to cardiac hypertrophy. Excessive sweating in these occupations
leads to lessening of the fluidity of the blood and induces excessive
thirst, which the workmen often assuage with quantities of beer and
other alcoholic drinks. The combination of vascular strain and
alcoholism leads to early arteriosclerosis, which in turn results in
hypertrophy of the heart. When large quantities of cold fluids are
drunk acute gastrointestinal catarrh is very liable to ensue.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

71

DUST EXPOSURE IN THE CHIPPING OP IRON AND STEEL CASTINGS.

Among the minor but important health-injurious processes in the
iron and steel industry a brief reference should be made to iron and
steel “ chipping.” This employment has been briefly described by
Hayhurst, as follows:
Chipping of iron and steel castings is another exceedingly dusty
and also dangerous procedure from the flying particles which are
created by the use of both hand or pneumatic tools.
The reference is particularly to the danger of eye injuries, but the
metallic-dust hazard in this employment is of even greater im­
portance. Hayhurst suggests that outside of the use of respirators
and individual goggles it is advisable to protect the ears by cotton,
for where pneumatic tools are used the deafening noise is productive
of shocks to the nervous system. Previous to the chipping castings
are usually subjected to the so-called process of tumbling, which
consists in the placing of a number of castings, as described by Hay­
hurst, “ in a revolving cylinder, called a 4rattler,’ in order to shake
off the mold dust and to smooth down certain imperfections.” He
explains that the cylinder which contains the material should be en­
tirely inclosed, since an immense amount of dust is created, but where
this is not practicable an efficient air exhaust or blast system may be
used for the control of the dust hazard. In employments of this char­
acter most of the labor, however, is of a casual nature and it is ex­
tremely rare to meet with men who have been exposed to the same
occupational hazard for a long period of time.1
MORTALITY OF IRON AND STEEL WORKERS— UNITED STATES REGISTRA­
TION AREA.

The mortality of iron and steel workers has been reported upon
for the years 1908 and 1909 b the Division of Vital Statistics of
}^
the United States Census Bureau, but no subsequent information has
been made public and the data are, therefore, limited to the years re­
ferred to. According to the census report, out of 5,035 deaths from
all causes, 853, or 16.9 per cent, were from pulmonary tuberculosis.
The details of the mortality of iron and steel workers, by divisional
periods of life, are shown in Table 16, compared with the mortality
of all occupied males, and of farmers, planters, and farm laborers.
1
C on sid era b le p rog ress has been m ade in the d ire ctio n o f p e rfe ctin g m eth od s o f e ye
p rotection , as illu stra te d by exh ibits a t the N a tion a l E x p o s itio n o f S a fety and S a n ita tio n ,
N ew Y ork C ity, u n d er th e au spices o f the N a tion a l S a fety C ou n cil an d th e A m e rica n
M useum o f S a fety, G ran d C entral P a lace, N ew Y ork C ity, 1917. A perm a n en t e x h ib it o f
s a fety g og gles o r oth er m eth od s o f eye p ro te ctio n is m ain ta in ed at the A m e rica n M useum
o f S a fety, 18 W e st T w e n ty -fo u rth S treet, N ew Y ork C ity.




72

MORTALITY FROM RESJIRATORY DISEASES IK DUSTY TRADES.

T able 1 6 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U L O SIS OF
IR O N A N D ST E E L W O R K E R S , OF A L L OCCUPIED M A LE S, A N D OF F A R M E R S , P L A N T ­
E R S , A N D FA R M L A B O R E R S , U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1908 A N D
1909, B Y A GE GR O U PS.

iron and steel workers.

All occupied males.

Deaths from
pulmonary
tuberculosis.
Age at death.

Deaths
from
all
causes.

Num­
ber.

Farmers, planters, and
farm laborers.

Deaths from
pulmonary
tuberculosis.

Deaths
from
Per
all
cent of causes.
deaths
from
all
causes.

Num ­
ber.

Deaths from
pulmonary
tuberculosis.

Deaths
from
Per
all
cent of causes.
deaths
from
all
causes.

N um ­
ber.

Per
cent of
deaths
from
all
causes.

15 to 24 years...........................
25 to 34 vears............................
35 to 44 years............................
45 to 54 years...........................
55 to 64 years...........................
65 years and over....................
Age unknown..........................

460
915
1,084
992
754
826
4

91
239
253
166
64
39
1

19.8 34,985
26.1 56,001
23.3 63,093
16.7 68,903
8.5 69,254
4.7 113,469
618
25.0

9,837
17,326
15,128
9,910
5,231
2,992
51

28.1
30.9
24.0
14.4
7.6
2.6
8.3

6,130
6,665
7,227
10,224
14,836
45,510
203

1,441
1,748
1,377
1,234
999
1,105
16

23.5
26.2
19.1
12.1
6.7
2.4
7.9

Total, 15 years and over-

5,035

853

16.9 406,323

60,475

14.9

90,795

7,920

8.7

T able 1 7 .—P R O P O R T IO N A T E M O R T A L IT Y FROM N O N T U B E R C U L O U S R E S P IR A T O R Y
DISEASES OF IR O N A N D S TE E L W O R K E R S , OF A L L OCCUPIED M ALES, A N D OF
FA R M E R S , P L A N T E R S , A N D F A R M L A B O R E R S , U N IT E D ST ATE S R E G IS T R A T IO N
A R E A , 1908 A N D 1909.

Deaths of iron and
steel workers.
Cause of death.

Deaths of farmers,
planters, and farm
laborers.

Per cent
Per cent
Per cent
Number. of deaths Number. of deaths Number. of deaths
from all
from all
from all
causes.
causes.
causes.

Asthma ........................................ .................
Bronchitis......................................................... 1
P neu m on ia......................................................
Other nontuberculous respiratory diseases.
Total........................................................

Deaths of all occu­
pied males.

12
35
508
54

0. 2
.7
10.1
1.1

1,031
3,522
31,889
4,280

0.3
.9
7. 8
1.1

262
1,049
6,333
824

0.3
1. 2
7.0
.9

609

12.1

40,722

10.0

8,468

9.3

Table 16 is suggestive of a rather high but not particularly exces­
sive mortality from pulmonary tuberculosis; but Table 17 shows
that in addition thereto there is a mortality from nontuberculous
respiratory diseases of 12.1 per cent for iron and steel workers. Of
this group of diseases asthma causes a proportionate mortality of
0.2 per cent; bronchitis, 0.7 per cent; pneumonia, 10.1 per cent; and
other respiratory diseases, 1.1 per cent. Combining pulmonary tuber­
culosis and nontuberculous respiratory diseases, the proportionate
mortality from all lung diseases is 29 per cent, which must be con­
sidered relatively high, since the group of iron and steel workers
T
includes those in many occupations not exposed to particularly
health-injurious conditions. The table confirms the results of other
investigations into the mortality of iron and steel workers of the
United States and other countries.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

73

MORTALITY OF IRON AND STEEL WORKERS— INDUSTRIAL INSURANCE
EXPERIENCE.

The general vital statistics of the iron and steel industry are, for
reasons elsewhere discussed at some length, of rather limited practical
utility. The most useful data for the Unite# States are the industrial
insurance experience statistics of the Prudential Insurance Co., in­
cluding for the industry considered as a whole, 5,332 deaths from all
causes, of which 700, or 21 per cent, were from pulmonary tuber­
culosis. The details of this experience, on account of the large num­
ber of deaths included, are of exceptional interest, and especially so
with reference to the younger ages.
T able 1 8 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y TU BE R CU LO SIS A M ON G
IR O N A N D S T E E L W O R K E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897
TO 1914, C O M PA R E D W IT H T H A T OF A L L M ALES IN U N IT E D STA T E S R E G IS T R A T IO N
A R E A , 1900 TO 1913, B Y A G E GROU PS.
Deaths of iron and steel
workers, 1897 to 1914,
from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
All causes.

Pulmonary
tuberculo­
sis.

Iron and
steel
workers.

Males in
registration
area, 1900
to 1913.

15 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 y ea rs ..........................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and over .................................................................

403
630
684
606
550
459

121
215
214
89
48
13

30.0
34.1
31.3
14.7
8.7
2.8

27.0
30.5
23.4
14. 7
7.9
2.6

Total, 15 years and o v e r ............................................

3,332

700

21.0

13.9

It is shown in Table 18 that the proportionate mortality from pul­
monary tuberculosis among iron and steel workers considered as a
group is only slightly excessive at ages under 35, but quite de­
cidedly so during the age period 35 to 44, while during the remainder
of life the mortality conforms to the normal. Considering that the
group represents many widely different occupations, it is self-evident
that the data must be interpreted with exceptional caution, but it
would seem a safe inference that the physical strain and stress at
the younger ages is a factor of some importance in the excessive pro­
portionate mortality from pulmonary tuberculosis at ages 35 to 44.
In addition to the relatively high proportionate mortality from pul­
monary tuberculosis, pneumonia is also relatively common, the nontuberculous respiratory diseases being accounted for as follows:
Asthma, 0.8 per cent; bronchitis, 1.4 per cent; pneumonia, 9.2 per
cent; and other respiratory diseases, 1.5 per cent. Combining all
the nontuberculous respiratory diseases, it appears that 12.9 per cent
of the mortality was caused by diseases of this group, which, com­
bined with the 21 per cent of deaths from pulmonary tuberculosis,




74

MORTALITY FROM RESPIRATORY DISEASES

IN

DUSTY TRADES.

indicates that nearly 34 per cent of the mortality from all causes in
the iron and steel industry is directly attributable to diseases of the
lungs.
The iron and steel workers considered as a group in the mortality
experience of the Prudential Co. are made up of puddlers, rollers,
heaters, furnace tenders, laborers, and miscellaneous employees. In
view of the fact that heretofore no thorough analysis has been pre­
sented even of the principal groups of the iron and steel industry,
the details of the present analysis are included, even though for cer­
tain occupations the data are quite insufficient for a definite con­
clusion, for, as shown by the table concerning laborers, the large
majority of workmen in the iron and steel industry are not further
designated as regards the specific occupation followed than that it
is stated that they are “ laborers at iron and steel works.”
M O R T A L IT Y OF P U D D L E R S .

The mortality of puddlers includes 251 deaths from all causes,
26, or 10.4 per cent, of the deaths being from pulmonary tuberculosis.
This low phthisis mortality is of special significance, in view of
the relatively high mortality from nontuberculous respiratory dis­
eases, which is accounted for as follows: Asthma, 0.8 per cent;
bronchitis, 1.6 per cent; pneumonia, 12 per cent; other respiratory
diseases, 2 per cent; and for all nontuberculous respiratory diseases
combined, 16.3 per cent; which compares with 12.1 per cent for all
occupations in the iron and steel industry. The details for pul­
monary tuberculosis are shown in Table 19.
T able 1 9 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y TU BE R CU L O SIS AM ON G
P U D D L E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, C O M P A R E D
W IT H T H A T OF A L L M ALES IN U N IT E D STATE S R E G IS T R A T IO N A R E A , 1900 TO 1913,
B Y A GE GROU PS.
Per cent of deaths from
pulmonary tubercu­
losis among—

Deaths of puddlers,
1897 to 1914, from—
Age at death.
A ll causes.

15 to

Pulmonary
tuberculo­ Puddlers.
sis.

Males in
registration
area, 1900
to 1913.

24 ye a rs ...................... ...................................................
to 34 yea rs..........- ...............................................................
to 44 years............................................................................
to 54 y e a rs ..........................................................................
to 64 y e a r s .........................................................................
65 years and over...................................................................

4
21
36
60

4
9
5

19 .0
25 .0
8 .3

27.0
30.5
23.4
14.7

74
56

5
3

6.8
5.4

7.9
2.6

Total, 15 years and over.............................................

251

26

10.4

13.9

25
35
45
55

M O R T A L IT Y OF R O L L E R S .

The mortality of rollers includes only 112 deaths from all causes,
of which 20, or 17.9 per cent, were from pulmonary tuberculosis.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

75

The proportionate mortality was relatively high at ages 35 to 44, as
shown by Table 20.
T able 2 0 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U BE R CU LO SIS AM ONG
R O L L E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, C O M PA R ED
W IT H T H A T OF A L L M ALES IN U N IT E D STATE S R E G IS T R A T IO N A R E A , 1900 TO 1913,
B Y A G E GROU PS.

Deaths of rollers, 1897 Per cent of deaths from
pulmonary tubercu­
to 1914, from—
losis among—
Age at death.
Males in
registration
area, 1900
to 1913.

A ll causes.

15 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 years............................................................................
45 to 54 y e a rs ...........................................................................
55 to 64 years............................................................................
65 years and over.................................................................._
Tolal. 15 vp.nrs and ovp .r__

______ __________

Pulmonary
tuberculo­
sis.

12
21
17
20
16
26

1
6
5
4
3
1

8.3
28.6
29.4
20.0
18.8
3.8

27.0
30.5
23.4
14.7
7.9
2.6

112

20

17.9

13.9

Rollers.

In addition to the mortality from pulmonary tuberculosis the
mortality from other respiratory diseases was accounted for as fol­
lows: There were no deaths from asthma, but the mortality from
bronchitis was 3.6 per cent; from pneumonia, 8.9 per cent; from
other respiratory diseases, 0.9 per cent; and from all nontuberculous
respiratory diseases combined, 13.4 per cent, which compares with
16.3 per cent for puddlers, and 12.1 per cent for all employees in the
iron and steel industry.
M O R T A L IT Y OF H E A T E R S .

The mortality of heaters is even less representative, in that there
were only 51 deaths from all causes, of which 8, or 15.7 per cent, were
from pulmonary tuberculosis.
T able 2 1 .— P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y TU B E R C U LO SIS AM ONG
H E A T E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, C O M P A R E D
W IT H T H A T OF A L L M ALES IN U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1900 TO 1913,
B Y AG E GROU PS.

Deaths of heaters, 1897
to 1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
A ll causes.

Pulmonary
tuber­
culosis.

Heaters.

15 to 24 y e a r s ..........................................................................
25 to 34 y e a r s ..........................................................................
35 to 44 years............................................................................
45 to 54 years .......................................................................
55 to 64 years............................................................................
65 years and over ...............................................................

11
6
6
11
10
7

3
1
3

27.3
16.7
50.0

1

10.0

Total, 15 years and over.............................................

51

8

15.7




Males in
registration
area,1900 to
1913.
27.0
30.5
23.4
14.7
7.9
2.6
13.9

76

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

In so far as the data can be relied upon the mortality from pul­
monary tuberculosis was distinctly excessive. The mortality from
nontuberculous respiratory diseases in this group is accounted for as
follows: Asthma, 2 per cent; pneumonia, 5.9 per cent; all nontuber­
culous respiratory diseases combined, 7.8 per cent. There were no
deaths from bronchitis or other respiratory diseases.
M O R T A L IT Y OF FURNACE T EN D ER ?.

The mortality of furnace tenders is represented by only 62 deaths
from all causes, of which 4, or 6.5 per cent, were from pulmonary
tuberculosis. The details of the experience are shown in Table 22.
T able 2 2 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U LO SIS AM ONG
FU RN A C E T E N D E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914,
C O M PA R ED W IT H T H A T OF A L L M ALES IN U N IT E D S T A T E S R E G IS T R A T IO N A R E A ,
1900 TO 1913, B Y A G E G ROU PS.

Deaths of furnace ten­
ders, 1897 to 1914,
from—
Age at death.
A ll causes.

Pulmonary
tuber­
culosis.

Per cent of deaths from
pulmonary tubercu­
losis among— *

Furnace
tenders.

Males in
registration
area,1900 to
1913.

15 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55 to G years............................................................................
4
65 years and over....................................................................

4
7
11
9
16
15

3
1

27.3
11.1

27.0
30.5
23.4
14. 7
7.9
2.6

Total, 15 years and over.............................................

62

4

6.5

13.9

The mortality from other respiratory diseases in this group is
accounted for as follows: Pneumonia, 6.5 per cent, and other re­
spiratory diseases, 1.6 per cent; all nontuberculous respiratory dis­
eases combined, 8.1 per cent. There were no deaths from asthma or
bronchitis.
M O RTALITY OF LABORERS AT IRON AND STEEL W ORKS.

Laborers and allied unskilled employments not specifically re­
turned are obviously within the group of general employees at iron
and steel works, and they are represented by 2,788 deaths from all
causes, of which 628, or 22.5 per cent, were from pulmonary tuber­
culosis. The details of the experience are shown in Table 23.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

77

T able 23.—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y TU B E R C U L O SIS AMONG
L A B O R E R S , ETC., IR O N A N D S T E E L W O R K S , IN D U S T R IA L E X P E R IE N C E OF P R U ­
D E N T IA L CO., 1897 TO 1914, C O M P A R E D W IT H T H A T OF A L L M ALES IN U N IT E D
S TA TE S R E G IS T R A T IO N A R E A , 1900 TO 1913, B Y A G E G R O U PS.

Deaths of laborers,
etc., 1897 to 1914,
from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
A ll causes.

Pulmonary
tuber­
Laborers.
culosis.

Males in
registration
area.1900 to
1913.

15 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and o v er....................................................................

361
569
604
492
422
340

113
202
189
77
38
9

.31.3
35.5
31.3
15.7
9.1
2.6

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over..............................................

2 788
,

628

22.5

13.9

Of the mortality from other respiratory diseases, 0.8 per cent
were deaths from asthma, 1.2 per cent from bronchitis, 9.1 per cent
from pneumonia, 1.5 per cent from other respiratory diseases, and
12.6 per cent from all nontuberculous respiratory diseases com­
bined.
M ORTALITY OF MISCELLANEOUS EMPLOYEES AT IRON AND STEEL W O RK S.

The remaining occupations, including nail makers, forgemen, iron
melters, etc., are combined in the group of miscellaneous iron and
steel workers in Table 24. There are only 68 deaths reported in this
group, of which 14, or 20.6 per cent, were from pulmonary tuber­
culosis.
T able 2 4 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U LO SIS AM ONG
M ISCE LLA N EO U S IR O N A N D S T E E L W O R K E R S , IN D U S T R IA L E X P E R IE N C E OF
P R U D E N T IA L CO., 1897 TO 1914, C O M PA R ED W I 1 H T H A T OF A L L M A LE S IN U N IT E D
STA TE S R E G IS T R A T IO N A R E A , 1900 TO 1913, B Y A GE G R O U PS.
Deaths of miscellane­
ous iron and steel
workers, 1897 to 1914
from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
A ll causes.

Pul­
monary
tubercu­
losis.

Miscellane­ Males in
ous iron
registration
and steel
area,
workers. 1900 to 1913.

15 to 24 years............................................................................
95 to 34 vears .......................................................................
35 to 44 years............................................................................
45 to 54 y e a rs ..........................................................................
55 to 64 vears............................................................................
65 years and over ................................................................

11
6
10
14
12
15

4
2
5
2
1

36.4
33.3
50.0
14.3
8.3

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over............................. ...............

68

14

*20. 6

13.9




•78

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

The excessive mortality from pulmonary tuberculosis in this group
is of special significance, in that most of the men are exposed to
arduous strain, heat, dust, weather changes, etc. The mortality from
other respiratory diseases in this group is as follows: Asthma, 2.9
per cent; bronchitis, 7.4 per cent; pneumonia, 10.2 per cent; or, from
all nontuberculous respiratory diseases combined, 20.6 per cent. It
is, therefore, shown that both tuberculous and nontuberculous lung
diseases are proportionately more common in this relatively small
but important group, however ill defined, than among heaters, fur­
nace tenders, rollers, and puddlers.
EVIDENCE OF UNSATISFACTORY HEALTH CONDITIONS.

The experience, of course, is too limited for entirely safe conclu­
sions, but it is distinctly suggestive of more or less unsatisfactory
health conditions, apparently predisposing to both pulmonary tuber­
culosis and nontuberculous respiratory diseases. It is, therefore, re­
grettable that there should be no other statistics useful for the
present purpose, for regardless of the considerable development of
the iron and steel industry in England and Wales, the employees
are not separatety returned, except under the rather general term
of nail, anchor, chain, and other iron and steel manufactures. This
group included, according to the census of 1901, 220,000 males above
the age of 15 years, of whom 216,000 were actively at work. It is
T
said in the report of the registrar-general that—
In this industry the mortality at every stage of life is above the
standard for occupied and retired males, the excess ranging from 4
per cent at ages 20 to 25, to 25 per cent at ages 65 and upward. At
every stage of life the death rate exceeds the average for metal
workers generally. In the main working period the comparative
mortality figure is 1,187, or 18 per cent above the standard. These
workers appear to suffer heavily from influenza and respiratory dis­
eases, the former being above the standard by 29 per cent and the
latter by 79 per cent. The mortality from diseases of the circulatory
system is also above the average by one-fifth part, but on the other
hand that from alcoholism and liver disease and from suicide is
below the standard.
It should be said, however, in this connection that there has been
a marked decline in the mortality of the group under considera­
tion during the preceding decade, equivalent to a reduction of nearly
25 per cent, the decline having occurred in practically every group
of diseases excepting cancer. The decline was most noticeable in the
case of influenza, phthisis, and respiratory diseases. The data^ how­
ever, must be used with caution in view of the fact that the group
includes too many widely different industries and employments to
be strictly representative for any one of them.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

79

ENGLISH MORTALITY STATISTICS.

The same observations, unfortunately, apply to other important
occupations in the iron and steel industry with more or less exposure
to metallic dust, combined in a single group in the official English
statistics under “ Engine, machine, boiler makers; fitters, millwrights,
engine fitters, etc.” This group in 1901 was represented by 351,000
persons, of whom 345,000 were actively at work. It is said with
reference to this group that—
In these occupations taken together the death rates were below the
standard for occupied and retired males at every age group except
55 to 65 years, the rates for boiler makers being below those for
engine fitters at ages under 25 and over 65 years but above them
throughout the main working period of life. The comparative mor­
tality figure from all causes was 913^ or 9 per cent below the standard;
the figure for engine makers being 893, or 11 per cent below the
average, while that for boiler makers was 1,032, or 3 per cent above
it. Among these workers collectively the mortality from nervous dis­
eases slightly exceeded the standard, but from digestive diseases and
from accident and suicide their mortality was below it. If the fig­
ures for engine fitters and boiler makers be compared, it will be
seen that the first-mentioned workers experienced higher mortality
than the latter from influenza, phthisis, and Bright’s disease, but
under every other heading the mortality of boiler makers exceeded
that of engine fitters. Engine fitters appear indeed to be by far the
healthiest section in the entire class of metal workers.
The preceding observations can not be said to apply with even
approximate conclusiveness to the iron and steel industry as the term
is generally understood and used in the United States. Most of
the occupations involve a fair amount of metallic-dust exposure
which under given conditions, such as, for illustration, in the case of
boiler makers, may assume serious consequences. The relative mor­
tality from phthisis among engine makers, fitters, millwrights, etc.,
or what in the United States would generally be considered ma­
chinists, in the broad sense of the term, was only 88 against 100
for occupied and retired males, and the corresponding mortality
from nontuberculous respiratory diseases was only 85; but for
boiler makers the relative mortality from phthisis was 80, while for
nontuberculous respiratory diseases it was 119. In contrast, it may
be pointed out that the relative mortality from phthisis for cutlers
and scissors makers was 285, and for file makers, 207. It may fur­
ther be said in this connection that the relative mortality from non­
tuberculous respiratory diseases was 178 for cutlers and scissors
makers, and 184 for file makers. In each and every comparison of
this kind the mortality of occupied and retired males from the dis­
eases stated is taken as 100.




80

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

RECENT ENGLISH OCCUPATIONAL-DISEASE INVESTIGATIONS.

Some exceptionally interesting observations on “ Industrial dis­
eases prevailing amongst iron and steel workers in the Middles­
brough district of England,” by J. Watkin Edwards, have been made
available through the British Medical Journal (July 22, 1916). In
a brief outline of the conditions which influence life and health in
industry it is observed that—
(а) The effects of overcrowding are more harmful during active
work than when workers are at rest; and
(h) The evils of overcrowding are aggravated by:
(1) Exposure to changes of temperature;
(2) Inhalation of dust and irritating particles;
(3) Absorption of chemical poisons; and
(4) The effects of undue strain and exertion.
A formula is presented according to which if the amount of air
inspired while at rest equals 1, the amount inspired when standing
erect is 1.3, and while walking at the rate of 4 miles per hour
is 5. It is, therefore, suggested that every effort should be made
in industrial towns toward making the lot of the workmen, both
while at work and when off work, as perfect as possible. In the
T
district of Middlesbrough pneumonia prevails to an alarming extent,
being nearly four times as frequent as pulmonary tuberculosis, and
more than three times as common as bronchitis. It is explained, how­
ever, that “ these figures do not at all fully represent the amount of
industrial disease prevailing in the town for there are many minor
complaints which do not appear as causes of death, but which give
patients a great deal of pain and practitioners a great deal of
trouble.” The local adverse influences which appear to affect the
general death rate, especially with reference to the mortality from
industrial diseases, are said to be:
(1) Working at high temperatures.
(2) Long hours of work, fatigue, insufficient rest, sleep, and recrea­
tion.
(3) Working at night.
(4^ Careless exposure to cold and wet.
(5) Intemperance.
(б) Inhalation of dust.
(7) Inhalation of poisonous gases, such as CO.
(8) Trauma.
With special reference to pulmonary tuberculosis it is stated that—
This condition was the cause of 70 deaths amongst males. The
causes which -lie at the root of its prevalence are:
(a)
Inhalation of dust at the works (where it is chiefly composed
of inorganic particles), but especially in our streets and dwellings
and places where people congregate. The disease known as pneu­
moconiosis is known to kill large numbers of Staffordshire potters,
Cornish and Transvaal miners, and Sheffield grinders. Dust from




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

81

any cause, especially that produced in the manufacture of manure
from basic slag, causes bronchitis, asthma, chronic cough and emphy­
sema, and pneumonia, and, no doubt, predisposes the body to the
attacks of the tubercle bacillus. As these dust diseases develop in­
sidiously, the workmen engaged in such occupations should have their
chests examined periodically, and any signs of commencing disease
should be regarded as a disqualification for that particular kind of
employment.
MORTALITY FROM PNEUMONIA AMONG ENGLISH IRON AND STEEL
WORKERS.

On account of the exceptional mortality from pneumonia among
males in the Middlesbrough district, it is of interest to note that
during the working period of life, that is, ages 25 to 65, the death
rate in the county boroughs of the North of England was 1.6 per
1,000; in Sheffield it was 1.2 per 1,000; in Middlesbrough, among
females, 0.9 per 1,000; and in Middlesbrough, among niales, 3.4 per
1,000. It is said in this connection that “ The death rate from pneu­
monia in Middlesbrough is between two and three times higher than
in the county boroughs of the North, in Sheffield, and in the country
generally among males between the ages of 25 and 65 years, while it
is between three and four times higher than that among females in
Middlesbrough.” With respect to possible occupational causes, in
explanation of the excessive mortality from pneumonia, the follow­
ing conditions are emphasized:
{a) Working in high temperatures with sudden exposure to cold,
strong currents of air, and to powerful blasts of fiery and^suffocating
gases.
(b) Inhalation of dust of various kinds, and especially dust given
off in the manufacture of slag manure.
(c) Injuries of any kind, especially to the chest.
(d) Excessive fatigue, especially after nightwork.
(e) Careless habits after leaving work.
(/) Intemperance in food and drink.
In the majority of cases it is held that “ the disease is conveyed by
autoinfection. A condition of lowered resistance, due to one or
more of the above causes, furnishes a state of ill health favorable to
the growth of an organism either already present in the mouth or
throat of the patient or inhaled with dust or bad air.” It is there­
fore suggested that patients who have suffered from pneumonia (as
well as those who have not) should exercise the greatest care in
keeping their teeth, mouth, and throat in a healthy condition. On
account of the fact that pneumonia in Middlesbrough is of a very
fatal type, accounting for one-fifth of all the deaths in 1911, it is
advised that—
The sputum should be carefully destroyed as soon as possible. For
this purpose the patient should expectorate into squares of paper or
106811°— 18— Bull. 231------ 6




82

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

into small cardboard receptacles containing a layer of common salt
or other suitable disinfectant, and the whole destroyed at frequent
intervals by fire. Every reasonable care should be taken to prevent
the patient coughing into the faces of the attendants, or onto the
bedclothes, or upon the floor; such accidents frequently happen, especially in the case of semiconscious patients. The infected spots should
be scrupulously cleaned with turpentine or spirit, and the clothing
of the nurses and of those in attendance should be protected by over­
alls. The rooms in which pneumonia patients have been treated
should be thoroughly disinfected, and I am glad to observe that this
is now being undertaken by the municipality.
GENEEAL CONCLUSIONS.

The foregoing observations regarding pneumonia are of special
importance in view of the obvious conclusion that the disease is
unquestionably increased in frequency and possibly in severity by
more or less continuous and considerable exposure to irritating
metallic and mineral dust. That similar conditions prevail, though
probably to a lesser degree, in the United States is made evident
by a recently issued technical paper by the United States Bureau of
Mines on Health Conservation at Steel Mills, by J. A. Watkins, of
the United States Public Health Service. The paper includes
observations on the medical supervision of employees, hospital facili­
ties, fatigue as a cause of occupational disability, the relation of
industrial buildings to the .health of employees, noise as a cause of
flowered efficiency, ventilation, temperature and humidity, hours of
duty, washing and sanitary facilities, drinking water, food, etc.
There are, fiowever, no observations in this interesting discussion on
industrial diseases as such, and no reference whatever to the dust
menace as common to a number of special processes in the iron and
steel industry, chiefly, of course, in grinding and polishing during the
final processes of manufacture. The discussion is, therefore, general
and has reference rather to sanitary conditions than to occupational
hazards, and a much more specialized investigation would be neces­
sary to establish the occupational-disease hazard in the American
steel industry as carried on under modern conditions at such model
plants as that at Gary, Ind., of which an admirable descriptive
account was published in the Engineering and Mining Journal for
December 26, 1908.
M ETAL GRINDERS.
THE HYGIENE OF METAL GRINDING.

The grinding trade includes a large variety of employments, of
which metal grinding, by either the dry or wet process, is hygienically as well as industrially the most important. The grinding of
metal probably involves as much exposure to decidedly health-in­




OCCUPATIONS W IT H EXP0SU BE TO M ETALLIC DUST.

83

jurious conditions as does any other employment, if not more so.
Chiefly as the result of the inhalation of relatively large quantities
of fine metallic dust, and not inconsiderable quantities of fine mineral
dust, the mortality from pulmonary tuberculosis in this occupation is
decidedly above the normal for occupied males generally. While the
sanitary and other conditions injuriously affecting the health of
metal grinders never have been so notoriously bad in the United
States as in England or in continental Europe, the observed mortality
of this occupation as carried on in this country fully warrants the
most serious conclusions as to the health-injurious effects of this
group of employments.
The mortality of metal grinders has been discussed by James H.
Lloyd, M. D.? in his treatise on “ Diseases of occupations,’' included
in the Twentieth Century Practice of Medicine, published in 1895.
Lloyd, after calling attention to the well-known fact that the trade
of the grinder is conspicuous above all others for the suffering that
is entailed from the inhalation of metallic dust, describes in detail
the different processes of grinding and their relation to health. He
says in part:
Grinding edge tools is of two kinds—wet and dry. The latter
method is by far the more injurious, as, naturally, it raises far the
greater amount of dust. For some tools both methods are used—the mixed method. The tools ground are scythes, saws, table knives,
machine knives, various other kinds of edge tools, files, penknives,
razors, scissors, forks, needles, etc. A great difference in their bad
effects is observed among the branches of the trade according as the
grinders use the wet or dry method and according to the tool ground.
The smaller objects are far the most trying and exacting upon health.
The worst of all branches are the fork grinding and needle grinding.
This is because in grinding these small objects the workman is obliged
T
to lean close over the stone and therefore inhales larg~e quantities of
the dust, and also because the dry grinding is used.
The dust raised by grinding is composed largely of minute bits of
steel. According to Hall, 12 razor blades forged in the rough, which
weigh 2 pounds and 4 ounces, lose 10 ounces in the process of grind­
ing. This loss represents so much fine metallic dust, mingled of
course with dust from the stone. This statement gives some idea of
the immense amount of dust produced by dry grinding. According
to Holland the concrete masses of this dust formed in needle grinding
have almost the specific gravity of iron.
TYPICAL [DISEASES OF GRINDERS.

In discussing the symptoms of the diseases typical of grinders as
the result of their employment, Lloyd points out further that—
They are those of a slowly advancing bronchitis with asthma and
sometimes with emphysema; later dilated bronchi with excavation
are observed; then, consolidation, and breaking down of lung tissue




84

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES. .

occur as the terminal processes. The exact relationship of these
processes to a tubercular infection in grinders is an interesting and
important subject, which, of course, did not receive much light from
the earlier writers. They endeavored, in fact, to draw distinctions
between true 6 consumption ” and grinders’ 6 asthma,” but the st^te
6
6
of pathological knowledge in their day was not such as to permit
them to do otherwise. It is quite evident from reading their reports
of cases that they had to do with a disease that was essentially
tubercular, but it would be interesting to have the exact relationship
of this infection to the grinders’ unwholesome occupation investi­
gated by the methods of modern bacteriology. I do not know
whether this has ever been done. There can be no doubt that the
influence of the grinder’s trade is that of a predisposing cause. The
inhalation of the irritating particles of steel into the lungs causes
a constant catarrhal bronchitis and pneumonitis, with increase of con­
nective tissue; and this prepares the soil for a tubercular infection
which characterizes the latter stages of the disease.
INJTJMOTJSNESS OF DRY-GRINDING PROCESSES.

A recent and more qualified discussion of the health-injurious cir­
cumstances of dry and wet grinding is by Oliver, who, in his Diseases
of Occupation, goes fully into all the details concerning the trade,
including a brief account of the corresponding conditions in the cut­
lery manufacture of Germany, at Solingen:
So far as the two methods of grinding cutlery are concerned, the
dry method is, from a health point of view, the more dangerous to
the workers. The dust is dry, and is in the form of a very fine
powder, which readily reaches the lungs owing to the attitude of the
men when at work. Steel grinders sit astride the grinding stone on
a saddle, and as they lean forward keeping close to their work, they
can not but inhale some of the dust, which is a mixture of steel and
stone. Forks and needles are generally ground by the dry method;
knives, scissors, and razors by the wet. Some are ground by both
methods, e. g., the backs of razors and scissors are ground by the dry
method and the remainder of the blade by the wet. It was in 1865
that Dr. T. C. Hall, of Sheffield, drew attention to the high death
rate of steel grinders from pulmonary phthisis. The average age at
death, of steel grinders was at this period only 29 years, but of late
this has improved. Dr. Hall’s statistics referred to dry grinding.
In wet grinding the running stone passes through a thin layer of
water in a trough below the stone, so that, as its surface is always
kept wet, comparatively little dust is given off during the process
of grinding; but while the atmosphere is clearer of dust, the floors
and walls of the workshop are damp and cold. The grinding is
carried on in rooms called “ hulls,” which are bounded by three blank
walls; the windows are without glass. Where dry grinding is car­
ried on there are fans, but these often prove ineffective. It is no
uncommon thing to find men engaged in different processes in one
large room, so that the dust which is generated affects not only the
workman sitting at his own grinding stone, but the other inmates
of the room as well. In Sheffield it has been ascertained that in




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

85

every 1,000 deaths among steel grinders pulmonary phthisis is the
cause of 345 and other respiratory diseases 295; that is, collectively,
pulmonary diseases account for 64 per cent of the entire mortality,
whereas among the adult population of the country generally phthisis
accounts for 144 deaths per 1,000 and other respiratory diseases
182, or collectively 32.6 per. cent. Steel grinders die comparatively
young. Dr. Sinclair White, in Dangerous Trades, page 414, says
that 458 grinders in every 1,000 die between the ages of 35 and 55,
compared with 261 in every 1,000 of the entire male population of
the country. Only 140 grinders out of every 1,000 reach the age of
55 and upward, whereas for every 1,000 of the adult male popula­
tion 391 reach 55 years and upward. Sinclair White is of the
opinion that phthisis is not so rife among steel grinders as formerly.
In Dr. Hall’s time the average age at death from phthisis was 29
years; at present it is 43.1
IMPROVEMENT IN THE HEALTH OF GERMAN CUTLERY GRINDERS.2

With reference to conditions in Germany and the remarkable im­
provement which has followed the introduction of sanitary precau­
tions, rational methods of ventilation, and other means of dust
prevention, Oliver holds:
In the town of Solingen and the neighborhood it is estimated that
there are 29,000 persons employed in making cutlery. Here all sorts
of steel goods are made— knives, forks, scissors, and swords. A good
deal of the work is done by the people in their homes, and it is inter­
esting to know that the home industry is rather encouraged by the
local authority, which provides the men with gas and electric power.
So prevalent is pulmonary consumption among the grinders in So­
lingen that it has attracted the attention of the Government factory
department. In the 10 years 1885-1895, 72.5 per cent of the deaths
among knife grinders in the Solingen district was due to phthisis,
against 35.3 per cent for the rest of the population over 14 years of
age, and an official examination showed that out of 1,250 grinders only
85 men were over 45 years of age. Dr. Shadwell speaks approv­
ingly of the methods adopted in some of the Solingen factories to deal
with the removal of dust. Oldeiidorf, in writing about che grinders
at Solingen, states that 24.7 per cent reached 50 years of age and 3.3
per cent 70; that at Runsched 33.8 per cent reached 50 years and 8
per cent 70; while at Kronenberg the numbers were 32.9 and 8.7,
respectively. The mean age at death of grinders employed in the
dry methods was 39.4, of workers in iron 48.3, and of the rest of the
male population 54.4 years. Taking all ages, the deaths from tuber­
culosis per 100 cases were for grinders 78.3, iron workers 59, other
persons 46.3
1 D iseases o f O ccu p a tion , T h om a s O liver, pp. 230, 231, L o n d o n , 1908.
2 In th is co n n e ctio n see “ G esu n d h eitsbu ch fu r die K le in e is e n -In d u s trie ,” v o n D r. G. D.
O rthm ann, B erlin , 1899 ; “ G ew erb lich e G esu n d h eitsp flege,” von D r. A . B ender, S tu ttg a rt,
1906 ; “ H a n d b u ch der A rb eiterk ra n k h eiten ,” v on D r. T h e o d o r W e y l, J en a , 1908.
3 D iseases o f O ccu p a tion , T h om a s O liver, p. 232.




86

MORTALITY FROM RESPIRATORY DISEASES IK DUSTY TRADES.

SANITARY PRECAUTIONS IN GERMAN CUTLERY SHOPS.

A very interesting account of the mortality of cutlery grinders in
Solingen was also included in the Report of the Chief Inspector
of Factories and Workshops of England for 1906, from which an
abstract is made to emphasize the sanitary and labor conditions
required for the reduction of the mortality of grinders to a minimum:
The atmosphere of Solingen is bright and clear. It is seldom that
black smoke is seen escaping from the factory chimneys. This is
largely the result of careful firing and the use of coal briquettes in­
stead of ordinary coal, which avoids the use of slack coal. The day’s
actual work is nine hours; on Saturday work ceases at 5.30 p. m.
The factories in Solingen are said to be marvels of order and cleanli­
ness ; the floors are of concrete and the air space for each worker must
be at least 565 cubic feet. Al] the grinding stones are protected by
guards. The walls of the workrooms are limewT
ashed every year; the
floors are swept every evening and damp-wiped once a week. The
u raising ” of grindstones is never undertaken during working hours
except under a stream of water or unless the stone is entirely inclosed
in casing except at the working place of the raising tool. The floors
are kept clean and provision is made for the removal of the dust
during grinding. Cutlery manufacture is recognized as a dangerous
trade in Solingen, and in recent years considerable improvement has
taken place in the means to prevent dust. In Solingen the grind­
stones and polishing wheels are run toward the worker; in Shef­
field they are run away from the worker, so that the dust has an
upward tendency and flies into the room.1
The subject is also considered in the Report of the Chief Inspector
of Factories and Workshops for 1907, in which the rules or police
regulations governing the trade at Solingen are republished in full.
A remarkable improvement in the health of the workmen has fol­
lowed the introduction of these rules.2
MORTALITY OF SHEFFIELD METAL GRINDERS.

Some exceptionally interesting and useful mortality data of m
efcal
grinders have been published for a period of years by the city of
Sheffield^ England, but unfortunately the statistics were discontinued
subsequently to 1910. Table 25 shows the mortality in detail of
2,190 grinders, of whom 1,070, or 43 per cent, died from pulmonary
tuberculosis, with an additional mortality of 621, or 24.9 per cent,
from nontuberculous respiratory diseases.
1 R e p o rt o f th e C h ief In s p e cto r o f F a c to r ie s an d W ork sh o p s, 1906, pp. 1 0 7 -1 0 9 .
2 F o r a d d itio n a l re feren ces on th e o cc u p a tio n a l d iseases o f G erm an file m akers and
rela ted in d u stries, see A lb rech t, H a n d b u ch d er P ra k tisch e n G ew erb eh yg ien e, B erlin , 1898,
pp. 96 a n d 7 9 6 ; S om m erfeld , H a n d b u ch der G ew erb ek ra n k h eiten , B erlin , 1898, p. 365
( in c lu d in g sta tem en t th a t a v era g e age a t d eath f o r file cu tte rs d y in g fro m p u lm on a ry
tu b ercu los is w a s o n ly 41.2 y ea rs an d from all oth er d iseases 46.1 y e a r s ).
O f special
im p o rta n ce is the m ore exten d ed d iscu ssion o f th is o cc u p a tio n in W e y l’s H a n d b u ch der
A rb eiterk ra n k h eiten , J en a , 1908, p p. 80, 91, 106, 135 e t seq.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

87

T ABLE 2 5 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y TU B E R C U L O SIS A N D
FR O M O T H E R R E S P IR A T O R Y DISEA SES C O M PA R E D W IT H T H A T F R O M A L L CAUSES,
AM ONG G R IN D E R S IN S H E F F IE L D , E N G L A N D , 1889 TO 1910, B Y A G E G R O U PS.
[Source: Annual reports of the medical officer of health, Sheffield, England.
able in these reports subsequent to 1910.]

Similar returns are not avail­

Deaths from pulmonary
tuberculosis.
Age at death.

Deaths
from all
causes.
Number.

Per cent of
deaths
from all
causes.

Deaths from respiratory
diseases o t h e r than
pulmonary tubercu­
losis.

Number.

Per cent of
deaths
from ail
causes.

Under 25 years..................................................
25 to 34 years.....................................................
35 to 44 years.....................................................
45 to 54 years ...................................................
55 to 64 years.....................................................
65 years and over.............................................

98
299
515
687
548
343

43
173
303
336
178
37

43.9
57.9
58.8
48.9
32.5
10.8

22
51
81
169
184
114

22.4
17.1
15.7
24. 6
33.6
33.2

T otal........................................................

2,490

1,070

43.0

621

24.9

According to this table, at ages under 25 of every 100 deaths from
all causes 43.9 are from pulmonary tuberculosis, the proportion in­
creasing to 57.9 per cent at ages 25 to 34, and 58.8 per cent at agss
35 to 44. Subsequently to this period the proportion declines to 48.9
per cent at ages 45 to 54, and to 32.5 per cent at ages 55 to 64; at
ages 65 and over the proportion of deaths from pulmonary tuber­
culosis is only 10.8 per cent of the mortality from all causes. The
corresponding mortality from nontuberculous respiratory diseases
must also be considered excessive at practically every period of life.
In view of the frequent use of the term “ grinders’ phthisis,” as
based chiefly upon the morbidity experience of Sheffield grinders,1
the following observations by J. M. Beattie, M. D., are of interest.
The extract is from a paper on the “ Hygiene of the steel trade,” pub­
lished in the Transactions of the Royal Sanitary Institute for 1912:
A great deal of attention has been centered on the dust problem,
and much of the legislation relating to the industries with which we
are dealing is concerned with the protection of the workers from dust
inhalation. The much more serious problem—the prevention of in­
fection with B. tuberculosis—has not received justice at the hands of
factory inspectors and factory legislators. During a five years’ ex­
perience in Sheffield it has been abundantly demonstrated that the
cutlers and grinders die from tuberculosis and not from nontuberculous fibrosis of the lung.
Let me protest against the loose use of the word “ phthisis.” Rightly
or wrongly, phthisis is now understood by medical men to mean
1 R e ga rd in g hea lth co n d itio n s am on g Sheffield grin d ers see “ T he V ita l S ta tistics o f
Sheffield,” by G. C. H ollan d, M. D., L on d on , 1843, pp. 1 5 2 -2 0 5 ; “ U nhealthy T ra d e s,” by
B. W . R ich a rd son , L ectu res b efore the S ociety o f A rts. R ep rin ted in S cien tific A m erican
Supplem ent No. 9 (F eb . 26, 187 6 ) ; “ M o r ta lity o f D u sty T ra d es in Sheffield,” by S curfield. B ritis h M ed ica l Jou rn al, A ug. 22, 1908, p. 4 8 0 ; “ A nnu al R e p o rts on the H ea lth o f
Sheffield, E n g la n d ,” S pecial T ables and O bservations on M o r ta lity in Sheffield T ra d es,
1 88 9 -1 9 0 7 .




88

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

tuberculosis of the lung* with cavity formation; and the term “ grind­
ers’ phthisis ” should be confined to that condition of the lung in
which tuberculosis is added to the interstitial fibrosis. For the condi­
tion which is produced by the inhalation of dust, the term “ fibrosis ”
is perhaps the most suitable; I shall, therefore, describe the condition
resulting from the inhalation of dust as fibrosis. The misuse of the
term “ phthisis ” makes it difficult to get at satisfactory statistics, and
we can therefore only regard the figures given as approximate.
MORTALITY OF GRINDERS— INDUSTRIAL INSURANCE EXPERIENCE,

No extended scientific study, medical or otherwise, has been made
of grinders’ phthisis, or the occurrence of pulmonary tuberculosis
among the grinders in the United States, but some suggestive obser­
vations on different aspects of the grinders’ trade have been reported
upon in detail by the division of occupational diseases of the Ohio
State Board of Health. The only conclusive mortality data for the
United States are the industrial insurance mortality statistics of the
Prudential Insurance Co., limited, however, to 305 deaths, of which
143, or 46.9 per cent, were caused by pulmonary tuberculosis. This
percentage is not much at variance with the corresponding figure for
Sheffield grinders, but is, in part, no doubt, the result of important
differences in age distribution, since the maximum number of deaths
in the United States occurred at ages 35 to 44, against ages 45 to 54
in the English experience. The excess in the mortality of grinders
from pulmonary tuberculosis is brought out with sufficient clearness
and conclusiveness in Table 26, in which comparison is made with
the corresponding mortality of males in the registration area.
T able 2 6 .— P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U L O SIS AMONG
G R IN D E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, C O M PA R E D
W IT H T H A T OF A L L M ALES IN U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1900 TO 1913,
B Y A GE G R O U PS,

1Deaths of grinders, 1897
to 1914, due to—

Per cent of deaths due
to pulmonary tuber­
culosis among—

Age at death.
All causes.

Pul­
monary
tubercu­
losis.

Grinders.

Males in
registration
area,
1900 to 1913.

15 to 24 vears............................................................................
25 to 34 years...........................................................................
35 to 44 vears............................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and over....................................................................

17
56
74
73
55
30

7
38
44
35
14
5

41.2
67.9
59.5
47.9
25.5
16.7

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over.............................................

305

143

46.9

13.9

According to this table, the proportionate mortality of grinders
from pulmonary tuberculosis is excessive at all ages, but most pro­
nounced at ages 25 to 34, when out of every 100 deaths from all
causes, 67.9 are from pulmonary tuberculosis, against 30.5 per cent
for males in the registration area. The data, while limited, may




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

89

be accepted as trustworthy regarding the mortality of grinders
from pulmonary tuberculosis in the United States at the present
time. The evidence is sufficient to show that the disease is of exces­
sive frequency among grinders at every divisional period of life, and
very considerably above the normal for the general male population.
MORTALITY OF INSURED GRINDERS— MEDICO-ACTUARIAL EXPERIENCE.

The foregoing observations are sustained by the medico-actuarial
experience, which, however, is only with reference to the mortality
from all causes. According to this experience, which includes cutlers,
scissors grinders, ax, plow, and other steel grinders, but excludes
foremen and superintendents, the actual mortality among 5,988 em­
ployees exposed to risk one year was 43 deaths, while the expected
mortality was 36.69, or 17 per cent in excess; in other words, to every
100 deaths expected on the basis of the normal experience there were
among the group considered 117. When the age factor, however, is
taken into account, it appears that at ages under 40 the actual mor­
tality was less than the expected, while there was a rapid and very
T
considerable rise in the excess at ages over 40. Unfortunately, the
numbers under observation are insufficient for strictly scientific con­
clusions. The results, in detail, are given in Table 27.
T able 2 7 .—M O R T A L IT Y FR O M A L L CAUSES AM ONG C U T L E R S A N D SCISSORS, A X ,
P L O W , A N D O T H E R S T E E L G R IN D E R S (E X C L U D IN G F O R E M E N A N D S U P E R IN T E N D ­
E N T S ), B Y AG E G R O U PS—M E D IC O -A C T U A R IA L IN V E S T IG A T IO N .

Age at death.

Number
exposed to
risk 1
year.

Actual
deaths.

E xpected
deaths.

Ratio of
actual to
expected
deaths.

15 to 29 years...........................................................................
30 to 39 years............................................................................
40 to 49 years............................................................................
50 to 59 years............................................................................
60 years and over....................................................................

3,208
1,841
667
254
18

12
9
10
12

14.55
10.19
6.17
5.04
.74

82
88
162
238

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

5,988

43

36.69

117

SANITARY INVESTIGATIONS BY THE OHIO STATE BOARD OF HEALTH.

Some very useful observations on the health of grinders have been
included in the report of the Ohio State Board of Health, by Hayhurst, who points out that—
The process of metal grinding is one closely associated with
foundry work and assembling processes upon both iron and soft
T
metals. It properly includes also the dressing of castings by other
means than grinding, such as “ sand blasting,” “ rattling ” in tumbling
machines, and “ chipping ” by means of steel tools. Sand blasting has
been considered elsewhere, while a word will be given here to each
of the other subsidiary processes. Metal grinding is usually per­
formed with emery wheels, which may be stationary or may be moved
about over large surfaces by means of a swing-belt attachment. Oc­




90

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

casionally it is done mechanically by a series of traveling emery
wheels, which pass up and down over the surfaces to be ground.
Sometimes it is done by belts covered with emery or other exceed­
ingly hard abrasive substances. Carborundum and corundum, two
substances of diamondlike hardness, are the chief abrasives used.
In the investigation by Hayhurst, including 64 establishments em­
ploying a total of 1,979 male wage earners, modern methods of work
were observed in 42 places, fairly modern methods in 14, and crude
or antiquated methods in the remaining 8. Health appliances, espe­
cially those consisting of blower systems to remove the dust created,
were considered good in 20 places, of only partial efficiency in 13, and
found entirely absent in the remaining 31. In 20 of the work places
other processes than metal grinding were carried on in the same
quarters, such as sand blasting, forging, welding, polishing, buffing,
etc. This condition is quite common throughout the dusty trades,
and illustrates the difficulty, if not the impossibility, of completely
separating one injurious process from another. As a broad generali­
zation, however, the present classification may be considered sufficient
for the purpose. The Hayhurst investigation, while limited to the
State of Ohio, may be considered fairly conclusive for the country
at large, although it is pointed out that—
It is probable that country-wide statistics w
^ould be much more
accurate, both because of the larger number of deaths and because
persons with bronchial or respiratory diseases have a strong tendency
to migrate to western States.
MORTALITY EXPERIENCE OP THE STOVE MOUNTERS’ INTERNATIONAL
UNION.

The investigation concludes with an interesting table of statistics
derived from a report submitted by the Stove Mounters’ Interna­
tional Union for the United States and Canada. These workers
are engaged only about one-fifth of their time in metal grinding,
and usually they are employed without the advantage of any pro­
tective devices whatever. Most of the time, however, they work in
an atmosphere more or less contaminated with fine metallic and
mineral dust. Table 28 is as follows:
T able 2 8 .—P E R C EN T O F D E A T H S F R O M E A C H S P E C IF IE D CAUSE AM ON G STO V E
M O U N TE R S TO W H O M D E A T H B E N E F IT S H A V E B E E N P A ID B Y T H E IR O R G A N IZ A ­
TION D U R IN G T H E P A S T F IV E Y E A R S , IN THE- U N IT E D S T A T E S A N D C A N A D A
(U N D E R D A T E OF S E P T . 17, 1914).




Cause of death.

Per cent.

Tuberculosis..............................
Heart disease.............................
A ccident.....................................
Pneumonia.................................
Other preventable causes___
Degenerative diseases...............
A ll other causes.........................

27.95
20.93
11.67
9.31
13.88
9.23
7.03

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

100.00

OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

91

GENERAL CONCLUSIONS.

The available evidence is, therefore, sufficiently conclusive that
metal grinding in probably any and all of its various forms must
be considered one of the most injurious occupations inciting a special
predisposition of the workers to tuberculous and nontuberculous
respiratory diseases. Aside therefrom, the Hayhurst investigation
ascertained in 17 plants an occurrence of 22 cases of industrial dis­
eases, as follows: Chronic lead poisoning, 5 cases; pulmonary
siderosis, 9; frequent attacks of brass poisoning, 2; bronchitis, 2;
pneumonia, 1; tuberculous empyema, 1; brush burns of the hands, 1;
conjunctivitis, 1.
The results seem to indicate generally unsatisfactory working
conditions, and they sustain the statement made by Hayhurst
that—
The better control of the dust is the first essential, while shorter
work hours, alternation of work to overcome monotony, and the
features mentioned under the respective hazards above, as well as
medical examination and supervision, are necessary to control health
iii this entirely unnatural and hazardous process.
Concerning the conflicting character of the official vital statistics
of grinders, it is stated in this connection, in the rej>ort on the draft
regulations proposed to be made for factories in which the grinding
of metals and the racing of grindstones is carried on, by Alfred
Herbert Lush (Parliamentary paper Cd. 4913, London, 1909) that—The figures were not in all respects easy to reconcile; but it was
clearly established that both the wet and the dry grinders were
affected by diseases of the respiratory organs, and especially by
fibrosis of the lungs and by phthisis, to an extent far beyond the
average of occupied males, the mortality from phthisis amongst them
being six times that average. The men who enter these trades are
usually above the ordinary standard of physique and vigor, because
weakly men are unsuited to the work; yet the proportion of damaged
lives found by Dr. Collis was very heavy, and the duration of life
is nearly the lowest of all the trades. The cutlers, who are said to be
as a rule of weaker physique to begin with, suffer less from phthisis
and have longer lives; but they appear to be more liable to the minor
diseases due to dust irritation, and in no respect can their health
conditions be considered satisfactory.
This report is an exceptionally valuable contribution to the prac­
tical study of dusty trades, and should be consulted in further
amplification of the observations on the special circumstances and
conditions tending to increase the exceptional liability of grinders to
pulmonary tuberculosis.1
1 See in th is con n ection “ T h e s tory o f the g rin d in g w h e e l,” by C. W . B lakeslee,
in T h e Iron A ge, rep rin ted in the S cien tific A m erican Supplem ent No. 2125, Sept. 23,
1916. M en tion should a lso be m ade o f th e rep ort on the d r a ft re g u la tio n s p rop osed f o r
fa cto rie s and w ork sh op s in* w h ic h the p rocess o f file cu ttin g by h a n d is ca rrie d on, b y
C hester Jone^ (P a rlia m e n ta ry p a p er Cd. 1658, L on d on , 1 9 0 3 ).




92

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

POLISHERS.

The polishing of metal ware is a widely diversified trade, and the
term u polisher ” is one of general rather than of special significance.
Under the term are included metal polishers and buffers working
upon steel, brass, gold, and silverware, but no data are available
which would permit of a proper classification of polishers according
to the metal or material manipulated.
POLISHING PROCESSES IN RELATION TO DUST.

The health-injurious effects of this employment have been recog­
nized by all who have written upon the mortality of dusty trades, and
the more important facts are summarized by Arliclge, in part, as
foil ows:
After being shaped and ground to the required dimensions, the
next business is to burnish or polish the articles. This is accom­
plished by wheels covered by leather, and also by a thick bundle of
linen rags cut and bound together in the form of a wheel, and which,
by rapid rotation, assumes the character of a solid mass, and, at the
same time, one so soft as to serve better than any other contrivance
for the purpose of surface polishing. To assist in giving polish to
the articles made, various powders are employed; for example, emery,
whiting, rouge, powdered pumice, etc. The use of these materials
adds vastly to the dust of the trade and to its pernicious results;
but no data are in existence to indicate what is its share in the causa­
tion of disease as compared with the dust of the grindstones. Still,
no question exists that these polishing powders, differing as they do
among themselves in physical qualities, differ likewise in the range
of their effects upon the lungs.
The rather involved circumstances affecting the polishers’ health
and mortality are also discussed in The Workers of the Nation, by
Mr. Gilson Willets, whose attention appears to have been attracted
by the particularly health-injurious conditions of the employment,
and whose conclusions are decidedly suggestive:
Metal polishers who have reached the age of 40 often look like old
men. There can hardly be found a trade more deleterious to health,
say those who follow it. Among the harmful conditions may be
mentioned the liability of the workmen to get their lungs full of
flying and impalpable dust, which is composed of metal, minerals,
and cotton fiber. They are also, in many cases, deprived of the
proper supply of light, and great injury to the eyes thus arises.
It is not easy to wear goggles or glasses, as the operator’s sight must
be of the keenest in order to detect blemishes. There are laws for the
protection of this class of workmen, but they are too seldom em­
ployed. New York statutes require that at each polishing lathe there
shall be an exhaust fan to carry off the dust, that each operative
shall have 250 cubic feet of air space, and plenty of light. It
has been claimed that not in 5 per cent of the shops do these desirable
provisions prevail. A buffing wheel, making 2,500 revolutions per




OCCUPATIONS W IT H EXPOSUKE TO METALLIC DUST.

93

minute, has wrecked many constitutions. From it, as the polisher
applies the metal, a cloud of dust arises, made of particles of cloth
and metal, and that is what the operator breathes. Generally the
.windows are hermetically sealed. Often the walls and floors are
covered with the accumulation of years. In the process of brighten­
ing silver-plated material there is given forth by the wheel a cloud
of dust of which crocus is a large constituent, while from the plating
room come fumes of nitric acid. In the process of polishing chande­
liers there is much dust set free, which is composed of particles of
brass, and permeates the air of the shop. Metal polishers often do
not care to complain, because their wages are high. Here is a good
field for activity among the factory inspectors, who should force em­
ployers to maintain proper conditions in the shops.1
SICKNESS EXPERIENCE OF THE METAL POLISHERS’ UNION.

More recent evidence has been presented in the published sickness
and mortality experience of the Metal Polishers’ Union, regarding
which it has been stated that—
The treasury of this union, in spite of the fact that the men are
steady and have no special temptations to excess, was found to be
constantly exhausted. The reason is that the death claims eat up all
the funds. An investigation of these claims showed that many of
the men were dying from pulmonary tuberculosis. There were some
deaths from accident, a few suicides, but the rest were all from pul­
monary diseases— and pneumonia was very rare as compared with
phthisis. The statistics for the last four years show that in 1903, 45
metal polishers died, of whom 43 succumbed to some lung trouble.
In 1904 there were but 38 deaths among the metal polishers, of which
T
only 3 were due to other causes than pulmonary disease. In 1905
there were 70 deaths among the metal polishers, 65 of which were due
to some form of lung trouble. In New York City a local union
having 170 men working exclusively on the precious metals had 8
death claims in two years, 7 being due directly to tuberculosis, while
400 men employed in all the other branches of the same industry
have had but 3 deaths from this cause in the same space of time.
A medical journal", commenting upon the above-quoted facts at the
time of their publication, argued very pointedly to the effect that—■
It would seem from these statistics that even the cleanest kinds of
dust, without a trace of infectious material in them, may still prove
a source of the greatest possible danger and be the indirect cause of
tuberculosis. This has been known for some time, but so startling a
confirmation of it is sure to emphasize the necessity for taking every
precaution for the avoidance of dust. Even what might seem to be
the most innocuous of dirt particles may, when inspired, constitute
foci of irritation in which tubercle bacilli may readily find a favor­
able nidus for implantation and growth.
The results of the earlier investigations by the Metal Polishers’
Union are in part confirmed by the statistics of the Metal Polishers,




1 The Workers of the Nation, Vol. I, p. 57.

94

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

Buffers, Platers, Brass, and Silver Workers’ Union of North America,
which, for the 5-year period from 1909 to 1914 include 242 deaths
from all causes, of which 31.9 per cent were from tuberculosis. The
details of the mortality analysis are as follows:
T able 2 9 .—N U M B E R A N D P E R CEN T OF D E A T H S D U E TO EACH S PE C IF IE D C A U S -,
AM ON G M E T A L P O L IS H E R S , B U F F E R S , ETC., 1909 TO 1914.
Number.

Per cent.

Tuberculosis............................................
Pneum onia..............................................
Heart disease...........................................
Violence (including 6 suicides)...........
Other preventable causes.....................
Other degenerative diseases.................
A ll other causes......................................

77
31
31
19
20
57
7

31.9
12.9
12.9
7.9
8.0
23.5
2.9

T otal...... , ......................................

242

100.0

Cause of death.

Table 29 is derived from the report by Hayhurst on “ Industrial
Hetilth Hazards,” 1915, in connection with which there has been
published a quotation from an official letter stating in explanation
that—
You will note from the report the large per cent of our members
that die from pulmonary tuberculosis. All of these deaths we be­
lieve were contracted by working at this trade, but the sad feature
is that at least 95 per cent of those that contract consumption, work­
ing at our dangerous trade, will not acknowledge they have the dis­
ease until they are too far gone for recovery. They then quit the
trade and try to get a position out in the air, often as collectors,
driving laundry wagons, on a farm, or, if fortunate enough, go West.
These we believe eventually succumb to the disease contracted while
working at the trade. We lose all track of them and have no record.
If it were possible to keep this record, the percentage of deaths in
our trade would be enormous.
In addition to the table, it is said that the median age at death
of the 242 metal polishers, buffers, etc., was 40.1 years, while for
those who died of tuberculosis it was 37.27 years. Most of the men
who enter this trade start work as mere boys, between 1C and 18
years of age, so that the health-injurious consequences are of increased
economic significance.
. POLISHING PROCESSES IN VARIOUS INDUSTRIES.

The observations by Hayhurst in connection with polishing and
buffing are of exceptional value, in that they are based upon an
extended personal investigation, including 51 plants, in 11 different
cities, employing a total of 846 wage earners. Since the surrounding
circumstances of polishers and buffers vary considerably on account
of the numerous industries in connection with which such processes
are carried on, it may be stated in this connection that among the in­
dustries investigated in Ohio were those manufacturing brass and




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

95

bronze products, electrical apparatus, mirror making, cash regis­
ters, stoves and furnaces, foundry and machine shop products, coffin
fixtures, cutlery and tools, copper, tin and sheet metal goods, automo­
biles and parts, jewelry, regalia, scales and balances, sewing machines
and parts, scientific instruments, fiber combs, aluminum combs, signs
and advertising novelties, etc. It is, therefore, quite clear that the
statistical data concerning the mortality of a group of employees
classified merely as polishers and buffers, and without reference to
the special line of work iri connection with which these particular
processes are carried on, can not be entirely conclusive. Hay hurst
in the report referred to points out that—
Dust in the breathing atmosphere was a negligible hazard in 12
places, fairly so in 17 more, but was bad in the remaining 22. It
consisted chiefly of iron, steel, brass and bronze alloys, other soft
metals, glass, etc., which were being worked upon, as well as the
components of the polishing wheels (emery, silica, etc.) and of the
buffing wheels (cotton and lint fibers, glue substances, etc.). In
some places it was kicked up from the floors because of inefficient
cleaning, and also dry sweeping during work hours. These dusts
are, of course, the most harmful to which workers may be subjected,
since they are exceedingly hard, crystalline, and very fine, or irritat­
ing, and, in the majority of instances, poisonous. There are so many
consumptives in the trade that the infection factor is also added.
VENTILATION AND SANITARY CONDITIONS.

With special reference to ventilation, it is stated that conditions
were good in 16 places, fairly so in 17, but the air was close and con­
fined and often contaminated with various fumes and gases from
other processes in the remaining 18. Constant standing in a partially
stooped posture with very little variation is referred to as an addi­
tional hazard in this industry. As regards the special liability to
the contraction of communicable diseases, this was considered excep­
tionally serious in 24 places and considerably so in at least 18 more,
“due particularly to promiscuous spitting on dusty floors and the
absence of cuspidors.” As to the use of protective devices, it is
said that, “ Occasionally some men were seen who were wearing
respirators and endeavoring by this means to filter out the dust from
the air which they inhaled.”
Aside from the dust hazard, polishers and buffers were found to be
subject to a liability to poisoning by lead, potassium cyanide, nitricacid fumes, phenol, amyl acetate, benzine, alum, crude paraffin, fur­
nace gas fumes, brass fumes, plating fumes, and acid-dipping fumes.
The general health appearance of the workers in 24 plants was found
to be good, in 13 it was bad, and in 14 ‘more it was only fair. Posi­
tive evidence of industrial disease was observed in 8 plants, includ­
ing 17 cases. Haylnirst concludes that—




96

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

As the constant breathing of harmful dust and the continual
assuming of unnatural and strained postures are foreign to the
physiology of the human organism, it is highly necessary that dust
be kept out of the breathing atmosphere and to introduce measures
which will vary the work for this class of workers. Unfortunately,
it is looked upon as a skilled trade and this makes it difficult to intro­
duce work variations. This does not detract, however, from its
hazardous character. ^ The toll of deaths from preventable causes
bears this out. It is a process of modern times. One point which
particularly impressed our investigators was that where blower sys­
tems were installed they were often very inefficient at the time of
inspection and w
^ere said to be so most of the time. There appears
to be but one way of getting around this—to make it somebody’s
business in each such room to see that such systems are in working
order and to provide for compensation for this purpose. A metal or
w
^ooden “ chest protector ” prevents harmful pressure against the per­
son. Other features, the liability to poisoning, etc., require the same
precautions as elsewhere. Especially should medical supervision be
adopted for this class of workers, as they are at a process which ap­
pears to take 20 or 25 years off of their lives.
DUST HAZARDS IN BUFFING.

Some rather interesting additional observations in connection with
the special dust hazard of buffing are contained in a descriptive ac­
count of the hazards of the tin and copper smith’s industry by
Charles C. Dominge, of the New York Fire Insurance Exchange
(Weekly Underwriter, Nov. 6, 1909), in part as follows:
The buffing process is the most hazardous of all on account of the
liability of spontaneous combustion. A very fine dust or lint is thrown
off the buffers in this process. This dust is very hazardous, as the
buffing wheels are in many cases saturated with oil used in polishing,
and if allowed to fall to the floor, or accumulate in corners where oil
or grease may be, it becomes an easy source of spontaneous combus­
tion. In most plants a small blower system empties the dust into a
barrel about half full of water located in a metal-lined room. A
standard condition would call for a blower system similar to that
used in woodworking establishments, only, of course, on a smaller
scale. The blowers should lead directly cn the outside of building
to the roof, discharging their contents into a “ cyclone ” or separator,
whence an outside duct carries the lint to a fireproof vault (with vent)
7
detached at least 5 feet from main risk. Inspectors should satisfy
themselves that there are no defects in the system, and should follow
same from start to finish.
MORTALITY OF BUFFERS, FINISHERS, AND POLISHERS— MEDICOACTUARIAL EXPERIENCE.

The precautions called for by the introduction of adequate meas­
ures for the control of the fire hazard are quite certain to react favor­
ably upon the sanitary conditions of the industry. In American lifeinsurance experience, metal burnishers, buffers, finishers, and polish­




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

97

ers, excluding foremen and superintendents, have proven decidedly
unfavorable as a class of risks at ages 30 to 59, with an excessive
mortality of about 14 per cent. The results of the medico-actuarial
investigation with reference to this group of employees are shown
in Table 30. The effect of medical selection must be taken into
account.
T able 3 0 .—M O R T A L IT Y FR O M A L L CAUSES AMONG M E TA L B U R N ISH E R S, B U F F E R S,
FIN ISH E R S , A N D PO L IS H E R S , E X C LU D IN G F O R E M E N A N D S U PE R IN T E N D E N T S,
B Y AGE G R O U PS—M E D IC O -A C T U A R IA L IN V E S T IG A T IO N .

Age at death.

Number
exposed
to risk
1 year.

Actual
deaths.

Expected
deaths.

Ratio of
actual to
expected
deaths.

15 to 29 years............................................................................
30 to 39 years............................................................................
40 to 49 years............................................................................
50 to 59 years............................................................................
60 years and over.....................................................................

7,601
5,500
1,422
316
35

28
35 ‘
14
7
2

34.47
30.78
12.35
6.15
1.27

81
114
113
114
157

Total, 15 years and over..............................................

14,874

86

85.02

101

The available evidence regarding the unfaithfulness of this group
of occupations is, therefore, quite conclusive. In view of the relatively
large proportion of young persons, both men and women, employed
at polishing and buffing, the required sanitary precautions are of
special importance. The efforts of the Buffers and Polishers’ Union
to bring the most trying conditions to public attention are deserving
of appreciation. The rigid enforcement of laws enacted to compel
factories and workshops where polishing and buffing are being done
to install exhaust fans to minimize the dust danger may be laid down
as a principle of labor legislation of the first order of importance.
Among the dusty trades there are few more typical, on the one hand,
of the health-injurious consequences of the continuous inhalation of
metallic and mineral dust, and, on the other, of the far-reaching
practical possibilities of effective ventilating devices so constructed
as to remove the largest possible quantity of dust at the point of
origin and of preventing general air pollution to the largest attain­
able degree.
MORTALITY OF POLISHERS— INDUSTRIAL INSURANCE EXPERIENCE.

The most conclusive ^mortality statistics concerning polishers are
the industrial insurance experience data of the Prudential Insurance
Co. of America for the period 1897 to 1914, including 964 deaths from
all causes, of which 355, or 36.8 per cent, were from pulmonary
tuberculosis.
106811°— 18— Bull. 231------ 7




98

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

3 1 .—P R O P O R T IO N A T E M O R T A L IT Y FROM P U L M O N A R Y T U B E R C U L O S I S
AMONG P O L IS H E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L C O ., 1897 T O
1914, C OM PARED W IT H T H A T OF A L L MALES IN U N IT E D STATES R E G I S T R A T I O N
A R E A , 1900 TO 1913, B Y A G E GROU PS.

T able

Per cent of deaths from
pulm onary tubercu­
losis among—

Deaths of polishers,
1897 to 1914, from—
Age at death.
All causes.

Pulmo­
nary tu­
berculosis.

Polishers.

Males in
registration
area, 1900
to 1913.

43.4
56.1
44.0
24.9
14.3

27.0
30.5
23.4
14.7
7.9

36.8

13.9

15 to 24 years........................... ..............................................
25 to 34 years............................................................................
35 to 44years............................. ............................................
45 to 54 years............................. ........................ ....................
55 to 64 years............................................................................
65 years and o v e r . ..............................................................

136
230
241
173

1 12

59
129
106
43
16

72

2

Total, 15 years and over.............................................

964

355

2.8

2.6

According to Table 31, the proportionate mortality of polishers
from pulmonary tuberculosis is relatively excessive at all ages, but
particularly so at ages 25 to 34, at which 56.1 per cent of the deaths
of polishers from all causes are from pulmonary tuberculosis, against
an expected proportion of 30.5 per cent. The excess in the pro­
portionate mortality is, however, significant and suggestive at all
ages, and sufficiently so to warrant the final conclusion that the
mortality from pulmonary tuberculosis in this occupation must
be considered as decidedly above the normal for the general popu­
lation, although somewhat below the corresponding average for
grinders.
CARD GRINDING.

The so-called “ carding” of the cotton in the manufacture of
cotton textiles is an exceedingly important process. Good card­
ing depends upon good grinding, for if the grinding is not done
to perfection, the setting of the cards can not be done with anything
like accuracy. The surface of the grinding rollers is usually covered
with emery-filleting, and the grinding itself is principally done by
the large grains of emery with which the outer surface of the roller
is covered. There is, therefore, a mixed exposure of metallic and
vegetable fiber dust, particularly in the cleaning process, since, when
the grinding is considered sufficient or u finished,” the cards must be
well brushed to clear away the dust, etc. The object of carding is to
“ disentangle the fibers of cotton and lay them lengthwise and parallel
with each other.” This process necessarily results in the production
of a considerable amount of fine fluff, of vegetable fiber origin, inter­
mixed with the metallic dust resulting from the use of emery sub­
stances. The quantity of emery dust generated in this process is,
however, apparently not very serious, and more importance is at­




OCCUPATION'S W IT H EXPOSURE TO METALLIC DUST.

99

tached to the cotton-fiber dust which must necessarily tend to increase
the health-injurious nature of this, as well as all other employments
in the carding room. Whether there is any essential difference in
the health and mortality of card grinders as differentiated from
carders is difficult to determine in the absence of trustworthy statis­
tical information.
Such observations as have been made regarding the personal
physical appearance of employees in connection with this process
have been suggestive of health-injurious results. The total number
of persons reported as being employed at card grinding during the
census year was only 1,091, of which 1,087 were males and 4 females.
On account of the small number reported employed, the age returns
can not be considered conclusive. Card grinding, apparently, is
quite often carried on in connection with other employments in the
carding room,, and this is especially true of small cotton mills.
FILE CUTTING.

]

The specific effect of this occupation on health and longevity is
medically recognized in the term “ file-cutters’ disease,” which is a
form of pneumoconiosis. The occupation is rarely carried on en­
tirely by itself, and there are no trustworthy data regarding even
the approximate number of men employed in this industry. The
making of rasps and files is generally carried on in connection with
other branches of the toolmaking industry. An important center of
manufacture is the city of Newark, N. J., but no conclusive data
regarding the mortality of men employed in this occupation have
been made available through local vital statistics. How far file
cutters require to be differentiated from file grinders is not ascer­
tainable at the present time.
VARIATIONS IN OCCUPATIONAL EXPOSURE.

^

Much of the modern work is done on wet grindstones, by means
of which the dust hazard has been materially reduced. Workers on
dry emery wheels are, of course, excessively exposed to a mixed dust
hazard of metallic and mineral origin. Aside from the dust hazard,
there is a liability to lead poisoning in connection with the harden­
ing process. By some authorities the hardening process is considered
more injurious than the dust exposure. The occupation is briefly
diseussed in the Report of the Massachusetts State Board of Health
upon the Sanitary Condition of Factories, etc*, 1907, in part, as fol­
lows:
In the manufacture of files the workmen are exposed to a double
danger, namely, exposure to metallic dusts and contact with me­
tallic lead. The best files are cut by hand, no machine having as
yet been invented which can produce their equal. The blanks are first




100

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

ground smooth with the aid of stones, and in this operation consider­
able mineral and steel dust is caused. During the process of cutting the
file lies on a base of lead and the lines are cut by a chisel struck by a
heavy hammer. The leaden bed offers sufficient resistance, while
at the same time it is sufficiently yielding to prevent a sharp recoil.
As the file is cut it is constantly brushed off, usually with the hand,
which thereby becomes to a certain extent coated with very fine
particles of lead, and the air becomes more or less impregnated with
lead and steel dust. A common habit of file cutters in manipulating
the file is to wet the finger and thumb with the tongue, thus convey­
ing to the mouth particles of lead, which, through the acts of con­
scious and involuntary swallowing, gain access to the stomach. The
work is very laborious, and the attitude which the workmen are
obliged to assume is one which does not admit of normal respiratory
movements, since they sit at a bench and stoop over the file. The
workmen of this class are notoriously careless, and are inclined to
reject the idea that their calling is not free from danger; but,
although in the establishments visited an occasional workman was
observed to be pale and sickly in appearance, it must be admitted
that as a class they looked well and strong. Five shops of this class,
employing from 5 to T persons (150 in all), presented reasonably
O
good hygienic conditions. All showed fairly good ventilation, and
but two were not well lighted. In two, employing, respectively, 8
and 60 workmen, considerable dust was perceptible in the air.
T
In 1903 the British Government published a report on the pro­
posed draft regulations relating to the process of file-cutting by
hand, which among other observations includes the statement that—
The trade of file cutting by hand is one that may be distinctly
classed as dangerous and certainly in need of regulation; in addition
to this, in Sheffield at all events, the trade is, generally speaking, car­
ried on under most insanitary conditions. The principal danger to
the worker arises from the handling of the lead bed on which the
T
file is cut, and from inhaling the lead dust produced by the blows
of the hammer in cutting the files, and in brushing the files when
cut. * * * It seems to be the better opinion that the danger
arising from the handling of the lead bed was greater than that
from the inhalation of the dust As the result of using the lead bed
the file cutter by hand is peculiarly liable to plumbism and to nervous
and urinary diseases. Phthisis is also a disease to which the file
cutter is subject considerably in excess of workers in most other
trades; this seems to be due to the insanitary conditions under which
he works acting on a system already enfeebled by the mischief of the
lead. * * * The expression “ file maker ” includes file cutters by
machinery as well as file cutters by hand. Now, as file cutting by
machinery does not involve the use of the lead bed and is not carried
on under the insanitary conditions prevailing in file cutting by hand,
file cutting by machinery can not be said to be a dangerous trade.
It is therefore obvious that the mischief amongst file cutters by hand
is greaterHhan that given by the tables as occurring amongst file
cutters as a whole.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

101

The subject has also been discussed in the Third and Fourth
Interim Reports of the Dangerous Trades Committee of the British
Home Office, 1898-99. In the absence of strictly conclusive mortality
data with a due regard to ages at death and the causes thereof, the
available information must be considered rather inconclusive.
DESCRIPTIVE ACCOUNT OF SANITARY CONDITIONS IN OHIO.

Hayhurst has reported, for Ohio, the results of an investigation
of four establishments employing 108 male wage earners, including
some machine file cutting in two establishments. It is stated that
there were no special devices which could be designated as health
appliances in any of the plants, even the forges in a large plant
being without hoods and vents. According to this investigation—
Dust was a hazard to grinders in all places, although the principal
work was done in the wet on large grindstones. The friction heat
present, however, with the flying of sparks, caused a certain amount
of fine dust to escape, in spite of the water. There were a number
of unprotected emery wheels. Polishing was also done by sand
blasts. A small but constant amount of dust was also produced dur­
ing cutting which always contained some lead scraped loose from the
“ bed ” which supported the file. Workers’ faces were also quite
close to the work. None of the places visited was exemplary in mat­
ters o cleanliness and order, while in three there was plenty of dirt
*f
and waste accumulations. A dirt floor was present in one place
located in basement-like quarters. Dampness was a feature of the
work in the grinding rooms, where the water occasionally escaped
from the grindstones and soaked up the floors. The lighting of the
quarters was good in two places and poor in the other two, in one of
which oil lamps were depended upon for the principal illumination.
The general ventilation of quarters was fair to good. The ceilings
in one place were scarcely 7 feet high. Contamination existed from
heating ovens, forge gases, tempering pots, and annealing furnaces,
and from crude heating arrangements in two places. The question
of fatigue is not debatable, at least for the skilled workers. There
is an unusual amount of reduplication of the same movements and
monotony in the hand cutting process (from continuous mallet and.
chisel work) and also in grinding, with the assumption of awkward,
stooped postures in both processes and pressure against the body.
It is estimated that the cutter strikes 45,000 blows a day in turning
out his quota of files. In one plant practically all work was piece­
work, while noise was excessive from trip hammers. The workday
was 9 hours in the smallest place and 10 hours in the other three,
with one-half hour for a noon recess. The liability to the contrac­
tion of communicable diseases was considerable in all places, due to
the use of common drinking cups, promiscuous spitting upon the
floors, and in dust and dirt accumulations, the absence of washing
facilities in two places, poor toilet arrangements, and the presence of
dust and dirt from the processes. The liability to industrial poison­
ing was considerable for the hand cutters where soft lead plates were
T
used beneath the files worked upon, due to the creation of a fine dust
and to the lack of personal care in keeping the soiled fingers away




102

MORTALITY PROM RESPIRATORY DISEASES IN DUSTY TRADES.

from the lips. Again, in the lead tempering process (part of the
tempering was done by heating in charcoal and coke and then im­
mersing in brine), there were the same hazards as described under
this process elsewhere. Chronic or slow lead poisoning is the form
of the disease most likely to be present, although the personal factor
of carelessness might produce acute poisoning in a short space of
time.
In addition to the foregoing observations it is pointed out that
special emphasis was placed upon the risk of lead'poisoning, and
that in some places there appeared to be an unnecessary exposure to
dust from grinding processes which apparently could have been
easily equipped with a blower system. Reference is also made to a
statement by Sir Thomas Oliver that—
The death rate of the cutters from pulmonary phthisis and lead
poisoning exceeds the mortality standard of ordinary occupied males
by 90 per cent, and after 35 years of age it is still higher.
FILE CUTTING BY HAND AND BY MACHINERY.

