115 56 D n i R! ' CO EW SMART M.D V GERMS, DUST, AND DISEASE : Chapters in ur Xife BY ANDREW SMART, M.D., F.R.C.P. \\ EDINBURGH. EDINBURGH: MACNIVEN AND WALLjACE. s TO MRS TRAYNER, THROUGH WHOSE ENLIGHTENED, ZEALOUS, AND PHILANTHROPIC INTEREST IN THE PEOPLE, THE EDINBURGH HEALTH LECTURES WERE FOUNDED, THESE PAGES- ARE RESPECTFULLY DEDICATED BY THE AUTHOR. PREFACE. THE Author, in yielding to the wish convoyed to him to repub- lish, in their present form, the two accompanying Lectures, does so, in the hope, that the attainment of the object contemplated by them will thereby bo furthered, The first Lecture, delivered under the title of " Proventiblo Diseases," gave, the Author believes, the first expression, to a popular audience, of the " Germ Theory " of Zymotic Disease. It is to the indomitable genius and philosophical sagacity of Joseph Lister that, the contest, in regard to the application of this theory to Surgery, is now virtually ended ; and, thereby, one of the brightest, most benign, and even romantic chapters has boon added to the history of Medical Hurgory. The battle of the germ theory, however, in its relation to the State control and prevention of infectious diseases, hat yet largely to be fought; and, to assist forward this great niov<;m or the accompanying Sketch. LECTUEE II. It would, doubtless, have added to the interest of the subject, had the limits of my topic allowed me to include, however briefly, some notice of those occupations which we are accus- tomed to speak of as the " professions." It could not fail to interest, as well as instruct you, to know why our Divines, by which I mean the clergy generally, pre-eminent by their learning, eloquence, piety, active benevolence and public spirit, should add the further distinction of being the longest lived; or why the legal profession, in its different branches, certainly, not less eminent in this metropolis, by their great talents, learning, literary tastes, solidity of judgment, forensic skill, and unique business capacity, should rank only second in the enviable possession of longevity. Or again, curiosity, if no other motive, might prompt in you the wish to know why the average life of the medical man should fall so considerably short of that of the preceding. But these professions and other interesting occupations do 'not come under the designation of "unhealthy," to which category I am restricted. But let me say, that, apart from them, I find that my theme is sufficiently if, indeed, not too ample. And there is this further drawback, that the subject has not hitherto received, at least in this country, the attention to which its importance entitles it. We are, accordingly, almost without any reliable statistical data or facts.* I am therefore obliged to seek for them else- * Thackrah's work, published in 1833, is not based on statistical data. 24 DUST A CAUSE OF DISEASE. where, and to construct and arrange the evidence upon which I wish all my statements to rest.* Should I, in doing so, tax your time, or tire you with calculations, I must bespeak your indul- gence ; but it shall be my endeavour to avoid this. Nearly all trades and manufacturing processes are attended by the evolution of dust, or of volatile particles, more or less considerable and more or less hurtful. Persons habitually breathing a dust-laden atmosphere of this kind, acquire a liability to diseases of various sorts ; but as the inhaled dust is necessarily, in every instance, brought into contact with the lungs, it is accordingly the pulmonary organs that chiefly suffer in the end. I propose, in this lecture, to direct your atten- tion, as fully as time will permit, to the injurious effects of certain occupations upon the health of those employed in them ; and, to enable me the more succinctly to do this, I shall state what I have to say under the following heads : Firstly, the effects of metallic dust ; secondly, the effects of mineral dust ; thirdly, the effects of vegetable dust ; fourthly, the effects of animal dust \ fifthly, the effects of certain gases and volatile emanations ; sixthly, the effects of constrained bodily position, conjoined with defective ventilation ; seventhly, the effects of dust from poisonous metals ; and eighthly, certain considerations as to the prevention of these effects. Metallic dust is of different kinds ; and we shall speak first of that which is emitted during the processes of iron and steel working. You have all, doubtless, curiously watched the operations of the street scissor-grinder as he plies his vocation. Each time the blade touches the swiftly revolving wheel, the grinder's head, as he bends over it, is enveloped in dust and sparks. Now, this peripatetic steel-grinder encounters no risk from his occupation only because it is carried on out of doors ; but were you to enter one of the busy workshops of Sheffield, and, for a time, amid the turmoil of machinery, attempt to breathe its stifling atmosphere, charged with minutely pulverised dust, emitted by hundreds of wheels, you would have a practical experience of the cause why few, if even one, of all the workers there will ever reach their fortieth year. * Vide appended Tables. STEEL, COPPER, AND LEAD. 25 Take the following examples. The average duration of life among the dry-grinders of forks is twenty-nine years ; of razor- grinders, thirty-one years ; edge-tool grinders, thirty-two years ; spring-knife and file-grinders, thirty-five years; and saw and sickle-grinders, thirty-eight years. The cause of this excessive mortality will be apparent, if you will now examine this table of figures. It shows that in every hundred sick among the needle-makers, seventy are consumptive ; and that among the file-makers, sixty-two in the hundred are consumptive \ and, taking the steel-grinders all round, rather over forty in the hundred are consumptive. It is a recognised fact that, in these particular branches, the quantity of dust is not only excessive, but finely comminuted, and the amount of injury inflicted by it, is, on that account greater. The effects of metallic dust on the lungs are, in the first instance, only mechanical, but afterwards, by their continued irritation of the organs, ulceration is induced, which terminates in consumption. The next group of workers, includes those who are exposed to the action of copper-dust. It comprehends the lithographers, moulders, engravers, &c. ; and it will be observed that, while the hurtful effects of the inhaled dust of this metal are more uniformly distributed over each class, consumption is here also, as among the steel-grinders, the predominant disease. In every one hundred sick lithographers, one half nearly is consumptive (48 '0). The moulders and watch-makers have each thirty-six, and the engravers twenty- six cases of consumption per hundred. The average duration of the life of the entire class is about forty-eight years. Lead-miners, painters, plumbers, workers in white lead, and occasionally compositors, and all who work with lead, are exposed to the risk of poisoning by that metal. The symptoms generally are those of some form of paralysis. The most frequent and best known of those kinds of paralysis are lead-palsy, painters-colic, and wrist-drop. White-lead is that form of the metal most generally used. It is the chief ingredient in paint, and largely enters into the composition of enamel-colours, 26 MINERAL DUST AND MORTALITY. enamels, and glazes. The glazing, which is, as you are aware, an important branch of industry carried on in potteries, is often attended with serious consequences. And in the enamelling arts, in which lead is used, there is always considerable risk to the operatives. By comparing the table which shows the effect of lead dust as a cause of consumption, you will observe, that it is less productive of that disease than are the effects of copper dust. It is, nevertheless, the cause of an excessive mortality. Thirty- four type-founders, and twenty-five each of the dyers and enamellers die of it in every hundred of each class. The painters and printers follow with a mortality of twenty-four and of twenty- one per hundred respectively. The average life of this class is probably not over forty-eight years. We now turn to the second head of our subject : THE EFFECTS OF MINERAL DUST. The table under this heading furnishes a list of the chief industries, in the carrying on of which the workmen are injured by the dust in this case mineral emitted during the manufac- turing processes. Notoriously over-topping all the other dusty occupations in their effects upon life and health, are those of the grind-stone makers, flint cutters, and glass polishers. The conditions, under which their work is carried on, are, in the highest degree, favourable to the production of pulmonary disease. They work in an atmosphere loaded with sharp spiculse, which lacerate the lungs, and quickly induce consumptive disease. Every grind-stone maker is cut down with it at, or soon after, the age of twenty-four. Hardly one escapes. The flint-cutter and glass-polisher have each eighty deaths, per hundred sick, of consumption, and their average life is under thirty years. Again the stone-cutters a term equivalent to that of our stone-masons (not builders), terminate their average life at the age of thirty-six years thirty-six, in every hundred sick, being consumptive. A glance at the rest of the column will TOBACCO-WORKER, WEAVER, AND JOINER. 27 at once inform you what occurs to the artificers employed in the other branches of this same group. THE EFFECTS OF VEGETABLE-DUST. The occupations, which are productive of vegetable-dust, in- clude a somewhat promiscuous and apparently incongruous variety of workers. Among these we have the cigar-maker, and the tobacco and snuff-worker. Although they enjoy an average life of fifty-five years, they nevertheless, head the list with thirty-six cases of consumption in every hundred. This unexpected result is, doubtless, owing chiefly to the irritant effects of tobacco-dust on the lungs ; but in some degree, I am of opinion, to the chemical ingredients superadded during the manufacturing processes. Amongst the different classes of workers in textile fabrics, the weavers, engaged in the cotton, flax, and hemp branches, are un- questionably the chief sufferers. The mortality from consump- tion, at one period, was so great as to lead the Privy Council to inquire into its causes. Dr Greenhow, who undertook the investigation, showed that it was during the preparatory processes, that most dust was given off, and the greater amount of disease engendered. These processes are known as " hackling/' " carding," " sorting," and " dressing." * It is stated, on the best authority, that three-fifths of the flax mill-workers of Belfast the chief centre of that textile manufac- ture are consumptive. In other words, sixty in every hundred die of that disease.t The average life of the weavers of this restricted class is forty-four years, whilst that of weavers in general is about fifty- seven. Carpenters, joiners, and cabinet-makers, are affected by their dusty occupations each group having fourteen consumptive cases in every hundred. These facts afford conclusive evidence that their work is considerably less hazardous than that of the stone- masons. I find it generally, but erroneously stated, and taken for granted, that the risks of the former class are equal to those * Vide Report of the Medical Officer of the Privy Council for 1858-60. t Vide Essay on Health of Belfast by Dr Purdon. 28 MILLER, BAKER, AND COAL-MINER. of the latter. The average length of the lives of the two classes respectively is a further proof of this mistaken view that of the carpenters, joiners, and cabinet-makers being forty-nine years, as compared with thirty-six years of the stone-masons. Compare now the operations carried on by the flour-miller with that of the grindstone maker, or of the needle-grinder. The atmosphere of a flour-mill is, certainly, much more dusty than that of the workshop in which grindstone making or needle-grinding goes on, but you will not fail to mark the great disparity in the effects of the different sorts of the dust. In every hundred of sick millers, ten are consumptive, and his average life is forty- seven years. The bread-baker is on a parity with the miller as regards his average length of life, but his occupation is less productive of con- sumption. While flour-dust is not, in these occupations, a sufficiently powerful factor to make consumption the predominant malady, it, nevertheless, conspires with the unfavourable surroundings of the workmen to produce other ailments scarcely less mischievous. Thus the miller, owing to the draughty nature of the premises in which he is accustomed to work, together with the irritation in- duced in the lungs by the inhaled flour, contracts a liability to acute inflammation of the pulmonary organs, from which, his class suffers in the proportion of twenty in the hundred. The baker again, immured for the most part in an underground workshop, for twelve or fourteen hours a-day, in an over-heated air, laden with flour-dust, often tainted with the poison of coal or sewer-gas, acquires a liability to acute disorders of the air-passages chiefly bronchitis, in the ratio of thirty in the hundred. This, in his case, becomes the predominating and fatal malady. It is interesting and instructive to notice the last-named occupation on this table. It is generally believed that the coal-miner's occupation is one most highly productive of pulmonary disease, and on that supposi- tion, when consumption occurs in the coal-miner, it is designated " miner's-phthisis." I feel bound to state that in my experience hospital and otherwise I have not been able to confirm this prevalent belief, nor do I believe it to be well-founded. IMMUNITY OF THE COAL-MINEE. 29 In every case of so-called " miner's-phthisis " which I have seen, there has been a distinct family-history of the disease. A man predisposed hereditarily to consumption, developes it, not more readily as a coal-miner, than in any other employment. The black expectoration seen in miner's consumption, proves no more than that the coal-dust has reached the lungs certainly not that it is the cause of the disease. Coal-dust or, to call it by its proper name carbon, from its highly antiseptic properties, acts as an excellent protective to the pulmonary organs. The figures on the table very strikingly corroborate this view. You will notice, perhaps with surprise, that among twelve hundred sick miners, only one case of consumption occurs ! THE EFFECTS OF ANIMAL-DUST. Animal-dust is evolved in the processes of brush-making and hair-dressing, in the operations carried on by the skinner, tanner, and hatter ; and in those of the button, harness, and clothmakers. I allude, of course, to these occupations as they are carried on upon a great scale in large manufacturing centres, where there is machinery, and where workmen are massed together in large bodies under one roof. In such a city as this, with its limited and well-regulated in- dustries, it is difficult to one,- not directly conversant with their details, to realise what such operations really imply. When, for instance, I name hair-dressing as one of the occupations of the present group, the term is intended to include all the pro- cesses connected with the preparation of hair for its artistic and commercial uses. So that the name, in this connection, suggests little, if anything, in common with the comparatively healthy avocation of the perfumer and hair-dresser familiar to us. I may as well remark here, to prevent misunderstanding, that this statement applies generally to all the occupations now under con- sideration. We have already observed that the excessive mortality prevailing among the cotton, flax, and hemp-weavers, has its origin chiefly in the irritation induced by the contact of shreds of these substances with the lungs. We have all experienced, I suppose, the trouble which a 30 WOOL-SORTER'S DISEASE. hair causes when lodged in a sensitive part of the air-passages ; and how much greater the discomfort if it happen to be a bristle from a tooth-brush. Now, if we hold in remembrance, that it is owing chiefly to the action of sharply cuminated particles from bristles that the brush-maker is exposed to, the fact will suffi- ciently account for his high death-rate of forty-nine in every hundred, from consumptive disease. The hair preparers for that is their proper designation have also a large proportion of deaths from consumption; the number being thirty-two per hundred. To those exposed to the effects of inhaled animal dust, there is moreover, the additional risk of poisoning, derived from the diseased animals from which the hair has been taken. There is a special liability in some of the lower animals to be attacked by a very fatal and contagious malady called anthrax. Should the hair of the infected animals unfortunately find its way into the market, and thence to the hands of the wool-sorter, he is certain to be attacked by the disease, and equally so to die of it. Special attention has lately been given to this disease, and much light thrown upon it in connection with the occupation called wool-sorting.