The conclusion advanced in the report on the draft regulations con­
cerning the process of file cutting by hand, that file cutting by ma­
chinery removes part of the hazard, is sustained by the Ohio inves­
tigation. That the risk has elsewhere been recognized is brought out
by the fact that the German Imperial Board of Health has issued
a special circular concerning health precautions to file makers, the
text of which, however, has not been available for the present pur­
pose.
W. Gilman Thompson refers to the industry in his treatise on4 The
6
Occupational Diseases,” in part, as follows:
In cutting the ribs of files the articles are ^imbedded in a block of
lead, which offers the proper degree of resistance or rebound when
the cutting chisel is struck by the hammer. Much lead dust, besides
iron filings, is thus produced, and the workmen have the habit of
moistening the fingers in the mouth to obtain a firmer grasp upon
the cutting instrument. Thus they both swallow and inhale much
lead dust. Wooden or tin blocks may be used to replace the lead,
but are less satisfactory. The increasing use of file-making machinery
is doing much to lessen the frequent cases of lead poisoning which
characterize this trade, but as the machines strike from 400 to 1,000
blows a minute they raise considerable lead dust.
LEAD POISONING.

Thompson quotes White to the effect that a out of 100 English file
cutters examined by him 74 exhibited the results of lead poisoning,
while the mortality of the trade was found to be excessive. Leaning
over the work and raising the lead dust by hammering constitute
the special risk, apparently.” Thompson also quotes Sprenger, ac­




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

103

cording to whom u among 93 file makers examined in Berlin more
than 5 per cent were afflicted with lead poisoning after having been
at work a little more than two years.”
Apparently the risk of lead poisoning is more serious than
the inhalation of metallic and mineral dust; but, as said before, ac­
curate and conclusive data concerning this occupation are not at
present available. The only statistical reference of value occurs in
the Supplement to the Sixty-fifth Annual Report of the Registrar
General of Births, Deaths, and Marriages in England and Wales, in
part, as follows:
File makers experience more than twice the average mortality from
nervous diseases and nearly four times the average from Bright’s
disease, but cutlers experience comparatively little excess of mor­
tality from either of these causes. In both industries the mortality
from phthisis is enormous, the figure for cutlers being nearly three
times and that for file makers more than twice the standard, and in
both occupations the mortality from respiratory diseases approaches
double the standard. Both these workers, however, experience a low
mortality from influenza, from alcoholism and liver disease, and from
accident, while among file makers the mortality from cancer is also
less than normal.
GENERAL CONCLUSIONS.

This statement sustains the earlier conclusion that this occu­
pation is not readily separated from other employments, chiefly the
manufacture of cutlery and tools, with which it has much in com­
mon. The general conclusion is that the employment is one involving
serious dust hazards demanding more qualified medical and admin­
istrative consideration.
TOOL AND INSTRUMENT MAKERS.

The manufacture of tools and instruments includes a large number
of grinders and polishers, but it is not possible to classify the occupa­
tions in detail. In the United States census statistics the industry
includes cutlery manufacture, while in English mortality statistics
the group comprehends tool, file, and saw makers, cutlers and scissors
makers, and needle and piti makers. The statistics of 1910 for the
United States return 20,212 males of known ages, 10 years or over,
employed in this industry as previously defined, and of this number
3,669, or lg.2 per cent, were 45 years of age or over. The propor­
tion attaining to old age was, therefore, somewhat larger than
expected, considering the high rate of mortality of grinders and
polishers, and others employed in the manufacture of tools,
instruments, etc.




104

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

SANITARY CONDITIONS OF EMPLOYMENT IN MASSACHUSETTS,

A special investigation into the sanitary conditions of this employ­
ment was made by the Massachusetts State Board of Health in 1907,
and the report included a number of very valuable and suggestive
references to conditions unfavorable to health and life, from which
the following extracts are made:
From a sanitary point of view, the one important part of this in­
dustry is the reduction‘ of the surface of the article in process of
manufacture from the roughness of the original casting to the
smoothness and brilliancy so necessary and desirable in the finished
product. This involves successive treatment by wet grinding, dry
grinding on emery and corundum wheels, and polishing with rouge on
buffing wheels. Each of these processes, even that of wet grinding
on large, coarse, and finer stones, causes to be cast into the air large
amounts of fine dust, made up of very fine particles of steel and of
the abrasive substance. In establishments properly equipped and
conducted, provision is made to reduce the danger of this dust to a
minimum by means of hoods connected with a system of exhaust
fans or blowers. In spite of the precautions taken to protect their
health, a very large proportion of grinders recklessly remove the
hoods, and thus expose themselves unnecessarily to this especially
dangerous form of dust. They assert that they prefer freedom of
movement with dust to the protection afforded by hoods.
The workmen are not, as a class, long lived; indeed, the nature of
the work is not compatible with longevity, and a person entering upon
it in middle life is unlikely to follow it many years. Whatever the
age at which the trade is taken up, a man in sound health who has
followed it a fewTyears is an acknowledged rarity. A study of the
death returns of the city of Northampton, which is one of the centers
of this industry, for the past 12 years, yields facts which can be
interpreted in only one way. During this period tuberculosis is given
as the cause of death in no less than 54.5 per cent of those wbose oc­
cupation is indicated by “ grinder ” or “ polisher,” and in 45.4 per
cent of those designated generally as “ cutlers,” and of the latter
36.4 per cent died of pneumonia. Taken together, the “ grinders,”
“ polishers,” and “ cutlers ” returns shbw that, during this period,
diseases of the lungs were responsible for 72.73 per cent of their mor­
tality. As was shown in the preliminary report on this industry,
the tuberculosis death rate for cutlers in Northampton is four times
as high as that for the entire adult male population.
DIFFICULTIES IN EFFECTIVE VENTILATION.

A difficult problem in the cutlery and tool industry is how to secure
effective ventilation, and many of the factories and workshops in­
spected were found to be seriously defective in this respect. A large
proportion of the workmen, including many young boys, are exj)osed to considerable dust, chiefly, of course, in the grinding and
polishing departments. While much has been done to improve the
sanitary conditions by artificial ventilation, there has been but a very




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

105

indifferent cooperation on the part of the operatives themselves, and
many in fact are interfering with the arrangements made for their
protection to the extent of removing the hoods and exhaust pipes
installed for the purpose of carrying off the dust.
VITAL STATISTICS OF ENGLISH TOOL AND CUTLERY MAKERS.

The most valuable official statistics are those for England and
Wales, published at decennial intervals in the supplements to the
reports of the registrar general of births, deaths, and marriages.
Only two comparatively recent investigations are here referred to.
The first of these, for the three years ending with 1892, included
2,529 deaths from all causes, of which 505, or 20 per cent, were from
pulmonary tuberculosis. Of diseases of the respiratory system other
than pulmonary tuberculosis, 384 deaths were from bronchitis, 286
from pneumonia, and 78 from other diseases of this group, a total
of 748, or 29.6 per cent, of the mortality from all causes. Combin­
ing the mortality from pulmonary tuberculosis and other respira­
tory diseases, it is found that 49.5 per cent of the deaths of tool and
instrument makers, as previously defined, were from diseases of the
lungs and air passages.
The most recent English mortality statistics of tool and cutlery
manufacture are for the three years ending with 1902, referred to in
the Supplement to the Sixty-fifth Annual Report of the RegistrarGeneral of Births, Deaths, and Marriages in England and Wales, in
part as follows:
In the occupation as a whole the mortality at ages under 25 is
below the standard for occupied and retired males; but among file
makers the death rate at these ages exceeds the standard. Beyond
age 25 the mortality in the whole occupation, as well as among cut­
lers and file makers, considerably exceeds the standard. At ages 45
to 65 years the death rate among cutlers is 72 per cent and that of file
makers is 84 per cent above the average. Within the main working
period of life the comparative mortality figure for the whole occupa­
tion is 1,315, or 31 per cent, above the standard. The mortality from
lead poisoning is nine times and that from phthisis is nearly double
the standard, and these workers suffer excessively from nervous, cir­
culatory, respiratory, and urinary diseases. On the other hand, the
mortality from alcoholism and liver disease and from accident is
about half the average. Among cutlers and file makers the compara­
tive mortality figures considerably exceed the average for the entire
occupation, the figure for the former being 56 per cent above the
standard for all occupied and retired males, while that for the latter
is 69 per cent in excess. Indeed, these two occupations appear to be
the most unhealthy in the whole group of workers in metal. It
should be mentioned in this place that the occupation of file maker is
one that is specially liable to lead poisoning, the mortality figure for
plumbism being no less than 56, whilst among all occupied and retired
males the mortality is represented by unity.




106

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

File makers experience more than twice the average mortality from
nervous diseases and nearly four times the average from Bright’s
disease, but cutlers experience comparatively little excess of mortal­
ity from either of these causes. In both industries the mortality from
phthisis is enormous, the figure for cutlers being nearly three times
and that for file makers more than twice the standard, and in both
occupations the mortality from respiratory diseases approaches
double the standard. Both these classes of workers, however, experi­
ence a low mortality from influenza, from alcoholism and liver dis­
ease, and from accident, while among file makers the mortality from
cancer is also less than normal.1
MORTALITY F0E3C PULMONARY TUBERCULOSIS AND NONTUBERCULOUS
RESPIRATORY DISEASES.

The English occupation mortality statistics for men employed at
tool, instrument, and cutlery making are quite conclusive of the more
or less unfavorable effects of this industry on health. In Table 32
a comparison is made of the mortality from all causes among men
in this group with occupied males generally, and the result is de­
cidedly suggestive of conditions in this trade more or less unfavor­
able to life and health, but in particular at ages 45 or over, when
the general mortality of this class exceeds the general average by
from 8.24 to 12.26 per 1,000.
3 2 .— M O R T A L IT Y FR O M A L L CAUSES AM ONG T O O L ,IN S T R U M E N T , A N D C U T L E R Y
M A K E R S , C O M PA R E D W IT H T H A T OF A L L OCCUPIED M A LE S, IN E N G L A N D A N D
W A L E S , 1900 TO 1902, B Y A G E GR O U PS.

T able

[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]
Death rate for tool, instrument,
and cutlery makers.
Age at death.

15 to 19 years............................................................................
20 to 24 years............................................................................
25 to 34 years...........................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and over........: ...........................................................

Death rate
per 1,000
for all
occupied
males.

2.44
4.41
6.01
10.22
17.73
31.01
88.39

Rate per
1,000.

2.09
3.32
6.32
13.65
25.97
42.05
100.65

Greater ( + )
or less ( —) Per cent of
than rate rate for all
for all
occupied
occupied
males.
males.
- 0.35
- 1.09
+ .31
+ 3.43
+ 8.24
+ 11.04
+12.26

86
75
105
134
146
136
114

The preceding table is self-explanatory. A more extended com­
parison, however, is made in Table 33, in which the mortality of
tool, instrument, and cutlery makers from pulmonary tuberculosis and
other respiratory diseases is compared with the normal mortality of
occupied males from these diseases by divisional periods of life. The
comparison shows that at ages 25 and over the mortality from pul­
1 P a r t I I , Supplem ent to the S ix ty -fifth A n n u al R e p o rt o f the R e gistra r-G en era l o f
B irth s, D eaths, and M arriages in E n gla n d and W ales, pp. lx ix , lxx.




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

107

monary tuberculosis is excessive among tool, instrument, and cutlery
makers, and decidedly so at ages 35 to 64, inclusive. The table
further shows that the mortality from other respiratory diseases is
excessive among men in this class, but.decidedly so at ages 45 or
over, reaching the highest rate at ages 65 and over, when the excess
is 7.69 per 1,000. The two tables, derived from English experience,
fully confirm the previous conclusion that the mortality of tool, in­
strument, and cutlery makers is excessive when comparison is made
with the normal mortality of occupied males generally, and that this
excess is largely because of a high degree of frequency of pulmonary
tuberculosis, particularly at ages 25 to 64, when the excess is from
0.91 to 4.09 per 1,000.
3 3 .—M O R T A L IT Y FROM P U L M O N A R Y TUBERCULOSI-S A N D F R O M O T H E R
DISEASES OF T H E R E S P IR A T O R Y SYSTEM AMONG TO O L , IN STR U M E N T, A N D CUT­
L E R Y M A K E R S, COM PA R ED W IT H T H A T OF A L L OCCUPIED M ALES, IN E N G L A N D
A N D W A L E S , 1900 TO 1902, B Y A GE G R O U PS.

T able

[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Mortality from pulmonary tuberculosis.

Mortality from other diseases of the respi­
ratory system.

Death rate for tool, instrument,
and cutlery makers.

Age at -death.

Deatih
rate per
1,000 for
all
occupied
males.

15 to 19 years.......
20 to 24 years.......
25 to 34 years.......
35 to 44 years........
45 to 54 years.......
55 to 64 years____
65 years and over.

0.54
1.55
2.03
.2. 74
3.04
2.1=6
1.11

Death rate for tool, instrument,
and cutlery makers.
Death
rate per
Greater ( + )
Greater ( + )
1,000 for
Gent
or less ( —) Per cent
or less ( —) Per rate
all
of
of rate
occupied Rate per than rate
Rate per than rate
■ all
for
-for all
for all
males.
for all
1,000.
1,000.
occupied
occupied
occupied
occupied
•males.
males.
males.
males.
0.17
1.57
2.94
5.90
7.13
5.26
1.97

-0 .3 7
+ .02
+ .91
+3.16
+4.09
+3.10
+ .86

31
101
145
215
235
244
177

0.24
.48
.77
1.66
3.32
•6.54
17.77 •

0.23
.56
1.14
2.01
5. 40
10.42
25. 46

-0 .0 1
+ .08
+ .37
+ . 35
+2.08
+3.88
+7.69

96
117
148
121
163
159
143

MORTALITY OF T0OL AND CUTLERY MASTERS— UNITED STATES
REGISTRATION AREA.

The mortality of American tool and cutlery makers has been re­
ported upon by the Division of Vital Statistics of the United States
Census Bureau only for the year 1909, and no subsequent information
has been made public, so that the data are of rather limited value.
According to the census report, out of 241 deaths of tool and cutlery
makers from all causes, 58, or 24.1 per cent, were from pulmonary
tuberculosis, which compares with 17,8 per cent for jewelers and
29.5 per cent for printers, lithographers, and pressmen. On account
of the rather peculiar age distribution the general average, however,
for all ages can not be safely utilized for comparative purposes. The
details of the mortality of tool and cutlery makers by divisional
periods of life are shown in Tables 34 and 35.




108

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

T able 3 4 .—P R O P O R T IO N A T E

M O R T A L IT Y OF T O O L A N D C U T L E R Y M A K E R S F R O M
P U L M O N A R Y TU BE R CU LO SIS, U N IT E D S TATE S R E G IS T R A T IO N A R E A , 1903, B Y
A G E G R O U PS.

-

Deaths from pulm o­
nary tuberculosis.
Age at death.

Deaths
from all
causes.
Number.

Per cent
of deaths
from all
causes.

15 to 24 years..................................................................................................
25 to 34 years..................................................................................................
35 to 44 vears..................................................................................................
45 to 54 years..................................................................................................
55 to 64 years.................................................................................................
65 years and over..........................................................................................
Age unknow n................................................................................................

22
37
45
38
42
56
1

4
15
19
10
8
2

18.2
40.5
42.2
26.3
19.0
3.6

T otal, 15 years and over....................................................................

241

58

24.1

T able 3 5 .—P R O P O R T IO N A T E M O R T A L IT Y OF T O O L A N D C U T L E R Y M A K E R S F R O M
N O N T U B E R C U L O U S R E S P IR A T O R Y D ISEASES, U N IT E D S T A TE S R E G IS T R A T IO N
A R E A , 1909.

Deaths from nontuber­
cuious respiratory dis­
eases.
Cause of death.
Number.

Per cent
of deaths
from all
causes.

A sthm a...................................................... ...........................................................................
Bronchitis..............................................................................................................................
Pneumonia............................................................................................................................
Other nontubercuious respiratory diseases.....................................................................

3
23
3

1.2
9.6
1.2

T otal............................................................................................................................

29

12.0

Table 34 emphasizes a decidedly excessive proportionate mor­
tality from pulmonary tuberculosis among tool and cutlery makers
at ages 25 to 64, inclusive. There is also, as shown in Table 35, a
relatively high proportionate mortality from nontubercuious re­
spiratory diseases, equivalent to 12 per cent of the mortality from
all causes, chiefly attributable to pneumonia. The proportion of
deaths from pneumonia is 9.6 per cent of the deaths from all causes,
W 'h i c h compares with 5.8 per cent for jewelers and 6.8 per cent for
printers, lithographers, and pressmen, according to the data derived
from the same official American sources.
MORTALITY OF TOOL AND INSTRUMENT MAKERS— INDUSTRIAL INSUR­
ANCE EXPERIENCE.

The only other available mortality data of tool and instrument
makers are derived from the industrial insurance experience of the
Prudential Insurance Co. of America for the period 1897 to 1914, in­
cluding 533 deaths from all causes, of which 170, or 31.9 per cent*




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

109

were from pulmonary tuberculosis. Table 36 is not, however, strictly
comparable with Table 34 on account of probably important differ­
ences in the classification of the occupations considered.
T a ble 3 6 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y TU BE R CU LO SIS AMONG

T O O L A N D IN STR U M E N T M A K E R S, IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO.,
1897 TO 1914, C O M PA R ED W IT H T H A T OF A L L M ALES IN U N IT E D ST A TE S R E G IS T R A ­
TION A R E A , 1900 TO 1913, B Y A G E GROUPS.
Deaths of tool and in­
strument m a k e r s ,
1897 to 1914, from—
Age at death.
All causes.

Per cent of deaths from
pulmonary tubercu­
losis among—

Pulmonary Tool and in­ Males in
tubercu­
strument registration
area, 1900
makers.
losis.
to 1913.

15 to 24 years............................................................................
25 to 34 years...........................................................................
35 to 44 years...........................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and ovei*...................................................................

88
93
111
98
67
76

33
49
41
33
7
7

37.5
52.7
36.9
33.7
10.4
9.2

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over..............................................

533

170

31.9

13.9

According to this table the proportionate mortality from pulmo­
nary tuberculosis is excessive at every divisional period of life,
but particularly so at ages 25 to 34, at which, of the mortality from
all causes, 52.7 per cent is from pulmonary tuberculosis. The data
for this group of occupations are not, of course, entirely conclusive,
in that the group considered includes a number of special employ­
ments of a varying degree of metallic-dust exposure. Since
tool and instrument manufacturing is frequently combined with
the cutlery and related trades the latter must be taken into ac­
count for comparative purposes. In all of these trades grind­
ing, polishing, and buffing are incidental operations, and: though
elsewhere separately considered, these are practically inclusive of
the entire group of tool and instrument-making and the cutlery
industries.
GENEBAL CONCLUSION'S.

With a.due regard to these rather serious limitations it is safe to
conclude that, considered as a group, the manufacture of tools and
instruments must be considered as one of the distinctly unhealthful
trades, and primarily so on account of continuous and considerable
exposure to the inhalation of metallic dust*
SAND BLASTING.

This is a rather obscure occupation, regarding which the literature
is of very limited extent. The census of 1910 returns only 101 persons
employed as sand blasters in connection with the iron and steel indus­
try, but in all probability the number so employed is much larger.




110

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

There are no occupation mortality data regarding this employment,
which, from a hygienic point of view, is of considerable impor­
tance.
DESCRIPTIVE ACCOUNT OF SAND-BLASTING PROCESSES.

The most useful discussion of this occupation occurs in Hayhurst's
Ohio Survey of Health Hazards, as follows:
Sand blasting is a process in which fine sand or similar hard sub­
stance is forced through a pipe by compressed air against objects
either for the purpose of cleaning their surfaces or of giving them
an etched, frosted, or rough effect.„ Hence the process is used upon a
considerable variety of materials. As it is very rapid, usually only
a few workers are so employed even in very large establishments.
Our investigations covered the process in 9 different industries, viz,
automobiles, cars, carriages, electrical apparatus, brass^ iron, glass,
cutlery and tools, and machine manufacture. There were 51 wage
earners, all males, found so employed. For some work considerable
skill is necessary, but in the majority of instances it is a process for
unskilled labor. Retention at the process was good in 3 places, fair
in 3, and very brief in the remaining 3. Health appliances, consist­
ing of isolation of the process in a room by itself and within a cup­
board through which the worker inserted his hands, or the wearing
of a helmet covering the entire head—these features were found
good in 3 places, fair in 3, and practically absent in the remaining 3.
Instructions to limit the dust in order to conserve the health of the
worker were good in 5 places, but very little attention was paid to
the same in^the remaining 4. In but 1 place did the workers enjoy
the privilege of a sick-benefit association. The work was done in
T
the same quarters with other processes in 3 instances, so that other
workers were exposed to the fine dust created. Of all the employees,
13 were over 40 years of age and 38 under 40.
DUST AND OTHER HEALTH HAZARDS.

Dust in the breathing atmosphere was a negligible factor in 2
places, a fair hazard in 4, and bad in 3. Cleanliness of quarters
took about the same proportions. Dampness was no feature of the
process, nor were harmful light effects. Heat, due to the proximity
to other processes as a rule, was bad in 1 place, fair in 2 more, and
no feature in the remaining 6. Cold weather, due to performing the
work, protected only by a roof, was a feature in 2 places. Fatigue
was not a special hazard, although hurrying piecework, monotony,
and constant standing were features in one-third of the places. The
workday was from 9 to 10 hours in all places. The noon recess was
1 hour in 1 place, three-quarters of an hour in 3, and one-half hour in
5 places. The liability to the contracting of communicable diseases
was negligible in 3 places, a fair risk in 5, and bad in 1, due, prin­
cipally, to the breathing of fine dust in quarters where there was
promiscuous spitting, absence of cuspidors, inadequate washing facili­
ties and improper closets, and the failure to inquire into the fitness
of the workers for such work. Poisoning was no feature. The gen­
eral factors favoring stimulantism were the irritating effects of fine
dust inhaled and swallowed and the absence of good drinking-water




OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

I ll

facilities in some places. The health appearance of the workers was
not good in one-third of the places. The workers’ complaints were
the breathing of dust, skin irritation in hot weather, and the ineffi­
ciency of some of the hoods used, while in 1 place the manager said
they were having it done at night because it made so much dust.
Comments.—Such work should be done in a manner to keep the dust
away from the employee, such as confining the process within an
impervious cupboard, through which armholes are made, or having
it done in a dust-tight room in which the worker should be supplied
with an impervious suit and helmet, to which is attached an air tube
supplying him with fresh outdoor air under pressure. The simple
wearing of respirators, even of helmets, without such air tubes is
not at all efficient, as can be demonstrated by noting the amount of
fine dust settled upon the workmen’s features when such coverings
are removed. Many places substitute sand blasting by cleaning small
' pieces in a rattler.
The occupation was inquired into by the New York State Factory
Investigating Commission and briefly referred to in its second re­
port (Vol. II, pp. 420 and 479,1913). It is said that-^Sand blasting is still done in closed bins or basements by ancient
and crude methods, without any other protection to the workers than
a cloth over the mouth and nose. The fumes from pouring molds
are allowed to disseminate in the air of shops, fume vents being found
in but few plants. Temperatures are often very high, especially
near the furnaces.
With special reference to the use of respirators in connection with
this process, it is stated that—
Neither in sand blasting nor in lead works nor in any other occu­
pation where the presence of poisonous gases, and excessive amounts
of dust vitiate the air have respirators been uniformly used. The
managers and owners resort to the same plea, viz, the ignorance of
the worker and his willful abandonment and neglect of these pro­
tective appliances. Few of these managers provide their employees
with them, and still fewer make their use compulsory.
A brief descriptive account of the process of sand blasting in con­
nection with castings, in open sheds, is given by Hanson, in his
“ Dangers to workers from dusts and fumes, and methods of pro­
tection,” in Bulletin 127, published by the United States Bureau of
Labor Statistics. 4 It is observed in connection with the process that
4
men who do the work are not properly protected, since the helmet
does not prevent the inhalation of very fine steel, iron, or brass dust.”
With reference to sand blasting castings in closed rooms, an “ im­
proved helmet” is described, but even this appliance is considered
an inadequate protection.
MOST DANGEROUS OP ALL MINERAL-DTJST -HAZARDS.

The most recent and thoroughly well-considered observations con­
cerning sand blasting are by W. Gilman Thompson, and on account of




112

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

their importance they are quoted in full from his treatise on “ The
Occupational Diseases” :
The sand blast is an apparatus constructed to blow a stream of
sand by means of compressed air with great force against metal
castings, to clean them from the earth which adheres from the cast­
ing molds and to smooth roughened surfaces. It is also employed
in cleaning stone and marble buildings and for the roughening of
the surface of glass to make “ ground glass ” and sometimes to mark
patterns upon glass, which is partially protected. Sand blasting
constitutes probably the most dangerous of all the mineral-dust
hazards, and it is impossible to engage in the work without protec­
tion of the eyes and face, for the sharp particles of fine silicious sand
are driven with such force against the objects operated upon that
they rebound toward the workman, and, despite the use of long hose
to conduct the blast a.way from the operator, the surrounding air is
constantly filled with flying sand, resembling a sandstorm in the
desert. The helmets in use for sand blasting can not have glass
windows, but fine wire netting shields the eyes, and cloths are in­
serted to breathe through.
An important method of reducing the risk of dust from the sand
blasting of metal castings is covered by a recent patent of C. Wedemeyer, of Hamburg. The operator stands in a cabinet directing
the sand blast away from himself toward the casting. Over his head,
at an angle of 45°, a strong blower fan directs a stream of air also
upon the casting with such force that the dust of both sand and
metal is blown downward toward the opening of a large exhaust tube
just above the floor. In this manner a strong, continuous draft
blowT the dust away from the operator and out of the cabinet through
s
the aspirator duct, which is connected with a powerful exhaust fan.
T
The descriptive illustration by Thompson, in addition to the pho­
tographic reproductions of sand-blasting processes by Hanson, in
Bulletin 127 of the United States Bureau of Labor Statistics, pre­
viously referred to, emphasize the necessity for thoroughly effective
safety precautions, more or less in conformity to the German method,
under which the operator is inclosed in a room or cabinet in which he
directs the blast of sand and compressed air against the casting in
front while a strong air current is forced from directly above his
head by a fan and passes outward toward a revolving, aspirating
drum' on the right. The illustration used by Thompson is from
Rauch und Staub (ii, Feb. 5, 1912).
COMBINED METALLIC AND MINERAL DUST EXPOSURE.

The preceding statements suggest the existence of more or less
health-injurious conditions, the control of which at present ap­
pears to receive inadequate technical consideration. Conditions, of
course, must vary ^according to the quality and degree of fineness
of the sand used. In the handling of sand in glass factories
serious respiratory difficulties have been experienced in much the
same manner as in sand-blasting operations, though apparently to




OCPT N W
C U A IO S ITH E P S R T M T L IC D S .
X OU E O E A L
UT

113

a lesser degree. The occupation, though of rather limited extent, is
obviously one which demands more qualified technical consideration
regarding its hygienic aspects and the probably quite needless waste
of life and health. Of course in the actual operation of sand blast­
ing there results a mixture of metallic and mineral particles, of
which the former are distinctly more injurious to health than the
latter. It is for this reason that the occupation has been included
among employments where the chief exposure is to metallic dust.
As measured by the quantity of dust. exposure, however, sand
blasting more properly belongs to the group of employments with
exposure to mineral dust. Thompson for these reasons includes sand
blasting under occupations where the chief exposure is to min­
eral dust.
PROTECTIVE, SAFETY, AND SANITARY DEVICES.

The most recent discussion of sand blasting with special reference
T
to safety and sanitary considerations is by Joseph Brinker, in the
Scientific American for September 2, 1916, who describes in some
detail the work of the operator in one room while the blast is car­
ried on in another, and under conditions which practically exclude
the dust hazard or at least the major portion of the same. It is ex­
plained at the outset that the preparing of metal surfaces for a cov­
ering of paint has given rise to the extensive use of the sand blast,
especially in connection with the manufacture of automobiles. It is
said that—
When the outfits are constructed of sufficient size to accommodate
large surfaces such as mud guards, hoods, and bodies, the problem
of protecting the workmen has presented serious difficulties.
After explaining that various forms of safety devices for the pro­
tection of the operator during the sand blasting have been tried, in­
cluding the common respirator with a sponge through which the
operator breathes, though often under serious difficulties, and various
forms of helmets similar to the one used in diving, in which fresh
r
air is supplied under pressure, it is pointed out that—The first renders it difficult to breathe; the second type is often so
cumbersome that it is discarded by the workmen at their own peril.
In fact the history of the use of safety sand-blast devices has proven
conclusively that when these may be used or detached at will by the
workmen, they are usually discarded, even if such neglect constitutes
positive danger.
This difficulty has apparently been overcome in the apparatus de­
scribed by Brinker which makes it necessary for the operator to use
7
the safety helmet if he is to work at all. A brief explanation of the
new method is as follows:
106811°— 18— Bull. 231-------8




114

M R A IT F K MR S IR T R D E S S IN D S Y T A E .
O T L Y J O E P A O Y IS A E
UT RDS

Each sancl-blast room is a small compartment of the double-hopper
type in which the heavy particles of the sand used in the cleaning
process are drawn out of the lower hopper and the lighter particles
out of the upper by air suction. The material to be cleaned is laid
on a grating between the two hoppers. It is introduced into the com­
partment through a door at one end. The sand-blast operator’s head­
dress, which is of canvas with a fine-mesh copper screen at the front,
is securely attached to the inside of a curjbain which forms the front
wall of the compartment. This curtain is fastened to sliding metal
doors which can be moved horizontally from side to side. In this
way it is impossible for the operator to see into the interior of the
compartment until he puts his head in the helmet. This being ac­
complished, he stands on the floor outside the compartment, moving
along as is necessary in the progress of his work by pushing the slid­
ing metal doors to either side with his elbows.1
GOLD-LEAF MANUFACTURE.

The work of the gold-leaf beater is nearly all handwork, except
in the operation of the rolling machines. The trade is carried
on to-day in about the same manner as in ancient times. The
weight of the hammer used averages 18 pounds, which is more
than that of the hammer used by the average blacksmith. Girls,
as a rule, are employed in connection with the less arduous operations
and the final packing of the gold leaves in boxes and packages. The
tissue used in connection with this process is coated with red chalk,
the dust of which, of course, enters into the atmosphere of the rooms,
usually badly ventilated. One of the chief difficulties in connection
with the ventilation is the fact that the slightest draft of air will
carry the scrap of gold leaf from one anvil to another and make
packing operations difficult or impossible. Evidence that the fine
particles of gold enter the atmosphere is found in the fact that work­
men with beards turn in less waste gold than clean-shaven workmen,
and they are now required to wash before leaving th£ shop, the water
being filtered for the recovery of the metal contained therein.
EARLY OCCUPATIONAL-DISEASE OBSERVATIONS.

Thackrah, writing in 1832, held that goldbeating must be con­
sidered a distinct employment, aside from the metal trade generally.
Goldbeaters are about half the day engaged in beating the metai with
heavy hammers and the rest in spreading the gold leaf on paper.
By this change in employment the process affords an excellent alter­
nation of labor and comparative rest. In his opinion the men were
T
not exposed to health-injurious conditions and were generally healthy
1 Of much practical importance is a descriptive account of the dustless Hoevel selfcontained sandblast automatic machine and a description in detail of a novel sand­
blast room, in Safety, published by the American Museum o’ Safety for January, 1918.
f




OCPT N W
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X OU E O E AL * UT

115

and robust.1 It is difficult, however, to accept these conclusions in
their entirety. The work of the goldbeater is carried on in rooms
the air of which is more or less contaminated and where provision
for proper ventilation is extremely difficult if not impossible.
The work is often commenced at rather early ages and, in Europe at
least, quite a considerable proportion of young persons are employed.
Whether gold dust is itself injurious has never been scientifically
determined, but it is quite probable that it is less injurious than
other metallic dust.
DESCRIPTIVE ACCOUNT OF MANUFACTURING PROCESSES.

The number of goldbeaters in the United States is small, only 607
male and 76 female workers having been enumerated in 1910. An
interesting account of the process of manufacture, by Edward Williston Trentz, is as follows:
The goldbeater receives his material in the form of a ribbon about
an inch wide and 24 feet long. This ribbon is first cut into 200
squares and placed in the “ cutch,” which is a pile of square pieces of a
peculiar paper, part animal and part vegetable in composition, the
preparation of which is a secret. A square of gold is placed between
each two leaves and the whole mass is ready for the first beating.
This is done with an iron hammer, weighing from 12 to 17 pounds,
while the cutch rests upon a granite block which is supported by a
heavy wooden post.
Under the heavy measured blows of the hammer the sheets of gold
begin to stretch or expand until, in half or three-quarters of an hour,
they have reached the edges of the cutch. They are then removed
and, with a thin strip of bamboo, are cut into quarters, so that the 200
pieces become 800. Next comes the “ shoder,” a collection of 800
pieces of skin, 4 inches square, made from the intestines of cattle. As
in the cutch, each piece of gold is placed between two leaves of skin,
and bands of parchment or vellum are slipped over the whole pile to
keep it together. Another beating, this time with a hammer weigh­
ing from 8 to 10 pounds, now follows. This takes about an hour,
during which the sheets of gold are all the time expanding.
The last stage is the u mold,” which, like the cutch and the shoder,
is composed of alternate leaves of gold and skin, but the mold is
about 5 inches square and made up of goldbeater’s skin. The prepa­
ration of this is a jealously guarded trade secret.
A mold contains 1,000 sheets. After the second beating the work­
man takes from the shoder a single leaf of gold at a time, handling it
with bamboo pinchers and, when necessary, smoothing it with a rab­
bit’s foot. With the strip of bamboo he cuts each sheet into quarters
again, so that the original 200 have now become 3,200. One shoder,
therefore, contains more than enough gold to fill three molds.
The final beating in the mold is done with a 7-pound hammer and
requires from three to four hours. By this time the gold leaf should
have expanded again to the edge of the skins and should be of the
1 Effects of Arts, Trades, and Professions on Health and Longevity, by C. Turner
Thackrah, Loildon, 1832, p. 48.




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requisite thinness, which is determined by holding it up to the light.
If it transmits green rays, it is done, and will measure about one twohundred-and-eighty-thousandth (m Voo)
an inc^
thickness.
The hammers used in beating gold are slightly convex on the face.
The art of the workman consists in so striking that the gold will
always be thinnest in the center. He must pound with evenness all
over the square in order that the sheets of gold may expand without
losing their form, but at the same time he must keep the thickest
part near the edges, so that when the sheets are finally trimmed to
size the thicker portions may fall in the waste to be recast. No
machinery has ever been devised which will do this successfully.
The tools of the craft are interesting and peculiar. The rabbit’s
foot is exceedingly soft and just oily enough to prevent the gold from
sticking, and the bamboo pliers and cutting slips are the only things
with which it is possible to do this delicate work. The gold does not
adhere to the fibers of the reed as it does to steel. The goldbeater
performs all this work standing. The use of the heavy hammers in
such continuous pounding would, one would think, impose an almost
intolerable strain upon the hands and arms. The men say, however,
that their arms never ache. The only place where “ it catches them ”
is in the bend of the knee. The lack of strain upon the arms is ac­
counted for by the fact that the hammer rebounds. It is an aston­
ishing but by no means rare thing to see a goldbeater change hands
while the hammer is in the air and without losing a stroke.
MORTALITY OF GOLD-LEAF BEATERS— INDUSTRIAL INSURANCE
EXPERIENCE.

On account of the limited extent of the occupation there are no gen­
eral vital statistics, but a fairly trustworthy basis of information
is furnished by the proportionate mortality statistics of the Pruden­
tial Insurance Co. of America, as given in Table 37.
3 7 .—PROPORTIONATE M O RTALITY FROM PULM ONARY TUBERCULOSIS AMONG
GOLDBEATERS, INDUSTRIAL EXPER IEN CE OF PR U D EN TIAL CO., 1897 TO 1914, COM­
PARED W IT H THAT OF ALL MALES IN UNITED STATES REG ISTRATIO N A R E A , 1900
TO 1913, B Y AGE GROUPS.

T a b le

Deaths of gold beaters,.
1897 to 1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
All causes.

Males in
Pulmonary Gold beat­
registration
tubercu­
ers.
area, 1900
losis.
to 1913.

35 to 44 years....... ...................................................................
45 to 54 years ......... ............................................................
55 to 64 years
* . ..........................................................
65 years and over.................................................................

7
12
11
8
4
11

3
8
4
2

42.9
66.7
36.4
25.0

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over........... .................................

53

17

32.1

13.9

15 to 24 years............................................................................

95 to 34 years............................................................................

There were 53 deaths from all causes, of which 17, or 32.1 per cent,
were from pulmonary tuberculosis. The proportionate mortality
was exceedingly heavy at ages under 45, reaching a maximum at




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ftges 25 to 84, when of the mortality of gold beaters from all causes
66.7 per cent was from pulmonary tuberculosis. The rather limited
number of observed cases does not warrant final conclusions, but the
statistical evidence would seem to confirm the view that the mortality
from tuberculosis in this occupation is distinctly above the average.
GENERAL CONCLUSIONS.

The sanitary problems in this industry are complicated by the fact
that, as a rule, the work is carried on in small shops in which it is
difficult to apply rational principles of factory hygiene. The actual
amount of gold dust inhaled is probably relatively small and, in so
far as the tuberculosis problem is complicated by the dust factor, it
is quite probable that other surrounding circumstances Teact more
unfavorably upon the system than the relatively small amount of
metallic dust inhaled during the gold-beating process. As observed
by W. Gilman Thompson, “ OwT
ing to the value of the metal, where
gold is being filed or beaten strong ventilation currents can not be used
without dissipating the precious gold dust.” Thompson mentions a
case personally know to him of a goldbeater’s shop “ in which there
~n
are no general ventilators and the windows have to be kept closed, but
at intervals small hoods are let down over the worktables and the
room is kept well aired.” How far it would be feasible to improve
upon this method is merely a matter of conjecture. The industry,
while of small extent, is, however, strictly within the classification of
unhealthful trades and deserving of more careful attention on the
part of the sanitary authorities.
JEWELERS.

The manufacture of jewelry in all its branches involves a large
variety of manipulations, including the melting and refining of small
quantities of the precious metals, and the handling, shaping, cutting,
and polishing of precious stones. An important part of the indus­
try is engraving and die cutting, which, however, for the present
purpose, is separately considered as a well-defined occupation, and
although often included with jewelers, is equally often included
with printers and compositors. Most of the articles made by jewelers
are of small dimensions, such as chains, rings, brooches, pins, and
buckles, which require painstaking care in handling and continuous
eye-straining attention in shaping and polishing. Aside from the
u^e of gold and silver, many other metals and mineral substances are
employed, such as jet, coral, tortoise, bone, ivory, etc. Zinc is also
extensively used as an alloy and for coloring purposes. The gems
must be cut with extreme care, and the work of the diamond polisher
and lapidary constitutes, next to that of the gold and silver smith,




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important separate branches of the trade. The manufacture of arti­
ficial gems, made of a paste, chiefly of a vitreous substance pre­
pared from rocks and crystals of flint powder, subsequently treated
with nitric acid with lead and borax as a flux, forms another im­
portant subdivision of the industry.
ASCERTAINED UNHYGIENIC CONDITIONS.

The work of the jeweler is naturally an indoor occupation, involv­
ing a stooping position, much like that of the engraver. The work­
shops are generally small and the ventilation is usually poor. The
dust generated in the processes of hammering, cutting, shaping, grind­
ing, polishing, etc., is considerable, but very minute, and not easily
observed. The dust accumulations are preserved and sold to refining
plants for remelting and the recovery of precious substances. The
health problem is complicated by the universal use of blowpipe
apparatus and of gas for heating purposes. In large factories the use
of machinery is increasing, but chiefly in connection with the manu­
facture of imitation jewelry and stones.
The unhygienic condition of many jewelry workshops and the gen­
eral effect of this employment on health were discussed at some length
in an early treatise by Thackrah, from which is quoted the following:
The jewelers’ workrooms are generally crowded, and the atmos­
phere consequently fouled by respiration, animal effluvia, and the
smoke of lamps, as well as by the specific exhalations of the manu­
facture. Its temperature is generally raised, and in summer the heat
is excessive. The labor is light, but the confinement to a leaning
posture, with the head much depressed, and the elbow generally fixed
^s
to the sides of the trunk, for 10, 14, or 16 hours a day, is irksome
and injurious. Intemperance is general, and dram drinking es­
pecially prevalent. The disorders of which jewelers principally
complain are pains and soreness of the chest, disorders of the stomach
and liver, and plethoric affections of the head. They enter the em­
ploy at about 13 or 14 years of age and are obliged to abandon it
generally at 45 to 50.1
Thackrah continues that “ an old jeweler is seldom to be found, and
leaving work, they seem to leave the world as well.” That this rather
unfavorable view regarding the health conditions in the jewelers’
trade is not exaggerated is made evident by the fairly trustworthy
vital statistics of the trade. The English mortality data of jewelers
and allied occupations for the three years ending with 1902 include
2,823 deaths from all causes, of which 598, or 21.2 per cent, were from
pulmonary tuberculosis.
In addition to a high mortality from pulmonary tuberculosis there
were 164 deaths from bronchitis and 247 from other respiratory dis­
1 Effects of Arts, Trades, and Professions on Health and Longevity, by C. Turner
Thackrah, London, 1832, p. 115*




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eases, a total of 1,009 deaths, or 35.7 per cent, from diseases of the
lungs and air passages in the mortality from all causes.1
D E S C R I P T I V E A C C O U N T OF T H E J E W E L R Y I N D U S T R Y .

The conditions of employment in the jewelry industry, with spe­
cial reference, however, to England and Wales, have been admirably
described by Arlidge, in part as follows:
Mere dealers in jewelry incur no liability to sickness or to a high
mortality, except so far as confinement to their shops and insanitary
surroundings concur to produce it. On the other hand, some special
health conditions are connected with the manufacture of jewelry—
of gold, silver, and precious stones. The incidentals are close, very
sedentary work, and with it a bent attitude whilst sitting; close
application of the eyes, much artificial light, heat from furnaces,
crucibles, and the blowpipe, and acid fumes. The working with
precious stones entails the minutest attention and observation,* to­
gether with strong visual exertion and most delicate manipulation
with the fingers and forceps or other tools in use. The lapidary’s
wheel is a source of dust from the polishing powders used— for the
most part rouge, emery, and diamond dust—and, as we le,arn from
Proust (Ann. d’Bygiene Publique, 1878), it is likewise a cause of
lead poisoning when a lead cylindrical rod is used for polishing
cameos. In this proceeding the cameo is held against the revolving
rod, and from time to time moistened with a mixture of tripoli
powder and vinegar, whence arises a dust consisting of acetate of
lead. Nitric acid is largely employed for dipping and to brighten
the surface of jewelry, and where many persons are employed in the
same shop, and that not well ventilated, there is enough nitrous acid
vapor given off to become a source of throat, chest, and stomach irri­
tation. The frequent contact of the acid also with the skin provokes
sores, eczematous eruptions, and cutaneous fissures, besides doing
injury to the nutrition of the nails. The leaning position of jew­
elers over their work aggravates all the other unhealthy incidents of
their occupation. The evils of dust production attend the makers
of polished steel ornaments in a much higher degree than lapidaries
by reason of the larger quantity of polishing materials needed and
the constant use of brushes.
Arlidge also directs attention to the sedentary character of the
jewelers’ work, its confinement, and the bent position long sustained,
aside from the more or less injurious but very common method of
artificial lighting and the heat proceeding from constantly burning
gaslights and gas jets used for blowpipes to melt solder and heat
soldering irons. In addition there is the waste of burnt gases, the
acid vapors, and last, but not least, the dust from polishing stones
and settings, all of which, according to Arlidge, “ represent a series
of health conditions suggestive of the production of phthisis, bron­
l The English data include watch and clock makers, makers of scientific instruments,
and other more or less closely allied trades. For this reason the English statistics are
not strictly comparable with other data for jewelers and are not, therefore, presented
here in tabular form.




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chitis, anemia, and general debility with digestive troubles— an
inference borne out by statistics.” He concludes, however, that there
is much encouragement in the favorable aspects of the industry, in
that the health-injurious conditions referred to are, for the most
part, remediable by sanitary arrangements, “ foremost among which
are ample working space and effective ventilation.” These, how­
ever, are unfortunately frequently wanting, quite generally so in the
smaller establishments.
MORTALITY FROM TUBERCULOSIS AND PNEUMONIA.

Among the watchmakers and jewelers in Scotland, according to
the latest published official statistics, “ the death rates from tubercu­
losis and pneumonia are not decidedly different from the correspond­
ing^ death rates of all males,” but the mortality from bronchitis,
which is of considerable practical importance in this connection,
could not be determined. Since in the corresponding investigations
for England and Wales the mortality of jewelers from all causes
was fairly normal, it is rather suggestive that in a similar study of
the mortality of jewelers in Paris and Switzerland the death rates
should have been excessive. The manufacture of jewelry includes,
of course, quite a number of specific employments, carried on under
widely varying conditions, but no strictly scientific study has been
made with a due regard to such variations and the health-injurious
circumstances of particular employments as would be necessary for
the end in view.1
M O R T A L IT Y

OF JEW ELER S— U N IT ED

STATES R E G IST R A TIO N

A R EA.

The mortality of jewelers has been reported upon for the two years
1908 and 1909 by the Division of Vital Statistics of the United
States Census Bureau, but no subsequent information has been made
public, and the data are therefore of rather limited value. The
information includes jewelers, clock and watch repairers, as well as
gold and silver workers. According to the census report, out of 686
deaths of jewelers, including those in allied employments, as previ­
ously explained, 122, or 17.8 per cent, were from pulmonary tubercu­
losis. This relatively low average figure for all ages is, however,
materially modified by reference to the proportionate mortality ac­
cording to divisional periods of life. The low average proportion for
all ages is accounted for by the peculiar age distribution of jewelers,
which, considered as a group, includes quite a large number of deaths
at ages 45 and over and a comparatively small proportion at the
1 Conditions surrounding the industry of jewelry, clock, and watch making in Switzer­
land are clearly and exhaustively set forth in “ Enqu§te sur le Travail a Domicile chez
les Bijoutiers du Canton de Genfeve,” by Dr. AndrS de Maday and Mme. Marthe de
M aday-Hentzelt, Geneva, 1911.




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younger ages. In contrast, for illustration, to the mortality in the
printing trades the proportion of deaths of jewelers at ages 45 and
over out of the mortality at all ages was 65.2 per cent compared with
44 per cent for printers, lithographers, and pressmen, as derived
from the same official American sources. The details of the mor­
tality by divisional periods of life are shown in Table 38.
3 8 .—PROPORTIONATE M O RTALITY OF JEW ELERS FROM PULM ONARY TUBER.
CULOSIS, UNITED STATES REGISTRATION A R E A , 1908 AND 1909, B Y AGE GROUPS.

T a b le

Deaths from pulmo­
nary tuberculosis.
Age at death.

Deaths
from all
causes.
Number.

15 to 24 years..................................................................................................
25 to 34 years.....................................................................'...........................
35 to 44 years.................................................................................................
45 to 54 vears.................................................................................................
55 to 64 years.......................................................................- .........................
65 years and over..........................................................................................
Age unknown........... . ...................................................................
Total, 15 vears and over...................................... ...........................

66
78
94
128

Per cent of
deaths from
all causes.

142
177

33
31
22
18
12
6

50.0
39.7
23.4
14.1
8.5
3.4

686

122

17.8

1

It is here shown that the proportionate mortality from pulmonary
tuberculosis at the younger ages was quite excessive, having been
50 per cent at ages 15 to 24, and 39.7 per cent at ages 25 to 34. Com­
pared with that of printers, lithographers, and pressmen, however, the
proportionate mortality from pulmonary tuberculosis was relatively
lower, with one important exception, at all ages over 25. The same
conclusion applies to nontuberculous respiratory diseases, as shown
in Table 39, which, in the aggregate, account for 8.3 per cent of the
mortality from all causes among jewelers against 8.8 per cent among
printers, lithographers, and pressmen considered as a group. The
table, in a general way, confirms the data derived from other sources,
and quite clearly indicates that the health conditions in the jewelry
trade are far from satisfactory.
3 9 .—PROPORTIONATE M O RTALITY OF JEWELERS^FROM NONTUBERCULOUS
R ESPIR ATO RY DISEASES, U NITED STATES REGISTRATION A R E A , 1908 AND 1909.

T a b le

Deaths from nontubercu lo u s respiratory
diseases.

Cause of death.

#

Number.

Bronchitis.................................................................... ................................... ................. ..............

Pneumonia . .

- ........................................................................................................

Total............ 1.............................................................................................................




Per cent of
deaths from
all causes.

2
8
40
7

0.3
1.2
5.8
1.0

57

8.3

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MORTALITY OF JEWELERS— INDUSTRIAL INSURANCE EXPERIENCE.

The mortality of jewelers in the industrial insurance experience
of the Prudential Insurance Co. of America includes 812 deaths from
all causes, of which 238, or 29.3 per cent, were from pulmonary
tuberculosis. Of the mortality of jewelers from other respiratory
diseases, 61 were from pneumonia, 5 from asthma, 10 from bronchi­
tis, and 7 from other respiratory diseases. The deaths from pul­
monary tuberculosis and nontuberculous respiratory diseases com­
bined show that 39.5 per cent of the mortality of jewelers was from
diseases of the lungs and air passages. The excess in the mortality
from pulmonary tuberculosis among jewelers is very clearty brought
out in Table 40, which shows the proportionate mortality from this
disease by divisional periods of life.
T a b le 4 0 . — PROPORTIONATE M ORTALITY FROM PULM ONARY TUBERCULOSIS AMONG

JEW ELERS, IN DUSTRIAL EXPER IEN CE OF PR UD ENTIAL CO., 1897 TO 1914, COMPARED
W IT H THAT OF A LL MALES IN UNITED STATES REGISTRATION AR E A , 1900 TO 1913,
B Y AGE GROUPS.

Deaths of jewelers,
1897 to 1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
Males in
registration
area,1900
to 1913.

All causes.

15 to 24 years............................................................................
25 to 34 years..........................................................................
35 to 44 vears..........................................................................
45 to 54 years............................................................................
55 to 64 years..........................................................................
65 years and over....................................................................
Total, 15 years and over............................................

Pulmonary
tuberculo­
sis.

Jewelers.

110
144
106
132
144
176

56
84
48
28
16
6

50.9
58.3
45.3
21.2
11.1
3.4

27.0
30.5
23.4
14.7

812

238

29.3

13.9

7.9

2.6

GENERAL CONCLUSIONS.

The preceding observations and statistical data confirm the conclu­
sion that jewelers as a class a*e subject to a decidedly excessive mor­
tality from pulmonary tuberculosis at ages under 45, but particularly
so at ages 15 to 34, inclusive. There can be no reasonable question of
doubt but that this excess is, in a large measure, the direct result of
health-injurious circumstances connected with the employment.
THE PRINTING TRADES.

The printing and allied trades give employment to a large number
of men and women, including a considerable proportion of young
persons. The printing trades have undergone material changes in
methods of composition, use of machinery, etc. To an increasing
extent composition is done by machines, which are, strictly speak­




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ing, typecasting machines, operated in quite a different manner
from the old-time process of setting type by hand. The best known
of these typesetting machines are the Mergenthaler linotype and
the Lanston monotype, both of which are extensively used throughout
the country.
L IN O T Y P E AND M ONOTYPE OPERATION.

4

As observed by Mr. Charles C. Dominge, insurance engineer, in an
article on the “ Processes and hazards of printing,” including stereo­
typing, electrotyping, etc., in the Weekly Underwriter, August 5,
19 1 1In the case of small job work, small newspapers, pamphlets, and
certain books the printing is done direct from the type, which is
locked tightly in metal chases and securely fastened in the proper
place in the press.
Most of the modern newspaper composition, however, is done by
means of linotype and monotype machines, the former of which is
described by Mr. Dominge in part as follows:

These machines derive their name from the fact that they set up
one continuous line of type. The machine is operated by means of
a keyboard and resembles somewhat a huge typewriter. When the
operator strikes a letter on the keyboard the matrices (brass slugs
on which is an impression of the desired character) fall down through
a channel until a line is made up. Metal followers push the line
across until it is dropped in front of a pot of hot type metal, where
a chamber is formed around it, of which the brass matrix or type
impression makes up one side. A plunger connected with the metal
pot ejects a charge of metal into the chamber under pressure, and
this metal, coming into contact with matrices, causes a line to be
cast. This “ line of type ” is then pushed off to one side, to be fol­
lowed by other “ lines of type,” and the matrices are automatically
conveyed and distributed to their respective tubes ready to be called
upon again.
The same writer points out as regards the monotype machines
that—
The monotype is perhaps more marvelous in its operations than
the linotype. The operator takes the copy and proceeds to write it
out on a machine somewhat like a typewriter, except that the result
is a long strip of paper with innumerable perforations thereon.
There are two perforations for each character, arranged in a series
of combinations, the purpose of which will be explained later on.
When *the operator has written out the “ story ” upon the strip this
paper is placed in position on the casting machine. As the strip
moves automatically through the machine two perforations are al­
ways brought into position simultaneously over a pair of “ lugs/’
which are forced through the perforations at once by means of com­
pressed air. These lugs govern the lateral direction of a matrix
containing 226 characters, which moves laterally in two directions




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until stopped by the lugs. Hence the necessity for the different
“ combinations ” in the perforations mentioned above. Molten type
metal is then forced against the matrix and a type is cast—not a
line, as is the case with the linotype, but a single type. This whole
process of casting takes about as long as it takes the average type­
writer to strike the keys of her instrument, so rapid is the action of
the monotype.
O CCUPATIO N AL H A Z A R D S OF T H E P R IN T I N G T R A D E .

The occupational hazards of printing are chiefly in connection with
the inhalation of a more or less badly contaminated atmosphere.
The dust factor, while frequently serious, is, as a rule, of secondary
importance to other unhygienic circumstances of the trade. As
regards the operation of the linotype and monotype machines it is
stated by Dominge that—
The only hazard in connection with these machines is the lead
pot, holding about 1 quart of molten lead, which is usually heated by
gas. If the gas connection is made of rigid iron pipe instead of
rubber tube, as formerly, the hazard is only moderate. In large
shops these lead pots are now heated by electricity, and if approved
by the underwriters this is the best arrangement.
There is no reference here to the dust factor which, of course, as a
fire hazard is of distinctly secondary, if any, importance.
S A N IT A R Y AN D M E D IC A L C O N SID E R A T IO N S.

The employment of printers differs in many essentials from most
of the other occupations considered in this discussion, since it is
homogeneous and well defined and common throughout the country.
While in many of the modern printing establishments the conditions
favoring health and life, with special reference to ventilation and
light, are probably satisfactory, in the smaller workshops the sani­
tary conditions, as a rule, are decidedly to the contrar}^, and predis­
pose to tuberculosis. Thackrah in 1832 called attention to the
diseases of printers, and in his opinion “ few appear to enjoy full
health.” Pulmonary tuberculosis, according to this writer, was fre­
quent, but was apparently caused rather by the confinement or indoor
employment than by direct injury to the respiratory organs. The
trade is one which has received a considerable amount of atten­
tion because of its recognized unhygienic features, and, in addition
to the general data upon this subject, the mortality experience of
various t}^pographic associations has been carefully investigated.
It is suggested by Oliver that “ Printing houses should be so con­
structed that free currents of air can get to them, and not, as is so
frequently the case, shut in by other buildings.”




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But such construction is even to-day the exception rather than the
rule. Considering that, as a class, printers probably rank above the
average mechanics in intelligence and earnings, it is difficult to un­
derstand why they should so persistently in the past have neglected
the important problem of workshop hygiene. The successful effort
to secure to the members of the craft in illness or old age a home
in the mountain region of the West emphasizes what could be done
by concentrated effort in other and even more important directions.
In the historical sketch of the Union Printers’ Home, at Colorado
Springs, it is, in fact, pointed out that the place was selected for
the location of the home primarily because of the special liability
of printers to all forms of lung and throat diseases, and in explana­
tion of the subsequent necessity for a hospital annex the statement
is repeated that “ consumption is one of the diseases to which the
printer is especially liable.”
E N G L IS H AN D A M E R IC A N M O R T A L IT Y S T A T IS T IC S .

Tatham, in commenting upon the excessive mortality of printers,
as disclosed by an analysis of the English mortality data, remarks
that “ like bookbinders, printers die very rapidly from phthisis, and
probably for a similar reason, namely, because of the excessively
unhealthful conditions under which their work is carried on.” 1
Tatham calls attention, however, to the decline in the mortality of
printers, due among other causes to the decrease in the deaths from
lead poisoning, which had fallen to one-half of the earlier figure.
The frequency of phthisis among English printers had decreased
during the decade by one-sixth of the former rate.
In the occupation mortality statistics of the Twelfth Census,
printers are grouped with compositors and pressmen, which is to be
regretted since there are certain important differences in the disease
liability of these allied employments which are sufficiently distinct
to warrant separate consideration, at least in the case of pressmen,
although the number of the latter is comparatively small. The total
number of persons included in this group in the registration States,
rtged 15 or over, according to the census, was 54,374, but of this num­
ber only 818, or 1.5 per cent, had attained to the age of 65 or over.2
This rather surprising result is confirmed by the statistics of the
New Jersey Bureau of Labor for 1891, according to which out of 462
printers only 2 had attained to the age of 60 or over. The census
mortality statistics of this group of printers, or as stated, composi­
tors, printers, and pressmen, are of some value though not entirely
conclusive on account of probable defects in the census enumeration.
1 D angerous T rad es, by T h om as O liver, London, 1 9 0 2 , p. 15 1 .
2 R eport o f the B ureau o f the Census on V it a l S ta tistic s, 1 9 0 0 , p. cclxxx ii.
been no subsequent census report giv in g com parable data.




Ther.e has

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4:1. —M O R T A L IT Y F R O M A L L C A U SE S A M O N G C O M P O SITO R S, P R IN T E R S , A N D
P R E S S M E N , C O M P A R E D W I T H T H A T O F T H E M A N U F A C T U R IN G A N D M E C H A N IC A L
CLASS A N D T H E M E R C A N T IL E A N D T R A D I N G C LASS, IN T H E R E G IS T R A T IO N S T A T E S ,
1900, B Y A G E G R O U P S.

T a b le

[Source: Report of the Bureau of the Census on Vital Statistics, 1900.]

Death rate per 1,000 among—
Age at death.

15
25
45
65

Compositors,
printers, and
pressmen.

to 24 years....................................................................................
to 44 years....................................................................................
to 61 years....................................................................................
vears and over............................................................................

5.05
12.29

20.01
108.80

The manufac­
turing and me­
chanical class.

The mercantile
and Irading
class.

4.43
8.35
20.16
105.43

2.60
6.72
19.91
93.79

According to Table 41 the death rate of printers at ages 15 to 24
is 5.05 per 1,000, compared with 4.43 for men in the mechanical and
manufacturing class, and only 2.60 for the mercantile and trad­
ing class. At ages 25 to 44 the rate is 12.29 for printers, but only
8.35 and 6.72, respectively, for the other two selected groups of occu­
pations. At ages 45 and over the differences in the mortality of
printers compared with that in other occupations are very slight, due
in all probability to the fact that on the one hand most of those at all
liable to tuberculosis had died an.d that on the other many of the
impaired in health had left the trade. In addition there is also the
factor of a possible defect in the census enumeration.
E X P E R IE N C E

OF

TH E

IN T E R N A T IO N A L

T Y P O G R A P H IC A L

U N IO N .

At the forty-sixth session of the International Typographical
Union, held at Milwaukee, Wis., in 1900, a statistical summary was
submitted showing that out of 419 deaths of printers during the pre- •
ceding year, 192, or 45.8 per cent, had been deaths from diseases of
the lungs or air passages, including under this term bronchitis,
asthma, pulmonary tuberculosis, pneumonia, and all other respira­
tory diseases. Of the 411 printers whose ages at death were known,
44, or 10.7 per cent, died at the age of 65 or over, while the average
age at death was only 41.25 years, compared with 52.2 years for all
males aged 15 or over in the registration area of the United States
in 1900.
Kober, in his article on “ Industrial hygiene,” in Bulletin No. 75 of
the Bureau of Labor Statistics, refers briefly to printers, type founders,
and typesetters, quoting Sommerfeld to the effect “ that among 38
occupations tabulated by him printers occupied the fifth rank in the
number of deaths from tuberculosis.” It is to be assumed, of course,
that this has reference to the death rate and not merely to the number
of deaths without reference to the exposed risk. Kober also quotes
Albrecht in the statement that “ the statistics of the Berlin Sick




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Benefit Insurance Fund, covering a period of 33 years, show that
48.13 per cent of the deaths among printers are caused by consump­
tion.” He observes in this connection that—
This may be due in part to the fact that many weaklings engage in
this occupation, but the work itself is often performed in most unfa­
vorable environments and in an impure and dusty atmosphere, which
has been found to contain traces of lead, arsenic, and antimony.
Special attention should be paid to proper ventilation, and particu­
larly to the collection and removal of dust from the type cases. One
gram of this dust has been found to contain 57.7 m of lead, 186.8
g*,
mg. of antimony, and traces of arsenic.1 Strasser has suggested a
type case with perforated tin bottom, which is placed within another
case, so as to facilitate the collection and proper disposition of this
injurious form of dust.
The results of an extended investigation into the sanitary condi­
tions of the printing trade, as prepared by Mr. George A. Stevens,
were published in the report of the New York State Bureau of Labor
Statistics for 1906. This investigation included the entire mortality
of the International Typographical Union for the five years ending
with 1905, or 2,498 deaths, representing a mean death rate of 12.63 per
1,000. The rate was highest among the printers of New York City,
or 16.32 per 1,000, and lowest in Chicago, or 10.12 per 1,000. The
average age at death for all printers was not quite 45 years. The
disease most frequent and severe among compositors was found to
be tuberculosis of the lungs. The average age at death of composi­
tors dying from tuberculosis was only 36.33 years. Out of 2,498
deaths from all causes, 660, or 26.4 per cent, were from tuberculosis,
equivalent to an annual mean death rate of 3.34 per 1,000. Pneu­
monia caused 258 deaths, or 10.3 per cent of the deaths from all
causes, equivalent to an annual mean death rate of 1.3 per 1,000.
In commenting upon the high degree of frequency of pulmonary
tuberculosis the report points out that “ scarcely any other occupa­
tion furnishes so large a quota of victims from consumption. The
domestic life of printers is parallel to that of other artisans in equal
financial circumstances. They are fairly compensated for their
labor, thus enabling them to have homes as healthful as those pro­
cured by the best-paid workmen in any community. Neither can it
be said that compositors are ill-nourished and, therefore, rendered
more susceptible to the tubercle bacilli. The determining cause of
their susceptibility to the harmful process of the great white plague
lies in a different direction—neglect of sanitary precautions in com­
posing rooms.” 2
Of the mortality at known ages, from all causes, 18.9 per cent were
deaths at 60 years of age and over. Of the 464 deaths in this group,
1 R oasah egyi, A r cM v . fiir H ygien e, M un ich an d Leip zig, vol. 3, p. 5 2 2 .
2 R ep ort o f the N ew Y o rk S ta te B u reau o f L a bor S ta tistic s, 1 9 0 6 , pp. cxxi and cxxii.




128

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

321 occurred between the ages of 60 and 69, 122 between T and 79,
O
19 between 80 and 89,1 at age 90, and 1 at age 96.1
C O M P A R A T IV E

V IT A L

S T A T IS T IC S OF CO M PO SITO R S I K
N EW YO RK.

TH E

ST A T E

OF

The statistics by Stevens indicate a rather wide variation in the
incidence of pulmonary and respiratory diseases among printers
according to localities, as shown by Table 42.
4 2 . —A N N U A L D E A T H R A T E P E R 1,000 F R O M P R IN C IP A L C A U SE S A N D A L L
C AU SES, A M O N G C O M P O SIT O R S IN C E R T A IN L O C A L IT IE S , F O R T H E F IV E Y E A R S ,
1901 TO 1905.

T a b le

(Source: Twenty-fourth Annual Report of the New York State Bureau of Labor Statistics, 1906.]

Death rate per 1,000.

Locality.

New York C ity.........................
Other New York State..........
Total New York State...........
Chicago, 111.................................
Philadelphia. P a ......................
All other United States.........
Total United States................
London, England______ . . . .

Tuber­
culosis
of lungs
and other
respira­
tory or­
gans.

3.82
2.54
3.48
2.42
3.65
3.38
3.34
3.69

Diseases
Pneu­
of ner­
monia, vous sys­
tem.

2.42
.97
2.03
1.57
.70
1.07
1.30
.67

1.91
1.49
1.80
1.04
2.26
1.33
1.44
1.16

Diseases
Diseases Diseases
of genito­
of diges­
of the
urinary
tive sys­
heart.
tem.
system.
%

1.63
.70
1.38
.98
-.70
1.02
1. os
.51

1.37
1.67
1.45
1.44
1.39
1.37
1.39
1.97

0.99
.97
.98
.45
.52
.74
.76
.51

Acci­
dents
and in­
juries.

0.89
.61
.82
.72
........ *60'
.64
.19

All
causes.

16.32
11.14
14.94
10.12
12.35
12.20
12.63
12.19

E X C E S S I V E F R E Q U E N C Y OF P U L M O N A R Y T U B E R C U L O S IS .

The corresponding proportionate mortality from pulmonary tu­
berculosis and other respiratory diseases among compositors varied
from 30.2 per cent for London, England, to 26.4 per cent for printers
in large cities of the United States, in contrast to a normal average
of approximately 15 per cent for adult men and women in the ter­
ritory under consideration.
As subsequently to be shown, there are reasons for believing that
printers are physically below the average of men employed in other
gainful occupations and that occupational selection has some bearing
1 A m ost im p o rta n t in v estig a tio n o f the h e alth o f prin ters is a recent bu lletin (N o . 2 0 9 )
o f the U . S. B ureau o f Labor S ta tistic s ( 1 9 1 7 ) , by D r. A lice H a m ilto n and M r. C harles
H . V e rrill.
T h is in vestigation includes a concise description o f p rin tin g p la n ts, observa­
tio n s on th e effects o f lead fum es and other poisons, descriptive accounts o f m odern
m ethods o f prin tin g by m eans of lin otype and m onotype m ach in es, extended observations
on the health o f printers in the U n ited S ta te s and foreign cou ntries, ob servations on the
health conditions o f men en terin g the indu stry and the h ealth cam paign of the In ter­
n a tion al T y p ogra p h ical U nion. A p pen dixes describe a proposed schem e for th e inspection
o f com posing room s in the D is tric t o f C olum bia, precautions fo r p rin ters published by
th e M assa ch u setts G eneral H o sp ita l, and hygienic regu lation s fo r p rin tin g and typ e­
castin g establish m en ts published by the D epartm en t o f L abor o f the S ta te o f N ew Y ork.
T h e rep ort is a m odel o f im p a rtia lity and scientific con clusiveness, sub ject, o f course, to
the lim ita tio n s o f scientific research inherent in all in v estig a tio n s o f th is kind.




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upon the excessive mortality from tuberculosis in the printing and
allied trades, aside from the special hazard of dust and fume ex­
posure.
The statistical data of the mortality rate among printers for the
United States are fully confirmed by the corresponding statistics for
German printers which were published in a small treatise on the
hygiene of the printing trade by Dr. Lewitt, of Berlin, in 1899.
According to this authority, out of 1,390 recorded deaths of print­
ers, 798, or nearly 61 per cent, were from diseases of the lungs and air
passages, including 630 deaths from pulmonary tuberculosis. Of
the total number, 243, or 17.5 per cent of the mortality at known ages,
had attained to the age of 60 or over. The suggestions made by
this writer regarding the prevention of tuberculosis and other diseases
in the printing trade are eminently practical and feasible in most
of the workshops in which printers are employed.
S A N IT A R Y CON TRO L OF T H E P R IN T I N G IN D U S T R Y I N G E R M A N Y .

The regulations of the Federal Council of the German Empire
with reference to the control of sanitary conditions in the printing
industry, put into effect July 31, 1897, are reprinted in Bulletin No.
75 of the United States Bureau of Labor Statistics, and these regula­
tions as amended in 1907 and in 1908 are reprinted in Bulletin No.
209. The corresponding regulations issued by the Austrian Depart­
ment of Commerce have been reprinted in a special bulletin (No..76)
on European Regulations for Prevention of Occupational Diseases,
published by the New York State Department of Labor, Albany,
March, 1916.
D U ST H A Z A R D S I N T H E P R IN T I N G IN D U S T R Y I N OHIO.

The investigations by Hayhurst with special reference to the
State of Ohio for the year 1915 include 26 establishments, in 12 of
which, however, printing was a more or less auxiliary feature. One
of the practical difficulties of separating specific processes in the
printing trade is that they are usually all carried on more or less in
common. According to Hayhurst—
Dust was a fair hazard in 10 places, bad in 1, and negligible in the
remaining. Quarters were kept clean in 14, fairly so in 9, and not
so in 3. Dry sweeping and dusting of fonts with an air blast are
pernicious. Cold and dampness, due to inefficient heating, were found
to exist in 4 places. Light was good in 17 places, fair in 4, and poor
in the remaining 5. General room ventilation was only fair in 10
places and bad in 7 more. Fatigue seemed a negligible factor in 8
places, fair in 10, and bad in the remaining 8, due, principally, to
hurrying piecework, monotony, constant standing, strain, chairs
and stools without backs, faulty postures, and in some cases jarring
106811°— 18— Bull. 231------ 9




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M R A IT F O R S IR T E D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

processes and loud noises. Eyestrain and myopia are special hazards
of the printers, and every such worker should be assured of the con­
dition of his eyes for such work.
The chief complaints of the employees were with reference to poor
ventilation, fumes, typesetting dust, risk of lead poisoning, and
working with fellow workers infected with tuberculosis.
Regarding typesetting machines and the special hazard in connec^
tion with linotyping, monotyping, stereotyping, etc., Hayhurst, on
the basis of personal investigation, writes as follows:
This class of procedure includes all processes in which type metal is
melted and used, such as linotyping, monotyping, and stereotyping.
(Electrotyping is practically identical with electroplating.) These
are here reported upon as the result of our investigation in 15 plants.
The total wage earners so employed was 361, of whom 348 were males
and 13 were females. Seven of the places were union shops. The
general attitude toward employees was good in 12 places, and at
least fair in the remaining. The workers were of intelligent type in
all places, except here and there a few non-English speaking laborers.
Retention of workers was good in 12 places, fair in 1, and not so in 2.
Health appliances, such as hoods and stacks over metal pots, furnaces,
and burners, were good in 5 places, fair in 2, and absent in the balance*
The dust factor in connection with these occupations was considered
of relatively small importance; the chief conditions detrimental to
health w
^ere the escape of gases and fumes from the hot processes,
and the absence of air agitators and means of effective ventilation.
Fatigue was not found to be a particular hazard in any one of the
working places examined. Industrial poisoning was found to be a
considerable hazard in 7 of the work places examined and a fair
hazard in 4 others, due chiefly to the absence of hoods and vent pipes
over metal pots, especially over gas burners and furnaces.1
The actual printing process or pressroom work was investigated by
Hayhurst in 13 plants employing 392 wage earners, including 32
T
females. Health appliances, consisting of hoods and flues for drawing off escaping gas fumes in drying freshly printed work, were
present in only 2 places. A slight amount of dust was observed
in the air in the majority of places, but no strictly scientific investi­
gations were made with reference to the exact degree of atmospheric
pollution. #
O CC U PA TIO N A L D I S E A S E S OF P R IN T E R S .

Occupational diseases among employees of printing plants have
not been made the subject of a thoroughly qualified and strictly scien­
1
See in th is connection Special B u lle tin N o. 82 o f the N ew Y o rk S ta te D ep artm en t o f
L a b o r on “ H oods fo r R em ovin g D u st, Fu m es, and G ases,” prepared by the division o f
in d u stria l hygiene, A lb a n y , M ay, 1 9 1 7 .
See also P u blic H e a lth B u lle tin N o. 8 l , W a s h ­
in g to n , 1 9 1 7 , on “ T h e E ffect o f G as-h eated A p p lian ces U pon the A ir o f W o rk S h o p s/*
by C harles W eissm a n .




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tific investigation.1 Exact information, however, is gradually in­
creasing, and among other recent investigations is one by Strumpf
and Zabel, with reference to the physical condition of a large num­
ber of typesetters employed in Strassburg, Germany. According to
the Journal of the American Medical Association of December 3,
1910—
One thing which impressed them was the rarity of typical cases of
lead poisoning. They observed, however, with great frequency, a
clinical syndrome characterized by a fatigued expression, nervous­
ness, irritability, insomnia, exhaustion especially in the morning
hours, vertigo, headache, particularly in the frontal and occipital
regions, general or local muscular pains, neuralgic pains in the ex­
tremities, nausea and vomiting, and constipation. Mild, moderately
severe, and severe cases were encountered. The authors find evi­
dence in the literature that this symptom-complex has been looked on
as a manifestation of chronic lead poisoning. The patients showed
no elevation of blood pressure, which, as Krehl has shown, is so
common in plumbism from spasm of the arterial walls; the erythro­
cytes had no basophilic granules; and leucocytosis was lacking.
Nor did the urine show traces of albumin or bile. On the contrary,
the red count was almost or quite normal even in the severe cases
with an absence of basophilic granules and there was leucopenia
with eosinophilia between 10 and 25 per cent. (Typesetters without
symptoms jpossessed as high as 9 per cent eosinophiles.2) The urine
was normal and likewise the blood pressure.
Since the facts observed suggested no connection with lead poison­
ing, further research led to the conclusion that the employees affected
had been suffering from chronic antimony poisoning, subsequently
confirmed by further investigations. As pointed out in the editorial
of the Journal of the American Medical Association—■
Thus a new danger to typesetters working with antimonial com­
pounds is brought to light and a distinct contribution added to the
growing subject of occupational diseases.
C A U S E S OF E X C E S S I V E F R E Q U E N C Y

OF P U L M O N A R Y T U B E R C U L O S IS .

Among American printers, using the term in a broad and com­
prehensive sense, the health conditions have been reported upon by
Dr. James Alexander Miller, of New York, in a paper read- before
1 A fa irly exten sive a n a ly sis o f the ava ilable m o rta lity d ata o f p rin ters is included in
the bu lletin (N o . 2 0 9 ) o f the U. S. B ureau o f Labor S ta tis tic s (1 9 1 7 ) on the H ygien e oE
the P r in tin g T rad es, by H a m ilto n and V e rrill.
T o be en tirely conclusive, how ever, a
m uch m ore specialized tech nical a n aly sis o f the s ta tis tic a l m aterial is required, w ith a
due regard to the stric tly m edical asp ects o f a problem o f exceptional tech nical com ­
p lexity.
A really con clusive in v estig a tio n should include a sufficient num ber o f p h ysical
exa m in ation s o f prin ters w ith a due regard to the len gth o f trade life and the variou s
special occupation s follow ed in the p rin tin g trade from the begin ning o f the ap pren tice­
ship to the a tta in m en t o f perm anency in the branch o f the in d u stry selected as a per­
m anent m ean s o f gain in g a livelih ood.
2 E o s in o p h ile : In bacterio lo gy and h istology, applied to m icrobes or histologic ele­
m ents show ing a peculiar affinity for eosin s ta in .




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M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E ' U T R D S

the Sixth International Congress on Tuberculosis in 1908.
mary of his more important findings follows:1

A sum­

The main point in the investigation was not only to determine the
extent of pulmonary tuberculosis but all other diseases were con­
sidered both in the history and the physical examination. It was
found that almost all the men were young, native-born Americans,
earning good wages, and living under good conditions; the majority
of them used alcohol and tobacco; 20 per cent of all used them in
excess, and about 20 per cent were total abstainers. One hundred
and twenty-four complained of unfavorable conditions in the shop
designated as follows: Poor ventilation, 49; metal fumes from un­
piped machines, 27; insanitary water-closets, 19; insufficient number
or absence of cuspidors, 14; dirty walls and ceilings, 8; metal dust,
5; overcrowded rooms, 7; poor light, 5. The medical history and ex­
amination showed that catarrh of the upper air passages was fre­
quent, also dry pleurisy, bronchitis, and pulmonary tuberculosis.
Pulmonary tuberculosis was present in 34 cases or 17 per cent of the
whole number. Dr. Miller concluded that pulmonary ^tuberculosis is
prevalent among printers and is largely due (1) to unfavorable
shop conditions, especially poor ventilation, overcrowding, dust and
dirt, promiscuous spitting, and poor lighting; (2) to the irregular
habits of the printers, especially alcoholism, careless habits of eating,
needless exposure to drafts, and insufficient outdoor exercise.1
S A N IT A R Y

C O N D IT IO N S. I N

GO V ERNM ENT

P R IN T I N G

AND

E N G R A V IN G .

A somewhat similar investigation concerning 4,000 persons em­
ployed in connection with Government printing and engraving was
reported upon by Dr. B. S. Warren, of the United States Public
Health Service, at the ninth annual meeting of the National Associa­
tion for the Study and Prevention of Tuberculosis, Washington,
1913. In part, Dr. Warren states that—
My purpose in writing of this unusual condition is to submit the
facts that here are 4,000 employees, working under very bad sanitary
conditions, and the death rate is surprisingly low. The force con­
sists of engravers, printers, printers’ assistants, examiners, counters,
mechanics, and all the help required in such an establishment. All
the buildings of this establishment are very badly overcrowded.
There are 1,731 employees working with less than 500 cubic feet of air
space and 30 square feet of floor space per person. Ventilation is
very poor, especially in the pressrooms, where from 150 to 300 print­
ers and printers’ assistants are at work. The poor ventilation is
made still worse by the small gas stoves required by each printer to
heat his plates. Ink fumes and often carbon monoxide rise from
these stoves.
The printing is done on piecework basis, and all are working at
top speed continuously. In the ink-making rooms the employees are
exposed to the dust rising from the dry, powdered colors. In the
steel-plate hardening room, cyanide of potash fumes were in the air
1 F o r paper in fu ll, see T r a n sa ctio n s o f the In tern a tio n a l
W a sh in g to n , 1 9 0 8 , V o l. I l l , pp. 2 0 9 - 2 1 7 .




C ongress

on Tu bercu losis,

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all the time; in fact, every insanitary condition that surrounds any
printing shop was noted.
A V E R A G E W E IG H T AN D H E IG H T OF P R I N T E R S .

Further and more strictly scientific investigations would be neces­
sary to produce the required evidence regarding the precise effect on
health (if at all ascertainable) of the obviously numerous factors and
conditions inimical to health in the printing and allied industries.
Since the problem is quite complicated, particularly in view of the
probably inferior physique of printing employees at entrance to
the trade, Table 43, derived from the ordinary mortality experience
(males only) of the Prudential Insurance Co. of America, 1886 to
1914, will prove of interest and value.
4 3 .'— A V E R A G E W E I G H T A N D H E I G H T O F P R IN T IN G E M P L O Y E E S C O M P A R E D
W I T H T H O S E O F A L L O CC U P IED M A L E S , AC C O R D IN G TO M A L E O R D I N A R Y M O R ­
T A L I T Y E X P E R I E N C E O F T H E P R U D E N T I A L IN S U R A N C E CO. O F A M E R IC A , 1886 TO
1914, B Y A G E G R O U P S.

T a b le

Male printers.

Age at entry.
Number.

All occupied males.

Average height
(inches).

Relative
Relative
Average
Average 1
weight
weight
Male
weight
weight ‘
(pounds
(pounds printers.
(pounds).
(pounds).
per inch).
per inch).

All occu­
pied
males.

15 to 24 years....................................
25 to 34 years....................................
35 to 44 years....................................
45 to 54 years....................................
55 to 64 years....................................
65 years and over............................

126
230
150
51
31

2.05

68.2

68.1

2.26
2.35
2.40
2.40
2.38

67.6
67.7
67.0
67.4
67.0

68.3

2.28
2.37
2.29
2.91

145
155
160
163
163
1*62

2.12

1

140
149
154
159
154
195

Total, 15 years and over. .

589

149

2.21

157

2.30

67.7

68.1

2.20

68.1
67.9
67.8
67.9

According to this table, at every period of life the average weight
of persons employed in the printing trade, with one exception, is
below the average for all occupied male£, to the extent of 8 pounds
for all ages combined. The one exception at ages 65 and over is,
of course, due to the fact that only a single case was under
observation. Since there is invariably an important correlation be­
tween height and weight, the last two columns of the table are in­
cluded for the purpose of emphasizing the fact that printers, on
examination, were not only below the average in weight, but also in
stature. The differences here are not quite so marked as shown by
the weight, but they are, nevertheless, of importance.
Correlating the height and weight, the table shows the relative
weight at entry in pounds of weight to each inch of stature, proving
conclusively a sufficient difference in the physique of printers to re­
quire consideration in the correct interpretation of the subsequent
mortality tables. The average relative weight of printers, according
to this table, was 2.21 pounds per inch of stature, against 2.30 for all




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M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

occupied males. It may be said in this connection that the propor­
tion of deaths from pulmonary tuberculosis among the 589 printers
under observation was 29.2 per cent for all ages, against 18.6 per
cent for all occupied males in the company’s ordinary experience.
E N G L IS H M O R T A L IT Y S T A T IS T IC S OF P R I N T E R S .

The most recent English mortality statistics of printers are for the
three years ending with 1902, referred to in the Supplement to the
Sixty-fifth Annual Report of the Registrar-General of Births,
Deaths, and Marriages in England and Wales, in part as follows:
The death rates of printers were above the standard for occupied
and retired males at all ages up to 35 years, but above that age
they were below the standard. Within the main working period of
life the comparative mortality figure of printers is 994, which practi­
cally corresponds to the standard; they show a slightly excessive mor­
tality from influenza, nervous diseases, and Bright’s disease; and
their mortality from phthisis exceeds the standard by 60 per cent.
On the other hand, their mortality from circulatory and respiratory
diseases is considerably below the average, and they appear to be
subject to small risk from fatal accident, and to be but little addicted
to alcoholism and suicide.
Since 1880-1882 there has been a continuous decline in mortality
from phthisis, liver disease, and accident. It is also worthy of notice
that the mortality from lead poisoning is now only one-fifth part as
high as it was 20 years ago. From the other causes shown in the
table the mortality in this occupation has fluctuated considerably.
The English occupation mortality statistics for printers are quite
conclusive of the unfavorable effects of this occupation on health.
In Table 44, which follows, the mortality from all causes among
men in this employment is compared with that of occupied males
generally, and the result is decidedly suggestive of conditions in this
trade more or less unfavorable to life and health, but in particular at
the early ages, or 15 to 34, when the excess in mortality is from 0.45
to 1.62 per 1,000. This table is deserving of particular consideration
in that it emphasizes the health-destructive circumstances of this
employment at a very early period of life. Among those who survive
to age 35 or over there is not apparently a decidedly unfavorable
mortality in comparison with other occupations, and in this respect
the English statistics are confirmed by the United States census sta­
tistics previously quoted. While the actual excess in the mortality of
printers at ages 20 to 24 is only 1.62 per 1,000, this excess is equivalent
to nearly 40 per cent of the normal mortality at this period of life.




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4 4 . — M O R T A L I T Y F R O M A L L C A U SE S A M O N G P R IN T E R S , C O M P A R E D W I T H T H A T
O F A L L O C C U P IED M A L E S , IN E N G L A N D A N D W A L E S , 1900 TO 1902, B Y A G E G R O U P S .

T a b le

[Source: Part I I, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Death rate for printers.

Age at death.

15 to 19 years....................................................................................
20 to 24 years....................................................................................
25 to 34 years............................................................................... *.
35 to 44 years....................................................................! .............
45 to 54 years...................................................................................
55 to 64 years...................................................................................
65 years and over...........................................................................

Death rate
per 1,000
for all oc­
cupied
males.

2.44
4. 41

6.01
10.22
17.73
31.01
88.39

Rate per
1, 000.

3.19
6.03
6.46
10.19
17.76
30. 76
87.61

Greater ( + )
or less ( —) Per cent of
than rate rate for all
for all oc­
occupied
cupied
males.
males.

+ 0 .7 5
+ 1.62
+ .45
- .03
+ .03
- .25
- .78

131
137
107

100
100
99
99

The preceding table requires no further comment. A more ex­
tended comparison, however, is made in Table 45, in which the
mortality of printers from pulmonary tuberculosis and other dis­
eases of the respiratory system is compared with the normal mor­
tality of occupied males from these diseases, by divisional periods
of life.1 The comparison showT that at all ages the mortality of
s
printers from pulmonary tuberculosis is excessive by from 0.49 to 2.11
per 1,000. The excess is most marked at ages 35 to 44, but the dif­
ference is a material one at all ages, 20 to 64, inclusive. The corre­
sponding mortality from other respiratory diseases among printers
was slightly excessive at ages under 20 and comparatively high at
ages 65 or over, but below the average at ages 20 to 64, inclusive.
Apparently the employment does not predispose seriously to respira­
tory diseases except such as assume the pulmonary form of true
tuberculosis of a rapidly developing type most destructive to young
printers at ages under 45. The table which follows is self-explana­
tory.
i F o r a d dition al d a ta on the h e a lth o f printers see table included in the footno te on
page 55 for th e year 1 9 1 4 for the city o f N ew York.
Accordin g to this table, a t ages
25 to 34 the pro portiona te m o rta lity from pu lm o nary tuberculosis w as 6 6 .6 per cent for
com positors and prin ters a ga in st 3 3 .5 per cent for all occupations.
E v ery sta tistic a l
in v estig a tio n o f th is kind confirms previous conclusions th a t the health o f prin ters is
unquestionably seriou sly im paired in consequence o f occupational hazards a t the present
tim e m ore or less ill defined and largely a m a tter o f conjecture.




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M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

4 5 .— M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS A N D F R O M O T H E R D IS ­
E A S E S O F T H E R E S P I R A T O R Y S Y S T E M A M O N G P R IN T E R S , C O M P A R E D W I T H T H A T
O F A L L O CC U P IED M A L E S , IN E N G L A N D A N D W A L E S , 1900 TO 1902, B Y A G E G R O U P S .

T a b le

[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Mortality from pulmonary tuberculosis.

Mortality from other diseases of the
respiratory system.

Death rate for printers.

Death rate for printers.
Age at death.

Death
rate per
1,000 for
all occu­
pied
males.

15 to 19 years........
20 to 24 years........
25 to 34 years........
35 to 44 years........
45 to 54 years........
55 to 64 years........
65 years and over.

0.54
1.55
2.03
2.74
3.04
2.16

1.11

Rate per
1,000.

1.03
3.41
3.65
4.85
4.27
3.42
1.60

Death
rate per
Greater
Per cent 1,000 for
( + ) or less
of rate for all occu­
( —) than
pied
all occu­
rate for all
males.
pied
occupied
males.
males.

+ 0 .4 9
+ 1.86
+ 1 .6 2
+ 2 .1 1
+ 1.23
+ 1.26
+ .49

191
220
180
177
140
158
144

0.24
.48
.77
1.66
3.32
6.54
17.77

Greater
Per cent
( + ) or less
of rate for
Rate per ( —) than
rate for all all occu­
1,000.
pied
occupied
males.
males.

0.36
.37
0 55
1.24
2.17
5.16
20. 76

+ 0 .1 2
- .11
- .22
- .42
- 1 .1 5
- 1 .3 8
+ 2 .9 9

150
77
71
75
65
79
117

T A C T S D ISC L O SE D B Y T H E N E W Y O R K S T A T E F A C T O R Y IN V E S T IG A T IN G
C O M M ISSIO N .

There are no other recent mortality statistics for American printers
obtainable through census investigations or the annual reports of State
and local boards of health than those subsequently to be referred to.
The most recent investigation of the existing labor conditions in the
printing trade was made in connection with the work of the New
York State Factory Investigating Commission. According to this
investigation 2,245 workers were employed in 25 establishments^
including 60 per cent male employees, 39 per cent females, and
1 per cent children under 16; 14 per cent of the employees were
found to be working in dirty shops, and 86 per cent were at work in
7
fairly clean or clean quarters. The statement is made that “ Print­
ers have improved in health and have suffered less from lead poison­
ing since the handling of type and inhaling of dust from the cases have
been so largely superseded by the newer processes.” But it is added
that there are still evils to be remedied, and special reference is made
to air contaminated by fumes from linotype machines not provided
with adequate ventilating devices. Some of the shops investigated
were found to require better ventilation with special reference to gas
or lead fumes. A large number of pressmen and paper handlers
were found to be subject to a high degree of heat and humidity,
7
owing to the need for quick drying and smooth flow of the ink. The
dust factor is obviously less important than gas and fumes and un­
suitable atmospheric conditions, but, as said in the report of the
same commission for the year 1913, “ There is a total lack of ade­
quate provision for ventilating printing establishments. The abun­




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dant dust from the type, the fumes from the molten lead, the par­
ticles of graphite from the stereotyping processes, the heat from the
artificial illumination and from the gas-heated lead pots in the lino­
type, all these cause extreme vitiation of the air in such establish­
ments.” The investigations of the commission ascertained that me­
chanical ventilation was made use of in only 6 per cent of the shops.
The statistical data of the commission are amplified by an ex­
tended review of the health of the workers, including many inter­
esting and useful observations derived from foreign sources.
S P E C IA L O CC U PA TIO N A L H A Z A R D S I N

T H E P R IN T I N G T R A D E S .

In reply to the question, “ What are the dangers in the trade or
conditions injurious to the workers? ” it is said that—
As has been stated, the chief dangers are lead poisoning and tuber­
culosis. Lead poisoning is caused by the lead dust which is so com­
mon in printing shops, and also by the fumes arising from the lead
in the various processes of machine composition. The dust in the
shops, especially that in the type boxes, contains a large amount of
lead and some antimony. Prof. Steingraber analyzed the dust from
a type box in Cracow and found it contained 16.43 per cent of lead.
Dust from the top of stove in a composing room contained 0.24 per
cent of lead, while that from the floor of a gallery 16.4 feet high in
the composing room contained 0.37 per cent of lead. Much of the lead
dust is undoubtedly inhaled by the workers. A great deal of dust
is raised by the foolish and highly insanitary method so prevalent
in old printeries of cleaning the dust out of the type boxes with bel­
lows. Much lead dust is also deposited on the fingers and hands
of the workers as well as upon their clothes, and remains there from
lack of proper washing facilities. The dust is very often ingested
with their food, which is commonly eaten at the workstand in the
printing shop.1
These observations are in strict conformity to the facts and are
suggestive of health-injurious conditions which have not heretofore
received the required consideration. As observed by the New York
State Factory Investigating Commission in their second report—
Grave as are the dangers to the life and health of male workers
in the printing industry, these are still greater in the case of women.
It is well known that women are more subject to lead poisoning
than men, and their general constitution is apt to fall a prey to the
dangers of the trade sooner than that of the more robust male
workers.
Attention is also directed to the prevalence of tuberculosis among
young persons employed in printing trades, and it is pointed out
that;—
1 New York State Factory Investigating Commission, Second Report, 1915, Vol. JI,
p. 525.




M E A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E ' U T R D S

138

Not only has legislation been introduced to limit the work of
minors in this trade, but in England as well as Germany stringent
medical examination is made of all minors entering this industry,
and a large number of applicants rejected. The opinion is prevalent
that no minors under 18 should be allowed to work in printing
establishments, and then only after a thorough physical examination.
Hahn as well as Teleky advocate a thorough medical examination of
all workers in lead every three months, especially minors.
M O R T A L IT Y OF P R I N T E R S — U N IT E D S T A T E S R E G I S T R A T IO N A R E A .

Printers, lithographers, and pressmen, considered as a group, have
been reported upon for the years 1908 and 1909 by the Division of
Vital Statistics of the United States Census Bureau, but no subse­
quent information has been made public, and the data are therefore
restricted to the two years referred to; in fact, the mortality of
lithographers included in the group is for 1909 only. The data are
of rather limited value, but on account of the large number of
deaths included the conclusions may be accepted as representative
for the printing trade. According to the census report, out of 2,847
deaths of printers, lithographers, and pressmen from all causes, 840
or 29.5 per cent were from pulmonary tuberculosis. The details of
T
the mortality by divisional periods of life are shown in Table 46.
4 6 . — P R O P O R T IO N A T E M O R T A L IT Y O F P R IN T E R S , L IT H O G R A P H E R S , A N D
P R E SSM E N F R O M P U L M O N A R Y T U B E R C U L O S IS , U N IT E D S T A T E S R E G IS T R A T IO N
A R E A , 1908 A N D 1909, B Y A G E G R O U P S.

T a b le

Deaths from pulmonary
tuberculosis.
Age at death.

Deaths
from all
causes.
Number.

15 to 24 years.............................................................................................. .............
25 to 34 years............................................................................................................
35 to 44 years............................................................................................................
45 to 54 years............................................................................................................
55 to 64 years............................................................................................................
65 years and over....................................................................................................
U nknow n............................................................................................ .....................

427
551
614
522
350
381

Total, 15 years and over..........................................................................

2,847

Per cent
of total
deaths.

186
278
223
27
14

43.6
50.5
36.3
21.5
7.7
3.7

840

29.5

112

2

4 7 .— P R O P O R T IO N A T E M O R T A L IT Y O F P R IN T E R S , L IT H O G R A P H E R S , A N D
P R E SSM E N FR O M N O N T U B E R C U L O U S R E S P IR A T O R Y D IS E A S E S , U N IT E D S T A T E S
R E G IS T R A T IO N A R E A , 1908 A N D 1909.

T a b le

Nontuberculous respira­
tory diseases.
Cause of death.
Number.

2

A sthm a...............................................................................................................................................
Bronchitis........................................................................................................ .................................
Pneumonia..................................................... 1.................................................................................
Other nontuberculous respiratory diseases..........................................................................

14
193
41

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

250




Per cent
of total
deaths.

-*

0.1
.5
6 8
L4

8.8

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Table 46 indicates conclusively an exceptionally high degree of
frequency of pulmonary tuberculosis among men employed in the
printing trade, and particularly so during the early years of life. At
ages 25 to 34, for illustration, the proportionate mortality from pul­
monary tuberculosis was 50.5 per cent, which is exceeded by the cor­
responding figure for few other trades or occupations with con­
tinuous and considerable exposure to inorganic dust. The table in
r general way confirms the data derived from other sources and quite
.
clearly suggests the relative unhealtlifillness of employment in the
printing trade, subject, of course, to the qualification that adverse
physical occupational selection, as elsew'here pointed out, may mate­
rially affect the mortality returns. It may be said in this connec­
tion, however, that the mortality from nontuberculous respiratory
diseases, as shown in Table 47, was 8.8 per cent of the mortality from
all causes, which compares, for illustration, with 12.2 per cent for
marble and stone cutters and 12.5 per cent for potters, according to
mortality returns derived from the same official American sources.
M O R T A L IT Y OF P R I N T E R S — IN D U S T R I A L IN S U R A N C E

E X P E R IE N C E .

The observations and conclusions of the New York State Factory
Investigating Commission are in conformity with the results of other
investigations, and are sustained by the insurance mortality statistics.
Table 48 shows the results of the mortality experience of the indus­
trial department of the Metropolitan Life Insurance Co. for the
three years 1911 to 1913. The experience is limited to white males.
4 8 .— P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS A N D
P N E U M O N IA A M O N G C O M P O SIT O R S A N D P R IN T E R S , M E T R O P O L IT A N L IF E I N S U R ­
A N C E CO., I N D U S T R I A L E X P E R I E N C E , 1911 TO 1913, B Y A G E G R O U PS.

TABLE

[C o m p iled from B ui. 2 0 7 , U . S. B ureau o f Labor S ta tistic s, pp. 33, 3 4 .]
.. =
Deaths of printers and
compositors, 1911 to
1913, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Deaths of printers and
compositors, 1911 to
1913, from pneumo­
nia.

Age at death.
Males in
registration
arfea, 19001913.

All causes.

Pulmona­
ry tuber­
culosis.

Printers
and com­
pose tors.

15 to 24 years..................................
25 to 34 years..................................
35 to 44 years..................................
45 to 54 years..................................
55 to 64 years..................................
65 years and over..........................

217
221
225
176
120
97

98
110
88
42
19
3

45.2
49.8
39.1
23.9
15.8
3.1

27.0
30.5
23.4
14.7
7.9
2.6

10
16
6
9
7
4

4.6
7.2
2.7
5.1
5.8
4.1

Total, 15 years and over. .
Average age at death..................

1,056
40.2

360
33.5

34.1

13.9

52
39.7

4.9

Number.

Per cent.

According to this table, out of 1,056 compositors and printers, 360,
or 34.1 per cent, died of tuberculosis of the lungs, at an average age
of 33.5 years. In addition there are 52 deaths from lobar and un­




140

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

defined pneumonia, accounting for 4.9 per cent of the mortality from
all causes, at an average age at death of 39.7 years.
The investigation of the Metropolitan Co. includes also an ex­
tended study of the mortality of printers from other diseases than
pulmonary tuberculosis. The details of the analysis are given in
an abbreviated form in the table below, which has been derived from
Bulletin 207 of the United States Bureau of Labor Statistics, on
“ Causes of Death by Occupation.”
T a b l e 4 9 .— N T 3M B E R

AND

C O M P O S IT O R S A N D

PER CENT OF

P R IN T E R S ,

BY

DEATHS

AGE

F R O M S P E C IF IE D C A U S E S

P E R I O D S , 15 Y E A R S

AND

AMONG

O V E R -W H I T E

M ALES.
[M etropolitan L ife Insurance C o.— In d ustrial d ep artm en t— M ortality experience, 1911 to 1913.]

A ges 15 years
and over.

Per cent of deaths d u rm g age period
(years)—

Cause of death.
Num ­
ber.

Per
cent.

15-24

25-34

35-44

45-54

55-64

65 and
over.

N u m b e r of deaths...........................................

1,056

217

221

225

176

120

97

T y p h o id fever...................................................
Tuberculosis of the lu ngs...........................
Cancer (all fo r m s)...........................................
Cerebral hemorrhage, a p op lexy, and
p aralysis.........................................................
Organic diseases of the h e a r t...................
P neum onia (lobar and u ndefin ed)___
Cirrhosis of the liv e r.....................................
B righ t's disease...............................................
Suicide (all form s)..........................................
A ccid en tal violence.......................................
A ll other causes...............................................

22
360
28

2 .1
34.1
2 .7

3 .2
45.2
.9

4 .5
49.8
.5

1 .8
39 .1
1.3

0 .6
23 .9
5 .1

15.8
5 .0

3 .1
7 .3

38
118
52
19
94
19
62
244

3 .6
11.2
4 .9
1 .8
8 .9
1 .8
5 .9
23.1

6 .0
4 .6
.5
1 .4
3 .2
10.1
2 4 .9

.9
5 .9
7 .2
.5
3 .6
3 .2
5. 4
1 8 .8

2 .2
1 0 .2
2 .7
1 .3
10.7
1.3
4 .8
2 4 .4

6 .8
13.1
5 .1
2 .3
18 .2
.6
7 .4
17.1

5 .8
19.2
5 .8
6 .7
11.7
1.7
28.3

12.4
23 .7
4 .1
2 .1
13.4
1 .0
2 .1
3 0 .9

T o ta l.........................................................

1,056

100.0

100.0

100.0

100.0

100.0

100.0

100.0

In connection with the table it is said in the text by Dr. Louis I.
Dublin, the author of the report, that—
In the age period 15 to 24 the relative index of fciberculosis of the lungs is
liigh (133.7) ; this cause accounts for 45.2 per cent of all deaths, as against
33.8 per cent in the general group. Accidental violence has a low index (52.6).
In the period 25 to 34 tuberculosis of the lungs is somewhat lower than in the
previous age period, though still high (121.8). Bright’s disease is low (80.0)
and accidental violence is still lower (43.2). In the age period 35 to 44 tubercu­
losis of the lungs (118.8) and organic diseases of the heart (132.5) are both
high. Bright’s disease is high (137.2). Pneumonia is very low (33.3). Both
suicide (44.8) and accidental violence (48.5) exhibit low relative indices. In
the age division 45 to 54 the high relative index for tuberculosis of the lungs
is maintained (129.2). Cerebral hemorrhage, apoplexy, and paralysis loom up
as important in this age period; the relative index is 130.8. The index for
pneumonia remains low (62.2) ; Bright’s disease is even higher than in the
previous age period (164.0). Suicide remains low as before (23.1), and acci­
dental violence shows an increase over the previous age period (87.1). In the
age period 55 to 64 tuberculosis of the lungs shows a very high relative index
(183.7). Organic diseases of the heart (120.8) are somewhat higher than the
average and pneumonia is lower (77.3). Accidental violence is very low (26.2).
There are no cases of suicide in this age group. In the age period 65 and over




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the cases in which variations from all occupations are noted are too few to
warrant discussion.

With special reference to tuberculosis it is said that confirmatory
data are provided by the returns of the United States Census, the
reports of the Registrar-General, and the experience of the Pru­
dential. All of the index figures derived from these sources are
higher than those of the Metropolitan experience. The high propor­
tionate mortality definitely marks this occupation as one in which
the environment favors the development of pulmonary tuberculosis.
All investigators are agreed as to this, yet there is a diversity of
opinion as to the exact causative factor.
As regards the possible effect of lead dust, it is said that in the
Metropolitan experience, out of 1,056 deaths of printers and com­
positors from all causes only 4 were from lead poisoning. It, how­
ever, is explained that4 It must not be inferred that the exposure to
4
lead is not a serious factor in the causation of tuberculosis. A similar
relation has been suggested between lead poisoning and Bright’s
disease, which also shows a high proportionate mortality in the ago
periods 35 to 44 and 45 to 54, the relative indices being 137.2 and
164.0, respectively.”
The experience of the Metropolitan Co. is fully confirmed by the
more extended data derived from the industrial experience of the
Prudential Insurance Co. of America for the period from 1897 to
1914, inclusive:
T a b l e 5 0 .— P R O P O R T IO N A T E M O R T A L I T Y F R O M P U L M O N A R Y T U B E R C U L O S IS A M O N G

P R IN T E R S

AND

C O M P O S IT O R S , I N D U S T R I A L

E X P E R IE N C E

OF

P R U D E N T IA L

C O .,

1897 T O 1914, C O M P A R E D W I T H T H A T O F A L L M A L E S I N T H E R E G I S T R A T I O N A R E A ,
1900 T O 1913, B Y A G E G R O U P S .

D eath s of printers an d
com positors, 1897 to
1914, from —

Per cent of deaths from
p u lm o n a ry tubercu­
losis am ong—

A g e at death.
A ll causes.

P u lm o n a ­
r y tub er­
culosis.

Printers
and com ­
positors.

Males in
registration
area,1900 to
19i3.

15 to 24 years.............................................................................................
25 to 34 y e a r s ....... ...................................................................................
35 to 44 y e a rs...........................................................................................
45 to 54 y e a rs,................................................... .......................................
55 to 64 y ears.............................................................................................
65 years an d over....................................................................................
A ge u nk now n ..........................................................................................

795
904
851
567
427
318
1

368
505
350
141
42
14

46 .3
55.9
41.1
24.9
9 .8
4 .4

27 .0
3 0 .5
23 .4
14.7
7 .9
2 .6

T o ta l, 15 years an d over........................................................

3,863

1,420

36 .8

13 .9

The mortality of printers in the industrial-insurance experience of
the Prudential Co. includes 3,863 deaths from all causes, of which
1,420,- or 36.8 per cent, were from pulmonary tuberculosis. Of the
mortality of printers from other respiratory diseases, 343 were from
pneumonia, 19 from asthma, 35 from bronchitis, and 55 were from




142

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

less frequent respiratory diseases. If the deaths from pulmonary
tuberculosis and nontubercuious respiratory diseases are combined,
48.5 per cent of the mortality of printers was from diseases of the
lungs and air passages. The excess in the mortality from tubercu­
losis among printers is decidedly suggestive of a typical indoor em­
ployment where the exposure to the inhalation of metallic dust,
complicated by more or less injurious gases and fumes, is continuous
and, in a measure, unavoidable. While, as shown by Table 50, the
mortality from pulmonary tuberculosis among printers is excessive at
all ages, the excess is most pronounced at ages 25 to 34, when out of
every 100 deaths from all causes 55.9 are from pulmonary tuberculo­
sis, against a normal expected proportion of 30.5 per cent. The pre­
ceding observations and statistical data derived from American and
foreign sources, including extensive industrial-insurance experience
data, fully confirm the conclusion that the printing trade is unques­
tionably subject to decidedly unfavorable health conditions more or
less predisposing to a high degree of tuberculosis frequency. The
data suggest the necessity for an improvement in shop conditions in
conformity with the Austrian and Swiss regulations covering sani­
tation in the printing trade.1
MORTALITY OF PRINTERS— MEDICO-ACTUARIAL EXPERIENCE.

The data as to height and weight prove that a large propor­
T
tion of printers are physically below the general average, and by
implication they suggest the great practical importance of a physical
examination on entrance and of a physical reexamination from time
to time for the purpose of ascertaining the earliest indications of
physical impairment. Life insurance companies have never dis­
criminated. against journeymen printers and compositors, and a
large number have been insured on the ordinary plan or with fra­
ternal insurance organizations. Since applicants for ordinary or
fraternal insurance are, however, subjected to a fairly rigid medical
examination, this class of risks would not be strictly representative
r
of the general average. The results of the medico-actuarial investi­
gation with regard to journeymen printers and compositors can not,
therefore, be considered entirely conclusive. The results, however,
are shown in Table 51.
1 See in th is connection th e pro p ortion a te m o rta lity d a ta fo r N ew Y o rk C ity prin ters
by d ivision al periods o f life and com p arative d a ta for selected occupation s as given in
footn o te to page 5 5 .




O C P T N \^IT E P S R T M T L IC D S .
C U A IO S
H X OU E O E A L
UT

143

5 1 .— M O RTALITY FROM ALL CAUSES AMONG JOURNEYM EN COMPOSITORS, B ^
AGE GROUPS—MEDICO-ACTUARIAL IN VESTIG ATIO N .

T a b le

Number
exposed to
risk one
year.

Age at death.

15 to 29 years............................................................................ .
30 to 39 years............................................................................
40 to 49 years............................................................................
50 to 59 vears............................................................................
60 years and over.....................................................................

Per cent
Expected actual are of
expected
deaths.
deaths.

Actual
deaths.

118

6,428
3,706
962
261
21

29.64
21. 23
9.58
4.95
1.04

73
121

11,378

Total, 15 years and over...............................................

35
20
7
6
68

66.44

102

According to this table the actual mortality of the risks under
consideration is 102 per cent, being highest at the two extremes, or
118 per cent at ages 15 to 29, and 121 per cent at ages 50 to 59. The
table would seem to prove that the health-injurious effects of the
printing trade are most pronounced in youth and after middle age.
It would make a valuable contribution to the scientific study of
the subject if the statistics of the International Typographical Union
could be subjected to a critical analysis. The same conclusion applies
to .the experience which has been had with sanatorium treatment at
the home for sick and aged printers in Colorado.
SPECIAL CONSIDERATION OF THE MORTALITY AND DISEASE LIABILITY
OF COMPOSITORS.

Compositors, considered as a distinct occupation (for many printers
are also compositors), are exposed to practically the same healthinjitrious conditions as are persons engaged in the other occupations
of the printing business, and in addition they suffer from eyestrain,
which may, under given conditions, affect very seriously the diseaseresisting capacity of the system. Stereotyping might have been in­
cluded here, and its enormous development as a separate branch of
the printing trade would warrant special consideration if any really
authenticated observations had been made a matter of record useful
for the present purpose. In stereotyping, the liability to lead poison­
ing is a serious factor, affecting especially the men employed in
melting the alloy and ladling it into the forms.1 The same obser­
vation applies to operatives on linotype machines, but our present
information regarding these employments is too indefinite to warrant
the conclusion that the exposure to the risk of plumbism increases
materially the mortality from tuberculous and respiratory diseases.
1 S t e r e o t y p in g is f u l l y d e s c r ib e d in t h e r e p o r t b y H a m i l t o n a n d V e r r i ll o n t h e “ H y g ie n e
o f th e P r in tin g T r a d e s ”
2 0 9 ),

in c lu d in g

D is e a s e s

as

p a r e n t ly

m ost

(B u lle tin

re fe re n c e s

regard s

th e

lia b le ,

to

th e

occu rren ce

o f th e
fin d in g s
of

p r o p o r t io n a t e ly

U n it e d
of

cases
to

th e

S ta te s

th e
of

B ureau o f L ab or

Illin o is

le a d

C o m m is s io n

p o is o n in g .

n u m b e rs

exposed

on

S ta tis tic s

to

r is k .

No.

O c c u p a t io n a l

S te re o ty p e rs

w ere

A c c o r d in g

ap­
to

H a y h u r s t t h e p r o p o r t io n o f le a d p o is o n in g a m o n g li n o t y p e r s w a s 3J p e r c e n t a g a i n s t 7 . 0
per cen t a m o n g s te r e o ty p e r s.




144

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT E DS

There are no general vital statistics of compositors separate from
those of printers and pressmen, since in both American and foreign
statistics these employments are considered as a group.
There is included here a brief extract from a letter by Mr. J. W.
Sullivan, a New York City printer, in the Typographical Journal
for November, 1903, and reprinted in the annual report of the New
York State Bureau of Labor Statistics for 1906, reading in part
as follows:
Typesetting is exhaustive work. Standing hour by hour brings on
backache, and in some men varicose veins and swollen feet. Sitting
on the high printing-office stools doubles the typesetter up, constrain­
ing his arm motions and interfering with his digestion. The lino­
type operator’s stool is too low, as it throws his legs into cramped
positions. From the pot of molten type-metal under his machine
comes a trying heat and offensive gases. He must watch the delicate
machinery lest it go wrong. The electric light thrown on his copy
often sharply conflicts with the daylight. His keyboard work with
wrist and fingers and his handling of hot slugs sometimes results
in numbness that threatens scrivener’s palsy. Whether typesetter or
linotype operator, the compositor’s brain is active every moment dur­
ing the workday. Composition can never be wholly mechanical.
Attention must be given to deciphering the copy, to spelling, to capi­
talizing, punctuating, office style, and correcting the lines as com­
posed. Each of these distinct mental acts, on the whole tedious and
monotonous, helps to drain the bodily forces. As the brain becomes
fatigued its cells shrink. With every type a man sets there is a touch
of wear on the cerebral tissue itself, only to be repaired by the
restorative operations of nature—through food, rest, and sleep.
SPECIAL CONSIDERATION OF THE MORTALITY AND DISEASE LIABILITY
OF PRESSMEN.

Pressmen in printing plants may also be separately considered,
although the information regarding this occupation is rather frag­
mentary and inconclusive. Arlidge Comments on the hygienic aspects
of the employment in part as follows:
Their old mode of working has been superseded by the wonderful
development of the modern printing machine, whereby the pressman
has become little else than an attendant upon it; and we see the
marvelous machine in newspaper offices strike off, fold, and count
the sheets by thousands in an hour. Bodily strength is consequently
at a discount, ^nd the disadvantages of the occupation limited to
the heat of the pressroom—caused principally by the heated cylin­
ders of the press, and to a greater or smaller extent, where coai gas
and not electricity is used for lighting, by the gas jets. Add to these
the noise of the machines, the standing posture, and confinement in
the pressroom and sustained attention to their work, and there re­
mains nothing else calculated to injure the pressman’s health, bar­
ring circumstances within his own control.




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The occupation of pressmen does not appear to have attracted the
special attention of American writers on occupation mortality, but
it is safe to assume that the disease liability of this class, and in par­
ticular the degree of frequency of pulmonary tuberculosis, do not
materially differ from the observed mortality of men employed in
the printing trade generally. More definite data, however, would
supply a much to be desired addition to our at present very limited
knowledge regarding the specific occupation mortality of this em­
ployment.
M O R T A L I T Y OF P R E S S M E N — M E D I C O -A C T U A R I A L E X P E D I E N C E .

The only available mortality data regarding pressmen as differ­
entiated from compositors are the medico-actuarial statistics, which,
of course, are inclusive of deaths from all causes and not with
special reference to tuberculosis. The number exposed to risk, espe­
cially at the younger ages, was relatively fairly large, and the experi­
ence shows that the actual mortality was 117 per cent of the expected,
in contrast to 102 per cent for journeymen compositors. The data
in detail are given in Table 52.
T a b l e 5 2 .— M O R T A L I T Y F R O M A L L C A U S E S A M O N G J O U R N E Y M E N

PRESSM EN, B Y A G E
G R O U P S — M E D I C O -A C T U A R IA L IN V E S T I G A T I O N .

A g e at death.

N um ber
exposed to
n s k one
year.

A c tu a l
deaths.

E xp ec te d
deaths.

P er cen t
actual are
of expected
d e a t h s .'

to 29 years.............................................................................................
to 39 years.............................................................................................
to 49 years.............................................................................................
to 59 years.............................................................................................
years and over....................................................................................

5,674
3 ,012
976
310
15

32
15
10
11
2

25.99
17.02
9 .2 9
6.93
.51

123
88
108
159
392

T o ta l, 15 years and over........................................................

15
30
40
50
60

9,987

70

59.74

117

This table is exceptionally interesting, in that it confirms the re­
sults of the previous analysis of the mortality of journeymen com­
positors, showing an excessive death rate from all causes at ages
under 30 and at ages over 50. It suggests the practical value of fur­
ther and more specialized inquiries in connection with the different
branches of the printing trade. It is of interest in this connection to
draw attention to the industrial mortality experience of the Pruden­
tial Co., which, in a general way, confirms the results of other inves­
tigations.
106811°— 18— Bull. 231------ 10




146

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

T able 5 3 .— P R O P O R T I O N A T E M O R T A L I T Y F R O M P U L M O N A R Y T U B E R C U L O S I S A M O N G
PRESSM EN,

IN D U S T R IA L

E X P E R IE N C E

OF

P A R E D W IT H T H A T O F A L L ’ M A L E S IN T H E

P R U D E N T IA L

C O ., 1897 T O

1914, C O M ­

R E G I S T R A T I O N A R E A , 1900 T O

1913, B Y

AG E GROUPS.

D eath s of pressm en,
1897 to 1914, from —

Per cent of deaths from
p ulm on ary tubercu­
losis am ong—

A g e at death.
A ll causes.

15 to 24 years.............................................................................................
25 to 34 vears.............................................................................................
'65 to 44 vears............................................................................................
45 to 54 years.............................................................................................
55 to 64 years.............................................................................................
65 years and over.................................................................... ...............

168
151
116
45
27

T otal, 15 years an d over........................................................
’
J
m

P ulm onary
tuberculo­
sis.

523

72
72
51
9

P ressm en.

Males in
registration
area, 1900
to 1913.

27.0

3

42.9
47.7
44.0
20.0
11.1

. 207

39.6

13.9

16

30.5
23.4

14.7
7.9
2 .6

GENERAL CONCLUSIONS.

The mortality of pressmen from pulmonary tuberculosis is shown
to be somewhat more favorable at the earlier ages than the corre­
sponding mortality of printers and compositors, but for the later
age groups the numbers are insufficient for a safe conclusion. In
a general way the differences are not sufficiently pronounced to sug­
gest material variations in the occupational hazards of the more
important occupational groups of the printing trade. At all ages
it is shown in Table 53 that out of 523 deaths from all causes amon^
pressmen, 207, or 39.6 per cent, are from pulmonary tuberculosis,
against a normal proportion of 13.9 per cent among males in the
United States registration area. The statistical evidence is there­
fore decidedly suggestive of more or less health-injurious conditions
common to this particular occupational group, which are elsewhere
shown to prevail in the printing trades generally.
In this connection attention may be directed to an exceptionally
carefully considered set of precautions for printers published by
the New York City Department of Health, through its division of
industrial hygiene, and published in the Monthly Eeview of the
United States Bureau of Labor Statistics, for December, 1915. The
suggestion made in these rules regarding the necessity of avoiding
lead dust should, however, be amplified to apply to the avoidance
of all forms of metallic or mineral dust common to the printing
trades generally.
ENGRAVERS.

Engravers are a fairly numerous and widely distributed class
of workmen, whose occupation is sufficiently well defined to warrant
separate consideration. According to the census of 1910 there were
11,766 engravers in the United States. Engravers upon copper, steel,




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147

or otlier metals are subject to much the same conditions injuriously
affecting health and life, and the differentiation of the employment
according to the kind of metal worked upon is not practicable.
The employment decidedly predisposes to tuberculosis, and all
the available data indicate an excessive proportion of deaths from
this disease among engravers, at least during the active working
period of life. Aside from health-injurious factors directly result­
ing from operations and processes inseparable from the employment,
there is also the unfavorable effect of a sedentary occupation demand­
ing a fixed and stooping position. Arlidge has called attention to
the fact that there are other accessory conditions unfavorable to
health in this employment, such as the frequent use of strong light,
severe taxing of the eyes,1 and the employment of strong acids.
Some fairly conclusive data are available regarding the mortality
of engravers, with particular reference to pulmonary tuberculosis,
but as an interesting case of extreme longevity mention may be made
of a Mr. Charles Harris, who died at the age of 93, and who for more
than half a century had been an engraver of the American Bank
Note Co. A somewhat similar case was that of a Mr. James P.
Mayer, who, at the time of his death at the age of 83, was reputed
to be the oldest steel engraver in America.
RELATIVE FREQUENCY OF PULMONARY TUBERCULOSIS.

These, however, are but illustrations of exceptions and rather
mark the rule of the comparative infrequency of extreme longevity
among men in this employment. Thackrah held that “ engravers
and copper plate printers present few examples of old age,” and he
may have included printers and lithographers and similar employ­
ments under this term. Tracy, writing with reference to more recent
and American conditions, holds that engravers, in common with lapi­
daries and watchmakers, are very liable to phthisis. It is probably
quite true, as pointed out by Sommerfeld, that the amount of metallic
or mineral dust generated in this occupation is comparatively small
in quantity, but it is practically certain to be injurious in its effects
just because of the minuteness of the particles. According to Sommerfeld’s data, 23.6 per cent of all cases of sickness of engravers
were diseases of the lungs and air passages. He suggests, among
other things, as a precaution, extreme care in the physical selection of
engravers’ apprentices to eliminate those already predisposed to pul­
monary tuberculosis. He further advises the proper A^entilation of
the workshops, which in most cases is almost entirely neglected.
1
by

For a n e x te n d e d d is c u s s io n o f th e c a u s e o f e y e s t r a i n , see B io g r a p h ic C lin ic s , V o l. I V ,
G eorge

M o n t h ly

M.

fo r

G o u ld ,

D ecem ber,




M.

D .,

1905.

P h il a d e lp h ia ,

1906,

p.

61

et

seq , ;

a ls o

P o p u la r

S c ie n c e

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

148

MORTALITY OF ENGRAVERS—UNITED STATES REGISTRATION AREA

The mortality of engravers has been reported upon for the year
1909 by the Division of Vital Statistics of the United States Census
Bureau, but no subsequent information has been made public, and
the data are, therefore, limited to the year referred to. According
to the census report, out of 112 deaths of engravers from all causes
23, or 20.5 per cent, were from pulmonary tuberculosis. The details
of the mortality by divisional periods of life are shown in Table 51.
T a b le 5 4 .— P R O P O R T IO N A T E M O R T A L IT Y O F E N G R A V E R S F R O M P U L M O N A R Y T U B E R ­

C U L O S IS , U N IT E D

S T A T E S R E G I S T R A T I O N A R E A , 1909, B Y A G E G R O U P S .

D eath s from p ulm onary
tuberculosis.
D eath s
from all
causes.

A g e at death.

Nu m ber.

Per cent
of deaths
from all
causes.

to 24 y ears........................................................................................................................
to 34 years........................................................................................................................
to 44 years........................................................................................................................
to 54 years........................................................................................................................
to 64 ye ars........................................................................................................................
years and o v e r ...............................................................................................................

10
23
20
15
19
25

5
8
5
1
3
1

5 0 .0
3 4 .8
2 5 .0
6 .7
15.8
4 .0

T otal, 15 years and o v e r ...................................................................................

15
25
35
45
55
65

112

23

20.5

According to this table the mortality from pulmonary tubercu­
losis is relatively high at the younger ages, but the data are too
limited for entirely safe conclusions. In a general way, however,
they confirm other statistics derived from American” and foreign
experience. As shown in Table 55, the mortality of engravers from
nontuberculous respiratory diseases was relatively low, or only 3.6
per cent of the mortality from all causes, the deaths being limited to
pneumonia and other nontuberculous respiratory diseases, excluding
asthma and bronchitis.
T a b le

5 5 .— P R O P O R T IO N A T E M O R T A L I T Y O F E N G R A V E R S F R O M N O N T U B E R C U L O U S
R E S P IR A T O R Y D IS E A S E S , U N IT E D

S T A T E S R E G I S T R A T I O N A R E A , 1909.

D eath s from n ontuber­
culous respiratory
diseases.
Cause of death.
N u m ber.
•

Per cent
of deaths
from all
causes.

A s th m a ................................................................................................................................................................
B ronchitis ............................................................................................................................................ ..
3
2 .7
P n e u m o n ia .......................................................................................................................................................
Other n ontuberculous respiratory diseases........................................................................
1
.9
T o ta l........................................................................................................................................................




4

3 .6

OCCUPATIONS W IT H EXPOSURE TO METALLIC DUST.

149

MORTALITY OF ENGRAVERS— INDUSTRIAL INSURANCE EXPERIENCE.

A large number of engravers are employed by the Bureau of En­
graving and Printing of the United States Government, which in
the past had most of its bank notes and postage stamps printed
by private concerns. In former years no doubt serious objections
were properly raised against the conditions under which Government
employees were at work in the Bureau of Engraving and Printing;
but most of the earlier disadvantages have been done away with.
The health conditions have correspondingly* improved and the more
or less inevitable degree of dust exposure has been reduced to a mini­
mum. The vital statistics of this branch of the Government service
if published would be of considerable practical value. At the
present time the only available data are the industrial insurance
mortality statistics for the period 1897 to 1914, covering 384 deaths,
of which 127, or 33.1 per cent, were from pulmonary tuberculosis.
The details of this analysis are given in Table 56.
T a b le

5 6 . — P R O P O R T IO N A T E M O R T A L I T Y F R O M P U L M O N A R Y T U B E R C U L O S IS A M O N G

E N G R A V E R S , IN D U S T R IA L

E X P E R IE N C E

P A R E D W I T H T H A T O F A L L M A L E S IN
T O 1913, B Y A G E

OF

P R U D E N T IA L

U N IT E D

C O ., 1897 T O

1914, C O M ­

S T A T E S R E G I S T R A T I O N A R E A , 1900

GROUPS.

D eath s of engravers,
1897 to 1914, from —

Per cent of deaths from
p u lm o n a ry tubercu­
losis am on g—

A ge at death.
A ll causes.

P ulm on a ry
tubercu ­ Engravers.
losis.

M ales in
registration
area,
1900 to 1913.

to 24 years.............................................................................................
to 34 years.............................................................................................
to 44 years.............................................................................................
to 54 y e a rs.............................................................................................
to 64 years.............................................................................................
years an d over....................................................................................

71
92
74
63
41
43

28
50
35
10
3
1

39 .4
54.3
47 .3
15.9
7 .3
2 .3

2 7 .0
3 0 .5
2 3 .4
1 4 .7
7 .9
2 .6

T o ta l, 15 years an d over........................................................

15
25
35
45
55
65

384

127

33.1

13.9

GENERAL CONCLUSIONS.

The general conclusions regarding engravers, including photo­
engravers, are briefly summarized by Dr. Kober, in Kober and Han­
son’s Diseases of Occupation and Vocational Hygiene (p. 615), as
follows:
The work of engraving upon steel, copper, or other material in­
volves not only considerable eyestrain, but also, in the absence of
suitable work benches, a faulty position which interferes with the
respiratory movements. Steel and copper plate engravers are also
exposed to mercury, and makers of stamping devices and seals to
lead and the fumes of nitric acid. The latter agent is likewise em­
ployed in mints in connection with the coinage of money. Accord­
ing to Sommerfeld, cited by Zadek, 73.6 per cent of all the deaths




150

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

among this class of workers in Berlin were caused by diseases of the
respiratory system, inclusive of 62.1 per cent from tuberculosis; this
is in part accounted for by the fact that so many weaklings engage in
this pursuit. Visual defects, neurasthenia, and diseases of the digestive
system are also quite common. Plate printers who have to look con­
stantly at bright plates suffer not only from eyestrain but occasion­
ally also from conjunctivitis and even retinitis. Photo-engravers han­
dle benzol for dissolving rubber films, alcohol, and ether, in collodium
films, strong acetic acid for the removal of films; they are also ex­
posed to gas fumes and ammonium dichromate in sensitizing copper
plates, and to ferric chloride and nitric acid fumes in etching. The
Report of the Photo-engravers’ Union for 1914, cited by Hayhurst,
discloses the fact that out of 217 deaths since 1903, 88, or nearly 41 per
cent, were due to tuberculosis. During the year 1914 five cases of
bichromate and one case of cyanide poisoning were reported.
Apparently the dust hazard is, by the writer, considered of minor
T
importance, which is not in conformity with the results of special­
ized statistical investigations into the mortality of engravers and
allied occupations. Specific occupational diseases are unquestionably
of considerable scientific interest, but they are of minor importance
in comparison with the excessive amount of pulmonary tuberculosis
directly or indirectly attributable to the employment, and more or
less subject to control by effective methods of sanitation.
BRASS WORKERS.

Brass workers, exclusive of brass polishers and buffers, who have
been separately considered, constitute a large group of widely diversi­
fied and often quite different employments. Brass casting, founding,
and molding are arduous occupations exposing to the inhalation of
considerable quantities of mineral dust more or less mixed with
metallic ingredients. Whether brass dust, as such, is more injurious
than the dust of iron and steel, for illustration, has not been deter­
mined. In the evidence submitted to the Departmental Committee
on Compensation for Industrial Diseases by the National Society of
Amalgamated Brass Workers,1 including about 7,000 members, it was
stated that about 2,000 of these were engaged in casting. The trade
was said to be divided into pattern making, chasing, casting, finish­
ing, burnishing, polishing, and putting together. The correspond­
ing classification of the trade in the United States follows practically
similar lines.2 Of the divisions mentioned, casting and founding were
considered the most injurious to health. Burnishing was held to be
less injurious than polishing, but the so-called putting together was
— ---------»—
1 G reat B rita in , H om e D epartm en t, M inutes o f Evidence, D epartm en tal C om m ittee on
C om pen sation fo r In d u stria l D iseases, 1 9 0 6 , p. 75 et seq.
2 Th e num ber o f bra ss w orkers in the U nited Sta tes in 1 9 1 0 w as 4 6 ,7 2 2 , and o f th is
num ber 3 ,0 6 2 w ere w om en.




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stated to be decidedly unhealthful on account of the use of white
lead- Evidently, in so diversified a trade the degree of dust exposure
must vary widely, and at best the degree of injury can only be meas­
ured approximately upon the basis of more or less indefinite mor­
tality data. The exposure of brass workers to dust inhalation is
only one of a number of specific factors in a trade decidedly in­
jurious to health and life, and of these mention may be made of the
exposure to fumes and vapors generated in the smelting processes.
Brass founders’ ague is a well-defined occupational disease, the symp­
toms of which are tightness of the chest with indefinite nervous sensa­
tion, followed by fever and previous sweating. Zinc and other fumes
inhaled are the chief causes of this ailment, and it is quite probable
that the lung injury resulting from the inhalation of fine particles
of metallic dust is a material contributory cause in brass founder’s
ague. Arlidge, in summing up the views of other authorities on
brass workers’'disease, points out that—■
Besides brass founding, there are other departments in the brassworking business that are damaging to health; and chiefly so by
reason of the dust produced. These branches are brass casting,
turning, filing, and polishing. The soft nature of brass is opposed
to the development of very fine and acuminated particles, and its
weight to its rising very freely and to its diffusion in the air. Never­
theless, those turning and filing it show clearly, by their clothes and
hair, that it is largely dispersed, the latter getting green, as happens
with brass founders. The inhalation of brass dust operates in simi­
lar fashion to that seen in connection with other metallic dusts, pro­
voking bronchial catarrh, which advances to bronchitis and ends in
fibrosis. It is reported by some writers that phthisis is unusually
prevalent, but no reliable statistics are available to support this
statement.
SANITARY CONDITIONS IN THE BRITISH BRASS INDUSTRY.

More recent investigations in England fully confirm these earlier
conclusions. In 1894 a departmental committee was appointed by the
secretary of state to report upon the conditions of work as affecting
the health of operatives in the manufacture of brass and kindred
amalgams. In its report, which was published in 1896, the commit­
tee stated as the result of its investigation, first, that brass workers
as a class were extremely liable to diseases of the respiratory or­
gans, and, second, that brass founders’ ague, so called, was found to
result from the inhalation of fumes given off by the molten brass at
the time of pouring, but in a less degree it was attributed to the
contamination of the workers’ food by the fumes, and that this
danger was in proportion to the amount of zinc used in the alloy.
The subject was also reported upon in much detail in the Report of




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M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
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the Chief Inspector of Factories and Workshops for the year 1905.
From this report the following suggestwe extracts are made:
Altogether some 500 brass workers were examined, and in addition
to the filling in by each one of them of the appended form, note was
made of the height, weight, chest measurement, and strength of
grasp; the heart, lungs, gums, and teeth were, whenever practicable,
examined, and the condition as to anemia, paresis, general health,
and prevalence of brass founders’ ague was determined.
The result of the replies of 216 casters and 199 polishers and others
to the question, Do you consider that your health has been in any way
injured by working in brass? was that 22.7 per cent of the casters
and 11.6 per cent of the polishers and others said they had suffered.
This is perhaps the strongest evidence obtained in the inquiry that
the casters are exposed to more trying conditions of work than are
other brass workers.
The nature of the injury was, as a rule, only very vaguely ex­
pressed; in the case of the casters it was nearly always either
u fumes ” or “ sulphur,” and in that of the polishers “ dust.” In one
casting shop, where 19 strip casters were examined, of whom 9 said
they suffered, illness or discomfort was attributed in some cases to
resin fumes in addition to those ordinarily present. Among the
casters there were indications that the older the workers were, and
also that the earlier the age of commencement of work, the more did
they say they had suffered, facts which could not be observed in the
case of the polishers.
In 8 casters (3.9 per cent) definite physical signs in the lungs were
found, and similarly in 3 (1.5 per cent) of the polishers and others.
In two of the casters these pointed to chronic phthisis, while the
remainder pointed to bronchial catarrh. I am not inclined to draw
any conclusions from these facts, because (1) the number of observa­
tions is too small, (2) the examination in some of the factories was
carried out under great disadvantages, owing to the impossibility of
securing a quiet room, and (3) it is well known that persons who are
the subjects of disease of the lungs in any marked degree are not
likely to be found at work.
Very strong evidence of the beneficial effect of good exhaust venti­
lation in connection with all kinds of polishing operations, and indi­
rectly of the lowered state of health from the nonremoval of the
dust, was obtained at one factory. Here the opinion of the occupier
was that the installation had paid for itself over and over again in
the better work which was turned out by the men, and by the im­
proved tone among them resulting from the absence of the obnoxious
dust. 'The remarks of the polishers bore this out. One said,
“ Worked for 18 years before the fan was put in, when the dust used
to make me feel sick, but it is not so now.” A second said, “ I prefer
this shop to any other.” A third, “ I never worked in a cleaner
shop ” ; and a fourth, “ The fan is a great improvement.”
A large amount of fluff, sand, and lime is given off in the process
of polishing with calico mops. It is not, therefore, difficult to under­
stand (even although actual injury to health from it may be hard to
prove) that removal of the dust is welcomed as tending to make the
work healthier. A sample of dust taken from under a polishing bob
was submitted to Dr. Thorpe, who reported: uThis sample con­




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tains a large proportion of fiber, the loss on ignition amounting to
37.6 per cent. The metallic portion of the residue—copper, zinc,
lead, and iron— amounts to 10.56 per cent of the total sample. The
lead present equals 0.22 per cent of the total samples, or 2.1 per cent
of the above metallic constituents, or, excluding the iron, 2.33 per
cent. Microscopically brass dust collected from near an emery wheel
showed all the appearances of an injurious metallic dust—fine par­
ticles with irregular jagged edges.”
Oliver concludes his observations regarding the hygiene of this
employment with the following statement:
The necessity of personal cleanliness on the part of workmen and
of well-ventilated workshops is apparent. Means ought to be pro­
vided for a ready escape of the fumes and for the removal of dust.
The workshops ought to be cleaned at least once a year and the walls
whitewashed. Hot and cold water should be provided for the men to
wash in. The workmen themselves have found out by experience
that milk is both a prophylactic or preventive as well as a curative
agent. While the use of respirators seems called for, the men can not
work well in them. Women and persons under 18 years of age are
not allowed to work in the casting shop.
ENGLISH MORTALITY STATISTICS OF BRASS WORKERS.

The most recent English mortality statistics of brass workers are
for the three years ending with 1902, referred to in the report of the
registrar general, in part, as follows:
The mortality of these workers is somewhat below the standard at
ages 15 to 20 and 25 to 35 years, but above the standard at every
other age group. In the main working period of life their compara­
tive mortality figure is 1,154, or 15 per cent above the average; the
greatest excess of mortality occurring under the head of phthisis, the
figure for which disease is above the average by 45 per cent. The
mortality from diseases of the nervous, circulatory, respiratory, and
urinary systems, as well as from suicide is also above the average.
These workers are only slightly liable to fatal influenza, and their
mortality from alcoholism and liver disease is also low. They like­
wise suffer less than the average from fatal accident.1
The English occupation mortality statistics for brass workers are
quite conclusive of the more or less unfavorable effects of this indus­
try on health. In Table 57 a comparison is made of the mortality
from all causes of men in this group with occupied males generally,
and the result is quite suggestive of conditions in this trade more or
less unfavorable to life and health, but in particular at ages 35 to 64,
when the general mortality of this class exceeds the general average
by from 2.57 to 5.59 per 1,000.
1 P a r t I I , Su pplem en t to the S ix ty -fifth A n n u a l R ep o rt o f
B irth s, D ea th s, an d M arriage s in E n g la n d and W a le s , p. lx x v .




th e R egistrar-G en eral

of

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M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
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5 7 . — M O R T A L IT Y F R O M A L L C A U SE S OF B R A S S W O R K E R S , C O M P A R E D W I T H
T H A T O F A L L O CC U P IED M A L E S , IN E N G L A N D A N D W A L E S , 1900 TO 1902, B Y A G E
G R O U PS.

T a b le

[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Death rate for brass workers.

Age at death.

15 to 19 years....................................................................................
20 to 24 years....................................................................................
25 to 34 years....................................................................................
35 to 44 vears....................................................................................
45 to 54 vears....................................................................................
55 to 64 years....................................................................................
65 years and over............................................................................

Death rate
per 1,000
for all
occupied
males.

2.44
4.41

6.01
10. 22
17.73
31.01
88.39

Rate per
1, 000.

2.22
5.13
5.86
12.79
20.90
36.60
83.78

G reater(+)
or less ( —) Per cent of
rate for all
than rate
for all occu­ occupied
males.
pied males.
- 0.22
+ .72
- .15
+ 2 .5 7
+ 3 .1 7
+ 5 .5 9
- 4 .6 1

91
116
98
125
118
118
95

The preceding table is self-explanatory. A more extended com­
parison is made in Table 58, in which the mortality of brass
workers from pulmonary tuberculosis and respiratory diseases
other than tuberculosis is compared with the normal mortality
of occupied males from these diseases by divisional periods
of life. The comparison shows that at ages 20 to 64, inclusive,
the mortality of brass workers from pulmonary tuberculosis
is excessive by from 0.42 to 1.79 per 1,000, the excess being greatest
at ages 35 to 44. The table further shows that the mortality from
respiratory diseases other than tuberculosis is excessive among men
in this class, but decidedly so at ages 55 and over, when the excess
is from 1.29 to 2.88 per 1,000. The two tables derived from English
experience fully confirm the previous conclusion that the mortality of
brass workers is excessive when comparison is made with the normal
mortality of occupied males generally, and that this excess is largely
because of the high degree of tuberculosis frequency, particularly at
ages 25 to 54.1
1 A n excellen t accou n t o f the com p arative social and h e a lth con ditions o f brassw orkers, en titled “ B rassw ork ers o f B erlin and o f B irm in g h a m ,” w as published by P. S.
K in g & Son, L o n d o n , in 1 9 1 0 .
T h is is a jo in t rep ort by a rep resen tative o f a large
brassw orks, the secretary o f the N a tio n a l Society o f A m a lg a m a ted B rassw ork ers, and
a rep resen tative o f the B irm in g h a m H o sp ita l.
T h e rep ort includes an in terestin g a c­
cou nt o f the B ra ssw o rk ers’ T rad e U nion and gen eral ob servations on the G erm an com ­
pu lsory h e a lth insurance system .




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T able 5 8 .— M O R T A L IT Y f E O M P U L M O N A R Y T U B E R C U L O S IS A N D F R O M O T H E R p i S E A S E S O F T H E R E S P I R A T O R Y S Y S T E M A M O N G B R A SS W O R K E R S , C O M P A R E D W I T H
T H A T O F A L L O C C U P IE D M A L E S , IN E N G L A N D A N D W A L E S , 1900 T O 1902, B Y A G E
G R O U P S.
[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England, and Wales.]

Mortality from other diseases of the
respiratory system.

Mortality from pulmonary tuberculosis.

Death rate for brass workers.
Age at death.

Death
rate per
1,000 for
all occu­
pied
males.

15 to T9 years........
20 to 24 years........
25 to 34 years.
35 to 44 years........
45 to 54 years........ .
55 to 64 years........
65 years and over.

0.54
1.55
2.03
2.74
3.04
2.16

1,11

Rate per
1,000.

Greater(+)
or less ( —)
than rate
for all
occupied
males.

0.49
2.17
2.93
4.53
4.61
2.58
.44

—«0.05
+ .62
+ .90
+ 1 .7 9
+ 1 .5 7
+ .42
- .67

Death rate for brass workers.

Death
rate per
P«r cent 1,000 for
of rate for all occu­
all occu­
pied
pied
males.
males.

91
140
144
165
152
119
40

0.24
.48
.77

1.66

1

3,32
6.54
17.77

Rate per
1, 000.

0.24
.52
.60
2.05
3.94
9. 42
19.06

Greater(+)
or less ( —) Per cent
than rate of rate for
all occu­
for all
pied
occupied
males.
males.

+ 0 .0 4
- .17
+ .39
+ .62
+ 2. 88
+ 1.29 :

100
10S
78
123
119
144
107

INVESTIGATIONS BY THE ILLINOIS COMMISSION ON OCCUPATIONAL
DISEASES.

A number of special investigations have been made of the brass
industry in the United States, but chiefly with reference to the occur­
rence of brass poisoning, or “ brass founders’ ague.” One of the
most important of these investigations is by E. R. Hayhurst, the
results of which were published by the Illinois Commission on
Occupational Diseases. Brass being an alloy composed of copper
and zinc, the actual degree of metallic dust exposure in the different
processes is quite considerable. No specialized investigations have
been made to ascertain the relative degree of dust exposure at the
furnaces and the foundries and in connection with manufacturing
processes. The dust inhaled is, of course, more or less mixed, and in
the majority of cases may be more mineral than metallic in character.
The so-called “ brass chills,7 or “ brass founders’ ague,” occurs almost
’
exclusively in brass foundries and never in the more specialized man­
ufacturing processes. According to Hayhurst, however, in addition
to brass founders’ ague there is a distinct liability to respiratory
diseases.
MORTALITY OF BRASS MOLDERS IN OHIO.

An investigation made in Ohio for the three years, 1910 to 1912,
included 43 deaths of brass molders and brass workers, of whom 14,
or 32.7 per cent, died from pulmonary tuberculosis. It is pointed
out in this connection in Hayhurst’s report on Health Hazards
that u While the number of total deaths reported is small, the high
rate of consumption is in harmony with observations concerning this




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M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E ' U T R D S

industry reported elsewhere.” Old age is rarely attained among
persons employed in the brass industry, and, according to Sir Thomas
Oliver, out of 1,200 brass casters in Birmingham (England) only 10
were found to be living beyond 60 years. How far this inferior lon­
gevity is the result of dust exposure is not, perhaps, directly ascer­
tainable, but there are reasons for believing that the excessive mor­
tality from tuberculous diseases among brass workers bears some rela­
tion to the relatively considerable and practically continuous exposure
to metallic and mineral dust.
This exposure, of course, is exceptionally great in grinding and
polishing brass, which are elsewhere discussed in detail without
particular reference, however, to the brass industry. The sanitary
conditions of the industry are, as a general rule, far from satisfac­
tory, and in the Ohio investigation, for illustration, “ in no place
were means adopted to confine and remove brass fumes during pour­
ing.” The general construction of brass foundries was determined as
h3r
gienically good in 42 places, fairly so in 21, and unsatisfactory in
the remaining 43. All of the special processes, such as core making,
metal grinding, casting cleaning, machine-shop practice, polishing
and buffing, involve a more or less definite hazard of dust exposure.
The air conditions in the foundry processes of the brass-working
plants investigated in Ohio were found to be good in only 17 places,
fair in 41, and decidedly hazardous to the health of the workers in 48.
MEDICAL ASPECTS OF THE BRASS INDUSTRY IN CONNECTICUT.

The medical aspects of the brass industry in Connecticut have
been investigated and reported upon by W. Gilman Thompson, who
states that:
The inhalation of powdered brass, the dust of brass filings, etc.5
irritates the respiratory mucosa and lungs. The metal may also be
swallowed after inhalation into the mouth, or conveyance to the mouth
by unclean hands or food or plug tobacco. In this manner chronic
poisoning in time results, with symptoms which differ considerably
from those of the ague, above described. Chronic bronchitis is usu­
ally to be found and sometimes fibroid phthisis and tuberculosis.
The digestive system is deranged, and the victim complains of dys­
pepsia, anorexia, gastro-intestinal catarrh, nausea, vomiting, thirst,
irregular action of the bowels, occasional intestinal colic, and a
metallic taste in the mouth. The tartar on the teeth may become
green from a deposit of copper salts. Headache and general muscular
pains are common, and the patients often become neurotic, depressed,
and hypochondriacal.
The evidence obtainable by means of such investigations would,
therefore, seem to sustain the statistical data derived from American
and foreign sources.




OCCUPATIONS WITH EXPOSURE TO METALLIC DUST.
M O R T A L I T Y OF B R A S S W O R K E R S — U N I T E D

157

ST A T E S R E G IS T R A T IO N A R E A .

The mortality of brass workers has been reported upon for the
year 1909 by the Division of Vital Statistics of the United States
Census Bureau, but no subsequent information has been made public,
and the data are, therefore, limited to the year referred to. Accord­
ing to the census report, out of 201 deaths of brass workers, 64, or
31.8 per cent, were from pulmonary tuberculosis. The details of the
mortality by age groups are shown in Table 59.
5 9 .— P R O P O R T IO N A T E M O R T A L IT Y O F B R A S S W O R K E R S F R O M P U L M O N A R Y
T U B E R C U L O S IS , U N IT E D S T A T E S R E G IS T R A T IO N A R E A , 1909, B Y A G E G R O U P S .

T a b le

Deaths from pulmonary
tuberculosis.
Age at death.

Deaths
from all
causes.

Per cent of
deaths
from all
causes.

Number.

15 to 24 Y e a r s .................................................................................................................................
25 to 34 years.......................... .................................................................................
35 to 44 years...........................................................................................................
45 to 54 years...........................................................................................................
55 to 64 years............................................................................................................
65 years and over............ ......................................................................................

25
42
35
48
26
25

Total, 15 years and o v e r .........................................................................

201

16

4
4

64.0
50.0
31.4
16.7
15.4
16.0

64

31.8

21
11
8

6 0 .— P R O P O R T IO N A T E M O R T A L IT Y OF B R A S S W O R K E R S FR O M N O N T U B E R C U ­
LO U S R E S P I R A T O R Y D IS E A S E S , U N IT E D S T A T E S R E G IS T R A T IO N A R E A , 1909.

T a b le

Deaths from nontuber­
culous respiratory dis­
eases.
Cause of death.
Number.

Bronchitis..........................................................................................................................................
Pneumonia.............. .......................................................................................................... - ...........
Ot.hftr nrmtnhArnnlmis rAsniratorv Hisfiases__________ _________ _ _ _____
___
T otal_____________

- .................. ..... ............... .....................

3

Per cent of
deaths
from all
causes.

18
1

1 .5
9 .0
.5

22

10 .9

Table 59 is extremely suggestive and indicates an excessive fre­
quency of pulmonary tuberculosis among brass workers, which term
unquestionably includes a considerable number of polishers and
buffers. Aside from the relatively high proportion of deaths from
pulmonary tuberculosis of 31.8 per cent in the mortality from all
causes, other nontuberculous respiratory diseases as shown in Table 60
cause a mortality of 10.9 per cent, or, respectively, 1.5 per cent from
bronchitis, 9 per cent from pneumonia, and 0.5 per cent from other
respiratory diseases. The table in a general way confirms the data
derived from other sources, and obviously suggests the relative un-




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healthfulness of employment in the brass industries, without specific
reference, however, to the particular occupations, as to which the
information is not available.
The results of this analysis of the available American vital statistics
of brass workers for the registration area are further confirmed
by the corresponding statistics derived from the industrial insurance
experience of the Prudential Insurance Co.
M O R T A L IT Y OF B R A SS W O R K E R S — IN D U S T R IA L

IN S U R A N C E

E X P E R IE N C E .

T able 6 1 .— P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS AM O N G
B R A S S W O R K E R S , I N D U S T R I A L E X P E R I E N C E OF P R U D E N T I A L CO., 1897 TO 1914,
C O M P A R E D W I T H T H A T OF A L L M A L E S IN U N I T E D S T A T E S R E G I S T R A T I O N A R E A ,
1900 TO 1913, B Y A G E G R O U P S .

Deaths of brass workers,
1897 to 1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
A ll causes.

Pulmonary
tubercu­
losis.

Brass
workers.

Males in
the registra­
tion area,
1900 to 1913.

15 to 24 years................................................... ......... ........... ..........
25 to 34 years.,................................................................................
35 to 44 years....................................................................................
45 to 54 years...................................................................................
55 to 64 years....................................................................................
65 years and over.........................................................................

91
149
146
99
93
55

53
76
64
24
15

58.2
51.0
43.8
24.2
16.1

27.0
30.5
23.4
14.7
7.9

Total, 15 years and over..................................................

633

232

36.7

13.9

2.6

The experience shown in Table 61 includes 633 deaths from all
causes, of which 232, or 36.7 per cent, are from pulmonary tuber­
culosis. The proportionate mortality from pulmonary tuberculosis
is decidedly excessive at all ages under 65. In support of the sta­
tistics quoted by Sir Thomas Oliver regarding the proportion of
brass workers attaining to old age, it is suggestive that out of 633
deaths of brass workers at all ages, 55, or only 8.7 per cent, should
have attained to ages 65 and over. The statistics of Sir Thomas
Oliver, however, apparently have reference to brass founders alone,
who are unquestionably exposed to greater health hazards than brass
workers generally. Unfortunately the data for a specialized analysis
by occupations, in detail, are not available for the brass industry at
the present time.
GENERAL CONCLUSIONS.

In a general way the insurance mortality statistics confirm the data
and observations derived from other sources. The dust hazard in
the brass working trade is, of course, only one of many health-in­
jurious conditions inherent in the industry, all of which are sug­
gestive of the exceptional urgency of thoroughly efficient sanitary




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precautions, and the use of protective devices on the part of those
most seriously affected by the liability to brass poisoning and its
related respiratory affections.
ARTIFICIAL FLOWERS.

'T
’his occupation is not strictly within the group of trades, indus­
tries, or occupations with continuous and considerable exposure to
metallic dust. It is, however, included in view of the observations
by Sir Thomas Oliver, that the workers employed in the manufac­
ture of artificial flowers, chiefly French roses, especially the double
roses, “ complain of headache, nasal catarrh, dryness of the throat,
probably from the dust, and also of vomiting.” In addition, he
observes, “ In at least one-third of those who suffer, the symptoms
are those of metallic poisoning, for on examination of the red leaves
of the roses several are found to contain salts of lead.” He draws
particular attention to the health-injurious effects of this group of
occupations upon the young women engaged in salesrooms where
artificial flowers are collected and distributed, and states that t,*a
(
few of them sh ^ a tendency to laryngeal and pulmonary catarrh,
ow
attended by a cough, owing to the dust given off by the flowers.
Upon a microscopic examination of the expectoration it was found
that particles of dust contained therein were identical with those
given off from the flowers.”
P R O C E S S E S O F A R T I F I C I A L -F L O W E R M A K IN G -.

An extended account of the processes of artificial-flower making
in the United States, by Walter O. Lincoln, is published in the
Weekly Underwriter, New York, March 17, 1914. The different
processes are not indicative of a considerable amount of dust ex­
posure, although mention is made of the use of tinsel including mica
in its composition. In connection with the manufacture of leaves
it is stated that the claim is made on good authority that “ the gasheated presses are injurious to the health of the operators, who are
required to sit many hours with the lower limbs extended under the
press, with gas burners near by, which overheat the abdomen and
cause stomach trouble.” There are, however, no intimations that
the manufacture of leaves or flowers involves a particular hazard
of metallic or mineral dust exposure.
A brief reference occurs in the Second Report of the New York
State Factory Investigating Commission (Vol. II, p. 1156), accord­
ing to which “ The danger in this industry was reputed to be from
the use of the arsenic greens for the purpose of dyeing and dusting
the material.” The different processes are briefly described in the




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preliminary report of the commission for 1912. In none of these
investigations was definite evidence produced tending to prove an
exceptional liability to pulmonary tuberculosis in consequence of
exposure to the inhalation of metallic and mineral dusts, but more
extended investigations would be required for the purpose of scien­
tific conclusiveness.
An admirable discussion of the life and labor of artificial-flower
workers by Miss Mary Van Kleeck was published by the Russell
Sage Foundation in behalf of the Committee on Women’s Work
(New York, 1913). The investigation is of special importance in
view of the fact that it was made in the city of New York where
three-quarters of all the artificial flowers produced in the United
States are made. All of the shops in the Borough of Manhattan
known to make artificial flowers, employing 5,240 workers, were
visited. The proportions in various age groups of 371 home workers
in 110 families were as follows: Children under 8 years of age, 10.2
per cent; children 8 to 14 years of age, 27.2 per cent; children 14 to
16 years of age, 11.3 per cent; and adults 16 years of age and over,
51.3 per cent. The proportions in various age groups of women shop
workers employed in artificial-flower making were: Ages 10 to 16
years, 14 per cent; ages 16 to 25 years, 63 per cent; and ages 25 and
over, 23 per cent. This compares with all women workers in manu­
facturing industries as follows: Ages 10 to 16 years, 9 per cent; ages
16 to 25, 53 per cent; and ages 25 years and over, 38 per cent. The
artificial-flower making industry is, therefore, typically representa­
tive of female workers at the younger or immature ages. An analysis
of the wages earned proves conclusively that the employments are
decidedly underpaid. An inquiry into the hours with special refer­
ence to fatigue seemed to justify the conclusion that, regardless of
the fact that the work* was light, the elements of fatigue were by
no means lacking; that many of the workrooms were poorly ven­
tilated, and that the air was vitiated because of the use of gas stoves
for heating the tools and sometimes by gas used in illumination.
Complaint was also made that certain dyes used were poisonous, and,
according to the author, “ this opinion was expressed so frequently by
the workers that it seems credible, although no medical examinations
have been made to support it. The girls say that they inhale the
dust from cheap flowers and that the color frequently stains their
hands and may inadvertently be rubbed on tfie mouth or eyes.” It
is, therefore, suggested that4 a special investigation of the physical
4
effects of these dyes ought to be made, but in the broader sense the
health aspects of the entire industry should be subjected to critical
and qualified consideration.”




OCCUPATIONS WITH EXPOSURE TO METALLIC DUST.

161

GENERAL CONCLUSIONS.

Since in this industry women are almost exclusively employed,
the industrial insurance experience data are inconclusive. There
have been only 13 deaths of male artificial-flower makers in the ex­
perience of the Prudential Insurance Co. during the period 190T to
1914, of which, however, 4, or 30.8 per cent, were from pulmonary
tuberculosis. Three of the deaths occurred at ages under 35, of
which two A
vere from this particular disease. The corresponding
data for women are not available. On account of its practical im­
portance as an employment for young persons, chiefly girls of the
period of early adolescence, it would seem a matter of some urgency
that the health aspect of this group of occupations with special refer­
ence to the dust hazard and the probable liability to an excessive
mortality from tuberculosis should be made the subject of a thor­
oughly qualified investigation.
106811°— 18— Bull. 231------ 11







CHAPTER III.—OCCUPATIONS WITH EXPOSURE TO
MINERAL BUST.
Mineral-dust exposure is most common in the stone industry,
among potters, in cement manufacture, and in mining. Mineral dust
varies widely and essentially in its mechanical and chemical prop­
erties, and much more so than is the case with the different varieties
of metallic dust. The quantitative degree of dust exposure is also
decidedly greater in the case of mineral dust, which frequently con­
taminates the entire atmosphere in a finely comminuted form for
prolonged periods of time. Since all dust is primarily injurious on
account of its irritating effects on the respiratory organs, it is selfevident that essential variation in the mechanical properties of the
dust must correspondingly affect the consequential results on lung
tissue and the development of lung fibrosis and pulmonary tuber­
culosis. It is estimated that at every inhalation an adult person
inhales about one-half liter of air, and since the normal respiration
is from 10 to 18 times per minute the approximate quantity of air
inhaled is from 8 to 9 liters per minute and from 480 to 540 liters
per hour. Continuous exposure, therefore, to* even relatively small
amounts of atmospheric impurities may have proportionately serious
pathological results. According to Hesse, a man working 10 hours
a day inhales approximately 0.09 gram of dust per day if employed
in a sawmill, 0.025 gram per day if employed in a flour mill, and 1.12
grams per day if employed in a cement mill. Regardless, however,
of the fact that the quantitative exposure to dust inhalation in cement
manufacture exceeds very considerably the corresponding exposure
in many other occupations, it is apparently well established by rea­
sonably trustworthy data that the inhalation of cement dust is
decidedly less injurious to lung tissue, with special reference to pul­
monary tuberculosis, than exposure to sandstone dust or granite
dust, etc. One important factor which is frequently overlooked is
the solubility or insolubility of the mineral dust inhaled, and the
chemical nature of the dust may therefore be of even greater im­
portance than its mechanically irritating qualities. The degree of
comminution is also of material importance in that in almost exact
proportion to the degree of fineness the dust particles will penetrate
into the remote portions of the lungs. It is therefore held that the
more minutely comminuted the dust, the more serious, in general
termSj will be the damage to the respiratory organs.




163

164

M R A IT F O R S IR T R D E S S IK D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS
M INERAL DUST A N D PULMONARY TUBERCULOSIS.

The term “ mineral dust ” for practical reasons is, for the present
purpose, limited to finely comminuted particles of mineral substances
as generally differentiated from metallic substances obtained by min­
ing, quarrying, or other extractive processes. No precise definition
regarding mineral dust seems practicable in view of the truly enor­
mous range of minerals, varying from potash salts and fuller’s
earth, phosphate rock, mica, slate, asbestos, mineral paints, graphite,
cement, gypsum, borax, asphalt, lime, coke, etc., to pure silica or
quartz, which for the present purpose must be considered the most
injurious of all forms of mineral dust, approaching quite closely in
degree of seriousness to the most irritating forms of metallic dust.
The relation of mineral-dust inhalation to pulmonary tuberculosis
and nontuberculous lung diseases is ascertainable only as regards the
more important mineral products, such as slate, cement, lime, coal,
silica, and other stones, chiefly marble, limestone, sandstone, bluestone, and granite. There are no trustworthy mortality statistics
regarding dust exposure and its relation to health in connection with
the mining of phosphate rock, mica, asbestos, sulphur, soapstone,
graphite, borax, asphalt, and abrasive materials. Few of these in­
dustries are relatively important as regards the number of persons
employed therein, but for scientific purposes it is most desirable
that the health-injurious results of each and every form of mineral
dust should receive the required extended and qualified consideration.
The typical form of industrial-dust phthisis met with in occupations
with exposure to mineral dust conforms more to the precise defini­
tion of industrial pneumoconiosis or nontuberculous lung disease
in its initial development, although as a general rule there is a super­
induced true pulmonary tuberculosis which is properly returned as
the immediate cause of death. In occupations with exposure to min­
eral dust it is therefore of even greater importance than in occupa­
tions with exposure to metallic dust that the nontuberculous lung
diseases, particularly asthma and chronic bronchitis, should receive
some consideration, aside from the invariably more important mor­
tality from pulmonary tuberculosis, although the latter often is not
the primary but rather a contributory cause of death.
LUNG DISEASES AN D M INERAL AND METALLIC DUST EXPOSURE.

This conclusion is quite fully sustained by Table 62, which is
derived from the industrial insurance experience of the Prudential
Insurance Co. for the period 1897 to 1914, and which may safely be
considered representative for the country at large.




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X O U E O IN R L U T

165

C O M P A R A T IV E P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R ­
CULOSIS A N D N O N T U B E R C U L O U S R E S P I R A T O R Y D IS E A S E S IN O C C U P A T IO N S E X ­
PO SIN G TO M I N E R A L A N D M E T A L L IC D U S T , I N D U S T R I A L E X P E R I E N C E OF P R U ­
D E N T I A L CO., 1897 TO 1914.

T a b le 6 2 .—

Deaths of workers exposed to—
Cause of death.

<

Metallic dust.

Mineral dust.

Number.

Per cent.

Number.

Per cent.

Pulmonary tuberculosis..............................................................

3,129

27.3

2,960

36.0

A sthm a.........................................................................................
Bronchitis........................................................................................
Pneumonia......................................................................................
Other nontuberculous respiratory diseases........................

105
173
-1,198
199

.9
1.5
10.5
1.7

47
70
696
132

.9
8.5

Total......................................................................................
All other causes..............................................................................

1,675
6,653

14.6
58.1

945
4,326

11.5*
52.5

Total, all causes..................................................................

11,457

100.0

8,231

100.0

.6
1.6

According to this analysis the proportionate mortality from non­
tuberculous respiratory diseases in occupations with exposure to
mineral dust is 14.6 per cent, against 11.5 per cent for occupations
with exposure to metallic dust. Every important form of non­
tuberculous respiratory disease is proportionately more common
among occupations with exposure to mineral dust, but the propor­
tionate mortality from pulmonary tuberculosis is only 27.3 per cent,
against 36 per cent for occupations with exposure to metallic dust.
M O R T AL IT Y FROM PU LM O N ARY TUBERCULOSIS IN OCCUPATIONS
W IT H EXPOSURE TO M IN ER AL DUSTS— U N ITED STATES REGIS­
TRATION AR E A .

The conditions of employment in the industries, trades, and occu­
pations which are considered in detail in this chapter are often so
widely at variance with one another that, as stated in the preceding
chapter with regard to metallic dust, the mortality data represent
averages which must be interpreted with extreme caution as regards
their application to particular employments with a more or less ascer­
tainable degree of exposure to mineral dust. Such exposure is nearly
always an important predisposing cause of pulmonary tuberculosis,
but particularly so in certain branches of the stone industry and
among potters. Tables 63 and 64 following are, therefore, merely in­
tended as a general statement of the essential mortality facts concern­
ing this group of occupations, with special reference to pulmonary
tuberculosis and nontuberculous respiratory diseases, as derived from
the available official statistics of the Division of Vital Statistics of the
United States Census Bureau. A subsequent additional table presents




166

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

the corresponding facts as derived from the extended experience
of a representative industrial insurance company. The practical
usefulness of this analysis is naturally rather limited for the reasons
stated, but the data provide a fairly trustworthy measure of the
relative frequency of pulmonary tuberculosis in the group of indus­
tries and occupations subject to a more or less ascertainable degree
of health-injurious exposure to the continuous and considerable
inhalation of mineral dust.
6 3 .— P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS IN
O C C U P A T IO N S W I T H E X P O S U R E TO M I N E R A L D U S T , U N I T E D S T A T E S R E G I S T R A ­
T IO N A R E A , 1908 A N D 1909, B Y A G E G R O U P S .

T a b le

Deaths from pulmonary
tuberculosis.
Deaths
from all
causes.

Afre at death-

Number.

Per cent
of deaths
from all
causes.

i
15 to 24 yea rs.. . . . . . . . . . . . . . __ . . . . . . . . . . . . . . . . . . ____. . . . . . . . . . . . . . . . . . .
25 to 34 years.................................................... ........... ».........................................
........................................ ......... ............. ............................................
35 to 44 years
45 to 54 years........ ............. ................................................. ............................. .....
55 to 64 years............................................................ ..................... ....................... ..
65 years and over............................................................ .......................................
Age unknown....................... ..................... ........................................... .................
Total, 15 years and o v e r .. . ...................................

756
1,524
2,172
2,399
2,258
2,162

33.9

256
582
700
523
259
87

38.2
32.2

21.8
11.5
4.0

10

1

10.0

11,281

2,408

21.3

6 4 .— P R O P O R T IO N A T E M O R T A L IT Y F R O M N O N T U B E R C U L O U S R E S P I R A T O R Y
D IS E A S E S IN O C C U P A T IO N S W I T H E X P O S U R E TO M I N E R A L D U S T , U N I T E D S T A T E S
R E G IS T R A T IO N A R E A , 1908 A N D 1909.

T a b le

Num ber of
deaths.

Cause of death.

Per cent
of deaths
from all
causes.

Asth m a...................................... ........................................................................................................
Bronchitis..........................................................................................................................................
Pneumonia................................................................................... *___________ _______________
Other nontuberculous respiratory diseases.......................................................................... .

26

0.2

840
124

7.4

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

1,086

9.6

INCONCLUSIVE OCCUPATIONAL MORTALITY

96

.9

1.1

STATISTICS.

The aggregate experience, according to Table 63, for the two years
under observation (no subsequent official statistics have been pub­
lished), indicates a proportionate mortality from pulmonary tuber­
culosis among men employed in occupations with exposure to mineral
dust of 21.3 per cent, which compares with 21 per cent for occupa­
tions with exposure to metallic dust, as ascertained by an analysis of
the corresponding data derived from the same official sources. The
data can not be considered entirely conclusive on account of the
fact that the industries and occupations with exposure to mineral




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X O U E O IN R L U T

167

dust include a relatively large number of persons not exposed to the
risk of dust inhalation to a serious degree. If it were practicable
to separate those directly exposed to the dust danger from
those not exposed to any such risk whatever, the resulting pro­
portionate mortality from pulmonary tuberculosis and nontuber­
culous respiratory diseases would, of course, be much more excessive.
For illustration, it is noted that the pottery industry as a whole is
chargeable with a serious risk of mineral-dust exposure. The particu­
lar dust hazard is experienced chiefly among flint-mill workers, mix­
ers, scourers, and sweepers. If the mortality rate of these employ­
ments could be correctly ascertained with particular reference to
pulmonary tuberculosis, there can be no question of doubt that
the proportionate mortality figure would be decidedly in excess of
the corresponding figure for jiggermen, jollymen, throwers, and
other numerically important pottery employees. The same conclu­
sion applies to the glass industry, where the handlers of materials
and mixers are exposed to a readily ascertainable dust hazard, which
to a lesser degree affects batch wheelers, carboy blowers, clay grind­
ers, clay trampers, gatherers, pot makers, etc., and to a still lesser
degree, glass blowers, finishers, lamp workers, pressers, etc. As far
as possible the occupational differences in particular industries are
considered in detail in the discussion following, but it has seemed
advisable to consolidate the available data for the purpose of ascer­
taining, as far as practicable, the general effect of mineral-dust ex­
posure, which, as previously observed, appears to be less serious with
reference to pulmonary tuberculosis than continuous and consider­
able exposure to metallic dust.
COM PAR ATIVE M O R TALITY B Y INDUSTRIES OR OCCUPATIONS.