* THE EFFECTS OF GASES AND VOLATILE EMANATIONS. Asthmatical and bronchial affections are those induced by inhaled gases of an irritant character. When, however, such occupations are associated with a sedentary posture and confined air, they induce considerable consumption. Thus, straw-hat makers, who are mostly women, are exposed to the fumes of sulphurous acid ; and jewellers, in the refining processes, to nitrous acid vapours. Consumption, in both, prevails to the extent of eighteen in each hundred ; and inflammation of the lungs (pueumonia) to the extent of eight in each hundred. Bleachers are exposed to chlorine gas and alkaline vapours. As a class they are not generally healthy, but their average life is comparatively good, being fifty-eight years. The operations * We are indebted to the careful researches of Professor Greenfield for much of what we know of this disease. HEALTHINESS OF CERTAIN OCCUPATIONS. 31 connected with soap boiling, tanning, parafine-making, and candle- making, belong to this class. On account of the disagreeable odours emitted, they are, in the Public Health Act, designated noxious trades. It is remarkable that these occupations have, from time inmemorial, and in all countries, ranked amongst the healthiest of the industrial employments. The average life of the workers is over sixty years.* Will you notice that, in one hundred sick among the charcoal burners, there are only two consumptives. This is the next lowest death-rate to that of the coal-miner ; and for the reason previously mentioned, that the carbon is protective to the lungs. Parafine-makers, although exposed to powerful vapours, enjoy a similar remarkable immunity from consumptive disease. This is accounted for by the antiseptic properties of parafine. Of those who are affected, not so much by dust, as by THE EFFECTS OF CONSTRAINED BODILY POSITION CONJOINED WITH DEFECTIVE VENTILATION, we restrict our attention to three well-known classes. These are, firstly, the needle-women of every class, including milliners and dressmakers ; secondly, tailors ; and thirdly, shoemakers. Their surroundings in their essential features are alike ; they all work under the disadvantages of a sedentary and constrained bodily posture, in over-crowded and ill-ventilated work-rooms. They are but little addicted to out-door exercise, and their habits of dieting are extremely faulty. From their excessive tea-drinking, they are, with few exceptions, confirmed dyspeptics. Pale in complexion, spare in bodily condition, they age prematurely. The women are afflicted with anosmia, which means the loss of red blood, giddiness, palpitation, shortness of breath, weak and trembling limbs, and, generally, the complete suspension of those functions upon which their health and usefulness depend. These symptoms, for the most part, terminate in consumption, unless their occupation is timeously relinquished. The conditions under which they carry on their respective employments, are so analogous that we * It is mentioned, as a matter of history, that during the plague called the " Sweating Sickness," tanners, curriers, and such as were employ unpleasant smelling businesses, all escaped infection. 32 MORTALITY OF SEDENTARY OCCUPATIONS. should expect each class, in a nearly equal degree, to suffer from the same maladies. The results of a perfectly independent inquiry into the case of of each class, remarkably corroborate this anticipation, as you may readily satisfy yourselves from the appended tables. The tailors and needle-women, you will observe, have each nineteen deaths from consumption per hundred sick. The shoe- makers fall short of that number only by a fraction, being 18'7. Under the head of THE EFFECTS OF DUST FROM POISONOUS METALS are included workers in phosphorus, in mercury or quick- silver, and in arsenic. Lucifer match-making is the sole occu- pation which exposes those who work at it to the action of phosphorus fumes. The inhalation of phosphorus vapours is productive of a frightful disease, namely, death of the jaw bone, necessitating its removal by a severe operation. The prevalence of this disease led, some years ago, to an inquiry into its cause, with the result, that a different kind of phosphorus (amorphous), unaccompanied by these effects, was substituted. The average life of the lucifer match-maker was formerly as low as forty-four years. Work people much employed in the use of mercury or quicksilver in the arts, are liable to a peculiar kind of paralysis, with salivation, tremors (called "trembles" by the work- people), and stammering. Chief among those affected in that class are the water-gilders, when an amalgam of gold and mercury is used. This process is now happily superseded by electro-plating ; while, at the same time, recent improvements in looking-glass making, further permit that branch of the art to be carried on with comparative immunity. The leading sufferers from mercury are now those who work in the quicksilver mines. Mercury, although a ponderous metal, is, nevertheless, volatile at ordinary temperatures. Every fourth man accustomed to in- hale its fumes dies consumptive, and the average life of the quick- silver miner is forty-seven years. Arsenic, besides being an invaluable medicine in the hands of EFFECTS OF ARSENICAL DUST. 33 the physician, is much prized in many of the arts for the great brilliancy and cheapness of the colours made from its salts. The chief of these is that pigment popularly known under the names of Emerald-green, Brunswick, or Vienna-green. This pigment is of two kinds, known to the chemist, the one as Scheele's, and the other as Schweinfurt's green. The former contains fifty-five, and the latter fifty-eight per cent, of white arsenic that is to say, more than a half of the pigment is pure arsenic. It is from this material that wall-papers in every shade of green, artificial flowers, fruits, feathers, dresses, &c., derive their colour. It is estimated that in England alone, seven hundred tons of this green are every year thrown into the market for use in these arts.* It is remarkable, that workmen employed in roasting the arsenical ores, and who are much exposed to arsenical dust, are less affected by it than others whose business it is to apply it to its industrial uses. It is believed by Dr Guy, and other eminent authorities, that these workmen suffer comparatively little, if at all. You will however see, from the tables, that this conclusion is not warranted by the facts of the case. In every one hundred sick among the arsenic makers, eleven are consumptive, and their average life is forty-seven years being the same as that of the quicksilver miners. If you will now compare these facts with the case of those who are engaged in the conversion of the arsenic into arsenical pigments, it will be seen that every fourth man among the latter is consumptive (25 -0) ; and his average life, is in a proportional degree, lessened. Once more, let me call your attention to the fact, that the artificial flower maker has a still greater mortality his death rate being one in three (36 -0) or thirty-six in every hundred sick. Let us here pause and for a moment contemplate some of the possible results which may attend the introduction of such sub- stances into our social and domestic usages. Here is a piece of a favourite and much-used arsenical wall-paper. An ordinary sized room, with one thousand square feet of wall surface covered with it, would contain twenty thousand grains of arsenic. * "Manual of Hygiene," Cameron. 