In addition to the mortality from pulmonary tuberculosis the com­
parative mortality from nontuberculous respiratory diseases, par­
ticularly asthma and bronchitis, is also distinctly excessive among
occupations with exposure to mineral dust, and even more so than
among the corresponding occupations with exposure to metallic dust.
The details of the proportionate mortality from pulmonary tuber­
culosis in the principal occupations for which the information is
ascertainable from the reports of the Division of Vital Statistics of
the United States Census Bureau, for the two years 1908 and 1909,
are, for purposes of convenience, shown in Table 65.




168

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

T a b le 6 5 .— P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS IN
S P E C IF IE D IN D U S T R IE S O R O C C U P A T IO N S W I T H E X P O S U R E TO M I N E R A L D U S T ,
U N IT E D S T A T E S R E G IS T R A T IO N A R E A , 1908 A N D 1909, B Y A G E G R O U P S .

15 to 24 years.

Occupation group.

Deaths
from pul­
monary
tubercu­
losis.

Deaths
from
all
causes.

Deaths
from pul­
monary
tubercu­
losis.

Deaths
from
all
causes.

Brick and tile m akers1.
Glassworkers....................
Marble and stone cut­
ters ..................................
Painters, glaziers, and
varmshers......................
Paper hangers1...............
Plasterers..........................
Potters1.............................

14
176

3 21.4
83 47.2

429
15
48
13

132 30.8
4 26.7
25.0
46.2

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

756

33.9

3 23.1
86, 42.6

5 27.8
56 33.1

1,524

Brick and tile m akers1.
Glassworkers....................
Marble and stone cut­
ters ..................................
Painters, glaziers, and
varnishers......................
Paper hangers1...............
Plasterers..........................
Potters1.............................
Total........................

26

407
1,474
33
205

1
2

2,258

Deaths
from
all
causes.

Num-| Ter
ber. cent.

2
0
117

15.0
19.7

299

132 44.1

167 41.6

1,423
60
177
26

415 29.2
33.3
61 34.5
42.3

42
189
32

278 17.4
21.4
16.4
37.5

582, 38.2

2,172

32.2

2,399

41

11
0

Deaths
from pul­
monary
tubercu­
losis.

36.9
44.4
31.5
44.4

74j 43.5
357i
16
34'
12

65 years and over.

7.7
7.9

11
0

13

22
0
170

55 to 64 years.

45 to 54 years.

N um ­ Per
ber. cent.

968
36
108
27

1
2
6

Deaths
from
all
causes.

Deaths
from pul­
monary
tubercu­
losis.

N um - Per
ber. cent,

N um ­ Per
ber. cent.

16

35 to 44 years.

25 to 34 years.

2
0
1
1

Age unknown.

523

2 .8
1

Total, 15 years
and. over.

4.0

133
867

16! 12.0
260' 30.0
509 30.7

23.3

316

7.9

1,657

9.0
3.0
16 7.8
5 41.7

1,398
31
249
26

3.3
6.5
3.6
3.8

7,294 1,361 18.7
217
52 24.0
977
163 16.7
136
47 34.6

11.5

2,162

4.0

11,281 2,408 21.3

132

1

1 Data are for 1909 only.

The table emphasizes the rather wide range in the mortality from
pulmonary tuberculosis in the different occupations^ industries, or
trades with exposure to mineral dust, a difference attributable
partly at least to variations in conditions of employment, or, more
precisely, to the proportion of all the employees of the industry con­
cerned who were considerably exposed to the dust menace. A much
more important influence, however, on the tuberculosis rate is the
variation in the chemical and mechanical properties of the mineral
clust inhaled and the quantitative degree of dust inhaled, which, as
elsewhere observed, probably reaches a maximum in certain processes
of cement manufacture. The statistics for the United States regis­
tration area are unfortunately limited to a comparatively small
number of specified industries and trades, but there are no reasons
for believing that the proportionate mortality figure would be
materially modified by the inclusion of similar or allied employments
or occupations for which the information is at present not ascer­
tainable from official sources. The comparison of the different em-




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X O U E O IN R L U T

169

ployments one with another is also subject to the further restriction,
as regards practical usefulness, that while for some industries and
occupations, such, for illustration, as painters, etc., the number of
deaths is relatively large and sufficient for the purpose, for other
occupations., such, for illustration, as brick and tile making and the
pottery industry, the number of deaths is too limited for entirely
safe conclusions.
M O R T AL IT Y FROM NONTUBERCULOUS RESPIRATORY DISEASES.

The limitations of the available statistics are even more serious in
the case of nontuberculous respiratory diseases, but it has seemed
advisable for the present purpose to include Table 66, which, how­
ever, gives data which refers only to all ages combined and not to divi­
sional periods of life on account of the relatively small number of
deaths available for analysis.
T a b le 6 6 . — P R O P O R T IO N A T E M O R T A L IT Y F R O M N O N T U B E R C U L O U S R E S P I R A T O R Y
D IS E A S E S IN S P E C IF IE D I N D U S T R IE S O R O C C U P A T IO N S W I T H E X P O S U R E TO M IN ­
E R A L D U S T , U N IT E D S T A T E S R E G I S T R A T I O N A R E A , 1908 A N D 1909.

Deaths caused by nontuberculous respiratory diseases.

Asthma.

Occupation group.

Bronchitis. Pneumonia.

Other.

Total.

Num ­ Per N um ­ Per N um ­ Per N um ­ Per Num ­ Per
ber. cent. ber. cent. ber. cent. ber. cent. ber. cent.
Brick and tile makers 1.................................
Glassworkers....................................................
Marble and stone cutters..............................
Painters, glaziers, and varnishers..............
.................................................
Paper hangers 1
Plasterers.................................. .........................
Potters 1...............................................................
Total.........................................................

.3
.7

5
29
47
3
11
1

0.6
1.8
.6
1.4
1.1
.7

8
67
131
533
13
79
9

6.0
7.7
7.9
7.3
6.0
8.1
6.7

2
6
33
64
2
11
6

.2

96

.9

840

7.4

124

2
9
11

0.2
.5
.2

3
1
26

1.5
.7
2.0
.9
.9
1.1
4.4

10
80
202
655
18
104
17

7.5
9.2
12.2
9.0
8.3
10.6
12.5

1.1 1,086

9.6

1 D a ta are for 1 9 0 9 only.

INDUSTRIAL INSURANCE MORTALITY EXPERIENCE.

In view of the limited extent of the available official occupation
mortality statistics of the registration area, the industrial mortality
experience of the Prudential Insurance Co. of America is somewhat
more conclusive, in that the number of specific occupations is more
representative of the industries and employments with exposure to
mineral dust. When considered as a group and for some of the
more important occupations, the actual mortality data are also more
extensive. The details of the experience are set forth in Table 67.




170

M R A IT F O R S IR T R D E S S IK D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

T a b le 6 7 .— P R O P O R T I O N A T E M O R T A L I T Y F R O M P U L M O N A R Y T U B E R C U L O S IS IN
O C C U P A T IO N S W I T H E X P O S U R E TO M I N E R A L D U S T , I N D U S T R I A L E X P E R I E N C E O F
P R U D E N T I A L CO., 1897 TO 1914.
%
Deaths from pulmo­
nary tuberculosis.
Age at death.

Peaths
from all
causes.
Number.

Per cent
of deaths
from all
causes.

15 to 24 years........... .......................................................... .....................................
25 to 34 years.............................................. .............................................................
35 to 44 years............................................................................................................
45 to 54 years........................................................................................ ............. ..
55 to 64 years........................................................................................ ............... ..
65 years and over.................................................................................. .................
Age unknown.......................................................................................................

1,141
1,920
2,280
2,303
2,127
1,684
2

365
875
823
602
355
109

32.0
45.6
36.1
26.1
16.7
6.5

Total, 15 years and over...........................................................................

11,457

3,129

27.3

T a b le 6 8 .— P R O P O R T I O N A T E M O R T A L I T Y F R O M N O N T U B E R C U L O U S R E S P I R A T O R Y
D IS E A S E S IN O C C U P A T IO N S W I T H E X P O S U R E T O M I N E R A L D U S T , I N D U S T R I A L
E X P E R I E N C E O F P R U D E N T I A L CO., 1897 to 1914.

Number
of deaths.

Cause of death.

Per cent of
deaths from
all causes.

105
173
1,198
199

0.9
1.5
10.5
1.7

1,675

14.6

1
Asthma______
- _
.
___ . . _
_____
Bronchitis...........................................................................................................................................
Pneumonia.........................................................................................................................................
Othfir nontuberculousresniratorv diseases___________ ________ . . . ___________ _____ ,
Total____ ____ ______________________ _____ ___________________

As observed in connection with the corresponding discussion of
the occupations with exposure to metallic dust, the insurance experi­
ence is not strictly comparable with the general mortality for the
country at large, for the principle of adverse selection must
be considered, and the fact that only a small proportion of the
risks accepted for industrial insurance are at entry subjected to a
thorough medical examination. A much more important factor,
however, is that the occupation analysis in the Prudential Co. ex­
perience is more strictly limited to specific occupations with
mineral-dust exposure as separate and distinct from industries or
groups of closely allied employments, which it is safe to assume are
more representative of the census mortality returns; in other words,
in the Prudential mortality experience the reference is rather to pot­
ters than to men employed in the pottery industry; to glassworkers
rather than to men employed in the glass industry; more so than is
the case in the returns made available through the Division of
Vital Statistics of the United States Census Bureau for the two
years 1908 and 1909.




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171

E XC E SSIV E FR EQ UENCY OF P U LM O N A R Y TUBERCULOSIS.

According to Table 67, the proportionate mortality from pul­
monary tuberculosis in occupations with exposure to mineral dust
is 27.3 per cent for all ages, which compares with 21.3 per cent as
shown by the census occupation mortality returns. The differences
are quite marked, and a maximum proportion is reached at ages
25 to 34, when out of 1,920 deaths from all causes among men with
exposure to mineral dust, 875, or 45.6 per cent, are deaths from pul­
monary tuberculosis, in contrast to a corresponding mortality of
49.6 per cent for men employed in occupations with exposure to me­
tallic dust. The proportionate mortality from pulmonary tuberculo­
sis among men employed in occupations with exposure to mineral
dust must therefore be considered distinctly excessive, but particu­
larly so at ages under 45. The mortality from nontubercuious re­
spiratory diseases affects rather the more advanced ages, and this is
especially the case with pneumonia, the incidence of which is appar­
ently increased by exposure to the continuous and considerable in­
halation of mineral dust, even more so than in the case of occupations
with exposure to metallic dust.1
PROPORTIONATE MORTALITY BY INDUSTRIES OR OCCUPATIONS.

The proportionate mortality by specific industries or occupations
and by divisional periods of life is shown in Table 69 following,
which will facilitate comparison with the corresponding table for
the registration area, but which is subject to the same suggestion of
extreme caution as regards the interpretation of the data derived, as
explained, from different sources.
___
1 T h e m o rta lity from pn eum on ia in the registration area has a p p aren tly been de­
creasin g du ring recent years, as show n by the fo llo w in g table, derived from official
sources :

M ortality from pneumonia ( exclusive of broncho pneum onia)— United S ta te s
registration area, 1905-1915.
[R a te per 1 0 0 ,0 0 0 o f p o p u lation .]

Males.

1905-1909
1915

Females.

Total.

116. 7
93. 7
................................................................................................................
105.4
1910-1914....................................................................................................................
SB. 8
...................................... .............................................................................
91.5
73.8
82.9

N o th oro u gh ly qualified an a ly sis has th u s fa r been m ade o f the m o rta lity from pneu­
m onia in the U n ited S tates, p a rticu la rly in its relation to the du sty trades.
T h e subject
is, how ever, deserving o f m ore extended and strictly scientific consideration.




96.8

172

M R A IT F O R S IR T R D E S S IN D S Y T A E .
O T L Y R M E P A O Y IS A E
UT RDS

6 9 .— P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS IN
S P E C IF IE D I N D U S T R IE S O R O CC U P AT IO N S W I T H E X P O S U R E TO M I N E R A L D U S T ,
IN D U S T R IA L E X P E R I E N C E O F P R U D E N T IA L C O., 1897 TO 1914, B Y A G E P E R IO D S .

T a b le

15 to 24 years.

Occupation group.

25 to 34 years.

Asbestos workers............
Brick, tile, and terra
Core m akers....................
GJassblowers----- .*...........
Glass cutters....................
Glassworkers, other
Lime,
cement, and
gypsum..........................
Lithographers..................
Marble and stone work­
ers ....................................
Molders..............................
Paint factories.................
Paper hangers.................
Plasterers..........................
Potteries............................
Total.......................

3
22.9
31.9
45.1
39.6
31.5

18
70

52.9

40
81

57
58
77

38.3
23.7
40.0
35.1
34.5
31.2

228
540
26
175
163
137

1,141

365 32.0

1,920

1 .1
1

60
266

1
0

Total.

1
11
2

N um­ Per
ber. cent.

Num ­ Per
ber. cent.

48
113
51
53
257

55 to 64 years.

Asbestos workers...........
Brick, tile, and terra
cotta................................
Core m akers....................
Glass blowers..................
Glass cutters....................
Glassworkers, other----Lime,
cement, and
gy p su m ........................
Lithographers..................
Marble and stone work­
ers ...................... v...........
Molders................ .*......... .
Paint factories............... .
Paper hangers................ .
Plasterers.........................
Potteries...........................

45 to 54 years.

Deaths
Deaths
Deaths
Deaths
from
from
from
from
pulmonary
pulmonary
pulmonary
pulmonary
Deaths tubercu­ Deaths tubercu­ Deaths tubercu­ Deaths tubercu­
losis.
losis.
losis.
losis.
from all
from all
from all
from all
causes.
causes.
causes.
causes.
N um ­ Per
ber. cent.

c o tta ...................................

35 to 44 years.

51
98
137
55
186

66.7

33.3

97
42
106
28
108

18.6
11.9
28.3
21.4
23.1

25.0
27 39.1

45
53

13 24.5

403
694
25
174
225

179 44.4
213 30.7
40.0
74 42.5
91 40.4
72 39.8

513
690
33
134
281
172

2,280

823 36.1

2,303

35.3
42.9
53.3
50.9
51.1

81
63
115
48
151

16 19.8
19 30.2
36 31.3
41.7
52 34.4

15 37.5
42 51.9

48
69

18
42
73
28
95

11 53.1
2
218 40.4
6 23.1

77 44.0
71 43.6
49.6

875 45.6

65 years and over.

N um ­ Per
ber. cent.

11
8

2
0

1
2
1
0

Age unknown.

26
52
24
103

19
342
480
14
72
314
87

2,127

355 16.7

1 11.5
1
1 .8
1
2 .1
1

39
31

1,684

222
325

46 20.7
125 38.3

9.4
5.8

2
2

135 26.7
87 13.9

3 23.1
82
105
175
80
274

4.5
10.5

1
1

506
624
16
96
330
147

602 26.1

527
357
546
220
897

2,052
3,294
124
708
1,371
801

4.7

92

12.5

23.5
30.2

5.9
27.3
5.4

129
15
85

1 .2
2

49
32

2 0 39.0
0
149 2 .6
1
7 2 .2
1
2 15.7
1

Total, 15 years and
over.
13

10.7
11.5
15.4
8.3
15.5

1 2 .2
0 2

3
13

4.2
4.1

109

6.5

1 1 .6
1 2

690
758
27
206
300
258

15.6
29.4
32.1
36.4
30.5

33.6
23.0
21.8
29.1
21.9
32.2

11,457 3,129 27.3

MORTALITY FROM NONTUBERCULOUS RESPIRATORY DISEASES.

On account of the importance of nontuberculous respiratory dis­
eases,1 Table 70 is included, showing the proportionate mortality
from asthma, bronchitis, pneumonia, and other respiratory diseases
1 On the nontuberculous resp ira to ry diseases, see “ D iseases o f the B ronch i, L u n gs,
and P le u ra ,” by F rederick T . L o rd M . D ., P h ilad elp h ia and N ew Y o rk , 1 9 1 5 , and
“ System o f M edicin e,” edited by Sir C lifford A llb u tt and H u m p h rey D a v y R ollesto n ,
London, 1 9 0 9 .




OCPT N W
C U A IO S ITH E P S R T M E A D S .
X O U E O IN R L U T

173

among workers in occupations with exposure to mineral dust, without
reference to divisional periods of life:
T able 7 0 .— P R O P O R T IO N A T E M O R T A L IT Y F R O M N O N T U B E R C U L O U S R E S P IR A T O R Y
D IS E A SE S IN SP E C IF IE D IN D U S T R IE S O R O CC U P A T IO N S W I T H E X P O S U R E TO M IN ­
E R A L D U S T , I N D U S T R IA L E X P E R I E N C E O F P R U D E N T I A L CO., 1897 TO 1914.

Deaths caused b y nontuberculous respiratory diseases.

Occupation group.

Asthma.

N um ­
ber.

Asbestos workers...........
Brick, tile, and terra
cotta................................
Core m akers....................
Glass blowers..................
Glass cutters....................
Glass workers, other___
Lime, cement, and gyp­
sum .................................
Lithographers.................
Marble and stone work­
ers....................................
Moldors..............................
Paint factories.................
Paper hangers..................
Plasterers..........................
Potteries............................
Total.......................

Bronchitis.

Per
cent.

Pneumonia.

Total.

Other.

Per
cent.

N um ­
ber.

Per
cent.

N um ­
ber.

2

15.3

12.9
11.2
5.9
9.5
7.9

10
7
8
2
13

1.9
2.0
1.5
.9
1.4

89
48
49
25
94

16.9
13.4
9.0
11.4
10.5

N um ­
ber.

Per
cent.

N um ­
ber.

Per
cent.

2

15.3

5
1
6
1
6

0.9
.3
1.1
.5
.7

68
40
32
21
71

6

1.1

3
1
4

.5
.5
.4

2

.9

3
3

1.4
.9

15
35

6.8
10.8

5
3

2.3
.9

25
41

11.3
12.7

28
25
1
1
9
25

1.4
.8
.8
.1
.7
3.1

52
51

2.5
1.5

2.4
2.0

1.1
1.7
1.7

9.6
14.1
8.9
8.6
9.8
5.7

49
65

8
23
14

198
463
11
61
135
46

9
9
19

1.3
.7
2.4

327
604
12
79
176
104

15.9
18.3
9.7
11.2
12.8
13.0

105

.9

173

1.5

1,198

10.5

199

1.7

1,675

14.6

It does not seem necessary, as observed in the discussion of occupations with exposure to metallic dust, to enlarge upon the facts dis­
closed by the preceding comparative statistics, which emphasize with
a sufficient degree of scientific conclusiveness the obviously healthinjurious consequences of considerable and continuous exposure to
the inhalation of mineral dust. It is clearly recognized that the sta­
tistical data utilized for the present purpose are of rather limited
intrinsic value, but they are in the main quite fully confirmed by the
more extended consideration of occupations in detail where the ex­
posure to mineral dust is sufficient to warrant their inclusion within
the plan and scope of the present discussion.
ENGLISH O C CUPATIONAL M O R TALITY D A T A .

In conclusion, however, it has seemed advisable to add to the pres­
ent observations a table obtained from English official sources which
shows the combined mortality of glassworkers, potters, paper
hangers, plasterers, and lithographers, and which may safely be
considered sufficiently representative of the entire group of occupa­
tions with exposure to mineral dust, in the absence of more extensive
information which unfortunately is not available.




174

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

T a b l e 2 1 .— M O R T A L IT Y

FR O M A L L CAUSES, FR O M P U L M O N A R Y TU BE R CU L O SIS, A N D
FR O M O T H E R R E S P IR A T O R Y DISEASES IN OCCUPATIONS E XP O SE D - T O M IN E R A L
DU ST, C O M PA R E D W IT H T H A T OF A L L OCCUPIED MALES,. I N E N G L A N D A N D
W A L E S , 1900 TO 1902, B Y A G E GROU PS.

[Source: Part II, Supplement to- the Sixty-fifth Annual R eport af the. Registrar^-General' o f Births, Deaths,
and Marriages-in England and Wales..!

Death rate per 1,000 due
to all causes among—

Death rate per 1,000 due
to. pulm onary tubercu­
losis among—

Death rstfc© per 1,000 due
to other diseases of
the respiratory system
among—

Age at death.
Occupations All occu­ Occupations
Occupations A ll occuAIT occuexposed to
exposed to
exposed to
. pied males.. mineral dust. ,pied males.. mineral dust; pied males. mineral dust.
15 to 19 years....................
20 to 24 years._____ ____
25 to. 34 years
......
35 to 44 years........... ......... '
45 to 54 years....................
55 to 64 years....................
65 years; and over.............

2.44
4.41
6.01
10; 22
17.73
31.01
88.39

2.35
4.02
5-24
12.46
23.74
40. 23
92.. 60

0.54
1.55
2.03
2.74
3.04
2.16
1.11

a 55
1.44
2.01
3.96
4.91
3.94
1.13

0.24
.48
.77'
1.66
3,32
6.54
17.77

0.27
. 50'
.78
2.12
6.05
12; 86
24.53

GENERAL CONCLUSIONS,

Table 71 brings out clearly the fact that the mortality from
pulmonary tuberculosis among men in occupations with exposure
to mineral dust is decidedly excessive at ages 35 to 64, but that
the mortality at the other ages is mot appreciably lower than for
occupied males generally. Death rates are, however, not as useful
and conclusive for purposes o f industrial hygiene as the proportion­
ate mortality figure which precisely emphasizes the quantitative im­
portance of a given disease or cause of death. The proportionate
mortality from pulmonary tuberculosis and nontuberculous respira­
tory diseases is excessive at all ages among men with exposure to
mineral dust, although the relative death rate per thousand exposed
to risi: is not, at least according to English experience, decidedly
excessive at certain periods of life. The data are not of sufficient
importance to invalidate the general conclusion-, and in the main the
death rates sustain the proportionate mortality figure, although this
is not invariably the case. The death rate from nontuberculous
respiratory diseases among men employed in occupations with ex­
posure to mineral dust, according to the English experience, is at
the older ages so deeidedty excessive that obviously much more
extended scientific consideration should be given to this group of
diseases than has heretofore been given it. At ages 55 to 64,, for
illustration, in the English experience there is an actual excess in
the mortality from all causes among men exposed to mineral dust of
9.22 per 1,0.00, equivalent to 29.7 per cent,. but in the mortality from
pulmonary tuberculosis there is an excess oi 1.78 per 1,000, equiva­
lent to 82.4 per cent, against an excess of 6.32 per 1,000 in the mor­




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST*

175

tality from nontuberculous respiratory diseases* equivalent to 96.6
per cent. The results of this analysis* therefore* reemphasize the
scientific concIusLveness of the extended discussion on “ Industrial
] neumoconiosis with special reference to dust phthisis,” by Edgar L,
Collis* in the Milroy Lectures of 1915, and the corresponding obser­
vations on pneumoconiosis by Sir Thomas Oliver in Allbutt &
Rolleston’s System of Medicine, Volume V, Diseases of the Respira­
tory System.
Of interest in this connection are the observations by Dr. J. S.
Haldane contained in a contribution to the Proceedings of the Insti­
tution of Mining Engineers, abstracted in a letter from London to
the Journal of the American Medical Association, August 19, 1916.
In the paper referred to Dr. Haldane pointed out “ that while up to
the age of 50 the death rate from lung disease is much lower among
colliers than in the rest of the population, above 50 the opposite holdsr
and there is a marked excess of deaths from bronchitis-” In con­
tinuation, however, he stated that “ the deaths from this disease have
greatly diminished since 1890, for which improved ventilation seems
to be the cause. Fifty years ago miners often worked in air con­
taining so much black damp that lamps and candles burned dimly.
In such air there is usually 2 or 3 per cent of carbon dioxide, which
enormously increases the breathing during muscular exertion. The
breathing is exactly regulated so as to keep an average of about 5.6
per cent carbon dioxide in the alveolar air; and with 3 per cent of
this gas in the air, a man breathes twice as much air, so as to keep
the alveolar percentage right. A man doing moderate muscular
work in pure air breathes about five or six times as much air as dur­
ing rest. In air containing 3 per cent of carbon dioxide he would
be breathing ten or twelve times as much air as during rest* and his
breathing would be taxed to the utmost. He would thus be much
more liable to contract emphysema. The better ventilation of coal
mines is largely a consequence of the greater amount of fire damp and
great heat encountered as mines have become deeper.”
Dr. Haldane is inclined to think u that both the fire damp and the
heat have indirectly caused great improvement to the health of
miners. Where there is plenty of lire damp there is usually also
plenty of fresh and dry air, and no harmful excess of carbon dioxide.
The proportion of deaths from bronchitis among old miners was
higher in Staffordshire in 1890-1892 and 1900-1902 than in any of
the other coal fields; and Staffordshire mines are exceptionally sub­
ject to black damp. The excess in bronchitis among old coal miners
has been attributed to the breathing of dust,” and Dr. Haldane was
“ previously inclined to agree with this theory. But it is difficult to
see why* if dust is the cause, there has been so great a diminution in




176

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES,

the bronchitis mortality in recent years. Coal mines have, on the
whole, become drier and more dusty with increasing depth and better
ventilation; and, if dust were the cause, one would have expected the
bronchitis to increase, whereas it has greatly diminished. Certainly
an excess in mortality from bronchitis is associated with the breath­
ing of harmful dust. But this excess is accompanied by a far greater
excess in mortality from phthisis, and begins comparatively early in
life, unlike the bronchitis mortality in colliers. Experiments on
animals carried out by J. M. Beattie show that both coal dust and the
shale dust usually associated with it on mine roads are relatively
liarmless.”
It is therefore quite clear that much remains to be ascer­
tained concerning the true nature and extent of dust phthisis and
that in the solution of this important industrial problem a consid­
erable advance is necessary in the practice of medicine, which to a
much larger degree should be made to rest upon knowledge con­
cerning disease causation ascertained by means of autopsies in indus­
trial districts subject to an excessive mortality from pulmonary
tuberculosis and nontuberculous respiratory diseases.
ASBESTOS.

The number of men employed in trades and industries involving
exposure to asbestos dust in the United States is unknown. Aside
from the mining of asbestos, in which exposure is rather limited,
there are numerous processes involving the conversion or remanu­
facture of the materials which are distinctly more serious in their
effects on health and longevity. Asbestos weaving and spinning are
described by Netolitzki on the basis of observations in Bohemia,
where the conditions were found to be decidedly unfavorable. For
this country our information is very limited, although the quantity
of asbestos used is very large. Its fire-resisting properties have
led to its extensive employment for the covering of pipes, furnaces,
etc., as well as its use in the form of wall plaster, roofing mate­
rial, etc. On account of its nonconducting qualities it is exten­
sively employed by electricians and also in the construction of stor­
age rooms of refrigerating plants.
M E T H O D S OP M IN IN G .

“ Geologically,” according to the Technical World Magazine,1 “ as­
bestos is a fibrous form of serpentine rock, occurring in strata of
crystalline limestone. The veins run in an average thickness of onefourth to one-half inch, but sometimes attain to as much as -6 inches.
1 “ M in in g m in era l w o o l,”
1 906.




by A u b rey F u lle rto n , in T e ch n ica l W o rld M a ga zin e, M a y,

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

177

The asbestos fibers are, as nearly as possible, crystals of serpentine
rock.” According to the same magazine—
The ore is mined mostly in open quarries. Overlying soil, to a
thickness of sometimes 20 or 30 feet, but quite often forming only a
thin layer on top, has first to be removed; and as soon as the asbestos
veins are thus laid bare, the actual quarrying operations may begin.
The rock is cut in a series of terraces, reaching a total depth of some­
times 150 or 200 feet. Underground work has not proved successful,
the open quarry having been found both more economical and more
effective, despite the disadvantages of exposure to the weather. Drill­
ing and blasting are employed much the same as in ordinary stone
quarrying.
When the rock is thus broken up it is rough sorted at the quarry.
Two or more grades are selected, according to the length of the fiber,
and are then sent on to the “ cobbing sheds,” where the further process
of dressing goes on. This process is merely the separation of the
asbestos fibers from the dead rock, and is done in some cases by hand,
but to an increasing extent by machine. Hand cobbing is the very
simple method of breaking the stone by small sledge hammers, throw­
ing the fiber into one box and the waste into another. This separa­
tion is ordinarily not difficult, since the fiber lies in layers more or less
loosely clinging to the rock, and can frequently be picked off with the
fingers. The crude fiber, thus separated as cleanly as possible from
the waste rock and looking very much like mineralized wool, is
packed in 100-pound bags, in which form it goes to the market and
the manufacturer.
Hand dressing is not, however, an absolutely thorough method.
The waste material from the cobbing tables and the fine pickings
from the quarries have still some fiber in them, and the utilization of
this frequently represents the largest profits of the mine. All these
fine pickings are mechanically dressed. In case the asbestos contains
a large percentage of water, the moisture is first dried out, by ex­
posure to the air, by steam pipes, or by rotary driers, and the rock is
then passed on to the crushers, where it is broken by successively
finer-set rolls. Cylindrical fiberizers and the cyclone machine reduce
it still further. The latter is the most effective apparatus yet devised
for asbestos separation. It consists of two beaters, one of the screwpropeller type, driven within a cast-iron chamber at a violent speed,
reducing the particles of stone almost to a powder. This is then
passed over a shaking screen to remove the sand, and in some mills
strong electric magnets are used to take up the particles of iron.
In all of these operations there must necessarily be a considerable
degree of dust exposure, which, however, becomes exaggerated in the
spinning and weaving processes in connection with the manufacture
of asbestos yarn and cloth. These processes are briefly referred to in
an article in the Engineering Magazine,1 in part, as follows:
The spinning and weaving of asbestos have offered many difficulties,
as the asbestos fibers have no rough surface like wool or cotton, but
1 “ A sb estos, its m in ing, p rep a ra tion , m arkets, and use,” by E . S ch a a f-R eg elm a n , E n gi­
neerin g M agazine, O ct. 1907.

106811°— 18— Bull. 231------ 12




178

MORTALITY PROM RESPIRATORY DISEASES IN DUSTY TRADES.

are very smooth, and thus have a tendency to slip by one another
when twisted and subject to tension. An admixture of vegetable or
animal fiber was therefore often necessary, but, while these facili­
tated the manufacturing operations, they impaired the fire resistance
of the fabric, and special machinery and ingenious devices had to
be invented to enable the successful spinning of a pure asbestos yarn.
It is, however, now possible to make a single asbestos thread which,
though weighing no more than 1 ounce per hundred yards, has a fair
strength, and braided material can be made much more resi-stant to
torsion and tension, while asbestos ropes, chiefly used by the fire
department, can be strengthened either by interwoven wires or by
having a wire-rope core.
H E A L T H -IN JU R IO U S O CC U PA TIO N A L C O N D IT IO N S.

On account of the rather limited extent of the asbestos industry
in the United States, at least in the large centers of population, the
industrial insurance mortality experience data are insufficient for
definite conclusions. During the period 1907 to 1914 in the Prudential
experience there were only 13 deaths, of which 3, or 23.1 per cent,
were from pulmonary tuberculosis. At ages 25 to 44, there were 6
deaths, of which 3, or 50 per cent, were from this disease. Asbestos
dust is not described in the extensive consideration of Dust Hazards,
by Hayhurst, nor by W. Gilman Thompson in his treatise on The
Occupational Diseases. In 1914 the production of asbestos in the
United States was only 1,247 tons, or much less than in earlier years,
indicating a very limited available source of supply. Most of the
asbestos used in the United States is mined in Canada, and an excel­
lent report on “ Asbestos, its occurrence, exploitation, and use,” has
been published by the mines branch of the Department of the Interior
of the Dominion of Canada (Ottawa, 1905), which contains a de­
T
scriptive account of mining methods and of the dressing of asbestos
by hand or by mechanical treatment, including the final crushing by
meails of rollers, fiberizers, beaters, cyclones, and pulverizers. All of
these processes unquestionably involve a considerable dust hazard, but
the hygienic aspects of the industry have not been reported upon. It
may be said, in conclusion, that in the practice of American and
Canadian life insurance companies asbestos workers are generalty
declined on account of the assumed health-injurious conditions of
the industry.1
It is regrettable that there should be no further information avail­
able regarding the asbestos industry in its various branches, includ­
ing the utilization of by-products of manufacture, on account of the
self-evident injuriousness of asbestos dust as a predisposing cause of
pulmonary tuberculosis. The subject is not referred to by Kober
1 F o r a d e scrip tiv e a cco u n t o f the C an adian asb estos d istrict, see E n gin e e rin g a n d M in ­
in g J ou rn a l, N ew Y ork , A p r. 30, 1910.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

179

and Hanson in their recently published treatise on Diseases of Occu­
pation and Vocational Hygiene, nor by Sir Thomas Oliver in his
recent work on Diseases of Occupation. The rapidly increasing de­
velopment of industries using asbestos, as ascertained from domestic
or foreign sources, suggests the urgency of more qualified medical
consideration than has heretofore been given the subject. There are
no references to asbestos in the Index Catalogue of the Surgeon Gen­
eral’s Library, which, however, brings the literature of the subject
down only to 1896. The discussion of asbestos in the annual reports
of the United States Geological Survey on Mineral Resources is lim­
ited entirely to the technical aspects of the mining industry, which
during recent years has experienced a rather retrograde movement
in that the production has diminished from a maximum of 7,600 tons
in 1911 to 1,247 tons in 1914. In contrast, however, there has been a
gradual increase in the quantity of the unmanufactured asbestos im­
ported, chiefly from Canada. The American production is prac­
tically limited to the States of Arizona, California, Georgia, and
Vermont. Georgia has for years been one of the chief producers of
asbestos in the United States, but no medical observations are on
record as regards the possibly injurious results experienced in the
mining and manufacturing of asbestos materials in that State. The
industry itself has been described, however,- in a report on the
asbestos, talc, and soapstone deposits of Georgia in Bulletin No. 29
of the Georgia Geological Survey, 1914.
EVIDENCE OF DUST EXPOSURE.

The relation of asbestos dust to pulmonary tuberculosis is reported
upon at some length in the Annual Report of the Chief Inspector of
Factories and Workshops for England and Wales for 1910. The in­
vestigation was made by Dr. Collis, who, states, in part, that—
Following up information received from the registrar-general, it
was found that five deaths of persons suffering from phthisis had
occurred in five years among a staff of under 40 workers employed
at a factory where asbestos is woven. The process which appeared
most dangerous is the production of asbestos mattresses. These mat­
tresses, which are composed of bags of woven asbestos filled with
short asbestos fiber, are placed on a table and beaten out flat by a
man with a wooden flail, from which process much dust arises.
Women who sew the mattresses into sections with asbestos threads
worked close to the man who beat the mattresses and of necessity
inhaled the dust. The reorganization of this process with the appli­
cation of localized exhaust draft was called for, and an annual medi­
cal examination of the workers by the certifying surgeon has been
instituted in the hope of detecting and removing from exposure to
dust those showing early signs of respiratory disease. Weaving
asbestos has only become an important industry during the last 15
years. Two other large asbestos factories were visited, each of
which was found to have its own specialty in the production of which
dust prevention is required.




180

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

There is evidently an urgent need for a more qualified and exten­
sive investigation of the health aspects of asbestos manufacture;
especially so, in view of the fact, as observed in the Scientific Ameri­
can (August 1,1916), that, on account of the restrictions placed upon
shipments of asbestos from Canada, the possibilities of utilizing the
asbestos deposits of this country are increased, as well as because of
the much larger demand for asbestos products on account of the
recognized value of asbestos for protective purposes in the further­
ance of the industrial safety movement. Of value in this con­
nection is the evidence of Dr. H. M. Murray before the De­
partmental Committee on Industrial Diseases, limited, however,
to the single case of an asbestos worker, verified as regards
diagnosis by a post mortem examination. In reply to a ques­
tion by the chairman of the committee as to whether, in view of
the fact “ that there is something characteristic in the earlier stages
of dust phthisis in the predominance of shortness of breath before
physical signs become very obvious,” such a condition had been
observed in the case of the asbestos worker under treatment by Dr.
Murray, and under observation for fourteen months, the doctor said
that it had been noticed in the case in question, and that, in
other words, there was a definite relation between the course of
phthisis and the physical incapacity resulting from the inhalation
of asbestos dust. It is therefore to be anticipated that the condition
of asbestos workers will attract more qualified attention in this
country in the future than it has in the past.
MICA.

No special investigation has been made to ascertain the more or
less health-injurious effects of mica dust. According to W. Gilman
Thompson the dust is slightly irritating to the respiratory system,
like dust containing any sharp solid particles, but as a general con­
clusion he states that the dust does not appear to be particularly
injurious. Mica is extensively used in the manufacture of electrical
machinery, as well as in the glazing trade, as a substitute for glass,
and in the decorative trades, including the manufacture of wall
paper. There are two principal varieties of mica, known as musco­
vite and phlogopite, but whether there is any essential difference
between the physical and mechanical properties of the dust has not
been determined. There are mica deposits in some 20 States of the
United States, but the annual production has fluctuated considerably,
reaching the lowest point in the last decade during 1914. Whether
there are any special hazards in mica mining in consequence of the
dust has not been ascertained. The occurrence, exploitation, and use
of mica have been admirably described in a report published by the
mines branch of the Department of the Interior of Canada. The re­




OCCUPATIONS' W IT H EXPOSURE TO MINERAL DUST.

181

port, however, includes no observations on the sanitary aspects of
the various employments. It is pointed out, with special reference
to the manufacture of ground mica, that the difficulties of grinding
are. great, owing to the tough and scaly nature of the mineral, which
may be assumed to indicate that even when reduced to a fine powder
the dust is apparently not of very serious importance to the em­
ployees.
Mica dust is briefly referred to by Kober and Hanson in their
Diseases of Occupation and Vocational Hygiene, in which it is
said that mica is “ a mineral of widely varying chemical compo­
sition, but is essentially composed of silicates of aluminum and an
alkali, such as potassium, sodium, or lithium.” It is stated that the
mineral splits easily into thin, flexible, colorless, transparent plates
or scales, known as isinglass, and that in the powdered form it is em­
ployed in the manufacture of giant powder, and that it is also used
for decorative purposes, chiefly in the manufacture of wall paper,
illuminated designs, etc. The only medical conclusion arrived at by
the authors is that “ mica dust is doubtless a frequent cause of in­
flammatory conditions of the eyes and air passages.” It is therefore
suggested by inference that the dust in finely comminuted form may
also have an irritating effect upon lung tissue, and to that extent
predispose mica workers to pulmonary tuberculosis, although much
more extended observations are required before definite conclusions
can be arrived at.1
T H E S T O N E IN D U S T R Y .

The stone industry in the United States is of vast areal extent and
commercial importance. The product for 1914 was valued at nearly
$80,000,000. Stone is quarried or produced in every State and
Territory, and the number of persons employed in the stone in­
dustry exceeds 100,000. The principal varieties are granite, trap
rock, marble, limestone, and sandstone. The industry may broadly
be divided into the manufacture of crushed stone for road making
and other purposes, paving stone, building stone, and monumental
stone. The two latter are subdivided into rough and dressed prod­
ucts. Thetlabor conditions in an industry of such vast extent and
fundamental differences in the nature of the product must neces­
1
F or a valu a b le d e scrip tiv e a cco u n t o f m ica, see the N a tio n a l M useum R ep ort, 1899,
p. 283.
F o r a d iscu ssion o f m ica m in in g in the U n ited S tates w ith sp ecial referen ce to un d er­
g rou n d con d ition s, see a n a rtic le in the E n gin eerin g and M in in g J o u rn a l, M ay 8, 1909.
W ith referen ce to m in in g m eth od s in C anada, see an a rtic le in the sam e p u b lica tio n in
the issue o f A p ril 18, 1908.
See also a n exten d ed d iscu ssion b y M r. C. H a n fo rd H en d erson on “ M ica and the m ica
m in es,” in th e P o p u la r S cien ce M on th ly f o r Sept., 1892.
A c c o r d in g to a sta tem en t by the m an ag er o f the C row n M iea C o., o f C uster C ity ,
S. D ., “ M ica m in in g is con sid ered very h ea lth y, as m ost o f it is done in op en cu ts .”




182

MORTALITY FROM RESPIRATORY DISEASES IN IHJSTY TRADES.

sarily vary widely, but from a hygienic point of view the essential
difference arises out of the mechanical and chemical properties of the
dust produced in the quarrying, the dressing, and the polishing of
the different varieties, which are too numerous to permit of even a
brief technical description.
E A R L Y O B SE R V A T IO N S ON H E A L T H -IN JU R IO U S C O N D ITIO N S.

The health of stone and marble cutters has, from earliest times,
been held to be notoriously bad, and the hygienic importance of
this trade was recognized by Ramazzini, who, as far back as 1705,
discussed the subject in an entire chapter in his work on Diseases of
Tradesmen, stating that—
In hewing marble or stones out of the rock, in polishing and cut­
ting them, they oftentimes suck in, by inspiration, the sharp, rough,
and cornered small splinters or particles that fly off; so that they
are usually troubled with a cough, and some of them turn asthmatic
and consumptive. * * * Our medical histories give many in­
stances of stones found in the stomach and lungs of these workmen,
for which we can assign no other material cause^but the dusty par­
ticles taken in at the mouth and gradually gathered into a heap.
* * * Withal, all possible caution must be used to avoid the
sucking in of these minute particles at the mouth.
From the earliest to the most recent observers upon the health
conditions in this trade, the conclusions have been decidedly un­
favorable and suggestive of circumstances more or less possible of
material improvement. Oliver, in his Diseases of Occupation,
remarks, with special reference to stonemasons:
The occupation of the stonemason and of the quarryman has for
long been regarded as one in which a higher death rate from lung
disease occurs than in most occupations. The disease, which usually
assumes a chronic character, is slow in its development and progress.
As it is attended by the ordinary physical signs and symptoms ob­
served in other forms of pneumoconiosis, the malady calls for no
special description other than this, that in contradistinction to miners’
phthisis, which occurs in men who work underground, stonemasons’
phthisis is met with in men who are working in the open air, a
circumstance which becomes a strong argument in favor of the dust
origin of pneumoconiosis as against the bacillary. After a time the
lung disease becomes tuberculous, hence the extraordinary fact of
the death rate from pulmonary tuberculosis among stonemasons and
marble cutters, who are following an outdoor occupation, being six
times that of bankers and brokers, who are leading an indoor life.
This want of harmony between occupation and mortality from pul­
monary phthisis is observed in other outdoor occupations than stonecutting. It would appear, therefore, as if the predisposing causes of
lung disease are often of greater importance than the exciting—in
other words, that the soil is of as much, if not of greater, influence
than the seed. The irritation of the lung caused by dust would seem
in some instances, especially in the early stages of the disease, to




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

183

create a favorable soil for the implantation of the tubercle bacillus,
while in the slowly developed forms of pneumoconiosis the hard and
unyielding fibrous tissue does not offer the same attractions to the
microorganism, and as a consequence it is in those parts of the lung
where the structure is least fibrous that the tubercle bacilli exert their
greatest power for harm.1
E X P E R I E N C E OF T H E O P E R A T IV E M A SO N S’ SO C IE T Y OF LONDON.

The remarks of Oliver are fully sustained by the available statis­
tical evidence. The secretary of the Operative Masons’ Society of
London, in his testimony before the committee on industrial diseases,
produced the mortality record for Newcastle for the period of 1871 to
1896, including an account of 160 deaths of stonemasons, and of this
number 71, or 44.4 per cent, had died from phthisis, at an average
age of only 42.23 years. It was admitted, however, that conditions
had improved, and more recent data resulted in a more favorable
showing. Out of 253 deaths of stonemasons reported in 1905 by the
same society, 79, or 31.2 per cent, were deaths from pulmonary tuber­
culosis. The same witness stated that the average age at death of
those dying from phthisis during 1905 was 44 years, against 51 years
for deaths from all causes.2
D E S C R I P T IV E ACCOUNT OF O CC U PA TIO N A L CO N D ITIO N S.

Conditions are probably somewhat different in this country, due to
the more general use of pneumatic tools, which generate considerable
quantities of fine dust, the complete prevention of which is always
difficult and often impossible. The degree of disease liability
varies materially according to the specific occupation, and the risk
is less in the case of paving-stone cutters and slate splitters than in
the case of monument or custom work, which requires close atten­
tion in matters of minute detail and which is more often carried
on indoors. Surfacing and carving and cutting with pneumatic
tools are the most dangerous employments, the risk being less in
polishing, grinding, sawing, and lathe work, most of which is car­
ried on by the wet process. Large quantities of dust are stirred up,
however, in the brushing off and cleaning up of the accumulated
dust, and in the moving of materials, dropping of slabs, etc. There
is, therefore, more or less dust exposure in all branches of the stone
industry, but the results of exposure vary according to the kind of
material, which includes a large variety of stones, chiefly, however,
granite, marble, limestone, sandstone, bluestone, and slate.
The stonecutters’ trade is one which requires both skill and arduous
physical labor. The men as a rule work in the open air, and in very
1 D iseases o f O ccu p a tion , L on d on , 1908, p. 305.
2 M inu tes o f E vid en ce, D ep a rtm en ta l C om m ittee on C om p en sa tion fo r In d u stria l D is­
eases, p. 322.




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MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

warm or wet weather under shelter; but all are liable to inhale the
dust and small particles from the material upon which they operate.
This on some kinds of stone is much more deleterious to health than
on others, the stone containing the largest proportion of flints being
much more injurious than that which has most lime in it. The re­
turns show that the present age of stonecutters is three years less
than that of carpenters or masons, while the average number of years
at work exceeds that of either by nearly one year. But this is ac­
counted for by reason of the difference in the ages at which they began
to work, which for 63.9 per cent of stonecutters was under 15 years of
age, while in the other two trades mentioned it was 13.8 per cent and
4 per cent, respectively. The explanation is that in England, Ireland,
and Scotland, as well as in other European countries, seven years are
the rule for apprenticeship of stonecutters, and a large proportion are
taken when 12 years old, and quite a number under this age. Eightythree and one-half per cent of the total number were foreign born
and but 16.5 per cent American born; and of the latter but ninetenths of 1 per cent began to work under 15 years of age; while 15.4
per cent of carpenters and 25.6 per cent of masons began to work at
their respective trades after the age of 20 years and upward, none
of the stonecutters had reached this age. This fully accounts for the
differences above noted.1
In his discussion of the hygiene of this occupation Lloyd2 makes
the following observations:
Stonecutters and quarrymen suffer in various degrees from the in­
halation of dust. The extent of the evil in their cases depends upon,
first, the character of the dust, and, second, the circumstances amid
which the work is pursued. The quality of the stone has much to do
with the extent of pulmonary disease among stonecutters. Some
stone is much more dusty than others. A sedimentary stone, for
instance, that was formed originally simply by the deposit of earthy
and siliceous particles under water is much more liable to give off a
large quantity of dust than is a stone that was fused in early geologi­
cal ages—the igneous stones, for instance, like granite. Although
the particles from these latter stones are exceedingly hard,#
yet there
is not much true dust, only the particles actually displaced by the
contact with the tool being thrown off. These probably do not
carry far in the air, and are mostly too large to gain access to the
alveoli as dust. This was the explanation given by Hamilton, of
Aberdeen (quoted by Arlidge), for the fact that the masons and
polishers at the Aberdeen quarries do not suffer much, if any, with
industrial phthisis.
R E S U L T S OF O F F IC IA L IN V E S T IG A T IO N I N M A SSA C H U SE T T S.

A brief abstract from a special report of the Massachusetts State
Board of Health on dangerous occupations,3 as suggestive evidence
1 F ou rteen th A n n u a l R e p o rt o f the B u rea u o f S ta tistics o f L a b o r a n d In d u strie s ,o f
N ew J ersey, 1891, pp. 176, 177.
2 “ T h e d iseases o f o cc u p a tio n s ,” b y J am es H en d rie L lo y d , M . D ., p u b lish ed in T w e n ­
tie th C en tu ry P r a c t ic e o f M od ern M ed ica l Science, N ew Y ork , 1895, V o l. I l l , p. 420.
3 C om m on w ea lth o f M a ssa ch u setts, S enate D ocu m en t N o. 250 , B o sto n , M a rch , 1907,
pp. 78, 79.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

185

particularly applicable to American conditions at the present time,
is included here:
It is preeminently a dusty trade, and the workmen are therefore
exposed to the danger of inhaling nonabsorbable and irritating par­
ticles of mineral matter. Accidents to the eyes from flying chips are
also very common, but they are generally less serious than those due
to fragments of steel from the tools employed. Of the various kinds
of stone dust, granite is regarded as more injurious than marble, and
soapstone the least of all; but different granites vary in this particu­
lar, some yielding a much finer dust than others, on account of dif­
ferences in texture. The greatest amount of dust comes from the sur­
facing machines, which are operated with compressed air. The tool
is either a large hammer or an instrument which presents four
smaller separate faces. Sometimes a bushing hammer, made of thin,
chisel-like blades bolted together, is used; this creates the finest dust
of all. The men who operate the surfacing tools rarely wear masks,
but many chew tobacco and spit, in the belief that the practice serves
to protect them from the effects of the dust to which they are ex­
posed. Some protect themselves from flying chips by means of
wire screens placed about the hammer; some wear wire masks and
some wear glasses. By a union regulation^ surfacing is done in the
open sheds in the yard. While the operation of smoothing can not
be done by the wet process, on account of clogging of the tools with
the pasty material which would thereby be produced, polishing is
conducted with the application of water, which prevents the evolu­
tion of dust. The sawing of granite and marble into slabs is con­
ducted ordinarily by the wet process, and is therefore unattended
by dust; but soapstone sawing and cutting for joints is frequently
done dry, and with the evolution of much fine dust Turning in
lathes is conducted in the wet way, and is dustless.
Of 343 deaths which occurred in the city of Quincy among stone­
cutters during a period of about 16 years, no fewer than 142
(41.4 per cent) were due to pulmonary tuberculosis, 41 (12 per cent)
to other diseases of the lungs, 44 (12.8 per cent) to diseases of the
heart, 24 (7 per cent) to violence, and 92 (26.8 per cent) to all other
causes. Excluding accidents, the percentage due to tuberculosis was
44.5. These statistics show even more strikingly than those quoted
in a report submitted two years ago the dangerous character of this
occupation. Therein it appears that, of a total of 30,000 deaths among
stonecutters, tuberculosis was the cause in 28.57 per cent. It must be
said, however, that the average age at death of the victims of the
disease in this industry, so far at least as the Quincy records show,
is somewhat high (47.8 years), but it is to be borne in mind that the
calling is one which is not open to the naturally weak, and that many
of those who become incapacitated through infection drift into other
lines of industry in which physical strength is not so essential, and
hence at death are not returned as belonging to this class.
U R G E N C Y OF S P E C IA L S C IE N T I F IC IN Q U I R I E S .

No very satisfactory data for this country are available to deter­
mine with accuracy the probable degree of difference in the healthinjurious conditions resulting from the cutting or 'manipulation




186

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES

otherwise of the different kinds of stone, such as granite, sandstone,
limestone, bluestone, slate, etc., except marble cutting, to be sep­
arately considered as a well-defined branch of the trade. The term
‘’ stonecutters ” is, therefore, practically inclusive of workers in all
branches of the industry and in all the different employments neces­
sary in connection therewith. An observer of conditions in the
sandstone industry states that “ stonecutters who work on sandstone
seldom live to be 50 years of age, and nearly all of them die of lung
disease, due to the inhalation of mineral dust” ; but how far this
is sustained by actual experience in the regions where sandstone is
quarried and cijt can not be stated at present. A physician of long
residence in the Bedford, Ind., limestone field, states that he has not
observed very serious consequences to result from employment in
that branch of the stone industry, but all such observations are sub­
ject to serious error in the absence of trustworthy statistical data for
a period of years.
D I F F E R E N T I A L E F F E C T S OF D U ST E X P O S U R E .

These differences of qualified opinion regarding the relation of
stone dust to health arise obviously out of the wide variations in the
physical, mechanical, and chemical properties of the different kinds of
stone subjected to modern processes of quarrying, dressing, etc., par­
ticularly in consequence of the extensive use of modern pneumatic
tools used for stonecutting purposes. Among all branches of the
dusty trades and occupations the stone industry is of the first order
of scientific importance. Aside from the industry itself, as regards
the production of stone for commercial purposes, practically the
entire mining industry is in a measure a branch of the stone in­
dustry, in that all the metals and nonmetallic minerals obtained by
mining methods are obtained by processes of extraction from rock
material more or less identical with the substances which enter into
the stones quarried and cut for commercial purposes. The most
thorough and strictly scientific study of dust phthisis with special
reference to the stone industries has been made by Dr. Edgar L. Collis,
His Majesty’s medical inspector of factories, presented in the Milroy
Lectures of 1915. The differential effects of dust containing a large
proportion of free silica (quartz) and dust relatively free therefrom
are emphasized in the most concise and conclusive manner.
LU N G D I S E A S E S OF F L I N T K N A P P E R S A N D B U H R S T O N E D R E S S E R S .

The correlation of these conditions to the relative frequency of
true phthisis or of lung fibrosis, with a subsequent tuberculous in­
fection, is made clear on the basis of indisputable clinical evidence
amplified by numerous Roentgen ray examinations. Stone dust con­
taining but a relatively small proportion of free silica, such as lime-




OCCUPATION'S W IT H EXPOSURE TO MINERAL DUST.

187

stone, is considered comparatively harmless, while the extreme seri­
ousness of stone dust consisting chiefly of free silica (quartz) is illus­
trated by numerous concrete cases, of which the so-called flint knappers and French buhrstone dressers are the most striking and
lamentable examples. Dr. Collis defines the term “ pneumoconiosis ”
as one which should be restricted to “ disturbances in health follow­
ing upon changes induced in the lungs by inhalation of nonviable
particles.” And he remarks that “ just as all germs are not patho­
genic, so all kinds of nonviable particles do not give rise to pneumo­
coniosis.” This extremely important conclusion in its particular
application to the stone industry requires constant application to the
more specialized consideration of its injurious results in employment
in the different branches of the industry. Referring to the flint
knappers of Brandon as the lineal occupational representatives of
the oldest of all industries, that of the making of prehistoric stone
tools and weapons, he states that they “ suffer a terrible mortality
from phthisis induced by flint dust generated in their work,” and he
recalls the results of earlier observations as regards the lamentable
consequences produced among the population of Meusnes, France,
by the introduction of the gun-flint industry, which, according to
Chateauneuf, “ slays those who follow it ; it kills them before their
time; for them there is no old age.” He illustrates these observa­
tions by a most interesting analysis of the mortality from phthisis
among flint knappers in the Brandon district, shown in Table 72.
T able 7 2 .— M O R T A L IT Y F R O M

P H T H IS IS O F F L IN T K N A P P E R S C O M P A R E D W IT H
T H A T OF C E R T A IN O T H E R CLASSES.
Cause of death, stated as percent­
ages from—

Class.
All
causes.

Flint knappers1...............................................
W ives (2) and widows (11) of flint knap­
pers.
Brandon rural d istrict3 ...............................
All males (England and Wales, 1900-1902)*

Total
Respira­
num­
tory dis­
ber of
A ll
Phthi­
eases
other deaths.
sis.
other
causes.
than
phthisis.

Calcula­
ted death
rate from
Aver­
phthisis
age
per
age at
annum
death.
among
1,000
living.

100.0
100.0

77.8

7.4
15.4

14.8
84.6

27
13

46
78

100.0
100.0

6.5
11.2

11.7
17.6

81.8
63
71.2 509,567

(4)

41.0
.8
1.6

i Average number em ployed for 25 years estimated at 16.5.
^ Population about 5,150. The figures for this class, supplied b y Dr. A. Harris, M. O. H ., Thetford,
Norfolk, are for all ages, 1901-1910.
3 The figures for this class, calculated from the Supplement to the Sixty-fifth Annual Report of the
Registrar-General, are for all males aged 15 years and upward, 1900-1902.
* Median age at death between 56 and 57.

M I X E D M I N E R A L A N D M E T A L L IC D U ST E X P O S U R E .

Next to the inhalation of steel dust the continuous and considerable
inhalation of flint dust is one of the most serious industrial condi­
tions predisposing .to pulmonary tuberculosis. In the pottery in-




188

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

clustry (see pages 247 to 271), the employees who handle or employ
flint dust in connection with production processes are known to be
subject to an exceptionally high mortality from pulmonary tuber­
culosis ; so much so that flint workers generally are considered uiiinsurable by all American life insurance companies.
SE C O N D A R Y IM P O R T A N C E OP B A C IL L A R Y IN F E C T IO N .

The effects of stone dust in the mining industry are briefly set
forth in the conclusions of the departmental committee appointed in
1902 to reinvestigate the causes of the persistently high phthisis mor­
tality among Cornish tin miners, which, excluding all other contrib­
utory circumstances, except dust inhalation, decided that—
So far as the Cornish miners are concerned it seems evident enough
that stone dust which they inhale produces permanent injury of the
lungs—gradually in the case of ordinary miners and rapidly in the
case of machine-drill men—and that this injury, while it is appar­
ently capable of gradually producing by itself great impairment of
the respiratory functions, and indirectly of the general health, also
predisposes enormously to tuberculosis of the lungs, so that a large
proportion of miners die from tubercular phthisis. That the primary
injury to the lungs is due solely to inhalation of stone dust would
seem to be practically certain.
In other words, the more generally recognized menace of baeillary
infection in tuberculosis was considered of secondary importance as
a causative factor in the production of so-called miners’ phthisis,
more directly and specifically attributable to the continuous and con­
siderable inhalation of silica dust. A descriptive account of the
different varieties of dust, based on the microscopical examination of
their physical and mechanical properties, is, therefore, a prerequisite
for a thorough understanding of the pathological consequences of
dust inhalation in the different branches of the stone industry. It is
pointed out by Collis that all classifications in general use are inad­
equate to the purpose and that in the main it seems best to ascertain,
first, the relation of each of the main respiratory diseases to dusts,
and then from that standpoint to examine the properties of the dusts
which are associated with an undue prevalence of each of these dis­
eases. This, of course, implies a much broader plan and scope than
the present investigation, which for practical purposes is limited
chiefly to pulmonary tuberculosis. The chemical properties of dusts
are occasionally of major importance on account of the solubility of
certain kinds of dust, best illustrated in the case of the cement indus­
try. As observed by Collis—
Only particles which are insoluble in the fluids of the body when
carried into the air passages remain as foreign bodies either to




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

189

stimulate the ciliated epithelium to overaction for their expulsion,
or, if they gain access to the lymph channels, to give rise to a pro­
liferation of the connective tissue; thus dusts of ivory, horn, bone,
and other animal structures, and of calcium sulphate (plaster of
Paris and alabaster), of limestone, and of oxide of iron are not
associated with pneumoconiosis in the way that dusts of vegetable
husks, emery, glass, sandstone, and flint are.
He adds to this extremely important practical conclusion the ob­
servation that, “ generally #speaking, dusts are more injurious as
their chemical composition differs from that of the human body, or
from the elements of which the body is normally composed.”
M O R B ID IT Y A N D M O R T A L IT Y OF T H E ST O N E W O R K E R S OF D E R B Y S H I R E .

The most useful application of the theory and conclusions of Dr.
Collis is to be found in the extended study which has been made of
the different branches of the stone industry of Derbyshire by Dr.
Sidney Barwise, in a report to the county council of Derbyshire,
on the basis of a careful study of the relation of phthisis incidence
to the surface geological formation. Dr. Barwise ascertained that
there was an excessive frequency of pulmonary tuberculosis on areas
showing millstone grit, and a preliminary investigation indicated that
“ the key to the higher phthisis mortality in the gritstone area was to
be found in the occupations of the males.” A subsequent analysis of
the mortality record for a period of 10 years proved conclusively
that the gritstone quarries experienced an exceptional mortality from
phthisis. It was found that of the deaths of quarrymen 29 per cent
was from phthisis, while only 4.6 per cent of the deaths of agricul­
turists was attributed to this cause. On the basis of the calculated
death rate, without reference, however, to the age distribution of
the employees, it was shown that the death rate from phthisis among
the agricultural group of-the county was 0.72 per 1,000, while among
the quarrymen and masons (stonecutters, dressers, etc.) it was 5,
or seven times as great. Subjecting the data to a thoroughly spe­
cialized and qualified analysis, it was then ascertained that “ among
the limestone workers there was not an excessive mortality from
phthisis, so that the mortality of gritstone workers separately con­
sidered was even higher than indicated by the combined mortality
rate for all quarrymen and stone workers in the section under con­
sideration. The results of this exceptionally valuable, and, broadly
speaking, scientific investigation, are set forth in Table 73, derived
from the 4 Report on the Prevalence of Phthisis among Quarry
6
Workers and Miners,” made by Dr. Sidney Barwise to the Derby­
shire county council, February 6, 1913.




190

MORTALITY FROM

r e s p ir a t o r y d is e a s e s i n

dusty

trades.

T a b le 7 3 .—D E A T H S F R O M P H T H ISIS OF M ALES O V E R 15, A N D N U M B E R OF M ALES O V E R

10 E N G A G E D IN C E R T A IN OCCUPATION S, W IT H D E A T H R A T E S F R O M PH TH ISIS P E R
1,000 M ALES O V E R 10 E N G A G E D IN SUCH OCCUPATION S, 1901 TO 1910.
Stone-workers’ group.
District.

Matlock registration subdistrict (chiefly gritstone):
The two Mattocks and the tw o Darleys....................
Certain rural parishes...................................................

Phthi­
W ork­
sis
ers.
deaths.

Rate
per
1,000.

Agriculture.
Phthi­
W ork­
sis
ers.
deaths.

Rate
per
1,000.

426
233

31
15

7.3
6.4

473
245

2
3

0.4
1.2

Total, Matlock registration subdistrict..................
Bakewell registration subdistrict (gritstone and lime­
stone):
Bakewell, Baslow, and certain rural parishes in
Bakewell registration subdistrict...........................
Tideswell registration subdistrict (chiefly limestone):
Certain rural parishes in Tideswell registration
sub district...................................................................

659

46

7.0

718

5

.7

530

20

3.8

1,079

10

.9

339

10

2.9

579

2

.34

Total, Bakewell registration district...................

1,528

76

5.0

2,376

17

.72

C O M P A R A T IV E P H T H I S I S D E A T H R A T E S A CCO RD IN G TO D U ST E X P O S U R E ,

According to this table the gritstone workers, who predominate
in the Matlock subdistrict, show a phthisis rate of 7 per 1,000, or
ten times greater than the agricultural group, whereas in the Bakewell subdistrict, where both limestone and gritstone deposits are
y
worked, the rate is only 3.8, and in the Tideswell subdistrict, in
which the proportion of gritstone workers is still less, the rate is
only 2.9. Subjecting the returns for the Matlock and the Tideswell
subdistricts to further analysis, it is shown that the phthisis mortal­
ity during the period 1901-1910, limited strictly to the workers them­
selves, is 13.7 per 1,000 for gritstone workers (chiefly exposed to
insoluble pure silica dust) ; whereas in the case of limestone work­
ers, chiefly exposed to a dust more or less soluble, the rate is only
1.2. In other words, the phthisis mortality of gritstone workers is
more than ten times the corresponding mortality of limestone work­
ers. It should be said in this connection that the number of men ex­
posed to risk was 124 in the case of gritstone workers, with 17 deaths
from phthisis, and 170 in the case of limestone workers, with 2
deaths from phthisis during the 10-year period. The results of the
investigation are summarized in a convenient form in Table 74.
T able 7 4 .—C O M P A R A T IV E P H T H ISIS D E A T H R A T E IN D E R B Y S H IR E C O U N TY, E N G ­
L A N D , 1901 TO 1910.
Persons.
Gritstone workers ________ . . . ................... ........................................................... ..
The two Matlocks and the two Darleys, stoneworkers (some in limestone)...........
Bakewell registration district, gritstone and limestone works...................................
Persons employed in and about limestone quarries and w orks_______ __________
Limestone w ork ers..............................................................- ...........................—.............
Persons employed in and about coal m ines...................................................................
Persons em ployed in agriculture.....................................................................................
Standard phthisis death rate............................................................................................




124
426
1,528
1,282
262
1,757
3,615
15,152

Rate ner
1,090.
13.7
7.0
5.0
1. 71
1.52
.68
.66
.77

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST,

191

In addition it was found that among those employed in gritstone
working, the proportionate mortality from phthisis was 45 per cent,
and among quarrymen and miners in the same district and working
on the same material 36.6 per cent, in contrast to a proportionate
mortality of 12.3 per cent for men employed as quarrymen and
miners in the limestone area, and 7.4 per cent among the men em­
ployed in coal mining. The highest proportionate mortality among
agricultural workers in the same district in which the proportionate
mortality of gritstone workers was 45 per cent was only 7.9 per cent.
The extremely injurious nature of gritstone dust, which is largely
pure silica in a crystalline form, with special reference to pulmonary
tuberculosis, is, therefore, conclusively established by these investi­
gations.
A M E R IC A N M O R T A L IT Y S T A T IS T IC S .

The Vermont State board of health has reported the mortality by
occupations during the six years ending with 1905, and during that
time there were 204 deaths from all causes among the granite and
other stone workers in that State. Of these deaths, 80, or 39.2 per
cent, were from pulmonary tuberculosis, and 27, or 13.2 per cent, from
other respiratory diseases. Of the deaths from all causes among
stone. workers in Vermont, 52.4 per cent were attributed either to
pulmonary tuberculosis or to other respiratory diseases.
The census mortality statistics for 1900 combine marble and stone
cutters into one group, including 26,141 males aged 15 years and
over in the registration States. Of the number stated, 659, or 2.5
per cent, had attained to 65 years of age or over, which compares with
3.9 per cent for men in mechanical and manufacturing industries gen­
erally. In the mortality from all causes the death rate is compara­
tively low at ages under 25, but high at ages 25 and over, as shown
in detail in Table 75. The census mortality statistics, however, are
subject to the criticism that in all probability the facts are under­
stated on account of defective enumeration.
7 5 .—M O R T A L IT Y FR OM A L L CAUSES AM ONG M A R B L E A N D STON E C U T T E R S,
C O M PA R E D W IT H T H A T OF T H E M A N U FA C TU R IN G A N D M ECH AN ICAL CLASS A N D
TH E M E R C A N TILE A N D T R A D IN G CLASS, IN T H E R E G IS T R A T IO N ST A T E S , 1900, B Y
A G E GROU PS.

T a b le

FSource: Report of the Bureau of the Census on Vital Statistics, 1900.]
Death rate per 1,000 among—
Age at death.

15 to 24 years..............................................................
25 to 44 years.....................................................................
45 to 64 years............................................................
65 years and over...................................




Marble
and stone
cutters.
3.35
9.32
24. 72
122.91

The manu­ The mer­
facturing cantile and
and
trading
mechanical
class.
class.
4.43
8.35
20.16
105.43

2. 60
6.72
19.91
93.79

192

MORTALITY PROM RESPIRATORY DISEASES IN DUSTY TRADES.

A further difficulty in connection with the vital statistics of stone
and marble cutters results from the fact that men in this trade are
a very mobile element, frequently moving from one place to another
in response to better trade conditions, higher wages, etc., in other
fields. The most suggestive result of the census mortality investiga­
tion is the extraordinarily high death rate from pulmonary tubercu­
losis, which is returned at 5.41 per 1,000, compared with 2.62 for the
mechanical and manufacturing class, and 1.66 for the mercantile and
trading class.
E N G L IS H O C C U P A T IO N A L M O R T A L IT Y IN V E S T IG A T IO N S .

For unknown reasons the Report of the Registrar-General for
England and Wales does not specifically consider stonecutters, but
combines them with quarrymen in stone and slate, which, of
course, precludes the utility of the resulting averages in an effort to
determine the relative degree of pulmonary tuberculosis frequency
in a well-defined specific occupation such as the stonecutters’ trade*
Even when considered as a group, however, quarrymen and stone­
cutters combined, according to English statistics, show an excessive
mortality from pulmonary tuberculosis and other respiratory dis­
eases, but it is a matter of regret that the data should not be sepa­
rately available for men employed in the more important branches of
the stone industry.
The health and mortality of men employed in granite, marble,
and stone quarrying, including stonecutters and polishers, has been
reported upon at length by Arlidge, who observes, in part, that—
All employed on these mineral substances suffer in various de­
grees with respiratory disorders, and, on the whole, more so than
coal miners. The quality of the stone, in regard to its petrological
characters, determines its severity of action; but observations have
hitherto not been sufficiently numerous to establish the fixed relations
between the character of the stone and the mischief caused by its dust.
Speaking generally, sedimentary rocks composed of siliceous and
readily detached particles do more harm on inhalation than primary
rocks in which a fusion of their constituents has taken place. Other
modifying characters are exhibited in the chemical composition and
in the miscibility of the mineral dust with fluid.
M O R T A L IT Y OF T H E G R A N IT E C U T T E R S OF A B E R D E E N .

With special reference to granite cutting in the district of Aber­
deen, Scotland, it is stated that men employed in the cutting, dress­
ing, and polishing of granite are seldom victims of pulmonary lesions
attributable to their occupation. Arlidge considers this a surpris­
ing fact, possibly explained by the density of granite and its lithological elements. He quotes Prof. Hamilton, of Aberdeen University,
to the effect that the explanation may be found in the igneous char­
acter of the rock, which opposes itself to the throwing off of dust,




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

193

because its particles, unlike those of stratifiefi rocks, do not exist in
granite ready formed, but must be made by the chisel of the work­
man. Prof. Hamilton concludes that—
The dust in granite working would in all likelihood be coarser
than in chiseling stratified rock, and would be caught in the superior
respiratory passages without gaining entrance to the air vesicles
where alone it seems to make its way into the pulmonary lymphatics.
Whether this explanation is accepted or not, it is a fact of con­
siderable importance that the men employed in the granite-cutting
industries suffer considerably from chronic bronchitis, but the severe
lesions indicative of fibrosis and industrial phthisis are practically
unknown among them.
According to the report of the chief inspector of factories for 1880
(p. 8 1 ) It seems that a like immunity is enjoyed by the laborers in the Purbeck and Portland quarries. Here the material is a limestone of
close, compact grain, and not a mass of imperfectly coherent par­
ticles of sand; in short, a marble—a substance recognized by those
who work it as but slightly detrimental to the respiratory organs.
In marked contrast, Arlidge directs attention to the extremely high
fatality rate among men employed in the Edinburgh stone quarries,
but no conclusive statistical information has been made public con­
cerning this. According to Dr. R. W. Philip, of Edinburgh, in a
statement to Dr. Arlidge, “ A large number of cases of stonemasons
suffering from phthisis seek relief at the local dispensary, and the
average age at Which they come under observation is only about 35
years. As a rule, the cases run a very chronic course, passing from
recurrent to persistent attacks of bronchitis.” Reference is made to
a much earlier observation by Prof. Alison in 1824, according to
which there was reason to believe “ that there was hardly an instance
of a mason regularly employed in hewing stones in Edinburgh being
free from phthisical symptoms to the age of 50.”
C O M P A R A T IV E O CC U PA TIO N A L M O R T A L IT Y OF T H E ST O N E W O R K E R S OF
ABERD EEN .

It is self-evident that these conflicting conclusions are more or less
attributable to important variations in the nature of the stone quar­
ried as well as to differences in the method of work. Modern pneu­
matic processes, for illustration, have practically revolutionized the
stone-cutting industry, and the dust menace has been very materially
increased in consequence. The mortality of stone workers in the
Aberdeen district has been reported upon with admirable thorough­
ness by Dr. Matthew Hay in an appendix to his annual report as
medical officer of health for the year 1909. He points out that—106811°— 18— Bull. 231-------13




194

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

A workman who has contracted phthisis in one occupation may
change his occupation some months or years before' death, and his
relatives on registering his death may or may not give his original
occupation as his ordinary occupation. Much depends upon the
length and nature of the last occupation, whether it is presumed to
be inferior or not, and on the person to whom it may fall to supply
the information required by the registrar. Even the registrars them­
selves act differently in such cases of changed occupation.
Other difficulties are the probable incompleteness of returns re­
garding the number of persons employed, which by inference sug­
gests the possibly greater .practical utility and scientific conclusive­
ness of proportionate mortality data. Hay points out that—
Considerable interest attaches in Aberdeen to the incidence of
phthisis among stonecutters and masons, owing to their considerable
number and to the danger to which they are exposed from the inhala­
tion of granite dust. All masons are not, however, so exposed, as a
proportion of them, varying with the character of the building, are
employed solely in building, and are known within the trade as
“ wallers,” while the remainder are engaged in hewing and dressing
stones. Wallers are not so distinguished in the death registers. Nor
is any distinction made in the registers between masons, whether
hewers or wallers, employed in connection with buildings and stone­
cutters employed in the numerous monumental yards. As a rule, a
hewer working in the latter is known as a stonecutter, but he is not
infrequently designated as a mason.
The results of the investigation are summarized in Table 76.
T a b le 7 6 .— A VE R AG E

A N N U A L D E A T H R A T E OF PE RSO N S 21 Y E A R S OF A G E A N D
O V E R (E X C L U D IN G E M P L O Y E R S ) IN A B E R D E E N , 1900 TO 1909, B Y OCCUPATIONS.

Occupation.

Esti­
Annual number of
mated
average
annual
Lung diseases.
num­
ber of
persons Phthi­
E x­
In­
over 21
clud­
sis.
clud­
years
ing
ing
of age
phthi­ phthi­
em­
sis.
sis.
ployed.

deaths per

Circu­
latory
and
nerv­
ous
dis­
eases.

1,000 persons due t o Tuberculosis.

Other
dis­
eases.

All
causes.

Wives
and
wid­
ows.

Un­
mar­
ried
chil­
dren.

MALES.

Stonecutters and masons .. ,t.
Stone polishers........................
Joiners, e t c ...............................
Painters....................................
Tailors.......................................
Bakers.......................................
Engineers, e tc ..........................
Printers, etc.............................
Comb makers..........................
Carters......................................
Laborers...................................

1,750
420
1,420
420
620
360
2,600
380
345
1,450
3,600

5.7
2.5

1.8
2 .1

3.2
1.4

1.8

4.5
4.3

1.1

2.5
4.8
3.4
4.0
5.6
4.4
2.3

8.2

4.3
3.1
5.6
1.5

4.2
7.9
5.3

4.6
4.8
7.0
9.3
9.0
6.4
5.2
4.5
7.2
3.0
8.3
3.9

3.4
5.4

6.8

2.7

3.3

9.4

1.1

7.3
5.2

6 .1
8.8
5.8
4.1
5.6

8.6

5.4
5.2

18.1
17.3

5.2
8.5
8.3
4.8
3.7
6.7
5.0
9.8
5.4

20.7
26.5

8.6

20.8

20.6

14.1
13.7
22.5

12 .2

1,220

2.3
3.8

1,750
3,500

2 .1

1.9

1.5
3.3

1.9

3.3

5.2

5.6

8.0

18.8

1.7

2.7

4.4

5.1

8.3

17.8

26.0
14.6

FEMALES.

Dressmakers and m illiners...
D omest ic ser vants..................
A ll males 21 years and ,
o v e r ............................
A ll females 21 years
and over .
...




8.8

2 1 .1

1.8
1.6
1.8
1.7
1.6
1.9
1.6
1.1
2.0
1.8
2 .1
1.1

4.7
5.5
3.7
4. 5
2.7
4.4
3.9

1.6

3.2
4.7
4.4
.7

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

195

This table is of additional interest in that it includes a number of
other important occupations with more or less exposure to industrial
dust. The table shows that stonecutters and masons rank above all
other employments considered, with a death rate of 5.7 per 1,000
from phthisis, which is three times as high as the average of 1.9 for
males above 21 years of age. Making allowance for persons not
directly employed in the cutting and hewing of granite, it is quite
probable that the true phthisis death rate of this class is 6.2 per
1,000. Next to stone workers, according to the table, come printers
and lithographers, with a phthisis mortality of 4.5 per 1,000, which
is slightly less than two and one-half times the average. In further
explanation of the table it ‘is said that—
As a rule, occupations with a high mortality from phthisis have
also an increased mortality from other lung diseases. This is not
the case with stonecutters and masons in Aberdeen, or with printers
and lithographers, or with clerks. In all three occupations, the
mortality from other lung diseases is under the average. Tailors
and comb makers, however, follow the usual rule, having a somewhat
high mortality from other lung diseases. The result is that, if the
rates for phthisis and other lung diseases are combined, tailors and
comb makers, with 8.8 and 8.6 per 1,000, respectively, take precedence
of stonecutters and printers, with 8.2 and 5.6, respectively. For
clerks it is 5.3. Indeed, the total death rate from lung diseases (in­
cluding phthisis) among clerks and printers is only very slightly
beyond the average (5.2) for all male persons above 21 years of age.
Soma of these differences in the incidence of phthisis and of other
lung diseases are probably in some measure more apparent than real,
being dependent upon the fact that the death rate from phthisis de­
creases after the age of 55 to 60, while the death rate from other lung
diseases rapidly increases with advancing age. Occupations with
a large proportion of old men have accordingly a lower death rate
from phthisis and a higher death rate from other lung diseases than
occupations with a smaller proportion of old men.
Attention is directed to the exceptionally large number of deaths
from phthisis among stonecutters after the age of 55, which is a
relatively rare occurrence in other occupations. The rather involved
terminology of English occupational terms precludes an accurate
comparison with corresponding statistics for this country. Two
occupations which show high death rates from phthisis in the Aber­
deen experience, namely, stonecutting and comb making, are both
referred to as dusty occupations, and there are grounds for believing,
not only from available statistics but from results of similar investi­
gations elsewhere, that the dust was the slow but ultimate cause of
death in many cases.
PHTHISIS, AND PNEUMATIC TOOLS.
The subject of stonecutters’ mortality in relation to the use of
pneumatic tools is considered briefly by Hay, who points out that—




196

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

In regard to the mortality from phthisis among stonecutters and
masons, the question has been raised as to whether the introduction
of pneumatically driven tools, which produce more fine dust than
the old hand chisels, has increased the amount of phthisis and lung
disease. I am informed that previous to 1900 very few pneumatic
tools were in use in Aberdeen. Between 1900 and 1905, and espe­
cially after 1902, their use rapidly extended, so that by 1905 they had
come into full use in practically all stonecutting yards.
The following table gives the number of deaths among stonecutters
and masons combined for each of the 15 years ending with 1909.
The first five years, 1895-1899, represent a period in which pneumatic
tools were coming into use; and the third five years, 1905-1909, a
period in which the tools were in full use. Only deaths at ages of
21 years and upward are included.
T a b le

7 7 .—N U M B E R

OF D E A T H S FR O M P H TH ISIS A N D FR O M O T H E R L U N G D ISEA SES
AMONG STO N E C U TTE R S A N D MASONS OF A B E R D E E N , 1895 TO 1909.
Cause of death.

Cause of death.

Year and period.

Year and period.
Phthisis.

Other lung
diseases.
Second period—concluded
1904.......... ....................

9

8

5
9

T otal..................

50

31

Third period:
1905
1906...............................
1907
1908...............................
6 1909...............................

11
10
g
11
8

3
3

T otal..................

49

12

7
13

8

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

47

28

Second period:
1900................................
1901
1902................................
1903................................

6
12

10

5
13

12

Other lung
diseases.

5

First period:
1895................................
1896
1897...............................
1898
1899................................

9

Phthisis.

1

10

5

2

2
1

3

The numbers for 1900-1904 are slightly above those for 1895-1899
in respect both of phthisis and of other lung diseases. The total
number for 1905-1909 is, however, considerably down; but the fall is
practically confined to deaths from lung diseases other than phthisis.
The first two periods are fairly comparable, except that allowance
should be made for an increase of, perhaps, 10 per cent in the number
of persons employed as between the first and second periods, and
for the fact that during the two periods the mortality from phthisis
in the community as a whole was falling. As probably the effect of
the latter influence did rather more than equalize the effect of the
former, a comparison of the first two periods would appear to show
that the introduction of pneumatic tools had produced some increase,
although not a large increase, in the death rate from phthisis and
other lung diseases.
As regards the third period (1905-1909), while the number of
stonecutters and masons employed in monumental yards has not
fallen off, but rather increased, there has been a great decline in the
number of building masons in employment, due to unusual depres­
sion in the building trade. Some of these out of employment as
mason hewers have, I believe, found employment as stonecutters in
monumental yards, and thus checked in some measure the advance­




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

197

ment of apprentices to the status of journeyman. Some have emi­
grated to America. Some have drifted into laboring, but not im­
probably in the event of death within two or three years of leaving
their trade, their deaths have been registered by their relatives as
the deaths of masons. It is difficult to know to what extent to make
allowance for these disturbing factors. Probably, any reasonable
allowance would not raise the total number of deaths from phthisis
and other lung diseases combined above or even up to the number
for each of the preceding two quinquennial periods, but it would
raise the number of deaths from phthisis above the numbers for these
periods.
After a brief discussion of possible errors attributable to the erro­
neous use of apparently equivalent occupational terms, it is said with
further reference to the use of pneumatic tools, that—
About the time of the introduction of pneumatic tools for granite
cutting, but not altogether as a consequence of it, the sheds, which
had usually been entirely open along the front, as in the case of an
ordinary builder’s shed, began to be closed. The closure, while
increasing the liability to the inhalation of dust, must at the same
time have afforded some protection against cold and possible chills.
This may possibly account in part for the diminution during the
past five years in the number of lung diseases other than phthisis.
But the numbers dealt with are small, and allowance must be made
for mere chance variations.
C O M P A R A T IV E F R E Q U E N C Y OF L U N G D I S E A S E S I N A B E R D E E N
E D IN B U R G H .

AND IN

In view of the foregoing, the final conclusion is advanced that “ the
unusual combination, in the case of workers in stone, of a high mor­
tality from phthisis, with a low mortality from lung diseases other
than phthisis, may serve to bear out the statement made by the late
Prof. Hamilton, professor of pathology in Aberdeen, that a definite
development of so-called lithosis, or a fibroid affection of the lungs
due to stone dust, is rare among granite workers, although common
among firestone workers in Edinburgh.” In part, this conclusion
would seem to be sustained by the examination of a relatively small
number of autopsy records. The strictly medical question, there­
fore, whether the form of tuberculosis met with among the granite
workers of Aberdeen was to be considered industrial fibrosis with a
superinduced tuberculosis, or strictly pulmonary tuberculosis in the
more limited sense of the term, can not be considered finally decided
by the information at present available. The investigation reem­
phasizes earlier conclusions regarding the importance of minute at­
tention to the character of the dust inhaled in the different branches
of the stone industry; certain forms of stone dust are obviously
much more injurious than others, and a general grouping of stone
workers for purposes of mortality analysis is therefore quite likely
to yield inconclusive results.




198

MORTALITY FROM RESPIRATORY DISEASES

IN

DUSTY TRADES.

P H Y S IQ U E OF ST O N E W O R K E R S .

Not only is it necessary to take into account the kind and nature
of the dust inhaled, particularly whether of granite trap rock,
sandstone, or limestone, but the different employments also re­
quire special consideration. Some occupations are unquestionably
very much more exposed than others. Additional attention is neces­
sary as regards the conditions of employment, whether outdoors or
indoors, and finally, there is the important relation of physique to
disease resistance. Table 78 shows the average chest expansion of
males in certain occupations, including the Aberdeen granite trade,
and has been derived from the discussion on industrial pneumoconi­
osis, by E. L. Collis, London, 1915, in the Milroy Lectures.
T a b le

78— A V E R A G E CH EST E X P A N S IO N IN INCHES OF M A LE S IN C E R T A IN CLASSES,
A T V A R IO U S A G E P E R IO D S .

Aberdeen granite trade.

Leis­
ured
class.

Age period.

14................................................
17................................................

2.31
2.45
2. 79
2.90
2.87
2.64
2.35
2.39
2.24

20 ................................................
95
2 0 ................................................

35............................
40................................................
45................................................
50................................................
55................................................
65 and over........ ........... ..........

2 .12
1.87

Sheffield cutlery trade.

Factory
opera­ P o t h ­
tives ers, etc.,
Cutters Cutters
not ex­ very
Light
in
posed slightly in open closed Cutters. grind­
ers.
to dust.
sheds. sheds.
ex­
posed
to dust.

2. 84
2.33
2.13

2.20

2.15
2.24
1.64

2. 58
2.57
2.58

2 .2 1

2.14
2.04
2.07
1.98
2.04
1.80

2.14
2.64
2.43
2. 51
2.19
2.13
2.16
1.92
1.73

2.40
2.60
2.44

2 .1 1

1.93
1.80
1.67
1.84
1.44
1.56

2.43
2.27
2.24
1. 96
2.09
1.92
1.73
1.56
1.49
1.50
1.13

2.54
2.37
2.45
2.40
2.14
2.07
1.75
1.58
1.58
1.53

Strip­
pers of
cotton
Heavy carding
grind­
ma­
ers.
chines.

2.67
2.49
2.19
2.19
2.04
1.89
L52
1.55
1.51
1.45

}■
|

3.33
2 . 75
2.45

}

1.86

}

1.69

}

1.72

.

In connection with the table Dr. Collis points out that—Inhalation of silica dust takes several years, varying with the in­
tensity of the exposure, in producing any obvious effect, but gradu­
ally the affected person notices that on exertion his breathing capacity
has become limited, and that a cough, slight at first, has become per­
sistent, though seldom accompanied by much expectoration; other­
wise he may look robust and feel well. This limitation in the breath­
ing capacity which has been noted by nearly every authority from
Hippocrates to the South African Miners’ Phthisis Commission of
1912 has been described as pathognomic of the disease and may at
first be the only objective sign present. In several inquiries in which
some thousands of operatives have been examined, I have collected
physical data which demonstrate this limitation, and the results are
stated in the table; but as Dr. Cumpston points out, “ the actual
amount of expansion in inches is not of so much importance as the
manner in which the chest wall behaves when an attempt at ex­
pansion is made.” This diminution in chest expansion must^ how­
ever, not be relied on as an indication of exposure to silica dust, as




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

199

it is present, though not so markedly, among workers exposed to
other dusts.
In further explanation, it is said that should the condition progress
until the age of 45 to 50 years, a definite clinical picture is presented,
briefly described as follows:
Such a man is usually somewhat below the average height for his
class, for exposure to dust inhalation during the growing period of
life appears to inhibit the normal growth; he looks well, but if he
has just ascended stairs or has hurried, he is out of breath for a few
minutes; and on being questioned, though unable to count 20 with­
out taking a breath, he speaks of himself as fit, and may even boast
of being a credit to his trade; but he owns to frequent colds, espe­
cially in winter, and a troublesome cough; he expectorates but little
sputum, and what there is is rejected with difficulty and is colored
by the dust produced in his work; in some industries, particularly
in tin mining and gold mining, he is stated to be subject to distinc­
tive attacks of dyspnoea, but this symptom is not prevalent among
metal grinders or granite cutters. When he is stripped he is found
to be well nourished, but respiration is seen to be carried on nearly
entirely by diaphragmatic action, and even though urged he seems
incapable of inducing his intercostal muscles to lift his ribs.
P R A C T IC A L V A L U E OF P H Y S IC A L E X A M IN A T IO N S .

These observations, arrived at after an exceedingly careful and
conservative study of the subject, emphasize strongly the great prac­
tical value of physical examinations, and reexaminations at
least once a year. The necessity for such an examination, includ­
ing a radiological photograph of the chest, becomes of supreme im­
portance in the case of men exposed to the risk of silica or quartz
dust inhalation, particularly in confined spaces, such as stopes of
deep mines, etc., for, as previously intimated, the general appear­
ance and general indications of health and strength may be very de­
ceptive, since the progress of the disease is often extremely chronic,
lasting in some cases, according to Wheatley, “ upwards of 20 years.”
Knowledge of the exact occupation followed is, therefore, of equal im­
portance and general conclusions, based upon groups of men in dif­
ferent specific employments, though following the same trade, can
not be relied on as trustworthy. According to Collis—
Silica dust is generated in the following among other industries:
Gold mining, tin mining, and lead mining; quarrying and dressing
sandstone and granite; flint knapping, making honing stones for
scythes; building millstones, which are used and require dressing
in such diverse industries as the milling of flour, ric,e, cocoa, cement
(occasionally), and white lead; the manufacture of grindstones,
which are used and require racing, trueing, and surfacing in the
grinding of metal articles, mother-of-pearl, bone, horn, and other
materials; sand blasting to clean castings and to etch glass; crush­
ing flints and quartz to make silica flour used in the manufacture of




200

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

pottery, certain abrasive soaps, sandpapers, chicken food, disinfect­
ing powders, and silica paints; the mining and quarrying of ganister
and silica stone; and the manufacture of silica bricks.
D E S C R I P T IV E ACCOUNT OF S IL IC A OR Q U A RTZ.

Pure silica, or the oxide of silicon, is the substance commonly known
as quartz, which is one of the most abundant of mineral substances.
According to Frank J. Katz, in a report on “ The Production of
Silica in 1913,” to the United States Geological Survey—
Its occurrences of commercial importance are in a great many
different forms, such as vein quartz; as a constituent of pegmatites;
as sand, sandstone, quartzite, or flint; as tripoli; and as diatomaceous
(infusorial) earth. In some forms, such as rose, smoky5 and ame­
thystine quartz, it has a gem value. This chapter deals with silica
from all sources exclusive of gem quartz, of all forms of silica used
for making glass, and also of all silica used in the form of sand,
gravel, and crushed material for building, for concrete and mortar,
for foundry and furnace work, and for cutting and grinding stone.
As regards the principal uses of silica, it may be said, in the words
of the same authority, that silica is employed in the manufacture
of pottery, paints, scouring soaps, as a wood filler, and as a polisher.
In pottery the use of silica: generally called flint in the pottery in­
dustry, diminishes the shrinkage in the body of the ware; it is also
used in many glazes. Silica for use in pottery should contain less
than 0.5 per cent of iron-bearing minerals. Considerable quantities
of very finely ground silica are used in the manufacture of paint.
In all of these processes it is self-evident that exposure to the inhala­
tion of silica or quartz dust must directly or indirectly result in
serious disease complications. The exact proportion of pure silica
in the dust inhaled should be ascertained in all cases where an effort
is made to establish with accuracy the health-injurious conditions of
an occupation with exposure to mineral dust.
SU G G E ST IO N S F O R P R O T E C T IV E P R E C A U T IO N S.

It is regrettable that no very extensive investigations should have
been made into the health-injurious conditions of the more important
branches of the American stone industry. Hanson, in his report on
“ Methods of Protection from Dusts and Fumes,” illustrates the
process of stonecutting and observes that—
The strong blast of air keeps the granite clean, but gives rise to a
great amount of dust. The surfacing tool is either a large hammer or
an instrument which presents four smaller separate faces. Some­
times a bushing hammer made of thin, chisel-like blades bolted
together is used; this creates the finest dust of all. The men who
operate the surfacing tools rarely wear masks. Some protect them­
selves from flying chips by means of wire screens placed about the
hammer, some wear wire masks, and some wear glasses.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

201

This is an admirable description of modern processes which, on
account of the extensive use of pneumatic tools, have become ex­
tremely injurious in numerous individual cases. Only superficial
precautions, as a rule, are adopted. The regulations of the Barre
branch of the Granite Manufacturers’ Association, for illustration,
provide:
A rticle 6. C utters m ust p rov id e them selves w ith broom , and no air p ow er to
be used to rem ove dust.
A rticle 7. T u rn in g dow n grin dstones to be done ou tside o f w ork in g hours,
unless said stones are th orou gh ly b oxed in. T h is agreem ent is m ade fo r th e
pu rpose o f elim inating the dust from grindstones.
A rticle 8. N o su rfa ce-cu ttin g m achine to be w ork ed in cu ttin g shed du rin g
w o rk in g hours, unless properly equipped w ith effective air su ction or oth er
dev ice to rem ove dust. H a n d su rfa cers shall n ot w eigh m ore than 12 pounds.
W ork m en to be am ply protected at all tim es fro m du st fro m sa id m achines,
w h eth er in the sheds or outside. T h is a rticle n ot to apply to pn eum atic tools
w eigh in g less than 7 pounds.

As a matter of fact, however, there is only inadequate protection
from dust at most of the machines and in most of the sheds which
have been investigated and reported upon, including the Barre dis­
trict of Vermont.
IN JU R I O U S O CCU PATIO N AL C O N D ITIO N S.

The occupation is also briefly referred to in a recent discussion by
Baker,1 in part as follows:
Much of the stonecutting is outdoors or in large, airy sheds. It
consists of shaping, smoothing, and cutting the stones into smaller
pieces, as for paving blocks. Formerly much of the work was done
by hand, but now pneumatic tools are used considerably. These
produce a finer dust and tend to increase the hazard. It is held by
some that the dangers are greater in sedimentary stones than the
harder stones, like granite, but no definite figures on this point could
be obtained. Dust is also stirred up in sweeping and moving the
stones about. Thirty-seven stonecutters were medically and physi­
cally examined, and of this number 12 patients showed respiratory
disease, 9 being ill with chronic and 3 with acute diseases. Three
workers had pulmonary tuberculosis, three emphysema, and one
each chronic bronchitis, chronic pharyngitis, chalicosis, acute bron­
chitis, acute pharyngitis, and acute laryngitis. Although only one
case of chalicosis is recorded, a greater number would probably have
been noted if other factors were studied as closely as physical signs.
In view of the fact that 21 of the stonecutters were over 40 years
of age, the number ascertained to be affected with pulmonary tuber­
culosis is relatively small, but the number affected with respiratory
diseases more or less predisposing to a terminal tuberculosis must
be considered very large. There is no information as to the kind of




1 Journal American Medical A ssociation, May 6, 1916.

202

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

dust inhaled or the nature of the stone cut. The sanitary conditions
of the shed were obviously far from what they should have been.
U R G E N C Y OF D R A S T IC R E G U L A T IO N S.

The importance and necessity of drastic regulations in stonecut­
ting, polishing, etc., have not been recognized in the factory legisla­
tion of this country. In the Edinburgh and Aberdeen districts of
Scotland the local inspectors, according to the annual report of the
chief inspector of factories and workshops for 1910—
have been pressing upon the granite cutters the question of local
exhaust. The pneumatic tools which are now universally used have
largely increased the amount of fine dust breathed by the workers.
Mr. Buchan says some idea of the action of granite dust can be gath­
ered from the fact that the glasses of the workers’ goggles become
so dim by the constant impact of the fine particles of granite that
monthly renewal is essential. Mr. Kirkwood says experiment has led
to the successful removal of dust at the point of the tool by the induced
draft, but he fears that the extra fitting with a pipe attached on the
side of the tool may cause difficulties in the manipulation at fine work.
One occupier has, however, undertaken to give the arrangement a fair
trial, and the workers seem anxious that something should be done.
P R A C T IC A L P O S S I B I L I T I E S OF D U ST P R E V E N T IO N .

There are abundant reasons for believing that much more could be
done to control the dust menace in the stonecutting industry than is at
present being done in practically all American stonecutting districts.
W. Gilman Thompson refers to the statistics of the Quincy, Mass.,
district for the year 1907, according to which 41 per cent of the
deaths of stonecutters were from pulmonary tuberculosis, and includ­
ing all forms of pulmonary disease the proportion was 53 per cent.
According to the same investigation, the tuberculosis mortality
among stone and marble cutters and carvers was found to be five
times greater than among farmers or lumbermen. The usual proc­
esses are explained and admirably illustrated in the work of W.
Gilman Thompson, who observes, in part, as follows:
The drilling of rocks and coal or mineral veins for blasting is
almost universally accomplished by machine drill hammers, operated
by compressed air or steam, which have replaced the slow method
with the crowbar and hand-wielded sledge hammer. When this pro­
cess is conducted by machines in mines, tunnel boring, or any kind of
hard dry stone without the use of a water spray to moisten the dust,
it is one of the most dangerous of all the trades which produce
chronic disease. When the drilling is done overhead, so that the dust
falls back toward the face of the machine operator, the hazard is at
its worst.
These observations apply in a large measure to rock drilling in
mines, tunnels, etc. In coal mining where the overlying strata are




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

2 03

usually of limestone, the dust menace is, of course, much less than in
deep mining where the quartz rock consists frequently of almost pure
silica. According to W. Gilman Thompson—
To lessen the dust hazard from the drill holes various expedients
have been devised. The simplest of these is the placing of wet cloths
around the drill hole to catch the dust and mopping up the dust,
procedures which are troublesome and time consuming. A recent in­
vention consists of a pipe attached to the drill at the mouth of the
bore through which a fine jet of water is forced under pressure into
the drill hole, where it unites with the compression air stream in
mixing the dust into a harmless paste which flows back out of the hole.
Another invention by Korfmann employs an exhaust pipe connected
with the drill, by means of which the dust is drawn out of the hole,
after the manner of a vacuum cleaner, and discharged into a vessel
of water or a moist bag. These inventions have the advantage that
they operate independently of the workmen and do not require pre­
cautions, which such workmen are notoriously reluctant to observe.
Actual experience has unfortunately shown many of these devices
to be rather impracticable in that they cause too much interference
with the work and consequently bring about a diminution in earn­
ings. The use of dust-spraying devices, etc., as well as respirators in
connection with exceptionally dusty processes where the dust consists
largely of pure silica, should be made obligatory upon the emxDloyees
as well as upon employers.
Although not directly pertinent to the present discussion, the fol­
lowing interesting reference to a case of Raynaud’s disease1in a stone­
cutter using pneumatic tools has been reported by Dr. Charles H.
Cargile, of Bentonville, Ark.:
D. E. F., aged 26, married, with good family and personal history,
except that he was neurotic, found that frequently and only when
cutting stone with a pneumatic tool the index and middle fingers of
his right hand would become white, cold, and numb. This instru­
ment, which oscillates from 900 to 1,600 times p&r minute, transmits
strong vibrations to the hand of the operator. The patient told me
of a fellow laborer who was similarly affected by using the same kind
of tool.
Whether there is a well-defined occupational relation between stone
cutting and the occurrence of Raynaud’s disease has not been suffi­
ciently investigated to justify definite conclusions at the present time.
1 R a y n a u d ’ s d isease is defined by G ou ld and P y le as : “ A v a s cu la r d isord er ch a r a c te r­
ized by three grad es o f in ten sity : (a ) L o ca l sy n c o p e , observed m ost fre q u e n tly in the e x ­
trem ities, and p ro d u cin g the c o n d itio n kn ow n as dead fingers o r dead toes ; it is a n a lo g o u s
to th a t p rod u ced by intense cold , (ft) L o ca l a sp h yxia , w h ich usu a lly fo llo w s lo ca l syn cope,
but m ay d evelop in d ep en d en tly. C h ilbla in s are the m ild est m a n ife sta tio n o f this c o n d i­
tion .
T he fingers and toes and the ears a re the p a rts u s u a lly a ffected .
In th e m o st
e xtrem e d egree the p a rts are sw ollen , stiff and liv id , an d the ca p illa ry circ u la tio n is
a lm ost sta g n a n t,
( c ) L o ca l sy m m etric g m ig ren e, th e m ild e st fo rm o f w h ic h fo llo w s lo c a l
a sp h y x ia .’*




2 04

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

M O R T A L IT Y O F M A R B L E A N D ST O N E C U T T E R S — U N IT E D S T A T E S
R E G I S T R A T IO N A R E A .

Most of the preceding observations have been derived from foreign
sources. The census statistics for 1900 can hardly be considered
applicable to present conditions, nor are they conclusive regarding
the different branches of the stone industry and the more specific
occupations followed.
The mortality of marble and stone cutters has been reported upon
for the years 1908 and 1909 by the Division of Vital Statistics of the
United States Census Bureau, but no subsequent information has been
made public and the data are therefore limited to the two years re­
ferred to. According to the census report, out of 1,657 deaths of
marble and stone cutters from all causes, 509, or 30.7 per cent, were
from pulmonary tuberculosis. The details of the mortality by divi­
sional periods of life are shown in Table 79.
T a b l e 7 9 . — P R O P O R T IO N A T E

M O R T A L IT Y OF M A R B L E A N D STON E C U TT ER S FROM
P U L M O N A R Y T U B E R C U LO SIS , U N IT E D S TA TE S R E G IS T R A T IO N A R E A , 1908 A N D 1909.

Deaths from pulmonary
tuberculosis.
Age at death.

Deaths
from all
causes.
Number.

Per cent of
deaths
from all
causes.

15 to 24 years..................................................................................................
25 to 34 years..................................................................................................
35 to 44 years..................................................................................................
45 to 54 ye^rs..................................................................................................
55 to 64 years..................................................................................................
65 years and over...........................................................................................
Age unknow n................................................................................................

61
170
299
401
407
316
3

16
74
132
167
95
25

26.2
43.5
44.1
41.6
23.3
7.9

Total, 15 years and over....................................................................

1,657

509

30.7

8 0 __ P R O P O R T IO N A T E M O R T A L IT Y OF M A R B L E A N D STON E C U T T E R S FR O M
N O N TU B E R C U LO U S R E S P IR A T O R Y D ISE A SE S, U N IT E D S T A T E S R E G IS T R A T IO N
A R E A , 1908 A N D 1909.

T a b le

Cause of death.

Number
of deaths.

Asthma..................................................................................................................................
Bronchitis.............................................................................................................................
Pneumonia............................................................................................................................
Other nontuberculous respiratory diseases.....................................................................

9
29
131
33

T otal............................................................................................................................

202

Per cent of
deaths
from all
causes.
0.5

1.8
7.9
2.0
12 .2

T U BE R C U LO U S AND N O N T U BER C U LO U S LU N G D IS E A S E S .

Tables 79 and 80 are of exceptional interest and value in that
they may be considered representative for the American stone in­
dustry at the present time. There are no reasons for believing that




205

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

material changes have occurred in the mortality during recent
years. The data conclusively indicate an excessive proportionate
mortality from pulmonary tuberculosis among marble and stone cut­
ters at every divisional period of life. Commencing with ages 15 to
24 the proportion of deaths, 26.2 per cent, is not exceptionally high
in comparison with other trades or occupations with continuous and
considerable exposure to metallic or mineral dust. Among plas­
terers, for illustration, the corresponding proportion, according to
data derived from the same official American sources, was 25 per
cent, and for potters, 46.2 per cent, and for glassworkers, 47.2 per
cent. At ages 25 to 34, however, the proportionate mortality from
pulmonary tuberculosis among marble and stone cutters was 43.5 per
cent, which compares with 31.5 per cent for plasterers, 44.4 per cent
for potters, and 42.6 per cent for glassworkers. The proportion con­
tinues high throughout the remainder of life; for illustration, at ages
65 and over, among marble and stone cutters, 7.9 per cent are from
pulmonary tuberculosis, compared with 3.8 per cent for potters, 4
per cent for glassworkers, and 3.6 per cent for plasterers. Aside from
an excessive mortality from pulmonary tuberculosis the mortality
from nontuberculous respiratory diseases among marble and stone
cutters is extremely high, or 12.2 per cent for respiratory diseases
considered as a group, or, respectively, 0.5 per cent for asthma, 1.8
per cent for bronchitis, 7.9 per cent for pneumonia, and 2.0 per cent
for other respiratory diseases.
C O M P A R A T IV E M O R T A L IT Y F R O M
N O N TU BER C U LO U S R E S P IR A T O R Y
D I S E A S E — U N IT E D S T A T E S R E G I S T R A T IO N A R E A .

On account of the exceptional importance of nontuberculous
respiratory diseases among certain groups of occupations with con­
tinuous and considerable exposure to mineral dust the following com­
parison is included in the present discussion:
T a b l e 8 1 . — C O M P A R A T IV E

P R O P O R T IO N A T E M O R T A L IT Y FR O M N O N T U B E R C U L O U S
R E S P IR A T O R Y DISEA SES IN S P E C IF IE D OC C U PA TION S E X P O S E D T O M IN E R A L ,
DU ST, U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1908 A N D 1909.

Per cent of deaths due to each specific cause
among—
Cause of death.
Marble and
stone cut­
ters.
Asthm a.....................................................................................
Bronchitis................................................................................
Pneumonia..............................................................................
Other nontuberculous respiratory diseases........................

0.5

1.8
7.9
2.0
12 .2

!
T otal...............................................................................
A ll other causes.......................................................................

87.8

Total, all causes............................................................

100.0




Potters.

Glassw-orkPlasterers.
ers.

0.2
.6

0.7
.7
6.7
4.4
87.5

0.3

1.1
8 .1
1.1
10.6

7.7
.7

12 .5

100.0

9.2
90.8

89.4

100.0

100.0

206

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

Table 81 brings out the interesting fact that the proportionate
mortality from bronchitis is particularly excessive among marble and
stone cutters in comparison with other occupations with exposure to
mineral dust, and with the exception of potters the conclusion applies
equally to asthma and other respiratory diseases, excepting pneu­
monia. The data are not sufficient for final conclusions, but they
suggest the practical value of thoroughly specialized investigations
into the occurrence of nontuberculous respiratory diseases among
marble and stone workers, particularly asthma and bronchitis.
The data are derived from official American vital statistics and are
quite generally confirmed by corresponding statistics derived from
insurance experience or foreign sources.
M O R T A L IT Y O F JO U R N E Y M E N S T O N E C U T T E R S — M E D IC O -A C T U A R IA L
E X P E R IE N C E .

In the medico-actuarial investigation journeymen stonecutters were
fortunately considered separately, and the results, based upon a fairly
extensive experience, indicate a truly lamentable condition. In the
interpretation of Table 82 it should be taken into consideration that
only the better class of stonecutters would be accepted for ordinary
life insurance, since in former years at least quite generally the prac­
tice was to decline stone workers entirely.
T a b le

8 2 .—M O R T A L IT Y FR O M A L L CAUSES AM ON G JO U R N E Y M E N S T O N E C U T T E R S ,
B Y A G E G R O U P S —M E D IC O -A C T U A R IA L IN V E S T IG A T IO N .

Age at death.

Number
exposed
to risk
1 year.

Actual
deaths.

E xpected
deaths.

Per cent
actual are
ofexpecied
deaths.

15 to 29 years............................................................................
30 to 39 years............................................................................
40 to 49 years............................................................................
50 to 59 years............................................................................
C years and over....................................................................
O

2,579
2,289
681
138
3

17
32

22

5

11.96
13.44
6.75
3.20

142
238
326
156

Total, 15 years and over..............................................

5,690

76

35.45

214

.10

According to this table the actual mortality of journeymen stone­
cutters in the combined experience of American life insurance com­
panies is 214 per cent of the expected, increasing rapidly with age
to a maximum of 326 per cent at ages 40 to 49. The table, of course,
includes all causes, and does not refer to pulmonary tuberculosis,
but, as subsequently to be shown, the excess in the mortality is
chiefly attributable to this disease. Out of 76 deaths at all ages of
journeymen stonecutters not a single death occurred at ages 60 and
over. This, of course, in part may possibly be the result of the lim­
ited extent of the experience under consideration.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

207

M O R T A L IT Y OF M A R B L E A N D ST O N E W O R K E R S — IN D U S T R I A L IN S U R A N C E
E X P E R IE N C E .

According to Table 83, the industrial mortality experience of the
Prudential Co. with reference to marble and stone workers for the
period 1897 to 1914 includes 2,052 deaths from all causes, of which
690, or 33.6 per cent, are from pulmonary tuberculosis.
8 3 .—P R O P O R T IO N A T E
M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U L O SIS
AM ON G M A R B L E A N D STON E W O R K E R S , IN D U S T R IA L E X P E R IE N C E OF P R U ­
D E N T IA L CO., 1897 TO 1914, C O M PA R E D W IT H T H A T O F A L L M A LE S IN U N IT E D
S T A T E S R E G IS T R A T IO N A R E A , 1900 TO 1913, B Y A G E G R O U PS.

T a b le

Deaths of marble and
stone workers, 1897
to 1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
A ll causes.

Pulm o­
nary tu­
berculosis.

Marble
and stone
workers.

Males in
registration
area, 1900
to 1913.

15 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
5-5 to 64 years............................................................................
65 years and over........................................... ........................

60
228
403
513
506
342

23
121
179
200
135
32

38.3
53.1
44.4
39.0
26.7
9.4

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over..............................................

2,052

690

33.6

13.9

The proportionate mortality from pulmonary tuberculosis is ex­
tremely high at all ages, but particularly so at ages 25 to 34, at which
out of the mortality from all causes 53.1 per cent was from pul­
monary tuberculosis, against 30.5 per cent among males in the regis­
tration area. I f it had been possible to separate this experience
according to the different branches of the stone industry and the
more important occupations with dust exposure, there are the most
convincing reasons for believing that the results of this analysis
would have been decidedly more suggestive of the seriously healthinjurious consequences of exposure to silica or quartz dust.
G E N E R A L CO N CLUSIO N S.

Inconclusive as these observations are with reference to the several
branches of the stone industry and the more important specific
occupations with dust exposure, the data are fully sufficient, for the
present purpose, to emphasize the extremely dangerous nature of
dust exposure in connection with practically all processes of stone
quarrying, cutting, polishing, etc. This conclusion applies also and
perhaps even more specifically to men employed in connection with
stone-crushing operations, which during recent years have assumed
very considerable proportions throughout the country. In practically
all of these rock-crushing processes no protective devices whatsoever
*are employed. Most of the men, it is true, work often only for a por­




208

MORTALiTY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

tion of the year, and much of the labor is of an itinerant nature, so
that the serious damage done to the lungs must frequently escape ob­
servation. On account of the extreme hardness of trap rock, virtually
the equivalent of flint, it is a practical certainty that dust exposure
in trap-rock crushing is very serious. The entire stone industry
must be more thoroughly investigated for the purpose of ascer­
taining the most health-injurious processes as well as such branches
as include work on limestone and similar mineral substances appar­
ently much less injurious than the so-called gritstone or granites,
etc. In view, however, of the universal use of pneumatic tools in the
stonecutting industry this aspect demands particular consideration
for the ascertainment of the required methods and means by which
the dust menace may be reduced to a minimum.1
The most recent medical observations on the mortality of stone­
cutters and marble workers are by Kober and Hanson in their treatise
on Diseases of Occupation and Vocational Hygiene, where it is
said, in part, that—
We know now that the inhalation of mineral dust develops sooner
or later pneumoconiosis which may eventuate in pulmonary tuber­
culosis. It is generally held that the liability to diseases of the
respiratory passages is less in the case of paving stonecutters and
slate splitters, and in the sawing, grinding, polishing, and lathe work
which can be conducted by the wet process, than in the case of monu­
ment or custom work, and particularly in the surfacing, carving, and
cutting with pneumatic tools! The greatest amount of dust is evolved
by the surfacing machines which are operated with compressed air.
T
Of the various tools employed the bushing hammer creates the finest
dust. Unfortunately, work with pneumatic tools can not be done by
the wet process, as the pasty material created by a mixture of water
and dust clogs up the tools. This work is usually done in large open
sheds or in the yards, but even under such conditions the men are
exposed to clouds of dust. The sawing of granite and marble into
slabs, turning in lathes, and the final polishing can be conducted by
the wet process; soapstone sawing and cutting for joints is frequently
done dry and is attended with exposure to considerable dust.
Kober also refers to the fact that experience has shown that the
mortality from pulmonary tuberculosis is generally excessive among
workers in sandstone and relatively low among workers in limestone.
No additional evidence, however, has been forthcoming in support of
this point of view, which for practical reasons is one of considerable
importance. The suggestions concerning the prevention of dust ex­
posure in the stone industry as advanced by Kober are also quite
1 A u sefu l trea tise on th e s u b je ct o f rock e x ca v a tion , in clu d in g o b se rv a tio n s on rock s
a n d th eir p rop erties, m eth od s o f ha n d and m ach in e d rillin g , q u a rry in g , open-erat e x ca ­
v a tin g , tu n n elin g , etc., is R o ck E x ca v a tio n , by H. P. G ille tte , N ew Y o rk , 1907. O f m o re
g en era l va lu e is a recen t trea tise on the E lem en ts o f M ining, by G eo. J. Y o u n g (N e w
Y ork , 1 9 1 6 ), w h ich in clu d es ob se rv a tio n s in d etail on rock breaking, b u t n o t w ith sp e cia l
r e feren ce to rock cru sh in g for. roa d -m ak in g p u rp oses, w h ich is th e b ra n ch o f the in d u stry
p rob a b ly m ost in ju rio u s to hea lth .




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

.209

inadequate for the purpose of the effective sanitary control of an in­
dustry which is so obviously injurious to health and life and with
regard to which the evidence of a decided predisposition to pul­
monary tuberculosis is incontrovertible and conclusive.
MARBLE WORKERS.

Marble workers constitute a distinctive and well-defined group of
the stone industry, which it has seemed best to consider separately,
though most of the general statistics appertaining to the occupation
are included in the stone industry considered as a whole. The
American marble industry is centered chiefly in Vermont, where
about 60 per cent of all the marble produced in the United States
is quarried, and most of it is cut and dressed, sawed, or polished,
as the case may be, in the locality where quarried. The Vermont
State board of health for some six years (1900 to 1905, inclusive)
reported the mortality by occupations, and of the 42 deaths of marble
workers from all causes reported in that State only 5 were from pul­
monary tuberculosis and 5 from other respiratory diseases. The fact
that Vermont is an otherwise exceptionally healthful State goes far
to mitigate the intrinsic dangers of the occupation resulting from
continuous exposure to the inhalation of stone dust.
Bertillon, in his observations on morbidity and mortality, refers
to stonecutters and workers in marble in Switzerland as being sub­
ject to a considerable mortality, principally from phthisis, which
rapidly increases with age. Under 20 years of age, according to
this authority, the mortality is lower than among the mass of the
population. From 20 to 29 the death rate equals the average, from
30 to 39 it is twice, from 40 to 49 it is thrice, and from 50 to 59 it is
four times the average rate of the Swiss as a nation. He also refers
to Italian statistics, which are significant on account of the remark­
able development of the marble industry at Carrara, stating that
stonecutters and pavers average fewer days of sickness than the
whole population up to 45 years, but considerably more above that
age. In Paris the workers in marble are subject to a high death
rate at all ages.
A very instructive descriptive account of the machine process as
generally employed in the marble industry was included in the report
on the stone industry for 1908, by Mr. W. C. Day, of the United
States Geological Survey, from which the following extract is made
as emphasizing the more or less health-injurious circumstances of
employment in marble manufacture:
After being sawed the slabs are placed on a 6 rubbing bed,” which
4
consists of a circular cast-iron plate, from 8 to 15 feet in diameter,
the older forms having a circular opening from 1 foot to 18 inphfrS
106811°— 18— Bull. 231------ 14




210.

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

in diameter in the center. The plate is planed to a smooth surface
and is mounted upon running gear so that it may revolve in a hori­
zontal plane. Fixed arms, usually four in number, are sustained
radially about one-fourth of an inch above the plate, either by an
upright passing through the central opening or by a framework
overhead (in the case of the newer solid forms of bed). The slabs
of stone to be polished are placed upon the bed in front of the arms,
and the bed is revolved slowly beneath them in such a direction as to
hold them firmly against the arms. An abrading material, such as
sand, sometimes mixed with “ chilled shot,” or crushed steel, with a
constant supply of water, is fed upon the plate. I f necessary, the
stones are weighted to increase the friction. From this rubbing bed
the slabs are removed to the emery bed, which is similar to the
lormer, fine emery being used for abrasion. They are then rubbed
down by hand with a fine, evenly grained sandstone, commonly called
a “ Scotch hone,” with a sufficient supply of water, and smoothed off
with pumice stone and w ater. The final polish is put on by rubbing
T
the slabs upon a buffing bed, similar in form to the rubbing bed, but
covered with a thick, specially prepared felt, upon which a small
amount of “ putty powder ” (oxide of tin) is fed, to give a high gloss.
The hand process consists in grinding on the rubbing bed as before,
and then rubbing down by hand successively with Nova Scotia a blue
stone,” “ red stone,” “ Scotch hone,” and pumice stone, after which
it is glossed with putty powder, or, in case of cheaper “ onyxes ” and
common marbles, with a mixture of two parts of oxalic acid and one
part of tin oxide.
In marble-cutting, as in the stone industry generally, the intro­
duction of pneumatic tools operated by compressed air has brought
in a new and decidedly health-injurious factor, since the amount
of very fine dust generated by this process is much greater than when
the work is done entirely by hand with the ordinary chisel and mallet.
Portable stone-dressing machines have been invented and quite widely
adopted, since in part the quality of the work done by these machines
is superior to handwork, while the productive capacity is claimed to
be from eight to fifteen times as much as when the work is done en­
tirely by hand. Exhaust air is employed to keep the stone clean
at the point of impact of the cutting tool, but the clouds of dust raised
by this apparatus are considerable, even though the work is usually
done outside of the shed. Aside from the dust generated in either
machine or hand cutting, a vast additional amount of dust is proeduced during cleaning-up operations, and while labor organizations
have, in part, provided against this risk by special regulations, the
generation of much dust is practically unavoidable under the exist­
ing methods by which the work is carried on.
The United States census mortality statistics combine marble and
stone cutters, so that it is impossible to separately consider statistic
cally the mortality of this employment. As has been previously
pointed out in discussing stonecutters generally, the evidence is en­




OCCUPATIONS 'W ITH EXPOSURE TO MINERAL DUST.

211

tirely conclusive that the mortality from pulmonary tuberculosis and
other respiratory diseases among this class is decidedly excessive. It
is observed in a discussion of the mortality in the manufacturing and
mechanical industries in the Report on Vital Statistics of the Census
of 1890 (Part I, p. 144) that “ it will be seen * * * that among
marble and stone cutters in the United States the greatest proportion
of deaths was due to pulmonary tuberculosis, being much greater
than the average proportion due to this cause in this class. The
proportion of deaths * * * due to diseases of the respiratory
system was [also] greater.” The respective death rates per 1,000
living were 3.15 for pulmonary tuberculosis for marble and stone
cutters, against an average of 2.11 among occupied males in manu­
facturing and mechanical industries generally, and 1.91 for other
respiratory diseases for marble and stone cutters against an average
of 1.54.
The more general aspects of marble dust in relation to health, and
with special reference to pulmonary tuberculosis, are considered in
the discussion of the several branches of the mineral industries. The
available data are unfortunately far from conclusive, but in a general
way it would seem that marble dust is distinctly more injurious to
health than the dust of limestone and slate. The difficulty of arriv­
ing at definite conclusions is chiefly due to the defective and even
misleading character of the occupation mortality returns in which
marble cutters and polishers are combined with other stone workers,
and even quarrymen. All of the available statistics, however, em­
phasize the lamentable fact that the proportionate mortality from
pulmonary tuberculosis is exceedingly high among marble cutters
and polishers, and there can be no question as regards an increased
liability to the disease in consequence of the almost universal use of
pneumatic tools for marble and stone cutting purposes.
No final conclusions, however, can be arrived at until the entire
subject of stone workers’ mortality has been subjected to a thor­
oughly critical and qualified analysis with a due regard to the chem­
ical and mechanical properties and especially the degree of fineness
of the different varieties of stone dust and their relation to .tubercu­
losis and nontuberculous lung diseases.
SLATE WORKERS.

The slate industry is of practical importance in only two States—
Pennsylvania and Vermont. Of the aggregate value of the product
sold in 1915, $4,958,000, these States are credited with $4,200,000, or
84.7 per cent of the total. The reduction in output during the last
few years is attributed to the increasing use of artificial roofing ma­
terials as well, as to the larger proportion of new buildings with flat
roofs. The industry, with observations on the chemical and micro­




212

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

scopical analyses of slates and methods of production, has been
reported upon in considerable detail by T. Nelson Dale and others
of the United States Geological Survey.1
H Y G I E N E OF T H E S L A T E IN D U S T R Y .

The hygienic aspects of the slate industry have been briefly de­
scribed by Arlidge, with special reference, of course, to English con­
ditions, which, however, do not very materially differ from those
common to the centers of slate production in this country. Accord­
ing to Arlidge, “ The dust examined microscopically appears made up
of irregular but sharply angular particles, often serrated,” but he
quotes Dr. Roberts to the effect that “ It is wonderful how little the
quarrymen complain of any irritation or direct inconvenience from
inhaling the dust. They soon become accustomed to their condition
in life, and the only two discomforts which they generally seem to
suffer are lassitude and thirst,” and these appear to be due to fatigue
rather than to any other cause. In the actual processes of slate saw­
ing and dressing, Arlidge states that, this being done in closed shops,
the workmen employed can not escape breathing the copious dust
given off. In this country, however, much if not most of the slate
splitting is done outdoors so that the dust hazard is materially re­
duced. Arlidge quotes Roberts in a statement that, taking all the
circumstances into consideration, slate workers are subjected to con­
ditions highly calculated to produce respiratory diseases.
M O R T A L IT Y OF S L A T E -P E N C IL M A K E R S .

The most thoroughly scientific study of the sanitary aspects of the
industry in Germany has been made by Sommerfeid, chiefly, however,
with reference to the manufacture of slate pencils and school slates.
The investigation emphasizes the unsatisfactory workshop conditions
common to the industry and more or less subject to material im­
provements. When carried on indoors the work is considered
decidedly injurious to health, particularly because of the unsatis­
factory economic conditions of the laborers. Tuberculosis is of fre­
quent occurrence, but in all probability the underlying causes are
social and economic rather than directly attributable to the risk of
slate-dust inhalation. Out of 260 deaths from all causes among slatepencil makers in two typical communities, 167, or 64.2 per cent,
were attributed to pulmonary tuberculosis and 25 to other dis­
eases of the respiratory organs. At certain ages the disease attained
extraordinary proportions, reaching 80 per cent of the mortality from
all causes at 40 to 45. Comparing the proportionate mortality with
certain other occupations in the same district, it is shown that among
woodworkers 50.6 per cent died of pulmonary tuberculosis, and
1 “ S late in the U n ited S ta te s,” b y T . N elson D ale a n d o th e rs, U. S. G e o lo g ica l S u rv ey,
B u lletin N o. 586, W a sh in g ton , 1.914.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

213

among all other occupations, excluding slate Avorkers, the proportion
was 45.9 per cent. The percentages for all occupations indicate that
the general health of the district was exceptionally bad and that the
predisposing causes of the high mortality from pulmonary tubercu­
losis were induced more by social and economic conditions than by
the liability to slate-dust inhalation. The average age at death for
slate-pencil makers Avas 45.7 years and for woodworkers 55.2 years.
But the former industry, in all probability, employs a larger propor­
tion of young persons. An analysis of a slate workers’ sick fund ex­
perience, including, however, only 189 employees, shows that nearly
one-third had commenced to work at the industry below the age of 14,
and some had been at work from the seventh year of life. Under
such conditions, irrespective of the dust danger, it would naturally be
expected that the liability to pulmonary tuberculosis would be
exceptionally high. Upon physical examination it was found that 34
per cent were of an inferior constitution and 34.4 per cent exhibited
some degree of lung impairment. The results of this investigation
can not be considered conclusive or applicable to the American slate
industry, which is carried on under decidedly better social economic
conditions. The investigation by Sommerfeld of this particular trade
is, however, one of exceptional importance and suggestive of the
methods to be followed in corresponding investigations in this
country.1
E N G L IS H S A N IT A R Y IN V E S T IG A T IO N S .

The slate industry was quite carefully inquired into in 1907 by
the English Departmental Committee on Industrial Diseases. Quite
a number of witnesses with practical experience, both medical and
otherwise, were examined, but the evidence obtained was far from
conclusive. In the main, however, the experience seemed to prove
that continuous and considerable inhalation of slate dust, according
to the work folloAved, was distinctly injurious and a causative factor
in the development of pulmonary tuberculosis. The evidence seemed
to show in many cases a preceding fibrosis, often of long duration,
suggestive of a considerable degree of similarity in the mechanical
properties of slate and quartz dust. The opinion seemed to prevail
that working in the quarries was distinctly less injurious than work­
ing in the mills, where, of course, the dust hazard would be much
greater. It was made quite clear, however, that pure slate dust was
xarely met with, but that as a rule the dust inhaled included a con­
siderable proportion of minute particles of adherent quartz. An
exceptionally interesting and valuable post-mortem report was pre­
1 Ila n d b u ch der G ew erb e-K ra n k h eiten ,
p. 225 et seq.




by T h e o d o r

S o m m erfeld , M. D ., B erlin ,

1898,

214

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

sented by Dr. Robert Owen, who, quoting from his notes, stated as
follows:
Report of the post-mortem R. R., 48 years, slate quarrier, working
in a quarry for 25 years. Permission only was given to open and
examine the chest. The body was that of a man over 6 feet, very
emaciated, and looked 10 years older than his age. Frequent attacks
of bronchitis during the last 20 years. Three years before he died
lie began to lose flesh and was short of breath. Bronchitis, followed
by a good deal of expectoration, which was muco purulent; when
his complaint was far advanced he was told that he was suffering
from tubercular consumption, but when his sputum was examined,
which was done repeatedly, no tubercle bacilli were present. Then
the thought occurred to us that the patient was suffering from nontubercular disease of the lung—that is, fibrosis. He became weaker;
Bright’s disease followed, and he soon died. That is the history of
the case. On examination the right lung was adherent to the chest
wall. The adhesions were so thick and firm that they had to be cut
with a knife. The pleura was adherent. The lung did not collapse
when removed from the body. The left lung was not adherent to the
chest wall. In the right lung the pleura was very thick. The
bronchi of both lungs were greatly thickened and surrounded by
dense bands of fibrous tissue. Both lungs were diminished in size;
they were hard and dense, almost like cartilage. Both lungs were
somewhat of a buff color, but there was no distinct pigment observed.
The bronchi contained much mucus and pus. On microscopical
examination of the lung it was found to be a real specimen of fibrotic
Jung tissue. This is partly a report I had from Glasgow, where I
sent a tissue to be examined. The walls of the air cells were thick­
ened; also the walls of the minute arteries were in the same condi­
tion. The bronchial glands were enlarged (that is my own observa­
tion) and of a peculiar color. They were nothing like the glands
you find in a coal miner. In this case no tubercular cavities were'
found; there w no breaking down of the lung. The second case
^as
is not so important, as tubercular disease supervened, but the general
condition of the lung was the same. I made no microscopical exami•nation in that case.
It would seem from this examination that the conditions observed
were quite typical of fibroid phthisis, more or less directly related
to slate dust; but in the case of a slate quarryman the physical condi­
tion of the lungs would, of course, be less seriously impaired than in
the case of a mill worker exposed more continuously and more con­
siderably to the fine dust inhaled. In the mill also the dust particles
would be much more minute than in the quarry and the favorable
outdoor conditions would be absent.
SO C IA L A N D S A N I T A R Y C O N D ITIO N S IN T H E A M E R IC A N S L A T E IN D U S T R Y .

In the United States, particularly in the Bangor slate district
of Pennsylvania, somewhat similar conditions have been observed.
The econcmic condition of the slate workers in this country is, how­
ever, so much superior to that of slate workers abroad that this




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

215

factor by itself unquestionably operates distinctly in the direction of
a lower death rate from pulmonary tuberculosis. The hours of labor
are reasonable, the wages are fairly high^ the proportion of home
owners is relatively large, and the moral conditions, particularly as
regards temperance, are distinctly good Slate work is frequently a
family trade and is, as a rule, commenced rather early in life. Boys
are often employed on scliool-slate work, which by itself is one of
the obviously unhealthy branches of the industry. The specific occu­
pations are quite numerous, but most of the employed are returned
as “ slaters,” millmen, hole men (quarry drillers), and quarrymen.
Employments such as slate cutters and slate dressers are more gen­
erally covered by the term “ slaters ” or “ millmen.” Work at the
quarries, which is all by the open or pit method, is considered danger­
ous, but not distinctly injurious, to health. The dust exposure is
apparently not serious, but the ladder-climbing in and out of the
quarry involves occasionally a heavy physical strain. Work at the
channeling machines is also relatively free from dust, and no evidence
is available to show that either quarrymen or those occupied in related
occupations suffer above the average from pulmonary tuberculosis.
After the slate has been quarried in good-sized blocks it is hoisted
out of the pit to the banks where the shanties or huts of the “ split­
ters ” or “ dressers” are located in large numbers. These are among
the principal occupations in connection with slate dressing, and,
while there is a reasonable amount of dust exposure, the fact that
most of the work is done out of doors reduces the liability to dust
inhalation considerably.
In connection with the work of the blocker, who performs the first
operation which somewhat resembles the work of paving-stone cutting,
the work is all done in the open air, and whatever dust is created by
the process is rather heavy and falls readily to the ground before it
has a chance to rise. The blocks are first wetted down by a swab or
mop, which is essential for good cleavage, and which also tends to re­
duce the dust menace. The work is not considered seriously to predis­
pose to pulmonary tuberculosis. The men observed in this and related
occupations in the slate industry present a favorable, robust, and
healthy appearance. From the block maker or bank men the block
or slab of slate goes to the splitter, who usually sits on a cushion or
wooden seat on the ground, his legs being covered with rugs or an old
blanket to guard against injury to the slabs of slate and- to protect
himself from cold and dampness. This constrained position must
in time have some effect upon health, particularly as regards circu­
latory and digestive disturbances. The dust at this stage of the opera­
tion is not very serious, except that on account of the splitter’s
peculiar position near to the ground it is more readily inhaled. The
dust danger, although present in this employment, is not considered




216

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

sufficient to produce an increased liability to pulmonary tuberculosis.
The next operation is that of the dresser, who by means of a cutting
machine trims the edge of the slate to the required size. The machine
is operated by foot power, and the steady up-and-down movement of
the right leg may in time have some health-injurious results, which,
however, have not become a matter of official record. The power
required to run the machine is quite considerable. Much dust is at
times created by this process, according to the character of the slate.
As a rule, however, the dust is heavy and falls at once to the ground.
Most of the men in this employment have been at work for many
years, and they give the personal impression of a healthy, robust,
sober type. The very fine dust is not considered excessive, and no
evidence is available to prove an abnormal frequency of pulmonary
tuberculosis among this class of employees.
O CC U PA TIO N A L H A Z A R D S I N S L A T E M IL L S .

The remaining occupations are generally comprehended under the
term “ millwork,” and it is in these that most of the dust injury occurs.
Millmen and others employed in this group of occupations of the
slate industry constitute about one-fifth of the whole. The work
includes the making of marbleized slate, which involves an addi­
tional dust problem. A brief description is difficult, but the exist­
ing situation in the Bangor and similar slate districts may be
summed up in the statement that the dust menace is fairly well recog­
nized and that no material conflict of opinion prevails concerning the
relation of certain mill processes to pulmonary tuberculosis. How
far it would be possible to control the dust problem in this branch
of the industry has not been ascertained by qualified inquiry. The
question was raised in the investigation made by the Departmental
Committee on Industrial Diseases and the conclusion arrived at was
essentially that effective ventilation would be quite difficult, but
that more spraying might be employed to advantage.
Concerning the control of the dust menace in the finishing processes
in the manufacture of writing-slates it is stated in the report of the
T
chief inspector of factories and workshops for 1910 that while a con­
siderable amount of dust is given off in this process, a certain amount
or proportion of the same can not be exhausted by ventilating devices
such as hoods and exhaust fans, on account of the weight of the dust,
which by gravity falls to the ground. Mr. J. L. Edwards, of Wrex­
ham, suggested a perforated worktable with a water trough under­
neath, which in actual practice was found to give good results.
It is regrettable that the available information regarding this
important branch of the mineral industry should be so limited and,
partly at least, inconclusive. The decline in production during the
last few years no doubt accounts, in a measure, for this neglect,




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

217

which is so much the more regrettable since, aside from humani­
tarian and economic considerations, the scientific aspects of the slatedust problem are of special importance. There are as yet 110
trustworthy official vital statistics for this country, although an
analysis of the mortality in slate-producing centers would unques­
tionably yield useful results. In the subsequent discussion of the
mineral industries slate workers are again briefly referred to, chiefly
with reference to slate quarrying. In a general way the data
sustain the conclusion that the inhalation of slate dust is relative!}"
less serious in its effects on the lungs than the inhalation of more
irritating forms of mineral and metallic dust.
In the industrial insurance experience of the Prudential Co,
during the period 1907 to 1914 there were 93 deaths of slaters, of
vvhich 12, or 12.9 per cent, were from, pulmonary tuberculosis. In
addition, there were 10 deaths from nontuberculous respiratory dis­
eases, equivalent to 10.8 per cent of the mortality from all causes.
There were also 7 deaths of slate makers, with 2 deaths from pul­
monary tuberculosis. The statistical evidence, although entirely too
limited for final conclusions, apparently sustains the' point of view
that exposure to slate dust is less serious in its effects than continued
and considerable exposure to more irritating forms of mineral and
metallic dust.
LIME WORKERS.

The lime and cement industries are so closely related to each other
that for practical purposes it has been found difficult to give separate
consideration to the mortality returns for each group of these em­
ployments, which have therefore been combined to provide a more
substantial statistical basis in support of the conclusions ad­
vanced. Cement and lime, of course, have different properties, de­
pendent upon their chemical composition and the methods of manu­
facture, and are generally classified either according to the chemical
reaction involved in setting or according to the conditions under which
they will harden. Chemically pure lime is the oxide of calcium, which,
as shown in the description of the cement industry, constitutes the
major portion of the cement product. Lime is a strong caustic
alkali which unites readily with many substances and is readily
soluble in water at ordinary temperature. On this account it is
T
claimed that the inhalation of lime dust is noninjurious, and some
authorities go so far as to ascribe beneficial results to lime-dust ex­
posure as a precautionary measure against a risk of tuberculo­
sis.1 There are, of course, numerous varieties of limestone which
may vary in their effects and unquestionably do so where there
is a considerable degree of intermixture with shell, chalky, cherty,
1 “ T h e Influen ce o f C a lciu m ,”
F . R . S. E ., E d in b u rgh , 1917.




A p p e n d ix

II, The

C an cer P ro b le m ,

by C. E .

G reen,

218

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

or other substances. The general processes of manufacture, with­
out reference, however, to sanitary conditions or dust exposure,
have been described in a report of the Missouri Bureau of Geology
and Mines on lime and cement resources (Jefferson City, Mo.,
1907) and in part 2 of the Mineral Resources of the United
States for the calendar year 1913, by Burchard and Emley, on
“ The sources, manufacture, and use of lime.” The annual reports
of the United States Geological Survey emphasize the magnitude of
the lime industry, but no satisfactory statistics are available con­
cerning the health of this class of employees with special reference
to tuberculosis other than the data elsewhere included in the discus­
sion. Hay hurst in his report on health hazards in Ohio reports
upon conditions observed in seven establishments employing, how­
ever, only 188 persons.. A brief reference is made to dust exposure
in the drawing or unloading of the kilns in connection with which
no protective devices were employed. As regards grinding and
packing, it is said that this is done in all plants but is practically a
side practice or process of lime manufacture. It is explained that the
lumps of lime- after cooling on the floor space are taken to the mill
and ground to powder and then sacked by machinery. The health
hazard is referred to as “ very bad.” The air is dense on account of
the dust in some places, and in only one was there an efficient suction
system, in connection with which it is pointed out “ the saving of
lime collected paid a very good interest on the money invested in
the blower system.” Skin irritation, especially in summer, is re­
ferred to as frequent, and eye inflammations were complained of, but
there is no mention of a specific liability to pulmonary tuberculosis.
The idea seemed to prevail that the inhalation of lime dust was bene­
ficial and in some communities medical evidence to this effect was
quoted. Some of the men observed, however, were decidedly pale
and a few were short of breath, an impairment acquired since enter­
ing the plant.
L I M E D U ST AN D P U L M O N A R Y T U B E R C U L O S IS .

The relation of lime-dust inhalation and pulmonary tuberculosis
was investigated by Reckzeh, who, according to a brief statement
in the Medical Record for December 5, 1903, concluded that—
The statistics in lime-producing districts show that pulmonary
tuberculosis is rare, and that sometimes when present its course is
favorably affected. Various authors ascribe this beneficial effect to
different features attending the occupation of lime burning. Such
are, an effect of the inhaled lime dust in facilitating calcification of
the suppurating foci, the dryness of the inhaled air, and the deeper
respiration it makes necessary, the warmth of the inspired air which
contains no tubercle bacilli, and the more active metabolism it causes.
In order to determine the effect of the lime dust suspended in the air
the author caused eight tuberculous patients to inhale air charged




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

219

with the dust by striking suspended bags filled with powdered lime.
At first the inhalations were carried on for five minutes daily, but the
time and frequency were gradually increased. The results were with­
out encouragement, no improvement in the pulmonary condition was
noted, while there were marked undesirable secondary effects, such
as headache, loss of appetite, and nausea.
R E L A T I V E IN F R E C lU E N C Y OF R E S P IR A T O R Y D IS E A S E S .

Selkirk subsequently investigated the same problem by personal
inquiry among lime workers with special reference to the prevailing
opinion that as a class they were exceptionally free from bronchitis
and pulmonary tuberculosis. According to the Journal of the Amer­
ican Medical Association, for December 12, 1908—
He was unable to find an instance of phthisis among them, nor
could he learn on inquiry ot any worker in limekilns having died
from tuberculosis. He asks whether those who inhale and swallow
much lime are abnormally free from tuberculosis of the lungs. He
discusses what is known of the therapeutics of calcium salts, and says
it appears that the continued absorption of calcium from the lungs
and intestines might maintain an abnormally high percentage of it
in the blood. He suggests that the workingman predisposed to tuber­
7
culosis might turn his attention to lime and cement w
rorking as an
occupation, and even hints at the organization of lime works as a
curative tuberculosis, colony. A rapid increase of weight is com­
monly observed in new workers at the Warren Cement Works, at
Hartlepool.
G E N E R A L C O N C LU SIO N S.

The same authority is also quoted, but in another statement, that
he found the health of workers in limekilns above the average, and
that there seemed to be far less than the normal amount of pulmonary
tuberculosis and bronchitis. He therefore concluded that—
It- is believed that the lime inhaled is dissolved by the carbonic
acid in the lungs and absorbed. Calcium in the intestinal canal pre­
vents fermentation. Lime-dust particles may, however, be deposited
in the lungs. It may be that continual absorption of calcium from
the lungs and intestine may maintain an abnormally high percentage
of it in the blood. The author asks. Does this occur in the lime
worker, and is it preventive of tuberculosis in him? Or is his free­
dom due to the external lime dust being unfavorable to the life and
growth of the bacillus outside of the body? It seems curious to sug­
gest an atmosphere of dust for the treatment of tuberculosis; it would
T
have been as curious some generations ago to have suggested fresh
air. At the least, have we not in this lime and cement working an
T
occupation which we may recommend to the workingman predis­
posed to tuberculosis or already in the early stages of it? Or could
the neighborhood of a limekiln be organized as a curative tubercu­
losis colony?
These observations arrived at by conservative medical investigators
seem to sustain the generally favorable conclusions concerning the
relative noninjuriousness of lime dust with special reference to pul­




220

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

monary tuberculosis. As a technical problem the lime industry offers
exceptional opportunities for the- ascertainment of urgently required
information concerning the differential effects of mineral dusts in
their relation to health and longevity and possibly even concerning
the therapeutic value of lime dust as intimated by the rather limited
investigations of Reckzeh and Selkirk.

An excellent descriptive account of 4 Lime: Its properties and
4
uses” has been published as a circular of the United States Bureau
of Standards of the Department of Commerce and Labor (Wash­
ington, 1911). This account precisely emphasizes all the essential
preliminary scientific considerations necessary for a thorough under­
standing of the underlying conditions which concern the health of
workers in occupations, trades, or industries more or less injurious
to health and life. The account includes a description of the method
of lime manufacture, definition, and classification, followed by a
description of general properties and an extended account of the
uses of lime and the various kinds of limestone, lime, and hydrated
lime in the chemical industries, including natural cement, sand-lime
brick, glass, bleaching powder, fertilizer, etc. The classification of
limestones according to their physical properties, as to whether hard
or soft, porous or dense, coarsely crystalline or fine grained, implies
probably widely differential results in health-injurious consequences,
proportionate, of course, to the continuity and amount of dust ex­
posure. Limestone, when metamorphosed—that is, when recrystal­
7
lized after deposition through the agency of heat—is known as
“ marble,” which by inference suggests that marble dust in all prob­
T
ability is not as serious in its consequences as granite dust and
possibly sandstone dust, both of which contain a larger proportion
of pure silica.
Some exceptionally interesting observations on dust exposure in
the working of oolitic limestone on the Isle of Portland, England,
contributed by Dr. Howard to the annual report of the chief in­
spector of factories and workshops (1913), include statistical observa­
tions for the 13-year period ending with 1912. The mortality from
phthisis per 1,000 living was, among general laborers, 1.9; among
stone quarriers, 1.5; among stone masons, 1.4; and among all other
males, 1.1. Corresponding statistics are those of Barwise for Derby­
shire, elsewhere referred to, according to which the death rate of
persons employed in gritstone quarries was 13.7, against 1.2 for lime­
stone workers. A brief reference is made in the discussion to an ad­
dress by Dr. Collis on the “ Effects of dust in producing diseases
of the lungs,” read at the Seventeenth International Congress of
Medicine held in London in August, 1913, in which after the effects
of dust on those employed in various industries had been cited, the
following conclusions were advanced:




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

221

1. Inhalation of all forms of dust is accompanied by diminished
power of chest expansion.
2. Diminished power of chest expansion so produced is accom­
panied by high blood pressure.
3. Animal dusts, apart from the presence in them of pathogenic
microorganisms, when inhaled, produce less effects than do vege­
table and mineral dusts.
4. Vegetable dusts, when inhaled, tend to produce a type of chest
affection best described as asthmatic.
5. Of mineral dusts, those composed of calcium salts are least
injurious.
6. Inhalation of mineral dusts which do not contain free silica
tends to produce irritation of the upper air passages and respiratory
diseases other than phthisis.
7. Inhalation of mineral dusts which contain free silica is associ­
ated with an excess of phthisis, an excess which bears a direct rela­
tion to the amount of free silica present.
8. In general, dusts appear to be more injurious as their chemical
composition differs from that of the human body or from the ele­
ments of which the body is normally composed.
Of the foregoing observations the conclusion that of mineral dusts
those composed of calcium salts are least injurious is, of course, of
special significance, in view of the preceding discussion regarding
the health of lime workers, which it is regrettable could not be ampli­
fied by other American or foreign vital statistics of a sufficiently
trustworthy character.
PLASTERERS.

The building trades are all more or less exposed to the inhalation of
mineral dust, the injurious effects of which are probably most severe
in the case of plasterers, masons, and allied occupations. This group
of occupations is not clearly defined, since many plasterers are also
masons, or bricklayers, while others are whitewashers or paper
hangers. The English vital statistics combine plasterers, white­
washers, and paper hangers.
E A R L Y O B SE R V A T IO N S ON T H E H E A L T H OF P L A S T E R E R S .

The health conditions in this trade w
rere commented upon by
Ramazzini, who, in the quaint language of the day, states that “ Lime
afid plaster are likewise offensive to those who burn them or handle
them, or sell them,” and he continues: “ I have frequentty observed
that those who boil, prepare, grind, sift, or sell it, do usually labor
under a difficulty of breathing.” As a safeguard, Ramazzini points
out that: “ Though such workmen have a cover for their mouth, they
can not avoid receiving the flying particles at the mouth and nose,




222

MORTALITY FROM RESPIRATORY DISEASES I3 T DUSTY TRADES.
S

upon which these particles enter the passages of respiration and mix
with the lymph, rise up in hard, chalky concretions, or by daubing
the winding passages of the lungs intercept freedom of breath. I
. found that such as continued in this business did die asthmatic
and cachetik.” He refers also to a still earlier author, Morton,
who connected the. inhalation of the dust with pulmonary tuber­
culosis. He concludes his observations with the statement that:
“ Care must be taken to observe the caution laid down above, with in­
tent to guard the mouth as much as possible from receiving the
offensive particles.” All this was written more than 200 years ago !

Thackrah, writing in 1832, took a more favorable view of the employment, holding that bricklayers and. their laborers, while par­
ticularly exposed to lime dust, suffered from diseases of the eye and
cutaneous eruptions, but not from internal disease, and he quotes
an adage common to the workmen in the trade of the period, that
T
“ bricklayers and plasterers’ laborers, like asses, never die.” Re­
garding plasterers and whitewashes, who are also exposed to lime
dust, he states: “ They suffer from no sensible injury,” and that
“ they are more pallid and less robust than bricklayers.” Thackrah,
however, did not support his observations with trustworthy data.
E N G L IS H M O R T A L IT Y D A TA .

The most recent English mortality statistics of plasterers and
paper hangers are for the three years ending with 1902, referred to
in the Supplement to the Sixty-fifth Annual Report of the RegistrarGeneral, in part as follows:
Between the ages of 35 and 65 years the death rate in this industry
exceeds the standard for occupied and retired males, while at ages
outside of these limits the rates are below it. In the main working
period of life the comparative mortality figure is 1,018, or within 1
per cent of the standard. The mortality from alcoholism and liver
disease, from phthisis, from respiratory diseases, and from cancer
slightly exceeds the standard, and except that these workers appear
to suffer but little from influenza, the figures for other diseases agree
closely with the average.
The English occupation mortality statistics for plasterers are
somewhat impaired in value by the fact that paper hangers and
whitewashers are combined with this occupation, but the statistics
may safely be accepted as indicating with approximate accuracy a
higher disease liability of men in this employment to pulmonary
tuberculosis and respiratory diseases. In Table 84 the mortality
from all causes among men in this group is compared with that
of occupied males generally, and the result is rather suggestive
of conditions in this trade more or less unfavorable to life and health.
The excess in the general mortality occurs at ages 35 to 64.
when the death rate of plasterers from all causes exceeds the mor­




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST1
.

223

tality of occupied males generally by from 1.30 to 1.52 per 1.000.
The mortality of the group is, however, below the average at ages
under 35 and at 65 years or over.
T a b l e 8 4 .— M O R T A L IT Y

FROM A L L CAUSES AM ONG P L A ST E R E R S, P A P E R H A N G E R S,

A N D W H I T E W A S H E R S , C O M P A R E D W I T H T H A T O F A L L O C C U P IE D M A L E S , I N E N G ­
L A N D A N D W A L E S , 1900 T O 1902, B Y A G E G R O U P S .
[Source: Part I I , S up p lem ent to the S ix ty -fifth A n n u al R ep ort of the R egistrar-General of B irth s, D e a th s,
an d Marriages in E n g la n d an d W a le s.]

D e a th rate for plasterers, paper
hangers, and whitew ashers.
D e a th rate
per 1,000
for all occu­
pied males.

A g e at death.

15
20
25
35
45
56
65

to 19 ye ars.................................................. .. ......................................
to 24 ye ars............................................................................................
to 34 y ea rs............................................................................................
to 44 y e a rs............................................................................................
to 54 y e a rs............................................................................................
to 64 years............................................................................................
years and o v e r ...................................................................................

2.44
4. 41
6.01
10.22
17.73
31.01
88.39

Greater ( + )
or less ( — ) Per cent of
than rate
rate for all
for all oc­
occupied
cupied
m ales.
males.

R a te per
1,000.

1.52
3.44
4.07
11.52
19.18
32.53
72.18

- 0 .9 2
.97
- 1.94
+ 1.30
+ 1.45
+ 1.52
-1 6 .2 1

62
78
68
113
108
105
82

The preceding table requires no further comment, except that it
confirms the view that the health-injurious effects of this employment
are not so pronounced as in many other dusty trades, particularly
such occupations as stonecutting, pottery manufacture, and glass
blowing. In Table 85 the mortality of plasterers, paper hangers, and
whitewashes from pulmonary tuberculosis is compared with the
normal mortality of occupied males from this disease by divisional
periods of life.
T able 8 5 . — M O R T A L I T Y F R O M
PAPER HANGERS, AND

PULM ONARY

T U B E R C U L O S IS

W H IT E W A S H E R S , C O M P A R E D

P IE D M A L E S , IN E N G L A N D

AND

AM ONG

W IT H

THAT

W A L E S , 1900 T O 1902, B Y A G E

PLASTERER S,
OF A L L

OCCU­

GROUPS.

[Source: P art I I , S up p lem ent to th e S ix ty -fifth A n n u a l R ep ort of th e R egistrar-G eneral of B irth s, D eaths
an d Marriages in E n g la n d a n d W a le s .]

D ea th rate for plasterers, pa^er
h a n g e rs,a n d w hitew ashers.

A ge at d eath .

1 to 1 7 e a rs............................................................................................
5 9
‘'O to 21 yea rs.............................................................................................
21 to 34 y e a rs.............................................................................................
3 to 4 y ea rs. . . ..................................................................................
o 4
4 to 5 vears.............................................................................................
5 4
5 to 6 v e a rs............................................................................................
5 4
£ years and o v e r....................................................................................
5




D eath rate
per 1,000
for all occu­
pied m ales.

R a te per

1,000.

!
Greater ( - f )
or less ( — ) j Per cent of
rate for all
th a n rate
occupied
for all oc­
cupied
m ales.
m ales.

0.54
1.55
2.03
2 74
.
3.04
2.16

0.41
1.06
1.22
3.98
3.62
4.01

—
0.13
— .^9
— .81
+1. 24
+ . 58
+1 8
. 5

7
6
6
S
60
15
1
19
1*8

1.11

1.53

+

138

.4 2

224

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.
R E C E N T A M E R IC A N IN V E S T IG A T IO N S .

The most recent investigation into the existing health conditions is
by Balentine C. Baker, M. D., published in the Journal of the Ameri­
can Medical Association for May 6, 1916. The results of this investi­
gation, made in connection with the Cornell University Medical
College, are, in part, stated as follows:
In the work of the plasterer there is exposure to dust, cold, and
dampness. The source of the dust is from the plaster, which is
usually composed of lime, sand, and hair moistened. Anyone at all
familiar with the work of a plasterer knows what dust there is when
the dried plaster is crumbled loose by walking, moving of objects,
and sweeping. The drafts of air through the open doors and win­
dows fill the atmosphere with dust, and this the worker has to
breathe. There is some controversy among investigators as to the
danger of lime to workers. Selkirk was unable to find any instance
of phthisis among them,, nor could he learn of any worker in lime­
kilns having died of tuberculosis.
The special investigation included 36 cases of plasterers under
treatment as patients at the hospital referred to, and of this number
17, or 47.2 per cent, were over 40 years of age. It is said in con­
clusion that—
The respiratory tract of the plasterers is chiefly affected as in the
preceding trades, there being 13 patients in this class. Seven patients
had chronic and 6 acute respiratory disease. Three patients had
pulmonary tuberculosis, 3 chronic bronchitis, 2 emphysema, 2 acute
bronchitis, 3 dry pleurisy, and 1 acute pharyngitis.
These observations are suggestive of nontuberculous respiratory
rather than of tuberculous affections, but the number of cases under
observation is too limited for a conclusive generalization.
M E T H O D S OF P L A S T E R OF P A R I S M A N U F A C T U R E .

A clear distinction, of course, must be drawn for practical
purposes between the manufacture of plaster of Paris and the occu­
pation of plasterer. The former includes the crushing of raw ma­
terial, employment at rotary driers, and the so-called “ dust room,”
with supplementary methods of bowl crushing .to a condition of
minute fineness on buhrstones, and finally calcining in kettles with the
terminal processes of handling through hoppers, bins, and conveyers.
No conclusive investigations have been made with regard to the
specific dust exposure in these processes and their relation to health,
but W. Gilman Thompson writes of the occupation of masons and
plasterers at some length, including concrete mixers, who, of course,
T
are exposed to fundamentally different conditions. He points out that
men in this group of employments inhale much dust of tile, brick, plas­
ter of Paris, gypsum, and cement, and that they are subject from these




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

225

combined conditions “ to catarrhs of the respiratory passages, and
such diseases as asthma, bronchitis, rhinitis, and atelectasis are fre­
quently met with among them.” There would seem to be much simi­
larity in the dust exposure of these occupations to that observed in
the case of lime and cement workers. The exposure to dust of this
character is most serious in connection with house-wrecking opera­
tions, where heavy clouds of masonry and plaster dust are generated
and inhaled in connection with particularly laborious work. Thomp­
son suggests, therefore, that in some cases, as in the tearing down of
old plaster in confined spaces, in tunnels, etc., where sprinkling can
not be resorted to, respirators may be used to advantage.1
M O R T A L IT Y OF P L A S T E R E R S — U N IT E D S T A T E S R E G I S T R A T IO N A R E A .

The mortality of plasterers has been reported upon for the years
1908 and 1909 by the Division of Vital Statistics of the United States
Census Bureau, but for the year 1908 the group includes whitewashers, who, of course, are engaged in a closely allied employment.
According to the census report, out of 9TT deaths of plasterers from
all causes, 163, or 16.7 per cent, were from pulmonary tuberculosis.
The details of the mortality by divisional periods of life are shown in
Table 86.
8 6 . — P R O P O R T IO N A T E
M O R T A L IT Y OF P L A S T E R E R S FR O M
TU B E R C U L O SIS , U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1908 A N D
GR O U PS.

T a b le

PU LM ONARY
1909, B Y AGE

Deaths from pulm onary
tuberculosis.
Age at death.

Deaths
from all
causes.

Number.

P ercent
of deaths
from all
causes.

15 to 24 years..................................................................................................
25 to 34 years..................................................................................................
35 to 44 years..................................................................................................
45 to 54 years..................................................................................................
55 to 64 years..................................................................................................
65 years and over . , .......................................................................................
Age unknown ...................................................................................

48
108
177
189
205
249
1

12
34
61
31
16
9

25.0
31.5
34.5
16.4
7.8
3.6

Total, 15 years and o v er....................................................................

977

163

16.7

1
T he d u st exp osu re in the m aking o f p la ster ca sts m ust he quite con sid era b le on
a cco u n t o f th e close co n ta c t w ith the m ateria l d u rin g e ve ry o p e ra tio n fro m the
m ak in g o f the m old s to the finished p roduct.
E xp osu re is p ro b a b ly m ost serious in the
scra p in g d ep a rtm en t, w h ich is sh ow n by illu stra tio n m a d e scrip tiv e a cco u n t on “ T h e
m ak in g o f ca sts in gela tin m old s,” by W . F ra n k M cC lure, pub lish ed in the S cien tific
A m erican fo r June 20, 1908. T h e w ea rin g o f fa ce p ro te cto rs is n ecessary in th is d e p a rt­
m ent. T h e o b je c t o f the s cra p in g is the rem ova l o f the m old seam an d o th e r u n av oid a b le
d efects. M ost o f the dust exposure, how ever, resu lts fro m the sca tte re d m aterial w h ich
d ries and is subsequently b low n a bou t. H ow fa r th is em p loy m en t is as a m atter o f fa c t
rea lly h e a lth -in ju rio u s and a p red isp os in g cause t o re s p ira to ry diseases, w h e th e r p u l­
m on a ry o r oth erw ise, has n o t been a scerta in ed .

106811°— 18— B ull. 231-------15




2 26

M O R TAU TY PROM RESPIRATORY DISEASES IN DUSTY TRADES.

8 7 .—P R O P O R T IO N A T E M O R T A L IT Y OF P L A S T E R E R S F R O M N O N T U B E R C U ­
LO U S R E S P I R A T O R Y D ISE A SE S, U N IT E D ST A T E S R E G IS T R A T IO N A R E A , 1908 A N D
1909.

T able

Deaths from nontuber­
culous respiratory dis­
eases.
Cause of death.
Number.

Per cent
of deaths
from all
causes.

I) r ^nchitis_________________ _______ ________________________________________ ____
Pneumonia.................................................................... ................................... ...............
Other nontuberculous respiratory diseases...................................................................

3
11
79
11

0.3
1.1
8.1
1.1

T o t a l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... .

104

10.6

The proportion of deaths from pulmonary tuberculosis in this
occupation is fairly high, but not distinctly excessive, excepting at
ages 35 to 44, when the proportion is 34.5 per cent for plasterers,
against 24 per cent for all occupied males, according to data derived
from the same official sources. Aside from the mortality from pul­
monary tuberculosis, the mortality from nontuberculous respiratory
diseases was also about normal, having been 10.6 per cent for plas­
terers, against 10 per cent for all occupations, the slightly higher
proportionate mortality from nontuberculous respiratory diseases
being chiefly attributable to bronchitis; but the numbers under con­
sideration are hardly sufficient for entirely definite conclusions.
M O R T A L IT Y O F P L A S T E R E R S — IN D U S T R I A L IN S U R A N C E E X P E R I E N C E .

In this connection the statistics of the Prudential Insurance Co.
are of additional interest and value, in that they include 1,371 deaths
from all causes, of which 300, or 21.9 per cent, were from pulmonary
tuberculosis.
T able 8 8 .—P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O SIS A M ON G

P L A S T E R E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, COM­
P A R E D W IT H T H A T OF A L L M ALES IN U N IT E D S TA T E S R E G IS T R A T IO N A R E A , 1900
TO 1913, B Y A G E G ROU PS.

Deaths of plasterers,
1897 to 1914, from—

Per cent of-deaths from
pulm onary tubercu­
losis among—

Age at death.
A ll causes.

Males in
Pulmonary
tubercu­
Plasterers. registration
a re a ,1900
losis.
to 1913.

15 to 24 years............................................................................
to 34 vears.............................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and over.....................................................................

58
163
225
281
330
314

20
71
91
66
39
13

34.5
43.6
40.4
23.5
11.8
4.1

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over..............................................

1,371

300

21.9

13.9




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

227

According to Table 88 the proportionate mortality from pulmo­
nary tuberculosis is excessive among plasterers at every divisional
period of life, but particularly so at ages 25 to 34, when out of 163
deaths from all causes, 71, or 43.6 per cent are from pulmonary
tuberculosis, against 30.5 per cent in the male mortality of the regis­
tration area. How far this excess in the mortality from pulmonary
tuberculosis is the direct result of dust inhalation or due to contrib­
utory social and economic causes can not be stated at the present
time. Nor is it possible accurately to differentiate plasterers from
men employed in the manufacture of plaster of Paris and related oc­
cupations, but it may be said in conclusion that such investigations
as have been made of existing conditions at plaster works prove that
there is abundant room for material improvement, and that in most
of the plants only the crudest and most unsatisfactory appliances are
employed for the prevention of dust and its inhalation by the men
employed.
In this connection a brief reference may be made to an excep­
tionally valuable tabulation of industries with exposure to inorganic
dusts in relation to the mortality from pulmonary tuberculosis and
the presence of free silica in the dust, in the annual report of the chief
inspector of factories and workshops of Great Britain, for 1912
(p. 216). As regards plaster of Paris, it is said that the composition
of the dust is chiefly that of calcium sulphate and that free silica is
not present; also that the mortality from pulmonary tuberculosis is
not above the normal. A similar reference is made to cement, as
regards the composition of which it is said that the dust consists of
silicates of magnesium, calcium, and aluminum; that the percentage
of free silica is less than 1 per cent (as compared, for illustration,
with 30 per cent in granite dust and 75 per cent in quartz dust of
the tin mines of Cornwall); and, finally, that the mortality from
pulmonary tuberculosis is “ not above normal.” Attention is directed
to the fact that the connection between silica dust and phthisis is
now well established, and that it has led to the adoption of preventive
measures to suppress this dust when generated in the process of
sand-blasting glass for engraving purposes and in the production of
finely powdered flint and quartz. Free silica, however, as brought
out in this investigation, is not present in the dust of plaster of
Paris which on that account chiefly is relatively noninjurious as re­
gards predisposition to pulmonary tuberculosis. The most recent ob­
servations, in Kober and Hanson’s Diseases of Occupation and Voca­
tional Hygiene, regarding plasterers, are regrettably inadequate and
inconclusive.
CEM ENT WORKERS.

The health-injurious conditions of cement-making processes are
quite well understood, being not only the dust, but also the noxious




228

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

vapors which arise through the process of burning. The vapors
are probably more a matter of discomfort than injurious, but the
subject attracted sufficient attention to suggest an investigation by the
Royal Commission on Noxious Vapors in 1878.1 As a result of the
vapors and the dust generated during the processes, cement works,
as a rule, are now located outside of large cities.
G A S, F U M E , A N D D U ST E X P O S U R E I N C E M E N T -M A K IN G P R O C E S S E S .

The health conditions in American- cement works have never been
fully investigated, but it appears to be the consensus of opinion that
the effects are not as serious as assumed upon the facts of a casual in­
spection.2 Fatal accidents have occurred as the result of asphyxiation
by carbon-monoxide gas, but such cases are very rare. Cases of
gassing, so called, which do not terminate fatally, are said to be com­
paratively common. Arlidge considered the employment of cement
making at some length, pointing out that the workmen are exposed to
dust in an intense form, but experience would seem to prove that the
effect on health is not so injurious as expected. He states that the raw
materials of cement are clay with flint and lime, and he briefly de­
scribes the process of manufacture as follows:
After the materials have been well mixed and ground together in
a sort of mortar mill to the consistency of liquid mud, the next busi­
ness is to drive off the water by heat, and then to subject the dried
substance in tins to a still higher temperature. Later all the cement
is withdrawn and then ground between rollers to the requisite fine­
ness. The primary mixing and grinding, being done with a free sup­
ply of water, exhibits no insanitary conditions. In working the kilns
the workmen suffer from great heat and dust, but the most continu­
ous dusty work is in the mill, the air of which is clouded with cement.
Inquiry among the workmen elicited the fact that after a while they
become short of breath and suffer cough, though not in a high degree,
and that on arising in the morning they had to clear their chests by
expectorating viscid mucus containing cement dust.
Q U A N T IT A T IV E E X T E N T OF A T M O SP H E R IC P O L LU T IO N .

The amount of dust generated in cement-making processes is enor­
mous. The workmen take practically no precaution to avoid this
dust, and considerable quantities are of necessity inhaled. It is
very rare to find employees who use a respirator or even a piece of
1 R ep ort o f the R o y a l C om m ission on N oxiou s V ap ou rs, L o n d o n , 1878.
M inu tes o f
E vid en ce taken b efore the R o y a l C om m ission on N oxiou s V ap ou rs, L o n d on , 1878.
2 T h is co n clu sio n is m od ified by th e in v e stig a tio n s o f D r. T u ck er, o f R iv e rsid e , C al.
(see pp. 233 to 2 3 7 ).
T h e in v e stig a tio n s o f D r. T u ck e r a re a n o ta b le c o n tr ib u tio n to
the s u b je ct o f cem en t d u st in its re la tio n to hea lth , b u t th ey can n o t be co n sid e re d
e n tire ly co n clu siv e, in th a t the s ta tis tica l d a ta — eith er th a t secu red b y h im fro m lo c a l
s ou rces o r th a t d erived fro m in su ra n ce exp erien ce— are n o t su fficien tly re p re se n ta tiv e
o f th e A m erica n cem en t in d u s try w ith a due reg ard to lo c a l v a ria tio n s in co n d itio n s
in ju r io u s to h ea lth .