34 ARSENICAL POISONING IN ARTS. The arsenic is held loosely adherent to the paper, and is easily detached and diffused through the room as dust. This dust, found on the shelves, and on other articles in the room, when analysed, yields arsenic. All those green papers, so much used in general merchandise, contain arsenic in varying proportions. Size-greens, sold at a cheap price, are now much in vogue for size-painting walls. They vary in strength from seven to thirty-six grains of arsenic in each square foot of wall. A child's picture-book has been found to contain fifty grains; but what shall we say of those bright poisonous colours so alluring to the young, which garnish their toys, and even sweetmeats 1 Here is an article belonging to the textile fabrics one of many treated to the arsenical process. A dress of this material, as now made, contains two thousand grains of arsenic. An artificial wreath, such as I show you, contains pro- bably not less than ten grains of the poison.* The case of a young woman of nineteen is reported, who died under symptoms of arsenical poisoning after being eighteen months employed in artificial green flower making.! Examina- tion after death showed that the poison had penetrated the tissues. It has been well said that, the feeling which prompts people to keep off the appearances of age as long as possible, sometimes leads them into practices which shorten life. Among the numerous articles used in this way, we must include those nostrums widely advertised as hair-restorers, which are reputed to preserve the pristine colour of the hair, or to restore it if lost. These dyes, for the most part, contain lead, and numerous cases of poisoning by their use are recorded. Face-enamelling the occupation of those artistes who profess to beautify their clients for ever is liable to similar objections. Cochineal, supposed to be harmless, and employed to give a peachy bloom to the cheek, contains, as stated by Tardieu, arsenic, mercury, and lead. And even the present fashionable * See excellent article on arsenic in " Common Things," by Dr Steven- s on Macadam. Sanitary Record. t " Public Hygiene," Cameron, Dublin. GERMANY AND POISONOUS PRODUCTS. 35 colours derived from coraline red, and aniline, are not free from suspicion. Having regard to the effects produced upon the health of those employed in the poisonous arts and manufactures, and to the grave consequences resulting to the community from their unrestricted use, the question naturally arises, is it right, or desirable to allow the manufacture and sale of articles attended with so much risk? Arsenic, as such, cannot be procured without certain legal precautions, such as a medical certificate, and the name and address of the purchaser; but I have just said that seven hundred tons of arsenic a moderate estimate of the quantity in England alone are sold as pigments, some of them containing more than 50 per cent of arsenic. Quantities of these may be bought for a few pence without any question being raised. No one, surely, would object to the prohibition of this traffic on the ground that such an act would infringe the liberty of the subject ! Might it not, on the contrary, with more reason, be alleged that our liberty suffers by the legalised continuance of such a state of matters 1 " An excess of liberty in any commonwealth," remarks the great Eoman commentator,* " degenerates to the opposite extreme in licentiousness and tyranny." It may be instructive to ascertain how this subject has been dealt with by some of our enlight- ened neighbours on the Continent. The German Government, for example, deeply impressed with the conviction that the manufacture and sale of such articles were incompatible with the liberty and safety of the subject, on the 1st May 1882, laid before their Parliament a decree of which I give, in effect, the substance. The preamble states that the object of the Act is the prohibition of poisonous pigments ; and the following substances are described as coming within the meaning of the Act, namely, antimony, arsenic, barium, lead, cromium, cadmium, copper, mercury, zinc, tin, gamboge, and picric acid. Secondly, the preserving and packing of food stuffs intended ?for sale, in wrappers coloured with the above cited poisonous colours, are prohibited. Thirdly, the employment of poisonous colours, * Tacitus. 36 DUST AND CONSUMPTION. enumerated in the Act, is prohibited in the manufacture of playthings. Fourthly, the use of arsenical colours for the manu- facture of paper-hangings, or for materials of dress, is prohibited. Fifthly, the sale of food stuffs, or food products, preserved or packed contrary to these regulations, is prohibited. Sixthly, the enactment shall come into operation on the 1st of April 1883. Now, you will perhaps characterise this proceeding on the part of the German government, as a bold, if not a sweeping and summary measure. Let us see what came of it. Germany is, as you are aware, the great manufacturing workshop of these pig- ments, and of the arts to which they are applied. Here, then, is an act that threatened the extinction of these industries, with its consequent widespread commercial ruin. In view of this disaster, we may believe there were no lack of appeals, remonstrances, and even threatenings. The government, however, remained firm in its determination to waive every consideration except those which had regard to the best welfare of the people. Now notice what comes of doing what is right regardless of consequences. The dreaded 1st of April the day on which the Act would come into force at length arrived, but with it, not the expected ruin. How was this 1 How often as in this case has necessity proved the "mother of invention," especially when it touches that sacred depository of the public conscience the pocket 1 ? In short, before the fated day, by the joint aid of money and science, new and poisonless pigments were devised, tried, and found to fully meet all the requirements of the case. Thus, Germany at this moment, has the proud satisfaction of having initiated a great sanitary reform. You have not, I am sure, failed to be struck with the fact that these effects of unhealthy occupations culminate, in an extra- ordinary degree, in the production of one particular disease. It is unfortunately the most prevalent and fatal of our maladies ; and it is on that account that I have chosen pulmonary con- sumption as the crucial disease by which to test the ill effects of these occupations. A high death-rate, amongst any class, from consumption, im- NUMBER OF WORKMEN AFFECTED. 37 plies a coincidently increased number of deaths from most other disorders. The statistical tables afford evidence in corrobora- tion of this fact. The proofs already submitted have sufficiently, I doubt not, impressed you with the extent of the evil to which they are intended to direct your attention. It is a question, to which attaches great interest, to know how many workmen in the United Kingdom are, by means of their employments, directly exposed to these effects. Have we any means of arriving at the knowledge of this important fact 1 We are certainly with- out any positive data to guide us, but I shall endeavour to arrive, as nearly as possible, at a correct estimate of their numbers. Taking then, as the basis of our calculation, the recently pub- lished census for the ten years previous to 1881, we find that the whole industrial class has, during that period, increased by one hundred and eighty-one thousand; and that in their aggregate strength, they at present constitute a fourth part of the entire population of the United Kingdom (24-97). That gives them, as you will see, a numerical strength, say, of eight millions, five hundred thousand : the entire population of the United King- dom being thirty-four millions, six hundred and twenty-eight thousand, three hundred and thirty-eight. Carefully scanning the various employments embraced by the entire industrial class, I reckon that a proportion of one-tenth of their number suffers that is to say, eight hundred and fifty thousand are thus exposed to the injurious effects of their occupa- tions. The first and immediate effect of this is, that every member of this eight hundred and fifty thousand has his life reduced to an average of