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

2 29

ordinary cloth to provide some protection against the health-inju­
rious conditions which surround them. The worst conditions are
probably in the sacking or packing department, where such pre­
cautions are occasionally adopted. Every department, however, is
filled with dust, and the avoidance of its inhalation by the majority
of employees is under present methods practically impossible. The
disease problem is complicated by a high degree of temperature in
some of the departments, in particular at the kilns. While many
descriptive accounts of the industry have been published, the hygiene
of the occupation has been generally ignored. Tracy refers to it
very briefly, holding that “ the workmen who make Portland cement
are greatly troubled by the dust caused by shoveling the mass intosacks after it has been burned and ground. They have a persistent
ceugh, and expectorate little lumps of cement. They find it impos­
sible to continue this part of their labor day after day, and are
obliged to take intervals of rest.”
P R O C E S S E S OF M A N U F A C T U R E .

Parry, in his Risks and Dangers of Various Occupations, refers to
cement workers as follows:
Those engaged in the manufacture and use of Portland cement are •
very liable to get the dust into their lungs. Portland cement is
made from some substance containing carbonate of lime, such as white chalk, existing in such immense quantities in this country, and
some material containing silica and alumina, such as a selected clay
or alluvial mud. These are ground together with water to a muddy
consistency, which is then dried by heating in chambers. This being
a wet process, no dust is raised, but during the next stage, the digging
out of the cement, a great deal of dust is created. The material
raised is then calcinated, ground between rollers, and finally packed
in bags. In the last two operations, the grinding and packing, much
dust is also scattered. The particles are of a sharp, irritating char­
acter, and therefore dangerous.
In Oliver’s Dangerous Trades the manufacture of cement from
a hygienic point of view is briefly discussed and illustrated by a
microphotograph of cement dust by Migerka. Oliver’s description
is as follows:
Under the microscope are seen a few sharp-edged little plates and
amorphous masses like small clumps. The particles are not of them­
selves so dangerous as might at first sight appear. Although cement
workers suffer from pulmonary disease, they do not do so to the great
extent that might be expected. Probably the harmful effects are
largely due to the hygroscopic character of the particles and their
alkaline reaction.
M E D IC A L O B SE R V A T IO N S ON C E M E N T D U ST.

The cement industry has also been reported upon by Hayhurst
with special reference to conditions in Ohio, including, however, only




230

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

two plants, employing a total of 98 men. It is stated that the work
was found to be very dusty and dirty and that the quarters in one
place were seldom cleaned. It is, of course, a foregone conclusion
that it is practically impossible to keep a cement plant in a thor­
oughly clean condition while in active operation, since the product
itself is the dust which permeates practically every part and por­
tion of the plant. According to Hayhurst, the dust is comx^osed of
“ cement, lime, silica, and powdered coal,” and thus far practically
no method has been evolved for the control of the dust menace. Heat
was found to be intense for some of the workers and there was prac­
tically no protection adopted against it. This, of course, applies to
the calcining furnaces, which do not essentially differ from converting
furnaces generally. The medical observations are to the effect that
there was great opportunity for contracting communicable diseases
because of promiscuous spitting, absence of cuspidors, and the dust
flying about. It was also noted that the cement dust tended to cake
in the nose and that same was more or less contaminated by the dust
of pulverized coal, which of course would probably not be a condition
common to cement plants generally. The observations can not be
considered conclusive in view of the very limited range of the
inquiry.
,
On account of the truly enormous extent of the development of the '
cement industry during recent years, general conclusions should
be accepted with extreme caution. Descriptive accounts of plant
conditions vary widely, and for a thorough understanding of the con­
ditions inimical to health a much more extended investigation is
required than has thus far been made In the special account of the
cement industry of the State of Kansas, prepared in connection with
the St. Louis Exposition, 1904, occurs a concise statement of the lola
Portland cement plant, which sets forth the general processes and
conditions with admirable brevity, as follows:
The materials used in the manufacture of the cement are a very
pure limestone nearly free from magnesia, a clay with about 75 per
cent of alumina, and silica. One thousand tons of rock are used
every 24 hours. These substances are mixed in the proper propor­
tion and then ground in a large rock crusher, which takes blocks as
large as a man’s hand and has a capacity of 15 tons per hour. The
gravel from these crushers then passes into a dryer heated by natu­
ral gas, where it loses 6 per cent of water, or 60 tons a day passing
off as steam. Next the gravel is ground in 21 Griffin mills, which
grind 2 tons an hour, or 48 tons per day, to a fine flour which will
pass through a 100-mesh sieve of 10,000 holes to the square inch.
This flour is then conveyed to the 15 agitators, large cylinders hold­
ing 90 cubic yards each, and it is thoroughly mixed in water by
revolving propellers.
When the material is thoroughly mixed to the satisfaction of the
chemist it is carried into 21 rotary kilns. These are cylinders lined




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

231

with fire brick and are 6 feet in diameter. They are in constant
rotation and inclined downward slightly toward the gas-heated end,
where the temperature reaches over 3,000° Fahrenheit. Each kiln
has a capacity of 160 barrels in 24 hours. The mixed flour mate­
rials pass out of the kiln in the form of a hard clinker, which is
carried by elevators over into the cooling room. When cooled, the
clinker is placed in a second set of Griffin mills, 21 in number. Each
one of these grinds 9 barrels (or 3,420 pounds) in an hour to a fine
flour. The finished cement now passes over into the storage room,
where it is run into barrels or sacks.
C O M P A R A T IV E D U ST H A Z A R D S I N T H E D R Y A 1TD W E T P R O C E S S E S .

The manufacturing processes have also been described by Mr. John
Calder, chief inspector of special risks for the Canadian Fire Under­
writers’ Association, who points out at the outset that there are two
methods, generally known as the dry and the wet system, which natu­
rally involve processes and conditions quite varying in their effects
on health and longevity. The dust danger in the dry process is, of
course, most serious, particularly in connection with the crushing,
mixing, and grinding briefly described as follows:
The limestone being received at the mill passes through a jaw
crusher. It then goes through rolls for a further reduction and is
elevated to storage bins. From the storage bins the rock goes to the
rock driers; these usually consist of metal cylinders from 40 to 60
feet long and 5 to 6 feet in diameter, with flanges inside and placed
horizontally with a slight inclination and revolving on roller bear­
ings. These driers are usually heated by a coal furnace or by waste
gases from the rotary kilns. The shale or clay is treated in a similar
manner, the whole going to the raw-stock bins. From these the two
materials are drawn and mixed, usually by automatic mechanical
mixers taking in the proper proportions required from an analysis
of the materials. The further reduction of the mixture is done by
two grindings, the first usually in the Ball Griffen or “ Kominuter ”
mills and the latter in ,the tube mill. The stock is then conveyed to
the raw-stock bins ready for burning.
W. Gilman Thompson has described the dust exposure in cement
manufacture, with special reference to American conditions, observ­
ing in part that—
In the crushing and drying rooms where the limestone is first
treated, and in barreling or bagging, the workmen are exposed to
risk of bronchial and pulmonary irritation as well as to irritation
of the skin and conjunctivae. In the better class of mills the crush­
ing and grinding machinery is inclosed and connected with aspirat­
ing ducts or hoods through which the dust is drawn to settling rooms
where it is filtered or precipitated with water. The packing in sacks
for transportation is sometimes also done by machinery. The work­
men frequently further protect themselves by binding thin cloths
over the nose and mouth or by wearing respirators. They often com­
plete the filling of the sacks by adding a few handfuls of cement to




232

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

make up the full weight, thereby scattering much dust and irritating
the hands. Cleaning out the clinkers from the ovens in which the
raw material has been roasted subjects the workmen'to dry heat as
well as coarse dust.
Regardless of even the most satisfactory precautions a consider­
able amount of dust exposure in cement plants is practically unavoid­
able. In plants in which insufficient attention is paid to dust pre­
vention the quantity of dust exposure is enormous. As observed by
W. Gilman Thompson in this connection:
Upon the whole, in proportion to the quantity of dust inhaled,
cement dust, like coal dust, produces less damage to the respiratory
system than might be supposed—less than the harder, sharper flint
or glass dust, although chronic bronchitis, asthma, and pneumo­
coniosis may result from it. It causes considerable itching in the
nose, to relieve which the workmen put their dusty fingers into the
nose and scratch the septum. This only increases the trouble, and in
some cases ulceration with perforation of the septum occurs, as in
chromic-acid poisoning. Workmen with sensitive skins sometimes
scratch the dusty skin so that ulcers form which are so slow in heal­
ing that they may be compelled to change their work. The cement
dust mixes with the perspiration of the skin and gives rise to a gen­
eral pruritus which the workmen call “ cement itch.”
S P E C IF IC O CC U PA T IO N A L D IS E A S E S .

Cement makers’ itch is a new disease, apparently neither para­
sitic nor contagious, but produced by the chemical or mechanical
action of the cement upon the skin. According to a brief discussion
in the Medical Times (October, 1909) —
Some physicians have attributed the corrosive action to Calcium
carbonate and to sulphuric acid. Fresh cement, however, does not
contain calcium carbonate; and it is questioned whether slacked lime
or even partly slacked lime will produce this effect, for masons work­
ing with lime mortar are seldom if ever attacked with cement
makers’ itch. The quantity of sulphuric acid in cement is very small.
Possibly the effect may be explained by mechanical friction between
the skin and very fine but hard particles of cement. Briquette
makers, observes Scientific American, are subject to a similar but less
serious annoyance. Cement makers’ itch and ordinary itch have one
sympton in common—intense itching, especially at night. The itch­
ing appears to be increased by the heat of the bed, and is also more
annoying in summer than in winter. Scratching may produce in­
fected wounds and swelling. Cement makers’ itch is an occupational
disease; true itch is seldom such. The latter can be cured compara­
tively easy; but not so cement makers’ itch, which is likely to be
followed by eczema and other complications. The managers of
cement works should always require their workmen to wear cotton
gloves and garments tightly fastened at the neck and at the wrists.
Cement workers on arches or ceilings should wear masks. Both
gloves and masks should frequently be washed.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

233

The reference is of some importance in connection with the still
debatable question as to whether cement dust is or is not, at least in
rare industrial cases, really seriously injurious to health.
E F F O R T S A T R E S T R I C T I V E L E G IS L A T IO N .

Under date of January 14, 1913, a bill was introduced into the
senate of the State of California providing for the protection of the
health of persons employed in the manufacture, packing, or handling
of Portland cement, as follows:
The people of the State of California do enact:
S e c t i o n 1. In any fa c to ry or oth er place in the State, w here P ortla n d cem ent
is m an u factu red , packed, or handled provision shall be m ade fo r p reven tin g the
escape o f cem ent dust into the atm osphere o f any room or com partm ent w h ere
p eople are em ployed.
S e c . 2. T h e pa ck in g o f P ortla n d cem ent shall be ca rried on in com partm ents
w hich shall be separated by d u st-p roof w alls, floors, and pa rtition s fro m a ll
oth er parts o f the fa c to ry or establishm ent w h ere people are e m p loy ed ; and
all co n veyors and eleva tors used fo r the con veyan ce o f P ortla n d cem ent shall
be in closed in m etal or som e oth er d u st-p roof m aterial.
S e c . 3. A ll P ortla n d cem ent m a n u fa ctu red in the State, or im ported from
any oth er State or foreign cou n try shall be packed in d u st-p roof containers, and
the com m issioner o f th e bureau o f labor statistics shall h ave the p ow er to issue
ord ers to prevent the loa d in g or u nloadin g o f any P ortla n d cem ent in or fo r
any vessel in any p ort in the State o f C a liforn ia or in or fo r any fre ig h t cars,
or any ra ilro a d or ra ilw a y in the State o f C a liforn ia if such P ortla n d cem ent is
n ot pack ed in a d u st-p roof c o n ta in e r ; and any person, firm , or corp ora tion w h o
shall disobey such ord er shall be gu ilty o f a m isdem eanor.
S e c . 4. A ll con tra cts entered in to by this State or any p olitica l su b d ivision
th ereof, fo r the pu rch ase o f P ortla n d cem ent or oth er like com m odity or fo r the
con stru ction o f p u b lic w ork w hich requires the use o f P ortla n d cem ent, shall
con ta in a p ro v iso th at all cem ent to be fu rn ish ed in the con stru ction o f such
p u b lic w o rk shall be packed in du st-p roof containers.
S e c . 5. A n y person, firm, or corp ora tion w ho shall viola te or fa il to com ply
w ith the p rovision s o f this act shall be gu ilty o f a m isdem ean or and shall, u pon
co n v ictio n th ereof, be pu nished by a fine o f not less than $50 or m ore than
$200, or by im prison m en t fo r not m ore than 60 days, or b y both such fine and
im prisonm ent.
S e c . 6. T h e com m issioner o f the bureau o f la b or statistics shall en force the
provision s o f this act.

E X P E R IM E N T A L M E D IC A L R E S E A R C H .

The bill has been included in its entirety as an illustration of con­
templated legislation intended to correct an evil of a more or less
debatable degree of seriousness by means practically equivalent to
the destruction of the industry concerned. The contemplated bill in
California led to perhaps the most thorough investigation of the
health conditions in a dangerous industry ever made in the United
States. The passage of the bill would have involved such serious
financial considerations to the cement manufacture of California that




234

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

all the available information on the subject was brought together at
the hearing held for the purpose, subsequently amplified by animal ex­
perimentation, etc., under the direction of Dr. George E. Tucker, in
behalf of the Riverside Cement Co.1 A brief was presented by Dr.
Tucker, which includes a review of the literature on the subject,
the results of the original investigation, including hospital records,
anthropometric data, physical examination of employees, with ref­
erence to time employed and dust exposure, etc. The investigation
was extended to include an original inquiry into the records of Cali­
fornia public hospitals and other public institutions for the purpose
of ascertaining whether an undue number of patients were being
treated on account of tuberculosis possibly contracted in the cement
industry, but the evidence was quite negative. The evidence of Dr.
Tucker was subsequently presented in the form of a brief discussion
on the “ Physical examination of employees engaged in the manu­
facture of Portland cement,’’ read before the American Public Health
Association in 1914. Dr. Tucker presented a typical analysis of
the raw mix or crude material which enters into the composition of
cement, as follows: “ Silica, 15.18 per cent; iron alumina oxide, 5.06
per cent; calcium carbonate, 76.34 per cent; magnesium carbonate,
2.90 per cent; undetermined, 0.52 per cent.” In contrast to the fore­
going, the finished cement shows the following analysis: “ Silica,
22.98 per cent; iron alumina oxide, 8.80 per cent; lime, 63.10 per
cent; magnesium oxide, 2.42 per cent; sulphuric anhydride, 1.42 per
cent; loss on ignition, 0.52 per cent; undetermined, 0.69 per cent.”
The difference in the silica content is of considerable practical im­
portance, as well as the very high proportion of lime, which, of
course, is readily soluble. Tucker quotes Kehmann, of Wurzburg,
to the effect that investigations have demonstrated that “ most in­
spired dust finds its way into the stomach and not into the lungs; and
most of the dust which enters the upper respiratory tract is caught
by the moist mucous membranes of the nose and throat and the dust­
laden secretion is then swallowed.” It is further stated that—
In the case of insoluble particles the gastrointestinal path may
furnish a most satisfactory channel for the consequent elimination of
the dust from the body, but soluble dust finds a peculiarly favorable
1 A c c o r d in g to a re p o rt m ade to th e S ta te D ep a rtm e n t b y C onsul G en eral J o h n P.
B ra y, o f S ydney, jtfew S outh W ales, a la b or co n tr o v e rs y has d evelop ed b etw een th e loca l
cem en t m a n u fa ctu rers and the w h a r f la borers a t S yd ney o ve r the h a n d lin g o f cem ent in
l>at?s, th e d u st from w h ich , it w a s cla im ed by th e la b ore rs, w a s in ju rio u s to health .
On
a cco u n t o f a v ir tu a l refu sa l t o ha n d le b agged cem en t in a fo rm in v o lv in g co n sid e ra b le
c'.ust exp osu re it is sta ted th a t th e lo ca l cem en t com p a n y, w ith an a p p ro x im a te ou tp u t o f
.jG.0 00 bags p er w eek, m ade a tria l sh ip m en t o f cem en t in bags lin ed w ith paper, but it
‘
w as fo u n d th a t th e co s t o f su ch bags w a s p r a c tic a lly p ro h ib itiv e , a n d th a t effo rts w o u ld
be m ade to h a ve th e bags p rod u ced b y m ach in ery at a m ateria l re d u ctio n in co st. N o
evid en ce is a va ila b le as regard s th e su ccess or fa ilu re o f th is exp erim en t o r w h eth er a
con tin u ed refu sa l t o h a n d le cem ent in o rd in a ry b ags has led to fu r th e r la b o r difficulties,
I t is p oin ted ou t, h ow ever, th a t sin ce paper bags are p rod u ced w h ich a re im p e rv io u s to
coa l d u st it sh ou ld n ot be im p ossib le to p rod u ce b ags im p e rvio u s to cem en t d u st.




OCCUPATIONS W IT H EXPOSURE TO MINERAL BUST.

235

chance for absorption along the same route, and the opportunity for
chronic intoxications is thus easily established. In any event, the
lungs escape the major part of the initial irritation.
CHEMICAL ASPECTS OP CEMENT DUST IN RELATION TO DISEASE.

The application of this conclusion to the cement-dust problem is of
exceptional practical importance. It is pointed out by Dr. Tucker
that it would appear that, since the principal ingredient of cement is
lime in the form of calcium oxide, undoubtedly this material is dis­
solved in the stomach and converted into lime water, which must be
considered to be without injurious effects, since the hydrochloric acid
of the stomach would undoubtedly be able to convert the oxide into
the chloride, and that this material can be ingested in large quanti­
ties over long periods of time without ill effects. Laboratory tests
show, according to Tucker—
That 99.7 per cent of five-tenths of a gram of cement is soluble in
500 c. c. of a one-tenth per cent solution of hydrochloric acid, and 99.7
per cent of five-tenths gram of cement is soluble in 250 c, c. of a twotenths per cent solution. The average per cent of hydrochloric acid
varies from one-tenth to two-tenths per cent in the gastric juices of
the normal stomach. Similar experiments conducted in the labora­
tory, using the so-called treater dust, or dust which escapes from the
stacks of the kilns heated to 800° C., showed that 81.44 per cent of
five-tenths of a gram was soluble in 100 c. c. of a one-tenth per cent
solution of hydrochloric acid. This solution became neutral when
reaction was complete.
MECHANICAL ASPECTS OF CEMENT DUST IN RELATION TO DISEASE.

These conclusions are important not only to the cement industry
but to many similar employments involving a continuous and con­
siderable inhalation of mineral dust. There have been no other ex­
tended studies of this aspect of the dust problem, although the results
would be of much practical value to the industries concerned. Ap­
parently strictly scientific and impartial investigations in California
public institutions, as well as among the employees of the Riverside
Cement Co., show a remarkable rarity of pulmonary tuberculosis.
The results of the investigation are summarized in the statement that
“ the membrane of the nose seems to exercise its complete function
and eliminate the dust from the inhaled air.” Since the cement dust
is practically sterile and chemically nonirritating there is very little
inflammation caused by its presence in the nose. The results of the
physical examinations of employees were subsequently confirmed by
animal experimentation. Out of 956 employees physically examined
7.2 per cent were found to be in bad physical condition, while the
proportion in this condition among 544 applicants for employment
was 7.7 per cent. Since a large proportion of the employees




236

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

and applicants for employment were Mexicans and Armenians, the
nativity factor naturally complicates the results. The average age
of the employees was 31 years 8 months, the average height was
5 feet 6| inches, and the average weight was 149§ pounds. The physi­
cal condition of the applicants for employment in these respects was
much the same.1
PHYSIQUE OF CEMENT WORKERS.

In further explanation of the physical examinations it is stated
by Tucker that—
It should be understood that the men called “ employees” were
not selected risks and underwent no physical examination prior to
employment, nevertheless the average weight of employed men was
the same as the average weight of the applicants for employment.
The average age of employees in the packing house was 29 years 4
months 23 days; the average weight, 1534 pounds; the average
height, 5 feet 6^ inches. The average weight of men employed in
the packing department was about 4 pounds more than the average
weight of all men employed. This is based on the examination of
73 men who had been employed an average of more than two years.
In the dusty parts of the mill figures show an average age of 31
years 6 months; average weight, 162 pounds; average height, 5 feet
6f inches. This is an average weight of 13 pounds more than general
average, and is based upon the examination of 106 men employed for
more than an average of two years.
i The only trustworthy information regarding the physique of Mexican laborers in this country is made
available through an analysis of height and weight of 1,112 applicants for industrial insurance with the
Prudential, during the period 1908-1916. Most of these applicants at the time were residents of southern
California. The average height of the Mexicans (see table below) was 66 in., against 68.5 in., in accordance
w ith the medico-actuarial standard. The average weight was 146 lbs. for the Mexicans, in comparison with
an average of 156 lbs., according to the medico-actuarial standard. The adjusted relative weight wT 2.2
as
lbs. per inch of height for the Mexicans, against a standard of 2.3 lbs. The average Mexican is, therefore,
2.5 in. below the average American standard of height and 10 lbs. belowr the average American standard
of weight. From such investigations as have been made regarding the mortality of Mexican laborers in
this country, it appears that the frequency of pulmonary tuberculosis among them is decidedly common.

C om parative Anthropometry of M exican M ales.
[Applicants for industrial insurance, experience of the Prudential, 1908-1916, and standard American
males according to the medico-actuarial investigation.]
Average height
(inches).

Average weight
(pounds).

Relative weight
(pounds per inch).

Age.
Mexicans.

Medicoactuarial
standard.

Mexicans.

24 years...............................
31 years...............................
41 years...............................
54 years...............................
61 years.............................

66
67
67
67
66
65

68.3
68.5
68.5
68.5
68.4
66.5

139
147
153
153
al45
ol57

147
155
161
165
165
166

2.1
2.2
2.3
2.3
2.2
2.4

2.2
2.3
&4
2,4
9.4
5

15 years and over........................

66

68.5

146

156

2.2

2.3

15 to
25 to
35 to
45 to
55 to




a Cases

Medicoactuarial
standard.

too limited in number for safe conclusions.

Mexicans.

Medicoactuarial
standard.

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

237

It would therefore appear that the employment was not physically
injurious to the extent of a loss in weight, but rather, to the con­
trary, a gain resulted among the men exposed in the most dusty parts
of the mill.
INFREQUENCY OF PULMONARY TUBERCULOSIS.

Among all the employees there were only 16 cases of suspected
tuberculosis and but two of these had worked in any dusty part of
the mill. The employment of these two covered a period of 1 and
10 days, respectively; but others had worked either in the quarry or
yard, departments in which there could be no substantial exposure to
cement dust, and the average length of employment of these was
four and one-half months. Among the applicants seven had physical
signs indicative of previous tuberculosis, so that even among the 16
cases previously referred to, it is a safe assumption that a fair pro­
portion at least had contracted the disease before employment. The
results of the investigation are summed up in the statement that—
In conclusion, as a result of an investigation of the dust problem
in conjunction with the manufacture of Portland cement, based upon
the review of literature on the subject, the examination of 956 em­
ployees in one plant, examinations of men employed in the dusty
departments of four other mills, the medical records of employees
and guinea pig experimentation, there appears to me to be no evi­
dence of injurious effects from cement dust upon employees engaged
in its manufacture. The reexamination of all employees and the con­
tinuation of the records will give us information of more value, and
annual reports of the results of the work at the Riverside Portland
cement plant will be available to any one interested in this most
important phase of the cement industry.
The California investigation has been referred to at length, in
view of its exceptional practical importance. It is one of the most
thoroughgoing efforts to ascertain precisely and conclusively the pos­
sibly health-injurious conditions in a leading American industry.
Whether the conclusions are accepted or not, the method of inquiry
itself is deserving of special recognition, particularly in view of the
fact that the medical and statistical research was amplified by animal
experimentation.
PROBLEMS OF DUST CONTROL.

In the case of the cement industry the problem is both simple
and complex. The enormous quantity of dust which is itself the
product of the industry must theoretically be assumed to be in­
jurious to health and a predisposing cause of respiratory and possi­
bly tuberculous diseases. Hirt, in the early seventies,1 presented data
according to which the proportionate morbidity from phthisis was
1 D ie S ta u b in h a la tion s-K ra n k h eiten , by D r. L u d w ig H irt, B resla u , 1871, p. 30.




238

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

only from 8 to 10 per cent among cement makers, against 80 per
cent among flint workers, and 70 per cent among needle polishers.
The industry in the meantime, however, has undergone such pro­
found changes that these earlier observations are not of practical
significance. Koelsch, in a more recent German contribution on
mortality in relation to tuberculosis,1 refers briefly to cement dust
as injurious, but without sufficient statistical evidence to sustain his
conclusions. His data, derived from the mortality of Bavaria for
the year 1898, are limited to four deaths of cement workers out of
a labor force of 1,267 exposed to risk. The resulting mortality rate of
3.16 per 1,000 compares favorably with 3.07 for all occupations, but
the number of deaths is too small for final conclusions. More trust­
worthy observations are brought forward in the report of the chief
inspector of factories and workshops of the United Kingdom for
the year 1911 (p. 183), who remarks as follows:
Cement making has for years been regarded as one of the specially
dusty trades in which difficulty has been experienced in confining the
dust within reasonable limits during the processes of manufacture,
grinding, and packing. The dust, however, has been held by some
authorities as “ not so damaging to health as might have been ex­
pected,” though by others it is considered to cause “ slight bronchial
and lung troubles as well as catarrh of the stomach and inflammation
of the eyes.”
Modern processes, it is pointed out, have, however, had a tendency
to materially reduce the quantity of dust which was formerly allowed
to escape into the atmosphere. On the basis of a careful inquiry
among friendly societies insuring persons employed in the cement
industry the conclusion was arrived at that—
These appear to show that the trade is on the whole a healthy one;
that deaths are few; that absence from work is rare and generally
due to influenza, colds, or accidents; and that there is often more
invalidity among workers in nondusty processes than in the dusty
occupations of kiln drawing, milling, and packing.
UOITCNJUILIOUSITESS OF LIME DUST.

The general conclusion was, therefore, advanced, after a careful
special inquiry into actual working conditions, that 4 while the dust
6
is not of an injurious nature, probably owing to the fact that free
silica is present in very small quantities, usually less than 1 per cent,
it does cause irritation and trouble in some cases, and if not injurious
it is at least a nuisance, and efforts should be made to prevent and
reduce the escape of dust wherever practicable.” This view has the
indorsement of a letter in the British Medical Journal for May 7,
1900, in which, following a reference to the general conclusion that
1 A rb e it und T u b erk u lose, b y D r. m ed. K o e ls ch ,
H yg ien e, V o l. V I , pp . 2 9 , 212, 2 7 6 ; L eip zig , 1911.




p u b lish e d

in

A r c h iv

fu r

S ozia le

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

2^?

all dust is more or less seriously injurious to health, it is said that
u a decided exception should be made in favor of lime dust.” In the
writer’s personal experience “ those breathing it habitually at lime­
kilns are free from tuberculosis, and a similar observation has been
made in France and Germany.” Furthermore, it is said that “ lime
dust in abundant quantity, either by acting on the body or on the
tubercle bacillus outside of the body, is antagonistic to tuberculosis.”
This conclusion would seem to have much in its favor, and, while not
entirely sustained by the available insurance mortality statistics, the
data at least indicate a relatively lower incidence of pulmonary
tuberculosis than is common to the obviously more hazardous dusty
trades.
MORTALITY OF CEMENT WORKERS— INDUSTRIAL INSURANCE EXPERI­
ENCE.

Table 89 shows the industrial mortality experience among cement
and lime workers as recorded by the Prudential Insurance Co. for
1897 to 1914. Of 222 cement and lime workers who died during that
period, 16, or 20.7 per cent, died from pulmonary tuberculosis.
T able 8 9 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y TU B E R C U LO SIS AM ON G
C EM EN T A N D LIM E W O R K E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO.,
1897 TO 1914, C O M P A R E D W IT H T H A T OF A L L M ALES IN U N IT E D S T A T E S R E G IS T R A ­
T IO N A R E A , 1900 TO 1913, B Y A G E G ROU PS.

Deaths of cement and
lime workers, 1897 to
1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at deatli.
A ll causes.

Males in
Pulmonary Cement and registration
tuber­
lime
area, 1900
workers.
culosis.
to 1913.

IS to 24 years...........................................................................
25 to 34 years..... .....................................................................
35 to 44 years............................... ............................................
45 to 54 years............................................................................
55 to 64 years..................................................................... .....
65 years and over...................................................... .............

18
40
48
45
49
22

2
15
12
10
6
1

11.1
37.5
25.0
22.2
12.2
4.5

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over.................... . .......................

222

46

20.7

13.9

The data are particularly suggestive at ages 25 to 34, when out of
40 deaths from all causes 15, or 37.5 per cent, were from pulmonary
tuberculosis, against 30.5 per cent expected on the basis of the mor­
tality data for the males of the registration area.
The American cement industry has within recent years attained
to such nation-wide importance that the preceding considerations
are applicable to a labor problem which at any time may assume
serious significance, as made evident by the proposed measure in
California aimed at the regulation of the industry by exceedingly




240

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

drastic methods, as regards the impervious packing of the product,
not with reference to the men engaged strictly in cement-making
processes but solely for the protection of men employed in the subse­
quent handling of the finished product while in course of transporta­
tion. This suggests future possibilities which make it exceedingly
important that the facts concerning the injuriousness or noninjuriousness of cement dust should be ascertained with impartial and
strictly scientific accuracy. Cement is produced in practically every
State of the United States, although the principal centers of produc­
tion are Pennsylvania, Indiana, New York, Illinois, California, Mis­
souri, Michigan, Iowa, New Jersey, and Kansas. These 10 States
in 1914 produced 82.6 per cent of the aggregate output, and there
are no reasons for believing that a material change occurred during
more recent years. How far local and important variations in the
chemical and mechanical properties of cement dust may affect the
preceding conclusions regarding the apparent noninjuriousness of the
dust in its relation to pulmonary tuberculosis can not be stated at the
present time. As observed by Kober and Hanson in their treatise
on “ Diseases of Occupation and Vocational Hygiene,” the manu­
facture of Portland cement varies in different countries, and they
remark that—
In England, where chalk is plentiful, this is used in connection with
some material containing silica and alumina, such as selected clay
or river mud. The raw materials are mixed in certain proportions
and ground together to the consistency of liquid mud. The excess
of moisture is driven off by heat, and the residue is dried in ovens
at a high temperature. The preliminary process, while sloppy, is
not dusty work, but the subsequent grinding between rollers and the
sacking and packing of the product is an extremely dusty process.
According to Koelsch and other German authors catarrhal affections
and diseases of the respiratory organs constitute from 30 to 40 per
cent of all the sickness. Diseases of the eyes and ears, impacted ear
wax, ulceration of the nose with perforation of the nasal septum,
and eczema, or cement itch, are also quite common.
Kober refers to a report made by Wittgen with reference to the
results obtained in German cement works in the direction of dust
removal and in consequence of which respiratory diseases were re­
duced fully one-third within a period of five years after the installa­
tion of exhaust ventilation, and the number of days lost by sickness
was reduced proportionately. Further investigations of a more
involved scientific nature are essential to the purpose of determin­
ing more conclusively the facts of a controversy, which is of impor­
tance not only to the cement industry of this and other countries,
but also to every occupation involving more or less exposure to
inorganic dust.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

241

GENERAL CONCLUSIONS.

On account of the common occurrence of pulmonary tubercu­
losis under all labor or industrial conditions, it is self-evident that
no crude statistical analysis of this kind can precisely measure
the health-injurious effects of any particular occupation, trade, or
industry. At best such data are only of approximate value, unless the
incidence of pulmonary tuberculosis is so pronounced as to justify
unqualified conclusions. In the case of cement dust it is apparently
shown that the results, if serious at all, are much less so than in the
case of most of the other dusty trades considered. It is difficult to
accept, without due reserve, the conclusions advanced by Tucker in
their entirety, and particularly his statement that 4 outside of the
4
packing room and the sack-cleaning room there is no department in
which cement dust escapes into the atmosphere in any appreciable
quantities.” It may be stated with confidence that practically all
branches or "departments of cement manufacture involve considerable
exposure to the dust hazard, and while the evidence may be wanting
that cement dust is a predisposing cause of tuberculosis, there can be*
no question but that certain forms of respiratory affections are rela­
tively common, at least among certain classes of employees. In the
entire absence of official vital statistics for the States and sections in
which the cement industry is represented by a sufficiently large number
of employees, it would seem of sufficient importance to suggest that
special inquiries should be made in the more important centers of
the cement industry in conformity to the admirable methods of
scientific investigation developed by the Riverside Cement Co.
BRICK, TILE, AN D TERR A-COTTA M AKERS.

These occupations are too complex to permit of a satisfactory
analysis of the available mortality data which, almost without ex­
ception, are quite general and do not refer to specific industries
or employments. The dust hazard necessarily varies widely in
an industry of such vast extent and which is carried on under
such varying conditions. Brickmaking has during recent years under­
gone material changes on account of the extensive introduction of
machinery. It.is estimated by Mr. W. Frank M’Clure in the Scientific
American for October 7, 1905, that one machine employed in extricat­
ing processes accomplishes the work of 75 men. The same writer
explains that—
After coming from the pug mill the pasty material is cut into the
shape of bricks by machinery which works automatically, and modern
methods also provide for the use of exhaust steam and heat from the
kilns for the heating of the drying house.
106811°— 18— Bull. 231------ 16




242

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

BRICXMAXING PROCESSES.

The processes of brickmaking in general are described with ad­
mirable brevity by this writer, as follows:
From the cars the clay and shale are shoveled into grinders, which
reduce these two products to a powder, which in turn is carried by a
bucket elevator to a big hopper. After it has been sufficiently screened
the powdered clay and shale next go to the pug mill, fcha# which will
not pass the screen going back to the grinders again. In the pug
mill—a sort of conical trough—the raw material is tempered with
water and kneaded by means of a device somewhat resembling a screw
propeller in shape. From this mill it is forced through a mold into
one long, continuous brick, and this, as it comes from the mill, is
carried on a wide belt to a cutting machine, which automatically
cuts the continuous brick into many bricks of the desired size, the
machine cutting 16 bricks at one time. As the bricks come from the
cutting machine, still soft and still resting on the belt, they are loaded
onto flat cars and removed to the drying house, where they remain
not less than a day and night. The capacity of a large drying house
is about 100,000 bricks. The different apartments of this house are
brick lined.
The brick next go to the kilns for baking. One of the engravings
gives a good idea of the manner in which these brick are piled within
the kilns. Five or six men often work three full days in filling one
kiln, which fact gives some idea of the size of the interior. After
the entrance to the kiln has been closed and sealed the fire beneath is
started. The baking process is then continued for 9 or 10 days, the
temperature maintained within being 2,300° F. Then, when the
kiln has been cooled, the bricks are taken out and are ready for ship­
ment. Where 15 or 16 kilns are in use the daily capacity of ordinary­
sized brick may reach 150,000.
HEALTH-INJURIOUS CONDITIONS.

In all of these processes there is a considerable degree of dust ex­
posure, the injuriousness of which, however, is materially reduced by
the fact that most of the operations are carried on in the open air.
The evidence presented to the departmental committee on industrial
diseases by Dr. Chalmers was to the effect that brickmaking could,
not be considered a healthy occupation. The same conclusion had
been arrived at in the earlier investigation into the experience of the
British Friendly Societies reported upon by Radcliffe. Apparently
the most injurious processes are in connection with the molding,
drying, and burning, where the dust exposure is occasionally quite
considerable, in that the dust is reduced to an extremely dry and
finely powdered condition. The process of manufacture with special
reference to tempering, molding, drying, and burning has been de­
scribed by Mr. T. C. Naulty, inspector of the Underwriters’ Associa­
tion of New York, in the Weekly Underwriter, for June 4, 1910.
The only comparatively recent investigation into the sanitary condi­
tions of brick and tile making, with special reference to grinding




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

2 43

and mixing is by Hayhurst.1 This investigation included 9 estab­
lishments in the State of Ohio, employing 67 workers in the processes
of grinding and mixing. In only two instances, however, were health
appliances, such as blowers, etc., present, it being observed that
boxed-in chutes rendered much aid in limiting the dust. Only 5 of
the 67 employees were over 40 years of age. It is said by Hayhurst
that—
The chief objectionable features to this process, from a health point
of view, were the breathing of clay dust, and the red coloring com­
pound often mixed with it, the dirt underfoot, the dampness, and, for
cooler weather, the absence of heating arrangements, all of which
were fair to bad hazards. In two places the work was housed in so
that the light was poor, and a similar condition existed for ventila­
tion in two places. In one place the mixing machine was so close to
a kiln that the workers were affected by the heat. In all places there
was a moderate risk of overfatigue, not so much from laborious work,
which was not the rule, but from monotonous application, constant
standing, and the loud noise from the grinding machine.
NEGLECT OF SANITARY PRECAUTIONS.

It is further pointed out by Hayhurst that the liability of contract­
ing communicable diseases was found to be bad in all the places in­
vestigated, except in one, due to promiscuous spitting into the dried-up
day dust on the floor, the absence of cuspidors, and the lack of
proper washing facilities. It is stated, however, that the outdoor
character of the work in most places mitigated against this hazard,
but attention is directed to the risk of contracting hookworm
disease on account of the primitiveness of the sanitary arrange­
ments.
GRINDING, MIXING, AND PRESSING.

The general appearance of the workers was found to be good in
only 40 per cent of the cases observed, but none of the men seen
presented a decidedly sickly appearance. The concluding observa­
tions with reference to grinding and mixing are to the effect that—■
These workers, as well as the rest of those in brick and tile works,
should be provided with proper sanitary and drinking facilities
because of the risk of typhoid fever and hookworm disease. Work­
ers predisposed to lung troubles should not engage in any part of
the brick industry. For certain intervals of very dusty work the
workers should put on respirators. Grinding and mixing processes
everywhere could be rendered entirely dustless for the places in
which the workers are required to remain, as was observed to bo
the case at one plant.
The same investigation included the pressing process, which fol­
lows the grinding and mixing, and which, in general terms, is




1 Industrial Health Hazards, 1915.

244

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

almost entirely mechanical. This investigation included nine estab­
lishments, employing 200 men, of whom only 1 was over 50 years
of age and 5 per cent were under 20 years. Dust from -the drying
of wet clays under foot was found to be a bad feature in three
places, and fairly so in three others, while in two places it was negli­
gible; but in one large place the dust was so thick in the air “ that
one could scarcely see 30 feet.” In six of the nine places the
work was damp enough to be considered hazardous, and workers
were found to be unable to keep dry, especially with the forms of
footwear and’ clothing used. In six places there seemed to be a
number of factors productive of fatigue. The general conclusions
were of much the same effect as previously stated with regard to
grinding and mixing.
KILN SETTING, FIRING, AND DRAWING.

Work at the kilns was investigated at nine establishments employ­
ing 116 men in setting, firing, and drawing the kilns of brick and
sewer pipe. There were found to be no appliances which could be
considered as having to do with the conservation of health, nor were
there found to be any instructions or placards suggestive of qualified
advice in this direction. Of the 116 men, practically all unskilled
laborers, 14, or 12.1 per cent, were over 40 years of age. According
to Hayhurst—
The chief hazards of this process were exposure to heat, alternating
with weather conditions. This seemed bad in 3 places, and some
hazard in all of the remaining. It depended somewhat upon the
methods of drawing the kilns. In some places workmen were put
upon them while the temperature was yet extremely hot. In one place
premises around the kilns were kept very neat and clean. As else­
where in this industry, fatigue factors were present, and probably
more so in this process than any other. Arranged in descending
order, as nearly as possible, these were: Monotonous application, with
constant standing for long periods, hurrying piecework, with evi­
dence of speeding up, laborious work under considerable strain, pres­
sure against the body, and long hours.
In conclusion it is said that the appearance of the workers was
generally good in most places, but some were found who complained
of their health and others who appeared to be in a decidedly inferior
physical condition. The conclusion advanced is that “ This^is a
process requiring hard, laborious work at intervals, but this should
not proclaim it necessarily unhealthy, provided the many other fea­
tures mentioned were not present to menace the health of the work­
ers.” These observations are far from conclusive and .they only
indirectly bear upon the question as regards the relative frequency
of tuberculosis in consequence of undue exposure to health-injurious
conditions. The conclusion, in the main, however, indicates labor




245

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

conditions far from satisfactory and, broadly speaking, probably
predisposing to general ill health. These conclusions apply also,
in a general way, to terra-cotta workers and tile makers, at least as
regards some of the processes, which are more or less identical with
brickmaking, but to a less extent than to brickmakers who in addi­
tion, of course, are exposed to numerous other health-injurious con­
ditions, such as the risk of inhaling lime or mortar dust, especially
in brick-cleaning processes and the taking down of old walls, etc.
MORTALITY OF BRICK AND TILE MAKERS— UNITED STATES REGISTRA­
TION AREA.

The mortality of brick and tile makers has been reported upon
only for the year 1909 by the Division of Vital Statistics of the
United States Census Bureau, and no subsequent information has
been made public, so that the data are of rather limited value. Ac­
cording to the census report out of 133 deaths of brick and tile
makers from all causes 16, or 12 per cent, were from pulmonary
tuberculosis. The details of the mortality, by divisional periods of
life, are shown in Table 90.
P R O P O R T IO N A T E M O R T A L IT Y OF B R IC K A N D T IL E M A K E R S F R O M P U L ­
M O N A R Y TU B E R C U LO SIS, U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1909, B Y A G E
GR O U PS.

T able 9 0 .—

*

Deaths from pul­
monary tuberculosis.

Age at death.

Deaths
from all
causes.

Per cent
of deaths
from all
causes.

Number.

15 to 24 years..................................................................................................
25 to 34 years..................................................................................................
35 to 44 years..................................................................................................
45 to 54 years..................................................................................................
55 to 64 years..................................................................................................
65 years and over..........................................................................................
Age unknow n................................................................................................

14
13
18
20
26
41
1

3
3
5
3
2

21.4
23.1
27.8
15.0
7.7

Total, 15 years and over...................................................................

133

16

12.0

Table 9 1 . — P R O P O R T IO N A T E M O R T A L IT Y OF B R IC K A N D T IL E M A K E R S FR OM NONTU BE R CU L O U S R E S P IR A T O R Y DISEASES, U N IT E D STATE S R E G IS T R A T IO N A R E A ,
1909.

Cause of death.

Deaths from nontuber­
cuious
respiratory
diseases.
Number.

Per cent.

Asthm a..................................................................................................................................
Bronchitis.............................................................................................................................
Pneumonia...........................................................................................................................
Other nontubercuious respiratory diseases...................................................................

8
2

6.0
1.5

T otal............................................................................................................................

10

7.5




246

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

The number of deaths under observation is too limited for entirely
safe conclusions, but in a general way the table is sustained by insur­
ance experience and foreign data. The proportionate mortality from
pulmonary tuberculosis is below the average for all occupied males
at ages under 35 and only slightly above the average at ages 35 and
over. It may be said that the mortality of brick and tile makers
from pulmonary tuberculosis approaches so closely to the normal for
all occupied males that there are apparently no decidedly healthinjurious conditions in this employment predisposing to pulmonary
tuberculosis, and, as shown by Table 91, to nontuberculous respira­
tory diseases. The proportionate mortality from this group is 7.5
per cent for brick and tile makers, which compares with 10 per cent
for all occupied males and 9.2 per cent for glassworkers.1
MORTALITY 0 * BRICK, TILE, AND TERRA-COTTA MAKERS— INDUSTRIAL
INSURANCE EXPERIENCE.

Additional statistical data as shown in Table 92 are available for
this group of employments through the industrial mortality statistics
of the Prudential Insurance Co. of America for the period 1897 to
1914, including 527 deaths from all causes, of which 82, or 15.6
per cent, are from pulmonary tuberculosis.
T able 9 2 .—P R O P O R T IO N A T E M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U L O SIS AM ONG
B R IC K , T IL E , A N D T E R R A -C O T T A M A K E R S, IN D U S T R IA L E X P E R IE N C E OF P R U D E N ­
T IA L CO., 1897 TO 1914, C O M PA R E D W IT H T H A T OF A L L MALLES IN U N IT E D ST A T E S
R E G IS T R A T IO N A R E A , 1900 TO 1913, B Y A G E G ROU PS.
Deaths of brick, tile,
and t e r r a - c o t t a
makers, 1897 to 1914,
from—

Per cent of deaths from
pulm onary tubercu­
losis among—

A ge at death.
Brick, tile, Males in
Pulm o­
A ll causes. nary tuber­ and terra­ registration
cotta
area, 1900
culosis.
makers.
to 1913.
15 to 24 years............................................................................
25 to 34 years................... , ......................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55to 64 years................................................ ..........................
65 years and over....................................................................

48
51
81
97
121
129

11
18
16
18
13
6

22.9
35.3
19.8
18.6
10.7
4.7

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and over..............................................

527

82

15.6

13.9

The proportionate mortality is relatively high at all ages, but not
excessively so when compared with more decidedly health-injurious
processes with exposure to metallic and more irritating mineral dust.
The corresponding industrial mortality experience of the Metro­
politan Co. is limited to masons and bricklayers considered as a
1 F o r e a rlie r referen ces t o th e h ea lth o f brick m akers, see th e J o u rn a l o f H ea lth , V ol. I I ,
p age 28G, and the C om p a ra tiv e R ates o f M o r ta lity in V ariou s O ccu p a tion s, pages 11, 27,
and 45. F o r m odern o b serva tion s on the h ea lth o f b rick m akers w ith special re fe re n ce
to h e a lth -in ju rio u s co n d itio n s, see the E n g lish re p o rt on In d u stria l D iseases, 1907* evi­
dence by C halm ers, page 4304.




247

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

group. It includes 1,748 deaths from all causes. Table 93 is derived
from Bulletin 207 of the Bureau of Labor Statistics, on “ Causes of
Death by Occupation.”
T able 9 3 .—N U M B E R A N D P E R C EN T O F D E A T H S F R O M S P E C IF IE D CAUSES AMONG
MASONS A N D B R IC K L A Y E R S , B Y A G E P E R IO D S , 15 Y E A R S A N D O V E R —W H IT E
MALES.
[Metropolitan Life Insurance Co.—Industrial department—Mortality experience, 1911 to 1913.]
Ages 15 years
and over.

Per cent of deaths during age period
(years)—

Cause of death.
Per
cent.

Num­
ber.

15-24

25-34

35-44

45-54

55-64

65
and
over.

Number of deaths....................................

1,748

59

124

250

327

475

513

Tuberculosis of the lungs......................
Cancer (all form s)...................................
Alcoholism ...............................................
Cerebral hemorrhage, apoplexy, and
paralysis...............................................
Organic diseases of the heart...............
Acute and chronic bronchitis...............
Pneumonia (lobar and undefined)___
Cirrhosis of the liver...............................
Bright’s disease......................................
Suicide (all forms)..................................
Accidental violence................................
A ll other causes...................................... .

332
113
18

19.0
6.5
1.0

28.8

45.2
1.6
2.4

42.0
2.8
1.6

26.6
4.6
1.8

10.5
10.3
.4

3.3
7.8
.6

136
227
18
132
34
178
29
133
398

7.8
13.0
3.4
1.0
7.6
10.2
1.9
10.2 *\” 5 .Y
1.7
1.7
25.4
7.6
22.8
25.4

.8
6.5
.8
7.3
.8
3.2
.8
8.1
22.5

2.4
8.0
6.0
2.0
5.6
1.2
9.2
19.2

2.4
9.2
.6
10.1
1.8
10.1
1.5
9.8
21.5

12.2
14.7
.6
6.7
2.9
12.2
1.9
5.7
21.9

12.3
18.9
2.3
7.2
1.6
12.9
1.9
5.1
26.1

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

1,748

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1 This title includes foremen and workmen: stonemasons, bricklayers, masons, bricksetters, tile layers,
and plasterers.

This table includes a number of other specified causes of death,
but throughout the most important disease is pulmonary tuberculosis,
which accounts for 19 per cent of the mortality from all causes at
ages 15 and over, and as much as 45.2 per cent of the mortality at
ages 25 to 34. As observed by Dr. Dublin in his interpretation of
the table, “ the United States figures, the English figures, and those
of the Prudential Insurance Co., all confirm the occurrence of rising
relative indices in successive periods up to age 65, suggesting a direct
causal relationship between tuberculosis of the lungs as a cause of
death and the duration of service in this occupation.” The inherent
limitation of all data of this character is due, however, to the in­
clusion of widely varying employments in a single group, which
rather requires the highly specialized consideration of carefully
segregated branches or specific occupations to determine the true
incidence of health-injurious conditions.
POTTERS.

The pottery industry includes the manufacture of earthenware,
china, and porcelain. It always has been recognized as one of the
unhealthiest of trades, but the health-injurious effects vary widely
according to particular employments. The most seriously exposed
are the dippers, flint-mill workers, ground layers, mixers, scourers,




2 48

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

and sweepers. In all of these employments except the first the ex­
posure to health-injurious mineral dust constitutes a serious menace
to health. In the case of dippers the liability to dust inhalation is
modified and increased in seriousness by the risk of lead poisoning.
The degree of dust exposure is also very serious in the case of kilnmen, mold makers, placers, pug-mill workers, sagger makers, and slip
makers. In the aggregate the industry gives employment in the
United States to about 26,000 persons, of whom one-fifth are women.
The sanitary conditions of the trade have often beeii investigated, and
the most recent evidence is to the effect that there have been material
improvements within the last few decades.* The most careful and
useful observations of the industry were made by Arlidge, who for
many years lived in the Staffordshire pottery district of England.
Before quoting Arlidge the fact may be briefly referred to that as
early as 1T05 Ramazzini, in commenting upon the diseases of potters,
pointed out that “ not all who go by the name of potters are subject
to the particular disease of the trade,” and that, therefore, discrimi­
nation was necessary in the medical treatment of the different classes
of employees. Ramazzini made a curious observation bearing upon
the question of eye strain, which has received qualified consideration
only within recent years, stating, with reference to potters, that
“ those who sit at the wheel and form the vessels by turning it about
with their feet are apt to have a swimming in the head if their eyes
are otherwise weak.”
SANITARY ASPECTS OF THE POTTERY INDUSTRY.

Arlidge, in discussing the effects of mineral dust in the manufac­
ture of pottery before the Sanitary Institute in 1893, remarked at the
outset that—
Scarcely any other manufacture has so strong a claim upon the at­
tention of sanitarians as has that of pottery. It stands nearly at the
head of the list of unhealthy occupations, and exercises its pernicious
effects almost wholly upon the respiratory organs, by production of
bronchitis and of consumption. Thus it is found that while workmen
engaged in other employments have a mortality from chest diseases
of 7.86 per cent, potters exhibit one of 12.29 per cent. Likewise with
respect to phthisis—nonpotters present one of 9.27 and potters one of
12.90.
After describing the various processes of manufacture and their
relation to health-injurious circumstances, Arlidge discussed the rela­
tion of clay dust and its irritating effects upon the mucous mem­
brane and epithelium of the lungs, holding the opinion that—
Clinical observation abundantly confirms this fact. For a consid­
erable time the inhaled dust is arrested in its advance toward the
lung tissue proper by the mucous secretion in the bronchial tubes, and
by the expulsive energy of the cilia lining of those tubes. But at
length these-resistant forces weaken before the constant entry of fresh




OCCUPATIONS W IT H EXPOSURE TO MINERAL BUST.

249

dust, and in course of time the noxious material passes into the lymph
channels, and also along the finer bronchi, until it reaches the intimate
structure and the air cells themselves. Here as a foreign substance it
sets up inflammatory action; lymph cells spring up, the air vesicles
become choked with inflammatory products, the tissue around them
gets indurated (lung sclerosis), and useless as breathing tissue.
The history of these pathological changes is reflected in the symp­
toms exhibited by the sufferers. In the primary stage little incon­
venience is felt; there arises a desire to clear the throat of some im­
peding mucous at the end of the day’s work, or upon transition to the
outer air from the warm shop, and especially on rising in the morn­
ing. This expulsive act soon develops into a cough, and relief is ob­
tained by the expectoration of more or less blackish viscid mucus.
Presently there is a feeling of tightness in the chest, and the breathing grows less free and full. As time goes on these signs of disturbed
lung function become more pronounced, and in the end the patient
grows asthmatic—a victim of potters’ asthma.
Until this advanced stage of disorder is reached it is singular to
notice how little attention and anxiety are bestowed upon the pul­
monary derangements. This is because the general health is, for the
most part, not seriously affected, and inasmuch as while the sufferer
breathes a warm air in his workshop or home, his lung trouble is felt
as little more than an annoyance; or as something which is to be
taken as a matter of course, and, like his wages: as an unavoidable
incident of his calling.
As with chronic maladies at large, so with potters’ bronchitis and
asthma, the tendency is to grow worse and the lung lesion to extend,
and soon the damaged respiration reacts upon the whole frame; the
sufferer can not get proper outdoor exercise, his appetite fails,’ his
sleep is broken, the expectoration augments and grows muco-purulent,
the body wastes slowly, while the increased effort to breathe entails
strain upon the heart, leading not infrequently to disease of that
organ, with the after consequences in the shape of dropsical effusions.
We now have before us the fully developed disease known as
potters’ consumption or potters’ asthma.
EFFECTS OF SILICA DUST.

The injurious effects of clay dust in the pottery industry are fur­
ther increased by minute particles of flint, and a possible additional
factor injurious to health is the extensive use of plaster of Paris,
employed in the making of molds and models. According to Arlidge,
the effects of plaster of Paris dust, however, are not apparently as
serious as the very destructive effects of silica dust and small par­
ticles of flint. He draws attention to the necessity of an efficient
system of ventilation as the only means by which material improve­
ments can be brought about.
LIABILITY TO LEAD POISONING AND PULMONARY DISEASES,

The health-injurious effects of lead, extensively used in potteries,
'which do not properly fall within the present discussion, must here be




250

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

passed over.1 It is true, of course, that a considerable amount of lead
dust is inhaled, but the effects are rather upon the system generally
than upon the lungs. The observations of Arlidge are so entirely sus­
tained by other qualified observers that it is not necessary to further
enlarge upon the sanitary aspects of this trade. The evidence, statis­
tical or otherwise, is conclusive that potters as a class suffer more, per­
haps, from phthisis and other diseases of the lungs than employees
in any other occupation, and their mortality from bronchitis and
other respiratory diseases is many times as high as the mortality of
occupied males generally; but it has been pointed out by Tatham, in
his contribution to Oliver’s “ Dangerous Trades,” that—
Potters succumb to nontubercular disease of the lungs much more
rapidly than they do to tubercular phthisis; and it is certain that
much of the so-called potters’ phthisis ought properly to be termed
cirrhosis of the lung. Deaths from this affection should never be in­
cluded under the head of phthisis, which term is now restricted, by
universal consent, to the tubercular malady of that name.
It is also necessary to keep in mind, in discussing the pottery in­
dustry, that it divides itself broadly into two principal departments—
that is, first, the making of the articles from potters’ clay, and, second,
their ornamentation by painting, gilding, etc. The latter group of
occupations is usually defined as decorators, and sometimes as print­
ers, and because of this fact many errors occur in occupation sta­
tistics as the result of erroneous classification—not based upon the
industry as.such, but upon the specific title of the employment.
SPECIFICALLY INJURIOUS PROCESSES.

One of the most health-injurious employments in the industry is
that of the brushing,, or dusting off, of the ware after it is taken from
the kilns. Oliver, in discussing at length the sanitary aspects of
china and earthernware manufacture and in particular potters’
asthma and pulmonary tuberculosis, draws special attention to this
process as observed in the porcelain potteries at Limoges. He remarks
that—
The brushing off or epoussetage of the fired or biscuited ware is
done both by women and men by means of soft feather brushes. It
is a very dusty operation, and where there are no fans for its removal,
as in some of the factories I visited, the air was thick with dust. The
windows were open at the time, but currents of air obtained by this
1 W ith resp ect t o lea d p o iso n in g in the p o tte r y tra d es see :
D ep a rtm en ta l re p o rt on “ T h e P o tte r y In d u s try in F ra n c e ,” b y T h o m a s O liver, M. D .
L on d on , 1899.
D ep a rtm en ta l r e p o rt on “ T h e E m p loy m en t o f C om p ou n d s o f L ea d in the M a n u fa ctu re
- o f P o t te r y ,” by T h orp e an d O liver.
L on d on , 1899.
D ep a rtm en ta l re p ort on “ L ea d in th e M a n u fa ctu re o f E a rth e n w a re a n d C h in a ,” V ols.
I . I I . a n d I I I . L o n d o n , 1910.
B u lle tin o f the U. S. B u rea u o f L a b or, N o. 104, “ L ea d P o is o n in g in P o tte r ie s , T ile
W ork s, e t c .,” by D r. A lic e H a m ilton . W a sh in g ton , 1912.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

251

means exercised no very appreciable influence upon the dust. It is
not this kind of ventilation that is required under these circumstances.
In the matter of the provision of artificial means for the removal of
dust and the renewal of air in the potteries of Limoges, some of the
manufacturers seemed to me to be rather behind than in advance of
the owners of large factories in Staffordshire. Accordingly I was
not unprepared for the information that among the potters, especially
the brushers off or scourers, in Limoges, the mortality from pulmo­
nary consumption and chest diseases is high. The harmful operations
in porcelain works are the emptying of the kilns, the removal of the
ware from the saggers and the brushing of this ware, while the hard
dust that rises during the polishing of the all but finished articles is
equally dangerous. The polishing has for its object the removal of
any roughness from the edges or surfaces of the ware, and it is gen­
erally done on a revolving wheel by means of a broken piece of china,
the workman using this as a smoothing agent. The men and women
employed in these operations are usually well covered with dust, yet
it is seldom that they wear respirators. Fans for the removal of the
dust were present in only very few of the factories. The employees
objected to them on the ground that they created a strong draft of
cold air. Dr. Raymondaud, one of the professors in the School of
Medicine, Limoges, has made a special study of the diseases of por­
celain makers, particularly of pulmonary consumption and chronic
bronchitis. He found that the potteries furnished a larger number
of patients suffering from lung diseases than did the other trades
of the district. Of T5 deaths registered in Limoges as occurring
among china makers, 36 were due to phthisis, and of 30 potters whom
Raymondaud examined, 20 were suffering from pulmonary consump­
tion. Pulmonary phthisis is regarded as the principal disease affect­
ing the workers in the Limoges potteries.
ENGLISH OCCUPATIONAL MORTALITY STATISTICS.

The most recent English mortality statistics of potters are for the
three years ending with 1902, referred to in the Supplement to the
Sixty-fifth Annual Report of the Registrar-General of Births*
Deaths, and Marriages in England and Wales, in part as follows:
Between the ages 20 and 35 years the mortality of potters falls
below that of occupied and retired males generally; at every other
age, however, it shows an excess which amounts to no less than 74 per
cent at ages 45 to 55 years, and to 66 per cent at ages 55 to 65 years.
In the main working time of life the comparative mortality figure
is 1,493, or 49 per cent above the standard. The principal excess falls
under the head of respiratory diseases, for which the mortality figure
is 473, or nearly thrice the standard. There is also a considerable ex­
cess in the mortality from phthisis, from nervous and circulatory
diseases, and from suicide. These workers are also specially liable
to lead poisoning, but from accident as well as from influenza,
T
Bright’s disease, and alcoholism their mortality is low.
In the last decennial supplement the mortality of potters was de­
scribed as enormous. From the present report, however, it will be
seen that since 1890-1892 their mortality has declined at every stage
of life; and in the main working period the comparative mortality;




252

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

figure has fallen from 1,970 to 1,420, or by no less than 28 per cent.
It is satisfactory to note that in the recent period the mortality of
potters from plumbism has fallen to less than half its former amount,
while there has also been a substantial decline under most other head­
ings; the mortality from respiratory and urinary diseases having
fallen by about one-third, that from phthisis, nervous and digestive
diseases by about one-fourth, and that from circulatory diseases by
about one-fifth part. Potters, however, now fall victims in increased
proportion to accident, and to suicide, and the mortality from cancer
has increased by more than half. Since 1860, ’61, ’71 the death rates
of potters both above and below 45 years of age have fluctuated some­
what, but the recent modified mortality figure is by far the lowest on
record. Since 1880-1882 there has been a continuous decline of mor­
tality from phthisis, from liver disease, and from diseases of the
nervous and digestive systems.
The English statistics for potters are quite conclusive of the un­
favorable effects of this industry on health. In Table 94 the mor­
tality from all causes among potters is compared with that of occu­
pied males generally, and the result is decidedly suggestive of
conditions more or less unfavorable to life and health, but in par­
ticular at ages 35 or over, when the mortality rate from all causes
exceeds by from 4.30 to 29.86 per 1,000 the corresponding mortality
of occupied males generally.
Table

9 4 .— M O R T A L IT Y F R O M A L L C AU SES A M O N G P O T T E R S , C O M P A R E D W I T H
T H A T OF A L L O CC UPIED M A L E S , IN E N G L A N D A N D W A L E S , 1900 TO 1902, B Y A G E
G R O U P S.

[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]
Death rate among potters.

Age at death.

15 to 19 years...................................................................................
20 to 24 years..................................- ...............................................
25 to 34 years....................................................................................
35 to 44 years....................................................................................
45 to 54 years,..................................................................................
55 to 64 years....................................................................................
65 years and over............................................................................

Death rate
per 1,000
for all occu­
pied males.

2.44
4.41
6.01
10. 22
17.73
31.01

88.39

Rate per

1,000.

2.62
3.68
5.26
14.52
31.64
54.15
118.25

Greater ( + )
Ratio to
or less ( —)
than rate rate for all
occupied
for all occu­
males.
pied males.

+
—
—
+

0.18
.73
.75
4.30

+ 13.91
+23.14

107
83
88
142
178
175

+29.86

134

The preceding table is self-explanatory. A more extended com­
parison, however, is made in Table 95, in which the mortality of
potters from pulmonary tuberculosis and from other diseases of the
respiratory system is compared with the normal mortality of occu­
pied males from these diseases, by divisional periods of life. The
comparison shows that the mortality from pulmonary tuberculosis
among potters is decidedly excessive at ages 35 to 64 by from 1.05
to 4.10 per 1,000. Still more marked is the excess in the mortality
from respiratory diseases other than pulmonary tuberculosis among
potters at ages 35 or over, which varies from 1.63 to 17.27 per 1,000.




OCCUPATIONS W IT H EXPOSURE TO MINERAL BUST.

2 53

Table 9 5 .— M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS A N D F R O M O T H E R D IS­
E A S E S OF T H E R E S P I R A T O R Y S Y S T E M A M O N G P O T T E R S , C O M P A R E D W I T H T H A T
OF A L L O CCUPIED M A L E S , IN E N G L A N D A N D W A L E S , 1900 TO 1902, BIT A G E G R O U PS.
Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Mortality from pulmonary tuberculosis.

Mortality from other diseases of the re­
spiratory system.

Death rate for potters.
Age at death.

Death
rate per
1,000 for
all occu­
pied
males.

15 to 19 years........
20 to 24 years........
25 to 34 years........
35 to 44 vears........
45 to 54 years........
55 to 64 years........
65 years and over.

Rate per

1,000.

0.54
1.55
2.03
2.74
3.04
2.16

11
.1

IN V E S T IG A T IO N S B Y

0.62
1.34
2.00
3.79
7.14
4.37
.97

Death rate for potters.

Greater
Ratio
( + ) or less
to rate
( —) than
for all
rate for all
occupied
occupied
males.
males.

+0.08
- .21
- .03
+1.05
+4.10
+2.21
- .14

115
86
99
138
235
202
87

Death
rate per
1,000 for
all occu­
pied
males.

Rate per

1,000.

0.24
.48
.77
1.66
3.32
6.54
17.77

D E P A R T M E N T A L C O M M IT T E E
D IS E A S E S .

0.46
.58
.64
3.29
10.78
23.10
35.04

Greater
( + ) or less
( —) than
rate for all
occupied
males.

Ratio
to rate
for all
occupied
males.

+ 0.22
+ .10
.13
+ 1.63
+ 7.46
+16.56
+17.27

192
121
83
198
325
353

197

ON IN D U S T R IA L

With further reference, however, to the excessive mortality from
respiratory diseases among potters, which, as subsequently to be
shown, is confirmed by American industrial insurance mortality ex­
perience, reference may be made to the discussion of the occurrence
of potters’ asthma, in the Report of the Departmental Committee on
Industrial Diseases. The evidence submitted to the committee dis­
closed a decided improvement in the disease liability of potters to
the fibroid form of phthisis, based upon the records of the North.
Staffordshire Infirmary, at Stoke-upon-Trent, covering the period
1873-1906. Upon a basis of 10,000 patients, the number of cases of
fibrosis of the lungs was found to have been 145 during the six years
ending with 1878, 107 during the six years ending with 1897, and
only 4 during the six years ending with 1906.1 In the opinion of a
qualified medical witness, the diminution was not the result of a
difference in the practice of diagnosing, but a real reduction in the
prevalence of the disease. The improvement in the disease liability
was attributed to a betterment in the conditions of work and a more
effective method of factory supervision, inspection, and control.
Aside from these favorable conclusions, however, the general mor­
tality statistics of this trade indicate continued unfavorable circum­
stances, reflected in the decidedly excessive degree of pulmonary
tuberculosis frequency and a correspondingly excessive mortality
from other respiratory diseases in the more advanced years of life.
1 M inu tes o f E vid en ce, D ep a rtm en ta l C om m ittee o n C om p en sa tion fo r In d u s tria l D is ­
eases, L on d on , 19 0 7, p. 60.




254

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

D E S C R I P T IV E ACCOUNT O F T H E A M E R IC A N P O T T E R Y IN D U S T R Y .

These preliminary observations are strongly indicative of an in­
dustry in which the dust problem is of exceptional importance in
its relation to health and longevity. The aggregate value of pottery
products in the United States in 1915 was nearly $40,000,000, or al­
most twice the value reported for 1901. The principal branches of
manufacture are (1) red earthenware; (2) stoneware and Rocking­
ham ware; (3) whiteware, including CC ware; (4) china, bone, delft,
and belleek ware; (5) sanitary ware; (6) porcelain, electrical sup­
plies; (7) miscellaneous. The number of active manufacturing
plants in 1913 was 426. The principal pottery-producing States are
Ohio, New Jersey, and West Virginia, which, combined, produce 76
per cent of the total product. The pottery industry has been admi­
rably described in a report of the Bureau of Foreign and Domestic
Commerce,1 including descriptive accounts of the various special
processes, with observations on methods and labor conditions in other
countries. The principal departments of the industry are (1) prepa­
ration of materials; (2) forming the ware; (3) firing the ware;
(4) decorating; (5) packing, etc. Each branch consists by itself of
numerous and often highly specialized processes, which do not permit
of being briefly described. Practically without exception, however,
it may be said that all processes involve more or less dust exposure,
the nature of which, of course, will vary considerably according to
the product. As a general conclusion, based upon reasonably thor­
ough investigations in this country and abroad, it may be said that
the sanitary and other conditions affecting the health of potters in
this country are decidedly better than those which affect the health
of potters, for illustration, in England and Wales. The workshops in
this country, as a rule, have a greater abundance of light and venti­
lation and more adequate provision for heating during the winter.
The more extensive use of machinery, by which most of the very hard
labor in mixing the clay and running the so-called jigger and jolly
machines is largely done away with, is also a factor of considerable
practical importance. On account of the specific liability to lead
poisoning in the pottery industry, it is suggested that the propor­
tion of lead used in the dipping processes in this country should be
generally much less than in England and Wales. The climatic con­
ditions in the United States are also in favor of a lower mortality
rate from respiratory diseases resulting from weather exposure.2
1

T h e P o ttery In d u stry .
M iscella n eou s Series, N o. 21.
D om estic Com m erce.
W a sh in g to n , 1 915 .
* L ead P oison in g, by Sir T h o m a s O liver.
L ondon, 191 4 .




U . S . B u reau Of F oreign an d

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

255

D E S C R IP T IO N OF P R O C E S S E S A C C O R D IN G TO D U ST E X P O S U R E .

The disease liability of employees in the various branches of the
pottery industry in the United States, roughly approximated, is as
follows: 1
1. Office workers, dust exposure very slight and general conditions
favorable.
2. General outside laborers, dust exposure slight, but general con­
ditions often far from favorable.
3. Mixers of materials for glaze, etc., dust exposure very consider­
able, especially of clay, flint, and white lead.
4. Slip makers, pug-mill workers, etc., considerable dust exposure
and dampness.
5. Mold makers, some dust exposure, chiefly to plaster of Paris.
6. Throwers, some dust exposure. Occupation is more or less ob­
solete.
7. Jigger men and jolly men, considerable dust exposure, but fairly
favorable indoor conditions.
8. Pressers of hollow ware, some dust exposure, but fairly favor­
able indoor conditions.
9. Pressers of flat ware^ some dust exposure, but fairly favorable
indoor conditions.
10. Pressers of sanitary ware, a lesser degree of dust exposure,
but occasionally considerable dampness.
11. Sagger makers, exposure to dust and dampness and frequently
heavy physical strain.
12. Kiln men, placers, considerable exposure to flint dust and other
unfavorable conditions.
13. Kiln men, drawers, considerable exposure to dust and fre­
quently extreme heat.
14. China scourers, brushers (women), very considerable exposure
to irritating flint and other dust.
15. Dippers and dipper helpers, exposure to risk of lead poisoning
and much dampness.
16. Decorators, printers, and fillers-in, exposure to mineral poisons,
lead poison, and atmospheric pollution on account of odor of tur­
pentine.
17. Ground layers (decorators), very considerable exposure to
risk of inhalation of dry dust of mineral paints.
18. Warehousemen, slight degree of exposure to inorganic dust.
19. Packers, considerable exposure to dust of straw and inorganic
dust.
20. Sweepers, exceptionally serious exposure to flint and clay dust.
1 T h is liat is based u p on p erson a l in v e stig a tio n s in to tb e p o tte r y i n d u s t r y c h i e f ly in the
States o f N ew J e rs e y , O hio, a n d W est V irgin ia .




256

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

21. Flint-mill workers, considerable and continuous exposure to
the most dangerous form of irritating flint dust.
These observations are only approximate, and it should be consid­
ered that the different employments are frequently, carried on in
conjunction with or in continuance of one another. The most ex­
posed employments are those of china scourers, ground layers,
sweepers, and flint-mill workers.
P A T H O LO G Y A N D SY M P TO M O LO G Y O F T H E D U ST P R O B L E M .

The pathology and symptomology of the dust problem in the pot­
tery industry has attracted the serious attention of all authorities
on occupational diseases. A concise and exceptionally conclusive
though very brief contribution to the study of lung sclerosis in
porcelain workers was made by a French authority—Dr. Lemaistre—■
in Le Progres Medical and translated in the Medical Record for
December 27, 1890, in connection with which it is stated that—
Sections of the lung are generally colored, according to the mate­
rial that has been introduced; but here the lung is blackish, although
the substance introduced may be white, owing to inflammatory con­
ditions. The symptoms are analogous to tuberculosis and the diag­
nosis is difficult. The posterior aspect of the lung is most frequently
the seat of the sclerosis. Sometimes the sounds of pulmonary em­
physema or of pleurisy may be heard. It is, however, differentiated
from emphysema by the absence of tympanitic sounds. The sputa
are characteristic. There is no hectic fever or nocturnal sweating.
Men are more frequently attacked than women. He has found
bacilli in the sputa and regards the disease as a tubercular fibrosis.
The siliceous particles produce ulcerations in the bronchi, upon
which the tubercular matter is grafted, and continues to exert an
irritant action which induces hyperplasia of the connective tissue.
This, to a certain extent, is salutary.
P O T T E R S’ A STH M A .

Partly in consequence of this condition inimical to the health of
pottery employees generally the term “ potters’ asthma ” has been
widely accepted as typical of the highly specialized conditions
under which respiratory affections resulting from continuous dust
exposure in the pottery industry are likely to occur. In a measure
potters’ asthma resembles miners phthisis, but it is frequently in­
distinguishable from true tuberculous phthisis, without the preceding
lung fibrosis. It was brought out in the evidence collected by the
departmental committee on industrial diseases that china scourers
and biscuit placers were probably the most liable to potters’ asthma,
but all the indoor occupations in the potteries are more or less af­
fected, though, of course, to a considerably varying degree. A table
was presented by Dr. Dawes of the deaths of potters in Longton,




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

257

Staffordshire, for the period 1898 to 1906, showing conclusively the
excessive incidence among potters of deaths from bronchitis, potters’
asthma, and fibroid phthisis. All of these terms are more or less
inclusive of each other.
C O M P A R A T IV E O C C U P A T IO N A L M O R T A L IT Y S T A T IS T IC S .

A table was also introduced into the evidence by Dr. Tatham,
based upon the mortality of England and Wales for 1900 to 1902,
including comparative statistics for other dusty trades, as follows:
Table 9 6 .— C O M P A R A T IV E M O R T A L IT Y F R O M P H T H IS IS A N D D IS E A SE S OF T H E R E S ­
P I R A T O R Y S Y S T E M IN C E R T A IN SP E C IF IE D O C C U P A T IO N S, E N G L A N D A N D W A L E S ,
1900 TO 1902.

Phthisis and diseases
of the respiratory sys­
tem.

Mortality figure.

Occupation.
Mortality
figure.

A griculturist..................................................................................
Dock laborer, wharf laborer......................................................
Potter, earthenware, etc., manufacturing............................
Cutler, scissors maker..................................................................
Tin miner......................................................... ...............................
Nail, anchor chain, and other iron and steel manufac­
tures.................................. .............................................................
Stone, slate quarrier...................................................................
Brass, bronze, manufacturer, founder, finisher, worker..
Bricklayer, mason, builder........................................................

Ratio.

10
0

Phthisis.

Diseases of
respiratory
system.

161
632
741
812
1,577

393
460
504
980

79
291
277
516
838

82
341
464
296
739

493
390
469
364

306
242
291
226

182
186
262
188

311
204
207
176

Note.— This table is to be read thus: Among a certain number of males aged 25 to 65 years in the general
population, 1,000 deaths occurred during the years 1900 to 1902; of these 1,000 deaths, 186 were due to phthisis
and 174 to diseases of the respiratory system. Among an equal number of agriculturists living, at the same
ages, there were 79 deaths from phthisis and 82 from diseases of the respiratory system. Among an equal
number of dock laborers, 291 and 341, respectively, and so on.

R E S U L T S OF S A N IT A R Y IM P R O V E M E N T S .

Attention was directed in the evidence to the material improve­
ment in the health conditions of the pottery industry of England
and Wales during the last 30 years, particularly by Dr. Frank Shufflebotham, who presented data relative to the frequency of fibrosis
of the lungs as observed in the experience of the North Stafford­
shire Infirmary, Stoke-upon-Trent, which is a center of the English
pottery industry. The seriousness of the existing situation, however,
in 1907, when the departmental committee on industrial diseases
made its investigations, is concisely set forth in a brief statement by
Dr. C. Petgrave Johnson, as follows:
I find that during the seven years, 1900-1906, of potters’ pressers
living in Stoke, 47 died. Of these, 14 died of bronchitis, 15 of
phthisis, and 5 of pneumonia, i. e., over 72 per cent of the deaths
were due to lung diseases. If the deaths in the North Stafford In­
firmary and the Stoke-upon-Trent Union Hospital are included,
106811°— 18— Bull. 231-------17




258

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

then 112 deaths among potters’ pressers occurred in the same seven
years. Of these 31 were due to bronchitis, 43 to phthisis, and 4 to
pneumonia, i. e., 70 per cent of the deaths were due to lung diseases.
These figures are correct.
I find that during the seven years, 1900-1906, in not a single in­
stance in any of the deaths amongst potters’ pressers occurring in
the North Stafford Infirmary or in the workhouse hospital or in
the borough of Stoke, is fibroid phthisis or potters’ asthma, or cir­
rhosis of the lungs, or fibroid pneumonia given as the cause of death.
Bronchitis, phthisis, pulmonary tuberculosis, pneumonia, are the dis­
eases of the lungs which are mentioned.
I should like to supplement this by stating that the changes in the
lungs caused by particles of dust progress very ^lowly, years pass­
ing during the development. Should tuberculosis of the lungs super­
vene, the man dies in a comparatively short time, and any lung
changes due to dust do not attract attention. Should bronchitis de­
velop, however, he survives for years, and latterly, in the intervals—
if any—of comparative freedom from bronchitis, the lung changes
due to dust may attract attention or may not. The bronchitis symp­
toms, however, always attract more attention.
IN JU R I O U S N E S S OF SC O U R IN G P R O C E SS.

These general observations concerning the pottery industry as
a whole are amplified by an extensive amount of evidence concern­
ing health-injurious processes in detail. Concerning china scouring,
for illustration, it is said in the report of the chief inspector of
factories and workshops for 1908, that—
“ Scouring ” is one of the many operations to which china is sub­
jected during the course of its manufacture and is comparatively
simple, being, in fact, merely subsidiary to the manufacturing proc­
ess. In order to prevent the pieces of soft unbaked clay from be­
coming fused to each other, or to sides of the saggers in which they
are placed during the firing in the kiln, each piece is separately
buried in a bed of fine flint dust with which the sagger is filled. After
the firing is accomplished this flint dust, which resembles fine sand,
has to be removed. The heat causes a considerable portion of it to
become fused to the surface of the baked ware to which it adheres,
and it is therefore necessary to get rid of this by scrubbing each piece
of ware with a dry and very stiff brush. The operation, as its name
implies, is more drastic than that of mere dusting. The piece is first
uknocked” and the sharp jars cause the loose dust to fall off, then
scrubbed with a revolving motion with a stiff brush (often worked
by power), and then it is rubbed with coarse flannel; finally, the re­
mains of the rough adhering particles are smoothed off by means of
sandpaper. From this description it will be seen that the operation
is a very dusty one.
IN JU R I O U S N E S S OF F L I N T D U ST.

Attention is directed in this statement to the difference between
china scouring and earthenware “ towing,” it being stated that in
earthenware the material to be removed is soft clay dust, while in




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

259

china it is a very finely ground flint, the microscopical particles of
which are sharp and jagged. The conditions are particularly unfa­
vorable in small plants where rules and regulations regarding mechani­
cal methods of dust removal can not be effectively applied except at
prohibitive expense. At the same time it is thoroughly well recog­
nized, and as pointed out in the report referred to, that “ a micro­
scopic examination of the flint in which china is bedded shows that
owing to the shape of the particles it forms one of the most mechani­
cally injurious of all dusts.” And in the Staffordshire district the
relation of this dust to pulmonary tuberculosis is so well known that
death certificates frequently merely mention as cause of death the
significant term “ flint.” Since most of this work is done by women,
in the United States as well as in England and on the Continent, the
mortality data, usually limited to males, have not become available.
A special investigation, however, was made in the Longton district
concerning the female population, with the result shown in Table 97.
9 7 . — M O R T A L IT Y F R O M R E S P I R A T O R Y D IS E A SE S (IN C L U D IN G P H T H IS IS ) IN
L O N G T O N : C H IN A SC O U R E R S A N D T O T A L F E M A L E P O P U L A T IO N C O M P A R E D , 1896
TO 1898.

T a .b le

[Rates are based on female population in 1891 (10,561) and number of cliina scourers in 1898 (160), ages

15 to 70.1
Deaths

from

respiratory diseases
phthisis) among—

A ll females.

Year.

Number.

1896......................................................................................................
1S97......................................................................................................
1S98 1..................................................................................................

45
49
29

(including

China scourers.

Rate per
per
annum.

10
,0 0

4.3
4.6
5.5

Number.

1
2
1
1
6

Rate per
per
annum.

10
,0 0

75.0
68.9
75.0

1 From January to June.

The data, of course, are of rather limited extent, but they are quite
sufficient for the purpose of emphasizing the extreme injuriousness
of china scouring as carried on under existing conditions which, as a
general rule, preclude adequate consideration of effective methods
for the control of the dust evil. As is well said in connection with
the foregoing table in the report referred to—
In order to reduce the appalling death rate shown in the table it is
necessary to prevent the inhalation of flint by the workers. It is a
fact that every form of dust produced during the course of a manu­
facturing process can be extracted from the workroom by means of
a sufficient number of properly placed and efficiently contrived ex­
haust fans. The important point is that this should be done in such
a manner as to prevent the dust from becoming dispersed in the air
or from being drawn past the faces of the workers. In several fac­
tories we found that fans had been introduced, and when these were




260

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

efficient the atmosphere and the clothes of the women themselves were
strikingly free from flint. In two factories we found substitutes for
a fan, but we observed no difference between these and the places in
which there were no means of removing the dust; in most cases the
benches are placed directly in front of the windows, so that when
these are open the dust is blown directly into the faces of the workers.
The structural conditions of some of the smaller china factories are
such that we are in agreement with the opinion of the medical mem­
bers of the committee of 1893, and with that expressed in the special
report of Profs. Thorpe and Oliver that u they are wholly or in
part unfitted for use as work places, inasmuch as work can not be
carried on in them without injury to health.5 In others, however,
5
alterations entailing a small expense would very materially improve
the conditions, while in ail, so long as they are permitted to remain
in use, effective means of drawing off the clouds of unhealthy dust
are a necessity.
C Q N T IN U O U S N E SS OF I N JU R I O U S C O N D IT IO N S.