forty-five years. Taking fifty-five years as a fair average standard to which each ought in favourable surroundings to attain, it follows that every one of these workmen loses ten years of his working life. Now we may assume that a working man enters on active employment at an age not later than fifteen, and from this it will appear that the average lifetime after beginning work is about forty years. But in the case of those whose 'average duration of life does not extend beyond the average of forty-five, there will be only thirty years of life after beginning work, or three-fourths of the normal period. It therefore follows, as three times fifteen complete the 38 IMPOVERISHMENT AND HEREDITARY DISEASE. average life of forty-five, that every fourth man, of the number above stated, drops out of account as completely as if he had not existed. This represents a loss of two hundred and twelve thou- sand, five hundred a number nearly equal to the population of this city in each successive group of eight hundred and fifty thou- sand men. But the same cause which removes this number of work- men leaves behind, at least, that number of persons who were dependent upon them, and who are thus impoverished. There can be no question that two-thirds, if not the whole, of that number are not only impoverished but pauperised, and in the end find their way on to the parish roll. The origin of our pauperism is one of the vexed questions of the hour. At a con- ference held lately at Aberdeen, intemperance and improvidence were, by common agreement, believed to be its chief causes. The advocates of such views would, I am disposed to think, entrench themselves in a more logical position, besides having a founda- tion of incontrovertible facts to rest upon, were they to accept the explanation I have now offered. Intemperance and improvi- dence are not causes, but the effects of causes which require to be themselves accounted for. But the mischief does not stop here. It is certain, that each of the two hundred and twelve thousand, five hundred, will, on a moderate estimate, leave at least one descendant, who will pro- bably, in course of time, develop the hereditary disease of which the parent died. We very safely assume that each of the number stated has died of pulmonary consumption. Here then, we have brought before us most probably, the chief cause which accounts for the increase of consumption in this country. The question is often asked, where does all this disease come from ? And there is, doubtless, an implied reproach on medi- cal science and on the healing art, when it is said, that they are comparatively powerless in dealing with it. I would only here take occasion to say in regard to that, that in the case of no other disease has there been so much lately added to our know- ledge that is substantial alike as to its nature and treatment. But fed, as it perennially is, by constant streams from those quarters which may be regarded as its natural breeding places, is it not mockery to speak of dealing with it by means of treatment I INCREASE OF CONSUMPTION. 39 In the face of an evil of such growing magnitude, there cannot, I affirm, be any remedy short of its prevention. In the mean- time, however, those who, in increasing numbers, are seeking our help must be cared for. The difficulty experienced, in doing this, is only really known to medical men, and more so to those connected with such an Hospital as our Eoyal Infirmary. Drawn to it, no doubt, by its fame, and to Edinburgh by the known benevolence of its citizens, we have to encounter the task daily of sending away crowds who cannot be admitted to its wards. You are, I daresay, aware that it is barely within the scope of that Institution to receive cases of the kind, partly, because it is a serious disadvantage to the other patients on account of the troublesome night cough with which such sufferers are afflicted. Nevertheless, be it told, alike to the credit of the Managers and of the Medical Officers, that there is not a ward which has not its full complement of them ; but, I need not say that this is a most undesirable state of matters. Let me here plead guilty to having gone a little aside from the main drift of my theme to speak of this matter. I have taken the oppor- tunity of doing so that I might direct attention to, and perhaps awaken an interest in, the subject. Whilst London has its half dozen hospitals for consumptive cases, and other considerable cities are not without some provision for them, Edinburgh, which owns a great medical school, is, it must be confessed, in the position of not having a single bed set apart for so necessary an object ! It would be a great and truly useful work to devote an edifice to so benevolent a purpose, and to the good Samaritan who should do so, there would be the reward I say, not of the approbation of his fellows, or the thanks of the medical profession, or the lasting gratitude of those who would reap its benefits but the enviable consciousness of a deed that would perpetuate the relief of a sadly numerous and interesting class of sufferers. We have now to speak of THE MEANS OF PREVENTING THE EFFECTS OF UNHEALTHY OCCUPATIONS. You will have observed that, in the case of almost every occupa- tion I have spoken of, the injury is inflicted through the agency 40 MEANS OF PREVENTION. of inhaled particles, or by personal contact, on the part of the worker, with poisonous substances, or by the breathing of irritant gases, or vapours, exhaled from them. In order to change the character of an unhealthy, to a healthy occupation, it is only necessary to free the air of its suspended matter, such as dust or other foreign bodies. To accomplish this object, many contriv- ances have been devised and tried ; but, as we shall see, without their having conferred any substantial benefit. The steel-grinders are provided with the magnetized wire-gauze respirator, which was proved to effectually prevent access of steel-dust to the lungs. Stone-cutters and millstone-grinders are likewise provided with a respirator, which would equally well protect them ; while the flax- workers of the north of Ireland are familiar with an instrument known as the "Baker respirator," specially designed for their benefit. The efficiency of an ingenious respirator, constructed to enable the London Eire Brigade to inhale an atmosphere of dense smoke, otherwise suffocating, was some years ago devised and successfully tested by Professor Tyndal. It is made of cotton wool, moistened with glycerine, and mixed with pieces of charcoal. Here is another instrument, a respirator, which I devised some time ago for a different purpose ; it is more complex, but the same in the principle of its construction as those I have named to you ; its objects are to warm, medicate, and filter the air in its passage to the pulmonary organs. From what I have said, you will have perceived that there is really no practical difficulty in depurating the air of its dust, and other hurtful foreign matter, by means of mechanical adaptations such as I have spoken of. The difficulty, as we shall afterwards see, is of another kind. In my lecture on " Preventible Diseases " to the Health Society, I took the opportunity, by means of an interest- ing experiment, to show you the important fact that cotton- wool held over the mouth and nostrils effectually frees the air of its suspended particles. I have had this cotton-wool prepared so as to remove its impurities, and at the same time enhance its absorbing property. In virtue of these combined properties, it is, not only an efficient dust filter, but also, by absorbing VENTILATION IN WORKSHOPS. 41 them, arrests the access of noxious vapours to the lungs. These qualities are still further improved by the wool being pressed into a kind of loose cloth such as I show you. Again, chemical and other vapours are rendered comparatively harmless when inhaled through cotton. The vapour of mercury may be made less hurtful to the workmen if the floors of the workshops are sprinkled with ammonia. In the case of all, whose work brings them into con- tact with poisonous metals, certain obvious precautions are neces- sary; such as that the hands and mouth should be washed before eating, and the wearing of a washable overall dress. By all who work among lead, water acidulated with sulphuric acid, should be taken freely as drink. It need hardly be added, that, to the worker in poisonous metals or arts, the constant use of the bath is indispensable to his safety. Efficient, as are these appliances when made use of, we must nevertheless regard them as sub- sidiary to the paramount question of ventilation. In a time, such as ours, when sanitary knowledge is as popular as it is widely diffused, it would be idle to argue that a certain quantity of pure air requires to be inhaled in a given period. The standard amount necessary for each individual to support life and maintain health is, as you know, five hundred cubic feet daily; or, to express it differently, three thousand gallons during that period. In other words, the imperative requirements of health impose on each of us the necessity of inhaling two gallons of good air every minute of our lives. To infringe this rule would be to court disease; and to live in the habitual disregard of it to en- counter premature death. To impress this fact upon your memory, it will 4 only be needful to mention a case or two in point. Dr Edward Smith, the distinguished sanitarian, in his report to the Government on the condition of the London tailors' workrooms, states, that the cubic space in these ill-ventilated places allowed to each operative and the gas-light, is one hundred and fifty-six feet. It is necessary to explain that each burner consumes about as much as an individual. Dr Smith states that the death-rate of the tailors working in these rooms is one-third greater than of persons of the same ages who pursue their occu- pations in good air. Dr Guy, in an inquiry into the health of 42 WORKMEN AND AMELIORATIONS. the London bakers, points out that thirty-one of them per hun- dred are consumptive, a fact, which he ascribes to their ill-venti- lated workshops. You are now in a position, from what I have already stated, to modify these views of Dr E. Smith and Dr Guy, as to the degree of mortality and its causes prevailing among the tailors and bakers. Eeferring to a London printing office, in which, only two hundred and two cubic feet of breathing space were allowed to each man, the same authority remarks that the deaths from consumption followed as fast on each other as- deaths from some contagious fever. It was no doubt this frequency of death from that disease, occurring in ill-ventilated workrooms, that first led to the belief that consumption was an infectious malady. I do not say for I cannot speak from personal knowledge of the fact that, in our great manufacturing workshops, the statutory amount of space is not given, but I do affirm, that, it would be an altogether inadequate space in an atmosphere constantly re- plenished with pernicious materials derived from the manufactur- ing operations. It must be obvious that their requirements are of a different kind from those of a dormitory or dwelling, or the wards of an hospital, and that the question of the proper ventilation of these places cannot be settled by the off-hand rule of so much space to so many individuals. The problem to be solved is this : how to environ each worker in the prosecution of his work with a pure atmosphere 1 It is not for me to undertake the solution of this problem, because I hold that to be a matter for which the responsi- bility rests upon the Legislature. I am nevertheless free to express my confident conviction that this result appears to me to be only a question of certain, simple, practical, mechanical adjustments, requiring no effort of genius, or even outlay, where there is so much already existing machinery. Let us pause and ask here : how do those who have most to gain or lose regard those proposed ameliorations which we have been considering 1 It would appear, that in some instances, they are not viewed with favour, and, owing to this want of unanimity, it is to be regretted, that they have not been generally adopted. Any NEED OP ADDITIONAL LEGISLATION. 43 -changes of the kind indicated, again it is alleged, are objected to on the ground that the effects would be to increase the number of working hands, cheapen labour, and make it more scarce. But this feeling is, I believe, chiefly confined to the steel grinders. I hope you will all agree with me that this is an altogether mis- taken view of the case ; and that feelings, of whatever kind, which thus stand in the way of their using the means provided for their benefit, ought not to be encouraged. Past experience has made it quite evident that all such measures ought, as in the case of the Davy safety-lamp, to be made compulsory. Have we any means of knowing how such matters are viewed by the employers ? In the first place, it is certain that they are not themselves fully aware of the extent of the mischief ; and secondly, that, although having at heart the best wishes for their people's welfare, their good intentions are apt to be frustrated by conflicting interests, arising out of rivalry and in- creasing competition, with reduced and precarious profits ; and thirdly, they do not feel that the onus rests upon them of taking the initiative the legislature having, by means of the Factory Acts, and otherwise, assumed the responsibility of regulating such matters. It would seem, then, that we must necessarily fall back upon government regulation and control as the only available remedies for these evils. Previous to the passing of the Factory Acts the ill effects of their work upon the health of the workmen were so notorious that, in response to the wish of the country, a Com- mission was appointed in 1833 to inquire into their causes. The Factory Acts were, at that time, undoubtedly a great boon to the people ; but it is evident that they are not now fitted to accom- plish the object for which they were intended in the sanitary regulation of our industries. The facts which I have eliminated and brought before you, fully, I think, prove this, and also, that an inquiry is urgently necessary. The vast increase in the country's industrial resources and population since 1833, together with corresponding improve- ments in machinery and in chemical appliances, have altered the entire complexion of our industrial occupations, and have led to 44 WORKMEN AND PUBLIC HEALTH. insanitary conditions which demand a remedy as much as did those for the removal of which the Factory Acts were originally passed. It is, however, neither consistent with our traditions nor experience to believe that measures of the desired kind will be vouchsafed without some decided expression of public opinion, perhaps pressure, or, it may even be a lengthened process of State education. To the class most interested, I would venture to say, remember that union is strength, and that you cannot unite for the attainment of a more desirable or legitimate object than the protecting of your health and the surrounding of it with every possible safeguard. I am glad to observe signs that the workmen of this country are about to assume their proper position in relation to sanitary questions affecting them ; and, perhaps, I may be allowed to quote an instance which I deem worthyiof example. The Trades' Union Congress, at their meeting held in Dublin in September 1880, passed the following resolution: "That the Parliamentary Committee be requested to continue their exertions on behalf of those engaged in wool-sorting, with the object of attaining for them protection against blood-poisoning caused by the use of imported wool-hair infected with a malignant and dangerous disease, and to which wool-sorters are liable in pursuing their occupations." While addressing you on the effects of animal dust, associated with a specific poison, you will doubtless remem- ber that I specially directed your attention to this disease. Whether we regard the terms in which this resolution is couched, or the dignified attitude of the Congress in passing it, it will, I am sure, commend itself to your respect, and I feel justified in congratulating the Congress on a step which marks a new depar- ture in their relation to such questions. In an address delivered to the British Association last autumn by a well-known English professor,* the working-classes are advised that, if they would reach a higher social platform, they must summon resolution to raise themselves above what is depres- sing in their immediate surroundings. Let me say frankly that in reference to the whole class whose occupations form the subject of this lecture, I regard the exhortation as simply impractic- * Professor Leone Levi. STATE EDUCATION. 