This lamentable condition has remained practically unchanged in
the pottery industry since its development on a large scale, for, as
shqwn by the evidence before the royal commission of 1841,1 inquiring
into the employment of children and young persons, the excessive
frequency of respiratory diseases resulting from exposure to flint
and other dust was thoroughly well recognized at the time but con­
sidered inherent in the conditions under which the industry was car­
ried on. Conditions in this country have not been subjected to an
equally thoroughgoing scientific investigation, but the recorded ob­
servations of factory inspectors, health officials, and others quite fully
confirm the prevailing view that while the health and mortality of
potters in America are more favorable this is chiefly because of better
sanitary surroundings, housing, food, etc., higher wages and shorter
hours, and a decidedly lesser incidence of habits of intoxication. Dr.
H. E. M. Landis, of the Phipps Institute of Philadelphia, in an in­
vestigation regarding American potteries points out that—
His own observations had led him to believe that more care should
he exercised on the part of the workmen in the disposal of the frag­
ments of clay which were thrown off in the fashioning of the various
utensils. Too much of it was allowed to fall on the floor about the
work bench, and as a result was walked upon and quickly pulverized
into dust. Face masks had been repeatedly advocated, but had never
been particularly successful, for the reason that the workmen were
r
averse to using them. He believed that these individuals, especially
those working in the dusty departments, should be subjected to fre­
quent medical inspections. A compulsory examination three or four
times a year would undoubtedly result in detecting many cases which
would otherwise pass into the terminal stages of potters’ asthma or
tuberculosis.2
1 P h y sica l and M oral C on d ition o f the C h ildren and Y ou n g P erson s E m p loy ed in M ines
and M a n u fa ctu res, L on d on , 1843.
2 M ed ica l R e co rd , J u ly 25, 1914.




OCCUPATIONS W IT H EXPOSURE TO M IN E R A L DUST.

261

S A N I T A R Y A S P E C T S OF T H E P O T T E R Y IN D U S T R Y IN OHIO.

Hayhurst in his numerous reports on industrial conditions in
Ohio has extensively dealt with the pottery industry, and in a gen­
eral way the results of his investigations confirm conclusions based
upon foreign experience. Concerning slip making, which means
the removing of the clays in the form of dust and lumps from the
stock bins, followed by grinding, water washing, and ^sifting proc­
esses, through the use of pug mills, agitators, compressing machines,
and drying kilns, the dust hazard was found to be serious in 23 work
places, fairly serious in 6, and of small importance in 9, out of a
total of 38. It was found that the chief causes of dust in the atmos­
phere in connection with slip making were the more or less constant
shoveling of clays in the dry form, its escape from grinding ma­
chines, and its being raised from the floor by moving air currents,
etc. In 20 of the places dampness was an additional occupational
hazard, chiefly because of faulty floor drainage, leaky vats, etc.
The general appearance of the workers was not more than fair in 30
of the 38 work places. Many prematurely aged, pale, and under­
weight men were seen among those longest employed. According
to a report in the Ohio Public Health Journal for January-March,
1916, “ the chief complaints of the workers were the breathing
of dust, damp quarters, heat, fatigue, poor washing facilities, and
general insanitary quarters.” Excepting, however, the dust hazard,
none of the other conditions was considered seriously injurious to
health.
I N JU R I O U S N E S S OF F L I N T -D U S T M A K IN G .

Flint-dust making without question is the most hazardous process
in the pottery industry. Only a few of the large firms were found
to employ this process on their own account, but the attention of the
investigators was directed to two firms employing foreign laborers
engaged in making this product, which involves crushing, grinding,
conveying, and packing, in connection with all of which there was
observed “ an unusual amount of fine, hard flint dust, which pervaded
the air of the work place and coated the openings of windows, doors,
and roof vents with a white flourlike powder.” It is, therefore,
properly suggested that dust-confining machinery, short hours, and
respirators are needed in all such places.
M OLD AN D SA G G E R M A K IN G .

In the same investigation the process of mold making was reported
upon for 16 plants. The molds are made of plaster of Paris, which
involves considerable exposure to a recognized injurious form of
mineral dust. Health appliances to handle and confine the dust




262

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES,

mechanically were found to be absent in all places. In 10 of the 16
places the dust was considered to constitute a fairly serious health
hazard. In 10 of the work places the appearance of the workers was
considered unsatisfactory. The chief complaint was on account of
the breathing of the dust and general unsanitary features. It is
suggested that it would appear “ that mechanical means could bo
contrived to convey and weigh the dusts used, for being a dusty oc­
cupation and an injurious type of dust, workers should be under
medical supervision, and, in addition, respirators should be furnished
and worn during the performance of unavoidably dusty operations.”
Sagger making is described by Hayhurst as consisting in the mak­
ing, shaping, baking, finishing, and repairing of the clay containers
in which the pottery ware is baked in the kilns. This occupation
employs relatively few persons in the pottery industry. The dust
factor was considered of importance in 10 out of 19 plants investi­
gated. The chief cause of the dust was 4 the careless handling and
4
dumping of clays and the disturbance of the dust on the floors and
benches by the workmen or by air currents.” The chief occupational
hazard, however, was not the dust, but the liability to chronic lead
poisoning. The general complaint was on account of the breathing of
dust and exposure to dampness, with resulting liability to rheuma­
tism. Heat exposure was not considered serious.
JIGGERMEN, JOLLYMEN, AND PRESSERS*

Pottery-making processes proper include the work of the throwers,
the jiggermen, the jollymen, and the pressers. More precisely the
employments in the Ohio pottery industry are stated by Hayhurst
to include 4 batters-out, pressers, jiggermen, jollymen, turners, han­
4
dlers, stickers-up, dish-specialty makers, finishers, machine pressers,
mold boys (called also mold runners and dog trotters), and helpers.”
The processes in connection with these employments were investi­
gated in 53 plants, including all branches of the industry, employing
3,048 wage earners, of whom 2,521, or 82.7 per cent, were males and
527, or 17.3 per cent, were females. The majority of all potters, it is
stated, are employed in the bisque-making rooms. The class of work­
ers was found to be mostly native and above the average. In 40 of
the work places the employees were found to be exposed to a con­
siderable hazard on account of the breathing of fine clay dust. Some
machine pressrooms were free from dust, but others were very dirty,
apparently because clays were handled drier. The finishers, chiefly
women, who scrape rapidly revolving articles, ran the greatest dust
hazard, while the mold boys and helpers, who handled the dried
bisques in the ovens, suffered next in hazards. In no places were local
exhaust systems found for the protection of finishers. Dampness




OCCUPATIONS W IT H EXPOSURE JO MINEEAL BUST.

263

was quite common and was found to be a serious hazard in 25 of the
work places investigated. Complaint was made of insufficient heat­
ing, and poor ventilation was reported in more than half of the
plants investigated, especially during the winter months. The basis
of this 'complaint was the large number of work people assembled
together, the presence of the baking ovens, and the lack of air agita­
tors and air-conditioning systems, and often to the absence of ordi­
nary vents in types of buildings which it was impossible to ventilate
sufficiently without mechanical means. The general appearance of
the workers was favorable in only 10 places, but in the balance many
fatigued, under-weight, and physically inferior employees were ob­
served. The usual complaints were on account of the heat, fatigue,
dust, poor ventilation, dampness, and cold. It is held that this
particular process is the chief source of tuberculosis in the pottery
industry, and that many instances of the disease were brought to the
attention of the investigators of the Ohio State Board of Health
by both workmen and employers, usually, however, with the informa­
tion that its occurrence was unavoidable. Among the hygienic short­
comings pointed out, the investigation emphasized the injurious
nature of atmospheric changes and the absence of physical examina­
tion. Attention is directed to the fact that pneumonia is a frequent
occupational disease among those who inhale clay and other mineral
dust, The generally dust-contaminated nature of the atmosphere in
the workrooms was sufficiently established to justify the conclusions
arrived at.
Similar conclusions apply more or less to other processes in the
pottery industry, the dangers of which in some cases, however, are
materially increased by the risk of lead poisoning. How far there
is a possible relation between lead poisoning and pulmonary tuber­
culosis has not been determined.1 It is, however, fair to assume that
whatever conditions result in a diminution of vital resistance gener­
ally must more or less act as a predisposing cause of pulmonary
tuberculosis.
LEAD POISONING AND PULMONARY DISEASES.

The dangers of lead poisoning in the pottery industry have been
reported upon in numerous official investigations, including Bulletin
104 of the United States Bureau of Labor Statistics. Dr. George
Reid, in a discussion of the evidence of the departmental committee
appointed to inquire into the dangers attendant on the use of lead
in the manufacture of earthenware and china, published by the
1 Sir Thom as Oliver, in M s “ Lead Poisoning/* London, 1914, pp. 83—88, carefully con­
siders the question as to whether or not lead poisoning of itself predisposes to tuberculosis,
including the opinion of Prof. Hahn of Munich and the animal experimentation of
G. Loriga. Oliver concludes that 4t the only way in which it can do so is by reducing the
general vital resistance of the individual.”




264

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

British Government in 1910, raises, however, a very important ques­
tion when, according to the British Medical Journal (Sept. 24, 1910),
he remarks that, “ without minimizing the gravity of the situation so
far as lead poisoning is concerned, the mortality from this cause is
a cipher compared with the deaths from phthisis and respiratory
diseases—the death rate from plumbism per 1,000 being 0.81 com­
pared with 7.05 for phthisis.” In the same publication it is said that
another interesting and far-reaching problem, which was also raised
by Dr. Reid, was with reference to compensation in cases of lung
diseases among potters, which is referred to as a problem bristling
with difficulties. In proportion, of course, as industrial lung diseases
are brought within the range of workmen's compensation for indus­
trial injuries, as possibly quite separate and distinct from industrial
diseases in the strictly limited sense of the term, the necessary methods
and means of dust prevention will receive more adequate considera­
tion.
The report of the departmental committee on the pottery trade
is one of the most important contributions to the literature of occu­
pational diseases, and although chiefly with reference to the dangers
of lead poisoning, the report includes a mass of related evidence of
exceptional usefulness in general consideration of the health prob­
lem in industry. The investigation of the special committee included
550 pottery works employing 63,000 persons and 7 lithographic trans­
fer works. It was found that out of 63,000 workers 6,856, or 11
per cent, were brought in contact with lead, whereas 23,000, or 37
per cent, were exposed to the inhalation of dust. The latter conclu­
sion, however, must be accepted in a restricted sense, since the com­
mittee apparently concerned itself only with dust obviously seri­
ously injurious and sufficiently determinable as to quantity and
health-injurious qualities. It is difficult to accept the conclusion that
53 per cent of the workers in English potteries, as stated in a letter in
the Journal of the American Medical Association, dated London,
July 9, 1910, “ are not exposed to any particular danger to health.”
Investigations in this country, particularly in Ohio, indicate that a
much smaller proportion of pottery employees is engaged in rela­
tively harmless employments.
MORTALITY OF POTTERS— UNITED STATES REGISTRATION AREA.

The mortality of potters has been reported upon only for the year
1909 by the Division of Vital Statistics of the United States Census
Bureau and no subsequent information has been made public, so that
the data are of rather limited value. This is particularly regrettable
in the case of so important an occupation as the pottery industry, for
the mortality returns for the United States registration area for the




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

265

year referred to are limited to 136 deaths from all causes, of which
47, or 34.6 per cent, were from pulmonary tuberculosis. The details
of the mortality by divisional periods of life are shown in Table 98.
T able 9 8 .—P R O P O R T IO N A T E M O R T A L IT Y OP P O T T E R S FR O M P U L M O N A R Y T U B E R ­
CULOSIS, U N ITE D STATE S R E G IS T R A T IO N A R E A , 1909, B Y A G E GROUPS.

Deaths from pulmonary
tuberculosis.
Age at death.

Deaths
from all
causes.
Number.

Per cent
of deaths
from all
causes.

15 to 24 years ......................... .................................... ................
25 to 34 vears __ . . . . . . . . . . . . . . . ............. .................. ............. .
_
35 to 44 vears .................................. - - ................................*.................
45 to 54 years*................................................................................................
55 to 64 years ...................................................................... - ............ - ........
C5 years and over....... .........................................................

13
27
26
32
12
26

6
12
11
12
5
1

46.2
44.4
42.3
37.5
41.7
3.8

Total 15 years and over..................................................... .............

136

47

34.6

T able 9 9 .—P R O P O R T IO N A T E M O R T A L IT Y OF P O T T E R S FROM N O N T U B E R C U L O U S
R E S P IR A T O R Y DISEASES, U N ITE D STATE S R E G IS T R A T IO N A R E A , 1909.

Deaths from nontuberc u 1o u s respiratory
diseases.
Cause of death.
Number.

Per cent
of deaths
from all
causes.

B ron ch itis...........................................................................................................
Pneumonia ........................................................ ............................. .
Other nontuberculous respiratory diseases...................................................................

1
1
9
6

6. 7
4.4

Totak..........................................................................................................................

17

12.5

0. 7
*7

Table 98, although limited to a relatively small number of deaths,
quite conclusively sustains the results of other investigations as re­
gards the excessive frequency of pulmonary tuberculosis in the pot­
tery industry throughout practically the entire working period of
life. Aside from the distinctly excessive proportion of deaths from
pulmonary tuberculosis the mortality from nontuberculous respira­
tory diseases, shown in Table 99, is also excessive, or 12.5 per cent,
compared with 9.2 per cent for glassworkers and 10 per cent for all
occupied males, according to data received from the same official
American sources.
MORTALITY OF POTTERY EMPLOYEES—MEDICO-ACTUARIAL EXPERIENCE.

The only really conclusive statistics regarding the mortality of
potters in the United States are derived from life insurance experi­
ence. As a general rule both life insurance companies and frater-




2 66

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

nal societies are extremely cautious in accepting risks on the lives of
persons employed in at least the more health-injurious processes of
the pottery industry. Dippers, fiint-mill workers, ground layers,
mixers, scourers, and sweepers are generally declined, uncondition­
ally. Kilnmen, mold makers, placers, pug-mill workers, sagger
makers, and slip makers are occasionally accepted, but at somewhat
higher premium rates than those charged men in recognized healthy
employments. Most of the risks accepted in the pottery industry
include decorators, fillers-in, jiggermen, jollymen, pressers, printers,
throwers, and warehousemen. These observations require considera­
tion in view of the results of the medico-actuarial investigation con­
cerning pottery employees, chiefly molders, excluding foremen and
superintendents.
T able 1 0 0 .—M O R T A L IT Y FR O M A L L CAUSES AMONG P O T T E R Y E M P L O Y E E S (C H IE F L Y
M O LD E RS, E X C L U D IN G F O R E M E N A N D S U P E R IN T E N D E N T S ) B Y A G E G R O U PS.
[Medico-Actuarial Investigation.]

Age at death.

Number
exposed to
risk one
year.

15 to 29 years....... - ..................................................................
30 to 39 years ......... ................................................................

1,194
999

59 t o -59 years
.......................................................................
00 years mid over....................................................................
Total...............................................................................

Actual
deaths.

Expected
deaths.

Ratio of
actual to
expected
deaths.

45
16

13
9
4
1
1

5.44
5.93
3. 68
.66
.74

239
152
109
152
135

2,645

28

16.45

170

3 9 1;

It is shown in Table 100 that the general mortality of pottery em­
ployees, subject to the preceding qualifications, is 70 per cent in excess
of the expected. The small number of risks under observation pre­
cludes final conclusions, but the data are decidedly suggestive of dis­
tinctly health-injurious conditions inherent in the American pottery
industry, even after excluding the recognized unhealthy branches of
the trade. In industrial insurance no such discriminations pre­
vail, all employments being accepted. Unfortunately, in the mortal­
ity returns the death certificates frequently fail to state the precise
occupation, and on account of the peculiar nomenclature common to
the pottery industry there is a considerable degree of confusion.
Thus decorators, pressers, printers, warehousemen, sweepers, etc-,
may be returned under entirely different occupational terms unless
it is specifically stated that the employment was in connection with
the pottery industry.
MORTALITY OP POTTERS— INDUSTRIAL INSURANCE EXPERIENCE.

In Table 101, derived from the industrial insurance experience
of the Prudential Insurance Co- of America, the term “ pot­
ters ” is limited to only such deaths as were clearly of persons con­




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

267

nected with the pottery industry, which, in part, explains the rather
limited mortality under observation. The table includes 801 deaths
of potters from all causes, of which 258, or 32.2 per cent, were from
pulmonary tuberculosis.
1 0 1 .—P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O SIS AM ONG
P O T T E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, C O M P A R E D
W IT H T H A T OF A L L M ALES IN U N IT E D STA TE S R E G IS T R A T IO N A R E A , 1900 TO 1913,
B Y A GE GROU PS.

table

Deaths of potters, 1897 to
1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
A ll causes.

15 to 24 years........................................................................
25 to 34 years........................................................................
35 to 44 years........................................................................
45 to 54 years........................................................................
55 to 64 years........................................................................
65 years and over...............................................................
Total, 15 years and over . ........................... .

Pulmonary
tubercu­
losis.

Potters.

Males in
registration
a re a ,1900
to 1913.

77
137
181
172
147
87

24
68
72
52
31
11

31.2
49.6
39.8
30.2
21.1
12.6

27.0
30.5
23.4
14.7
7.9
2.6

801

258

32.2

13.9

The table exhibits an excessive frequency of pulmonary tuberculosis
at all ages; in fact, an extremely high proportion is maintained
throughout the older ages when in the general experience other dis­
eases tend to predominate. The experience confirms the preceding
observations and conclusions derived from American and foreign
experience, that the pottery industry in general, and among many
of the more specialized processes in particular, must be considered
seriously injurious to health and life, and for the reasons stated the
requirement of thoroughgoing sanitary rules and regulations is selfevident. While there has been some progress in the direction of im­
proved methods of factory supervision in this country with special
reference to the pottery industry, we are as yet far from having at­
tained to the more well-considered governmental practices of Euro­
pean countries.
FOREIGN SANITARY REGULATIONS OF THE POTTERY INDUSTRY.

Attention may be directed in this connection to the regulations
adopted under date of January 2, 1913, by the British Government
with special reference to the manufacture and decoration of pottery,
reprinted in a special bulletin of the New York Department of Labor.1
The particular regulations concerning the suppression of dust, the
use of respirators, and ventilation are as follows:
1 E u rop ea n R eg u la tion s fo r P re v e n tio n o f O ccu p a tio n a l D iseases.
S pecial B u lletin
N o. 76, pu b lish ed by the N ew Y ork S ta te In d u s tria l C om m ission, A lb a n y , March* 1916.




268

MORTALITY FROM RESPIRATORY DISEASES
R

e g u l a t io n s

for

the

S u p p r e s s io n

IN

of

D

DUSTY TRADES.
ust.

( a) The following processes shall not be carried on without the use of an
efficient exhaust draft:
(i) The fettling of flat ware, whether china or earthenware, by towing
or sandpapering, provided that this shall not apply to the occasional
finishing of pieces of china or earthenware without the aid of mechanical
power;
( ii) The sand-sticking of sanitary ware;
(iii) Any other process of fettling on a wheel driven by mechanical
power, except where:
(a) The fettler is fettling, as an occasional operation, only ware
of his or her own making; or
( b ) The fettling is done wholly with a wet sponge or other moist
material; or
( c) The fettling is done by the worker who has made the articles,
whilst the latter are still in a moist state.
(iv) The sifting of clay dust for making tiles or other articles by pres­
sure, except where:
( a) This is done in a machine so inclosed as effectually to prevent
the escape of dust; or
( b ) The material to be sifted is so damp that no dust can oe
given off.
(v) The pressing of tiles from clay dust; an exhaust opening being
connected with each press; this clause shall also apply to the pressing
from clay dust of articles other than tiles, unless the material is so damp
that no dust is given off.
(vi) The fettling of tiles made from clay dust by pressure, except where
the fettling is done wholly on or with damp material; this clause shall also
apply to the fettling of other articles made from clay dust, unless the
material is so damp that no dust is given off.
(vii) The processes of bedding and flinting.
(viii) The brushing of earthenware biscuit, unless the process is carried
on in a room provided with efficient general mechanical ventilation or
other ventilation which is certified by the inspector of factories for the
district as adequate, having regard to all the circumstances of the case.
(ix) Scouring of biscuit ware which has been fired in powdered flint,
r
except where this is done in machines so inclosed as effectively to pre­
vent the escape of dust.
(x) Batting of biscuit ware which has been fired in powdered flint.
(xi) Glaze blowing.
(xii) Ware cleaning after the application of glaze by dipping or other
process, except as set forth later in this regulation.
(xiii) The preparation or weighing out of flow material which yields to
dilute hydrochloric acid more than 5 per cent of its dry weight of a
soluble lead compound calculated as lead monoxide when determined in
the manner described in the definition of low solubility glaze.
(xiv) The lawning of dry colors, except where not more than an ounce
at a time is lawned for use in painting.
(xv) Ground laying, including the wiping off of color after its applica­
tion to the surface of the ware.
(xvi) Color dusting, whether underglaze or on-glaze, including the
wiping off of color after its application to the surface of the ware.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

269

(xvii) Color blowing or aerographing, whether underglaze or on-glaze.
including the wiping off of color after its application to the surface of
the ware.
(xviii) The making of lithographic transfers, including the wiping off
* of color after its application to the surface of the transfer sheets.
( b) In the process of mold making, every bin or similar receptacle used
for holding plaster of Paris shall be provided with an efficient exhaust draft
so arranged as to prevent the escape of plaster of Paris dust into the air
of the work place, except where a cover is provided for the bin or other recep­
tacle and the plaster of Paris is conveyed in a sack, the mouth of which is
tied and only loosened after it has been placed in the bin or other receptacle.
(c) The dry grinding of materials for pottery bodies shall be done either
with an efficient exhaust draft for the removal of dust, or in machines
so inclosed as effectually to prevent the escape of dust; except that it shall
not be deemed necessary in pursuance of this regulation to provide an ex­
haust draft to remove small amounts of dust given off at the hopper of
an inclosed machine in the course of feeding the same, if an outlet into an
exhaust duct or to the outside air is fitted to the receptacle into which the
powdered material is delivered.
(cl) In the process of sand sticking of sanitary ware, suitable provisi m
shall be made for collecting any material which falls on the floor.
( e) In the process of making tiles from clay dust by pressure, supplies of
material shall be conveyed to the •workbenches in such a manner as to dis­
perse as little dust as possible into the a ir; clay dust shall not be carried
into any press shop in sacks except where hoppers or similar receptacles are
provided for receiving the clay dust, in which case a sack in sound repair
shall be used and the mouth of the sack shall be tied and only loosened after
it has been placed in the hopper or other receptacle, which shall be provided
with a cover. This clause shall also apply to the making from clay dust of
articles other than tiles, unless the material is so damp that no dust is
given off.
(/) After one year from the date on which these regulations come into
force, biscuit flat ware which has been bedded for firing shall not be removed
from the saggers after firing, except at a bench fitted with an efficient exhaust
appliance for the removal of dust.
( g)
Flat knocking and fired-flint shifting shall be carried on only in in­
closed receptacles, which shall be connected with an efficient exhaust draft,
unless so contrived as to prevent effectually the escape of dust.
(Ji) In the process of w are cleaning of earthenware after the application
T
of glaze by dipping or other process, wherever it is practicable to use damp
sponges or other damp materials they shall be provided in addition to the
knife or other instrument, and shall be used.
(7c) Nothing in these regulations shall render it compulsory to provide
an exhaust draft for ware cleaning if this process is carried on entirely
with the use of wet materials; or if the ware cleaning be done within 15
minutes after the moment when the glaze was applied; but an efficient ex­
haust draft shall always be provided and used if any dry materials or im­
plements, such as knives or scrapers, are used after the glaze is dry or more
than 15 minutes after the moment when the glaze was applied.
(I) In the process of ware cleaning, after the application of glaze by
dipping or other process, sufficient arrangements shall be made for any glaze
scraped off, which is not removed by the exhaust draft, to fall into water.
All water troughs or other receptacles provided in pursuance of this clause




270

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

shall be cleaned out and supplied with fresh water as often as necessary, and
in r o case less often than once a week; and no scrapings of glaze shall be
allowed to collect in a dry condition on the sides of the water receptacle.
Where grids or gratings are fitted over the water trough or other receptacle
named in the foregoing paragraph, they shall be kept clean by repeated spong­
ing or wiping with wet material during the time that the process of ware
cleaning is being carried on. No boards or other articles shall be placed, even
temporarily, on any such water trough, in such a way as to interfere with the
efficient use of the trough.
{ m) In all processes the occupier shall, as far as practicable, adopt efficient
measures for the removal of dust and for the prevention of any injurious
effects arising therefrom.
( n) Every process for which an exhaust draft is prescribed shall be carried
on inside a hood or exhaust funnel, provided that where the occupier can
show that this is impracticable it shall be sufficient if the work is done within
the effective range of an exhaust opening.
R

e s p ir a t o r s .

( a) No person shall be allowed to work without wearing a suitable and
efficient respirator, such as a damp sponge tied across the mouth and nostrils,
in any of the following processes:
(i) The emptying of sacks of plaster of Paris into a bin in a moldmaking shop.
(ii) The weighing out, shoveling, or mixing of unfritted lead com­
pounds in the preparation or manufacture of frits, glazes, or colors con­
taining lead, or any process carried on in a room wherein any such
weighing out, shoveling, or mixing has taken place within the previous
30 minutes.
unless an efficient exhaust draft is provided to prevent the escape of dust
into the air of the work place.
(&) All respirators required by this regulation shall be provided and main­
tained in a cleanly state by the occupier, and each respirator shall bear the
distinguishing mark of the worker to whom it is supplied.
V e n t ix a t io n .

( а) Every place in which any worker or workers are employed shall be
thoroughly ventilated.
(б) All workrooms in which articles are left to dry shall be ventilated in
such a way as to insure a continuous movement of the air in the room in a
direction away from the workers and toward the articles in question.
(c) All drying stoves shall be ventilated direct to the outside air by shafts
having upward inclinations and terminating vertically or by louvers in the
roof or by other effective means.
( d) All mangles shall be so ventilated as to provide for the maintenance of a
flow of air into the hot chamber from the adjoining workroom.
In the case of vertical or “ tower ” mangles :
(i) The pipes for heating the mangle shall be fixed above the top of
any opening at which workers put in or take off ware; and
(ii) There shall be a free outlet into the air above so formed and placed
as to insure an outflow whatever the direction of the wind.
( e ) Fresh air shall, where practicable, be admitted to all workrooms by
inlets placed along the sides of the room at a height of as nearly as possible




OCCUPATIONS W IT H EXPOSURE TO MINERAL BUST.

271

6 feet above

the floor level, hopper opening being used for the purpose wherever
possible.
( /) Where it is not practicable to provide such fresh air inlets arrangements
shall be made for the entry of an adequate amount of pure air by a flue with
apertures at intervals along its length or other means, which will secure an
even distribution o f the air through the room.
(g ) In no case shall fresh-air inlets be so arranged that a -draft can blow
direct from them onto any worker.
( h ) Wherever the natural air currents are found to l)e insufficient without
assistance to afford thorough ventilation, exhaust fans, or other artificial means
of creating a •current o f air shall be provided and maintained In use.
(1c) Where an exhaust draft is provided for the removal of dust generated
in a manufacturing process precautions shall be taken to prevent dust being
drawn into the general atmosphere of the room from other sources of dust in
places in the vicinity; communication with sueh places shall be stopped wher­
ever possible, and the fresh-air inlets hereinbefore mentioned shall be so
arranged as to insure that no extraneous dust is drawn toward the workers
by the exhaust draft.
GENERAL CONCLUSIONS.

These rules find regulations are an admirable illustration of
really effective methods by which the intrinsic health-injurious
factors in a given industry can be reduced to a practically attainable
minimum. The conclusions, while specifically applicable to the pot­
tery industry, are equally suggestive of a far-reaching reduction of
occupational hazards in other dusty trades.
P AINT A N D COLOR WORKERS.

The dust hazard in paint and color manufacture is chiefly of a
mineral nature, but the use of metallic substances frequently includes
industrial poisons which it must be assumed tend to increase the
resulting hazard to health and life. Antimony, arsenic, chromium,
lead, manganese, mercury, zinc, etc., are the usual ingredients of
paints and colors used extensively in the industries and arts. Mineral
paints are divided into three groups— (1) natural mineral pigments,
(2) pigments made directly from ores, and (3) chemically manu­
factured pigments, all of which during ordinary processes of manu­
facture expose the workmen to a considerable amount of dust. Many
minerals or mineral products, it is stated in the annual report of the
United States Geological Survey.for 1914, by James M. Hill, u are
used in the paint trade, such as asbestos and products derived from
it, aluminium, asphalt, barytes, clay, graphite, gypsum, magnesite,
mica, pyrite, quicksilver, shells, silica, talc, tripoli, and many by­
products.”
CHEMICAL ASPECTS OE PAINT MANUFACTURE.

How far these wide variations in the basic nature of the materials
used affect health and life with special reference to pulmonary
tuberculosis is at the present time not even a matter of scientific con­




272

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY. TRADES.

jecture. The natural mineral pigments which constitute an important
group, comprise, according to the same authority, “ ocher, umber,
sienna, ground slate and shale, metallic paint, and mortar colors.”
The three ores of iron, hematite, siderite, and limonite, are the basic
constituents of metallic paints which enter to a considerable extent
into numerous processes of manufacture directly or indirectly, as
the case may be. Pigments made directly from ores, it is stated,
comprise zinc oxide, leaded zinc oxide, sublimated white lead, and
sublimated blue lead.1 In the chemically manufactured pigments
basic carbonate white lead, litharge, red lead, orange mineral, lithophone, and Venetian red are extensively used. The importance of
the mineral paint industry is best illustrated by the statement that
during 1914 the United States product was valued at nearly

$10,000,000.
EXPOSURE TO METALLIC DUST.

The amount of metallic dust in paint manufacture would be rela­
tively unimportant were it not for the frequently poisonous nature
of the substances used. As observed by W. Gilman Thompson with
reference to white lead, the material is first dried, then pulverized,
and diluted with oil and pigment, in connection with which processes
the dust hazard is quite important, while there exists the additional
risk of an increased susceptibility to pulmonary tuberculosis. Paint­
ers, in connection with the use of paints, are probably exposed to a
jesser liability to dust inhalation than is common to dry-color grind­
ing and related processes, but it is quite possible that the risk of lead
poisoning is more serious.
HYGIENE OF THE PAINTERS’ TRADE.

The hygiene of the painters’ trade has been reported upon with
admirable completeness, but with special reference to industrial
poisoning, by Alice Hamilton, M. D., in Bulletin 120 of the United
States Bureau of Labor Statistics. The importance of dust as a
cause of lead poisoning is emphasized by Dr. Hamilton, it being
stated that British experiments show that lead enters the bronchial
tubes and lungs and even penetrates the capillaries, thus reaching
the blood stream. She refers to German authorities as holding that
“ if any lead is absorbed through the respiratory tract, it must be
small in amount, and while it is true that the breathing of lead dust
causes poisoning, this is not because the lead reaches the bronchial
tubes, but because it is caught in the mouth and throat, mixed with
the saliva, and swallowed.” Lehmann, a German authority, is
quoted to the effect that4 the great bulk of the inhaled dust finds its
4
way into the stomach and not into the lungs.” It is said that the
dust lodges on the nasal and pharyngeal mucous membrane, and that
1 Lead and Zinc Pigments, by Clifford Dyer Holley, M. S., Ph. D.f New York, 1909.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

273

the dust-laden secretions are then swallowed. It is estimated that at
most less than one-fourth of the dust reaches the lungs. Soluble
dusts are easily absorbed, and the conclusion is advanced that, irre­
spective of the theory accepted, “ there is no question that poisoning
takes place more rapidly the dustier the occupation, and therefore
those parts of the painters’ trade that are accompanied by dust pro­
duction are the most dangerous.”
These observations bear directly upon the broader question of in­
creased liability to pulmonary tuberculosis in consequence of metallic
or mineral dust inhalation. The serious importance of lead poison­
ing in paint manufacture and the painters’ trade probably account
for the very limited consideration which has been given to the equally
important question of a possibly enhanced liability to pulmonary
tuberculosis.
SANITARY CONDITIONS IN THE GERMAN PAINT INDUSTRY.

The most important investigation into the health of persons em­
ployed in the manufacture of paint was published in 1893 through
the cooperation of the color manufacturers, Meister, Lucius & Briining,
of Hochst a. M., and Dr. Grandhomme, who thoroughly examined
into the sickness experience for the preceding decade and whose ob­
servations include the results of a study of factory conditions, raw
materials, and the processes of manufacture in detail, but with special
reference to the analine-dye industry.1 On account of the excellence
of hygienic precautions and the emphasis placed upon the personal
hygiene of the workmen, the observed experience is probably not con­
clusive with regard to paint and color factories in the United States.
The amount of sickness was relatively high and apparently on the
increase, but the average duration of the sickness was comparatively
favorable, having varied between 5 and 9 days per case and between
4.1 and 8.4 days per workman per annum. The medical results of
the investigation are too involved to permit of a brief analysis, but
with special reference to pulmonary tuberculosis it may be said that
the number of cases observed was apparently not excessive. Of the
entire morbidity, including 18,723 cases of sickness, 2,762, or 14.7 per
cent, were attributed to diseases of the respiratory organs, including
pulmonary tuberculosis. The mortality from all causes during the
period 1883-1892 was 7 per 1,000, which can not be considered exces­
sive, although the proportion of young persons employed was prob­
ably relatively high. Out of 126 deaths from all causes, 55 were from
pulmonary tuberculosis, 11 from pneumonia, and 12 from other
respiratory diseases. An excessive amount of mortality from tuber­
culosis and other respiratory diseases is, therefore, conclusively
1 Die Fabriken der Aktien-Gesellschaft Farbwerke vorm. Meister, Lucius & Bruning zu
Hochst a. M., Frankfurt a. M., 1893.

106S110— 18— Bull. 231------ 1?




274

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

brought out by the mortality analysis, although apparently in con­
tradiction to the morbidity experience. This is in part explained by
the relative frequency of digestive disorders and general nutritional
disturbances, as well as affections of the skin. Aside from the con­
siderable number of cases of industrial injuries, as far as the expe­
rience permits of a definite conclusion, it would appear that the mor­
tality from pulmonary tuberculosis in the German paint and color
industry, even under a well-considered plan of hygienic supervision
is unduly high, and that it is safe to assume that the excess in the
incidence of the disease is directly attributable to the more or less
considerable risk of continuous inhalation of metallic and mineral
dust, increased in the severity of its effects by the presence of poison­
ous substances, generally arsenic and lead.
LIABILITY TO METALLIC POISONING.

The paint industry was inquired into by the New York State Fac­
tory Investigating Commission. In the report for 1913 (vol. 2, p.
1152) it is said that six factories were inspected and that three used
arsenic colors, but to a limited extent, the principal output being lead
colors. No cases of poisoning were found among the workers, and
the information secured was, therefore, negative. It is stated, how­
ever, “ That there is danger can not be doubted, for the reports of
other countries and the report of one case to the department of labor
demonstrate the fact. The process wherein the danger lies is from
the dust created in handling the dry arsenic color. In this indus­
try there is danger of mixed poisoning.” Other observations on the
part of the commission have reference to the risk of lead poisoning,
but there is an extended description of a plant engaged in the manu­
facture of arsenic color with regard to which it is said that the
special process of mixing the materials is “ very dusty.” No pro­
vision was made for keeping down the dust or exhausting it. It is
interesting to note that one worker was examined who said he had
been employed for 32 years, but who showed no symptoms and gave
no history of ever having had arsenic poisoning. The irritant action
of arsenic dust was fully demonstrated by experimental inquiry, and
the conclusion is advanced that the chief danger from the dust is
in the processes of drying, bolting, and packing. No direct relation
between arsenic dust inhalation and a predisposition to pulmonary
tuberculosis was shown to exist by the investigation referred to.
MORTALITY OF PAINTERS, GLAZIERS, AND VARNISHERS.

The mortality of painters, glaziers, and varnishers considered as
a group has been reported upon for the years 1908 and 1909 by the/
Division of Vital Statistics of the United States Census Bureau.
The group, unfortunately, is so very large and inclusive of so many
widely different specific employments or occupational conditions




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

275

that the results of the analysis must be accepted with reserve. Pro­
portionately, of course, painters predominate in the group under con­
sideration and it is a safe assumption that the other occupations do
not very materially modify the proportionate mortality figure from
pulmonary tuberculosis. Thoroughly specialized investigations,
however, regarding particular employments (for, of course, even the
term “ painter ” covers quite a group of more or less varying occu­
pations) might and probably would disclose important differences
in the specific liability to pulmonary tuberculosis, particularly with
reference to exposure to health-injurious minerals and metallic dust.
Among painters, naturally, the liability to lead poisoning is a special
occupational danger, but the actual mortality from lead poisoning
is proportionally so small, at least among American painters, that the
relative effect of the same can not be considered of material im­
portance. According to the census report, out of 7,294 deaths of
painters, glaziers, and varnishers from all causes, 1,361, or 18.7 per
cent, were from pulmonary tuberculosis. The details of the mor­
tality by divisional periods of life are shown in Table 102.
T able 10 2 .—P R O P O R T IO N A T E M O R T A L IT Y OF P A IN T E R S , G L A ZIE R S, A N D V A R N IS H E R S
F R O M P U L M O N A R Y T U B E R C U LO SIS , U N IT E D STATE S R E G IS T R A T IO N A R E A , 1908
A N D 1909, B Y A G E GROU PS.

Deaths from pulmonary
tuberculosis.
Age at death.

Deaths
from all
causes.
Number.

Per cent of
deaths
from all
causes.

15 to 24 years..............................................................................................
25 to 34 years..................................................................................................
35 to 44 years..................................................................................................
45 ta 54 years................................................................................................
55 to 64 years..................................................................................................
65 years and over............................................. ..........................................
Age unknown...............................................................................................

429
968
1,423
1,598
1,474
1,398
4

132
357
415
278
132
46
1

30. 8
36.9
29. 2
17.4
9.0
3.3
25.0

Total, 15 years and o ver...................................................................

7,294

1,361

18.7

T able 1 0 3 .—P R O P O R T IO N A T E M O R T A L IT Y OF P A IN T E R S, G L A ZIE R S, A N D V A R N ISH E R S
FROM N O N TU BE R CU LO U S R E S P IR A T O R Y DISEASES, U N IT E D STATES R E G IS T R A ­
T IO N A R E A , 1908 A N D 1909.

Deaths from nontuberc u 1o u s respiratory
diseases.
Cause of death.
Number.

Per cent of
deaths
from all
causes.

Asthm a..................................................................................................................................
Broiichitis.............................................................................................................................
Pneumonia.................................................................................................................. ........
Other nontuberculous respiratory diseases....................................................................

11
47
533
64

0.2
.6
7.3
.9

T otal.... .......................................................................................................................

655

9. a




276

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

COMPARATIVE MORTALITY OF PAINTERS, GLAZIERS, VARNISHERS, AND
AGRICULTURAL LABORERS.

The proportionate mortality from pulmonary tuberculosis among
painters, glaziers, and varnishers considered as a group was above the
average for all occupied males throughout the entire working life­
time, but the excess does not assume serious proportions, which, how­
ever, does not preclude the conclusion that more selected groups of
occupations in the entire group of allied employments under con­
sideration would show a much more decided liability to pulmonary
tuberculosis than is shown to be the case for the employment con­
sidered in the aggregate. In a general way, however, the mortality
of painters, glaziers, and varnishers from pulmonary tuberculosis
conforms to the general average for all occupied males, but it is de­
cidedly above the average when comparison is made with agricul­
tural employments, as is shown in Table 104.
T able 1 0 4 .— C O M P A R A T IV E M O R T A L IT Y FR O M

P U L M O N A R Y T U B E R C U LO SIS AM ONG
P A IN T E R S, G L A ZIE R S , A N D V A R N IS H E R S , A N D F A R M E R S , P L A N T E R S , A N D F A R M
L A B O R E R S , U N IT E D STATE S R E G IS T R A T IO N A R E A , 1908 A N D 1909, B Y A G E G R O U P S.
Per cent of deaths from
all causes due to pul­
monary tuberculosis.
Age at death.
Agricul­
tural em­
ployments.

Painters,
etc.

15 to 24 years.........................................................................................................................
25 to 34 years.........................................................................................................................
35 to 44 years.........................................................................................................................
45 to 54 years.........................................................................................................................
55 to 64 years.........................................................................................................................
65 years and over..................................................................................................................
Age unknown.......................................................................................................................

23.5
26.2
19.1
12.1
6.7
2.4
7.9

30.8
36.9
29.2
17.4
9.0
3.3
25.0

Total, 15 years and over...........................................................................................

8.7

18.7

The preceding comparison is especially suggestive in that it em­
phasizes the inherent limitations of a mortality comparison in which
all occupations are considered the standard. For the present pur­
pose it has seemed advisable to compare painters, who, of course,
numerically constitute an exceptionally important group of occupa­
tions, with employments typical of outdoor labor carried on under
the most wholesome conditions as regards physical activity, air,
relative freedom from dust exposure, etc. The comparison, through­
out, is distinctly in favor of agricultural employments, and em­
phasizes the more or less health-injurious conditions under which
painters, glaziers, and varnishers, considered as a group, are em­
ployed throughout practically the entire working period of life.
How far the relatively high mortality from pulmonary tuberculosis
as determined by this comparison is attributable to the special risk
of lead poisoning can not be determined at the present time; but it is
a safe conclusion that there is some such relation, although the
recorded mortality from lead poisoning among American painters




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

277

is comparatively low; in other words, it is rather because of compli­
cations resulting from gradual lead absorption as a factor in other
diseases, including pulmonary tuberculosis, than as a direct cause
of death that lead poisoning assumes importance in occupational
or industrial hygiene. Aside from the relatively high proportion
of deaths from pulmonary tuberculosis the mortality from nontuber­
culous respiratory diseases among painters, glaziers, and varnishers
in comparison with farmers, planters, and farm laborers is not ex­
cessive. For painters, etc., considered as a group the proportionate
mortality from all nontuberculous respiratory diseases is 9 per
cent, which compares with 9.3 per cent for farm laborers. The pro­
portions for asthma, pneumonia, and other respiratory diseases are
about the same, but for bronchitis the mortality figure for agricul­
tural workers is exactly twice the average for painters, considered
as a group, or 1.2 per cent against 0.6 per cent. These conclusions,
however, must not be carried too far, in view of the fact that two
groups are compared which include quite a number of employments
with a more or less varying degree of exposure to conditions un­
favorable to health and longevity.
MORTALITY OF PAINT MIXERS— INDUSTRIAL INSURANCE EXPERIENCE.

There are no conclusive vital statistics of men employed in the
American mineral paint industry, whether considered as a group or
according to its several more important subdivisions. In the ex­
perience of the Prudential Co. ,(1897-1914) 36 deaths from all causes
in paint factories, excepting mixers, occurred, of which 6, or 16.7
per cent, were from pulmonary tuberculosis. The experience is, of
course, too limited to be conclusive. Among paint mixers, separately
considered, however, there were 88 deaths from all causes, of which
21, or 23.9 per cent, were from pulmonary tuberculosis. This expe­
rience is given in detail in Table 105.
T able 1 0 5 .—P R O P O R T IO N A T E M O R T A L IT Y FROM P U L M O N A R Y TU BE R CU LO SIS AM ONG
P A IN T M IX E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, COM­
P A R E D W IT H T H A T OF A L L M ALES IN U N IT E D STA T E S R E G IS T R A T IO N A R E A , 1900
TO 1913, B Y A G E GR O U PS.
*

Deaths of paint mixers, Per cent of deaths from
pulmonary tubercu­
1897 to 1914, from—
losis among—

Age at death.
A ll causes.

Pulmonary
tuberculo­
sis.

Paint
mixers.

Males in
registration
•area, 1900
to 1913.

15 to 24 years ........................................................................
25 to 34 years............................................................................
35 to 44 years.......................................................................
45 to 54 years............................................................................
55 to 64 years..........................................................................
65 years and over....................................................................

6
17
16
27
13
9

4
5
5
7

66. 7
29. 4
31.3
25.9

27. 0
30.5
23.4
14.7
7.9
2. 6

Total, 15 years and over.............................................

88

21

23.9

13.9




278

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

The statistics, though unfortunately too limited for entirely safe
conclusions, may be accepted as a sufficiently trustworthy indication
that paint mixers are unquestionably liable to an excessive mortality
from pulmonary tuberculosis, which in all probability upon further
inquiry will be found to correspond proportionately to the nature
and the quantity of the dust inhaled in the mixing processes. Even
in the case of men employed in paint factories, excluding mixers, the
experience is fairly suggestive of unfavorable conditions, though
obviously much less so than those known to exist in the mixing
processes separately considered. When the data for paint factories
are made to include mixers, the experience is represented by 124
deaths from all causes, of which 27, or 21.8 per cent, were from pul­
monary tuberculosis. At ages 35 to 44, out of 25 deaths, 10, or 40
per cent, were caused by pulmonary tuberculosis, which, of course,
is decidedly excessive.
GENERAL CONCLUSIONS.

In the absence of more definite and trustworthy data, the fore­
going brief observations concerning an important and rapidly in­
tending industry are suggestive of the urgency of better sanitary
conditions, chiefly the use of practical methods of dust prevention,
both by more adequate dust-removing processes at the point of
origin and the use of respirators in processes where the control of the
dust danger must necessarily be one of exceptional difficulty.
LITHOGRAPHERS.

Lithographers constitute an important branch of the printing trade.
According to the census of 1910 there were some 8,138 lithographers
in the United States, of which number 477 were females. For
hygienic reasons the employment of the lithographer should be con­
sidered separately from printing and engraving, since the former
is exposed chiefly to mineral dust, while the latter are exposed pri­
marily to the inhalation of metallic dust. Lithographic stone has been
defined as a fine, compact homogeneous limestone, practically all of
which is (or was) imported from Germany. The small amount of lith­
ographic stone quarried in the United States varies in its mineral and
metallic constituents from the Bavarian stone, containing nearly 7
per cent of magnesia. No accurate observations have been made a
matter of record to determine the degree of possible lung injury
resulting in the case of the lithographer’s occupation, but it is safe
to assume that the employment should be included in the group
of dusty trades. This conclusion is fully sustained by a knowledge
of the technical processes which constitute the lithographic art.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

2 79

The sanitary conditions of this employment received consideration
by Sir John Simon in his report as medical officer of the Privy
Council. Simon called attention to the dust resulting from the use
of colors and pigments, against the inhalation of which only very
few of the workmen had adopted intelligent precautions. The most
pernicious of the mineral or metallic colors employed in connection
with lithography were emerald green and bronze. Simon did not
connect the inhalation of this dust with the occurrence of phthisis,
but the inference would seem warranted that such a connection
exists, at least in exceptional cases.1
Parry, in his “ Risks and Dangers of Various Occupations,”
confirms the earlier opinion, and holds that in lithographing
green arsenical pigments are used, the poisonous dust of which is
inhaled and conveyed to the stomach. It is evident that the poison­
ous character of the colors or pigments is a more serious factor than
the dust of the stone itself, but how far either form of dust increases
the liability to tuberculosis has not been determined.
MORTALITY OF ENGLISH LITHOGRAPHERS.

The most recent English mortality statistics of lithographers are
for the three years ending with 1902, referred to in the Supplement
to the Sixty-fifth Annual Report of the Registrar-General of Births,
Deaths, and Marriages in England and Wales (p. lix), in part as
follows:
At all ages except 20 to 25 and 45 to 55 the death rates among these
workers exceed the standard for all occupied and retired males.
These workers experience a lower mortality than printers up to the
age of 45, but beyond that age the mortality in the two occupations
differs but slightly. In the main working period of life the com­
parative mortality figure of lithographers is 964, or 4 per cent, below
the average. Their mortality from influenza and phthisis consider­
ably exceeds the standard, while that from respiratory diseases is
below it by about an equal amount.
The English mortality statistics for lithographers are rather in­
conclusive as to a decidedly unfavorable effect of this industry on
health, and while in Table 106 a comparison is made of the mortality
from all causes of men in this group with occupied males generally,
the death rates are, as a rule, below the average for occupied males
generally except at ages 20 to 24 and 45 to 54, inclusive.
1 Report of the medical officer of the Privy Council for 1860, pp. 30 et seq. and 102
et seq.; for 1861, pp. 11 et seq. and 138 et seq.; for 1862, pp. 10 et seq. and 126 et seq.;
and for 1863, pp. 29 to 31.




280

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

T able 1 0 6 .— M O R T A L IT Y FR O M A L L CAUSES OF L IT H O G R A P H E R S , C O M P A R E D W IT H
T H A T OF A L L OCCUPIED M A LE S, IN E N G L A N D A N D W A L E S , 1900 TO 1902, B Y AGE
G R O U PS.
[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Death rate for lithographers.

Age at death.

15 to 19 years............................................................................
20 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55 to 64 years.................. ........................................................
65 years and over....................................................................

Death rate
per 1,000
for all occu­
pied males.

2. 44
4.41
6.01
10. 22
17. 73
31. 01
88. 39

R ate per
1,000.

Greater ( + )
Ratio to
or less ( —)
than rate rate fcr all
occupi:d
for all occu­
males.
pied males.

1. 55
5.36
5.62
8. 41
19.94
30. 84
82. 25

—0. 89
-j- . 95
— .39
—1. 81
+2. 21
— .17
-6 .1 4

64
122
94
82
112
99
93

The preceding table is self explanatory, but a more extended com­
parison is made in Table 107, in which the mortality of lithographers
from pulmonary tuberculosis is compared with the normal mortality
of occupied males from this disease, by divisional periods of life.
This table shows that the mortality of lithographers from tubercu­
losis is above the average at all ages by from 0.23 to 2.17 per 1,000.
The excess is not very marked and does not warrant decidedly un­
favorable conclusions.
»
T able 107.—M O R T A L IT Y FROM P U L M O N A R Y TU BE R C U L O SIS AM ONG L IT H O G R A ­
P H E R S , C O M P A R E D W IT H T H A T OF A L L OCCUPIED M ALES, IN E N G L A N D A N D
W A L E S , 1900 TO 1902, B Y A G E GROU PS.
[Source: Part II, Supplement to the Sixty-fifth Annual Report of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]
Mortality from pulmonary tuberculosis.
Death rate for lithographers.
Age at death.

15 to 19 years............................................................................
20 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 years............................................................................
45 to 54 years...........................................................................
55 to 64 years.....................*......................................................
65 years and over.....................................................................

Death rate
per 1,000
for all occu­
pied males.

0. 54
1. 55
2.03
2. 74
3.04
2.16
1.11

Rate per
1,000.

0. 77
2.68
2. 70
3.13
4. 27
4.33
1. 44

Greater ( + )
Ratio to
or less ( —)
than rate rate for all
occupied
for all occu­
males.
pied males.

.

+0.23
+1.13
+ .67
+ .39
+1.23
+2.17
+ .33

143
173
133
114
140
200
130

The preceding table, derived from English experience, requires no
further comment except that it may be pointed out that the data un­
der observation are far from sufficient to warrant definite conclu­
sions. The occupation has been investigated in the United States
by Hayhurst, with regard to 10 establishments in Ohio, employing




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

281

539 persons, of whom all but 11 were males. Only 50 of the em­
ployees were over 40 years of age. There were no special complaints
of importance, except as relating to the ventilation of lithographic
workrooms. Neither the fume nor dust hazard seemed to be of seri­
ous importance. W. Gilman Thompson only briefly refers to litho­
graphers, stating that they suffer from sedentary work and close
application, resulting in dyspepsia and anemia, and that they have
a somewhat high mortality from tuberculosis.
MORTALITY OF LITHOGRAPHERS— INDUSTRIAL INSURANCE EXPERIENCE.

The conclusions based upon Table 108 are sustained by the indus­
trial insurance experience data of the Prudential Co. for the period
1897 to 1914, according to which, out of 325 deaths from all causes,
125, or 38.3 per cent, were from pulmonary tuberculosis.
ta b le 108.—P R O P O R T IO N A T E
M O R T A L IT Y
FR O M
P U L M O N A R Y TU B E R C U LO SIS
AM ONG L IT H O G R A P H E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897
TO 1914, C O M PA R E D W IT H T H A T OF A L L M ALES IN U N IT E D STATE S R E G IS T R A T IO N
A R E A , 1900 TO 1913, B Y A G E G R O U PS.

Deaths of lithogra­
phers, 1897 to 1914,
from—

Per cent o f deaths from
pulm onary tubercu­
losis among—

Age at death.
A ll causes.

Pulmonary
tubercu­
losis.

Lithog­
raphers.

Males in
registra­
tion area,
1900 to 1913

15 to 24 years.................................................T........................
25 to 34 years............................................................................
35 to 44 years....... . . ................................................................
45 to 54 years..........................................................................
55 to u4 years............................................................................
65 years and o v e r ... .- .. * ......................................................
Age unknown..........................................................................

70
81
69
53
32
19
1

37
42
27
13
4
2

52.9
51.9
39.1
24.5
12.5
10.5

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and o v er.. . ...................................

325

125

38.3

13.9

GENERAL CONCLUSIONS.

The mortality from pulmonary tuberculosis is, therefore, extremely
high in this occupation at ages under 45 and in marked contrast to the
mortality from this disease among the male population of the regis­
tration area. The statistics, .though limited, may be accepted as
conclusive and indicative of more or less unsatisfactory sanitary con­
ditions common to the lithographic industry. For reasons partly
inherent in the occupation, ventilating devices are often quite defec­
tive and occasionally impracticable. The dust hazard is only one of
several which tend#to make this employment a particularly un­
healthy one, and this conclusion is sustained by the fact that out of
325 deaths of lithographers at known ages from all causes, only 19,
or 5,9 per cent, were of ages 45 and over.
It is regrettable that the mortality of lithographers was not sepa­
rately considered in the occupational mortality statistics of the Divi­




282

MORTALITY FROM RESPIRATORY DISEASES 11T DUSTY TRADES.
S

sion of Vital Statistics of the United States Census Bureau, in which
lithographers are combined with printers and pressmen. It has been
observed in this connection by Kober, in Kober and Hanson’s u Dis­
eases of Occupation and Vocational Hygiene ” (p. 614), that the work
of chromolithography “ is often carried on under unfavorable hygi­
enic conditions as regards light, air space, and ventilation, which is all
the more regrettable, as some of the processes involve the employment
of injurious agents, such as arsenic pigments, chromium, lead, and
bronze powder.” It is said further that—
The lithographic process varies in different establishments; the
design or picture may be engraved by means of a diamond or steel
needle upon a fine-grained sandstone, generally imported from
Bavaria, or the drawing may be made upon the stone with a greasy
composition. In photolithography the printing surface is largely
prepared by a photographic process. In all of the processes of
chromolithography the stone is dampened on those portions of the
design which are not to appear in'the first printing; this prevents
taking the ink or colors. The actual application of colors and presswork is performed by another set of operatives. According to
Leiser (WeyPs Handbuch der Gewerbekrankheiten, 1908, p. 339),
in a total membership of 11,807 employees in this industry in Berlin
during 1904, 2,002 males and 1,840 females, or 32.6 per cent, were
reported sick, with 90 deaths; of the sick about 12 per cent suffered
from tuberculosis; 11 per cent had skin affections, especially obstinate
forms of eczema caused by contact with acid dips, bronzing powder,
toxic color pigments, impure turpentine, etc.; 10.5 per cent of the
sick suffered from disorders of the digestive system: and 19 per cent
of the females were anaemic. There were 356 accidents, mostly con­
tusions of the fingers contracted in presswork. Cohen estimates that
about 45 per cent of the lithographers suffered from near sight or
other visual defects.
The possible serious exposure to bronze dust in chromolithography
can not be discussed on account of the want of precise and conclusive
data. As far as the available information derived from fairly trust­
worthy sources justifies a preliminary conclusion, there does not ap­
pear to be an excessive incidence of pulmonary tuberculosis among
men employed in the manufacture of bronze powder. As regards the
bronzing process in chromolithography, Kober observes that this may
be done by the dry or wet method or Ky hand or machinery, and that
in spite of the metallic covering of the machinery and methods of
exhaust ventilation the bronze powder escapes freely into the air
and the employees who tend the machine “ wear handkerchiefs over
the nose and mouth ” and “ look pale and unhealthy, and all show
the characteristic green perspiration due to contact with bronze.”
The great majority of employees, however, he remarks, appear to
be healthy, which no doubt has reference to the men not directly con­
nected with dust-producing processes. In the absence of more con-




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

283

elusive information and the required statistical evidence derived
from official or insurance sources, no final conclusion can be arrived
at further than that with reference to lithographers as a class the
evidence is entirely sufficient to prove the excessive incidence of pul­
monary tuberculosis and the prevalence of more or less decidedly
unsatisfactory sanitary conditions in the lithographic industry.
FOUNDRY-M EN AND MOLDERS

Foundry-men and molders are to a considerable degree exposed
to the continuous inhalation of both metallic and mineral dusts.
While the proportion of metallic dust is quantitatively small, it is
probably the more injurious of the two’, although its effects are modi­
fied by the relatively much larger amount of mineral dust. The in­
dustry is varied, of large extent, and widely distributed throughout
the country. The conditions affecting health naturally vary, and
chiefly so on account of the metal used in casting, which may be iron,
steel, brass, etc. The employments in foundry practice are chiefly
those of molders and clay mixers, of which molders, again, are sub­
divided into those who work at a bench, or in the making of small
ware, and those who work on the floor or in the pits in the making of
castings of larger size. Within recent years labor-saving appliances
have been extensively introduced into the large foundries, chiefly in
connection with iron and steel works, but corresponding progress
has not been made in the smaller establishments. The introduction
of machinery has led to the employment of much unskilled labor of.
low grade, which complicates the use of the available mortality
returns. It is also necessary to take into consideration the not incon­
siderable accident liability of men employed in foundries, and the
occasional or general exposure to extreme heat and the liability to
overstrain inseparable from the lifting of heavy weights of metal.
An investigation into the sanitary aspects of this employment
made by the State board of health of Massachusetts disclosed the fact
that at 14 foundries in which castings of all kinds were made,
in 7 the conditions as to light, ventilation, and dust removal were
very poor. Of 9 stove foundries inspected, 4 presented moder­
ately bad and 1 distinctly bad conditions affecting the health of
employees. In the polishing room of one factory, conducted under
almost ideal conditions, the emery wheels were well-equipped with
hoods and exhaust ventilators, but the report states that “ the men,
unmindful of the protection provided, habitually remove the hoods,
and become covered with emery and iron particles.”
In reporting in some detail upon the establishments found to be
more or less unsatisfactory as to light, ventilation, and dust removal,
the report states that one shop “ employs 275 men, in low-studded,




284

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

poorly lighted, unventilated buildings, in which there is no attempt
to remove the dust arising from the processes of polishing and buff­
ing, by hoods and exhaust ventilation. In the tumbling room the
dust is so thick that objects a few feet distant can not clearly be made
out. Many men refuse to work in this establishment in the hot
months, on account of the excessive heat and general discomfort.”
The high mortality of foundry-men and molders from pulmonary
tuberculosis observed to occur at advanced ages is decidedly sugges­
tive. Evidently the progress of the disease in these occupations is
slow, and often, if not as a rule, assumes the form of fibroid phthisis.
There can be no question of doubt that there is in these occupations an
intimate connection between the continuous exposure to metallic and
mineral dust inhalation and the relative frequency of the disease.
Considering the nature of the dust inhaled, this is what would be ex­
T
pected. The dust being largely mineral, but partly metallic, the pro­
portion of iron dust, while considerable, is not so excessive as the iron
or steel dust inhaled by men engaged in cutlery grinding or file cut­
ting. No doubt many of the dangers of the employment could be
guarded against by attention to safety devices, chiefly respirators, to
be worn during some of the mold-making processes. The employ­
ment, by its very nature, however, precludes radical methods of dust
prevention, and the most effective safeguard would be short hours of
labor and a more rational use of leisure hours and vacations.1
MORTALITY OE MOLDERS— INDUSTRIAL INSURANCE EXPERIENCE.

There are no official vital statistics of these occupations either for
the United States or for England and Wales. The recorded indus­
trial insurance mortality statistics of foundry-men and molders are
very extensive and include 3,294 deaths from all causes, of which 758,
or 23 per cent, were from pulmonary tuberculosis. Of the deaths of
foundry-men and molders from nontuberculous respiratory diseases,
25 were from asthma, 51 from bronchitis, 463 from pneumonia, and
65 from other diseases of this class. If the deaths from pulmonary
tuberculosis and from other respiratory diseases are combined, 41.3
per cent of the mortality of foundry-men and molders were from dis­
eases of the lungs and air passages. The mortality of foundry-men
and molders from pulmonary tuberculosis was excessive at all ages
over 25, but the excess was most pronounced at ages 25 to 34, when
out of every 100 deaths of foundry-men from all causes, 40.4 were
from pulmonary tuberculosis, against a normal expected proportion
of 30.5. The analysis of the mortality from pulmonary tuberculosis
of foundry-men and molders in detail is set forth in Table 109;
1 F o r a b r ie f b u t p r a c tic a lly u sefu l a cco u n t o f occ u p a tio n a l h a zard s in fo u n d rie s, see
“ P r a c tic a l S a fe ty M eth od s an d D e v ice s,” by G eorge A . C ow ee, N ew Y o rk , 1916.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

285

1 0 9 . — P R O P O R T IO N A T E M O R T A L IT Y FR O M
P U L M O N A R Y TU BE R CU LO SIS
AMONG F O U N D R Y -M E N A N D M O LD E R S, IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L
CO., 1897 TO 1914, C O M PA R E D W IT H T H A T OF A L L M ALES IN U N IT E D STATE S R E G IS ­
T R A T IO N A R E A , 1900 TO 1913, B Y A G E GROU PS.

T able

Deaths offoundry-m en
and molders, 1897 to
1914, from—

Per cent of deaths from
pulm onary tubercu­
losis among—

Age at death.
A ll causes.

Pulmonary Foundrymen and
tubercu­
losis.
molders.

Males in
registra­
tion area,
1900 to 1913.

15 to 24 years............................................................................
25 to 34 years............................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and over....................................................................

266
540
694
690
624
480

63
218
213
149
87
28

23.7
40.4
30.7
21.6
13.9
5.8

27.0
30.5
23.4
14.7
7.9
2.6

Total, 15 years and o v e r............................................

3,294

758

23.0

13.9

The preceding observations and statistical data, derived from
industrial insurance mortality experience, confirm the conclusion
that this employment is more or less injurious to health, and that
the degree of frequency of pulmonary tuberculosis is excessive at ages
25 and over.
SANITARY CONDITIONS IN MASSACHUSETTS FOUNDRIES.

The sanitary conditions in foundries have been investigated by
the Massachusetts State .Board of Health and reported upon under
date of April, 1911. Two hundred and nine foundries were in­
spected, including a large variety of processes of more or less impor­
tance from a hygienic point of view, but with special reference to
extremes of temperature, and more or less irritating dust, gases, and
vapors. Many of the foundries inspected were found to be improp­
erly heated during the winter months, and the workmen were said
to suffer more or less discomfort from the cold. In the immediate
vicinity of the furnaces, however, particularly in the pouring of the
metal, the heat was apt to be excessive. Gases and vapors were
ascertained to prevail in some instances to an injurious degree, and
especially was this found to be the case in brass foundries, with refer­
ence to the occurrence of so-called brass-founders’ chills. It is a fair
assumption that unfavorable temperature conditions and continuous
exposure to noxious vapors must tend in a measure to reduce vitality
and predispose to diseases, particularly of the respiratory organs,
for as has been thoroughly well established for the metal mining
industries, a preexisting condition of fibroid phthisis materially in­
creases the liability to pulmonary tuberculosis. Fibroid phthisis con­
tracted in consequence of dust exposure predisposes to pulmonary
tuberculosis. The same conclusion applies to other unfavorable
health conditions tending toward a lowering of vital resistance and
an increased predisposition to particular specific diseases.




286

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

DUST EXPOSURE IN SAND BLASTING.

In the Massachusetts investigation of foundries it was found that
the floors, benches, and the hands of operatives were covered with
sand dust, and it is explained that the dry sand from which the cores
are made is sifted on a fine wire netting, a process which gives rise
to considerable fine dust. This process, however, is not usually carried
on to any prolonged extent, but is done, for the most part, several
times a week for only a few hours at a time. In one foundry the dust
generated was decidedly objectionable, and upon the suggestion of
the State inspector of health a covered sifter was provided to remove
this source of annoyance. The most dusty process was ascertained to
be the cleaning of castings, elsewhere briefly referred to under sand
blasting. It is explained in this connection that—
Castings are cleaned in tumbling mills, by sand blasts, emery
wheels, or by hand with wire brushes. The tumbling mills are bar­
rel-like chambers in which the castings are placed, together with
small pieces of scrap iron. After the doors are closed, power is ap­
plied and the mills are set in a rotary motion. From the constant
action of the castings upon each other and upon the scrap iron the
surfaces- are smoothed and the castings are cleaned of any sand
which may be adherent. The dust generated by this process was, in
most foundries, removed by exhausts. Moreover, these mills were
usually located in some corner away from the workmen who did not
have to attend to them during operation. The emery wheels on
which the castings were cleaned were in many cases provided with
hoods and exhausts.
These observations apply in a general way to modern foundries,
but exceptions are sufficiently numerous to suggest the urgency of
qualified and continuous supervision of the processes referred to.
Neglect in this direction is invariably followed by health-injurious
consequences, for as pointed out in the Massachusetts report—
A serious exposure to fine dry sand was observed in those foun­
dries where sand blasts were in use for cleaning the castings. This
process, which is usually carried on in a room separated from the
rest of the foundry, consists of playing a stream of fine dry sand, by
means of compressed air, upon the castings. So great is the force
of the sand stream that the steel nozzle which is used is quickly cut
through. In some foundries exhaust fans and hoods were provided
to carry off the dust, although in spite of this precaution the rooms
were so filled with dust while the sand blasts were in operation that
objects could n®t be clearly seen. When doing this work the work­
men usually wore masks to protect the eyes. These masks, however,
did not prevent the inhalation of dust, which appeared to enter the
respiratory passages with a good deal of force. In one factory a man
was observed to wear a helmet with a tubing through which fresh
air was supplied from the outside. In another foundry such a helmet
was provided, but the man did not use it “ as it was too much bother
to put it on and take it off.” The length of time a man can keep at




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

287

this work is said to be short; in about a year or a year and a half he
begins to show the effects of the work and is forced to leave.
PHYSICAL EXAMINATION OE MOLDERS IN THE FALL RIVER DISTRICT.

The foregoing observations have been quoted in full as evidence
of the thoroughness with which the Massachusetts investigation was
carried out. In the Fall River district physical examinations
were made of 320 molders, with the following results: Bron­
T
chitis, asthma, and emphysema were ascertained in 41, or 12.8 per
cent, of the molders examined. In addition thereto 39, or 12.2 per
cent, were suffering from diseases of the heart, chiefly valvular
disease or dilation; and 23, or 7.2 per cent, were suffering from dis­
eases of the kidneys. In the aggregate, of the 320 examined 103, or
32.2 per cent, were found to be in a more or less serious condi­
tion of ill health. The ages of those examined ranged from 45 to
72, so that the conclusions apply entirely to molders well advanced
in years, and no doubt for a considerable period engaged in the
occupation.
NATURE AND PROPERTIES OF MOLDING SANDS AND DUSTS.

In the main, the health-injurious exposure is to the highly com­
minuted sand disseminated in the form of dust throughout the foun­
dries, but chiefly in connection with cleaning and so-called sand
blasting processes. The nature and properties of molding sands
have been described by Mr. Percy Longmuir before the British
Foundrymen’s Association, in the Engineering Magazine.1 Sand
used for casting iron molds usually contains 84 per cent of silica
and, in addition thereto, varying amounts of alumina, magnesia,
lime, and metallic oxides. The pure silica is, however, recognized
as the most injurious form of dust, but especially so when very finely
comminuted, as is generally the case in molding processes. The
health aspects of fou n d s work are, therefore, of special importance,
but particularly so with reference to the control of the needless
degree of dust exposure. What can be done in this connection is
emphasized in a brief reference to the subject in the annual report
of the chief inspector of factories and workshops for the year 1913,
m which it is said that—
Early in 1913 the prevention of dust in various departments of
iron foundries was discussed at Falkirk with representative em­
ployers, and it was agreed that steps should be taken to improve the
conditions in dressing, grinding, and fitting shops. Satisfactory
arrangements have already been installed in some of the foundries,
and before long it is hoped that all principal machines will be dealt
1 E n g in eerin g M a ga zin e, v ol. 30, M a rch , 1906, pp. 9 0 9 -9 1 1 .




288

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

with. Experiments are also to be tried to devise means for carrying
off dust generated by the hand brushing of castings, as this operation
frequently leads to most undesirable conditions. Meanwhile some
effort is being made to keep floors cleaner, so as to reduce the dust
stirred up by the movements of the workers.
EOTJNDRY INVESTIGATIONS IN OHIO.

Quite recently, also, the conditions of employment in iron foun­
dries have been investigated by Hayhurst, of the Ohio State Board
of Health, including 43 establishments in 14 cities, employing a total
of 4,721 wage earners. Foundry processes, it is said, are carried
on in connection with a variety of industries, chiefly, however,
foundry and machine shop products, iron and steel mills, stoves
find furnaces, agricultural implements, automobiles and parts, musi­
cal instruments, brass and bronze products, electrical apparatus, etc.
Reference is made to a report by the financier of the International
Molders’ Union of North America to the effect that, out of 204 deaths
in the Ohio branch of the molders5 union in the five-year period
1909 to 1913, the chief causes of death were pneumonia, 30, or 14.7 per
cent; heart disease, 30, or 14.7 pqr cent; tuberculosis, 27, or 13.2 per
cent; and violence, 18, or 8.8 per cent. With reference to the ex­
perience of the same organization, it is said that—
We can well understand that foundry conditions are such as to
promote the prevalence of both throat and lung disorders, and also
rheumatism. The violent changes in temperature, the drafts and
dampness of the foundry, are conducive to suffering of this kind.
It might truly be said that rheumatism in its several forms appears
to be the nearest approach, if any, to what might be designated as
an u occupational disease.”
These observations were in a large measure confirmed by the in­
vestigations' of Hayhurst, who states that—
The presence of foundry dust appeared a negligible hazard in 7
places, fairly so in 17 more, and bad in the remaining 19. This
dust was composed chiefly of mold sand, iron oxides, iron, dross,
slag, cinders, and dirt. Of these the first is to be considered the most
harmful. While it is practically impossible to avoid dust in iron
foundries, the presence of subprocesses, such as casting cleaning, and
furnacing, as well as other processes, which might be carried on in
separate quarters, add greatly to the amount of fine dust floating in
the air.
AIR CONTAMINATION BY GAS AND SMOKE.

Further reference is made to air contamination by mold fumes,
gas fumes, smoke, and steam, and in a number of work places the air
was badly vitiated during the winter season by the presence of
coke-burning braziers used for heating, placed about in the quarters
and yielding immense amounts of invisible coke gas due to the ab-




OCCUPATION’S W IT H EXPOSURE TO MINERAL DUST.

289

senee of flue connections to the outside. Cold, due either to the lack
of efficient heating or to the rush of cool drafts, was considered a
hazard to many workers in at least 15 of the places inspected. With
reference thereto it is said by Hayhurst that—
It is but natural that chilling of certain muscles and groups of
muscles, which at intervals must be called into sudden severe strain­
ing actions, usually in hot places, should be greatly affected with
sprains and rheumatism, shown as lumbago, wry neck, sciatica, neu­
ritis, severe chest and shoulder pains, stiffness of joints, etc. Par­
ticularly is this condition favored by the going out-of-doors to closets,
or at noontimes, or going home while wearing sweaty underclothes.
The results of the inquiry are summarized in the conclusion that—
Founding is an example of an industry which in itself should be
harmless; in fact, should promote health and longevity the same as
any application requiring the general use of nearly all of the body
functions. It is rendered dangerous chiefly because it is done in­
doors. On this account a great many precautions are necessary to
be taken, as indicated, including the general medical supervision of
the workers.
DUST EXPOSURE IN CASTING CLEANING.

With special reference to casting cleaning it is said that this is
necessarily a very dusty process, as usually performed, and whether
done by hand or steel brushes or with sand and air blasts, or by
knocking and tapping, laborers so engaged should be protected from
the dust, probably best by helmets supplied with compressed-air
blasts, and the tumbling of small pieces or cleaning within inclosures
or other dust-confining means should be used wherever possible.
GENERAL CONCLUSIONS.

Regardless of the foregoing conditions, which are quite generally
known and understood, there has not thus far been the required de­
gree of sanitary progress urgently called for by the highest consid­
erations of the health and longevity of the men employed. The
special liability to pulmonary tuberculosis as brought out by the
statistical analysis of the available mortality data is confirmed by
specialized investigations, summarized in an editorial note on tuber­
culosis among metal molders in Massachusetts, in the July (1914)
issue of the Journal of the Massachusetts State Sanatoria, where it is
said that—
The chief factors, then, in the molder’s life in connection with the
development of tuberculosis are the exhausting nature of the work,
the overheat and subsequent exposure while exhausted to cold out­
door air, the exposure to dust and gases, and, as stated, the exposure
of certain molders to the debilitating effects of the fumes of poison­
ous metals. And to these must be added that factor so common to
106811°— 18— Bull. 231------ 19




2 90

MORTALITY FROM RESPIRATORY DISEASES IN t>USTY TRADES.

all exhausting occupations, the abuse of alcohol, which appears to be
almost a direct result of the nature of the work.1
CORE MAKERS.

Core making is an essential branch of foundry practice. This occu­
pation gives employment to a considerable number of young persons,
mostly boys, but of late years girls have been drawn into the trade,
although it is held that the more arduous duties and surrounding con­
ditions of the occupation are unsuited to the female sex. No qualified
investigation appears to have been made into the health conditions of
this employment, but in a general way the conditions approximate
those of foundry practice in general.2 There is a considerable ex­
posure to both mineral and metallic dust, but the fact that large num­
bers follow this occupation for only a comparatively short time no
doubt prevents the more serious results which would follow if the
exposure were continued for many years.
SANITARY CONDITIONS IN FOUNDRIES.

The process of core making in connection with foundries is, of
course, quite general to the iron and steel industry, the brass industry,
etc. The general exposure, however, is rather to mineral dust than
to metallic dust, although under given conditions the latter may as­
sume prior importance. The dust in connection with the core-making
process is described by Hayhurst3 as consisting of sand, earths, and
mold powders, but this conclusion no doubt was one based upon gen­
eral observation rather than upon microscopical analysis. Among
related sanitary features injurious to health Hayhurst refers to damp­
ness, poor light, and poor aeration, the latter, of course, being chiefly
due to the fumes and smoke. Variations in temperature conditions
are also noticed, and fatigue is mentioned as a considerable hazard
in the majority of the work places investigated. The chief com­
plaint of the workers was the breathing of burned-gas fumes and
smoke; but apparently no specific complaint was made of healthinjurious dust.
NEW YORK STATE FACTORY INVESTIGATION.

The condition of foundries was inquired into by the New York
State Factory Investigating Commission, who directed particular
attention to the employment of women, chiefly in connection with
1 A m erica n J o u rn a l o f P u b lic H ea lth , 1914, p. 1254.
3 O f sp ecia l in terest an d va lu e in th is c o n n e ctio n a re th e R u les a n d R e g u la tio n s o f the
N ew Y o r k S ta te D ep a rtm en t o f L a b o r re g a rd in g fou n d rie s and w ork in co re -m a k in g ro o m s
m w h ich w om en a re em p loyed . (L a b o r L a w an d the In d u s tria l Code, A lb a n y , 1916, R ules
5 8 2 -5 8 5 .)
3
C ore m ak in g is d iscu ssed b y H a y h u rs t in the O h io S ta te B u lle tin o f th e B o a r d o f
H ea lth , F eb ru a ry , 1915, p. 165.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

291

core-making processes.1 They state, as a result of their investigation,
that molders were found to suffer from rheumatism, pulmonary dis­
eases, and kidney troubles, which by implication applies also to core
makers. They refer to the fumes and the heavy dust from the cast­
ings cleaned in the workrooms, which, being inhaled by the workers,
render them more or less susceptible to all forms of respiratory
diseases. They give expression to the opinion that “ the employment
of women in work of this kind in the foundries of the State should
be prohibited.”
MORTALITY OF CORE MAKERS— INDUSTRIAL INSURANCE EXPERIENCE.

The only available vital statistics of core makers are those derived
from industrial insurance experience, including 357 deaths, of which
105, or 29.4 per cent, are from pulmonary tuberculosis. The details
of the mortality are showT in Table 110.
n
P R O P O R T IO N A T E
M O R T A L IT Y
FR O M
P U L M O N A R Y T U BE R CU LO SIS
AM ONG C O R E M A K E R S , IN D U S T R IA L E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO
1914, C O M PA R E D W IT H T H A T OF A L L M ALES IN U N IT E D STATE S R E G IS T R A T IO N
A R E A , 1900 TO 1913, B Y A G E G R O U PS.

T a b le 1 1 0 .—

Deaths o f core makers,
1897 to 1914, from—

Per cent of deaths from
pulm onary tubercu­
losis among—

Age at death.
All causes.

15 to 24 yoars............................................................................
25 to 34years................ ...................... . . . ........ ....................
35 to 44 years............................................................................
45 to 54 years..........................................................................
55 to 6-± y e a r s ..........................................................................
65 years and over.................................................... - ..............
Total, 15 years and over.............................................

Pulm onary
tubercu­
losis.

Core
makers.

Males in
registra­
tion area,
1900 to 1813.

113
98
03
42
26
15

36
42
19
5
3

31.9
42.9
30.2
11.9
11.5

27.0
30. 5
23. 4
14.7
7.9
2.6

357

105

29.4

13.9

When considered by divisional periods of life it appears that the
proportionate mortality from pulmonary tuberculosis is highest
at ages 25 to 34, when out of the mortality from all causes 42.9 per
cent are from this disease, against 30.5 per cent expected on the
basis of the mortality experience for the United States registration
area. There are no corresponding statistics available for women.
The data suggest the importance of further investigation and the
possibility of a material improvement in sanitary conditions in con­
sequence of the use of dust-laying devices. It may be said in con­
clusion that, according to the United States census of 1910, the num­
ber of male core makers was 16,479, and of female core makers, 1,836.
A considerable portion of core makers of both sexes were under 20
years of age.
1
F o r a b rie f d iscu ssion o f th e em p loy m en t o f w om en in co re room s see N ew Y o rk S ta te
F a c t o r y In v e s tig a tin g C om m ission R e p o rt fo r 1018, V ol. I, pp . 2 5 5 -2 6 3 .




292'

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

GENERAL CONCLUSIONS.

Core making is so generally carried on in connection with foundries
that the occupation is frequently combined with molders, etc. Core
makers in brass and iron foundries are briefly referred to by Kober
and Hanson in their recent work on “ Diseases of Occupation and
Vocational Hygiene,” but the observations are quite inadequate and
inconclusive. In view of the fact that a large proportion of women
are employed as core makers, it is reasonable to assume that with them
the health-injurious consequences are more serious on account of
dust exposure than in the case of men more resistant to disease and
more inclined to change their occupation. Kober observes in this
connection that core and mold makers are “ exposed to the inhalation
of large quantities of dust, especially in sifting the sand for the
cores and in dusting the completed molds with powdered charcoal
and graphite.” He also remarks that female labor is often em­
ployed in the making of cores for small castings, and that the men
engaged in breaking up the hot molds “ naturally inhale large quan­
tities of dust,” determined by Ahrens on the basis of German inves­
tigations to amount to 28 mg. of dust per cubic meter in the air of
foundry rooms, and by Hesse to amount to 71.7 mg. per cubic meter
in the air of the cleaning and polishing room, which it is calculated
would subject each operative to the inhalation of 42 grams of dust
per annum. It is self-evident that the occupation is one which re­
quires thoroughly well-considered methods of factory supervision if
the readily apparent dust hazards are to be reduced to a harmless
minimum. On account of the considerable employment of relatively
young persons, including women, in core-making processes^ intelli­
gent supervision and control are urgently required.
THE GLASS INDUSTRY.

The glass industry in the United States in 1909 gave employment
to some 69,000 wage earners, of whom about 5 per cent were children
under 16 years of age. The industry is a varied one, including among
others the manufacture of blown and pressed ware, of window glass
and plate glass, and finally of so-called crystal or cut glass, which
for the present purpose is considered as a separate industry. The
Jabor division of the trade includes numerous and well-defined occu­
pations, each of which is subject to more or less injurious circum­
stances, but of these the handling of materials and the mixing are
the most liable to the risk of continuous inhalation of mineral dust.
The most important employment is that of the glass blower, but there
are few accurate statistics which separate this employment from the
industry as a whole. For the present purpose, however, it has seemed
best, as far as practicable, to consider separately the mortality of




OCCUPATIONS W IT H - EXPOSURE TO MINERAL DUST.

293

glass blowers, although the medical and statistical observations sub­
sequently to be quoted refer more or less to glassworkers as a class.
Changes in manufacturing processes and the introduction of laborsaving machinery have resulted in sanitary improvements, which in
consequence have had a favorable effect upon the health of glass
blowers, at least in the United States, as far as the rather fragmen­
tary statistical data can be relied upon. Among glassworkers as a
class pulmonary tuberculosis is of exceptional frequency, in addition
to which there is a comparatively high mortality from other respira­
tory diseases, lead poisoning, and heat prostration.1
EARLY OBSERVATIONS ON THE HEALTH OF GLASSWORKERS.

Thackrah, writing in 1832, held that glassworkers as a class were
liable to catarrh and cough, but not to pleurisy and pneumonia. He
commented upon the appearance of a fine dust at the furnaces which,
T
however, in his opinion did not produce any marked effect on the
health of the operatives. He also mentioned individual cases of glass­
workers remaining at their employment at ages T to 80, but in the
O
majority of instances failing eyesight at ages 50 to 60 disqualified for
the employment. Thackrah’s account of this occupation was, how­
ever, very superficial, and some of his conclusions were not at all in
conformity to the facts as reported by other authorities. Tracy, writ­
ing in 1879, held that—
In the manufacture of glass the workmen who grind and powder
the siliceous material inhale great quantities of very irritating dust
and suffer from constant hacking cough and conjunctivitis. It is
rare to find a sound man among them and they are not able to con­
tinue long at the work. According to Hirt’ they should not be
allowed to labor, at a stretch, more than two or three weeks, and
should then work at something else, or, at any rate, give up this
occupation for at least double the working time. In this way, by the
use of relays, the health of the men may be sustained.2
ENGLISH OCCUPATIONAL MORTALITY STATISTICS.

As shown by the census returns the actual numbers, as well as per­
centages, of glassworkers at advanced ages are surprisingly small. It
is evident that the rapid diminution of the number at work after age
35 must be partly, at least, the result of a high death rate at the
younger ages, and in particular due to an excessive mortality from
pulmonary tuberculosis, which at this period of life causes from one1 See, W o rk in g C on d ition s and E fficien cy as A ffected by H ea t, by B a sil M. M a n ly , in
R e p o rt on C on d ition s o f E m p loy m en t in th e Iro n and S teel In d u stry .
U. S. B u rea u o f
L a b or S ta tistics, V ol. I l l , 1912, pp. 2 8 7 -3 3 2 .
2 B u ck ’ s H yg ien e an d P u b lic H ea lth , V ol. I I , pp. 36, 37.




294

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

third to one-half of the deaths from all causes. Tatham, in Oliver’s
“ Dangerous Trades” (p. 139), considers this employment at some
length, and his observations, based largely upon English mortality
data, are quoted in part as follows:
The making, blowing, and engraving of glass occupies a promi­
nent place among unhealthy trades for several reasons. In the first
place, the workers are exposed to extreme variations of tempera­
ture—in some processes, that of glass blowing especially, the opera­
tives are constantly exposed to the intense heat of the furnace, as
well as to that which radiates from the pots of molten glass which
they are engaged in blowing. The intense heat and profuse sweating
naturally induce painful thirst, which the workmen evidently allay
by excessive drinking; this is shown by the fact that their mortality
from alcoholism and from nervous disorders is nearly double that
experienced by operatives in other trades. * * * The compara­
tive mortality figure for glass makers is 1,487, and is, therefore, in
excess of the average by 56 per cent. Phthisis and diseases of the
respiratory system are especially fatal to workmen in this industry,
and they suffer more severely than other occupied males from dis­
eases of the circulatory, digestive, and urinary systems, as well as
from cancer. Since 1881 the mortality of glassworkers has in­
creased considerably, and this is true of the younger as well as the
older workers in this industry.
The English mortality statistics upon which these conclusions rest
include 1,092 deaths of glassworkers, and of this number 229, or 21
per cent, died from pulmonary tuberculosis. At ages 25 to 34, how­
ever, out of 177 deaths of glassworkers from all causes, 79, or 44.6
per cent, were caused by this disease. Of the mortality from other
causes, bronchitis caused 146 deaths, pneumonia 123, and other
respiratory diseases 25. These combined with deaths due to pul­
monary tuberculosis make a total of 523, or 47.9 per cent, from
diseases of the lungs and air passages in the mortality of glass­
workers from all causes. The most recent English mortality sta­
tistics of glass manufacture are for the three years ending with 1902,
referred to in the Supplement to the Sixty-fifth Annual Eeport of the
Eegistrar-General of Births, Deaths, and Marriages in Englard and
Wales, in part as follows:
In this occupation the death rates exceed the standard for occu­
pied and retired males at all ^stages of life by proportions ranging
from 12 to 32 per cent. In the main working period the comparative
mortality figure is 1,260, or 25 per cent above the standard. The ex­
cess of mortality among these workers is most marked in the case of
plumbism, phthisis, respiratory diseases, and Bright’s disease; they
also suffer heavily from influenza and from diseases of the nervous
and circulatory systems. The mortality from alcoholism, accident,
and suicide, however, is below the average.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST*

2 95

COMPARATIVE MORTALITY PROM ALL CAUSES AND FROM DISEASES OF
THE LUNGS.

The recent English mortality statistics for glassworkers are quite
conclusive of the more or less unfavorable effect of this industry on
health. In Table 111 the mortality from all causes among men
in this group is compared with that of occupied males generally,
and the result is decidedly suggestive of conditions in this trade
more or less unfavorable to life and health. The excess in the
general death rate of glassworkers is met with at all ages, but the
relative and actual excesses are greatest with advancing years, being
6.41 per 1,000 at ages 45 to 54, 10.83 at 55 to 64, and 30.99 at 65 and
over.
1 1 1 .—M O R T A L IT Y F R O M A L L CAUSES AM ON G G L A S S W O R K E R S , C O M P A R E D
W IT H T H A T OF A L L OCCUPIED M A LE S, IN E N G L A N D A N D W A L E S , 1900 TO 1902, B Y
A G E G R O U PS.

T a b le

[Source: Part II, Supplement to the Sixty-fifth Annual R eport of the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Death rate for glassworkers.

Age at death.

15 to 19 years..........................................................................
20 to 24 years...........................................................................
25 to 34 years...........................................................................
35 to 44 years.... .............................................. ......................
45 to 54 years..........................................................................
55 to 64 years...........................................................................
65 years and over......................... ..........................................

Death rate
per 1,000
for all
occupied
males.

2. 44
4. 41
6. 01
10. 22
17. 73
31.01
88. 39

Rate per
1,000.

3.22
5.09
6. 74
13.14
24.14
41. 84
119.38

Greater(+)
or less ( —)
R atio to
than rate rate for all
for all
occupied
occupied
males.
males.
+ 0 78
+ . 68
+ . 73
+ 2.92
+ 6.41
+10. 83
+30. 99

132
115
112
129
136
135
135

A more extended comparison is made in Table 112, in which
the mortality of glassworkers from pulmonary tuberculosis and
other respiratory diseases is compared with the normal mortality
of occupied males from these diseases, by divisional periods of life.
The comparison shows that the mortality from pulmonary tubercu­
losis is excessive at all ages, 15 to 64 inclusive, the excess being most
marked at ages 35 to 54. The table further shows that the mortality
of glassworkers from other respiratory diseases is excessive at all
ages, the excess being most marked at ages 45 or over. The two
tables derived from English experience fully confirm the previous
conclusion that the mortality of glassworkers is excessive when com­
parison is made with the mortality of occupied males generally, and
that this excess is largely because of the high degree of pulmonary
tuberculosis frequency at ages 25 to 54, and a high mortality from
other respiratory diseases at ages 35 or over.




296

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

1 1 2 .—M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O SIS A N D F R O M O T H E R
D ISEASES OF T H E R E S P IR A T O R Y SYSTEM AM ON G G L A S S W O R K E R S , C O M P A R E D
W IT H T H A T OF A L L O CCUPIED M A LE S, IN E N G L A N D A N D W A L E S , 1900 TO 1902, B Y
A G E GROU PS.

T a b le

[Sourcc: Part II, Supplement to the Sixty-fifth Annual Report o f the Registrar-General of Births, Deaths,
and Marriages in England and Wales.]

Mortality from pulmonary tuberculosis.

Age at death.

Mortality from other diseases of the respi­
ratory system.

Death rate for glassworkers.
Death
rate per
Greater
1,000 for
Ratio to
( + ) or less rate for
all occu­
Rate
( —) than all occu­
pied
males. per 1,000. rate for all
pied
occupied
males.
males.

Death rate for glassworkers.
Death
rate per
Greater
1,000 for
to
( + ) or less Ratiofor
all occu­
Rate
( - ) than rate
pied
all occu­
males. per 1,000. rate for all
pied
occupied
males.
males.

0.54
1.55
2.03
2. 74
3. 04
2.16
1.11

15 to 19 years.......
20 to 24 years.......
25 to 34 years.......
35 to 44 years.......
45 to 54 years.......
55 to 64 years.......
65 years and over.

0. 56
1. 81
2.88
4.56
4. 87
2.97

+0. 02
+ .26
+ .85
+ 1.82
+ 1.83
+ .81

104
117
142
166
160
138

0.24
.48
.77
1. 66
3.32
6.54
17. 77

0. 28
.60
.99
2. 43
5. 76
10. 75
28. 68

+
+
+
+
+
+
+

0.04
.12
.22
.77
2.44
4.21
10. 91

117
125
129
146
173
164
161

MATERIALS USED IN GLASS MANUFACTURE.

The American glass industry has made considerable progress dur­
ing recent years, but it may be questioned whether material modifica­
tions have been introduced into the manufacturing processes with
special reference to necessary precautions against health-injurious
conditions. The processes have been described in detail by Charles
C. Dominge, who, with reference to the materials used, states that—The principal ingredients are washed and dried sand (white), lime,
soda ash, potash and cullet, i. e., old broken glass and waste from
melting pots. In some risks you may also find charcoal, oxide of lead,
kelp, saltpeter, and cobalt (the latter used for coloring purposes).
The lime and charcoal should be skidded and kept under a tight roof.
The saltpeter or niter bags are likely to take fire spontaneously, there­
fore they should be removed from the building as soon as they are
emptied.
The same authority describes the actual process of glass manufac­
ture, in part, as follows:
The above materials are mixed together, forming what is known as
“ batch,” which is placed in a fire-clay pot, inserted in brick-inclosed
pot furnace, with soft coal feed. This “ batch ” is then subjected to a
temperature of approximately 2,500° F., which causes a perfect union
and fusion of the materials. When this “ batch ” (i. e., glass ready for
working) has cooled to a temperature of, say, 1,900° F., it is ready
to be gathered. This is done by means of an iron blowpipe, which is
thrust into the fire-clay pot, the molten glass clinging to the end of
the pipe, resembling a ball. - To make his material perfectly true,
concentric with his iron pipe, the worker rolls it dextrously on an iron
table or wooden block of special design. The glassmaker then blows




OCCUPATIONS W IT H EXPOSURE TO M IN E R A L DUST.

297

through the blowpipe, which inflates the batch “ soap-bubble fashion,”
at the same time deftly shaping, altering, coaxing it into form and
proportion with cunningly devised hand tools. The glass design is
then placed in a water-jacketed mold, after which it goes to the
brick-set tempering oven (known as “ lehr ” ), which resembles a long,
horizontal, brick-set boiler. These lehrs are fed by coke or gas, with
the heat directly at the entrance, where the glass objects are placed on
a traveling platform. About 1,000° F. is maintained here. The object
is to give the glass the vital “ temper,” a provision against the piece
bursting later in the decorator’s hand. The glass cools slowly in its
travel from the entrance where the heat is maintained to the other
end, sometimes 40 to 125 feet long. Some of the heavier glass pieces
require a week before they are removed from the oven.
Conditions of employment, with special reference to occupational
hazard, vary, of course, according to the type of melting furnace
used. Dust exposure is apparently more serious at the old style pot
furnaces than at modern tank furnaces, which are* usually built in
three compartments or sections, each of which is he.ated to a different
temperature. It is explained by Mr. Dominge that—
The newer factories now use what is known as the melting tank or
melting furnace or continuous tank. They are usually built in three
compartments or sections, each of which is heated to a different
temperature. The heated glass runs through an orifice near the base
of the first section into the second section, where it is refined, after
which it flows into the third compartment. The glass is now ready
to be “ gathered ” by the glass worker. The temperature in the first
section is about 2,500° F., the molten glass being at this stage color­
less and translucent. The temperature in the second section is about
1,900° F., while the last section is so heated as to allow the glass to
get into a form resembling paste.
Other processes involving heat and dust are the working of the
so-called “ glory holes,” which are small, brick-inclosed circular fur­
naces used for heating glassware, for edge trimming, and other
purposes; annealing furnaces, “ which resemble somewhat a baker’s
oven., arranged in a series of three or four adjoining and heated by
open and gas flames about waist high above the foundation.” Into
this “ the hot glassware is introduced by hand and removed from
one oven to the other, each being heated at a reduction in tempera­
ture to perfect annealing without rupture.” The so-called “ lehr ”
or tempering furnaces are of quite a different type, but the work
involves about the same degree of temperature and dust exposure.
Theoretically the most hazardous process is probably the so-called
“ pot making,” which consists in the making of the furnace mold of
fire clay molded by hand and the grinding up of old pots • the
on
premises, with a considerable exposure to irritating mineral dust.1
1 A u seful and d escrip tiv e a cco u n t o f th e gla ss-m ak in g p rocess o ccu rs in the A nnu al R e­
p ort o f the N ew Jersey B ureau o f L a b or fo r the y e a r 1906. T h e a cco u n t includes all o f
th e essential su b div ision s o f the in d u stry and a m on g oth ers w ood en -m old b low ers, ca rb o y
Dlowers, lam p w ork ers, b a tch m akers, ten d in g boys, shearers, etc.




298

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

LABOR CONDITIONS IN OHIO AND NEW YORK.

Hayhurst, in a brief description of glass-making processes, *adds
much new and useful information, stating that the process consists
“ in combining the various siliceous materials, alkalis, and other in­
gredients,” and that the work is usually done in part by machinery
and in part by hand labor, “ the latter causing a great deal of dust
because of shoveling and scooping.” Dust in the air was noted in
all work places investigated, and in the majority the conditions were
bad, “ due to the manner of handling the ingredients.” With special
reference to the mixing process it is suggested that “ this work should
be done in light, ventilated, dry quarters^ above ground preferably,
and, where mechanical means will not confine dust, workers should
be furnished respirators of some sort and compelled to wear them.
Those handling or exposed to poisonous dusts should be selected for
intelligence, properly instructed, and seen by a physician at least
once a month.” This last suggestion has special reference to ex­
posure, to dust contamination by arsenic and red lead. The glass
industry was also briefly inquired into by the New York State Fac­
tory Investigating Commission, who, in their second report, 1915
(Vol. II, p. 1115), refer to two different kinds of glass manufac­
tured— a flint glass containing no lead and used principally for
bottles and a glass containing lead compounds and other poisonous
ingredients used chiefly for other purposes. It is explained that—
The lead and other compounds are weighed and mixed in one room,
then taken to the furnace room and mixed with a quantity of old
glass; the entire mixture is then put into the furnace or pot and
fused. The material in the pot is kept in a liquid state by high tem­
perature, and into this the glass blower dips his pipe, taking out the
amount he wishes to work. The greatest danger is from the handling
of the dry ingredients and inhaling the dust created during the
weighing and mixing.
Conditions in a typical mixing room are described, and it is said
that during the mixing process no methods were employed “ to carry
away the dust created, but although the men were furnished respira­
tors none were found to wear them.” Evidence of lead poisoning was
met with in a number of cases. The chief factor of neglect is the
absence of precautions to guard against dust. Analyses of samples
taken in the mixing room showed 3.3 mg. of lead per cubic meter of
air. In another plant it was also found that no special precautions
were employed, and while mixers were furnished respirators they
would not wear them.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

299

OCCUPATIONAL HAZARDS IN GLASS MANUFACTURE.

The most recent observations with regard to American conditions
are by W. Gilman Thompson, who points out that—Glassworkers are subject to four prii*cipal forms of occupation
hazard, namely, (1) exposure to great heat; (2) mechanical and
chemical dust irritation; (3) poisoning by certain metals, such as
lead oxide, zinc oxide or arsenic, used for coloring, etc.; (4) irrita­
tion of the eyes, caused by excessive heat and light.
It is explained that certain raw materials, such as flint, sand,
quartz, powdered marble, limestone, soda, Glauber’s salt, and potash,
are finely ground and mixed, usually in open vessels, which he con­
siders extremely dusty work. The temperature near the heating fur­
naces may reach 140° F., and the workmen in winter are, therefore,
subjected to great changes of temperature in passing in and out. He
explains further that—
The result of inhalation of so many kinds of dust, from the raw
materials used, the particles of ground glass, and the grinding mate­
rials, such as emery, etc., may give rise to pulmonary fibrosis and
chronic bronchitis, which predispose to tuberculosis, but emphysema
is not produced by glass blowing, as formerly supposed, despite the
deep inspiration and prolonged expiration employed in the process.
Emphysema is due to connective tissue changes in the lungs, and
this disease is no more frequent among glass blowers than among any
similar group of workmen when due regard is had for age, alcohol­
ism, chronic pulmonary disease, and other predisposing factors.
PRACTICAL SANITARY PRECAUTIONS.

Thompson concludes these exceptionally interesting and useful ob­
servations with suggestions for the prevention of the more specific
health-injurious conditions, as follows:
The raw materials of glass, when being mixed, should be kept in
covered receptacles as much as possible. The introduction of mechan­
ical apparatus for glass blowing is doing much to mitigate the evils
of this occupation when performed by mouth. Workmen should
be examined by a physician, and all who are actively syphilitic ex­
cluded. The excessive heat from the furnaces may be guarded
against by the use of asbestos screens and forcible introduction of a
stream of cool air by means of a blow fan and duct. The eyes should
be protected from the light and heat of the ovens by blue and gray
goggles, and face masks may be worn to protect the skin of the face
from blistering. All grinding rooms should be thoroughly cleaned
daily and dust removed from the wheels, tables, and benches. The
wheels should be incased as much as possible, and a strong exhaust
duct should be operated in connection with them. Women and chil­
T
dren should be excluded from the more hazardous departments of
w
^ork. When handling sharp-edged glass vessels or working with
lamp chimneys or thin bottles which are liable to explode, the hands




300

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

should be protected from injury by stout leather gloves. The grind­
ing or cutting of quartz, crystal and jet, jade, and similar substances
presents the same hazards to the respiratory system as those of glass
grinding.
PRESENT-DAY LABOR CONDITIONS.

An exhaustive report upon labor conditions in the glass industry,
with some extended references to sanitation and mortality, was in­
cluded in the Senate report of the Commissioner of Labor on the
“Condition of Woman and Child Wage Earners in the United States,”
Washington, 1911. This report includes a descriptive account of
American glass-making processes, with observations on physical
strain, interchange of occupations, dust, fumes, heat conditions, hours
of labor, night work, etc. The mortality data are limited to glass
blowers, elsewhere referred to, but in a general way the conclusions
are applicable to glassworkers as a class. An extended descriptive
account is included, from the. Twenty-fourth Annual Report of the
Bureau of Statistics of Labor and Industries of New Jersey, for
1901, which in a large measure is applicable to the present time.
Attention is directed in this report to the improvement in working
conditions introduced into glass works during the last two decades,
but apparently much remains to be done to eliminate many objec­
tionable features, especially such as refer to weather exposure, damp­
ness, extreme heat, etc. It is said in this connection, however, that
the improvements referred to “ have removed some of the most seri­
ous causes of ill health, and they hcvve greatly lessened the workmen’s
liability to contract disease while at work.” A new element of
danger, however, has been introduced in consequence of the extensive
use of the so-called “ continuous-tank .furnace,” which is said to be
“ severe upon all blowers and especially so on the older men who
have been accustomed for years to work out of a pot furnace and
only during the day.” The heat of a tank furnace is much greater
than that of a pot furnace, and “ the alternation from day to night
work weakens the system and reduces its power of resistance to
attacks of disease.” In concluding the report, it is pointed out that
“ it is certain that the environments of the workmen” (in glass fac­
tories) “ create tendencies'to disease, which, taken with their own
lack of care have greatly aggravated attacks of sickness and in many
cases caused them to assume characteristics very difficult to treat.”
Out of 814 cases of sickness specifically reported there were no cases
of pulmonary tuberculosis, but there were 18 cases of pneumonia, 21
of inflammation of the lungs, 16 of inflammation of the throat, and
10 of bronchitis, aside from 76 cases of la grippe. It is self-evident,
of course, that without a qualified medical examination of the em­
ployees the true extent of incipient tuberculosis could not be ascer­
tained, and it is a reasonable assumption that in a more advanced




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

301

condition of the disease the employee would not be at work. The
statistics, however, suggest a relatively high frequency of respiratory
diseases, which, as elsewhere observed in the general discussion of
pneumoconiosis, is generally a predisposing condition in pulmonary
tuberculosis.
SPECIFIC LIABILITY TO RESPIRATORY AND TUBERCULOUS DISEASES.

In so far as the evidence is available, the general conclusion is dis­
tinctly unfavorable regarding employment in the glass industry,
with special reference to an increased liability to respiratory and
tuberculous diseases. The rather inconclusive American evidence is
quite fully confirmed by more extensive investigations into the
hygiene of glassworkers in Germany1 and Austria, referred to at
some length in the report of the Commission of Labor on the con­
dition of womah and child wage earners in the United States, with
special reference to the glass industry, which should be referred to
for more extended consideration. It seems sufficient for the present
purpose to conclude these observations with the following extract
from a^translation 'of a German treatise on the diseases of glass­
workers, by Dr. C. F. Schmidt:
In the foreground among all diseases of the glass grinders stands
the damage to the lungs by glass dust. This glass dust produces
its effect by the mechanical irritation of the fine, sharp-angled and
needle-pointed particles of glass. The dust particles may at length
find their way into the lymph current and be deposited in the lungs
and bronchial glands. Meinel, for example, found in the lungs of a
glass blower a siliceous content of 30.7 per cent. Soon there super­
venes a chronic catarrh of the larger bronchial tubes and bron­
chioles, the desquamated and inflamed mucous membrane of which
finally affords a congenial soil for colonies of tubercle bacilli. Tuber­
culosis of the lungs makes early victims of .a large proportion of the
glass grinders. This is readily explicable, because, even as appren­
tices, they are exposed to the glass dust.
These observations, in addition to the foregoing statistical data
and descriptive references, quite fully sustain the conclusion that
employment in the glass industry must be considered as obvi­
ously injurious to health, with a measurable predisposition to pul­
monary tuberculosis, partly, if not largely, on account of the con­
siderable and continuous exposure to the inhalation of mineral dust.
INDUSTRIAL INSURANCE MORTALITY STATISTICS.

Since glass blowers and cutters are separately considered, and in
view of the foregoing observations with special reference to mixers
1 A m ost u sfu l referen ce t o h y g ie n ic con d ition s in the G erm an glass in d u stry o ccu rs
In the rep ort o f C onsul G en eral F ra n k D illin g h a m , re p rin te d in th e D a ily C on su lar a n d
T ra d e R ep orts, W a sh in g ton , Feb. 4 , 1909.




302

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

and handlers of raw materials, as well as workmen generally exposed
to the dust hazard, the following vital statistics derived from the
industrial insurance mortality experience of the Prudential In­
surance Co. of America are only for glassworkers other than blowers
and cutters. Table 113 includes 897 deaths of glassworkers not other­
wise specified, and of this number 274, or 30.5 per cent, are deaths
from pulmonary tuberculosis.
1 1 3 .—P R O P O R T IO N A T E
M O R T A L IT Y FR O M P U L M O N A R Y T U B E R C U L O SIS
AM ON G G L A S S W O R K E R S , E X C L U D IN G B L O W E R S A N D C U T T E R S , IN D U S T R IA L
E X P E R IE N C E OF P R U D E N T IA L CO., 1897 TO 1914, C O M P A R E D W IT H T H A T OF A L L
M ALES IN U N IT E D S TA TE S R E G IS T R A T IO N A R E A , 1900 TO 1913, B Y A G E G R O U PS.

T able

Deaths of glassworkers,
1897 to 1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at deatli.
Males in
registration
area,
1900-1913.

A ll causes.

Pulmonary
tuber­
culosis.

15 to 24 years............................................................................
25 to 34 years........ ...................................................................
35 to 44 years............................................................................
45 to 54 years............................................................................
55 to 64 years............................................................................
65 years and over....................................................................

257
186
151
108
103
92

81
95
52
25
16
5

31.5
51.1
34.4
23.1
15. 5
5.4

27.0
30. 5
23. 4
14.7
7.9
2.6

Total, 15 years and over.............................................

897

274

30.5

13.9

Glass­
workers.

The table shows further that the proportionate mortality from
pulmonary tuberculosis was extremely high among glassworkers not
otherwise specified at ages 25 to 34, or 51.1 per cent, against the
expected normal mortality of 30.5 per cent. The data are extremely
suggestive and emphasize the importance and in fact the necessity
of thorough-going methods of factory supervision and State control
of industrial processes inimical to health and longevity.
MORTALITY 0 * GLASSWORKERS— UNITED STATES REGISTRATION AREA.

The mortality of glassworkers has been reported upon for the
years 1908-1909 by the Division of Vital Statistics of the United
States Census Bureau, but blowers and workers in general are in­
cluded only for the year 1908. No explanation is made in the text
of the report regarding the inclusion or exclusion of particular occu­
pations for either one of the two years, during which the analysis
was made by industries or occupations with reference to specific
causes of death by divisional periods of life. According to the census
report, out of 867 deaths of glassworkers from all causes 260, or 30
per cent, were from pulmonary tuberculosis. This is distinctly ex­
cessive when contrasted with 14.9 per cent for all occupied males and
16.7 per cent for plasterers. The details of the mortality by divisional
periods of life are shown in Table 114.




OCCUPATIONS W IT H EXPOSURE TO M IN E R A L DUST.

303

T able 1 1 4 .—P R O P O R T IO N A T E M O R T A L IT Y OF G L A S S W O R K E R S F R O M P U L M O N A R Y

TU B E R C U LO SIS,
G R O U PS.

U N IT E D

S T A T E S R E G IS T R A T IO N

AREA,

1908 TO 1909, B Y A G E

Deaths from pulmo­
nary tuberculosis.
Age at death.

Deaths
from all
causes.

Number.

Per cent of
deaths
from all
causes.

15 to 24 years..................................................................................................
25 to 34 years..................................................................................................
35 to 44 years..................................................................................................
45 to 54 years..................................................................................................
55 to 64 years..................................................................................................
65 vears and over...........................................................................................
Age unknown................................................................................................

176
202
169
117
101
101
1

83
86
56
23
8
4

47. 2
42. 6
33.1
19. 7
7.9
4.0

Total, 15 years and over....................................................................

867

260

30.0

T able 1 1 5 .—P R O P O R T IO N A T E M O R T A L IT Y OF G L A S S W O R K E R S F R O M N O N T U B E R ­
CULO U S R E S P IR A T O R Y DISEA SES, U N IT E D S T A T E S R E G IS T R A T IO N A R E A , 1906 TO
1909.
Deaths from nontuber­
culous
respiratory
diseases.
Cause of death.

Number.

Per cent of
deaths
from all
causes.

Asthm a..................................................................................................................................
Bronchitis.............................................................................................................................
Pneumonia...........................................................................................................................
Other nontubarcuknis respiratory diseases....................................................................

2
5
67
6

0.2
.6
7. 7
.7

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

80

9.2

According to Table 114 the proportionate mortality was excessive
at all ages throughout the entire working period of life, but par­
ticularly so at ages 15 to 24, when out of the mortality of glass­
workers from all causes 47.2 per cent were from pulmonary tuber­
culosis. The corresponding proportion for potters was 46.2 per cent,
and for marble and stonecutters 26.2 per cent. At ages 25 to 34 the
differences are less pronounced, the proportion of deaths from pul„ monary tuberculosis having been 42.6 per cent of the mortality from
all causes among glassworkers, against 44.4 per cent for potters and
43.5 per cent for marble and stonecutters. In a general way the
table confirms other investigations and may be considered fairly
conclusive, except in so far that the same applies to the glass industry
in general rather than to specific occupations or employments subject
to the most trying conditions of mineral dust exposure, complicated,
of course, by physical strain, heat exposure, temperature changes, etc.
Aside from the mortality of 30 per cent from pulmonary tuberculosis
glassworkers show an additional mortality from nontuberculous
respiratory diseases of 9.2 per cent, which compares with 12.5 per




304

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

cent for potters and 12.2 per cent for marble and stone workers. As
far as it is possible to judge, therefore, the mortality from non­
tuberculous respiratory diseases is not distinctly excessive, for in
comparison the mortality of all occupied males is 10 per cent, or
respectively, 7.8 per cent for pneumonia against 7.7 per cent f :•
glassworkers, and 0.9 per cent for bronchitis against 0.6 per cent tvr
glassworkers.
GENERAL CONCLUSIONS.

Employment In the glass industry, therefore, while predisposing
to pulmonary tuberculosis, appears to have no directly measurable
relation to the occurrence of nontuberculous respiratory diseases.
This conclusion is of special importance on account of the assump­
tion that heat exposure and sudden temperature changes* which are
quite common to the glass industry, predispose decidedly to pneu­
monia and other nontuberculous respiratory diseases. In the Ameri­
can glass industry this is apparently not the case.
GLASS CUTTERS.

Glass cutters, including under this term all who are employed in
the manufacture of crystal or so-called cut glass, constitute a separate
and well-defined occupation division in glass manufacture.
SANITARY ASPECTS OF GLASS CUTTING AND POLISHING.

The most important employments are roughing, smoothing, polish­
ing, and puttying, but of these the last named is the most injurious,
chiefly because of a specific liability to lead poisoning. The sanitary
aspects of the employment have received the special consideration of
a British committee on dangerous trades, which, in its Third Interim
Report, remarked with special reference to the injurious effects of
putty powder in the form of dust that—
It will thus be seen that all persons employed in places where
“ putty powder5 is used, though themselves not handling it, are
5
liable, through inhalation of the dust, to illness and even death
through juxtaposition with those engaged in its use. Under existing
circumstances the wet powder splashes onto the clothes not only of
the polisher who uses it, but onto those of his neighbors; it gets
dry after a time, comes off in fine dust, and enters the system either
by inhalation through the lungs or by swallowing or through the
pores of the skin.
Among other recommendations for the amelioration of the more
D less health-injurious conditions inherent in this employment, the
r
committee suggested that all persons engaged in the department of
glass cutting and powdering, where so-called putty powder is used,




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

305

should be examined once a month by the certifying surgeon for the
district, who should be empowered to order temporary or permanent
suspension of work.
EXPOSURE TO MINERAL AND METALLIC DUSTS.

Aside from the exposure to the inhalation of dust containing lead
or other metallic ingredients, there is a further liability to the inhala­
tion of considerable quantities of mineral dust in a large variety of
forms. It would obviously be very difficult to estimate with even
approximate accuracy the degree of lung injury resulting from dust
exposure in glass cutting and polishing, but it is the opinion of quali­
fied authorities that practically every branch of the trade is more or
less affected, with a resulting excess in the mortality from pulmonary
tuberculosis. Tracy comments briefly upon the health-injurious
aspects of this occupation, in part as follows:
But the most dangerous work is that of the grinders and polishers
of cut glass. About 35 per cent of them have chronic pneumonia
(phthisis), and their average age at death is variously given at from
30 to 42 years. Putegnat (de Luneville) has described a peculiar
form of gingivitis which he has observed among glass cutters, and
which, he says, attacks 95 out of every 100 workmen. It comes on in
about three months after the person begins work, and toward the
sixth month is well developed. It attacks by preference the upper
jaw, and is accompanied by the same blue line that is found in cases
of lead poisoning. The acid secretion of the gums destroys the
enamel of the teeth, which soon become pointed, brittle, and.break off
close to the alveoli, leaving a permanent stump. The gums remain
soft and spongy, and the breath is very fetid. At no time is there
any pain or hemorrhage. He supposes it to be caused by malnutri­
tion, bad air, etc. (Tardieu.) These symptoms certainly appear
suspiciously like those of lead poisoning, and the suspicion is ren­
dered stronger by the fact that French flint glass contains about 20
per cent of lead, and that other symptoms of lead poisoning are not
uncommon in glass cutters, as colic, constipation, muscular pains, etc.
Garrod has noticed the frequency of gout among them, and brings
it forward to support his theory of a connection between that disease
and saturnine poisoning.
The grinding or etching of glass by the sand blast fills the rooms
with a dust composed of particles of sand and glass mingled. The
business is a comparatively new one, and the workmen so far do not
appear to be injured by it, with the exception of a slight tickling
cough when they first begin work. The dust is rather coarse and
heavy, and I am inclined to think it does not penetrate very far into
the lungs, perhaps not even getting beyond the trachea, whence it is
easily expectorated.
Lloyd also considered this employment, holding that—
Flint glass contains lead, being chemically a compound of silicon
(silicic acid) with an alkaline and an earthy base, the latter being
1 0 6 8 1 1 °— 18 — B u ll. 2 3 1 --------




20

306

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

represented by lead. It is this flint, or lead, glass that is used for cut
glass because of its brilliancy. The glass cutter’s mill is a revolving
disk of wrought or cast iron on which is fed a mixture of sand and
water, with which the cutting and polishing are accomplished. In
this process, which requires the artisan to bend closely over his mill,
dust and fine particles of glass are given off. Emery and putty pow­
der also are used, the latter containing lead. These are the noxious
agents by which these cutters and polishers of flint glass acquire lead
poisoning.
Unfortunately there are no official vital statistics of this occupa­
tion, since the comparatively small group of cutters of crystal glass
is included in the census vital statistics with glassworkers generally.
Cutters of crystal glass are continuously and considerably exposed to
the inhalation of fine particles of mineral dust, which must indeed
disastrously affect the lungs of the workmen, but in particular such
as are otherwise predisposed to pulmonary tuberculosis. The sugges­
tion of Oliver and others that crystal glass polishers and cutters
should be periodically medically examined for cases of lead poison­
ing applies equally to the purpose of discovering incipient cases of
tuberculosis more or less the result of the employment.1
MORTALITY OF GLASS CUTTERS— MEDICO-ACTUARIAL EXPERIENCE.

According to the medico-actuarial investigation, which, however,
combines glass bevelers, grinders and cutters, excluding foremen and
superintendents, the relative mortality from all causes was extremely
high, or 46 per cent in excess of the normal. The details of this
experience are shown in Table 116.
T a b l e 1 1 6 .— M O R T A L IT Y F R O M A L L C A U S E S A M O N G G L A S S B E V E L E R S , G R IN D ­

E R S , A N D C U T T E R S , E X C L U D IN G F O R E M E N A N D S U P E R IN T E N D E N T S , B Y A G E
GROUPS.
[Medico-Actuarial Investigation.]

-------------- <2
Age at death.

Number
exposed
to risk
one year.

Actual
deaths.

Expected
deaths.

Ratio of
actual to
expected
deaths.

15 to 29 years........................... .................. ............................
30 to 39 years...........................................................................
40 to 49 years............................................ - ............................
5ft to 59 years........................... ......... .....................................
00 years and over............................ .............................

4,857
3,187
813
193
39

26
33
9
6
3

22.24
17.45
7. 73
3.43
1.75

117
189
116
175
171

T otal...............................................................................

9,089

77

52.60

146

1 F o r a d d ition a l referen ces to the h e a lth -in ju rio u s circu m sta n ces in gla ss cu ttin g and
po lish in g , see th e R e p o rts o f the C h ief In sp e cto r o f F a cto rie s and W ork sh op s fo r 1895,
V o l. I, p. 3 6 ; 1896, p. 2 5 ; 1899, pp. 16, 3 1 3 ‘; 190 0 ; p. 2 0 7 ; 1901, £>art I, p. 220.
F or a
d e sc rip tiv e a cco u n t o f the va riou s m a n u fa ctu rin g processes, see S cien tific A m erican f o r
A p r. 30, 1904.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

307

MORTALITY OF GLASS CUTTERS— INDUSTRIAL INSURANCE EXPERIENCE.

It is regrettable that the foregoing experience should not be avail­
able with reference to causes of death. The mortality from pul­
monary tuberculosis among glassworkers is, however, clearly shown
in Table 117, derived from the industrial insurance mortality experi­
ence of the Prudential Insurance Co. of America, for the period
1897 to 1914, including 220 deaths from all causes, of which 80, or
36.4 per cent, were from pulmonary tuberculosis.
T a b le 1 1 7 . — P R O P O R T IO N A T E M O R T A L IT Y F R O M P U L M O N A R Y T U B E R C U L O S IS
A M O N G G L A S S C U T T E R S , I N D U S T R IA L E X P E R IE N C E O F P R U D E N T IA L CO..
3 897 TO 1914, C O M P A R E D W I T H T H A T O F A L L M A L E S IN U N IT E D S T A T E S
R E G IS T R A T IO N A R E A , 1900 T O 1913, B Y A G E G R O U P S .

Deaths of glass cutters,
1897 to 1914, from—

Per cent of deaths from
pulmonary tubercu­
losis among—

Age at death.
Males in
registration
area, 19001913.

A ll causes.

15 to 24 years.......................... . ..............................................
25 to 34 years.................................... ............ .........................
35 to 44 years___ . . . . . ............... ............................................
45 to 54 years.. . . . . . . . .................................................- ..........
55 to 64 years...........- ...........................................- .................
05 years and o v e r ...,................................................... ........
Age un know n._______ ____ ___________ _
Total, 15 years and over......... .

Pulmonary
tubercu­
losis.

53
55
48
28
24
11
1

21
28
20
6
2
3

39.6
50.9
41.7
21.4
8.3
27.3

27.0
30.5
23.4
14. 7
7.9
2.6

220

80

36.4

13.9

Glass
eutters.

According to this table the proportionate mortality of glass cutters
from pulmonary tuberculosis is highest at ages 25 to 34, when out
of 55 deaths from all causes 28, or 50.9 per cent, are from pulmonary
tuberculosis. The mortality from this disease, however, must be con­
sidered excessive at every divisional period of life. There appears
to have been no material improvement in the health condition of glass
cutters during recent years; and, with possibly the exception of the
reduction of the liability to lead poisoning, there can be no question
of doubt but that sanitary conditions are generally far from satis­
factory and that effective dust-removing devices are frequently ab­
sent. There are no reasons for questioning the possibilities of a
material improvement in the health conditions of this specific group
of occupations in the glass industry, nor can the conclusion be called
into question that the principal cause of ill health is the dust gen­
erated in connection with glass-cutting processes and inhaled to a
more or less considerable and measurable degree.
LABOR CONDITIONS IN MASSACHUSETTS.

Glass cutting and polishing were reported upon in the Massa­
chusetts investigation of 1907, but it should be considered that




308

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

the industry is, relatively, of very limited extent in that State. It is
said in the report referred to that—
Operations which cause glass dust in the air are recognized as
especially dangerous to health, such dust being quite as irritating as
steel dust, if not more so. This being the case, glass cutting and
polishing are conducted with a minimum of danger in the wet way.
In cutting, the pattern is marked out with red lead or with graphite,
and then the object is held against a rapidly revolving steel wheel
upon which fine quartz sand and water are dropped continuously, or
upon a wheel of fine emery and corundum. When the pattern has
been cut out the glass is plunged into hydrofluoric acid in lead tanks,
connected with the exhaust pipe of a steam-propelled blower. This
smooths the cut surfaces, but acts on the uncut parts to such an
extent as to make polishing necessary. This is done with pumice
or rottenstone and water or oil on revolving brushes, and putty
powder or rouge and wax on wooden wheels. The use of oil or water
serves to prevent dust, and the employment of wooden shields pro­
tects the worker from being spattered with the mixture of oil and
glass powder and other materials thrown off in the process. For
successful work good light is very necessary, and in this respect all
five of the establishments visited were found to be beyond criticism.
The conditions as to ventilation and toilet arrangements were found
to be equally commendable. All cutting and polishing is done by the
wet method, and in no instance was any dust perceptible. In two
of the establishments in which glass blowing also is carried on the
employees are necessarily exposed to high temperatures and to the
possible danger which resides in the use of blowpipes, which are
introduced indiscriminately into the blowers’ mouths. Otherwise no
objectionable features were noted. The number of persons employed
in the several factories ranged from about 30 to several hundred.
As a class they appear to be of a rather high order of intelligence
and to enjoy good health.
These observations should be accepted with caution for the reason
stated.
L A B O R C O N D ITIO N S I N P E N N S Y L V A N IA A N D OHIO.

In Pennsylvania, where glass cutting is quite extensively developed,
no qualified investigation has been made by official authority, but
private inquiries have disclosed a considerable variation in sanitary
conditions, sufficiently so to suggest the possibility of material and
far-reaching improvements.
Hayhurst, in the Ohio survey of 1915, gives expression to the
opinion that “ the work at glass grinding was done only at intervals
and created a great deal of dust.” This may have reference to excep­
tional conditions in Ohio plants, for as a rule cut-glass grinding is a
continuous process and relatively free from health-injurious dust
when sufficient water is used and the surroundings are kept scrupu­
lously clean. The dust danger rises chiefly from unsanitary conditions
rather than from the grinding which, as a rule, is carried on by the
wet process. The danger to be guarded against is rather the liability




OCCUPATIONS W IT H EXPOSURE TO MINERAL DTTST.

309

to lead poisoning, but there are reasons for believing that the occu­
pation also involves, though only to a limited extent, an increased
liability to pulmonary tuberculosis. The four essential processes of
roughing, smoothing, polishing, and puttying all involve exposure
to widely varying conditions, but the risk is most serious in the
puttying, chiefly on account of the liability to lead poisoning. In
this process a mixture of oxide of lead is used, which, by means of
a brush wheel, is applied to the nearly finished article for the purpose
of giving the same the brilliant polish, which is the most distinctive
feature of the highest grade of cut glassware. A “ dust,” or rather
a splash,” is created, and small particles of the same are readily
observed on the faces and hands of the operators. The. hands are
constantly dipped into a mixture of lead, putty, and water, and
unquestionably some lead is occasionally introduced into the sj^stem
in small quantities, either by inhalation or by habits of uncleanliness.
Lead poisoning resulting from this occupation has, however, been
very materially reduced during recent years, and cases of lead
paralysis are now rarely met with.
Reference may be made here to a brief statement regarding glass
polishing in the Report of the Chief Inspector of Factories and Work­
shops for 1898. The evidence is cjuite conclusive that in this country
lead poisoning in glass cutting is less common than in the United
Kingdom. The most recent investigations in this country have been
reported upon by the New York State Factory Investigating Com­
mission, 1913 (vol. 2, p. 1116), chiefly with reference to the risk of
lead poisoning, but it is said in conclusion that “ in this industry the
principal measures to be taken are cleanliness, especially on the part
of the worker; and while there may be some dust in the air, it is
negligible, as the results of our analyses fail to show any lead present
in the samples taken.” This conclusion, of course, has reference only
to lead and has no bearing upon the question of mineral dust in
relation to lung diseases, whether of the tuberculous or nontuber­
culous variety.
G E N E R A L C O N CLU SIO N S.

In a general way it would seem that the available evidence regard­
ing glass cutters and polishers indicates a very marked improve­
ment in the hygienic conditions of the principal plants which have
been thoroughly investigated and the practical elimination of lead
poisoning. In the principal centers of the glass-cutting industry in
the United States cases of lead paralysis are now extremely rare.
The process of puttying has been largely eliminated and in place
thereof the use of the method of dipping the nearly finished glass­
ware into hydrofluoric acid has become quite general. The underly­
ing cause of the practical elimination of lead poisoning is, however,
the decidedly more sanitary condition of the shops, which by inference




310

MOKTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

suggests a similar improvement in the partial control of the dust
hazard. Processes of ventilation and dust removal have not been as
thoroughly developed as would be desirable, but there can be no
reasonable question of doubt as regards a material recent improve­
ment in the health and longevity of glass cutters and polishers in
contrast to the truly deplorable conditions prevailing in the past.
GLASS BLOWERS.

The hygiene of glass blowing with special reference to pulmonary
tuberculosis is of exceptional interest as a labor problem in the glass
industry. The number of blowers employed proportionate to the
total number of wage earners is relatively large, and, from a wage
point of view, the employment is of the first order of importance.
D E S C R I P T IV E ACCOUNT OF G L A SS-B L O W IN G P R O C E S S E S .

In a descriptive account of the glass industry, published in the
Pennsylvania Labor Report for 1888, it is stated that—
The occupation of blowing requires great dexterity and nimblcness
of the fingers to manipulate the glass; and while not laborious in.
the sense of requiring great muscular power, every limb and muscle
is brought into use in molding a bottle, whether a large or small one.
The blower in a shop is constantly on his feet, moving in a circle,
and usually takes from six to seven steps to each bottle he molds.
When it is considered that in making some sizes he molds from 175
to 200 dozen in a day we have some idea of the endurance required.
There is scarcely an affliction that man is liable to that does not inter­
fere with his work. The least sore on any of his fingers, hands, or
feet, sore lips, sore throat, or toothache, or any of these, and he is
obliged to lay off. The gaffer sits while at his work and is not liable
to be laid up by so many ailments as the blower. Although subjected
to heat, dust, and the gases that arise from the use of coal or oil
in heating the glory hole, his workmanship is not impaired by most
of the afflictions that disqualify a blower. Hence gaffers are usually
superannuated blowers.
S P E C IA L O CC U PA TIO N A L H A Z A R D S.

Health conditions vary considerably, according to the nature of
the blowing process, whether for the purpose of bottle making,1
1 F o r a b r ie f b u t t h o ro u g h ly scien tific a cco u n t o f gla ss b o ttle m a n u fa ctu re fro m the
m ix in g o f th e in g red ien ts to the m o ld in g o f b ottles by m a ch in e ry , see th e S cie n tific
A m erican S u p p lem en t, N o. 213 5 , fo r D ec. 2, 1916. W ith re fe re n ce to th e in g red ien ts
used it is said in p a r t th a t “ T h e b asis o f b o ttle g la ss is a s ilicio u s san d, t o w h ich is
som etim es a dded lim eston e, to g e th e r w ith s u lp h a te o r ca rb o n a te o f soda . T h ese in ­
gred ien ts, in p u lv erized fo rm , are th row n in to a la rg e tan k fu rn a ce , w h ere th e y are m elted
and com b in ed , fo r m in g a th ick liq u id o f siru p y co n siste n cy . In th e fa c to r ie s th a t m ake
th e b etter grad es o f gla ss su ch as tab lew a re and w in d o w glass, it is p e rio d ica lly d esirab le
to clea n ou t th e ir m e ltin g p ots, an d th e re is a lso con sid e ra b le d am aged m a te ria l th a t
m ust be d is c a r d e d ; th a t is ca lled “ cu lle t,” a n d is sold to th e b o ttle m ak er, w h o
m ixes it w ith his m a teria ls, tog eth er w ith a ll the d a m a ged b o ttle s t h a t a ccu m u la te
a rou n d th e fa c t o r y .”
T h e re la tio n o f th is p rocess to d u st exp osu re and h ea lth -in ju rio u s co n d itio n s is o b viou s.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

carboy making, or window glass, etc.
Oliver—

311

According to Sir Thomas

The risks to health incurred by makers of glass are mainly those
due to exposure to excessively high temperatures, e. g., bronchial and
pulmonary affections; many of the men die from phthisis. They
bear pneumonia badly, owing to their intemperate habits. Dr.
Scheele, in the Berlin Kleinische Wochenschrift, March, 1900, has
drawn attention to what is known as “ glass-blowers’ mouth.” Large
swellings like air cushions can be seen and felt in some glass blowers,
extending from the angle of the mouth to below the ears. The
swellings look like mumps. They involve the parotid gland only.
They crepitate under the finger and by pressure can be made to dis­
appear. It is only recently that these swellings in the cheeks of
glass blowers have attracted attention, and especially in France.
The relaxation of the cheeks, the jous casees of French glass blowers,
is by some attributed to a faulty method of blowing. From glass
blowers under my care in the Newcastle Infirmary I have ascertained
that the malady is not unknown among the men in the work on
Tyneside. Dr. Scheele found that it was present in only 2.5 per cent
of blowers, some of whom had worked for years. In those who had
thus suffered the duct that leads from the interior of the mouth to
the parotid gland had become dilated, owing to the repeated entrance
of air into it under considerable pressure; the mucous membrane of
the inside of the cheek, too, showed thick pale patches, plaques opal­
ines, which Guinard regarded as the result of the great pressure and
straining the buccal mucous membrane was exposed to during the
act of blowing. Under ordinary forced expiration the pressure inside
the closed mouth is equivalent to from 6 to 9 millimeters of mercury,
but in glass blowing it may rise to 90 and even as high as 110 mm.
In the course of an ordinary day a good workman will blow as
many as from 600 to 700 bottles.
F R E Q U E N C Y OF L U N G D IS E A S E S .

The foregoing observations are far from conclusive, but they em­
phasize the urgency of more extended investigations. A brief refer­
ence to lung affections in glass blowers occurs in an abstract of a
paper on the subject by Prettin,1 as follows:
Prettin found that the muscles seem to adapt themselves to their
task, so that glass blowers are not apparently more liable than others
to have pulmonary emphysema. But, on the other hand, he found
an unusually large proportion of tuberculous lesions among them.
Fully 20 per cent of the workmen presented evidences of a tuber­
culous lung affection, while emphysema was observed in only 5 out of
the 230 glass blowers examined. It was very slight in the 2 subjects
between 40 and 50 years old, and the 3 others were 52 to 58 years
old, and had been glass blowers for 34 to 43 years. He cites Fischer
to the effect that not a single instance of emphysema was found in
500 members of military bands, as published in 1902.
1 Journal American Medical A ssociation, Mar. 19, 1904.




312

MORTALITY FROM RESPIRATORY DISEASES,IN DUSTY TRADES.
G L A SS B L O W E R S ’ C A TA R A C T .

Medical interest has rather been confined to the question of glass
blowers’ cataract, a description of which, however, is outside of the
scope of the present discussion. The affliction is one of serious im­
portance, especially with reference to workmen’s compensation and
as a medical problem in relation to the syphilitic infections. Since
any and all diseases which impair physical efficiency or result in a
diminution of disease resistance have an indirect bearing upon, the
frequency of pulmonary tuberculosis, the following reference to glass
blowers’ syphilis in the Medical Record (Feb. 11, 1888) is included:
Prof. N. De Smet, of Brussels, in commenting upon a case of
syphilis occurring in the mouth of a glass blower, referred to several
epidemics which have been reported as having occurred among
artisans of this description. He said that only two plans for pre­
venting these outbreaks had been devised, viz, giving a separate
movable mouthpiece to each man, and instituting frequent, rigorous,
and periodical inspection of the persons of the employees. The first
plan is always declared by the workmen to be impracticable, from
the loss of time which would be occasioned by fitting the different
T
mouthpieces on the tubes.
The second would, of course, be resisted by the men, but he thinks
y
their objections could be overcome by showing them the danger to
themselves and their families which arises from the present system.
M O R T A L IT Y

OF G LA SS B L O W E R S — M E D IC O -A C T U A R IA L

E X P E R IE N C E .

The mortality, of glass blowers not using machinery and excluding
foremen and superintendents was investigated by the MedicoActuarial Association, with the result shown in Table 118.
T able 1 1 8 .— M O R T A L IT Y F R O M A L L C A U S E S A M O N G G L A S S B L O W E R S N OT
U SIN G M A C H IN E R Y , E X C L U D IN G F O R E M E N A N D S U P E R IN T E N D E N T S , B Y
A G E G R O U PS.
[M e d ico -A ctu a ria l I n v e s tig a tio n .]
^

Age at death.

15 to 29 years...................................................................................
30 to 39 years...................................................................................
40 to 49 years...................................................................................
50 to 59 years...................................................................................
60 years and over...........................................................................
Total

.................... .............................................................

N umber
exposed
to risk
one year.

Actual
deaths.

Expected
deaths.

5,002
4,216
1,008
144
13

26
30

1
2
2

22.95
22. 75
8.91
2. 83
.46

10,383

70

57.90

.Ratio of
actual to
expected
deaths.

113
132
135
71

11
2

The experience shows that the actual mortality of this class of
workmen is 21 per cent in excess of the expected, the excess being
most marked at ages 30 to 49.




313

OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

M O R T A L IT Y OF G L A SS B L O W E R S — IN D U S T R IA L IN S U R A N C E E X P E R I E N C E .

The only available statistics of glass blowers’ mortality from pul­
monary tuberculosis are the data derived from the industrial insur­
ance experience of the Prudential Insurance Co. of America for the
period 1897 to 1914, which includes 546 deaths from all causes, of
which 175, or 32.1 per cent, were from pulmonary tuberculosis.
T able 1 1 9 .— P R O P O R T IO N A T E

M O R T A L IT Y
FROM
PULMONARY
T U B E R C U L O S IS
A M O N G G LASS B L O W E R S , I N D U S T R I A L E X P E R I E N C E O F P R U D E N T I A L CO., 1897
TO 1914, C O M P A R E D W I T H T H A T O F A L L M A L E S IN U N I T E D S T A T E S R E G IS T R A ­
T IO N A R E A , 1900 TO 1913, B Y A G E G R O U P S.

Deaths of glass blow­
ers, 1897-1914, from—

Per cent of deaths from
pulmonary tuberculo­
sis among—

Age at death.
A ll causes.

Pulmonary
tuberculo­
sis.

15 to 24 years....................................................................................
25 to 34 years...................................................................................
35 to 44 years...................................................................................
45 to 54 years...................................................................................
55 to 64 years...................................................................................
65 years and over...........................................................................

51
137
115
106
52
85

23
73
36
30

Total, 15 years and over........ .........................................

546

Glass
blowers.

Males in
registration
area,
1900-1913.

27.0
30.5
23.4
14.7
7.9

5

45.1
53.3
31.3
28.3
15.4
5.9

175

32.1

13.9

8

2
.6

According to Table 119, the proportionate mortality from pul­
monary tuberculosis is excessive at all ages, but especially so at
ages 25 to 34, when of the deaths of glass blowers from all causes,
53.3 per cent are from pulmonary tuberculosis, against 30.5 per cent
among males in the United States registration area. The table may
be accepted as fairly conclusive, but, as said before, health and sani­
tary conditions vary considerably in the different branches of glass
blowing, but no data are at present available which would permit
of definite conclusions. It is, however, a.safe assumption that carboy
blowing, which requires much more strength than bottle blowing, is
probably more injurious and involves an increased predisposition to
pulmonary tuberculosis. How far the excessive liability to tuber­
culous diseases is increased by the dust factor can not be determined
at the present time. The occupation group is one deserving of much
more qualified medical and other technical consideration than it has
heretofore received.
M O R T A L IT Y E X P E R I E N C E OF T H E G L A SS B O T T L E B L O W E R S ’
A SSO C IA T IO N .

The foregoing observations and conclusions are quite fully sus­
tained by an analysis of the mortality of glass blowers, presented by
the records of the Glass Bottle Blowers’ Association of the United
States and Canada for the period 1892 to 1908, inclusive, contained
in the report of the United States Commissioner of Labor on the




814

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

Condition of Woman and Child Wage Earners in the United
States, with special reference to the glass industry, Washington,
1911. The experience includes 898 deaths from all causes, of which
287, or 32.0 per cent, were from pulmonary tuberculosis. In addition,
there were 8 deaths from other forms of tuberculosis, or 0.9 per cent
of the mortality from all causes; 69, or 7.7 per cent, from pneumonia;
and 28, or 3.1 per cent, from other diseases of the respiratory sys­
tem. Combining the mortality from tuberculosis and nontuberculous
respiratory diseases, the proportionate mortality from this group of
causes in the mortality from all causes was 43.7 per cent. The mor­
tality in detail, by divisional periods of life, is shown in the usual
form in Table 120.
T a b l e 1 2 0 .—

M O R T A L IT Y OF GLASS B L O W E R S , GLASS B O T T L E B L O W E R S ’ ASSOCIA­
T IO N O F U N IT E D S TA TE S A N D C A N A D A , 1892 T O 1908.

A ge at death.

Deaths
from
all
causes.

Deaths from
pulm onary
tuberculosis.

N um ­
ber.

Per
cent.

15 to 24 years. .........................
25 to 34 years............................
35 to 44 years............................
45 to 54 years...........................
55 to 64 years............. .............
65 years and over....................
Age unknow n........ , ...............

48
266
272
140
86
74
12

24
119
93
34
9
4
4

50.0
44.7
34.2
24.3
10.5
5.4
33.3

Total, 15 years and over..

898

287

32.0

Deaths from
other
tuberculous
diseases.
Num ­
Per
ber. , cent.

5
3

1.9
1.1

8

.9

Deaths from
pneumonia.

N um ­
ber.

Per
cent.

Deaths from
other
respiratory
diseases.
N um ­
ber.

Per
cent.

5
20
27
7
3
7

10.4
7.5
9.9
5.0
3.5
9.5

2
4
7
5
3
7

4.2
1.5
2.6
3.6
3.5
9.5

69

7.7

28

3.1

It would be outside of the purpose of the present investigation to
enlarge upon the frequency occurrence of other causes, but it may be
said in this connection, with special reference to alcoholism, that
there were 7 deaths from this cause, or 0.78 per cent of the total, and
11 deaths from cirrhosis of the liver, or 1.22 per cent, which, however,
can not be considered conclusive evidence regarding an excessive
amount of gross intoxication among glassworkers, which is fre­
quently assumed to be of relatively common occurrence. It is also
suggestive that the mortality from pneumonia, which is often as­
sumed to be increased in frequency by exposure to extreme heat and
variable weather conditions, was not excessive in the experience re­
ferred to. The average age at death of all glass blowers was 41.4
years, and of those who died from pulmonary tuberculosis, 38.8
years.
S P E C IF IC D IS E A S E L I A B I L I T Y OP G L A SS B L O W E R S.

The statistical analysis in the report referred to is amplified by ex­
tracts from reports on investigations into the hygiene of glass­
workers in this country and Germany. According to an account of
the diseases incident to the glass industry, in the Twenty-fourth An­




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

315

nual Report of the Bureau of Statistics of Labor and Industries of
New Jersey for 1901, glassworkers are much exposed to unfavorable
weather conditions, working, as they frequently do, in a temperature
exposure of from 100° to 130°. It is said further, with reference to
habits of life, etc., in the report of the United States Commissioner
of Labor, that—
Irregularity in eating and sleeping, disregard of ordinary pre­
cautions, the habitual use of large drafts of ice water, are the prime
factors in creating acute attacks of dyspepsia and indigestion, from
which glassworkers suffer so much, and imprudent and unnecessary
exposure aggravate and intensify diseases which attack the air pas­
sages. There is scarcely a glass blower to be found who does not
suffer from some form of catarrh. Forethought and care exercised in
guarding against the change from a high temperature to a low one
would greatly improve the health conditions of men who work in the
intense heat of the glassworks. When a workman leaves the high
temperature of the factory, say 90° to 100°, in midwinter to face the
temperature outside, say 10° to 12°, his underclothing wet with per­
spiration, without preparing himself thoroughly for the great
change, he certainly invites disease to fasten upon his throat and
lungs or give a dangerous chill to the circulatory system no matter
how stalwart his frame or how robust his general health may be.
The reaction is too sudden and severe.1
In contrast, it has been maintained by Mr. Denis A. Hayes, presi­
dent of the Glass Bottle Blowers* Association of America, in an ad­
dress before the American Academy of Political and Social Science,
May, 1906, that—
It has been the common belief for years that glass blowing is
an unhealthy occupation. Some insurance companies discriminate
against the workers in this industry, but their action is based more
upon suspicion than facts, because I doubt if glass blowing, so far
as the work itself is concerned, is any more injurious than many
other indoor occupations. There are, however, conditions which
surround the work that are a menace to health and long life, but
these unfavorable conditions can be and are being removed.2
Of interest also is the statement by Mr. Hayes that—
The sudden changes in temperature experienced by men in this
condition may be resisted while youth and vigor remain, but, owing
to the early age at which they go to work, their strength and vitality
are not given a chance to fully develop or are almost entirely de­
stroyed at an age when other men are entering the prime of life.
Being deprived of schooling they can have very little knowledge of
hygienic rules or laws, hence do not sufficiently know how to protect
themselves against the conditions here described. The result is that
early in life they become victims of rheumatism, catarrh, throat
troubles, and tuberculosis. The latter disease especially is most
dreaded by our members.1
1

R ep ort o f U . S. C om m ission er o f L a b or on W om a n and C hild W age E a rn ers in the

U nited S tates, V ol. I l l , G lass In d u stry , pp. 2 54 , 255.

a Idem , p. 257.




316

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

According to German observations by Dr. C. F. Schmidt, con­
tributed originally to Weyl’s Handbook of Occupational Hygiene,
but translated for the report of the Commissioner of Labor on the
glass industry, 1911, it is stated that—
As a rule, glass blowers are people of stalwart frame. Some have a
pale but many a ruddy complexion, caused by the intense heat. They
are generally spare, for they are obliged to undergo great physical
exertion, and, in consequence of this exertion and the great heat,
they perspire freely. The constant exercise makes the muscular devel­
opment of the upper part of the body, especially the arms, excep- '
tionally powerful, while they are sometimes observed to be bowlegged on account of continual standing.1
As glass blowers are forced to work in an atmosphere of a high
temperature and are constantly exposed to the cool draft which
rushes in through the open door of the factory, they are predisposed
to colds. On one hand there are rheumatic inflammations, on the
other catarrhal diseases of the bronchial tubes and of the lungs from
which they suffer. Smoke often tends to produce bronchial catarrh,
especially in the older factories where it is occasionally driven by
unfavorable winds, directly from the openings of the furnaces, ail
through the factory. Sin<ce acute catarrhs of the larynx and bron­
chial tubes are often repeated, chronic bronchitis occasionally super­
venes, from which pulmonary tuberculosis sometimes results.2
It was formerly believed that glass blowers often contracted
emphysema of the lungs, and theoretically this seemed quite probable,
since they are obliged continually to inhale a great volume of air
and then by forced expiration to drive it out through the contracted
glottis, by which means great demands are made upon the elasticity
of the lungs. This opinion was refuted by Prettin and Leibkind.
They examined 230 blowers from different glass factories who had
followed this occupation for at least 10 years. Two hundred and
eighteen of them were from 25 to 50 years of age, and 12 were from
51 to 62. One hundred and two had been blowing glass more than
10 years, and an equal number more than 20 years. Among the
blowers under 40 years of age practically no emphysema was found.
Of 54 blowers from 40 to 50 years old, only 2 had emphysema in a
slight degree. Among the 12 oldest, there were but 3 cases of severe
emphysema of the lungs. Of the 230 blowers, therefore, only 5 in
all had emphysema, and even with these it was doubtful whether the
emphysema was superinduced by the blowing or by other diseases of
the lungs. But it was demonstrated by spirometric tests that the
vital capacity of glass blowers’ lungs is very large, for the spirometer
indicated'an average amounting to 3,350 cubic centimeters (183.25
cubic inches.)2
P R E D IS P O S IT IO N TO P U L M O N A R Y T U B E R C U L O S IS .

All of these observations reemphasize the earlier conclusion that
glass blowers unquestionably are subject to an excessive mortality
1 R ep ort o f U. S. C om m ission er o f L a b or on W om a n and C hild W age E arn ers in the
U nited S tates, V ol. I l l , G lass In d u stry , p. 265.
2 Idem , p. 267.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

317

from pulmonary tuberculosis, largely in consequence of the con­
tinued and considerable inhalation of mineral dust. It is, therefore,
of special importance that any and all measures concerning dust pre­
vention should receive sufficient consideration, and that, as far as
practicable, they should be adopted. With special reference to the
possibilities of sanitary and other improvements, it is suggested by
Dr. Schmidt that—
Since it has been demonstrated that pulmonary emphysema is not
due to blowing, except in very rare instances, the necessity for a
mechanical blower no longer appears so urgently requisite as it was
formerly assumed to be. An apparatus has been invented by means
of which glass masses are blown into shapes- required by compressed
air. By the use of this contrivance not only might the need of
strenuous exertion in blowing be obviated, but the danger of syphi­
litic infection and of the transmission of tuberculosis might also be
removed. But in most of the factories the pipe continues to be used,
because, it is claimed, the inflation by this method is more uniform.
The transmission of syphilis may be prevented by a simple device,
namely, by the use of an individual mouthpiece for every blower.
But this method is opposed by the blowers because by its employment
they are hindered in their work. Regular examinations are also
recommended, but the workmen rebel against such inquisitorial regu­
lations. The attempt has been made to reduce the intense heat radi­
ation by placing asbestos-coated iron curtains in front of the ovens.
These curtains are raised by a lever so arranged as to be automati­
cally set in motion by the weight of the workman’s body. For lower­
ing the temperature revolving fans have also been installed in prox­
imity to the working place. These create an artificial breeze to cool
the workmen. Blue or gray panes of glass placed before the open­
ings of the furnace serve as a protection for the eyes.1
P O S S I B I L I T I E S OF D U ST P R E V E N T IO N .

Finally, on the question of the prevention of dust, it is said:
The prevention of dust presents the greatest difficulties, though a
large part of it is held captive by means of water. In polishing with
the sand blast the sand is so drawn up by the agency of a suction
appliance devised by Gutmann that no dust can escape. The dan­
gerous explosions of lamp cylinders are now prevented in a glass
factory at Weisswasser by a mechanical apparatus by which tlu
cylinder is heated in a narrow zone throughout its entire circum­
ference, and then by a light blow with a sharp instrument it is
cracked off. But in the grinding department even the simplest pro­
tective arrangements are often wanting, or are not employed be­
cause the work is retarded by them. Above all, sufficient ventilation
should be provided for, and a scrupulous daily cleansing of the
grinding rooms. In every room, too, there should be an adequate
supply of cuspidors. By systematic instruction of the grinders the
danger of tubercular infection may be minimized. Personal hygiene
1 R ep ort o f U. S. C om m ission er o f L a b or on W om a n an d C hild W age E arn ers In the
U nited States, V ol. I l l , G lass In d u stry , p. 270.




318

MORTALITY FROM RESPIRATORY DISEASES

IN

DUSTY TRADES.

would be promoted by the installation of bathrooms in the factories;
and, in addition, good drinking water should be supplied.1
Most of the methods of dust prevention and other sanitary im­
provements are practical, if not in their entirety at least in part, and
suggestive of much more extensive consideration in this country
than has, heretofore, been the case.
M E C H A N IC A L G L A SS B L O W IN G A N D P R E S S I N G .

Glass blowing and pressing by means of mechanical devices are
of comparatively recent introduction. Entirely automatic bottleblowing processes date from 1898, and the work in connection there­
with practically dispenses with glass blowing in the generally ac­
cepted sense of the term. Such processes, however, are quite fre­
quently carried on in conjunction with typical methods of glass
blowing and related operations, so that in a general way the occupa­
tional hazards have remained much the same. There are no vital
statistics of mechanical glass blowers and pressers, but it is quite
probable that when carried on under proper sanitary supervision
the use of machinery may prove distinctly advantageous to health
and longevity. The blowing of window glass by machinery is of
much more recent introduction and the process thus far has not be­
come extensively developed. (See Scientific American, July 19,
1913.) Glass-making machines are of three important types, as
described in the Report of the Bureau of Labor on the Condition of
Women and Child Wage Earners in the United States, with special
reference to the glass industry (Washington, 1911). The first type
is the press machine, the second the blow^ machine, and the third
the automatic machine which improves upon the simple blowing ma­
chine by using a self-feeding and self-pressing device. In all of
these processes human labor is to a considerable extent dispensed
with and no skilled glass workers are required, since machinists, in
a restricted sense of the term, are sufficient for the purpose. One
advantage of the automatic machine is that it tends greatly, accord­
ing to the report referred to, to reduce the number of boys employed,
and it tends further to raise the age of the boys that are employed,
and older boys are usually preferred.
No statistical information is available as regards the possibly
beneficial results to health in consequence of the universal use of
glass-making machines and the practical elimination of glass blowing
by hand. It, however, would seem to be a safe inference that in
the absence of thoroughly efficient methods of sanitary supervision
and control, with special reference to the dust hazard, the specific
1 R e p o rt o f U. S. C om m ission er o f L a b o r on W om a n an d C h ild W ag e E a rn e rs in the
L n ite d S ta tes, V ol. I l l , G lass In d u stry, pp. 270, 271.




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

319

liability to pulmonary tuberculosis in the glass industry is not likely
to be materially reduced as the result of the extensive and even
universal introduction of glass-making machinery.
DIAMOND CUTTERS.

Diamond cutting, although an employment of rather limited
extent in the United States, is of interest and*importanee as an occu­
pation with exposure to mineral dust. Hand cutting is very rare
and machine cutting is at the present time the general rule in the
trade, as carried on under American conditions. There has been a
decided improvement in labor conditions as the result of the active
efforts of the Diamond Polishers’ Union, which has a membership
of about 400 in IS ew York City alone. The occupation has the ad­
T
vantage of being well paid, at least in many individual instances,
and some of the cutters are reported to receive as much as $80 and
polishers as much as $60 a week.
P R O C E S S E S OF M A N U F A C T U R E .

The process of diamond cutting and polishing consists of two parts.
After the stone has been cut it is taken to the polishing rooms, where
the setter selects a suitable sized brass cup, called a dope, fills it with
a mixture ©f lead and tin, and melts it in a gas flame. After working
the solder to its proper shape, he places the diamond in the center,
leaving only a very small part exposed. A mark is made on the
solder before it becomes fairly set, and then the stone is passed on
to the polisher. By the mark made on the solder the latter knows at
once the exact run of the grain and the way it will polish to the best
advantage. The polisher uses a circular disk composed of very
porous iron, so that as the diamond is polished away in the form of
dust it enters the pores of the iron, the result being that diamond
cuts diamond.
According to Hirt, the first part of the process is exceedingly un­
healthful. The bent position of the workman, the heat, and the dan­
ger of lead poisoning all contribute to make the occupation an un­
healthful one. The principal bad features of the second part of the
process are the dust inhalation and the straining of the eyes. While
very little dust escapes into the air, the little, according to Hirt, is
very bad in its effects, as the particles are angular, sharp, and, of
course, very hard.
M O R B ID IT Y OF D IA M O N D C U T T E R S A N D P O L IS H E R S .

Arlidge in his observations upon the diamond cutters’ trade re­
marks, however, that—
From our own observation of diamond cutting and polishing we
can scarcely imagine any definite morbid result from the dust of the
gem. It is far too precious to fritter away into dust by any coarse




320

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

grinding likely to give off a tangible quantity of this substance, and
we suspect that the recorded ill health of diamond workers is chiefly
attributable to accidental circumstances connected with the charcoal
furnaces formerly used; to overheated and badly ventilated work­
shops; and to dissipated habits among the employees. So far as
diamond dust may possibly be thrown off in the polishing process,
so far, doubtless, woul(l it be an irritant to the respiratory organs by
reason of the very sharp and angular character of its atoms.
Tracy comments upon the sanitary aspects of the employment as
follows:
In diamond cutting the amount,of dust created is small, and }^et
the occupation is a very injurious one. The “ setter ” prepares the
diamond for the cutter by soldering it on the end of a copper rod
with an alloy of 4 parts lead to 1 of tin. He does this with a char­
coal fire, and is exposed to great heat, as well as to poisonous gases.
The setters suffer from headache, tinnitus aurium, impaired diges­
tion, and irregularity of the bowels. In Coster’s factory, at Amster­
dam, 73% per cent oi them were pale and emaciated, 57 per cent had
palpitation, giddiness, prcecordial distress, 56 chronic headache, 36
asthma, etc. The use of solder produces lead poisoning. Out of 90
examined, 30 showed traces of poisoning. In general, they are all
sick men, and suffer from lung troubles. Nine per cent had phthisis.
The cutters or polishers grind the gems on iron wheels covered with
diamond dust and oil. The dust inhaled by them, though small in
quantity, is enough to cause frequent chronic lung troubles. In
Coster’s factory, 52 per cent of them were thin and pale, 40 per cent
asthmatic, 33.75 per cent suffered from headaches, etc.
H E A L T H -IN JU R IO U S R E S U L T S OF D IAM O N D C U T T IN G .

The extensive development of the diamond industry in Holland,
chiefly in Amsterdam, has been reported upon by United States
Consul Frank W. Mahin, who points out that there are some 70
establishments in Amsterdam which cut and polish diamonds and
employ more than 10,000 work people, of whom about 1,700 are
cleavers and cutters and 4,700 polishers, the remainder being en­
gaged about the offices and in other work. He explains the occupa­
tional process, in part, as followT :
s
Cleavers split the diamonds; cutters take off the rough and sharp
edges and corners and make the general shape of the stone; polishers
polish the stones and make their facets; turners turn the diamonds
around in the apparatus which holds them, so that the facets can be
made, every diamond worked in a first-class manner having from 58
to 64 facets; sawers saw stones which can not be cloven or which it is
more profitable to saw; sometimes a stone is cleft and the parts are
then sawed, but very small stones can not be sawed.
A more extensive technical account of the Amsterdam diamond in­
dustry has been contributed by Sir Thomas Oliver, in his report on
Industrial Lead Poisoning, published by the United States Bureau




OCCUPATIONS W IT H EXPOSURE TO MINERAL DUST.

321

of Labor Statistics (Bulletin 95), Washington, 1911. Upon the basis
of his personal investigation he states that he found the workrooms
overheated, owing to the large number of gas jets in use, and that the
rooms generally were badly ventilated. u Work under these circum­
stances,” he observes, “ creates on the part of those following it an
oversensitiveness to changes of temperature and a diminishing re­
sistance to colds.” Aside from a serious liability to lead poisoning,
Sir Thomas Oliver’s investigation failed to establish a special pre­
disposition or liability to pulmonary tuberculosis. The occupation,
however, has not been sufficiently investigated, but there are con­
vincing reasons for believing that the dust factor in diamond cutting
and polishing is of sufficient importance to prove inimical to health.
Unquestionably important variations in liability are met with in the
five principal groups of employment, viz, cleavers, polishers, turners,
cutters, and sawers. Eyestrain is an important factor, and to the
extent that any disease or physical disability tends to undermine
health generally and reduces vital resistance. This factor, together
with the liability to lead poisoning, is deserving of serious consider­
ation. Although quite extensively developed in this country, chiefly
through American branches of Amsterdam firms, there are no Amer­
ican vital statistics of this occupation, which, however, for the rea­
sons stated, seems to require inclusion among unhealthy trades in
which the mortality from pulmonary tuberculosis is quite probably
above the normal,
G E N E R A L C O N C LU SIO N S.

Diamond cutting is briefly referred to in Kober and Hanson’s
Diseases of Occupation and Vocational Hygiene, but chiefly with
reference to the risk of lead poisoning. On account of the European
war the industry has been quite extensively developed in the United
States, and, according to the Scientific American Supplement (Oct.
7, 1916), New York instead of Amsterdam is now the center of the
diamond industry. In a descriptive account of diamond-cutting
methods in the article referred to it is said that in the process of cut­
ting about 60 per cent of the weight of the rough stone is lost, but as
far as practicable “ every particle of waste material from the splitting
and sawing of the stone is carefully saved for use in the sawing
and other subsequent operations.” This, of course, implies the pos­
sibility of a fair degree of diamond dust intermixture with the
general atmosphere and the consequential mechanical injury to the
lungs on account of the inhalation of the diamond-dust particles.
It is suggested in 'this connection by Kober that “ all polishing
processes should be carried on by the wet process and guarded by
hoods and efficient exhaust ventilation.” Aside from necessary safe100811°— 18— Bull. 231------ 21




322

MORTALITY. FROM RESPIRATORY DISEASES 1ST DUSTY TRADES.

guards against lead poisoning, Kober recommends attention to gen­
eral ventilation, adjustable workbenches, and improved working
conditions as regards light, air, space, and heating. In the
absence of more conclusive evidence, it is not apparent that the
diamond-cutting industry as carried on in this country under
modern conditions is distinctly injurious to health, or that it seri­
ously predisposes to pulmonary tuberculosis, on account of the
special liability to the risk of mineral and metallic dust inhalation.




CHAPTER IV.— THE MINERAL INDUSTRIES (MINES,
QUARRIES, ORE REDUCTION, AND SMELTING).

The mineral industries of the United States are of such enormous
extent and variety that an adequate consideration of the health and
mortality of the large number of persons employed therein would
extend far beyond the scope of the present discussion of the mor­
tality from respiratory diseases in dusty trades. In 1914 the
approximate value of the mineral product of the United States,
including both metallic and nonmetallic resources, exceeded $2,115,000,000, and the number of persons employed in the different branches
of the industry was in excess of 1,000,000. An almost infinite variety
of products are mined, quarried, and subjected to ore dressing, smelt­
ing and refining processes equally varied and complicated in extent.
Table 121 illustrates the principal divisions or main branches of the
mineral industry, and for the group of persons employed in metal
mining, in addition, the number and proportion of persons employed
underground. The table has been derived from Technical Paper
No. 129 of the United States Bureau of Mines.
T able

1 2 1 .—N U M B E R O F PE RSO N S E M P L O Y E D IN M IN E R A L IN D U ST R IE S OF T H E
U N IT E D STATE S, IN 1914.

Total
employed.

Number
employed
under­
ground.

Coal mines . . ........................................... ...p ..
Copper mines
. ............. ........ .........................
Gold and miscellaneous metal mines_____ ________ . . . . . . . . . . . ______
Iron mines
......... ....................................................... .
Lead and zinc m in es1 .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Miscellaneous mineral mines......................................................... ............

763,185
44,686
48,438
44,807
10,935
9,249

639,334
31,265
35,432
24,847
7,609
2,465

83.8
70.0
73.1
55.5
69.6
26.7

Total, mines.........................................................................................
Ouarrvinff
.
...............................................
Oolreovens
•
. . ............................. . . . . . . . . . . . . . . . . . . . . .
Smelting
...
Ore dressing
*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

921,300
87,936
22,313
26,960
14,501

740*, 952

80.4

K ind of mine, etc.

Per cent
employed
under­
ground.

1 Mississippi Valley only.

V ARIED CONDITIONS OF EMPLOYMENT.

All general conclusions applicable to an industry of such varied
extent must necessarily be of limited scientific value. Even with




323

324

MORTALITY FROM RESPIRATORY DISEASES IN DUSTY TRADES.

reference to well-defined groups, such as the subdivision of metal
mining, or the broad division of coal mining into anthracite and
bituminous, general conclusions must fall short of the required degree
of scientific exactitude. As shown by the table, the proportion of
men employed underground attains to 70 per cent in copper mining,
while in iron mining the corresponding proportion is only 55.5 per
cent. In the latter the process of open-cut mining or what is called
stripping is quite generally employed. To a lesser extent, a similar
method is employed in copper mining in the States of Utah and
Nevada. Obviously, underground employment must by its nature be
less healthy and predispose more to pulmonary tuberculosis than em­
ployment in the open, especially when carried on in connection with
more or less health-injurious processes such as drilling, the use of
pneumatic tools, etc. The number of specific employments in mines
is much larger than is generally assumed to be the case, and the gen­
eral use of the term “ miners ” in vital statistics is, broadly speaking,
quite seriously misleading. Also the proportion of “ miners 5 in the
5
strict sense of the term varies considerably, according to the metal
or mineral mined, and the term itself is becoming obsolete on account
of the extensive use of machinery, rock drills, etc., by means of which
the old-time pick and shovel miner has been replaced by machine
miners, rock drillers, etc.
LIMITATIONS OF OCCUPATIONAL STATISTICS.

Much has been written in general terms on the health of miners
and other mine employees which, for the reasons stated, requires to
be accepted with extreme caution. No very satisfactory progress has
been made in the perfection of vital statistics to the extent that the
relative health and mortality of specific employments under and
above ground can be ascertained, especially with regard to the rela­
tive incidence of pulmonary tuberculosis and nontuberculous respir­
atory diseases. As elsewhere pointed out, the health-injurious condi­
tions are frequently limited to a comparatively small group of under­
ground employees, as best emphasized in the case of the rock drillers
in the gold mines of the Transvaal. All general conclusions, there­
fore, understate the true liability of the persons directly employed in
the most health-injurious occupations in the mining industry and all
broad conclusions concerning the relation of the industry in its en­
tirety or its principal branches must be considered inadequate for
medical and public-health purposes, or as a basic consideration for
protective labor legislation. The generally accepted official statistics
on the health of mine employees relate to the main branches of the
mining industry of the United Kingdom. Much useful, and, in a
measure, even more conclusive information is available, in part, for




325

M IN ES, QUARRIES, ORE REDUCTION, AND SMELTING.

the mines and other mineral industries of the European continent,
South Africa, and the several States of the Australian Common­
wealth, but nearly all of the available data at the present time have
reference to the mining industry as a whole and not, as the usual
titles of the official tables would imply, to “ miners ” within the more
restricted sense of the term.
COMPARATIVE MORTALITY OF ENGLISH MINERS.

The most recent English statistics, for the years 1900-1902, assign
to certain branches of the mining industry a relatively favorable
position in comparison with other more or less unhealthful occupa­
tions, chiefly with reference to dust exposure, as shown by the table
following, derived from the Supplement to the 65th Report of the
registrar general for England and Wales (London, 1908) :
T able 1 2 2 .—CO M P A R A TIV E

OCCUPATION M O R T A L IT Y
W A L E S , 1900 TO 1902.

STATISTICS, E N G LA N D A N D

[Data are for both occupied and retired.]

Phthisis and
diseases of the
respiratory
system.
Occupation.
Mor­
tality
figure.

Ratio.

Dis­
Dis­
eases
eases
of the
of the
Phthisis
respir­ circu­
atory
latory
system. system.

Mortality figure.

A g ricu ltu rist.....................................................................................

171

100

85

86

96

Ironstone miner.........................................................................................
•
Carpenter, joiner..................................._...................................................
Coal miner....................................................................................................
Wool, worsted—manufacturer.............................................................
Baker, confectioner...................................................................................
Miller, cereal food manufacturer.........................................................
Blacksmith, striker...................................................................................
Gas works service......................................................................................
Carpet, rug, felt—manufacturer.........................................