45 able, so long as the real cause of that depression continues to exist ; and that cause is to be found in the unhealthy character of these occupations. Will you, with me, take a momentary survey of what the surroundings are 1 The strongest and hardiest among the workers are soon sensible that there is a loss of energy. Then, as the seeds of their insidious malady are being daily sown, there steals over them a lethargy and apathy which no effort of will can bid away. Then comes loss of appetite and the increasing burden of their daily toil to which they feel unequal. This is the moment of supreme trial to most of them, for it is then that they seek to rally their sinking spirits and failing strength by recourse to stimulants. There is not, I maintain, any a priori cause why our countrymen, more than others, should be addicted to intemperance, except it be through their unhealthy occupations superinducing a condition a disease I call^t which craves for it. It might be well if our social reformers would regard our prevailing intemperance from this point of view, for I am satisfied that it is an incredibly fruitful, if not the chief, source of it. I find that I have inadvertently used an expression to which attaches a kind of political significance. Let me at once disavow any such intention in speaking of "educating" the State, and, at the same time, explain to you what I mean by that expression. It is almost trite to remark that every nation has its own indi- vidual life history. Its childhood, youth, and maturity are each a period fraught with its own peculiar and fitting education. That part of history, which shows us how those lessons have been learnt upon which a nation's ultimate stability depends, is not the least instructive. Let us, for example, take the matter of national health. We have it on the authority of Niebuhr that the preval- ence of plagues, more than ethical or political causes, influenced the destinies of such cities as Florence and Athens; and, that the de- cline and fall of such an empire, as the Eoman, were brought about, not, as we are accustomed to believe, by a species of moral dry-rot, but by the pestilences which carried off the adult male population, and left the then proud mistress of the world an easy prey to the barbarian. Who can read the long continuing death-tax of our 46 HISTORICAL EETROSPECT. own nation, without asking, what has saved her from a like fate ? A brief historical retrospect will show you this. During the four- teenth century our ancestors had to grapple with that fierce plague named the " Black Death," which destroyed nine out of every ten whom it attacked. The fifteenth and sixteenth centuries found them struggling with the " Sweating Sickness," killing its victims in a few hours, and leaving a heavy death-roll. For three cen- turies prior to the close of the eighteenth, that terrible distemper called "Gaol Fever," taking its origin in our prisons, never ceased to infect the Army, Navy, and the civil population. Another plague, called the Oriental, prevailed through much of the six- teenth and seventeenth centuries ; its smallest death-toll being one in five, but often three in five. Then, there followed Asiatic cholera, with its attendant epidemic dysentry ; and lastly, unvaccinated small-pox, not less ghastly in its death-rate or repulsive con- comitants. This dark catalogue of pestilences was more or less associated with those fevers confusedly known under the various names of spotted, typhus, relapsing, famine, and typhoid. With our greater light, it is difficult to understand why the nation so slowly awoke to the full comprehension of the enormous jeopardy and cost" of these invasions. It was only with the advent of John Howard in 1794 that there came also the dawn of an epoch marked by a regard to public health, whose growth and influence are, I believe, the causes of our being now in the van of civiliza- tion. You all doubtless know what is meant by John Howard's parliamentary triumph. Single handed he obtained at a time when such concessions were a great victory an Act to inquire into the state of our prisons. What were the results of this Act? These pestilential dens, which, for centuries, had poisoned every stream of our national life, were abolished, and, as a matter of fact, our prisons are now the healthiest places in the country. What I wish you to particularly note here is the fact that the second step in this great reform was brought about by an Act of the Legislature the first being that of Howard's representation of the facts. Two years later, there occurred another Parliamentary triumph when the discoverer of vaccination was voted 30,000 to extend the COMPARATIVE MORTALITY. 47 benefits of his discovery. Here also, you will again observe, that an Act of the Legislature is the crowning event. I have said that I am arguing on the assumption that our unhealthy occupations ought to be dealt with by legislative measures. I am accordingly adducing historical evidence of the efficacy of well-directed sani- tary legislation, while I am, at the same time, seeking to impress upon you the desirableness, and even urgency, of your representing to the Legislature such considerations as will satisfy it that fresh and more cogent measures are needed. The beneficial effects resulting from such measures are constantly brought under our attention. I select one out of a multitude of instances. One of the household regiments the Foot Guards was found to have more deaths from consumption than prevailed among the soldiers of the Horse Guards. The former had thirteen deaths per thousand, the latter seven. The Army Sanitary Commission appointed to inquire into the case, reported, that the cause of the discrepancy was a deficiency in the breathing space allowed to the former. The defect was no sooner rectified than the abnormal death-rate disappeared. Taking the whole of the occupations, to whose condition I have specially directed your attention, I find, that twenty-six of these, in every hundred, die of consumption ; while the pro- portion of deaths from that disease among the general population is only twelve in the hundred.* It is a matter of history that this long-continued State educa- tion, in its reference to national health, culminated on the 1st of June 1774, when Lord Howe achieved the all-decisive victory which gave to Britain the supremacy of the seas. On that memorable occasion, for the first time in the annals of our naval engagements, perfectly healthy crews, numbering in all seventeen thousand two hundred and forty-one, went into action against the more heavily armoured and manned fleet of the enemy, but with this difference that the enemy's crews were less * As this 12 per cent, among the general population includes all deaths from consumption arising from the unhealthy occupations referred to, it would be necessary in order to institute a fair comparison to exclude the latter. The result would then show. a still greater disparity, as the rate among the general population would then be reduced.to ten in the hundred at the outside. 48 PECUNIARY LOSS TO THE STATE. efficient through disease. It may he fairly questioned whether we owe the victory more to Lord Howe than to his physician, Dr Trotter, to whose discretion he wisely left the entire sanitary equipment of the fleet. But, in any case, its immediate and ulti- mate effects were not less notable in their sanitary than in their political and diplomatic consequences. It is my contention, as you will perceive, that our great opera- tive industrial classes are entitled, equally with the combatant, to be cared for and protected, as to their health, in the pursuit of their avocations. They have a claim to it in respect of their numbers, social and political standing, and usefulness. They are the back-bone and sinews of the nation's strength, and its capital and wealth makers. The number of men withdrawn from peaceful occupations for fighting purposes, during the whole of the twenty-two years that our country was engaged in the revolutionary wars, did not exceed a quarter of a million. I estimate that a quarter of a million nearly of these workmen is continuously lost to the State a loss which covers the whole period of each man's work- ing life. For a moment, consider the effects of this from a merely economical point of view. Taking the figures, as I have- already given them, to be two hundred and twelve thousand,, five hundred, and reckoning each man's wages at one pound a week, there is thus a yearly loss in wages to the industrial wage class amounting to upwards of eleven million pounds ! * If we now add to this the loss of the wealth that would have been produced by the workers so cast off, there results the grand total of thirteen millions, seven hundred and fifty thousand pounds, the whole of which is annually lost to the 'country ! In point of fact, that sum, would, in about fifty-seven years, clear off the whole of the national debt. So much for the money aspect of the question. But what of the needless waste of life and its atten- dant sickness : of the consequent impoverishment, pauperism, and demoralisation; and the increasing legacy of hereditary disease 1 ? Were I to attempt the rdle of the historic Glendower, and summon spirits from the vasty deep, my performance would, I * Taking into account the natural increase of the industrial population* there will be a yearly increase to this money loss of over 20,000. DUTY OF THE LEGISLATURE. 49 fear, be as unproductive as that of the original. But will ?you permit me, in form at least, to invoke the shade of our great countryman might I not say townsman? Adam Smith. We should not certainly expect the renowned economist to indite a new "wealth of nations," from a modern stand-point, a century after his great work was given to the world ; for what he wrote in 1 776 appears to have been given for all time. But look- ing back, and gathering up the lessons of the past, one can imagine that he would, at least, add a prefatory note somewhat in these words; that is, if I may be permitted to suggest words to so great an oracle : There are two primary and fundamental considerations upon which national stability and permanency rest. The first regards the health of the people the other its education. Any system of government, without full provision being made for these, will be incomplete : and, in regard to the former, the best guarantee of a nation's security will be wanting. Therefore, above all things, let no government, in its administrative capacity, be without its health department, presided over by a wise and energetic Health Minister, whose supreme duty it shall be to create and to vigilantly administer laws, the aim of which shall be to pro- tect the health of every subject, and especially to surround that of the dependent industrial population, with every possible safe- guard. Then, addressing his own countrymen, might we not sup- pose the philosopher, with increased emphasis, to add : A nation, such as ours, of thirty-four millions, with a vast manufacturing in- dustry, a most busy and flourishing commerce, an Indian Empire to govern and maintain, colonies to attract the most vigorous and enterprising of our people, great fortresses to man and defend, cannot afford to waste the lives of its citizens, any more than those whom it has chosen and trained to fight its battles. Are not labour and capital the two pillars upon which a free common- wealth rests ? Disease paralyses labour and wastes capital. It ought then to be the primary object of an enlightened State to prevent disease, preserve health, and prolong life ; and to main- tain the whole people in the highest efficiency alike for the labours of peace, or the struggles of war.* * For part of closing sentence vide " Public Health," passim, Dr Guy. TABLES SHOWING THE EFFECT OF DIFFERENT KINDS OF DUST UPON THE HEALTH OF THE WORKERS.* TABLE I. METALLIC DUST. STEEL DUST COPPER DUST In eveiy 100 Patients Are Mean Duration among Consumptive. of Life. Needlemakers, . 69-6 50-0 Filemakers, . , , 62-9 54-0 Grinders (steel), 40-4 40-4 Pinmakers, 12-5 Cutlers, . ... 12-2 Lock-Smiths, . 11-5 49-1 __ Farriers, . 10-7 55-1 f Lithographers, . 48-5 Moulders, . 36-9 Watchmakers, . 36-5 55-9 Engravers, 26-3 54-6 Bellmakers, . . 197 | Tinmen, . 14-1 47-0 [ Workers in Copper, . 9-4 48*6 "Typefounders, . V 34-9 Dyers, 25-0 63-7 Lacquerers (enamellers), 25-0 45-0 Painters and Colour ) f>A-f) 57-fi Grinders, . / 10% U t/ I U Printers (including ) 21-6 54.3 Compositors), . j ' -I VI Lead-Mine and White ) Lead workers, . J 20-0 51-7 Workers in Brass, , 6-0 LEAD DUST - BRASS DUST * Dr Ludwig Hirt, die Krankheiten der Arbiter, Beitrage. 1873-78 modified and adapted. Leipzig, APPENDIX. 51 TABLE II. MINERAL DUST. In every 100 Patients among Grindstone-makers, . Flintcutters, Glass cutters and Polishers, Stone-cutters (including Masons), Workers in Glass, Plasterers, .... Porcelain workers, Potters, . . . ... Diamond workers, . Cement workers, Are Mean Duration Consumptive. of Life. 90-0 80-0 24-0 36-4 36-3 35-0 42-5 19-0 16-0 42-5 14-7 53-1 9-0 35* 8-10 50-0 TABLE III. VEGETABLE DUST. Cigar-makers (including Tobacco ) workers), / Weavers, Cotton, Flax, and Hemp Dressers, Kopemakers, Joiners (including Cabinetmakers, ) Upholsterers, and Carpenters), J Millers, ...... Bakers, ...... Chimney Sweeps, Miners (Coal), . TABLE IV. ANIMAL DUST. Brush-makers, . Hair-dressers, . Skinners, Turners, Hatters, Button-makers, . Harness-makers, Cloth-makers, . 36-9 49-1 32-1 23-2 16-2 15-5 15-0 12-8 10-0 55-0 25-0 51-7 60-0 44-0 18-9 44-0 14-6 49-8 10-9 45-1 7-0 6-5 45-3 0-8 57-9 50-5 57-4 51-6 52 APPENDIX. TABLE V. ANIMAL DUST WITH SPECIFIC POISON. In every 100 Patients Are Mean Duration, among Consumptive. of Life. Wool-sorters, . . . '..... Eag-pickers, . . . Paper-makers, . \ . . 37-6 TABLE VI. > GASES AND VOLATILE EMANATIONS. Straw-hat makers, .... Jewellers, ..... 53'0 Bleachers, 58'0 Soap-boilers, 9'3 61-3 Tanners and Curriers, . . . 9-2 61 '3 Charcoal-burners, .... 2'0 Parafme-makers, .... Candle-makers, .... 62 '0 Grinders of Oleaginous Grains, . TABLE VII. No DUST, CONSTRAINED BODILY POSITION, AND BAD VENTILATION. Needle-women (of every class), . . 19-0 Tailors, 19'0 Shoe-makers, 187 Glovers, Writers' Clerks, . . . . 10-0 TABLE VIII. * DUST FROM POISONOUS METALS. PHOSPHORUS Workers in Phosphorus, 44 '0 MERCURY Workers in Quicksilver, 25-0 47 '4 Workers in Arsenic, ll'O 47 '0 Arsenical Green Pigment- ARSENICAL ! workers, . . 25-0 DUST j Workers in Arsenical Blue, Artificial Flower-makers in Arsenical Green, 36*0 APPENDIX. 53 TABLE IX. SHOWING DISEASES AND AVERAGE LIFE AMONG FARRIERS, CUTLERS, LOCK- MAKERS, AND FILE-CUTTERS. 1 . 1 4 . 1 i N In 100 Patients. I || ! >t I II li "c3 g s S>* 8 o| 1 1 si g 1 |.| o H M H < Farriers. . . 107 9-8 05 6-6 37-5 24-2 9-8 0-9 55-1 Cutlers . . . 12-2 12-2 37 3-2 35-3 27-1 6-3 2-0 Lock-makers . 11-5 9-2 2-6 5-8 38-2 19-4 10-3 3-0 491 File-cutters . 62-2 17-4 12-2 17-6 ... ... 54-0 TABLE X. DISEASES AMONG WORKERS IN WOOD. j ,- d I 4 s 1 i* In 100 Patients. f 1 g A i "3 ^ '3:3 11 I a i u2 ^S 53 p -g So W s i i I 1 Joiners . . . 14-6 10-1 3-9 6-0 34-0 18-4 10-4 2-9 49-8 Carpenters Wheelwrights 14-4 12-5 0-5 0-2 0-9 1-3 0'9 5-2 29-2 11-6 14-4 187 17-4 9-2 4-3 1-3 557 TABLE XL KELATIVE FREQUENCY OF CHEST DISEASE FROM ANIMAL DUST. In 100 Patients. isumption. d |g si A .2 || II 1 S 1 c*c3 2 f a a 8 H I g K .2 Brush makers . 49'1 28-0 3-4 7-0 12-2 37 Hairdressers . 32-1 47-8 2-5 10-7 25-4 14-6 .. . 51-9 Saddlers . . 12-8 7'5 2-5 5-0 40'1 22-6 7-6 1-9 53-5 Upholsterers . Farriers . . 25-9 23-2 117 107 27 47 10-3 8-1 24-9 23-3 277 10-9 4-0 12-6 2 : 5 50-5 Hatters. . . 13-5 67 1-0 5-6 53-3 287 5-5 ... 51-6 54 APPENDIX. TABLE XII. RELATIVE DISEASES AMONG TANNERS, CATGUT-MAKERS, BUTCHERS, AND SOAP-MAKERS. d . rf , 5 ai s - 1 L "S. .22 g 'S GO | .2 % In 100 Patients. g CrC >> | "SS "s'S S pi J3 1 ^ <"3 .^3 1 a M 1 S fi fA w 1^ Tanners . . 9-2 7'4 7'4 7-4 31-9 12-9 16-8 61-2 Catgut-makers 60'2 Butchers . . 7'9 6-3 1-1 9-9 42-2 17-6 13-3 0-7 56-5 Soap-makers . 9-3 18-0 5-3 8-9 37-5 14-5 5-3 61-3 YC 88628 Micr* Soc. . THE UNIVERSITY OF CALIFORNIA LIBRARY